The relationship between eating disorders and substance use disorders has long puzzled clinicians. Epidemiological studies consistently show that these conditions co-occur at rates far higher than chance would predict, yet eating disorder symptoms are rarely measured in substance use research. This gap matters because the two disorders may share underlying mechanisms, particularly difficulties in emotional regulation and impulsive behavior when distressed. If researchers studying youth substance use ignore eating pathology, they may be missing a crucial piece of the puzzle that explains why some young people develop severe substance-related problems while others do not. The new study set out to determine whether a brief screener could close that gap without adding meaningful burden to research participants or clinical staff.

The research team analyzed data from 682 young people between the ages of 15 and 25, assessed across 722 visits through a standardized intake process. Each participant completed the Eating Disorder Screen for Primary Care, known as the ESP, along with a comprehensive battery of psychological measures. These included the Difficulties in Emotion Regulation Scale Short Form for emotional dysregulation, the UPPS-P Revised Child Impulsivity Scale for impulsive personality traits including negative urgency, the Patient Health Questionnaire for depression, the General Anxiety Disorder seven-item questionnaire for anxiety, and validated instruments for problems related to cannabis and electronic cigarette or nicotine use. Participants also reported their substance use over the previous thirty days using timeline follow-back methods, a well-established calendar-based approach for reconstructing recent consumption patterns.

The ESP itself is remarkably simple. It asks respondents to rate, on a scale from zero to two, how often they experience concerns such as feeling terrified of being overweight, avoiding eating when hungry, going on eating binges, vomiting after eating, or exercising excessively to control weight. In primary care, a score of two or higher is traditionally used as the clinical cut-off indicating possible eating disorder. But the researchers wanted to know whether that threshold, developed for general medical patients, would perform well in a population of young people recruited specifically for substance use research, where the presentation of eating pathology may differ from typical clinical samples.

To answer that question, the team applied receiver operating characteristic analysis, a statistical technique that evaluates how well a screening tool discriminates between people who have a condition and those who do not across all possible cut-off scores. Clinical diagnoses were established using the Mini International Neuropsychiatric Interview, a structured diagnostic instrument. The analysis examined sensitivity, the proportion of true cases correctly identified; specificity, the proportion of non-cases correctly cleared; and positive and negative predictive values across a range of possible thresholds from two to five. The results showed that the traditional clinical cut-off of two or higher yielded high sensitivity but poor specificity, meaning it caught most true cases but also flagged many young people who did not meet diagnostic criteria.

The receiver operating characteristic curves pointed to a better balance at a score of three or higher. At this revised threshold, the ESP achieved acceptable diagnostic accuracy for detecting eating disorder diagnoses within this particular population, trading a small loss in sensitivity for a meaningful gain in specificity. The finding carries practical significance: screening tools embedded in substance use research protocols and clinical intakes can be tuned to the population being assessed rather than relying on thresholds imported from different settings. For researchers, the tailored cut-off means that a two-minute questionnaire can now yield interpretable eating disorder risk data in studies that were never designed with eating pathology in mind.

Having established the optimal threshold, the researchers then compared young people who screened at risk with those who did not, using Wilcoxon rank sum tests to account for the non-normal distribution of the psychological and substance use measures. The differences were substantial and consistent. Youth who endorsed eating disorder risk reported significantly higher emotional dysregulation, meaning greater difficulty identifying, tolerating, and modulating their emotional states. They also scored higher on negative urgency, a specific facet of impulsivity that describes the tendency to act rashly when experiencing intense negative emotions. This trait has been implicated in both binge eating and substance use, and the new findings suggest it may be a common pathway connecting the two classes of disorders.

The psychiatric burden among those at risk extended to mood and anxiety. Participants flagged by the revised ESP cut-off reported significantly more depressive symptoms on the PHQ and more anxiety symptoms on the GAD-7 than their non-risk peers. Their substance use profiles were equally distinctive. Although they reported lower quantity and frequency of alcohol consumption, they used cannabis more frequently and reported greater problems related to both cannabis, measured with the Marijuana Adolescent Problem Inventory, and nicotine, measured with the Penn State Electronic Cigarette Dependence Index. This pattern suggests that eating disorder risk in youth does not simply generalize to all substance use; instead, it clusters with specific substances, particularly cannabis and nicotine, while alcohol use may actually be reduced.

The authors argue that these findings point to emotional dysregulation as a central risk factor for the co-occurrence of eating disorder symptoms and substance use in young people. When the capacity to manage distressing emotions is compromised, multiple maladaptive behaviors, from restrictive eating and bingeing to cannabis and nicotine use, may emerge as alternative strategies for emotional relief. This transdiagnostic perspective has implications for treatment: interventions that build emotion regulation skills, such as dialectical behavior therapy approaches, could potentially address both conditions simultaneously rather than treating them in isolation. It also suggests that substance use treatment programs should consider screening for eating pathology, since young people with co-occurring eating disorder risk may require tailored support to achieve better outcomes.

For clinicians and researchers alike, the study offers a pragmatic message. Brief, low-effort screening tools like the ESP can be incorporated into substance use research and clinical intake processes with minimal burden, yet they capture clinically meaningful information that would otherwise be lost. The tailored cut-off of three or higher demonstrated acceptable diagnostic accuracy in this youth sample, and the psychological profile it identifies, marked by emotional dysregulation, negative urgency, depression, anxiety, and heavier cannabis and nicotine involvement, provides researchers with concrete targets for understanding why eating disorders and substance use disorders so often travel together. As youth mental health services grapple with rising rates of both conditions, a one-minute questionnaire may prove to be an unexpectedly powerful window into the shared roots of these intertwined disorders.

Subject of Research: Eating disorder risk screening and its mental health and substance use correlates in adolescents and young adults

Article Title: Distinct mental health and substance use patterns in youth who endorse eating disorder risk using the eating disorder screen for primary care

Article References: Giddens, E., Kirkland, A. E., Mahlberg, J., Ferguson, P. L., Steward, T., Verdejo-Garcia, A., Tomko, R. L., & Squeglia, L. M. (2026). Distinct mental health and substance use patterns in youth who endorse eating disorder risk using the eating disorder screen for primary care. Journal of Eating Disorders. https://doi.org/10.1186/s40337-026-01792-7

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01792-7

Keywords: eating disorders, substance use, screening tools, youth, emotional dysregulation, impulsivity, cannabis, nicotine, depression, anxiety, primary care, diagnostic accuracy

The research team used an explanatory sequential mixed-methods design, a strategy that pairs broad statistical mapping with in-depth follow-up interviews. In the quantitative phase, 760 undergraduate students completed validated instruments measuring risky behaviors, self-control, coping with stress, and perceived social support. The qualitative phase then zoomed in on 18 participants deliberately selected because they displayed either elevated or low risk for alcohol and substance use, allowing the researchers to hear directly from students on both sides of the divide about what drives use and what holds it back.

Statistically, the picture that emerged was strikingly consistent. Being male and being a smoker were both positively associated with an increased risk of alcohol and substance use, a pattern that echoes earlier findings linking nicotine with broader experimentation and with masculine norms around risk-taking. More interesting, however, were the protective factors. Effective stress coping skills, particularly strong self-control, were negatively related to substance use risk, meaning that students who could regulate impulses and manage emotional pressure were substantially less likely to report dangerous drinking or drug use.

Self-control has long been a central construct in criminology and personality psychology. Classic work by Tangney, Baumeister, and Boone showed that people high in self-control adjust better, achieve more, and suffer less pathology. The present findings extend that logic into the university context: a student’s capacity to delay gratification, suppress impulsive urges, and stick to long-term goals appears to function as a psychological firewall against the cascade of temptations that campus life presents. The authors also found that avoidance-oriented coping was negatively related to risk, a nuance suggesting that stepping back from stressors in certain structured ways may, in this population, accompany lower substance involvement.

