drug abuse report writing

Case report

Addiction Science & Clinical Practice welcomes well-described reports of cases that include the following:

• Unreported or unusual side effects or adverse interactions involving medications.
• Unexpected or unusual presentations of a disease.
• New associations or variations in disease processes.
• Presentations, diagnoses and/or management of new and emerging diseases.
• An unexpected association between diseases or symptoms.
• An unexpected event in the course of observing or treating a patient.
• Findings that shed new light on the possible pathogenesis of a disease or an adverse effect.

Case reports submitted to Addiction Science & Clinical Practice should make a contribution to medical knowledge and must have educational value or highlight the need for a change in clinical practice or diagnostic/prognostic approaches.

Addiction Science & Clinical Practice will not consider case reports describing preventive or therapeutic interventions, as these generally require stronger evidence. Case reports should include relevant positive and negative findings from history, examination and investigation, and can include clinical photographs, provided these are accompanied by written consent to publish from the patient(s). Case Reports should include an up-to-date review of all previous cases in the field.

Authors are encouraged to describe how the case report is rare or unusual as well as its educational and/or scientific merits in the covering letter that will accompany the submission of the manuscript.

Case report submissions will be assessed by the Editors and will be sent for peer review if considered appropriate for the journal. For case reports, Addiction Science & Clinical Practice requires authors to follow the CARE guidelines . The CARE checklist should be provided as an additional files. Submissions received without these elements will be returned to the authors as incomplete.

Authors should seek written and signed consent to publish the information from the patients or their guardians prior to submission. The submitted manuscript must include a statement to this effect in the consent section. The editorial office may request copies of the informed consent documentation upon submission of the manuscript.

A note on addiction terminology

The editors of  Addiction Science & Addiction Science  advise authors to avoid the terms "MAT" or "medication-assisted treatment". The editors instead recommend using "MOUD" or "medications for opioid use disorder". For further reading, please see Friedmann and Schwartz, 2012 and this statement from ISAJE .

Preparing your manuscript

The information below details the section headings that you should include in your manuscript and what information should be within each section.

Please note that your manuscript must include a 'Declarations' section including all of the subheadings (please see below for more information).

Title page 

The title page should:

• "A versus B in the treatment of C: a randomized controlled trial", "X is a risk factor for Y: a case control study", "What is the impact of factor X on subject Y: A systematic review, A case report etc."
• or, for non-clinical or non-research studies: a description of what the article reports
• if a collaboration group should be listed as an author, please list the Group name as an author. If you would like the names of the individual members of the Group to be searchable through their individual PubMed records, please include this information in the “Acknowledgements” section in accordance with the instructions below
• Large Language Models (LLMs), such as ChatGPT , do not currently satisfy our authorship criteria . Notably an attribution of authorship carries with it accountability for the work, which cannot be effectively applied to LLMs. Use of an LLM should be properly documented in the Methods section (and if a Methods section is not available, in a suitable alternative part) of the manuscript
•  indicate the corresponding author

The Abstract should not exceed 350 words. Please minimize the use of abbreviations and do not cite references in the abstract. The abstract must include the following separate sections:

• Background: why the case should be reported and its novelty
• Case presentation: a brief description of the patient’s clinical and demographic details, the diagnosis, any interventions and the outcomes
• Conclusions: a brief summary of the clinical impact or potential implications of the case report

Keywords 

Three to ten keywords representing the main content of the article.

The Background section should explain the background to the case report or study, its aims, a summary of the existing literature.

Case presentation

This section should include a description of the patient’s relevant demographic details, medical history, symptoms and signs, treatment or intervention, outcomes and any other significant details.

Discussion and Conclusions

This should discuss the relevant existing literature and should state clearly the main conclusions, including an explanation of their relevance or importance to the field.

List of abbreviations

If abbreviations are used in the text they should be defined in the text at first use, and a list of abbreviations should be provided.

Declarations

All manuscripts must contain the following sections under the heading 'Declarations':

Ethics approval and consent to participate

Consent for publication, availability of data and materials, competing interests, authors' contributions, acknowledgements.

• Authors' information (optional)

Please see below for details on the information to be included in these sections.

If any of the sections are not relevant to your manuscript, please include the heading and write 'Not applicable' for that section. 

Manuscripts reporting studies involving human participants, human data or human tissue must:

• include a statement on ethics approval and consent (even where the need for approval was waived)
• include the name of the ethics committee that approved the study and the committee’s reference number if appropriate

Studies involving animals must include a statement on ethics approval and for experimental studies involving client-owned animals, authors must also include a statement on informed consent from the client or owner.

See our editorial policies for more information.

If your manuscript does not report on or involve the use of any animal or human data or tissue, please state “Not applicable” in this section.

If your manuscript contains any individual person’s data in any form (including any individual details, images or videos), consent for publication must be obtained from that person, or in the case of children, their parent or legal guardian. All presentations of case reports must have consent for publication.

You can use your institutional consent form or our consent form if you prefer. You should not send the form to us on submission, but we may request to see a copy at any stage (including after publication).

See our editorial policies for more information on consent for publication.

If your manuscript does not contain data from any individual person, please state “Not applicable” in this section.

All manuscripts must include an ‘Availability of data and materials’ statement. Data availability statements should include information on where data supporting the results reported in the article can be found including, where applicable, hyperlinks to publicly archived datasets analysed or generated during the study. By data we mean the minimal dataset that would be necessary to interpret, replicate and build upon the findings reported in the article. We recognise it is not always possible to share research data publicly, for instance when individual privacy could be compromised, and in such instances data availability should still be stated in the manuscript along with any conditions for access.

Authors are also encouraged to preserve search strings on searchRxiv https://searchrxiv.org/ , an archive to support researchers to report, store and share their searches consistently and to enable them to review and re-use existing searches. searchRxiv enables researchers to obtain a digital object identifier (DOI) for their search, allowing it to be cited. 

Data availability statements can take one of the following forms (or a combination of more than one if required for multiple datasets):

• The datasets generated and/or analysed during the current study are available in the [NAME] repository, [PERSISTENT WEB LINK TO DATASETS]
• The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
• All data generated or analysed during this study are included in this published article [and its supplementary information files].
• The datasets generated and/or analysed during the current study are not publicly available due [REASON WHY DATA ARE NOT PUBLIC] but are available from the corresponding author on reasonable request.
• Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
• The data that support the findings of this study are available from [third party name] but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of [third party name].
• Not applicable. If your manuscript does not contain any data, please state 'Not applicable' in this section.

More examples of template data availability statements, which include examples of openly available and restricted access datasets, are available here .

BioMed Central strongly encourages the citation of any publicly available data on which the conclusions of the paper rely in the manuscript. Data citations should include a persistent identifier (such as a DOI) and should ideally be included in the reference list. Citations of datasets, when they appear in the reference list, should include the minimum information recommended by DataCite and follow journal style. Dataset identifiers including DOIs should be expressed as full URLs. For example:

Hao Z, AghaKouchak A, Nakhjiri N, Farahmand A. Global integrated drought monitoring and prediction system (GIDMaPS) data sets. figshare. 2014. http://dx.doi.org/10.6084/m9.figshare.853801

With the corresponding text in the Availability of data and materials statement:

The datasets generated during and/or analysed during the current study are available in the [NAME] repository, [PERSISTENT WEB LINK TO DATASETS]. [Reference number]  

If you wish to co-submit a data note describing your data to be published in BMC Research Notes , you can do so by visiting our submission portal . Data notes support open data and help authors to comply with funder policies on data sharing. Co-published data notes will be linked to the research article the data support ( example ).

All financial and non-financial competing interests must be declared in this section.

See our editorial policies for a full explanation of competing interests. If you are unsure whether you or any of your co-authors have a competing interest please contact the editorial office.

Please use the authors initials to refer to each authors' competing interests in this section.

If you do not have any competing interests, please state "The authors declare that they have no competing interests" in this section.

All sources of funding for the research reported should be declared. If the funder has a specific role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript, this should be declared.

The individual contributions of authors to the manuscript should be specified in this section. Guidance and criteria for authorship can be found in our editorial policies .

Please use initials to refer to each author's contribution in this section, for example: "FC analyzed and interpreted the patient data regarding the hematological disease and the transplant. RH performed the histological examination of the kidney, and was a major contributor in writing the manuscript. All authors read and approved the final manuscript."

Please acknowledge anyone who contributed towards the article who does not meet the criteria for authorship including anyone who provided professional writing services or materials.

Authors should obtain permission to acknowledge from all those mentioned in the Acknowledgements section.

See our editorial policies for a full explanation of acknowledgements and authorship criteria.

If you do not have anyone to acknowledge, please write "Not applicable" in this section.

Group authorship (for manuscripts involving a collaboration group): if you would like the names of the individual members of a collaboration Group to be searchable through their individual PubMed records, please ensure that the title of the collaboration Group is included on the title page and in the submission system and also include collaborating author names as the last paragraph of the “Acknowledgements” section. Please add authors in the format First Name, Middle initial(s) (optional), Last Name. You can add institution or country information for each author if you wish, but this should be consistent across all authors.

Please note that individual names may not be present in the PubMed record at the time a published article is initially included in PubMed as it takes PubMed additional time to code this information.

Authors' information

This section is optional.

