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Substance Use Disorders

Image of a group therapy session

Substance use disorders affect more than 23 million Americans. Over the last 20 years, the US has experienced a five-fold increase in drug-related deaths and the overdose epidemic continues to grow with an estimated 86,000 fatal overdoses observed in 2019. Without addressing root causes, the epidemic is likely to persist without abatement into the next phase of its evolution.

Learn more about our work on opioid misuse through CARES >>

As such, the Center for Addiction Research and Effective Solutions (AIR CARES) applies a social determinants of health (SDoH) framework to its work. An approach grounded by SDoH recognizes that the most influential points of intervention for health outcomes are often upstream of individual-level factors. While individual behavior may be part of the path to health, the context in which individuals make health-related choices dictates their ability to act on knowledge, attitudes, and beliefs.

Expanding the narrow focus of the traditional biomedical model for addressing substance use disorder means considering how employment, housing, social and community context, education, and access to quality healthcare play a role in prevention, treatment, and recovery.

Employment
Increasing employment opportunities for people in treatment or recovery is particularly important for communities experiencing dual dilemmas of unemployment and addiction.

Employment interventions have a positive impact on addiction treatment outcomes and employment can be an effective addiction prevention and recovery strategy. Research has also demonstrated at the community level the association between unemployment and economic downturn and increases in substance use and overdose deaths. Increasing employment opportunities for people in treatment or recovery is particularly important for communities experiencing dual dilemmas of unemployment and addiction. Due to historic and systemic issues in the U.S., minorities and other groups are vulnerable to higher rates of unemployment during periods of economic downturn and have fewer safety nets to overcome the strain.

Through leveraging AIR's experience in workforce development, and evidence-based design of tailored interventions and technical assistance, AIR CARES works to address barriers to employment for people with current or history of substance use, and design human capital solutions to help employers recruit and retain talent, with a macro-level lens toward improving the social and economic well-being of workers and the communities they live in.

Housing
Adults who experience homelessness are nine times more likely to die from overdose than those who are stably housed.

The Fair Housing Act forbids discrimination on the basis of disability (of which addiction qualifies under the ADA); yet some local public housing authorities and private landlords continue to use the discretion afforded to them by federal housing policy to target people with a history of substance use through punitive eligibility criteria and eviction triggers. One collateral consequence of a law enforcement-focused response to a medical condition is that criminal justice involvement creates additional barriers to securing stable housing following release from prison or jail. Justice-involved individuals are almost 10 times as likely to experience homelessness than those without criminal justice involvement. Innovative housing models, such as Housing First, demonstrate that housing can improve substance use disorder outcomes. Without housing, recovery can be a challenge. Adults who experience homelessness are nine times more likely to die from overdose than those who are stably housed.

CARES draws on AIR’s rich expertise on homelessness and housing to support work that is grounded in the belief that people who use drugs that are experiencing homelessness deserve housing and are worthy of dignity and housing is as a critical first step toward recovery from substance use disorder.

Social and Community Context
Stigma and social norms related to drugs drive policy and, in turn, punitive policies drive stigma.

A focus on social and community context is needed to improve the psychosocial, intergenerational, and interpersonal connections needed to prevent and recover from substance use disorder. Effective solutions must act as a counterbalance to the historic disinvestment and traumatization of many communities. Stigma and social norms related to drugs drive policy and, in turn, punitive policies drive stigma. CARES supports communities through work that is driven by respect and humility, builds community capacity and sustainable relationships, empowers the people whose lives are impacted by the work, improves health, restores justice, and contributes to knowledge and social change.

Education

AIR’s work spans the learning life course—from pre-K to postsecondary education, career readiness, and adult education—and focuses on a wide range of topics, including STEM, social and emotional learning, and state and federal education policies. AIR CARES recognizes that the education system has a role in preventing and/or delaying problematic alcohol and drug use as well as connecting youth to care who may need behavioral health services for mental health and substance use needs. Schools also serve as a first line of defense for youth experiencing trauma, which—left unaddressed—has long-term implications for addiction, mental health, and other chronic conditions.

Providing quality education in safe and supportive learning environments is a key prevention strategy for addiction.

