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The American Society of Addiction Medicine defines addiction as, "a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences."
Numerous individuals grappling with addiction may not be trapped by substances like drugs. Instead, addiction can manifest in various forms, such as excessive reliance on cell phones. Addiction triggers intricate chemical responses in our brains, leading to dependency on said chemicals.

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Various internal and external factors can cause addiction such as biology, the environment, personal development, and mental health disorders

Biology: Once a drug is used, it can be influenced into an addiction based in the inherited genetic traits. The genes in your body may delay or speed up the disease progression.

Environment: Things such as peer pressure, physical or sexual abuse, stress, early drug use, and lack of parental guidance can increase the likelihood of developing addiction

Development: Although addiction can progress at any age, it is more likely to proceed faster the earlier in life drug use begins. This is because the drugs used can stunt brain development and affect areas of the brain that control decision-making, judgment, and self-control; typically in the adolescent ages.

Mental health disorders: It is seen that individuals with ADHD or PTSD may be more likely to become addicted to drugs. Drug and alcohol use is typically associated with the idea of coping mechanisms for anxiety, depression, loneliness, or negative thoughts. However, using drugs to avoid these negative feelings can make them worse.

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Drug addiction (substance use disorder) - Symptoms and causes

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Drug addiction affects your brain and behavior to the point where you can’t control your use of legal or illegal drugs, even when you know they cause harm.

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Some may be intrigued by the profound impact addiction can have on the brain and the physical and mental changes it can induce. In this exploration, we delve into specific areas and the processes within the brain's chemistry that are affected.

The Basal Ganglia- Influencing positive motivation, these regions are pivotal for pleasurable experiences in healthy activities such as eating, socializing, and sex, as well as habit formation. Terming the brain’s "reward circuit," drugs can excessively stimulate it, causing the euphoria of a drug high. However, with frequent exposure, the circuit adapts, reducing sensitivity and hindering pleasure from anything other than the drug.

The Extended Amygdala- This plays a role in stressful feelings like anxiety, irritability, and unease, which characterize withdrawal after the drug high fades and thus motivates the person to seek the drug again. This circuit becomes increasingly sensitive with increased drug use. Over time, a person with substance use disorder uses drugs to get temporary relief from this discomfort rather than to get high.

The Prefrontal Cortex- Powering the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. This is also the last part of the brain to mature, making teens most vulnerable. Shifting balance between this circuit and the circuits of the basal ganglia and extended amygdala makes a person with a substance use disorder seek the drug compulsively with reduced impulse control.

Other parts of the brain are affected by opioid addictions. Specifically, in the brain stem which controls basic functions such as breathing, heart rate, and sleeping. This interference explains why overdoses can cause depressed breathing and death.

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Suffering from addiction can have many negative effects on one's social, physical, economic, and mental health primarily. These are possible (but there is no limited number) effects according to the National Institutes of Health

Social:

Relationship distress and dissatisfaction: Families may experience high rates of tension and conflict related to addiction and the problems it causes in the family.

Family instability: This may result from abuse or violence, or family breakup due to separation, divorce, or removal of children from the home

Physical:

Damage to reproductive organs: Addiction has been shown to decrease and have adverse effects on reproductive health and fertility in both men and women.

Damage to vital parts of the brain: Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug use that marks addiction.

Economic:

Economic burden: This may be caused by money spent on substances, or money problems associated with addiction.

Mental:

Emotional burden: Some may feel anger, frustration, anxiety, fear, worry, depression, shame and guilt, or embarrassment due to their addiction.

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Abstract

Substance use disorders (SUDs) are associated with numerous medical, psychiatric, psychological, spiritual, economic, social, family, and legal problems, creating a significant burden for affected individuals, their families, and society. This paper focuses on the effects of SUDs on family and social problems and emphasizes the need for clients in treatment to address these domains in their ongoing recovery. Individual, group, and family interventions to address these issues for clients with SUDs and their families are reviewed.

Keywords: family, social, treatment, recovery, addiction

1. Effects of Substance Use Disorders on the Family

Many studies and reports document adverse effects of substance use disorders (SUDs) on the family system and individual members, including children [ 1- 8]. These disorders clearly affect many people in addition to the individual with the problem, often creating a burden for the family and its members. These effects on the family may include:

Emotional burden. Members may feel anger, frustration, anxiety, fear, worry, depression, shame and guilt, or embarrassment.