You may choose to use this section to include any relevant information about the author(s) that may aid the reader's interpretation of the article, and understand the standpoint of the author(s). This may include details about the authors' qualifications, current positions they hold at institutions or societies, or any other relevant background information. Please refer to authors using their initials. Note this section should not be used to describe any competing interests.

Footnotes can be used to give additional information, which may include the citation of a reference included in the reference list. They should not consist solely of a reference citation, and they should never include the bibliographic details of a reference. They should also not contain any figures or tables.

Footnotes to the text are numbered consecutively; those to tables should be indicated by superscript lower-case letters (or asterisks for significance values and other statistical data). Footnotes to the title or the authors of the article are not given reference symbols.

Always use footnotes instead of endnotes.

Examples of the Vancouver reference style are shown below.

See our editorial policies for author guidance on good citation practice

Web links and URLs: All web links and URLs, including links to the authors' own websites, should be given a reference number and included in the reference list rather than within the text of the manuscript. They should be provided in full, including both the title of the site and the URL, as well as the date the site was accessed, in the following format: The Mouse Tumor Biology Database. http://tumor.informatics.jax.org/mtbwi/index.do . Accessed 20 May 2013. If an author or group of authors can clearly be associated with a web link, such as for weblogs, then they should be included in the reference.

Example reference style:

Article within a journal

Smith JJ. The world of science. Am J Sci. 1999;36:234-5.

Article within a journal (no page numbers)

Rohrmann S, Overvad K, Bueno-de-Mesquita HB, Jakobsen MU, Egeberg R, Tjønneland A, et al. Meat consumption and mortality - results from the European Prospective Investigation into Cancer and Nutrition. BMC Medicine. 2013;11:63.

Article within a journal by DOI

Slifka MK, Whitton JL. Clinical implications of dysregulated cytokine production. Dig J Mol Med. 2000; doi:10.1007/s801090000086.

Article within a journal supplement

Frumin AM, Nussbaum J, Esposito M. Functional asplenia: demonstration of splenic activity by bone marrow scan. Blood 1979;59 Suppl 1:26-32.

Book chapter, or an article within a book

Wyllie AH, Kerr JFR, Currie AR. Cell death: the significance of apoptosis. In: Bourne GH, Danielli JF, Jeon KW, editors. International review of cytology. London: Academic; 1980. p. 251-306.

OnlineFirst chapter in a series (without a volume designation but with a DOI)

Saito Y, Hyuga H. Rate equation approaches to amplification of enantiomeric excess and chiral symmetry breaking. Top Curr Chem. 2007. doi:10.1007/128_2006_108.

Complete book, authored

Blenkinsopp A, Paxton P. Symptoms in the pharmacy: a guide to the management of common illness. 3rd ed. Oxford: Blackwell Science; 1998.

Online document

Doe J. Title of subordinate document. In: The dictionary of substances and their effects. Royal Society of Chemistry. 1999. http://www.rsc.org/dose/title of subordinate document. Accessed 15 Jan 1999.

Online database

Healthwise Knowledgebase. US Pharmacopeia, Rockville. 1998. http://www.healthwise.org. Accessed 21 Sept 1998.

Supplementary material/private homepage

Doe J. Title of supplementary material. 2000. http://www.privatehomepage.com. Accessed 22 Feb 2000.

University site

Doe, J: Title of preprint. http://www.uni-heidelberg.de/mydata.html (1999). Accessed 25 Dec 1999.

Doe, J: Trivial HTTP, RFC2169. ftp://ftp.isi.edu/in-notes/rfc2169.txt (1999). Accessed 12 Nov 1999.

Organization site

ISSN International Centre: The ISSN register. http://www.issn.org (2006). Accessed 20 Feb 2007.

Dataset with persistent identifier

Zheng L-Y, Guo X-S, He B, Sun L-J, Peng Y, Dong S-S, et al. Genome data from sweet and grain sorghum (Sorghum bicolor). GigaScience Database. 2011. http://dx.doi.org/10.5524/100012 .

Figures, tables and additional files

See  General formatting guidelines  for information on how to format figures, tables and additional files.

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Addiction Science & Clinical Practice  is affiliated with the  International Network on Brief Interventions for Alcohol & Other Drugs .

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Addiction Science & Clinical Practice  was formerly published by NIDA and previous issues of the journal can be viewed here .

Addiction Science & Clinical Practice

ISSN: 1940-0640

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Addiction and Substance Misuse Reports and Publications

Alcohol and drug misuse and related disorders are major public health challenges that are taking an enormous toll on our society. Recently more than 27 million people in the United States reported that they are using illicit drugs or misusing prescription drugs, and nearly a quarter of adults and adolescents reported binge drinking in the past month.  The annual economic impact of substance misuse is estimated to be $249 billion for alcohol misuse and $193 billion for illicit drug use. The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—have become common chronic illnesses in the U.S. Although there are effective treatments for opioid use disorder, only about one in four people with this disorder receive any type of specialty treatment. Mitigating the opioid and substance abuse epidemics ravaging our country is a major priority of the Surgeon General.  The Surgeon General is also championing efforts to prevent drug use, overdose, and addiction infectious disease, and more fully leverage public health, business, law enforcement, and community resources to address these issues head on.

Read the publications below to learn in detail what the Surgeon General is doing about addiction in America.

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Investigation Report Example: How to Write an Investigative Report

Here’s how to write an investigation report that is clear, complete, and compliant.

Do you dread the end of an investigation because you hate writing investigative reports? You’re not alone.

However, because it’s an important showcase of the investigation, you can’t skimp on this critical investigation step. Your investigation report reflects on you and your investigation, so make sure it’s as clear, comprehensive, accurate, and polished.

How do you write an investigation report? What are the parts of an investigation report? What's an investigation report example? In this guide, you’ll learn how to make your reports effective and efficient.

How mature are your workplace investigations?

An investigations maturity model can reveal your investigations program's strong points and areas for improvement. Learn how to evaluate your program in our upcoming fireside chat with investigations expert Meric Bloch.

Table of Contents

What is the importance of an investigative report.

• How to Write an Investigative Report: "Musts"

Executive Summary

Preliminary case information, incident summary, allegation subject, investigation details & notes, investigation interviews, conclusion & recommendations, final edits, how case iq can help.

An investigation report can:

• Spark some sort of action based on the findings it presents
• Record of the steps of the investigation
• Provide information for legal actions
• Provide valuable data to inform control and preventive measures

In short, your report documents what happened during the investigation and suggests what to do next.

In addition, the process of writing an investigation report can help you approach the investigation in a new way. You might think of more questions to ask the parties involved or understand an aspect of the incident that was unclear.

How to Write an Investigative Report: “Musts”

Before you begin, it’s important to understand the three critical tasks of a workplace investigative report.

• It must be organized in a such way that anybody internally or externally can understand it without having to reference other materials. That means it should have little to no jargon or specialized language and be a stand-alone summary of your investigation from start to finish.
• It must document the investigative findings objectively and accurately and provide decision makers with enough information to determine whether they should take further action.  With just one read-through, stakeholders should be able to understand what happened and how to handle it.
• It must indicate whether the allegations were substantiated, unsubstantiated, or whether there’s something missing that is needed to reach a conclusion. Use the evidence you’ve gathered to back up your analysis.

You might be wondering, “What are the contents of an investigation report?” Now that you know what your report should accomplish, we’ll move on to the sections it should include.

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The executive summary should be a concise overview of the investigation from beginning to end. It should not contain any information that is not already in the investigation report.

This may be the most important component of the investigation report because many readers won’t need to go beyond this section. High-level stakeholders get an overall picture of the allegations, investigation, and outcome without having to pore over the details.

To make this section easy to read, write in an active voice. For example: “I interviewed Carrie Smith,” not “Carrie Smith was interviewed.”

Example:   On February 23 rd , 2023, the Human Resources Manager received a written complaint of sexual harassment submitted by Carrie Smith, the stockroom manager. Smith claimed that on February 22 nd , 2023, her supervisor, Mark Robinson, pushed her against the wall in the boardroom and groped her breasts. Smith also alleged that Robinson on another occasion told her she was “too pretty” to be working in the stockroom and that he could arrange for a promotion for her. 

On February 24th, the Human Resources Manager assigned the case to me.

On February 25th, I interviewed Carrie Smith and two witnesses to the alleged February 22 nd  incident, John Jones and Pamela Miller. Jones and Miller did not corroborate the groping allegation but said they saw Smith running out of the boardroom in tears. Miller also reported hearing Robinson tell another employee, Sara Brown, that she had “a great rack”. 

On February 26 th , I interviewed Mark Robinson. He denied the groping incident and said he was “just joking around” with her in the boardroom but did not actually touch her and that Smith was too sensitive. He admitted to telling Smith she was too pretty to work in the stockroom, but contends that it was meant as a compliment.

Based on the interviews with the complainant and the alleged offender, I find that the complainant’s allegation of sexual harassment is substantiated.

It is my recommendation that the company provide the respondent with a written account of the findings of the investigation and a reminder of the company’s expectations for employee behavior. I also recommend that the respondent receive sexual harassment training and be advised that repeated harassing behavior may result in further discipline up to and including termination.

This section outlines the preliminary case information in a concise format, with only the most important details. It can go either before or after the executive summary.