Schools have a role in addressing the intergenerational factors related to addiction. Youth with at least one adverse childhood experience (ACE)—which include insufficient access to basic necessities, violence, parental incarceration, parents with substance use disorder—are two to four times more likely to begin alcohol and drug use at an early age, compared to youth without adverse childhood experiences. ACEs are tied to a number of health outcomes, demonstrating a dose response. Having five or more ACEs is associated with a 10-fold risk for addiction. For vulnerable families, schools are a safety net that can directly or indirectly provide resources that decrease addiction risk for children and their families.

Lack of access to quality education and its neighborhood correlates lead to marginalization and places individuals at higher risk for addiction. Providing quality education in safe and supportive learning environments is a key prevention strategy for addiction. When we are able to prepare youth for learning and keep them engaged, helping them to achieve age-specific educational and social milestones, we lower the risk of addiction.

Access to Quality Healthcare

AIR CARES brings extensive expertise in providing training and technical assistance to expand access to and quality of evidence-based addiction treatment. AIR CARES understands that there are a variety of challenges in ensuring that people get timely access to quality, accessible, and appropriate services, including but not limited to:

AIR CARES understands that there are a variety of challenges in ensuring that people get timely access to the quality, accessible, and appropriate services.
  • Historical separation of addiction treatment and medical services;
  • Lack of addiction training in schools of nursing, medicine, social work, and other health professions;
  • Stigma associated with treating addiction and with the use of medications for addiction treatment;
  • Cultural competence in medicine;
  • Poor infrastructure to allow delivery of integrated services; and
  • Reimbursement limitations.

AIR CARES uses a tailored approach to address these challenges and ensure successful adoption, implementation, and sustainability of addiction treatment services that center the work on the context in which services are delivered, meeting the needs of the people served, and workforce development best practices.

Latest Work

Image of AIR expert Amanda Latimore
7 Apr 2021
Q & A

Meet the Expert: Amanda Latimore

Amanda Latimore, Ph.D., leads AIR’s Center for Addiction Research and Effective Solutions (AIR CARES). She also teaches social epidemiology as an adjunct assistant professor at the Johns Hopkins Bloomberg School of Public Health. Before joining AIR, Latimore held leadership roles with the Baltimore health department and behavioral health authority.
17 Dec 2020
Brief

Using Telehealth to Meet the Challenges of the Opioid Epidemic

Necessitated by the COVID-19 pandemic, the use of telehealth for medications for opioid use disorder and overall treatment of opioid use disorder has dramatically accelerated. Colleagues across AIR and IMPAQ collaborated on an issue brief to understand the pandemic’s impact on treatment approaches for OUD and what policymakers, providers, and stakeholders can do to ensure equitable and effective telehealth treatment with medications for opioid use disorder.
18 Mar 2020
Podcast

AIR Informs Episode #1: Focusing on Facts and Evidence During a Health Crisis

Dr. Elizabeth Salisbury-Afshar, a practicing physician, researcher, and director of the AIR Center for Addiction Research and Effective Solutions (AIR CARES), provides some advice for finding reliable sources of information, rooted in science and evidence, while avoiding a sense of panic.
Image of doctor consulting with patient
11 Sep 2019
Brief

What I Want My Doctor to Know About How Arthritis and Chronic Pain Affect My Everyday Life

The rapid growth in opioid overdoses has put a spotlight on prescribing patterns, with increased pressure on clinicians to reduce opioid prescribing, especially for long-term management of chronic, noncancer pain. This brief is the result of interviews conducted with people with a disability due to arthritis, who are on long-term opioids or have stopped taking opioids after developing an opioid use disorder.
Elizabeth Salisbury-Afshar
1 Aug 2019
Q & A

Meet the Expert: Dr. Elizabeth Salisbury-Afshar

As an expert on substance use disorders, Elizabeth Salisbury-Afshar, M.D., directs the Center for Addiction Research and Effective Solutions at AIR (AIR CARES). She is board certified in family medicine, preventive medicine/public heath, and addiction medicine and holds a Master of Public Health degree in health disparities and human rights.
Image of Elizabeth Salisbury-Afshar
10 Jun 2019
Video

Tackling the Opioid Epidemic Through Research and Patient Care

Elizabeth Salisbury-Afshar, director of AIR’s Center for Addiction Research and Effective Solutions (AIR CARES) and a practicing physician at Heartland Alliance Health in Chicago, discusses her personal experience in treating patients with addiction and how research can help tackle the opioid epidemic.
Project