Perhaps the most surprising result concerns social support. Decades of public health research have treated perceived social support as a near-universal protective factor, buffering people against stress and reducing harmful behaviors. Yet in this study the role of perceived social support remained limited in predicting the risk of alcohol and substance use. The statistical signal was weak once self-control and coping styles were accounted for. This does not mean friendships are irrelevant, but it does suggest that in higher education settings the quality of an individual’s internal regulatory resources may matter more than the warmth of the surrounding network.

The qualitative interviews added texture that numbers alone cannot capture. Students who used alcohol or substances cited five principal motivations: thrill-seeking, curiosity, belonging and socializing, avoiding or coping with stress, and dealing with withdrawal symptoms. These reasons map neatly onto established theories of addiction. Sensation-seeking and curiosity reflect approach motivations common in emerging adulthood, while stress-driven use aligns with the self-medication hypothesis, which holds that some people use substances to dampen negative emotional states. The mention of withdrawal symptoms among the motivations is particularly concerning, because it hints that for a subset of students use has already crossed from recreation into dependence.

On the protective side, the rationales for abstinence were religious conviction, perceived health concerns, and familial restrictions. Each of these operates through a different mechanism. Religious conviction supplies both a moral framework and a community that discourages use, a pattern documented in prior studies of religiosity as a protective factor among first-year university students. Health concerns reflect a rational appraisal of costs, while familial restrictions show that even after students leave home, the internalized expectations of parents continue to exert a restraining force. Together these findings suggest that prevention programs should not rely on a single lever but should engage identity, health literacy, and family ties simultaneously.

The theoretical scaffolding of the study draws on the biopsychosocial model, which treats health behaviors as products of biological, psychological, and social factors interacting over time, and on the stress and coping tradition inaugurated by Folkman and Lazarus, in which coping is understood as a dynamic process of appraisal and response rather than a fixed trait. Within that framework, substance use can be seen as one possible outcome of a coping transaction: when demands exceed resources and adaptive strategies are unavailable, chemical shortcuts become attractive. Self-control, in this reading, is not merely willpower but a resource that determines which coping strategies are even accessible under pressure.

The methodological rigor of the work deserves note. The quantitative phase was powered using G*Power calculations, the regression analyses controlled for multicollinearity, and the qualitative phase followed thematic analysis procedures described by Braun and Clarke, with reporting aligned to the COREQ checklist for interview research. Ethical approval came from the Social and Human Sciences Research and Publication Ethics Committee of Hacettepe University, and all participants gave informed consent. The combination of a large survey sample with a small, purposively selected interview group is precisely the kind of design that allows researchers to move from correlation to plausible mechanism.

The practical implications are clear and, the authors argue, urgent. Intervention strategies designed to reduce alcohol and substance use among young people in higher education should target self-control directly and foster efficient stress coping skills, rather than assuming that simply connecting students to supportive peers will suffice. Programs that train impulse regulation, teach structured coping techniques, and address the specific motivations students themselves report, from thrill-seeking to withdrawal management, are more likely to change behavior than generic awareness campaigns. As universities worldwide grapple with rising mental health demands, this study offers a deceptively simple message: the strongest shield against substance use risk may be built from the inside out.

Subject of Research: Risk factors for alcohol and substance use among university students, focusing on self-control, stress coping, and social support

Article Title: Substance use risk in higher education: the interplay of self-control, coping with stress, and social support

Article References: Çevik, A., & Tuncay, T. (2026). Substance use risk in higher education: the interplay of self-control, coping with stress, and social support. Current Psychology, 45(19), Article 1553. https://doi.org/10.1007/s12144-026-10075-y

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10075-y

Keywords: substance use, university students, self-control, stress coping, social support, alcohol use, risk factors, mixed methods, prevention, Current Psychology, Substance, risk

The study team, led by Anh P. Nguyen of the Institute for Health Research at Kaiser Permanente Colorado, assembled a matched cohort of 100,140 people aged 12 years or older. Of these, 16,693 had received a diagnosis of cannabis use disorder, a clinical condition marked by impaired control over cannabis use, continued use despite harmful consequences, and physiological dependence in some patients. Each person with the disorder was compared against individuals without the diagnosis drawn from the same health system, allowing the researchers to isolate the association between the condition and mortality while accounting for shared characteristics of the patient population.

Follow-up extended through June 2024, with a median observation period of 7.7 years. Death records came from state vital statistics, enabling the team to classify not only whether people died but why. Over the follow-up window, 1,197 individuals with cannabis use disorder died, representing 7.2 percent of that group. The raw numbers were stark: people with the disorder died at a crude rate of 899.5 per 100,000 person-years, compared with 374.6 per 100,000 person-years among matched individuals without the diagnosis, a difference of more than a factor of two before any statistical adjustment.

Because people with substance use disorders often carry other health and social burdens, the investigators used Cox proportional hazards regression to adjust for confounding factors and estimate adjusted hazard ratios. Even after this statistical correction, the signal remained strong. Cannabis use disorder was associated with a 52 percent higher risk of death from any cause, with an adjusted hazard ratio of 1.52 and a 95 percent confidence interval of 1.30 to 1.77. The confidence interval excludes the null value of 1.0, indicating that the association is unlikely to be explained by random variation in the data.

The researchers then split deaths into two broad categories: injury-related and illness-related. Injury deaths, which include overdoses, accidents, and self-harm, occurred at a crude rate of 295.3 per 100,000 person-years among people with cannabis use disorder versus 62.5 among matched comparators, nearly a fivefold difference in unadjusted rates. After adjustment, the disorder was associated with a 91 percent higher risk of injury-related death, with a hazard ratio of 1.91 and a confidence interval of 1.37 to 2.67. Illness-related mortality, covering deaths from disease, was also elevated, at 604.2 versus 312.1 per 100,000 person-years in crude terms, with an adjusted hazard ratio of 1.40.

Drilling down into specific causes of death revealed a differentiated pattern. The strongest association was with drug overdose: people with cannabis use disorder had nearly 2.6 times the risk of dying from an overdose, with a hazard ratio of 2.59 and a confidence interval of 1.30 to 5.19. This finding aligns with a growing body of evidence that cannabis use disorder frequently co-occurs with other substance use disorders, and that polysubstance use multiplies overdose danger. Deaths from accidents were also significantly elevated, with a hazard ratio of 1.96, consistent with concerns about impairment-related injuries in an era of expanding cannabis availability.

Cancer mortality emerged as another significant contributor, with an adjusted hazard ratio of 1.71 and a confidence interval of 1.20 to 2.46. The authors and related literature note that cannabis is most commonly consumed by smoking, and recent observational studies have begun to examine links between cannabis smoking and lung cancer as well as broader cancer risk in the context of legalized access. By contrast, the study found no statistically significant elevation in deaths from self-harm, cardiovascular disease, or respiratory disease. The hazard ratios for those causes were 1.18, 1.25, and 1.29 respectively, but all of their confidence intervals crossed 1.0, meaning the data could not distinguish those estimates from no increased risk.

The findings arrive at a moment of rapid change in the American cannabis landscape. Self-reported cannabis use in the United States has risen markedly over recent decades, and prior research has documented increases in cannabis use disorder following recreational legalization in several states. National surveys have also shown that the prevalence of marijuana use disorders grew substantially between the early 2000s and the early 2010s. Yet cannabis use disorder remains underrecognized in routine care, and evidence on mortality among affected individuals has historically been limited, often relying on treatment-seeking populations or emergency department cohorts rather than broad health-system samples.