• Your name and investigator identification number, if you have one
• Case number
• Date the case was assigned to you
• The date the report was reviewed
• How the report was received (e.g. hotline, email to HR manager, verbal report to supervisor)
• Name of the reporter/complainant

If the reporter is an employee, record their:

• Email address
• Work telephone number
• Employment level/position
• Employee identification number
• Department identification number

If the source  is not an employee, only record their:

• Personal telephone number

In either case, note the date that the report was submitted, as well as the date(s) of the alleged incident(s).

The purpose of this section is to answer the who, what, where, and when about the incident.

• What type of case is it? For example, is the case alleging harassment, discrimination, fraud, or other workplace misconduct?
• Specify the case type further.  For example, is it  sexual  harassment,  gender  discrimination,  accounts payable  fraud, etc.
• Who is the alleged victim?  For example, is it the reporter, another employee, a customer, or the whole company?
• If the alleged victim is an employee, identify the person’s supervisor.
• Were any other people involved besides the subject and the alleged victim?
• Where did the incident(s) take place?
• When did the incident(s) occur?
• Capture details of the allegation.  Example : Stacey Smith alleges that John Jones, an accounts payables clerk, has been funneling payments to a dummy supplier that he has set up in the company’s procurement system. Stacey says that she noticed a discrepancy when one of the suppliers she deals with questioned a payment and she had to ask an accounts payable clerk, Tom Tierney, to pull the file for her. When Tom accidentally brought Stacey the wrong file, she saw that monthly payments were being made to a supplier she had never heard of, and that the address of the supplier was John Jones’s address. Stacey knows John’s address because her sister is John’s next-door neighbor.

Describe the allegation or complaint in simple, clear language. Avoid using jargon, acronyms, or technical terms that the average reader outside the company may not understand.

In this section, note details about the alleged bad actor. Some of this information might be included in the initial report/complaint, but others you might have to dig for, especially if the subject isn’t an employee of the organization.

For every subject, include their:

• Email (work contact if they’re an employee, personal if not)
• Telephone number (see above)

If the subject of the allegation is an employee, also include their:

• Employment status (e.g. full-time, part-time, intern, contractor, etc.)
• Business location

Begin outlining the investigation details by defining the scope. It’s important to keep the scope of the investigation focused narrowly on the allegation and avoid drawing separate but related investigations into the report.

Example:   The investigation will focus on the anonymous tip received through the whistleblower hotline. The objective of the investigation is to determine whether the allegation reported via the hotline is true or false.

Next, record a description of each action taken during the investigation. This becomes a diary of your investigation, showing everything that was done during the investigation, who did it, and when.

For each action, outline:

• Type of action (e.g. initial review, meeting, contacting parties, conducting an interview, following up)
• Person responsible for the action
• Date when the action was completed
• Brief description of the action (i.e. who you met with, where, and for how long)

Be thorough and detailed, because this section of your report can be an invaluable resource if you are ever challenged on any details of your investigation.

Write a summary of each interview. These should be brief outlines listed separately for each interview.

Include the following information:

• Who conducted the interview
• Who was interviewed
• Where the interview took place
• Date of the interview

Include a list of people who refused to be interviewed or could not be interviewed and why.

Write a Report for Each Interview

This is an expanded version of the summaries documented above. Even though some of the information is repeated, be sure to include it so that you can use the summaries and reports separately as standalone documentation of the interviews conducted.

For each interview, document:

• Location of the interview
• Summary of the substance of the interview, based on your interview notes or recording.

Example:   I asked Jane Jameson to describe the events of July 13 th , 2016. She said: “After work, Peter approached me as I was leaving the building and asked me if I would like to work on his team. When I said that I was happy working with my current team, he told me that my team had too many women on it and that ‘all those hormones are causing problems’ so I should think about moving to a ‘sane’ team.”

I asked her how she reacted to that. She said: I told him that I found that offensive and he said that I needed to stop being so sensitive. I just walked away.”

I asked Jane to describe the events of the next day. She said: “The next day he came to my desk and asked me if I had given any thought to moving to his team. I repeated that I was happy where I was. At that point he started massaging my shoulders and said that moving to his team would have its ‘perks’. I asked him to stop twice and he wouldn’t. Sally walked over and told him to get lost and ‘leave Jane alone’ and he left.”

I thanked Jane for her cooperation and concluded the interview.

Assess Credibility

Aside from collecting the evidence, it is also an investigator’s job to analyze the evidence and reach a conclusion. Include a credibility assessment for each interview subject in the interview report. Describe your reasons for determining that the interviewee is or isn’t a credible source of information.

This involves assessing the credibility of the witness. The EEOC has published guidelines that recommend examining the following factors:

• Plausibility – Is the testimony believable and does it make sense?
• Demeanor – Did the person seem to be telling the truth?
• Motive to falsify – Does the person have a reason to lie?
• Corroboration – Is there testimony or evidence that corroborates the witness’s account?
• Past record – Does the subject have a history of similar behavior?

Example:   I consider Jane to be a credible interviewee based on the corroboration of her story with Sally and also because she has nothing to gain by reporting these incidents. She has no prior relationship with Peter and seemed genuinely upset by his behavior.

A well-written report is the only way to prove that an investigation was carried out thoroughly.

Download this free cheat sheet to learn best practices of writing investigation reports.

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In this section, describe all the evidence obtained. This could include:

• Video or audio footage
• Email or messaging (e.g. Slack, Teams, etc.) records
• Employee security access records
• Computer or other device login records
• Documents or papers
• Physical objects (e.g. photos, posters, broken objects, etc.)

Number each piece of evidence for easy reference in your chain of evidence document.

As you gather and analyze evidence, it’s critically important to include and fully consider everything  you find. Ignoring evidence that doesn’t support your conclusion will undermine your investigation and your credibility as an investigator. If you aren’t weighing some pieces as heavily as others, make sure you have a good explanation as to why.

In the final section of your report, detail your findings and conclusion. In other words, answer the questions that your investigation set out to answer.

This is where your analysis comes into play. However, be sure to only address the issue(s) being examined only, and don’t include any information that is not supported by fact. Otherwise, you could be accused of bias or speculation if the subject challenges your findings.

Investigation Findings Example:   My findings indicate that, based on the evidence, Bill’s allegation that Jim blocked him from the promotion is true. Jim’s behavior towards Bill is consistent with the definition of racial discrimination. The company’s code of conduct forbids discrimination; therefore, Jim’s behavior constitutes employee misconduct.

It’s important for your conclusion to be defensible, based on the evidence you have presented in your investigation report. Reference reliable evidence that is relevant to the case. Finally, explain that you’ve considered all the evidence, not just pieces that support your conclusion.

In some cases, you might have been asked to provide recommendations, too. Depending on your conclusion, you may recommend that the company:

• Does nothing
• Provides counselling or training
• Disciplines the employee(s)
• Transfers the employee(s)
• Terminates or demotes the employee(s)

Example: It is my recommendation that the company provide the respondent (Jim) with a written account of the findings of the investigation and a reminder of the company’s expectations for employee behavior. I also recommend that the respondent (Jim) receive anti-discrimination training and be advised that repeated discriminatory behavior may result in further discipline up to and including termination.

Grammatical errors or missed words can take even the best investigation report from professional to sloppy. That’s why checking your work before submitting the report is perhaps the most important step of them all.

Keep in mind that your investigative report may be seen by your supervisors, directors, and even C-level executives in your company, as well as attorneys and judges if the case goes to court.

If spelling, grammar, and punctuation aren’t your strong suit, enlist the services of a writer-friend or colleague to proofread your report. Or, if you’re a lone wolf kind of worker, upgrade your skills with a writing course or a read-through of books like  The Elements of Style by Strunk and White. At the very least, remember to run a spell check before you pass on any document to others.

Finally, do a quick scan to make sure you’ve included all the necessary sections and that case details are consistent.

Want more report-writing tips?

Watch our free webinar to get advice on what to include (and not include), proper language and tone, formatting tips, and more on how to effectively make an investigation report.

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If you’re still managing cases with spreadsheets or outdated systems, you’re putting your organization at risk.

With all your investigation information stored in one place, you can create comprehensive, compliant investigation reports with a single click. Case IQ’s powerful case management software pulls all the information from the case file automatically, so you can close cases faster.

Learn more about how Case IQ can reduce resolution time and improve your organization’s investigations here.

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On this page:  Criteria for publication |  Elements of a reviewer report |  Providing constructive feedback |  Confidential comments to editors |  Submitting your report

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RX Abuse Online Reporting: Report Incident

Substance Use in Women Research Report Summary

People may face unique issues when it comes to substance use, as a result of both sex and gender. Sex differences result from biological factors, such as sex chromosomes and hormones, while gender differences are based on culturally defined roles for men and women, as well as those who do not identify with either category. Gender roles influence how people perceive themselves and how they interact with others. 1,2 Sex and gender can also interact with each other to create even more complex differences among people. While the NIH is working to strengthen research on sex/gender differences across domains of health, current evidence is limited; for the purpose of this report, male and female subjects identify as such across both sex and gender.

Examples of Sex and Gender Influences in Smoking Cessation

Sex Difference: Women have a harder time quitting smoking than men do. Women metabolize nicotine, the active ingredient in tobacco, faster than men. Differences in metabolism may help explain why nicotine replacement therapies, like patches and gum, work better in men than in women. Men appear to be more sensitive to nicotine's pharmacologic effects related to substance use disorder.