Economic burden. This may be caused by money spent on substances, or money problems associated with the loss of jobs or reliance on public assistance.

Relationship distress or dissatisfaction. Families may experience high rates of tension and conflict related to the SUD and problems it causes in the family.

Family instability. This may result from abuse or violence, or family breakup due to separation, divorce, or removal of children from the home by Children and Youth Services.

Effects on the developing fetus and children. Alcohol use during pregnancy can harm fetal development causing birth defects and problems in child development. Infants born to opioid-dependent mothers are at increased risk for neonatal abstinence syndrome, which can contribute to developmental or cognitive delays. Children of parents with SUDs are at increased risk for abuse or neglect, physical problems, poor behavioral or impulse control, poor emotional regulation, conduct or oppositional disorders, poorer academic performance, psychiatric problems such as depression or anxiety, and substance abuse.

Effects on parents. Mothers with SUDs may show less sensitivity and emotional availability to infants. Parents of a child with a SUD may feel guilty, helpless, frustrated, angry, or depressed.

The effects of a SUD on a specific family or concerned significant other are determined by the severity of the disorder, the presence of other serious problems such as psychiatric illness, behaviors exhibited by the family member with an SUD, support available for the family, and the family members' coping strategies. Some family members are more resilient than others and less prone to the adverse effects of the SUD.

2. Social Effects of Substance Use Disorders

SUDs impact the social functioning of individuals and create a burden for society as well. These disorders contribute to medical or psychiatric conditions, disability, and death as a result of accidents or diseases caused or worsened by substance use, or higher rates of suicidality, all of which affect society. Other social problems associated with SUDs include housing instability, homelessness, criminal behaviors (victim or perpetrator) and incarceration, the transmission of HIV due to IV drug use or high-risk sexual behaviors, and unemployment or dependence on welfare. The costs associated with these social problems are staggering, creating an economic burden for governments or payors who spend considerable sums of money on treatments for addiction, medical or psychiatric disorders, and other related problems such as those associated with welfare dependence, unemployment, or involvement in the criminal justice or social service systems.

3. Interventions for Social or Family Problems

Components of comprehensive treatment for SUDs include a continuum of professional addiction and related services (assessment, detoxification, rehabilitation, counseling or therapy, continuing care, substance use monitoring, medications, case management, and mutual support programs) [ 9]. Social, family, and other problems can be addressed through the use of family, child care, vocational, mental health, medical, educational, HIV/AIDs, legal, financial, housing, and transportation services in addiction treatment agencies or within the community.

Many individual [ 10- 13] and group treatments [ 14- 19] for SUDs address social recovery issues in recovery, as these have implications for relapse and quality of life. These interventions may address issues such as how to: avoid or minimize contact with high-risk people, places or events; resolve relationship problems; develop new friendships; develop a recovery network of sober friends and supportive people; resist social pressures to use substances; improve communication or assertiveness skills; ask for help and support from others; engage in substance-free social activities; engage in mutual support programs; and/or make amends to those harmed by one's SUD.

Family interventions can help the family influence or pressure the member with the SUD to enter treatment and get help, address the impact of the SUD on the family system and members, help the family support the member with the SUD, and help the family address their own reactions and problems associated with their loved one's SUD. The latter may involve participation in treatment, family support programs, or both.

There is considerable literature supporting couples and family approaches to SUDs [ 5, 9, 20, 21]. These may reduce the emotional burden for family members and enable them to cope more effectively with the affected family member. The following are strategies adapted from the literature on engagement, treatment, and recovery to help families.

Engage the family in care

When possible, engage the family in the assessment process and early in treatment. Outreach efforts may be needed to engage families in treatment. A number of effective interventions have been used with families to increase their rates of involvement with the family member with the SUD in treatment [ 8, 9, 22].

Provide education

Families benefit from education on SUDs (symptoms, causes, effects), treatments (including medication-assisted treatments), recovery challenges for members with a SUD, relapse, mutual support programs, the impact of SUDs on families and members, and professional services and mutual support programs available for families.