The new study adds to a small but growing literature. A 2025 analysis published in JAMA Network Open linked cannabis use disorder-related emergency department visits and hospitalizations to elevated five-year mortality, and a 2025 systematic review and meta-analysis of cohort studies reported increased all-cause mortality associated with cannabis use. The Colorado cohort strengthens this evidence base by using matched comparison individuals from the same integrated health system, by capturing deaths through official vital records rather than electronic health data alone, and by distinguishing injury-related from illness-related causes of death within a single analytic framework.

The authors caution that the study is observational: it identifies associations, not proof of causation, and cannabis use disorder may act partly as a marker for a constellation of risks, including co-occurring substance use, mental health conditions, and social determinants of health that themselves predict premature death. Still, the researchers conclude that a diagnosis of cannabis use disorder may serve as a clinically meaningful signal of elevated all-cause, injury-related, and illness-related mortality risk, and they call for comprehensive prevention strategies to address the heightened risk in this population. As cannabis potency and availability continue to climb, the study suggests that identifying and treating cannabis use disorder in primary care settings could become an increasingly important piece of the mortality-prevention puzzle.

Subject of Research: Mortality risk associated with cannabis use disorder in a matched Colorado health system cohort

Article Title: Cannabis Use Disorder and Mortality Risk: A Matched Cohort Study from a Colorado Health System

Article References: Cannabis Use Disorder and Mortality Risk: A Matched Cohort Study from a Colorado Health System. (n.d.). https://doi.org/10.1007/s11606-026-10845-1

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10845-1

Keywords: cannabis use disorder, mortality, matched cohort study, drug overdose, cancer, injury-related death, Cox proportional hazards, Colorado, public health, substance use, epidemiology, Journal of General Internal Medicine

The study was conducted by an international team of researchers based in the United States, Hungary, Switzerland, Gibraltar, Germany, and Canada. Led in part by Damla Aksen, then affiliated with training programs in neuroimaging and substance abuse research, the collaboration included investigators with long-standing expertise in behavioral addictions, trauma, and impulse-control disorders. The team set out to answer a question that has lingered in the trauma literature for decades: if sexual abuse is associated with elevated substance use, why do some survivors develop frequent use patterns while others do not? Their answer centers on the moderating role of impulsivity, the tendency to act quickly and without adequate forethought.

Impulsivity is not a single, unitary construct. Researchers typically decompose it into several facets, including negative urgency, the tendency to act rashly when experiencing distress; positive urgency, rash action in the context of intense positive emotion; lack of premeditation, or difficulty thinking through consequences before acting; lack of perseverance, the inability to stay focused on taxing tasks; and sensation seeking, the appetite for novel and intense experiences. In the context of trauma research, negative urgency has attracted particular attention because it links emotional dysregulation, a common consequence of abuse, directly to behavior. Survivors who experience intense negative affect and who also tend to act rashly under that affect may be especially likely to use substances as a rapid, if maladaptive, means of relief.

The theoretical framework underlying the study draws on established models of trauma and addiction. Sexual abuse is consistently associated in prior research with post-traumatic stress symptoms, depression, anxiety, and difficulties in emotion regulation. Self-medication theories propose that some survivors use alcohol, drugs, or nicotine to blunt these symptoms, and epidemiological work has repeatedly linked abuse histories to elevated rates of substance use disorders. At the same time, neurobiological research shows that early-life adversity can alter stress-response systems and prefrontal circuits that support inhibitory control, potentially creating both greater craving and weaker behavioral brakes. Impulsivity sits at the intersection of these processes, which is why the researchers hypothesized that it would strengthen the association between abuse history and how frequently people use substances.

To test this hypothesis at scale, the team analyzed data from 64,472 participants recruited through an international survey. The large sample allowed the investigators to examine whether the pattern held across countries, gender identities, and sexual orientations, dimensions that smaller studies often cannot adequately power. Participants reported whether they had experienced sexual abuse, completed validated measures of impulsivity, and indicated how frequently they used drugs, alcohol, and tobacco. By modeling impulsivity as a moderator rather than a simple covariate, the researchers could ask whether the strength of the abuse-substance use association itself changed as a function of impulsivity, a statistically distinct question from whether impulsivity independently predicts use.

The results supported the moderation hypothesis. Among participants with a history of sexual abuse, higher impulsivity was associated with more frequent use of drugs, alcohol, and tobacco. In practical terms, two survivors with comparable abuse histories and demographic profiles would be expected to differ in substance use frequency according to their impulsivity levels, with the more impulsive individual reporting more frequent use across the substances examined. The authors report that these patterns were examined across countries, gender identities, and sexual orientations, reflecting the study’s explicit aim of testing generalizability in a way that few prior investigations of this question have attempted. The consistency of the moderation pattern across such a large and diverse sample strengthens the case that impulsivity is a genuinely transdiagnostic risk amplifier rather than an artifact of any single population.

The findings carry several implications for clinical practice. Screening for impulsivity among trauma survivors could help clinicians identify individuals at heightened risk of frequent substance use before patterns become entrenched. Brief behavioral interventions that target impulsive responding, such as those emphasizing distress tolerance, delay discounting, and emotion regulation skills, are already used in treatments for borderline personality disorder and substance use disorders, and the new results suggest they may be particularly valuable for survivors of sexual abuse. Because the study measured use frequency rather than formal diagnoses, the results speak most directly to patterns of consumption, but frequent use is itself a well-established precursor to dependence, making early identification of high-frequency users a meaningful prevention goal.

The study also contributes to a broader scientific conversation about why trauma-related health disparities persist. Public health approaches to substance use often focus on availability, pricing, and policy, while individually oriented approaches focus on motivation and dependence. The current findings highlight a psychological trait that operates between trauma exposure and behavior, suggesting that interventions aimed at strengthening inhibitory control could reduce the downstream burden of substance-related harm among survivors. This framing aligns with a growing emphasis in psychiatric research on transdiagnostic mechanisms, constructs such as impulsivity, emotion dysregulation, and stress sensitivity that cut across diagnostic categories and may explain why a single risk factor, in this case sexual abuse, manifests as different outcomes in different people.

As with any survey-based study, the design has limitations that the authors and commentators must weigh. The data are cross-sectional, meaning they capture a snapshot rather than tracking participants over time, so the findings demonstrate associations rather than definitive causal sequences. Retrospective reports of sexual abuse and self-reported substance use are subject to recall and disclosure biases, and survey samples, however large, may not perfectly represent national populations. The authors also note funding and disclosure details in their conflict of interest statement, with several team members reporting consulting relationships, research support, or editorial roles with entities related to gambling, mental health publishing, and pharmaceutical or gaming organizations; the funders, according to the disclosure, had no role in study design, data collection, analysis, or manuscript preparation. These disclosures are standard practice and allow readers to evaluate the work in context.

Nevertheless, the scale and diversity of the sample make this one of the most comprehensive examinations to date of how impulsivity conditions the relationship between sexual abuse and substance use frequency. The convergence of evidence across countries, gender identities, and sexual orientations suggests that the underlying psychological mechanism is broadly shared, even as the absolute levels of substance use may vary across groups. For researchers, the study provides a template for large-scale moderation analyses that treat individual differences as central rather than incidental. For clinicians and prevention specialists, it offers a concrete, measurable risk marker that can be assessed quickly and addressed with existing evidence-based techniques. And for survivors and the people who support them, the findings underscore that the path from trauma to substance use is not uniform: understanding and treating the impulsive tendencies that can amplify risk may be as important as addressing the trauma itself.