Gender Difference: Although men are more sensitive than women to nicotine's addiction-related effects, women may be more susceptible than men to non-nicotine factors, such as the sensory and social stimuli associated with smoking (e.g. greater sensitivity to visual and olfactory cues as triggers and greater concern about weight gain while quitting).

For example, women and men sometimes use drugs for different reasons and respond to them differently. Additionally, substance use disorders can manifest differently in women than in men. A substance use disorder occurs when a person continues to use drugs or alcohol even after experiencing negative consequences.

Some of the unique issues women who use drugs face relate to their reproductive cycles. Some substances can increase the likelihood of infertility 3–5 and early onset of menopause. 6 Substance use is also further complicated during pregnancy and breastfeeding. Pregnant women using drugs, including tobacco and alcohol, can pass those drugs to their developing fetuses and cause them harm. Similarly, new mothers using drugs can pass those to their babies through breast milk and cause them harm. (See Substance Use While Pregnant and Breastfeeding )

Women, pregnant or not, have unique needs that should be addressed during substance use disorder treatment. Effective treatment should incorporate approaches that recognize sex and gender differences, understand the types of trauma women sometimes face, provide added support for women with child care needs, and use evidence-based approaches for the treatment of pregnant women. 10 (See Sex and Gender Differences in Substance Use Disorder Treatment )

Despite the many differences between men and women, for many years most animal and human research has traditionally used male participants. To find out more about sex and gender differences to inform better treatment approaches, federal agencies have developed guidelines to promote the inclusion of women and analyses of sex and gender differences in research. 11,12 (See The Importance of Including Women in Research )

Report on Drug Abuse and Addiction

Drug Addiction

Reasons For Why People Take Drugs

In general, people begin taking drugs for a variety of reasons:

• To feel good. Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the “high” is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction.
• To feel better. Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction.
• To do better. The increasing pressure that some individuals feel to chemically enhance or improve their athletic or cognitive performance can similarly play a role in initial experimentation and continued drug abuse.
• Curiosity and “because others are doing it.” In this respect adolescents are particularly vulnerable because of the strong influence of peer pressure; they are more likely, for example, to engage in “thrilling” and “daring” behaviors.

Problems Of Drug Abuse

At first, people may perceive what seem to be positive effects with drug use. They also may believe that they can control their use; however, drugs can quickly take over their lives.

Consider how a social drinker can become intoxicated, put himself behind a wheel and quickly turn a pleasurable activity into a tragedy for him and others. Over time, if drug use

continues, pleasurable activities become less pleasurable, and drug abuse becomes necessary for abusers to simply feel “normal.” Drug abusers reach a point where they seek and take drugs, despite the tremendous problems caused for themselves and their loved ones. Some individuals may start to feel the need to take higher or more frequent doses, even in the early stages of their drug use.

The initial decision to take drugs is mostly voluntary. However, when drug abuse takes over, a person’s ability to exert self control can become seriously impaired. Brain imaging studies

from drug-addicted individuals show physical changes in areas of the brain that are critical to

judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.

Why do some people become addicted to drugs, while others do not?

As with any other disease, vulnerability to addiction differs from person to person. In general, the more risk factors an individual has, the greater the chance that taking drugs will lead to abuse and addiction. “Protective” factors reduce a person’s risk of developing addiction. Individual’s  genes, age when started taking drugs, and family and social environment all play a role in addiction. Risk factors that increase individual’s vulnerability include:

• Family history of addiction
• Abuse, neglect, or other traumatic experiences in childhood
• Mental disorders such as depression and anxiety
• Early use of drugs

Factors Increase Risk Of Addiction

No single factor determines whether a person will become addicted to drugs. The overall risk for addiction is impacted by the biological makeup of the individual—it can even be influenced by gender or ethnicity, his or her developmental stage, and the surrounding social environment (e.g., conditions at home, at school, and in the neighborhood).

• Biological Factors

Scientists estimate that genetic factors account for between 40 and 60 percent of a person’s vulnerability to addiction, including the effects of environment on gene expression and function. Adolescents and individuals with mental disorders are at greater risk of drug abuse and addiction than the general population.

• Environmental Factors
• Home and Family. The influence of the home environment is usually most important in childhood. Parents or older family members who abuse alcohol or drugs, or who engage in criminal behavior, can increase children’s risks of developing their own drug problems.
• Peer and School. Friends and acquaintances have the greatest influence during adolescence. Drug-abusing peers can sway even those without risk factors to try drugs for the first time. Academic failure or poor social skills can put a child further at risk for drug abuse.
• Other Factors
• Early Use. Although taking drugs at any age can lead to addiction, research shows that the earlier a person begins to use drugs the more likely they are to progress to more serious abuse. This may reflect the harmful effect that drugs can have on the developing brain; it also may result from a constellation of early biological and social vulnerability factors, including genetic susceptibility, mental illness, unstable family relationships, and exposure to physical or sexual abuse. Still, the fact remains that early use is a strong indicator of problems ahead, among them, substance abuse and addiction.
• Method of Administration. Smoking a drug or injecting it into a vein increases its addictive potential. Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense “high” can fade within a few minutes, taking the abuser down to lower, more normal levels. It is a starkly felt contrast, and scientists believe that this low feeling drives individuals to repeated drug abuse in an attempt to recapture the high pleasurable state.

Surveys indicate some children are already abusing drugs by age 12 or 13.

Drug abuse starts early and peaks in teen years.

DRUG ABUSE VS. DRUG DEPENDENCE(ADDICTION)

• Paying bills late, collection agencies calling, inability to keep track of your money
• Being arrested, doing things that you would normally not do, such as stealing to obtain drugs

Employment Or

• Continuing to use drugs even though you realize your job or education is in jeopardy
• Missing work or school, or going in late due to drug use

Family And Friends

• Feeling annoyed when other people comment on, or criticize your use of drugs
• Feeling remorse or guilt after using drugs
• Associating with questionable acquaintances or frequenting out of the ordinary locations to purchase or use drugs

Social Life

• Scheduling your day around using drugs
• Focusing recreational activities around obtaining drugs, using drugs, or recovering from drug use
• Using drugs when alone

Signs And Symptoms Of Cannabis Use (Marijuana And Hashish)

• Heightened visual and auditory perceptions and increased sensitivity in taste
•  Increased appetite
•  Problems with memory, difficulty concentrating, paranoid thinking
•  Decreased coordination, slowed reaction time
• Bloodshot eyes, elevated blood pressure, increased heart rate
• Impairments in learning, memory and cognitive functioning
• Losing interest in activities and hobbies that were once pleasurable

Risky behavior

• Sharing needles
• Having unsafe sex

  Drug Use Can Lead To Addiction

People with conditions such as Attention-Deficit/Hyperactivity Disorder (ADHD) or mood disorders such as depression and anxiety may find that a street drug makes them feel less jumpy, depressed or anxious.

The line between substance abuse and drug dependence is defined by the role drugs play in your life. Addiction and drug dependence occurs when drugs become so important that you are willing to sacrifice your work, home and even family. Once individual’s brain and body get used to the substances individual is taking, he begin to require increasingly larger and more frequent doses, in order to achieve the same effect.

Drugs such as Heroin, a painkiller, over-stimulate the pleasure centers of the brain producing euphoric effects which cause compulsive drug-seeking behaviors and affect self-control and judgment. These drugs are highly addictive and require a medical detoxification (detox) to cleanse the chemicals from your system. The severity of withdrawal symptoms such as chills,

shakes, muscle pain, nausea, vomiting, headaches, and cravings can be reduced in detox with prescribed medications that can be slowly decreased over time. Withdrawal affects you physically and emotionally resulting in sadness, depression and exhaustion.

More Statistics

This table is a representation of the people who tried a drug once, the fraction that

became addicted:

  The Last Forty Years Have Seen An Explosion In Drug Use

In 1962, 4 million people reported having tried drugs, however by 1992, this figure

jumped to 80 million.

In the 1960’s the drugs of choice were primarily marijuana and the psychedelics. 1975-

1990 saw an increase in the use of cocaine, and in the past couple decades heroin use has

increased significantly.

Some Recent Statistics On Drug Use

Nicotine – 50 million users (greatest cause of preventable deaths in the US)

Nicotine use has stabilized over the past few years, and the increase in adolescent use has

Alcohol – 12-18 million

Alcohol use is stable to declining with some increase in binge drinking.

Marijuana – 5 million use it weekly

Currently, 24% of high school seniors use marijuana. This figure is a slight decrease from

Cocaine – 2-3.5 million

Cocaine use has been declining, however the decrease in the number of cocaine addicts

has been slow because cocaine treatment is very difficult.

Heroin – 810,000 addicts

Heroin use has been increasing. Cheap, pure heroin has replaced cocaine on the drug

market. Additionally, this purer heroin is easier to use (since it is so potent, it does not

have to be injected; snorting or smoking produces the same high).