Provide or facilitate family treatment

Couples or family sessions can help families address their questions and concerns, change how they interact within the family system, and improve communication. Families can also benefit from addressing their own emotional burden and behaviors that can interfere with the recovery of the member with the SUD. Treatment can be provided in sessions with the individual family or in multiple family groups, which provide a supportive environment for families to share their common experiences and concerns. Families can form bonds with each other and learn what has worked for others.

Reduce the emotional burden of the family

Family members experience a wide range of emotions such as anger, fear, anxiety, and depression. The burden experienced by the family can be reduced as they learn about specific disorders, get support and help for themselves, identify with other families experiencing similar problems, and share their own feelings and concerns. As families feel empowered by learning information and acquiring new coping skills, their emotional burden often lessens.

Help the family support the member with the SUD

Members can attend sessions together to learn ways to help the member with the SUD without "enabling" this individual. Learning about potential relapse warning signs or actual episodes of substance use and how to intervene early in the relapse process can empower family members. So can participating in discussions of a continuing care plan following completion of a rehabilitation program.

Help family members engage in recovery to meet their own needs

Families often benefit from mutual support programs like Al-Anon or Nar-Anon, which provide them the opportunity to learn from others affected by a loved one's SUD. These programs mainly aim to get family members to focus on themselves and what they can do to make positive changes. Initially, it is common for families to focus most of their attention on the member with the SUD. However, these programs aim to get families to focus on their own needs and engage in recovery to address these needs.

Focus on children

Families can be helped to understand the impact of SUDs on children and examining how their own children may have been harmed by the SUD in the family. Parents with SUDs can be encouraged to talk with their children about their impact on their family and the children, and maintain an open dialogue with kids to address their feelings, questions, or concerns. They can help kids learn about SUDs, treatment, and recovery. Establishing normal routines and rituals in the home, taking an active interest in the child's life, engaging them in family activities, and facilitating an evaluation for a child with a psychiatric or substance use disorder are other ways of helping the family.

4. Conclusions

SUDs are associated with many social and family problems. These problems create challenges for the member with the SUD in treatment and/or recovery, the family, and society. There are many effective interventions and treatments, and mutual support programs, to help individuals with SUDs and families address these issues.

Families can help their loved one in several ways: facilitate their involvement in treatment; attend sessions together to address the SUD and recovery needs; engage in ongoing discussions about recovery, and what can and cannot be done to help the member with the SUD; point out early warning signs of relapse that their loved one may ignore; and help them stabilize from a relapse should one occur.

Families can also help themselves by discussing their experiences with the member with the SUD, examining their own behaviors and emotional reactions, and dealing with their own reactions. This can be accomplished by involvement in treatment, mutual support programs, or other programs. While family members often enter treatment and/or mutual support programs initially to help their loved one, they often discover that they need emotional support and help themselves since SUDs can have many effects on them.

Acknowledgments

The preparation of this paper was supported in part by NIH NIDA grant U10DA020036.

References

8. Szapocznik J, Zarate M, Duff J, et al. Brief strategic family therapy: engaging drug using/problem behavior adolescents and their families in treatment. Soc Work Public Health. 2013;28:206-223. [[ PMC free article] [ PubMed] Google Scholar]

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Family and social aspects of substance use disorders and treatment

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Substance use disorders (SUDs) are associated with numerous medical, psychiatric, psychological, spiritual, economic, social, family, and legal problems, creating a significant burden for affected individuals, their families, and society. This paper focuses ...

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In 2024, there are addictive products everywhere in the U.S. From online gambling right off your phone, to legalized marijuana stores, tobacco shops, and liquor stores. People have easy access to products that are designed to cause addictions, so you have to go back. There are five main products that cause the most addictions in the U.S.

1. Alcohol: Alcohol is the number one most addictive product in the U.S. In 2020, nearly 140 million people reported drinking alcohol. That is nearly half of all people over the age of 12.  Alcohol being a social event item, noticing an addiction to alcohol is extremely difficult. Alcohol abuse can lead to liver disease, overdose and drunk driving that claims thousands of lives a year.

