Two decades of treatment seeking for substance use disorders in Saudi Arabia: trends and patterns in a rehabilitation facility in Dammam

Substance misuse disorder in Saudi Arabia: A comprehensive examination of current demographic patterns, trends, and intervention requirements

Introduction

This review examines substance misuse disorder (SMD) in Saudi Arabia, drawing insights from 43 prior studies. It explores the prevalence and patterns of SMD across diverse demographics.

Methodology

Our analysis integrated data from various studies involving adolescents, university students, psychiatric patients, and the general population as well as postmortem cases. It identifies key risk factors and challenges in managing SMD, underscoring the importance of comprehensive data collection for evidence-based policymaking.

Results

SMD in Saudi Arabia were categorized into two groups: common traditionally abused drugs (such as Captagon, khat, heroin, ethanol, and cannabis) and substances that have emerged in recent years (e.g., methamphetamine "Shabu", pregabalin, and benzodiazepines). Trends in SMD include early substance initiation and increased amphetamine and polysubstance use.

Conclusion and recommendations

Drug-related challenges persist in Saudi Arabia; however, because of limited data from recent epidemiological studies on drug disorders, the full extent is unknown. Saudi Arabia is unique because it as an Islamic country with strict regulations against drug trafficking and a religious prohibition on drugs and alcohol, which contributes to distinct trends in substance misuse disorder (SMD). Although some aspects mirror global patterns, others exhibit regional characteristics specific to the country. Despite data variability, actionable recommendations have emerged for SMD prevention and treatment. During the COVID-19 pandemic, a high number of reports was evident; however, SMD publications often reiterate old findings and overlook emerging psychoactive substances (EPS), such as 'Shabu", pregabalin, and benzodiazepines. Further studies are needed, including educational initiatives, national surveys, stricter drug regulations, and an early warning system for traditional SMD and EPS.

Validity and reliability of the Arabic version of the population postpartum depression literacy scale (PoDLiS): a web-based survey in Saudi Arabia

BACKGROUND

Proper knowledge about postpartum depression (PPD) will help recognize symptoms and encourage women to seek the needed professional help. Until now, there has been a scarcity of research on the literacy level of PPD among the Saudi population and the factors affecting it. This study translated the Postpartum Depression Literacy Scale (PoDLiS) into Arabic and evaluated its psychometric properties. Furthermore, the Saudi population's mental health literacy for PPD and the factors associated with it were examined as a secondary objective.

METHODS

This cross-sectional study involved 2,336 participants selected via convenience sampling from all over Saudi Arabia, all of whom willingly agreed to participate. Data collection was done through an online questionnaire using Google Forms, covering sociodemographic characteristics and the Arabic PoDLiS.

RESULTS

The Arabic version of PoDLiS showed acceptable goodness-of-fit between the observed data and the resulting six-factor solution, RMSEA = 0.049, 90% confidence interval RMSEA (0.010-0.050), pCLOSE = 0.742, CFI = 0.962, TLI = 0.940, χ2(270) = 1576.12, p-value = 0.742. The total Cronbach's alpha (α) of the PoDLiS showed acceptable internal consistency, measuring at 0.742. High literacy was seen in married and young participants with a postgraduate degree and sufficient household income who have known someone with PPD. Significantly lower literacy was seen in male, non-Saudi participants and those residing in the central and northern regions of Saudi Arabia.

CONCLUSIONS

The Arabic version of the PoDLiS showed good psychometric properties, and it can be used to assess PPD literacy among perinatal women and to examine the impact of PPD awareness programs. Despite reporting relatively good PPD literacy in the Saudi population, there is a persistent gap in participants' beliefs about available professional help and the attitudes that facilitate recognizing PPD. Our findings highlight the importance of implementing public education campaigns to improve overall knowledge about PPD and promote prevention, early recognition, and treatment of PPD.

Socio-Demographics of Initial Substance Use Exposure and Its Relation to Progression: A Cross-Sectional Study in Saudi Arabia

INTRODUCTION

Empirical evidence on substance use in Saudi Arabia is lacking. This quantitative study is aimed at describing the socio-demographics of initial exposure to substance use and its relation to substance abuse progression.

METHOD

A questionnaire about socio-demographics during initial exposure to substance use was completed by 379 participants.