Commonly abused drugs

(Benzodiazepine)

• Valium and Xanax (tranquilizers)

Cannabinoids

• Marijuana and Hashish

Hallucinogens and Psilocybin

• LSD and PCP
• Magic Mushrooms
• Aerosols, Nitrous oxide, Nitrites (poppers)

Drugs for increasing muscle

• Anabolic steroids

  Drugs And The Brain

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. In brief, the brain regulates your basic body functions; enables you to interpret and respond to everything you experience; and shapes your thoughts, emotions, and behavior.

The brain is made up of many parts that all work together as a team. Different parts of the brain are responsible for coordinating and performing specific functions. Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the

compulsive drug abuse that marks addiction. Brain areas affected by drug abuse—

• The brain stem controls basic functions critical to life, such as heart rate, breathing, and sleeping.
• The limbic system contains the brain’s reward circuit—it links together a number of brain structures that control and regulate our ability to feel pleasure. Feeling pleasure motivates us to repeat behaviors such as eating—actions that are critical to our existence. The limbic system is activated when we perform these activities— and also by drugs of abuse. In addition, the limbic system is responsible for our perception of other emotions, both positive and negative, which explains the mood-altering properties of many drugs.
• The cerebral cortex is divided into areas that control specific functions. Different areas process information from our senses, enabling us to see, feel, hear, and taste. The front part of the cortex, the frontal cortex or forebrain, is the thinking center of the brain; it powers our ability to think, plan, solve problems, and make decisions.

Communication System Of Brain

The brain is a communications center consisting of billions of neurons, or nerve cells. Networks of neurons pass messages back and forth to different structures within the brain, the spinal column, and the peripheral nervous system. These nerve networks coordinate and regulate everything we feel, think, and do.

• Neuron to Neuron

Each nerve cell in the brain sends and receives messages in the form of electrical impulses. Once a cell receives and processes a message, it sends it on to other neurons.

• Neurotransmitters—The Brain’s Chemical Messengers

The messages are carried between neurons by chemicals called neurotransmitters. (They transmit messages between neurons.)

• Receptors—The Brain’s Chemical Receivers

The neurotransmitter attaches to a specialized site on the receiving cell called a receptor. A neurotransmitter and its receptor operate like a “key and lock,” an exquisitely specific mechanism that ensures that each receptor will forward the appropriate message only after interacting with the right kind of neurotransmitter.

• Transporters—The Brain’s Chemical Recyclers

Located on the cell that releases the neurotransmitter, transporters recycle these neurotransmitters (i.e., bring them back into the cell that released them), thereby shutting off the signal between neurons.

The Way How Drugs Work In The Brain

Drugs are chemicals. They work in the brain by tapping into the brain’s communication system and interfering with the way nerve cells normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure “fools” receptors and allows the drugs to lock onto and activate the nerve cells. Although these drugs mimic brain chemicals, they don’t activate nerve cells in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network. Other drugs, such as amphetamine or cocaine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals. This disruption produces a greatly amplified message, ultimately disrupting communication channels. The difference in effect can be described as the difference between someone whispering into your ear and someone shouting into a microphone.

Drugs Work In The Brain To Produce Pleasure

All drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.

Stimulation Of The Brain’s Pleasure Circuit Teach Us To Keep Taking Drugs

Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.

Drugs More Addictive Than Natural Rewards

When some drugs of abuse are taken, they can release 2 to 10 times the amount of dopamine that natural rewards do. In some cases, this occurs almost immediately (as when drugs are smoked or injected), and the effects can last much longer than those produced by natural rewards. The resulting effects on the brain’s pleasure circuit dwarfs those produced by naturally rewarding behaviors such as eating and sex. The effect of such a powerful reward strongly motivates people to take drugs again and again. This is why scientists sometimes say that drug abuse is something we learn to do very, very well.

Keep Taking Drugs Lead To Tolerance

Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive and transmit signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to bring their dopamine function back up to normal. And, they must take larger amounts of the drug than they first did to create the dopamine high—an effect known as tolerance.

Long-Term Drug Abuse Impairs Brain Function

We know that the same sort of mechanisms involved in the development of tolerance can eventually lead to profound changes in neurons and brain circuits, with the potential to severely compromise the long-term health of the brain. For example, glutamate is another neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate for this change, which can cause impairment in cognitive function. Similarly, long-term drug abuse can trigger adaptations in habit or nonconscious memory systems. Conditioning is one example of this type of learning, whereby environmental cues become associated with the drug experience and can trigger uncontrollable cravings if the individual is later exposed to these cues, even without the drug itself being available. This learned “reflex” is extremely robust and can emerge even after many years of abstinence.

Chronic exposure to drugs of abuse disrupts the way critical brain structures interact to control behavior—behavior specifically related to drug abuse. Just as continued abuse may lead to tolerance or the need for higher drug dosages to produce an effect, it may also lead to addiction, which can drive an abuser to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while sending intense impulses to take drugs.

Medical Consequences Of Drug Addiction

Individuals who suffer from addiction often have one or more accompanying medical issues, including lung and cardiovascular disease, stroke, cancer, and mental disorders. Imaging scans, chest x-rays, and blood tests show the damaging effects of drug abuse throughout the body. For example, tests show that tobacco smoke causes cancer of the mouth, throat, larynx, blood, lungs, stomach, pancreas, kidney, bladder, and cervix. In addition, some drugs of abuse, such as inhalants, are toxic to nerve cells and may damage or destroy them either in the brain or the peripheral nervous system.

Treatment And Recovery

Addiction is a treatable disease. Discoveries in the science of addiction have led to advances in drug abuse treatment that help people stop abusing drugs and resume their productive lives. Addiction need not be a life sentence. Like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract addiction’s powerful disruptive effects on brain and behavior and regain control of their lives.

Healthy Person

The chronic nature of the disease means that relapsing to drug abuse is not only possible, but likely, with relapse rates similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors, and relapse does not mean treatment failure. For the addicted patient, lapses back to drug abuse indicate that treatment needs to be reinstated or adjusted, or that alternate treatment is needed.

The Basics Of Effective Addiction Treatment

Research shows that combining treatment medications, where available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient’s drug abuse patterns and drug-related medical, psychiatric, and social problems.

• Medications For Treatment Of Drug Addiction

Different types of medications may be useful at different stages of treatment to help a patient stop abusing drugs, stay in treatment, and avoid relapse.

•                    I.            Treating Withdrawal. When patients first stop abusing drugs, they can experience a variety of physical and emotional symptoms, including depression, anxiety, and other mood disorders; restlessness; and sleeplessness. Certain treatment medications are designed to reduce these symptoms, which makes it easier to stop the abuse.
•                 II.            Staying in Treatment. Some treatment medications are used to help the brain adapt gradually to the absence of the abused drug. These medications act slowly to stave off drug cravings, and have a calming effect on body systems. They can help patients focus on counseling and other psychotherapies related to their drug treatment.
•              III.            Preventing Relapse. Science has taught us that stress, cues linked to the drug experience (e.g., people, places, things, moods), and exposure to drugs are the most common triggers for relapse. Medications are being developed to interfere with these triggers to help patients sustain recovery.
• Behavioral Therapies For Treatment Of Drug Addiction

Behavioral treatments help engage people in drug abuse treatment, modifying their attitudes and behaviors related to drug abuse and increasing their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and prompt another cycle of compulsive abuse. Moreover, behavioral therapies can enhance the effectiveness of medications and help people remain in treatment longer.

• Cognitive Behavioral Therapy. Seeks to help patients recognize, avoid, and                    cope with the situations in which they are most likely to abuse drugs.
• Motivational Incentives. Uses positive reinforcement such as providing rewards or privileges for remaining drug free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
• Motivational Interviewing. Employs strategies to evoke rapid and internally motivated behavior change to stop drug use and facilitate treatment entry.
• Group Therapy. Helps patients face their drug abuse realistically, come to terms with its harmful consequences, and boost their motivation to stay drug free. Patients learn effective ways to solve their emotional and interpersonal problems without resorting to drugs.

Intraocular Implants for Extended Drug Delivery

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Expressive Writing as a Therapeutic Process for Drug Dependent Women

Sarah meshberg-cohen.

1 Department of Veteran Affairs, VA Connecticut Healthcare System, West Haven, CT

2 Department of Psychology, Virginia Commonwealth University, Richmond, VA

3 Department of Psychiatry, Yale University School of Medicine, New Haven, CT

Dace Svikis

Thomas j mcmahon.

Although women with Substance Use Disorders (SUD) have high rates of trauma and post-traumatic stress, many addiction programs do not offer trauma-specific treatments. One promising intervention is Pennebaker’s expressive writing, which involves daily, 20-minute writing sessions to facilitate disclosure of stressful experiences.

Women ( N = 149) in residential treatment completed a randomized clinical trial comparing expressive writing to control writing. Repeated measures analysis of variance was used to document change in psychological and physical distress from baseline to 2-week and 1-month follow-ups. Analyses also examined immediate levels of negative affect following expressive writing.

Expressive writing participants showed greater reductions in post-traumatic symptom severity, depression, and anxiety scores, when compared to control writing participants at the 2-week follow-up. No group differences were found at the 1-month follow-up. Safety data were encouraging; while expressive writing participants showed increased negative affect immediately after each writing session, there were no differences in pre-writing negative affect scores between conditions the following day. By the final writing session, participants were able to write about traumatic/stressful events without having a spike in negative affect.