Subject of Research: The moderating role of impulsivity in the association between sexual abuse and substance use frequency

Article Title: Among people with a history of sexual abuse, being impulsive is associated with more frequent use of drugs, alcohol and tobacco, per international survey study of 64,472 participants

Article References: Among people with a history of sexual abuse, being impulsive is associated with more frequent use of drugs, alcohol and tobacco, per international survey study of 64,472 participants. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: sexual abuse, impulsivity, substance use, alcohol, tobacco, drugs, trauma, PLOS One, international survey, moderation analysis, emotion regulation, public health

The scientific premise behind Project Adhere rests on a well-documented paradox. Oral PrEP, typically a combination of emtricitabine and tenofovir disoproxil fumarate, reduces the risk of HIV acquisition by more than 90 percent when taken as prescribed, a finding established in landmark trials such as iPrEx and PROUD. Yet the protective effect of the drug is exquisitely sensitive to adherence. Pharmacologic studies measuring intracellular tenofovir-diphosphate in dried blood spots have shown that protection drops steeply when fewer than four doses per week are taken. Black men who have sex with men, the very group facing the highest incidence of new infections, have repeatedly been shown in prior research to be less likely to initiate, adhere to, and persist on oral PrEP compared with their white counterparts.

To understand what drives this gap, the research team, led by Darren L. Whitfield of the University of Maryland School of Social Work together with colleagues at Emory University, New Mexico State University, and Vanderbilt University Medical Center, designed an observational study that tracked both behavior and psychology over time. Participants were recruited from Ending the HIV Epidemic jurisdictions, geographic areas selected by federal health agencies because they account for a majority of new HIV diagnoses in the United States. By concentrating on these hotspots, the investigators aimed to study adherence in the settings where improvements would have the greatest public health impact.

The methodological design of Project Adhere reflects a growing recognition that self-reported adherence is unreliable. Previous studies comparing self-report with pharmacologic measures have found that participants frequently overestimate the doses they take, a pattern documented among young men who have sex with men in both clinical trials and community settings. To counter this bias, Project Adhere monitored participants’ PrEP use objectively over the six-month follow-up period while simultaneously administering validated psychometric instruments. These included the Patient Health Questionnaire for depression, the Alcohol Use Disorders Identification Test for alcohol consumption, the Drug Abuse Screening Test for other substance use, and the Brief Resilience Scale for the capacity to recover from stress.

The headline finding of the study is that substance use was significantly associated with lower PrEP adherence. This result aligns with a systematic review published in AIDS and Behavior in 2023, which synthesized evidence from studies enrolling men who have sex with men and transgender women and found consistent links between substance use and diminished adherence to HIV pre-exposure prophylaxis. It also echoes earlier findings from the HPTN 073 trial, in which self-reported substance use behaviors among Black men who have sex with men were associated with both PrEP acceptance and adherence outcomes. The consistency of this association across independent cohorts strengthens the case that substance use is not a peripheral issue but a central mechanism undermining chemoprophylaxis in this population.

The mechanisms linking substance use to missed doses are plausibly multifactorial. Alcohol and drug use can disrupt daily routines that anchor medication-taking habits, impair memory and executive function during intoxication, and increase the perceived burden of a daily pill. Qualitative work with PrEP-prescribed gay and bisexual men has documented that participants themselves perceive alcohol consumption and substance use as direct obstacles to consistent adherence, sometimes describing complete lapses in their medication routines during periods of heavy use. There is also the phenomenon of interactive toxicity beliefs, the concern that combining PrEP with alcohol or drugs could harm the body, which prior research has linked to stigma, substance use, and reduced PrEP uptake.

What makes the Project Adhere findings notable is that substance use emerged as the significant correlate while other psychosocial factors did not reach statistical significance in this sample. Depression, anxiety, stigma, resilience, and self-efficacy have all been implicated in prior literature as barriers or facilitators of PrEP adherence. A syndemic perspective, which holds that clustered psychosocial epidemics such as depression, substance use, and violence exposure interact synergistically to elevate HIV risk, has been widely applied to young Black gay and bisexual men. The Project Adhere results do not invalidate this framework, but they do suggest that within a six-month observational window in this cohort, substance use was the factor with the clearest measurable signal, and that the effects of other psychosocial and structural variables require further study with larger samples.

The study’s limitations are important for calibrating interpretation. With 69 participants, the sample size constrains statistical power, meaning that modest but real associations between other psychosocial factors and adherence may have gone undetected. Observational designs cannot establish causation; it is possible that unmeasured confounders influence both substance use and adherence. Nevertheless, the authors argue that the findings point toward a practical intervention target. Screening for substance use in PrEP clinics serving Black men who have sex with men, and integrating substance use support into HIV prevention services, could address a modifiable behavior that directly compromises the pharmacologic protection the medication is meant to provide.

The structural context surrounding these individual-level findings cannot be ignored. Black men who have sex with men navigate layered stigma related to race, sexuality, and PrEP use itself, along with medical mistrust rooted in historical and contemporary discrimination. Studies in Jackson, Mississippi and Boston documented how stigma, mistrust, and perceived racism suppress PrEP awareness and uptake. Research in Harlem and Atlanta has shown high discontinuation rates even among those who initiate the regimen. Structural racism and racial trauma have been proposed as upstream determinants that shape both mental health burdens and engagement with prevention services. Within this landscape, a daily pill demands a stability of routine, trust, and access that structural inequities actively erode.

The federal Ending the HIV Epidemic initiative has set the goal of reducing new infections by at least 90 percent by 2030, and mathematical modeling suggests that PrEP could substantially reduce incidence among Black sexual minority men if coverage and adherence were equitable. Population-based analyses of the first decade of PrEP use in the United States, however, have documented persistent disparities in uptake by race and ethnicity, with Black men who have sex with men remaining underrepresented among PrEP users relative to their share of new infections. Project Adhere adds a granular, longitudinal, and methodologically careful data point to this national picture, indicating that closing the gap will require more than expanding prescriptions. It will require interventions that meet Black men where the evidence now points: at the intersection of substance use, daily routine, and the social conditions that shape both. The authors call for further research to determine the full impacts of psychosocial and structural factors on adherence and persistence, and for interventions designed to assess and assist Black men who use substances, so that the promise of PrEP can finally be delivered equitably to the communities that need it most.

Subject of Research: Psychosocial and structural factors influencing PrEP adherence among Black men who have sex with men

Article Title: Associations Between Psychosocial Factors and Pre-exposure Prophylaxis (PrEP) Adherence Among Black Men Who Have Sex with Men in Ending the HIV Epidemic Jurisdictions: Findings from Project Adhere

Article References: Whitfield, D. L., Caldwell, J., Edwards, O. W., Mammadli, T., Chandler, C. J., Sullivan, P., & Jones, J. (2026). Associations Between Psychosocial Factors and Pre-exposure Prophylaxis (PrEP) Adherence Among Black Men Who Have Sex with Men in Ending the HIV Epidemic Jurisdictions: Findings from Project Adhere. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03433-1

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03433-1

Keywords: PrEP, HIV prevention, Black men who have sex with men, medication adherence, substance use, Ending the HIV Epidemic, psychosocial factors, health disparities, Archives of Sexual Behavior, Project Adhere, Associations, Between

The research team, led by U. Venkatesh of the All India Institute of Medical Sciences in Gorakhpur, together with colleagues from AIIMS campuses in Nagpur, Rajkot, Deoghar and Guwahati as well as JIPMER in Puducherry, set out to address a persistent gap in the literature. Most research on adolescent substance use has concentrated on risk factors such as peer pressure, family conflict and easy access to psychoactive substances. Far less attention has been paid to the psychosocial assets that may buffer young people against initiation and continued use, and the evidence that does exist comes disproportionately from high-income countries. For low- and middle-income settings, where the majority of the world’s adolescents live, robust data on protective resources have been scarce.

The study defined current substance use as the self-reported use of at least one assessed psychoactive substance during the preceding three months. Complete information on this outcome was available for 4,848 of the 6,168 enrolled adolescents, a response coverage of 78.6 percent. Within this analytic sample, 545 adolescents, or 11.2 percent, reported current substance use. Rather than singling out one substance, the researchers cast a wide net across the psychoactive substances commonly assessed in adolescent health surveys, capturing the full spectrum of use from tobacco and alcohol to other substances.