2. Nicotine: As of 2020, people aged 12 and older 8.5% of Americans reported struggling with nicotine addiction. Luckily, cigarette use has decreased over the last ten years while vaping products have skyrocketed. Vape products are everywhere from convenience stores, liquor stores, and mainly in schools. High schools and Middle schools have seen a pandemic with the use of vape products in schools with nearly 2.5 million kids using.

3. Marijuana: Over the last five years, marijuana has been legalized in 38 states. Recreational use of marijuana has become extremely common. In 2020, 5.1% or 14 million Americans aged 12 or older had marijuana disorder. There are a lot of jobs that no longer drug test for marijuana. Marijuana is not an extremely addictive product, but the continuous push can cause an epidemic.

4. Opioids: 1.1% or 2.7 million Americans aged 12 or older had an Opioid disorder in 2020. Opioids related deaths had increased nearly 30% from 2020 to 2021. The most common use of Opioids is through prescriptions, not a drug dealer. Opioid addiction can develop from seemingly harmless levels of use. Most people don’t realize they have an addiction until they try to stop. Opioids may not be the most used item but can cause the most problems.

5. Gambling, over the last five years online gambling has become the easiest way to become addicted. There are several different live 24/7 casinos that you do not have to leave from the comfort of your home to go like MGM, DraftKings, and FanDuel. A gambling addiction is the most common addiction to lie about. Online gambling has become one of the most addictive products in five years.

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Over the past century, the United States and much of society have invested a lot of money and effort into preventing addiction, specifically drug addiction. The most common of these investments are evidence-based prevention programs which are “designed to prevent substance use and related negative outcomes. Most strategies are designed to be delivered in specific settings, to specific age groups, and to specific populations” (Prevention 5). The goal of these prevention programs is to reduce the risk of someone becoming addicted as well as lowering the harm done if a person becomes addicted. They also provide techniques for avoiding drug use and offer advice if all else fails.

A few other examples of evidence-based prevention programs that may be familiar are as listed:

Family-based Programs (ex: Nurse-Family Partnership, Parenting classes)

School-based Programs (ex: D.A.R.E, Say No to Drugs)

Community-based programs (ex: Local conversations addressing addiction issues within the community)

Population Specific programs

Prevention Strategies in Health Care Settings (ex: Doctor recommendations, Prevention pamphlets)

Workplace Programs
(Prevention 5)

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"While many people try drugs at some point in their lives and even continue to use them, only some people develop substance use disorders. No single factor determines whether a person will develop a substance use disorder. These chronic but treatable health conditions arise from the interplay of many different individual and societal factors across a person’s life" (Prevention 2)

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Although extensive efforts are made many of these programs fail to achieve their intended outcome. D.A.R.E (Drug Abuse Resistance Education) was an evidence-based program targeted at grade-school students “to inoculate or strengthen children to resist the temptation of drug experimentation and the pressure of peers who want them to engage in drug use” (Program 2).

This program ultimately failed according to their research when students who were involved in the programs showed no significant improvement 5 years later compared to students who did not participate. (Program 3)

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Addressing the stigmas and barriers surrounding addiction requires comprehensive efforts, including education, DE stigmatization campaigns, policy changes, and improving access to evidence-based treatment and support services.

1. Social Stigma: Addiction is often seen as a moral failing or a lack of willpower rather than a complex medical condition. This stigma can lead to shame and discrimination, making it difficult for individuals to seek help or disclose their struggles.

2. Legal Stigma: In many places, there are legal consequences associated with drug use or possession, leading individuals to fear legal repercussions if they seek help for their addiction.

3. Employment and Financial Barriers: People with addiction may face difficulties in finding or maintaining employment due to discrimination or impaired functioning. Financial instability can further exacerbate the challenges of seeking treatment.

4. Access to Treatment: There may be limited access to affordable and evidence-based treatment options for addiction, especially in rural or underserved areas. Lack of insurance coverage or high out-of-pocket costs can also be significant barriers.

5. Fear of Judgment from Healthcare Providers: Some individuals may avoid seeking help for addiction due to concerns about being judged or treated poorly by healthcare professionals.