Supporting Restorative Reentry in Detroit

This randomized-controlled trial seeks to understand how family-based restorative justice can improve the lives of men and women suffering from addiction as they transition from the criminal justice system back to their communities.
8 Nov 2018
Q & A

A Quick Word With: Dr. Elizabeth Salisbury-Afshar, Director of AIR’s Center for Addiction Research and Effective Solutions (AIR CARES)

Cross-sector collaboration is crucial to address the opioid crisis, and AIR’s new center on opioids is poised to play a role. The Center’s director, Dr. Elizabeth Salisbury-Afshar, addresses this and more.

pills-prescription-pad-1026217952-grid.jpg

Image of pills and prescription pad
Project

Improving Assessment of Opioid Use Disorder (OUD) for People with Disabilities and Chronic Arthritis Pain

The rapid growth in opioid overdoses has put a spotlight on prescribing patterns, with increased pressure on clinicians to reduce opioid prescribing, especially for long-term management of chronic, noncancer pain. As part of a grant provided by National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), AIR is working to lay the groundwork for primary care providers and specialists to accurately assess opioid use disorder in people with disabilities who are taking opioids long term to manage musculoskeletal pain.
Image of addiction counselor and patients
11 Jul 2018
Video

Using Data to Drive Community-Based Approaches to the Opioid Crisis

What role can data play in developing community-based approaches to opioid misuse prevention, treatment, and recovery? How can data help health, law enforcement, and criminal justice professionals—and community members—better understand the opioid crisis in their localities and develop targeted interventions? AIR held a Capitol Hill briefing to address these questions on June 18, 2018.
18 Jun 2018 | 11:00 AM - 12:00 PM
Event

Using Data to Drive Community-Based Approaches to the Opioid Crisis

What role can data play in developing community-based approaches to opioid misuse prevention, treatment, and recovery? How can data help health, law enforcement, and criminal justice professionals—and community members—better understand the opioid crisis in their localities and develop targeted interventions? Please join AIR to explore these and other issues in a panel discussion at 11AM EDT on Monday, June 18, 2018 in the Dirksen Senate Office Building.
14 Jun 2018
In the Field

Facilitated Opioid Workshops in Tennessee

Like many other states, Tennessee is facing an opioid epidemic. As part of their Prevention for States activities, the Tennessee Department of Health chose to host three community summits and engaged AIR to serve as a facilitator for these workshops in Nashville, Knoxville, and Memphis in April 2018.
Image of Susan Heil discussing opioid treatment
14 Jun 2018
Video

Expanding Medication-Assisted Treatment to Curb the Opioid Epidemic

Expanding local access to medication-assisted treatment (MAT) is a critical step towards improving the lives of people with opioid use disorder and starting to curb the epidemic. Susan Heil talks about the barriers to adopting MAT and what can be done to assist its adoption, especially in rural areas with fewer primary care providers and prescribers.

Hand-with-bottle-of-pills-200373577-cropped.jpg

Image of hand with bottle of pills
Project

Community Solutions to End the Opioid Epidemic in Tennessee

Although progress is being made, each day in Tennessee, at least three people die from an opioid-related overdose. AIR is working with the Tennessee Department of Health to convene summits across the state, for which it will review current opioid-related data, discuss the relevance and analysis of data, and develop preliminary plans to shape the strategic direction for intervention activities.

Hand-with-bottle-of-pills-200373577-cropped.jpg

Image of hand holding pills
Project

Opioid Misuse Prevention and Reduction Project - Middlesex County, MA

Last year alone, over 2,000 people in Massachusetts died from an opioid involved overdose. In partnership with the Middlesex County District Attorney’s Office, AIR developed a cross-system study to develop locally-relevant and research-informed strategies to reduce and prevent opioid misuse.
Image of troubled teen girl
25 Sep 2017
Blog Post

Helping Courts Guide Young Lives Back on Track

As communities across the country mark National Recovery Month, Roger Jarjoura explains why recovery can be particularly challenging for youth, and how the juvenile justice system must address their specific needs.
Image of Mona Kilany
20 Jul 2017
Video

Long Story Short: What Role Can Providers Play in Addressing the Prescription Opioid Epidemic?