Methodologically, the investigators constructed study-specific composite scores for three domains: protective factors, coping mechanisms, and social engagement. Each score was assembled from questionnaire items embedded in the parent multicentre study and then categorized as low, moderate, or high using cut-offs derived from the interquartile range of the score distributions. This approach allowed the team to examine whether associations with substance use differed across the spectrum of psychosocial resources rather than treating these constructs as continuous variables, an important design choice given that the relationship between psychological resources and behavior is not always linear.

The headline result concerned protective factors. Compared with adolescents in the low category, those with moderate protective-factor scores had 40 percent lower odds of current substance use, an adjusted odds ratio of 0.60 with a 95 percent confidence interval of 0.47 to 0.76, which excludes the null value and therefore reaches conventional statistical significance. Strikingly, the estimate for adolescents with high protective-factor scores was weaker and less precise, at 0.78 with a confidence interval of 0.59 to 1.02, a range that includes the null. The same pattern emerged for coping mechanisms: moderate coping scores were associated with 35 percent lower odds of current use, an adjusted odds ratio of 0.65 with a confidence interval of 0.51 to 0.82, while high coping scores yielded a weaker estimate of 0.81 with a confidence interval of 0.60 to 1.10 that crosses the null.

Social engagement told a different and more equivocal story. The moderate category showed essentially no independent association with substance use, with an adjusted odds ratio of 0.98 and a confidence interval spanning 0.77 to 1.25. The high-category estimate, at 2.27 with a very wide confidence interval of 0.71 to 7.24, was highly imprecise and cannot support any firm conclusion about whether greater social engagement raises, lowers, or leaves unchanged the odds of adolescent substance use. The researchers also conducted exploratory interaction analyses to test whether peer norms modified these relationships, finding only limited evidence of such effect modification.

To probe the overall direction of the associations, the team performed adjusted ordinal analyses examining trends across increasing categories of each psychosocial measure. These analyses indicated overall inverse ordinal trends, meaning that, on average, higher categories of protective factors and coping were associated with lower substance use. However, the authors are emphatic that the category-specific estimates did not consistently demonstrate monotonic patterns. Because the moderate categories showed stronger associations than the high categories, the findings should not be interpreted as evidence of dose-response relationships, in which each incremental rise in psychosocial resources produces a corresponding drop in substance use. This distinction matters both for statistical interpretation and for the practical design of interventions.

The statistical models were carefully adjusted for a battery of potential confounders, including age, sex, household economic status, living arrangement, the amount of pocket money available to the adolescent, peer norms, and study site. This adjustment is critical because older adolescents, boys, those with more disposable income, and those in permissive peer environments are known to differ systematically in both psychosocial resources and substance use. By holding these factors constant, the analysis isolates the association between the psychosocial composites and substance use, though it cannot eliminate confounding by unmeasured variables.

The authors are equally candid about the limits of what a cross-sectional design can establish. Because exposure and outcome were measured at the same point in time, the study cannot determine whether lower protective factors and coping capacity preceded substance use or, conversely, whether substance use eroded those resources. Temporality and causality remain unresolved questions. The composite scores, while constructed systematically from study questionnaire items, were not validated instruments, which introduces the possibility of measurement error. The authors call explicitly for longitudinal studies using validated psychosocial measures to clarify these associations over time.

Even with these caveats, the study carries significant implications for adolescent health programming in India and comparable settings. The work is embedded in a larger research effort funded by the Indian Council of Medical Research under an Extramural Research Grant, part of a cluster randomized controlled trial evaluating a community-based peer-led intervention to prevent substance use among adolescents within the school health programme under Ayushman Bharat, India’s national health initiative. If subsequent longitudinal research confirms that moderate psychosocial resources confer the greatest protection, school-based programmes may need to look beyond simply maximizing every student’s resilience scores and instead focus on ensuring that no adolescent falls below a functional threshold of protective resources. The ethical scaffolding of the study was rigorous: approvals were obtained from the institutional ethics committees of all six participating institutions, informed consent was secured from all adolescents, written parental or guardian consent was obtained for participants under 18, participation was voluntary, and confidentiality was strictly maintained, in accordance with the Declaration of Helsinki. As substance use during adolescence remains a pressing public health concern with consequences that ripple across the life course, this large, multi-regional analysis offers policymakers a data-driven starting point, and a caution against linear thinking, in designing prevention strategies for the world’s largest adolescent population.

Subject of Research: Psychosocial protective factors, coping mechanisms and social engagement associated with current substance use among school-going adolescents in India

Article Title: Protective factors, coping mechanisms and social engagement associated with current substance use among adolescents from 108 schools in India: a multicentre cross-sectional study

Article References: Venkatesh, U., Gandhi, A. P., Joshi, K., Bhattacharya, S., Agarwalla, R., Chinnakali, P., & Hossain, M. (2026). Protective factors, coping mechanisms and social engagement associated with current substance use among adolescents from 108 schools in India: a multicentre cross-sectional study. BMC Psychology. https://doi.org/10.1186/s40359-026-05658-0

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05658-0

Keywords: adolescents, substance use, protective factors, coping mechanisms, social engagement, India, school health, psychosocial resources, cross-sectional study, public health, BMC Psychology, prevention

The methodological core of the study is what statisticians call multilevel latent class analysis, or MLCA. Traditional variable-centered approaches ask how single factors, such as partner age or substance use, relate to outcomes like condomless sex. Person-centered mixture models instead search for hidden subgroups within a population, defined by co-occurring patterns across many indicator variables simultaneously. The multilevel extension is crucial for sexual network data, because each participant, or ego, nominated multiple partners, or alters, creating a nested structure in which partnerships are clustered within individuals. Ignoring this nesting can distort estimates and obscure the fact that a single man may move fluidly between very different kinds of sexual encounters. The researchers modeled both levels at once: lower-level classes describing types of individual partnerships, and upper-level groups describing the overall composition of each man’s sexual network.

Data collection relied on an egocentric social network approach implemented through the Network Canvas platform, with participants recruited through a modified respondent-driven sampling strategy led by a community-based sexual health clinic. Each participant named the people with whom he had anal or vaginal sex in the past six months and reported detailed characteristics of each relationship: whether the partner was a main or casual partner, whether condoms were always used, which sexual positions involved condomless contact, whether the partner disclosed an HIV status, and how emotionally close the respondent felt to that person. Covariates included alcohol and other substance use when the dyad met to have sex, the respondent’s current PrEP use, country of nativity, and total sexual network size. Participants averaged 34.5 years of age, 88 percent were born outside the United States, and 57 percent reported currently using PrEP.

The analysis converged on a three-class, two-group solution. At the partnership level, three distinct sexual partner typologies emerged. The first, accounting for 37 percent of partnership contexts, was an elevated-risk context with a main sexual partner: seroconcordant dyads in which both partners disclosed being HIV-negative, marked by high emotional closeness, main partnership status, and a high probability of versatile condomless sex. The second class, 35 percent of contexts, was labeled selective and close casual partnerships, in which men reported condomless sex in only one position, such as insertive or receptive anal sex exclusively, alongside moderate emotional closeness. The third class, 27 percent, comprised low-exposure casual partnerships with little condomless sex, variable closeness, and a high probability that the partner’s HIV status was simply unknown. At the network level, two groups emerged: one dominated by casual partnerships, accounting for 54 percent of sexual partnerships, and one centered on a main sexual partner, accounting for 46 percent.