6. Family Dynamics: Family members may contribute to the stigma surrounding addiction, either through misunderstanding or enabling behaviors. This can create additional barriers to seeking treatment or support.

7. Cultural and Religious Stigmas: Cultural or religious beliefs may view addiction as a personal failing or a taboo subject, making it difficult for individuals to seek help within their communities.

8. Internalized Stigma: Individuals struggling with addiction may internalize negative beliefs about themselves, leading to feelings of worthlessness or hopelessness, which can further impede their recovery journey.

9. Lack of Education and Awareness: Misconceptions and misinformation about addiction can perpetuate stigma and prevent people from understanding the true nature of the condition and available treatment options.

10. Dual Diagnosis Stigma: People with co-occurring mental health disorders and addiction may face additional stigma and challenges in accessing appropriate treatment for both conditions.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is a great resource for finding third-party support. This website is government-guided and includes a confidential, 24-hour information service and emergency hotline. There are different types of recovery available for the different types of addictions, SAMHSA provides information for

health care support (professional or via programs)

treatment centers

learning how to cope

how to help someone who is suffering from addiction (who may not seek help themselves)

3 out of 10 people in the United States have issues with mental health, drugs, or alcohol.

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1) Is there anything you did not know about the impact of addiction on the brain? What was most surprising to you to find out? Or were you not surprised at all, and why not?

2) Were you aware of how/where to access resources for addictive behavior? Do you feel more confident in your ability to help someone suffering from addiction (in terms of noticing symptoms and suggesting further steps)?

3) How has learning this information affected your perspective on substance addictions or addictions in general? Do you feel any more or less empathetic to those struggling with addiction?

4) How can we break down the barriers and stigma surrounding addiction to ensure all individuals receive the support and treatment they need? How can we empower communities to shift from punitive approaches towards addiction to ones focused on empathy, education, and comprehensive support systems?

5) Why have we continued the use of addictive products like alcohol, nicotine, gambling, opioids if we have seen the repercussions. Why does society continually use if we have seen the negative side effects?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158844/

https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain

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Introducing the Human Brain

The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity-you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. The brain regulates your body's basic functions, enables you to interpret and respond to everything you experience, and shapes your behavior. In short, your brain is you -everything you think and feel, and who you are.

How does the brain work?

The brain is often likened to an incredibly complex and intricate computer. Instead of electrical circuits on the silicon chips that control our electronic devices, the brain consists of billions of cells, called neurons, which are organized into circuits and networks. Each neuron acts as a switch controlling the flow of information. If a neuron receives enough signals from other neurons that it is connected to, it fires, sending its own signal on to other neurons in the circuit.

The brain is made up of many parts with interconnected circuits that all work together as a team. Different brain circuits are responsible for coordinating and performing specific functions. Networks of neurons send signals back and forth to each other and among different parts of the brain, the spinal cord, and nerves in the rest of the body (the peripheral nervous system).

To send a message, a neuron releases a neurotransmitter into the gap (or synapse) between it and the next cell. The neurotransmitter crosses the synapse and attaches to receptors on the receiving neuron, like a key into a lock. This causes changes in the receiving cell. Other molecules called transporters recycle neurotransmitters (that is, bring them back into the neuron that released them), thereby limiting or shutting off the signal between neurons.

How do drugs work in the brain?

Drugs interfere with the way neurons send, receive, and process signals via neurotransmitters. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter in the body. This allows the drugs to attach onto and activate the neurons. Although these drugs mimic the brain's own chemicals, they don't activate neurons in the same way as a natural neurotransmitter, and they lead to abnormal messages being sent through the network.

Other drugs, such as amphetamine or cocaine, can cause the neurons to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals by interfering with transporters. This too amplifies or disrupts the normal communication between neurons.

What parts of the brain are affected by drug use?

Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug use that marks addiction. Brain areas affected by drug use include:

The basal ganglia, which play an important role in positive forms of motivation, including the pleasurable effects of healthy activities like eating, socializing, and sex, and are also involved in the formation of habits and routines. These areas form a key node of what is sometimes called the brain's "reward circuit." Drugs over-activate this circuit, producing the euphoria of the drug high. But with repeated exposure, the circuit adapts to the presence of the drug, diminishing its sensitivity and making it hard to feel pleasure from anything besides the drug.