Prescription drug misuse has reached epidemic proportions, with negative consequences for families and communities across the country. Mona Kilany explains how connecting prescribers with the proper tools and knowledge can help them address this significant public health issue in their practices.
14 Jul 2017
Service

Opioid Misuse, Overdose, and Death: A National Public Health Emergency

Increasing rates of opioid misuse, overdose, and death in America represent a complex public health emergency that merits widespread public and private resources and solutions. This brochure describes AIR's response to this public health crisis.
14 Jun 2017
Toolkit

Juvenile Drug Treatment Court Guidelines

Nationwide, more than 400 juvenile drug treatment courts (JDTCs) offer a way to respond to the complex needs of youth with substance use disorders, which often require specialized interventions.

Project

Expanding Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care

Oklahoma is among the states hardest hit by a combination of national trends in nonmedical uses of opioid prescription drugs, past-year heroin use, and opioid-related mortality. AIR recently led and evaluated a project for the Agency for Healthcare Research and Quality—Increasing Access to Medication-Assisted Treatment Among Rural Providers—to train rural Oklahoma primary care clinicians to identify and treat patients with opioid use disorders using medication-assisted treatment, an evidence-based intervention that combines behavioral therapy and medication to treat substance use disorders.
Stressed woman
1 Dec 2015
Commentary

Rising Death Rates Bring New Meaning to Mid-Life Crisis for Americans—Especially White Women

A recent high-profile study of sharply rising mortality rates for some Americans brought to light the hazards of chronic stress. Principal researcher Kathryn Paez explores why the health of middle-aged white women in particular is suffering.
Project

Evaluation of the Effectiveness of a Prescriber Education Campaign

Prescription drug misuse—defined as the use of a medication in a way that is not prescribed, without a prescription, or for non-medical purposes—is a significant public health concern. AIR is evaluating the Partnership for Drug-Free Kids' Prescriber Education Campaign, focusing on its effectiveness in increasing physicians’ use of prescription drug monitoring programs and awareness of tools and resources to prevent prescription drug misuse.
6 May 2015
Journal Article

The Legal High: Factors Affecting Young Consumers’ Risk Perceptions and Abuse of Prescription Drugs

A recent National Survey on Drug Use and Health indicates that nearly one-third of people aged 12 years and older who used drugs illegally for the first time began by using a prescription drug for a nonmedical purpose.

23 Jan 2015
Guide

Treating Substance Use Problems in Youth Who Also Have Mental Health Conditions

Substance use and mental health conditions often co-occur among youth, but caregivers often do not know what to do when youth show signs of substance use problems. The Caregiver Guide: Substance Use Disorder Treatment Planning for Youth with Co-Occurring Disorders is designed to provide caregivers with a single source of information relevant to treating co-occurring substance use disorders and mental health conditions.
Project

Substance Abuse Youth Topic Page on Youth.gov

AIR's Substance Abuse Youth topic page on Youth.gov provides information and resources for youth-serving agencies. The new topic provides information and resources focused on substance abuse prevalence, risk and protective factors, warning signs, screening assessments, and prevention and treatment.
Project

Project Combine

Evidence-based treatment and mentoring services have each been shown to be effective in addressing substance use and delinquency in teenage youth involved with justice systems.

15 Apr 2011
Report

Key Strategies for Violence and Substance Abuse Prevention I: Working with Children and Families

Three National Center for Mental Health Promotion and Youth Violence Prevention publications highlight key prevention strategies: one for children and their families, another that targets the role of classroom and school environments, and a third that explores ways in which community-based strategies can contribute to the prevention of school violence and substance abuse.
11 Mar 2009
Report

Evaluation of the Minnesota Supportive Housing and Managed Care Pilot

The Minnesota Supportive Housing and Managed Care Pilot evaluation suggests that it is possible to end homelessness for the most marginalized single adults and families in America with housing and intensive supports. Although this population has experienced long spells of homelessness exacerbated by physical health problems, mental illness, chemical dependency and traumatic stress, this evaluation found that stable housing, recovery and reintegration into community life are possible. The intervention of supportive housing—housing and services focused on the unique needs of people exiting homelessness—broke the cycle of homelessness.
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Image of Amanda Latimore

Amanda Latimore

Director, Center for Addiction Research and Effective Solutions (AIR CARES)

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