Conclusions

Results suggest expressive writing may be a brief, safe, low cost, adjunct to SUD treatment that warrants further study as a strategy for addressing post-traumatic distress in substance-abusing women.

INTRODUCTION

Studies point to overwhelming rates of trauma in the lives of women with Substance Use Disorders (SUDs). In SUD treatment settings, 55% to 99% of women report at least one lifetime trauma ( 1 ). As many as 80% of women seeking drug abuse treatment report lifetime histories of physical or sexual assault ( 2 ), and many display Posttraumatic Stress Disorder (PTSD) symptomatology ( 3 ). Trauma and addiction comorbidity studies reveal these women are likely to have poorer health, increased disability, more severe clinical profiles, and poorer treatment adherence, than those without trauma or PTSD ( 4 ).

While trauma interventions have traditionally not been incorporated into SUD treatment programs, studies indicate that addressing trauma during SUD treatment may improve treatment outcomes ( 5 ). Historically, there has been an ongoing debate regarding which problem to treat first; the trauma or the SUD. Among SUD treatment providers, the general consensus was that addressing trauma during the early phase of SUD recovery may “open Pandora’s box” and derail SUD treatment improvement ( 5 ). Recent research, however, suggests the opposite; that trauma should be treated concurrently, even in the earliest stages of SUD treatment ( 6 ).

Accumulating evidence over the past two decades indicates that disclosure of traumatic or stressful experiences through Pennebaker’s expressive writing has widespread benefits. The typical laboratory research for Pennebaker’s expressive writing involves randomly assigning individuals to one of two conditions (e.g., expressive writing [emotional disclosure] versus control writing [neutral topic]). Expressive writing involves writing about the most traumatic or stressful event of one’s life for 15 to 20 minutes a day over three to five consecutive days, and is typically done with no feedback given ( 7 ). Studies have demonstrated the efficacy of expressive writing as a brief therapeutic intervention, with significant reductions in distress ( 8 ), and improved psychological ( 9 ) and physical health ( 10 ).

For instance, Pennebaker’s expressive writing has revealed that writing about a stressful or traumatic event is associated with a reduction in the degree to which the experience is distressing or painful ( 11 ), reduced depression among depressed women ( 12 ), a decrease in health center and doctor’s visits ( 10 ; 13 ), fewer missed days of work or school ( 14 ), improved immune functioning ( 15 ), and decreases in sympathetic nervous system activity ( 16 ).

In a meta-analysis of expressive writing studies, Smyth ( 17 ) found a 23% symptom improvement in the traumatic disclosure writing condition over a control writing condition. The average effect size was comparable or larger than those found in other psychological, educational, or behavioral interventions ( 8 ). Cognitive Processing Therapy (CPT), which also employs writing about stressful events, has recently revealed decreases in PTSD and depression symptoms ( 18 ). Furthermore, research indicates no harm to participants has been encountered as a result of Pennebaker’s expressive writing. While there is a rise in negative affect immediately after trauma writing, it is usually transient; and at follow-up, participants generally report that they feel better than they did before writing ( 19 ).

Although much attention has focused on benefits of Pennebaker’s expressive writing, to date, it has not been examined in populations affected by SUDs. Expressive writings’ efficiency (15 to 20 minutes over three to five days), efficacy, and low cost suggest that writing as a means for disclosing traumatic experiences may be a powerful adjunct to traditional SUD treatment.

The purpose of this study was to determine whether Pennebaker’s expressive writing is beneficial as a brief adjunct to traditional treatment for women currently undergoing residential treatment for SUDs. This randomized clinical trial (RCT) tests two hypotheses. First, it was hypothesized that participants randomized to the expressive writing condition would show more improvement in psychological and physical health at the 2-week and 1-month follow-up, compared to control writing participants. While it was expected that there would be improvements for both writing conditions as a function of being in residential treatment, expressive writing participants were expected to show greater improvement. Second, it was hypothesized that negative affect measured immediately after each writing session would be higher among expressive writing participants compared with control writing participants, but that these increases in negative affect would be short-lived.

Participants

Participants were 149 women admitted to a gender-specific residential SUD treatment facility from June 17, 2007 to November 6, 2008. Specific services within this facility include individual counseling, motivational enhancement therapy groups, and case management for such needs as housing, transportation, and childcare. To be eligible for the study, women had to: (a) be at least 18 years old; (b) meet DSM-IV criteria for a SUD; and (c) have approval for 60 days of residential treatment from a third-party payer to help facilitate presence for the 1-month follow-up. Women were ineligible if they: (a) had an acute mental disorder (e.g., current suicidality) that would make it difficult to provide informed consent and/or follow the study protocol; or (b) had literacy problems that would prevent them from being able to complete the writing sessions or the research assessments.

With the exception of demographic questions and the Structured Clinical Interview for DSM-IV-TR - Alcohol and Substance Use Disorders Module (SCID) ( 20 ), measured at baseline, the same battery of measures was administered at baseline, and at the 2-week and 1-month post-writing follow-up. All assessments were completed on-site and instructions were read aloud by the researcher. The primary outcome measure included the Posttraumatic Stress Diagnostic Scale (PDS) ( 21 ). Secondary outcomes included the: Center for Epidemiological Studies-Depression Scale (CES-D) ( 22 ), Pennebaker Inventory of Limbic Languidness (PILL) ( 23 ), and Brief Symptom Inventory (BSI) ( 24 ). Process measures included the: Positive and Negative Affect Scale (PANAS) ( 29 ), measured pre- and post-writing session, as well as the Essay Evaluation Measure (EEM) ( 30 ), measured post-writing session, and the follow-up questionnaire, measured at 2-week and 1-month post-writing intervention.

The SCID ( 20 ) is a diagnostic interview assessing SUD diagnosis, including alcohol and other drugs. The SCID has demonstrated good validity and high interrater reliability for SUDs ( 25 ).

The PDS ( 21 ) is a 49-item self-report measure focused on PTSD symptom severity and diagnosis, with items parallel to DSM-IV criteria ( 26 ). The PDS has high test-retest reliability ( r = .83), high internal consistency (α = .92), and high convergent validity ( 27 ). Trauma symptom severity was defined as the sum scores for items focused on re-experiencing, arousal, and avoidance symptoms. At baseline, internal consistency for trauma symptom severity for this sample was .99.

The CES-D ( 22 ) is a 20-item self-report measure of depression, and has high internal consistency in psychiatric settings (α. = .90). Internal consistency at present study baseline for this sample was .87.

The PILL ( 23 ) is a 54-item scale that assesses the frequency of common physical symptoms and sensations (e.g. “headaches” “congested nose” “coughing”). Chronbach’s alphas for the PILL range from .88 to .91, with 2-month test-retest reliabilities of .79 to .83. PILL has a mean score of 112.7 (SD = 24.7) ( 23 ). At baseline, internal consistency for this sample was .94.

The BSI ( 24 ), a 53-item self-report measure, is a shortened version of the Symptom Check List-90 (SCL-90). It assesses nine symptoms of distress (Somatization; Obsessive-Compulsive; Interpersonal Sensitivity; Depression; Anxiety; Hostility; Phobic Anxiety; Paranoid Ideation; Psychoticism). The BSI has high scale-by-scale correlations with the SCL-90, as well as high internal consistency (Cronbach’s α.: .71-.85), convergent, discriminant, and test-retest reliability (r = .68–.91), and construct validity ( 28 ). At baseline, internal consistencies for the 9 BSI indices for this sample were .74-.87.

Process Measures

The PANAS ( 29 ) assesses negative affect (NA) and positive affect (PA), using 10 items for NA and 10 items for PA. It was administered pre- and post-writing, and only the negative affect scale was used in this study. The NA scale has high internal consistency reliabilities, ranging from .84 to .87, and they are unchanged by the time point used. Internal consistency for the post-writing NA scale on Day 1 of writing for this sample was .92.

The EEM ( 30 ) served as manipulation check to evaluate participants’ self-reports of their response to the experimental and control manipulation after each writing session. It assesses participants’ report, along separate 7-point scales, ranging from 1 (not at all) to 7 (a great deal), the extent to which their essays were meaningful, personal, and revealing, and the extent they had actually talked to others, had wanted to talk to others, and had actively held back from talking to others about the subject(s) of the essays ( 31 ). After the first writing session, internal consistency of the measure for this sample was .79.

The follow-up questionnaire was an investigator-developed survey that examined issues of cross-contamination inherent in studies done in residential settings. The follow-up questionnaire served as a fidelity check, and measured possible diffusion of treatment. The questionnaire included closed and open-ended questions and surveyed whether participants heard about, shared or received writing instructions from others in the facility. It also addressed whether the participant found the writing helpful and talked about the subject matter from her essays during treatment.

The University’s Institutional Review Board approved research procedures. A CONSORT diagram ( Figure 1 ) summarized study screening, enrollment, treatment, assessment, and retention of participants. Admission records identified potential study participants and those women were approached within the first few days of treatment. Those who met inclusion criteria were invited for participation in a study that involved writing stories related to their life ( 32 ).

Women providing informed consent were randomly assigned (using a random numbers table) to one of two conditions: (a) expressive writing (emotional topic) or (b) control writing (neutral topic). Writing instructions were based on protocols used by Pennebaker et al. ( 14 ) and Sloan and Marx ( 33 ). In addition to being read aloud by the investigator before each writing session, a copy of the writing instructions was attached to the front flap of each journal so that participants could re-read instructions at any time.