RESULTS

For most participants, the commencement of substance abuse occurred at the age range of 19‒23 years, and while in high school, they first started taking drugs with school friends. The two psychoactive substances most commonly taken for the first time were hashish and alcohol. The two main reasons for first drug exposure were teenage curiosity and joy-seeking. The chi-square test revealed statistically significant differences between substance abuse progression by sex, current age, father's education level, parent's marital status, and one's company in substance use. Female participants were more likely to continue taking drugs.

CONCLUSION

Young people must be educated about the risks and consequences of substance use from early adolescence.

The Intersection of Health Rehabilitation Services with Quality of Life in Saudi Arabia: Current Status and Future Needs

Quality of life (QoL) is essential for maintaining a healthy, balanced lifestyle, especially among individuals with chronic diseases. Saudi Arabia (SA) launched a health sector transformation program as part of the nationwide Vision 2030 initiative to ensure the sustainable development of efficient healthcare services, aiming to improve health by increasing well-being and QoL. More investigation into the current status of health rehabilitation services provided to individuals with chronic diseases and future needs to optimize services and improve QoL is needed. This was narratively discussed by experts from different health rehabilitation services in SA. Comprehensive health rehabilitation services including orthopedic, occupational, cardiac, pulmonary, critical care, perioperative, hearing and speech, substance use disorders, and vocational rehabilitation services were addressed. Health rehabilitation services in SA, as in other countries, are suboptimal for individuals in health rehabilitation programs. To optimize the QoL of individuals with chronic diseases, health rehabilitation services should be tailored based on the unique requirements of each service and its serving patients. The shared need to improve health rehabilitation services includes the adoption of home-based and telehealth services, the integration of multi-governmental sectors, the empowerment and allocation of health rehabilitation specialists, public awareness campaigns, policy legislation and guideline development, and the implementation of a long-term follow-up system. This review is one of the first to address the intersection of health rehabilitation services and QoL in SA; urgent and holistic actions are paramount to address the pressing need to optimize SA's health rehabilitation services. The experts' recommendations in this study may be applicable to other countries' health systems, as health rehabilitation services are not well optimized globally.

Evaluation of Substance Use Disorder Readmission and Length of Hospital Stay in a Major Rehabilitation Center in the Gulf States: a Retrospective Cohort Study

Substance use disorders (SUDs) patients have longer lengths of hospital stay, and more unplanned readmissions than other hospitalized patients. We aim to evaluate SUD-related rehospitalization and length of hospital stay in a major rehabilitation center that serves countries of the Gulf States. In a retrospective cohort study for 16-year data set in Al-Amal Hospital Electronic Health Record in the city of Dammam, Eastern region of Saudi Arabia, patients received services from the SUD treatment programs in the period of January 1, 2005, to December 31, 2021. We used cause-specific Cox proportional hazards regression model to estimate risk of readmission, and general linear model to examine the association between substance use disorders and length of hospital stay. Of the total cohort, 4398 (30.17%) were readmitted within 1 year of discharge date. More than half of the cohort were unemployed patients (52.93%). Patients diagnosed with amphetamine use disorder were 1.36 higher risk of readmission compared to no amphetamine disorder (HR = 1.36; CI (1.04, 1.78) P.02). Patients diagnosed with mental disorder had 7.25 times higher risk of longer hospital stay compared to no mental health disorder (coefficient = 7.25; P < .0001). Amphetamine use disorder increased the risk of readmission. A secondary diagnosis of mental disorders among SUD patients increased length of hospital stay. As a targeted region of amphetamine smuggling in the world, policy and clinical decision-makers in Saudi Arabia and the Gulf States should consider taking proactive steps to minimize the future anticipated high demand for addiction treatment in the region.

Overview of the Saudi National Mental Health Survey

OBJECTIVES

To present background information for the Saudi National Mental Health Survey (SNMHS) on the Saudi mental healthcare delivery system and previous epidemiological research on the prevalence and treatment of mental disorders in the Kingdom of Saudi Arabia (KSA).

METHODS

Archival information and the results of a literature review are presented.

RESULTS

KSA is the largest sovereign nation in the Middle East and the largest free market economy in the Middle East and North Africa. A national mental health policy has been in existence since 2006, but mental health spending still is less than in most other high-income countries. The Ministry of Health has recently begun developing a new healthcare system based on a patient-centered model of care that will integrate care of mental disorders with care of physical disorders. Previous epidemiological research on mental disorders in KSA has been limited, making the SNMHS important for policy planning purposes to obtain accurate estimates of prevalence, treatment, and barriers to treatment.