Perhaps the most striking finding concerns what these typologies reveal about trust. Consistent with the dyadic framework for HIV prevention developed by Karney and colleagues, the study found that risk behaviors clustered within emotionally close relationships rather than anonymous encounters. Condomless sex was most prevalent in main partnerships, where intimacy and trust may paradoxically substitute for barrier protection, and lowest in casual partnerships where serostatus was undisclosed. Partners in the low-exposure casual class frequently had unknown HIV seroconcordance, which may itself have prompted greater caution. Meanwhile, classes with higher perceived closeness involved partners who disclosed being HIV-negative, more versatile condomless practices, and more substance use when the dyad met for sex. This inversion of the intuitive risk hierarchy, in which the most trusted relationships carry the most condomless exposure, has been documented in prior research among Latino men and now receives a rigorous person-centered confirmation.

The multinomial logistic regression results sharpened the picture of who occupies which network context. Respondents currently using PrEP had 1.60 times greater odds of belonging to the group whose networks were composed primarily of main partnerships with elevated risk contexts, relative to the casual-network group. Latino men born outside the United States had 43 percent lower odds of having elevated-risk main-partner contexts compared to those born in the country. Network size mattered as well: every additional partner reduced the odds of belonging to the main-partnership group by 29 percent. Substance use when the dyad met to have sex was independently associated with roughly threefold higher odds of condomless sex in a random intercept model, and within the multilevel model, substance use sharply reduced the odds of membership in low-exposure casual classes relative to elevated-risk main-partner contexts.

These associations carry important caveats that the authors themselves emphasize. The data are cross-sectional, so the temporal direction of the PrEP finding remains unresolved: men may adopt PrEP because they are in higher-exposure partnerships, or their partnerships may take a particular shape because PrEP has reduced their perceived need for condoms. PrEP, when taken as directed, is extremely effective against HIV acquisition but does not prevent other sexually transmitted infections, and systematic reviews have documented elevated STI diagnosis rates among PrEP users, potentially reflecting both reduced condom use and increased testing frequency. The study also captured only the daily-pill form of PrEP, predating wider availability of long-acting injectable options, and the reporting window overlapped with the COVID-19 pandemic, when social distancing measures may have altered sexual network patterns in ways that differ from pre- and post-pandemic behavior.

Cultural and structural context adds further layers of complexity. Miami-Dade is a distinctive setting in which 69 percent of residents identify as Latino, more than half were born outside the United States, and 68 percent of adults speak Spanish. Approximately one-third of foreign-born participants had lived in the country for a year or less, a period that may be insufficient to establish close, serious partnerships and during which navigating new social and sexual environments can shape partner selection, communication, and trust. Prior research suggests that cultural values such as collectivism and familismo can support condom use, while acculturative processes, language barriers between partners, and hypermasculine norms may complicate safer-sex negotiation. The authors argue that future work should move beyond a simple US-born versus foreign-born dichotomy and apply syndemic theory or intersectional perspectives to capture how immigration experiences, stigma, substance use, and cultural values interact to shape vulnerability.

The practical implications point toward interventions designed at the level of the dyad and the network rather than the isolated individual. Couples-based programs can facilitate conversations about relationship agreements, the increasing openness of sexual partnerships, and the role of substances in sexual decision-making, while network interventions that engage opinion leaders can diffuse prevention messaging through the social structures the study has now characterized in detail. The researchers also propose expanding clinic screening tools to include brief egocentric sexual network modules, allowing providers to tailor recommendations, whether PrEP, doxycycline post-exposure prophylaxis, routine testing, or negotiated safety agreements, to the specific partnership typologies a patient actually experiences. By replacing blunt risk categories with empirically derived partnership profiles, the study offers a template for precision HIV and STI prevention that respects the fluid, context-dependent reality of Latino men’s sexual lives in one of America’s hardest-hit communities.

Subject of Research: Sexual partnership typologies and HIV/STI risk contexts among Latino men in Miami analyzed with multilevel latent class analysis of egocentric sexual network data

Article Title: Sexual Partner Typologies Among Latino Men Living in Miami, Florida: A Multilevel Latent Class Analysis

Article References: Despres, L., Rodriguez, E., Johnson, A. L., Bravo, A., Vilchez, L., Doblecki-Lewis, S., Fallon, S., & Kanamori, M. (2026). Sexual Partner Typologies Among Latino Men Living in Miami, Florida: A Multilevel Latent Class Analysis. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03441-1

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03441-1

Keywords: HIV, sexually transmitted infections, Latino men, Miami-Dade County, multilevel latent class analysis, sexual networks, PrEP, condomless sex, substance use, dyadic prevention, immigration and acculturation, syndemic theory

The research, conducted by Joaquín Rodríguez-Ruiz of the University of Huelva along with Raquel Espejo-Siles and Izabela Zych of the University of Córdoba, appears in the International Journal of Mental Health and Addiction. It draws on the psychological concept of moral disengagement, first described by Albert Bandura and colleagues in the 1990s. Moral disengagement is the process by which people switch off their internal moral sanctions, allowing themselves to commit acts that violate their own ethical standards without feeling remorse. Mechanisms include moral justification, euphemistic labeling, advantageous comparison, and diffusion of responsibility.

Decades of research have linked moral disengagement to aggression, bullying, cyberbullying, and violence in adolescents. Evidence connecting it to substance use has been sparser. Cross-sectional studies in Australia found that moral disengagement was associated with underage drinking, heavy episodic drinking, and cannabis use among secondary school students. Research with British college athletes linked the construct to doping attitudes, and an online survey of British adults found that high moral disengagement predicted cocaine use. But cross-sectional designs cannot establish which comes first, leaving a crucial gap in understanding.

To address this, the Spanish team followed 533 adolescents, 48.1 percent female and 51.9 percent male, across three consecutive school years starting in fall 2020. Participants were on average 12.46 years old at the first assessment. The researchers measured perceived parental moral disengagement using a questionnaire asking adolescents how often their parents justified immoral behavior, with items such as my parents think it is fine to treat certain people badly. They also administered a short version of Bandura’s Moral Disengagement Scale and a substance use subscale covering legal substances like beer, wine, spirits, and tobacco, as well as illegal ones including cannabis, cocaine, and amphetamines.

The statistical strategy was rigorous. Because the data were non-normal, the team used bootstrapping with 1,000 resamples to estimate robust standard errors and compute bias-corrected 95 percent confidence intervals for indirect effects. If the confidence interval for an indirect effect excludes zero, that effect is considered statistically significant. This approach allows researchers to formally test mediation, meaning whether a third variable explains the pathway between a cause and an outcome.

The results were strikingly specific. Parental moral disengagement at the first wave showed no significant direct effect on licit substance use at the third wave. But the indirect pathway was significant. Parents who morally disengaged had adolescents who themselves scored higher on moral disengagement a year later, and those adolescents went on to report more alcohol and tobacco use the following year. The indirect effect was statistically significant with a 95 percent confidence interval that did not include zero.

Why the asymmetry between legal and illegal substances? The authors point to accessibility and perceived risk. Alcohol and tobacco are easy to obtain, widely consumed, and sometimes even reported in childhood, so parental justification may readily extend to them. Illegal drugs, by contrast, are more harmful, harder to access, and often tied to criminal settings. That severity may keep both parents and adolescents from morally excusing their use, explaining why parental moral disengagement at baseline did not predict later illicit substance use.

The theoretical framework combines Bandura’s Social Learning Theory with Robert Putnam’s Social Capital Theory. Social learning holds that children acquire attitudes and behavioral scripts from their social environment, most powerfully from parents. When a parent routinely justifies harmful behavior, the child learns a cognitive style, not just a specific attitude. Social Capital Theory adds that healthy social relationships protect against problem behavior, so a family environment saturated with moral excuses erodes one of the strongest protective resources an adolescent has.

The study has limitations worth noting. Data came from self-reports, which can be shaped by social desirability, although self-reports remain the standard tool for measuring problem behavior in adolescents. The sample was selected by convenience from 16 schools in the province of Córdoba rather than being nationally representative, and attrition from the first to third wave was 38.28 percent, mostly due to absences, school changes, and unusable codes. The authors also call for future models that account for confounders such as availability, peer pressure, and comorbid psychiatric conditions.