Writing Procedure

Once enrolled, participants completed baseline assessments, four 20-minute writing sessions on consecutive days, and both a 2-week and 1-month follow-up assessment. In order to reduce unintentional expectancy effects and investigator bias, one experimenter administered baseline assessments and all writing instructions, while a different experimenter, blind to study condition, administered PANAS, EEMs, and follow-up assessments.

Writing Session One

The day after completing baseline assessments, each participant was administered the writing instructions. Participants were asked not to discuss the study or writing instructions. After receiving writing instructions from one experimenter, participants were introduced to a second experimenter.

The second experimenter had participants complete a PANAS ( 29 ) prior to handing them a blank notepad. Participants located a comfortable place where they would not be disturbed (e.g., their room), and wrote about their assigned topic for 20 minutes. Twenty minutes later, the second experimenter administered the PANAS and EEM ( 33 ). Notepads, marked by participant ID, were then dropped into a cardboard box along with participants’ responses to PANAS and EEM responses.

Writing Sessions Two through Four

Participants were greeted for each session by the first experimenter, who read the writing instructions aloud. The second experimenter instructed participants to complete PANAS before writing for 20 minutes. The PANAS and EEM were completed after each writing session.

2-Week and 1-Month Follow-Up

Participants completed follow-up assessments 2-weeks and 1-month post-writing intervention. A 2-week follow-up was added after 22 participants had already been enrolled; this was done to insure some data collection from participants who might leave against medical advice (AMA) prior completing their 60-day treatment, as well as to assess the shorter-term effects of the intervention.

Participants received a $5 gift card after completing the baseline assessment, a $5 gift card after each writing session ($20 total), a $10 gift card after completing the 2-week follow-up, and a $15 gift card upon completion of the 1-month follow-up.

Data Analysis

Kolmogorov-Smirnov and Shapiro-Wilk statistics determined that primary and secondary outcomes were normally distributed. T- and chi-square tests examined whether significant baseline differences existed between conditions. A series of analyses of variance (ANOVA) were then used to test for between-group differences in (a) 2-week clinical outcomes, and (b) clinical outcomes at the end of the 1-month follow-up. For the first research hypothesis, 2-week effects were examined with a 2 Condition (expressive writing; control writing) by 2 Time (baseline; 2-week follow-up) repeated-measures analysis of variance (ANOVA) separately for each outcome measure (PDS, CES-D, PILL, BSI). One-month effects were also tested by examining between-group differences over time using a 2 Condition (expressive writing; control writing) by 2 Time (baseline; 1-month follow-up) repeated-measures analysis of variance (ANOVA) for each outcome measure (PDS, BSI, CES-D, PILL). Condition × Time interaction effects were examined for differential treatment effects with post-hoc analysis of the main effect of time within each treatment group. Since an investigator was present during assessments, missing data were minimal. In the intention-to-treat analyses, with the entire sample (149 participants), however, missing outcome data for ‘non-completers’ (e.g., participants who did not complete all writing sessions, the 2-week, and/or the 1-month follow-up assessments) were addressed by carrying forward each participant’s previous score.

For the second research hypothesis, a repeated measures analysis of negative affect was derived from PANAS. A 2 Condition (expressive writing; control writing) by 4 Session (writing 1; writing 2; writing 3; writing 4) by 2 Time (pre- and post-writing session) repeated measures multivariate analysis of variance (MANOVA) examined the interaction between pre-post writing NA and condition at each of the four sessions.

T- and chi-square tests compared writing conditions on items of the EEM and follow-up questionnaire to evaluate participants’ self reports of their response to the experimental manipulation. Because participants completed the EEM four times (after each writing session), the mean of the four days for each participant was used in analyses.

Participant Characteristics

Overall, women enrolled in the study ( Table 1 ) were an average of 36.3 ( SD = 8.6) years old; and had completed an average of 11.2 ( SD = 1.8) years of education; most (92.7%) were single/never married; and a majority (70%) identified their race as African-American. Most participants reported at least one lifetime trauma at baseline (assessed by PDS). Over half met diagnostic criteria for current PTSD. SUD women with co-morbid PTSD reported significantly more types of trauma than women without PTSD, t (147) = 5.1, p < .005. A majority of participants indicated cocaine as one of their primary drugs of dependence, with over half meeting DSM-IV criteria for substance dependence for more than one drug.

Participant Characteristics: Expressive Writing (n = 82) and Control Writing (n = 67)

Randomization

Participants randomized to expressive writing had higher CES-D depression scores than controls ( M = 25.2 [SD = 12.0] versus M = 21.1 [SD = 10.9], t (148) = 2.2, p < .05), and higher BSI Anxiety scores ( M = 1.3 [SD = 1.1] versus M = 0.8 [SD = 0.8]), t (148) = 3.0, p < .005. There were no other baseline differences between conditions.

Writing Session Attrition

A chi-square analysis showed no significant relationship between condition assignment and number of writing sessions completed, p > .05. As depicted in the CONSORT diagram, rates of compliance for both conditions were high. Specifically, 97.6% of expressive writing and 97.0% of control writing participants completed at least two writing sessions, and most (94.6%) completed all four writing sessions.

Follow-Up Assessment Attrition

Among expressive writing participants, there were no differences between ‘completers’ versus ‘non-completers’ on dependent variables at 2-week follow-up. Among control participants, women who did not complete the 2-week follow-up were significantly more depressed at baseline compared to those who completed the follow-up ( M = 28.0 [SD = 6.8] versus M = 20.0 [SD = 11.1]), t (65) = 2.1, p < .05), and were more likely to have had clinically elevated depression (≥ 16 CES-D cutoff) at baseline (100 % versus 62.1%), χ 2 (2, N = 67) = 5.1, p < .05. No differences between ‘completers’ versus ‘non-completers’ were found at 1-month follow-ups on any dependent variables, p > .05.

Hypothesis 1: 2-Week and 1-Month Effects of Expressive Writing

Trauma symptom severity.

There was a Condition × Time interaction for levels of traumatic stress at 2-week follow-up, F (1,149) = 5.8, p < .05, partial eta 2 = .04. Planned contrasts revealed a significant decrease in trauma symptom severity from baseline to 2-weeks among expressive writing, F (1,82) = 8.6, p < .005, partial eta 2 = .10, but not among control writing participants, p > .05. There was no interaction for trauma symptom severity at 1-month follow-up, p > .05; however, both conditions revealed significant improvements ( Table 2 ). Expressive writing participants revealed a significant decrease from baseline to 1-month follow-up, F (1,82) = 11.1, p < .005, partial eta 2 = .12, as did controls, F (1,67) = 7.3, p < .01, partial eta 2 = .10.

Effects of Expressive Writing versus Control Writing on Two-Week Follow-Up (Intent-to-Treat)

There was a significant Condition × Time interaction for depression, F (1,149) = 4.3, p < .05, partial eta 2 = .03 at 2-weeks. Planned contrasts demonstrated significant decreases in depression among expressive writing, F (1,82) = 7.4, p < .01, partial eta 2 = .08, but not among control writing participants, p > .05. There was no interaction at the 1-month follow-up ( p > .05), however, both conditions revealed significant improvements in depression. Expressive writing participants showed significant improvements in depression at 1-month follow-up, F (1,82) = 16.1, p < .005, partial eta 2 = .17, as did control participants, F (1,67) = 9.3, p < .005, partial eta 2 = .12.

Physical Health

There was no Condition × Time interaction in the reduction of physical health symptoms and sensations at the 2-week, p > .05, or 1-month follow-up, p > .05. However, significant improvements were found at 1-month follow-up for both the expressive writing, F (1,82) = 18.3, p < .005, partial eta 2 = .18, and control writing condition, F (1,67) = 4.5, p < .05, partial eta 2 = .06.

There was a significant Condition × Time interaction for anxiety, F (1,149) 13.9, p < .005, partial eta 2 = .09. Expressive writing participants showed significant improvements in anxiety scores at the 2-week follow-up, F (1,82) = 14.1, p < .005, partial eta 2 = .15, while control participants did not, p >.05. There was no interaction at 1-month follow-up, p > .05.

There was a trend approaching a significant interaction for the Somatic Index, F (1,149) = 3.8, p = .05. While the control condition revealed an increase in somatic symptoms from baseline to 2-week follow-up, F (1,67) = 4.4, p < .05, partial eta 2 = .06, the expressive writing condition revealed no differences suggesting a possible protective factor of the writing. This trend was not maintained at the 1-month follow-up, yet overall improvements were seen for both conditions. There were no interactions between conditions over time for the remaining seven BSI indices (all > .05).

Hypothesis 2: Expressive Writing on Negative Affect

There was a significant Condition × Session × Time interaction for PANAS negative affect scores, F (4,149) = 7.3, p < .005, partial eta 2 = .30. Additionally, univariate F tests revealed that groups did not differ in negative affect prior to writing, suggesting that the immediate increase in negative affect after writing was brief ( Table 3 ).

Negative Affect: Pre-Post Writing Session

Note: Time 1 PANAS was assessed after writing instructions were given, but prior to writing.