CONCLUSIONS

The SNMHS will provide valuable information for policy planning purposes on the burden of untreated mental disorders in KSA and barriers to treatment.

Substance use disorders in Saudi Arabia: a scoping review

BACKGROUND

Substance use disorders (SUD) are mental health conditions that arise from chronic drug use. There is an increased recognition of this problem in Saudi Arabia.

OBJECTIVE

Conduct a comprehensive review of published literature on SUD to identify knowledge gaps and to guide future research.

METHODS

PubMed, Embase and Cochrane databases were searched with suitable keywords for SUD publications up to June 10, 2019. Eligible studies (primary research conducted in Saudi Arabia) were organized into three broad domains: (1) risk (or protective) factors of SUD, (2) perspectives on drug use of people who use drugs, and (3) impact on family. The quality of the included studies was assessed with the Newcastle-Ottawa Scale.

RESULTS

Of the 113 search records, 23 were eligible for analysis (19 cross-sectional and 4 case-control). All studies were conducted in clinical settings; all but two included males only. There were 4 studies about SUD risk factors, 6 studies about the perspectives of people who use drugs, and none about family impact. None of the cross-sectional studies (0%) and 25% of case-control studies were of good quality.

CONCLUSIONS

The available studies were few in number, weak in methodology, and poor in quality. Quantitative as well as qualitative studies about SUD are warranted in each domain and should represent both genders.

Family Physicians' Approaches to Mental Health Care and Collaboration with Psychiatrists

Objective This study aimed to determine the proportion of family physicians referring patients to psychiatrists and conducting psychotherapy or mental health consultations themselves. Additionally, the factors affecting family physicians' approaches to dealing with mental health patients were investigated, including referrals to psychiatrists and physicians' views about better management plans for patients with mental health disorders. Method In this cross-sectional observational study, online surveys were distributed, using Google forms, to family physicians in primary healthcare centers and hospitals in Jeddah, Saudi Arabia. The participants were 175 family physicians. A previously developed survey under the name "collaboration between psychologists and primary health care physicians" was adapted to suit the purposes of the present study, by changing the aim of the survey from psychologists to family physicians. Results Physicians who received inter-professional training in a clinical training program were more likely to agree that their education prepared them well for collaboration with psychiatrists, compared to those who did not receive such an education (p<0.001). The younger and less experienced physicians were more likely to carry out psychotherapy and mental health consultations by themselves more often than were the more experienced physicians (33.1% versus 9.7%; p<0.001), it has also been shown that almost 90% of physicians agreed that collaboration with psychiatrists is necessary for the care of their patients, and only a third responded that psychiatrists were accessible if and when they want to consult with them. Conclusions Family and primary care physicians must collaborate with psychiatric professionals in order to provide effective services. Moreover, family physicians should receive more education about mental health, and effective communication should be encouraged in order to deliver better care to psychiatric patients in primary healthcare settings.

Association between obesity/overweight and dental caries in psychiatric patients

BACKGROUND

Patients with psychiatric illness are more prone to develop obesity and dental caries due to general self-negligence associated with psychiatric illness and side effect of various medications used in psychiatry.

OBJECTIVE

Assess the association between dental caries status and obesity among resident patients.

DESIGN

Descriptive, cross-sectional.

SETTING

Mental health hospital.

PATIENTS AND METHODS

A sample of psychiatric in-patients was recruited. Dental caries detection was performed according to the World Health Organization criteria and body mass index (BMI) was measured. Relationships were assessed using multivariable logistic regression.

MAIN OUTCOME MEASURES

Relationships between decayed, missing and filled teeth (DMFT) and obesity.

SAMPLE SIZE

223.

RESULTS

The sample included 126 males and 97 female with a mean (SD) age of 42.3 (2.2) years. The prevalence of dental caries was 92.6%. The mean (SD) DMFT score was 5.2 (4.2). Twenty-seven percent were schizophrenic, 21.9% had mental retardation and 19.7% had bipolar mood disorder. The mean (SD) BMI was 27.7 (6.3) kg/m². One hundred twenty-three (55.2%) of in-patients were classified as normal weight, 47 (21.1%) as overweight, and 45 (20.2%) as obese. The logistic regression model showed a strong association between caries and obesity/overweight (adjusted odds ratios=2.7; 95% CI=1.4 - 4.3, P<.001).