The practical implications are nonetheless compelling. Because the pathway from parents to substance use runs through the adolescents’ own moral disengagement, programs that strengthen adolescents’ moral competencies could interrupt the chain even when parents continue to model moral shortcuts. Schools, the authors argue, could play a central role in such efforts. And since parental involvement boosts the effectiveness of adolescent psychosocial interventions, prevention programs may need to target parents’ moral reasoning as well. This research, the first to link parental moral disengagement prospectively to substance use, suggests that the fight against adolescent drinking and smoking may begin not with the substances themselves, but with the everyday excuses families make.

Subject of Research: Intergenerational transmission of moral disengagement and its longitudinal mediation of adolescent licit substance use

Article Title: Parental Moral Disengagement and Adolescent Substance Use: The Mediating Role of Adolescents’ Moral Disengagement in a Three-Wave Longitudinal Study

Article References: Rodríguez-Ruiz, J., Espejo-Siles, R., & Zych, I. (2026). Parental Moral Disengagement and Adolescent Substance Use: The Mediating Role of Adolescents’ Moral Disengagement in a Three-Wave Longitudinal Study. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-026-01730-3

Image Credits: AI Generated

DOI: 10.1007/s11469-026-01730-3

Keywords: moral disengagement, parenting, adolescence, substance use, alcohol, tobacco, Social Learning Theory, longitudinal study, mediation analysis, prevention, moral development, addiction

The research team, led by Lateef Olutoyin Oluwole and Adetunji Obadeji of the Department of Psychiatry, conducted four focus group discussions with 22 young adults aged 18 to 47 who were receiving treatment for mental and behavioural disorders linked to psychoactive substance use. Seventeen of the participants were male and five female, with a mean age of just over 25 years. Most had tertiary education, a detail that punctures the stereotype of the fraudster as an uneducated dropout. Participants were identified through careful, ethically supervised clinical screening, and only those who had personally disclosed direct or vicarious involvement in internet fraud were included. Sessions lasted between 60 and 90 minutes and were analysed thematically using Braun and Clarke’s established six-step framework, with the research team continuing until data saturation was reached at the fourth discussion.

The scale of the underlying problem is staggering. Recent studies cited by the authors document lifetime psychoactive substance use among Nigerian university students reaching 86 percent, with regional prevalence rates of 44 percent for alcohol, 30 percent for tramadol, between 6 and 16 percent for cannabis, and 11 percent for codeine. More alarming still is the emergence of new psychoactive substances, including synthetic cannabinoids sold under street names such as “Wiz,” “Black Mamba” and “Colorado,” which are marketed through online platforms and local outlets with deceptive labelling and are associated with severe neuropsychiatric effects including psychosis and hallucinations. Against this backdrop, Nigeria’s demographic profile, in which individuals under 35 constitute more than 70 percent of the population, means that the intersection of drug use and cybercrime touches an enormous share of the nation’s future workforce.

What the focus groups revealed is that the relationship between substances and fraud operates through at least three distinct patterns. The first is functional linkage: substances used deliberately to enhance fraudulent performance. Participants described smoking synthetic cannabinoids to stay awake through long nights of online scamming, or using tramadol and cannabis to summon the confidence needed to manipulate victims. “When they use tramadol or loud, it gives them confidence to talk to clients online,” one participant explained. The second pattern is independence, where the two behaviours coexist without direct connection; many participants knew fraudsters who avoided drugs entirely, and drug users with no involvement in fraud. The third, and perhaps most destructive, is bidirectional reinforcement, in which fraud proceeds fund escalating substance use while substances sustain the emotional and physical capacity to continue defrauding victims.

Peer influence emerged as the most consistently cited driver across every discussion group. The researchers frame this through Sutherland’s Differential Association Theory, which holds that deviant behaviour is learned through intimate social interaction. Participants described acquiring not only the technical knowledge of fraud schemes but also the rationalisations that make them acceptable. “If your guy is doing Yahoo and you see him driving Benz, you go want join too,” one speaker said. Crucially, the authors found that peer influence now extends beyond face-to-face networks into mediated channels: Instagram displays of fraud-derived wealth create aspirational models that reach far beyond immediate friendship circles, effectively digitising the social transmission of deviance.

Beneath the peer dynamics lies a structural engine that the researchers interpret through Merton’s Strain Theory. When culturally prescribed goals, financial success, material display, social status, are pursued in a society where legitimate routes such as education and formal employment are systematically blocked, illegitimate pathways become rational choices for some. Participants spoke of poverty as the fundamental push factor and of intense family expectations, particularly on firstborn sons, to provide. “It’s poverty that is pushing them… they want to make it fast,” one participant said. The frustration of educated unemployment, the perception that the system has failed, and the visible rewards of fraud combined to produce what the authors describe as a maladaptive response to the disjuncture between aspiration and opportunity.

Perhaps the most unsettling finding concerns the family and community. Rather than uniformly condemning fraud, participants described a spectrum of parental responses ranging from unknowing enablement to active complicity. Some parents remained silent once money began flowing home; a few reportedly prayed for their sons’ success in fraud; others took their children to traditional healers, or babalawos, for spiritual “fortification” before fraudulent ventures. The authors argue that this cultural ambivalence, a system that simultaneously prohibits and enables, may be more consequential for youth behaviour than either clear condemnation or clear approval, because it creates exploitable ambiguity. Social media, pop culture and the visible material success of “big boys” reinforce the normalisation, with participants noting that fraud is now regarded in many communities as a normal job, morally softened by comparisons such as “not stealing with a gun.”

The biopsychosocial model completes the theoretical triad. Biologically, substances alter brain chemistry in ways that impair judgment and increase impulsivity, effects that may facilitate fraud. Psychologically, substances serve as self-medication for the distress arising from economic pressure, family conflict and the moral tensions of deceiving others. Socially, peer networks supply both the context for use and the normative framework for fraud. The authors stress that these frameworks are complementary rather than competing: strain theory explains the structural pressures, differential association explains how deviant responses are transmitted, and the biopsychosocial model explains how these forces manifest in individual experience.

Yet beneath the bravado and the Benz photographs, the study documents a hidden toll. Despite widespread normalisation, participants consistently reported guilt, remorse, depression, anxiety, sleep disturbance, intrusive thoughts about victims and difficulty forming trusting relationships. “Sometimes it’s hard to sleep, even after making money. The guilt is real,” one speaker admitted. Others described violence and depression when fraud ventures failed. This coexistence of external reward and internal distress, the authors note, complicates simplistic portrayals of “Yahoo boys” as simply immoral; even within deviant subcultures, individuals retain a moral awareness that carries real psychological cost, and young adults with mental health conditions appear significantly more vulnerable to new psychoactive substances, which in turn further impair judgment and increase susceptibility to fraudulent involvement.

The participants themselves offered a roadmap for intervention that the authors endorse: economic empowerment and job creation, parenting and family training programmes that replace punitive discipline with emotional connection, recreational and vocational initiatives, mental health support and mentorship, and faith-based moral reorientation. “If there are jobs or skills training, many won’t do Yahoo or drugs,” one participant said. The researchers caution that their sample, drawn from a single treatment facility in southwestern Nigeria, may limit generalisability, and that the clinical setting could have emphasised pathological aspects of participants’ experiences. Still, the consistency of narratives across groups lends weight to the central conclusion: substance use and internet fraud among Nigerian youths are not isolated acts of deviance but interconnected maladaptive coping strategies within contexts of structural inequality, demanding integrated, youth-focused responses that address mental health, family dynamics and economic opportunity together rather than treating either crisis alone.