The extended amygdala plays a role in stressful feelings like anxiety, irritability, and unease, which characterize withdrawal after the drug high fades and thus motivates the person to seek the drug again. This circuit becomes increasingly sensitive with increased drug use. Over time, a person with substance use disorder uses drugs to get temporary relief from this discomfort rather than to get high.

The prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. This is also the last part of the brain to mature, making teens most vulnerable. Shifting balance between this circuit and the circuits of the basal ganglia and extended amygdala make a person with a substance use disorder seek the drug compulsively with reduced impulse control.

Some drugs like opioids also disrupt other parts of the brain, such as the brain stem, which controls basic functions critical to life, including heart rate, breathing, and sleeping. This interference explains why overdoses can cause depressed breathing and death.

How do drugs produce pleasure?

Simple activities in everyday life can produce small bursts of neurotransmitters in the brain bringing pleasurable feelings. Drugs can hijack that process.

Pleasure or euphoria-the high from drugs-is still poorly understood, but probably involves surges of chemical signaling compounds including the body's natural opioids (endorphins) and other neurotransmitters in parts of the basal ganglia (the reward circuit). When some drugs are taken, they can cause surges of these neurotransmitters much greater than the smaller bursts naturally produced in association with healthy rewards like eating, hearing or playing music, creative pursuits, or social interaction.

It was once thought that surges of the neurotransmitter dopamine produced by drugs directly caused the euphoria, but scientists now think dopamine has more to do with getting us to repeat pleasurable activities (reinforcement) than with producing pleasure directly.

How does dopamine reinforce drug use?

The feeling of pleasure is how a healthy brain identifies and reinforces beneficial behaviors, such as eating, socializing, and sex. Our brains are wired to increase the odds that we will repeat pleasurable activities. The neurotransmitter dopamine is central to this. Whenever the reward circuit is activated by a healthy,

pleasurable experience, a burst of dopamine signals that something important is happening that needs to be remembered. This dopamine signal causes changes in neural connectivity that make it easier to repeat the activity again and again without thinking about it, leading to the formation of habits.

Just as drugs produce intense euphoria, they also produce much larger surges of dopamine, powerfully reinforcing the connection between consumption of the drug, the resulting pleasure, and all the external cues linked to the experience. Large surges of dopamine "teach" the brain to seek drugs at the expense of other, healthier goals and activities.

Cues in a person's daily routine or environment that have become linked with drug use because of changes to the reward circuit can trigger uncontrollable cravings whenever the person is exposed to these cues, even if the drug itself is not available. This learned "reflex" can last a long time, even in people who haven't used drugs in many years. For example, people who have been drug free for a decade can experience cravings when returning to an old neighborhood or house where they used drugs. Like riding a bike, the brain remembers.

Why are drugs more addictive than natural rewards?

For the brain, the difference between normal rewards and drug rewards can be likened to the difference between someone whispering into your ear and someone shouting into a microphone. Just as we turn down the volume on a radio that is too loud, the brain of someone who misuses drugs adjusts by producing fewer neurotransmitters in the reward circuit, or by reducing the number of receptors that can receive signals. As a result, the person's ability to experience pleasure from naturally rewarding (i.e., reinforcing) activities is also reduced.

This is why a person who misuses drugs eventually feels flat, without motivation, lifeless, and/or depressed, and is unable to enjoy things that were previously pleasurable. Now, the person needs to keep taking drugs to experience even a normal level of reward-which only makes the problem worse, like a vicious cycle. Also, the person will often need to take larger amounts of the drug to produce the familiar high-an effect known as tolerance.

Long-term drug use impairs brain functioning.

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Drugs and the Brain | National Institute on Drug Abuse

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https://www.who.int/ (World Health Organization)

https://www.samhsa.gov/ (Substance Abuse and Mental Health Services Administration)

https://www.apa.org/ (American Psychological Association)

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SAMHSA - The Substance Abuse Mental Health Services Administration

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SAMHSA - Substance Abuse and Mental Health Services Administration

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SAMHSA.gov, Substance Abuse and Mental Health Services Administration