CONCLUSION

The present study demonstrated a significant association between the frequency of caries and obesity/overweight among resident patients at a psychiatric hospital.

LIMITATIONS

Since the data were cross-sectional, causal relationships cannot be established and the observed association could be due to other unexplored factors.

CONFLICT OF INTEREST

None.

Substance abuse at early age as a potential risk factor for driving under the influence of substance in Jeddah, Saudi Arabia: A cross-sectional study

OBJECTIVE

Worldwide, trauma is a major health problem, and road traffic accidents (RTAs) are the primary cause of death among young men in Saudi Arabia. The aim of our study was to estimate the extent of driving under the influence of an abused substance in Saudi Arabia and to explore the associated factors.

METHODS

This is a cross-sectional survey conducted between May and September 2016 at Al-Amal Hospital in Jeddah, Saudi Arabia, a referral center for addiction. We included all patients who were admitted for additional education and rehabilitation and had no psychotic symptoms. We used a standardized and pretested questionnaire to collect data regarding sociodemographic and socioeconomic characteristics, history of and current substance abuse, driving under the influence of an abused substance, injuries, imprisonment, and fatalities under the influence of an abused substance. Whenever possible, we compared self-reported data with medical records and resolved any conflict by discussion with the patient.

RESULTS

A total of 101 out of 112 invited patients participated in our study (90.2%). The mean age of the participants was 33.28 years (SD = 9.46 years). Of the total, 93.1% (n = 94) drove under the influence of an abused substance. Amphetamines and alcohol were the first substance abused (56.4% [n = 57] and 25.7% [n = 26] of patients, respectively). As currently abused substances, amphetamines and cannabis were reported in 38.6% (n = 39) and 24.8% (n = 25) of participants, respectively. The mean age at the time of the first substance abuse was 18.76 years (SD = 4.99 years). In the univariate regression (odds ratio [OR] = 0.86; 95% confidence interval [CI], 0.75-0.99; P = .046) but not the multivariate regression (OR =0.87; 95% CI, 0.75-1.00; P = .056), a younger age at the time of the first substance abuse was associated with a higher probability of driving under the influence of an abused substance.

CONCLUSIONS

Our study showed that among individuals hospitalized due to substance abuse problems, driving under the influence of drugs and alcohol was common. Preventive measures to reduce driving under the influence should be introduced in addition to specialized hospitals. Further research is required to investigate the factors associated with driving under the influence of abused substances in Saudi Arabia.

Patterns and sociodemographic characteristics of substance abuse in Al Qassim, Saudi Arabia: a retrospective study at a psychiatric rehabilitation center

BACKGROUND

The problem of substance abuse is one of the top 20 risk factors for poor health worldwide. Though widely prevalent in the Middle East, there are few studies in Saudi Arabia.

OBJECTIVE

Record the pattern of substances abuse and the sociodemographic characteristics of abusers attending the local rehabilitation center.

DESIGN

Descriptive, retrospective medical record review.

SETTING

Patients admitted to psychiatric rehabilitation center.

METHODS

The sample included all patients admitted to a rehabilitation center during the period of January 2016-December 2016. Data was collected retrospectively from patient records.

MAIN OUTCOME MEASURES

Descriptive epidemiological data and statistical comparisons.

SAMPLE SIZE

612 patients.

RESULTS

The majority of patients (73%) were 21-40 years of age. Polysubstance abuse (60%) and amphetamine (24%) abuse were most predominant in the 20-40 year olds (45%) and high school dropouts (41%). The average number of drugs being used by polysubstance abusers was 2.5 (and the maximum was 6). There was no relationship of family history of drug abuse and mental illness.

CONCLUSION

There was an increased use of polysubstances and amphetamine with a decreased abuse of prescription drugs when compared to previous studies reported in Saudi Arabia. There was a decreasing prevalence for heroin and alcohol. Substance abusers have certain epidemiological, social and drug patterns and we recommend that authorities and planners integrate their efforts to look for the reasons for substance abuse.

LIMITATIONS

Females not included and prevalence of tobacco smoking not studied.

CONFLICT OF INTEREST

None.