Subject of Research: The psychosocial and cultural drivers linking psychoactive substance use and internet fraud among Nigerian youths

Article Title: Psychosocial and cultural dynamics shaping substance use and internet fraud among Nigerian youths

Article References: Oluwole, L. O., Obadeji, A., Ajiboye, A. S., & Atofarati, M. A. (2026). Psychosocial and cultural dynamics shaping substance use and internet fraud among Nigerian youths. Discover Mental Health, 6(1), Article 178. https://doi.org/10.1007/s44192-026-00476-7

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00476-7

Keywords: substance use, internet fraud, Yahoo Yahoo, Nigeria, youth, cybercrime, mental health, peer influence, strain theory, new psychoactive substances, qualitative research, cultural normalisation

The study was conducted by Kıvanç Uzun of Uşak University, Gökmen Arslan of Burdur Mehmet Akif Ersoy University and the University of Melbourne, and Umut Aydoğdu of Burdur Mehmet Akif Ersoy University. Drawing on the psychological literature on emerging adulthood, the researchers set out to answer a question that has grown urgent for campus mental health services worldwide: why do some lonely students turn to substances and compulsive behaviors while others seem to cope without harm, and can the difference be measured and targeted?

To find out, the team recruited 419 students from a state university in Türkiye. The sample was 56.10 percent female and 43.90 percent male, with participants ranging in age from 20 to 28 years and an average age of 25.96 years with a standard deviation of 2.38. Because the research used a cross-sectional design, in which all measurements were collected at a single point in time, the authors are careful not to claim that loneliness causes addiction outright. Nevertheless, the statistical architecture of the study, which combined mediation and moderation analyses, allowed them to map the relationships among the variables with unusual precision.

The theoretical scaffolding for the work draws on several influential frameworks. Agnew’s general strain theory proposes that negative emotional states such as strain and distress push individuals toward deviant or compensatory behaviors, including substance use, as a way of managing painful feelings. The self-medication hypothesis, articulated by Khantzian, similarly holds that people use addictive substances to regulate overwhelming emotions. Loneliness research by Cacioppo and colleagues has shown that perceived social isolation is not merely an unpleasant feeling but a biological warning signal that reshapes cognition, heightens vigilance to social threat, and dysregulates stress physiology. In parallel, Sinha’s work on chronic stress has documented how sustained stress exposure sensitizes the brain’s antireward circuitry, increasing vulnerability to addiction.

Within this framework, the researchers proposed a mediated moderation model. First, they hypothesized that loneliness would positively predict addictive behavior. Second, they proposed that perceived stress, measured with established instruments rooted in the classic Cohen, Kamarck and Mermelstein conception of stress as the degree to which life situations are appraised as unpredictable, uncontrollable and overloaded, would partially mediate this link. The logic is straightforward: loneliness generates distress, and distress generates a motivational pressure to escape, and addictive behaviors offer the fastest available escape route. Third, and most novel, the team predicted that psychological flexibility would moderate the entire process, protecting lonely students from translating their pain into addictive action.

Psychological flexibility, the central construct of acceptance and commitment therapy as developed by Hayes and colleagues, refers to the ability to contact the present moment fully and, depending on what the situation affords, either persist with or change one’s behavior in the service of chosen values. Psychologically flexible individuals can feel lonely, notice the feeling, accept its presence without being dominated by it, and still choose actions aligned with their long-term goals. Psychologically inflexible individuals, by contrast, tend to fuse with painful thoughts, experientially avoid discomfort, and reach for immediate relief, a pattern that Hayes and colleagues have long associated with behavioral disorders including addiction.

The results confirmed the central predictions. Loneliness significantly and positively predicted addictive behavior among the students. Perceived stress played a partial mediating role in this relationship, meaning that part of the effect of loneliness on addictive behavior traveled through elevated stress. In other words, lonely students felt more stressed, and the stress itself contributed to the pull of addictive behaviors. The persistence of a direct effect alongside the indirect pathway suggests that stress is an important mechanism but not the only one; loneliness may also erode the social controls, belongingness and meaning structures that normally restrain compulsive behavior, a possibility consistent with Hirschi’s social control perspectives and recent cross-national evidence from Savolainen and colleagues linking perceived loneliness to youth addictive behaviors.

The moderation findings were the study’s most striking contribution. When students reported low psychological flexibility, the relationship between loneliness and addictive behavior was strong. When students reported high psychological flexibility, the relationship was not statistically significant. Put plainly, psychological flexibility appeared to neutralize the lonely-to-addictive pathway entirely at high levels. The finding echoes prior work by Kelly and colleagues, who studied US veterans during the COVID-19 pandemic and found that psychological flexibility influenced how loneliness related to substance use and functioning, and a growing body of intervention research showing that acceptance and commitment therapy can improve psychological flexibility in populations affected by substance dependence.

For campus health professionals, the practical implications are twofold. Preventive programs that merely address substance availability or peer pressure may miss the deeper engine of the problem, which is the emotional cascade from isolation through stress to escape-seeking behavior. Counseling services could instead screen for loneliness and perceived stress as early warning signals, and incorporate skills-based training in acceptance, mindfulness, values clarification and cognitive defusion, the active ingredients of flexibility-focused interventions. The authors emphasize that their results provide an important basis for preventive and supportive interventions targeting addictive behavior among college students, and prior meta-analytic work on risk and protective factors for addiction supports the notion that strengthening individual regulatory capacity can meaningfully reduce risk.

The study also carries broader cultural and developmental significance. Emerging adults aged roughly eighteen to twenty-nine occupy a uniquely volatile developmental window, as Arnett’s theory of emerging adulthood describes, in which identity exploration, residential mobility and unstable social networks converge. In collectivist cultural contexts such as Türkiye, where family connectedness and relatedness carry particular weight as Kağıtçıbaşı’s cross-cultural work has shown, separation from familiar support networks may generate especially acute loneliness. At the same time, the digital environments in which contemporary students socialize have been repeatedly linked to problematic use patterns, from smartphone and internet addiction to social media compulsion, with studies such as those by Bian and Leung and by Li and colleagues demonstrating that loneliness fuels these behaviors through boredom and diminished self-control.

As with any cross-sectional study, important limitations temper the conclusions. The single-time-point design cannot establish the direction of causality; it is plausible that addictive behaviors also deepen loneliness by damaging relationships, a bidirectional dynamic suggested by Mendelian randomization research on loneliness, smoking and alcohol use by Wootton and colleagues. The sample, drawn from one state university in a single country, limits generalizability, and self-report measures remain vulnerable to bias. Still, the size of the sample, the theoretical grounding of the model and the consistency of the findings with prior international evidence lend the work considerable weight.

What makes the research resonate beyond academia is its quietly hopeful message. Loneliness, stress and addiction form a chain that many students know intimately, but the chain has a weak link, and that link is trainable. Psychological flexibility is not a fixed trait reserved for the resilient few; it is a set of learnable skills that can be cultivated through therapy, structured programs and everyday practice. If lonely students can learn to hold their pain without being ruled by it, the study suggests, the path from isolation to addiction may be blocked before it begins. In an era when universities worldwide report rising mental health concerns, that insight may prove one of the most valuable tools campuses can offer.

Subject of Research: The roles of perceived stress and psychological flexibility in the relationship between loneliness and addictive behavior among college students.

Article Title: I feel lonely and stressed: psychological flexibility and addictive behavior in college students

Article References: Uzun, K., Arslan, G., & Aydoğdu, U. (2026). I feel lonely and stressed: psychological flexibility and addictive behavior in college students. Current Psychology, 45(18), Article 1525. https://doi.org/10.1007/s12144-026-10078-9

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10078-9

Keywords: loneliness, addictive behavior, psychological flexibility, perceived stress, college students, mental health, moderated mediation, emerging adulthood, substance use, acceptance and commitment therapy, prevention, Current Psychology