Drug use patterns and demographic correlations of residents of Saudi therapeutic communities for addiction

Objectives

This study describes the characteristics of residents in Saudi therapeutic communities (TCs), their patterns of drug use, and the correlations between these variables.

Methods

This retrospective study examined all Saudi TC residents admitted since the establishment of the first TC in 2000 until mid-2014. The TCs include three governmental and two non-governmental enterprises: two TCs in Dammam and one each in Riyadh, Jeddah, and Taif, with a total population of 2023 residents.

Results

All TC residents were adult males; 85.6% were Saudis, and almost all remaining residents were from the Gulf Cooperation Council countries. The mean age of residents was 33.9 years (±8.8 years), and their educational levels were mostly high school or lower; 25% were married, and 70.8% were jobless. The pattern of drug use indicated that 35.8% used opioids, 15% used hash, 11.9% used both hash and amphetamine, 11.1% used amphetamine, 7.9% used alcohol, and 10.9% used 3 or more drugs simultaneously. Amphetamine and hash dependencies were more prevalent among younger residents in comparison to opioids and alcohol, which were more common among older residents. Opioids were more used by the western region residents, while northern and southern regions residents preferred amphetamine.

Conclusion

This study showed that the residents' drug use patterns are similar to those in other inpatient treatment services. However, opioid dependency is overrepresented. Furthermore, the type of drug used differs according to the residence region, which may warrant consideration when planning services for these regions.

The pattern of substance use disorder in the United Arab Emirates in 2015: results of a National Rehabilitation Centre cohort study

Background

Substance use disorder (SUD) is a global problem with no boundaries, which also afflicts individuals from countries of the Arabian Peninsula. Data from this region is limited. In an effort to develop targeted prevention and intervention initiatives in the United Arab Emirates (UAE), it was necessary to identify the nature of substance use by describing the characteristics of those using different substances. Consequently, this study in the UAE was conceived to describe the pattern of SUD in a first-ever cohort that was systematically recruited from the country’s National Rehabilitation Centre (NRC) in Abu Dhabi.

Methods

Two hundred and fifty male patients were recruited from the NRC. Information on substance use was collected using a questionnaire that was completed at an interview with patients who consented to participate. The questionnaire was based on information that the study was designed to capture. It was reviewed by members of institutional ethics committees and approved prior to use. Two hundred and fifty male subjects from the Emirates Family Registry (EFR) were used as a comparison group.

Results

In the cohort studied, SUD correlated with smoking and marital status. Poly-substance users formed the majority of the cohort (84.4 %) with various combinations of substances identified across different age groups. Opioid and alcohol were the most common substances used. The use of pharmaceutical opioids, primarily Tramadol (67.2 % of opioid users), was higher among the youngest age group studied (<30 years old), while older opioid users (≥30 years old) commonly used illicit opioids (Heroin). The use of prescribed medication for non-medical use also included Pregabalin (mean of 8.3 capsules ± 0.5 per day), Procyclidin (6.1 tablets + 0.6 per day) and Carisoprodol (4.2 tablets ± 0.4 per day) and was again highest in the age group below 30 years.

Conclusion

This 2015 study highlights the importance of examining the pattern of poly-substance use in a population in order to develop targeted prevention programs to arrest the prevailing trends. It has drawn attention to the rise in use of prescription medication in the UAE, in particular among younger patients (<30 years), and continuing use of illicit opioid amongst males above 30 years. Specific prevention and intervention strategies, targeting differences between these distinct demographic profiles will capture a large subset of sufferers.

Factors associated with domestic violence: a cross-sectional survey among women in Jeddah, Saudi Arabia

OBJECTIVE

This study aims to identify the factors associated with domestic violence (DV) among women in Jeddah.

DESIGN

Cross-sectional survey.

SETTING

Outpatient departments of three tertiary hospitals in Jeddah.

PARTICIPANTS

Convenience sample of women, aged 15-70 years, at the outpatient and inpatient clinics.

INTERVENTIONS

Between 15 December 2011 and 30 May 2012, a psychologist and a professional health assistant explained the purpose of the research to participants, who were then asked to fill a 50-item questionnaire. The questionnaire was created based on questions from three questionnaires: the NorVold Domestic Abuse Questionnaire, the Pregnancy Risk Assessment Monitoring System and the Kansas Marital Satisfaction Scale. The questionnaire was used to assess the association between DV and family status, male partner attitudes, age, educational attainment, employment, financial and socioeconomic status.

RESULTS

A total of 2301 women participated in the survey (81% response rate). The mean±SD age of the participants was 34.4±10.9 years. The lifetime prevalence of DV was 34%. Abused women had more children than non-abused women (p=0.001), and their spouses were significantly older than those of non-abused women (p<0.0001). Financially dependent women and those with a high educational status were significantly more likely to report abuse (p=0.003 and p<0.001, respectively). Abused women were also likely to report that their spouse was a smoker (p<0.0001) and had completed at least primary or secondary education (p<0.0001). A significantly lower proportion of abused women reported that their male partners were alcohol users (p=0.001). The results of logistic regression showed that women who were financially dependent had about 1.5-fold odds of being physically abused by a spouse.

CONCLUSIONS

Many factors are associated with DV against women, thereby highlighting the need to design effective DV prevention programmes.

Meth/amphetamine use and associated HIV: Implications for global policy and public health

Amphetamine type stimulants (ATS) have become the focus of increasing attention worldwide. There are understandable concerns over potential harms including the transmission of HIV. However, there have been no previous global reviews of the extent to which these drugs are injected or levels of HIV among users. A comprehensive search of the international peer-reviewed and grey literature was undertaken. Multiple electronic databases were searched and documents and datasets were provided by UN agencies and key experts from around the world in response to requests for information on the epidemiology of use. Amphetamine or methamphetamine (meth/amphetamine, M/A) use was documented in 110 countries, and injection in 60 of those. Use may be more prevalent in East and South East Asia, North America, South Africa, New Zealand, Australia and a number of European countries. In countries where the crystalline form is available, evidence suggests users are more likely to smoke or inject the drug; in such countries, higher levels of dependence may be occurring. Equivocal evidence exists as to whether people who inject M/A are at differing risk of HIV infection than other drug injectors; few countries document HIV prevalence/incidence among M/A injectors. High risk sexual behaviour among M/A users may contribute to increased risk of HIV infection, but available evidence is not sufficient to determine if the association is causal. A range of possible responses to M/A use and harm are discussed, ranging from supply and precursor control, to demand and harm reduction. Evidence suggests that complex issues surround M/A, requiring novel and sophisticated approaches, which have not yet been met with sufficient investment of time or resources to address them. Significant levels of M/A in many countries require a response to reduce harms that in many cases remain poorly understood. More active models of engagement with M/A users and provision of services that meet their specific needs are required.

Perception among medical students in Riyadh, Saudi Arabia, regarding alcohol and substance abuse in the community: a cross-sectional survey

Background

This study was conducted to examine the perception and views of medical students regarding the extent of alcohol and substance abuse in the community and the possible predisposing factors for this problem.

Methods

It is a cross-sectional study involving samples from two medical colleges in Riyadh, Saudi Arabia. The students who decided to participate in the study without the offer of any incentives filled an anonymous, self administered questionnaire which had been designed to meet the purpose of the study.

Results

Two hundred and fifteen out of three hundred and thirty students (65% response rate) participated in this study. About 75% of them believe that alcohol and substance abuse is a common problem in the community. Students' views also correspond with the reported view that the problem is mainly present in young adult males. Married males and senior students perceived the problem as more serious than their other colleagues. Students perceived that alcohol was the most commonly abused drug in the community, followed by amphetamines, heroin, cannabis and cocaine. They believe that influence of friends, life stressors, tobacco smoking and curiosity are the most important predisposing factors for abuse of alcohol and other substances. According to the students' perception, the main beneficial effect of alcohol and substance abuse was stress alleviation. About 3% of the students have also indicated that they may use alcohol or some other substance in the future.

Conclusion

Despite scarce information on the subject and a strong religious belief in Saudi Arabia against the use of alcohol and other addictive substances, a significant majority of the medical students in Riyadh, the capital of Saudi Arabia, perceived that alcohol and substance abuse is a common problem in the community. Some students appear to perceive the seriousness of the problem less than others. Efforts are needed to educate young men and women at an early stage of their academic life, as a medical student about the existence of this problem in the community, its consequences and predisposing factors. Teaching teenagers and young adults about stress coping strategies may be of special importance in reducing the risk of alcohol and substance abuse.