Univariate tests revealed a significant interaction between time by condition at writing session one, F (1,149) = 29.9, p < .005, with a significant group main effect, partial eta 2 = .17. There was a significant time by condition interaction at writing session two, F (1,149) = 15.6, p < .005, with a significant group main effect, partial eta 2 = .10. The interaction continued to be significant at writing session three, F (1,149) = 9.3, p < .005, with a significant group main effect, partial eta 2 = .06. At writing session four, however, there was no interaction, F (1,147) = 2.0, p > .05. As illustrated, analyses revealed that the main effects decreased over time; by writing session four, expressive writing participants were able to write about traumatic event without having the spike in negative affect afterward.

Manipulation and Fidelity Checks

When compared to control writing participants, expressive writing participants described their essays as more meaningful, t (139) = 9.1, p < .0005, more personal, t (139) = 13.3, p < .0005, and more revealing of one’s emotions, t (139) = 18.0, p < .0005. They were more likely to have wanted to discuss it with others, t (139) = 8.7, p < .0005, than control writing participants. They also reported being more likely to have talked with others about the content of their essays, t (139) = 10.0, p < .0005, and also to have actively held back from talking with others about the content, t (139) = 4.5, p < .0005, than controls.

Follow-up Questionnaire

Only 2 (1.7%) participants in the control condition reported hearing about the expressive writing instructions from another participant. Furthermore, expressive writing participants were more likely than controls to: report finding the writing to be helpful (98.6% versus 72.0%), χ 2 (2, N = 120) = 18.6, p < .005, continue journaling using the writing instructions given after the sessions ended (42.0% versus 14.0%), χ 2 (2, N = 120) = 10.8, p < .005; and to have talked about the subject matter form their essays during treatment (15.9% versus 0.0%), χ 2 (2, N = 120) = 8.8, p < .005 . All (100%) of the expressive writing participants who talked about the subject matter from their essays during their treatment found it to be helpful. Expressive writing participants reported that expressive writing helped them work through issues and deal more effectively with emotions related to trauma/stress ( Table 4 ).

Follow-Up Questionnaire: 5 Randomly Selected Quotes from Each Condition

The present study collected benchmark data on whether Pennebaker’s expressive writing could be applied to women in residential SUD treatment. Trauma rates in this study were comparable to those previously reported in the literature ( 5 ), supporting the rationale for the clinical trial and study hypotheses.

2-week and 1-Month Outcomes

Supporting hypothesis one, expressive writing participants showed greater reductions in trauma symptom severity, depression, and anxiety than control writing participants at the 2- week follow-up. Expressive writing may be a protective factor in somatic symptoms. While no group differences were found at the 1-month follow-ups, both conditions showed significant positive changes, likely due to being in residential treatment for 30 days ( 34 ). Due to baseline differences between conditions, results should be interpreted with caution.

Short-term (2-week) findings are consistent with research suggesting that writing about emotional experiences using Pennebaker’s expressive writing results in a decreased degree to which the experience is emotionally distressing or painful ( 35 ). One potential reason is based on exposure theory, which suggests that attempting not to think about traumatic events in order to avoid overwhelming emotions may generate further feelings of distress and fear ( 11 ). Thus, expressive writing may act as a medium for exposure to previously avoided stimuli. Repeat exposure over several writing sessions may allow for habituation and extinction of negative emotional associations and/or offer corrective information to the person about the stimuli, responses, and meaning of the event ( 32 ).

While it is generally thought that exposure to the same traumatic event is essential for extinction, expressive writing does not require writing about the same event at each session, suggesting that stimulus-related habituation may take place regardless ( 7 ). Studies to-date comparing instructions for participants to write about the same or different topics each day have yielded mixed results. For instance, Sloan and colleagues ( 35 ) found college students with a trauma history who wrote about the same trauma experience at each session showed improvements at follow-up, while those instructed to write about a different trauma each day did not. Other studies have obtained more robust results when participants were allowed to choose their writing topic at each session ( 8 ; 36 ).

The importance of short-term improvements at 2-weeks versus 1-month should not be discounted, particularly since we are dealing with a clinical population and a chronic disorder. It is likely that extending the intervention in ways that “boost” the intervention (e.g., more writing sessions during different points in treatment) would be helpful. While writing conditions did not differ at 1-month, both conditions demonstrated positive changes on core outcomes. The present study is unique, however, in that it was conducted in the context of residential treatment, which, in and of itself, is likely to produce improvements in physical and psychosocial functioning over time.

Expressive writing participants showed significant reductions in depressive symptoms at the 2-week follow-up, while controls did not. Results are consistent with research among women who had endured intimate partner violence ( 12 ), showing greater drops in depression among those in the traumatic disclosure as compared to the control writing condition. However, given that baseline depression differences existed, this finding should also be interpreted with caution.

There were no differences between the two conditions in the reduction of physical health symptoms and sensations over time, which conflicts with an extensive body of research that suggests physical health benefits from expressive writing ( 37 ). However, there were improvements in physical symptoms regardless of condition at 1-month follow-up. While we did not find the health improvements we expected from Pennebaker’s expressive writing, the present study uses a sample of women who, generally speaking, were receiving little to no healthcare treatment prior to admittance. Once admitted into treatment, they began receiving psychotherapy and/or medication, which likely influenced symptoms and self-reports above and beyond improvements we may otherwise witness as a result of the writing intervention.

Expressive writing participants reported greater reductions in anxiety than controls at 2-weeks; however, there were no group difference at the1-month follow-up. Again, caution should be used when interpreting these findings due to baseline differences. Nonetheless, these outcomes suggest expressive writing might assist with emotion regulation by promoting attention, habituation, and cognitive restructuring. Expressive writing can potentially help influence attention toward or away from different dimensions of a stressor ( 11 ). Another theory suggests that cognitive restructuring may initiate changes in stress-related thoughts and appraisals. To the degree that people can cognitively negotiate stressful experiences, they should experience a decrease in and possible extinction of anxiety and intrusive thoughts.

Analyses revealed a trend approaching significance for the Somatic Index, which might suggest expressive writing could have a protective effect during the early stages of residential treatment. If women with SUDs are likely to show initial increases in somatic problems (start of treatment), possibly as a result of their bodies readjusting to no longer being physically dependent on drugs, then expressive writing may benefit women by preventing somatic deterioration.

Expressive Writing on Negative Affect

Consistent with hypothesis two, negative affect produced by expressive writing was short-lived. Increased negative affect immediately following writing is consistent with previous literature ( 38 ), and provides evidence for emotional engagement and (fear) activation ( 39 ). Trauma experts claim emotional engagement is essential for habituation ( 40 ). In order for successful habituation, individuals should endure strong negative emotions initially ( 11 ), followed by gradual reductions in negative emotions within and across writing sessions. Such habituation may indicate desensitization to trauma-related thoughts and memories (i.e., stimulus-specific habituation), and possibly an enhanced tolerance of ones’ negative emotional responses to stress-provoking stimuli in general (i.e., response-specific habituation) ( 11 ). Thus, initial spikes in distress and consequent habituation may be reflective of emotional processing and enhanced self-regulation, and should be associated with improvements in one’s reaction (psychological and physical) to traumatic memories ( 41 ).

Limitations

The study had a number of limitations. First, although participants were randomized to conditions, expressive writing participants started with higher pre-writing scores; while, depression and anxiety scores were the only significant pre-writing differences, these differences raise concerns that the effects could be the result of a regression to the mean. Another limitation is that one month is a relatively short follow-up period. Future studies should examine group differences over longer periods of time post-intervention (including post-residential treatment outcomes and substance use), even though some studies show the most dramatic effects more immediately following the intervention.

Furthermore, it was realized 22 participants into recruitment that short-term follow-up would be beneficial in catching participants who did not stay the intended 60 days; therefore, we did not have 2-week assessments on those 22 participants. It would also be useful to examine potential moderators, such as high versus low avoidance personalities ( 42 ). Finally, individuals with more severe mental health problems (e.g., SUD, PTSD) may require more writing sessions or longer writing sessions to realize positive effects.

Study Implications and Applications

This study has a number of important implications. First, it provides evidence that trauma-focused interventions can be incorporated into traditional residential SUD treatment without triggering more harm. Women safely expressed their deepest emotions and thoughts, many for the first time, about a traumatic and/or stressful event without any indications of a lasting increase in psychiatric distress. During follow-up assessments, the majority of expressive writing participants reported that it helped them work through issues and deal more effectively with emotions related to trauma/stress. These reports were offered spontaneously by participants, as well as through the follow-up questionnaire.

To the best of our knowledge, this study was the first to examine the utility of Pennebaker’s expressive writing with drug-dependent women. The ability to reduce trauma symptom severity, depression, and anxiety early in drug treatment can be beneficial in many ways (e.g., increasing patients’ ability to concentrate during counseling sessions, reducing risks for leaving treatment prematurely, and reducing risks for relapse). Thus, future studies should explore whether extending the intervention in ways that maintain or further ‘boost’ short-term improvements at a later time, possibly through more writing sessions distributed over the course of SUD treatment, may enhance longer-term effects. Future analyses should examine essay content and congruence between topic chosen and measures of traumatic stress, as well as whether the same versus difference topic across all writing sessions.

The population also represents women of diverse race, substance use diagnoses, and psychiatric symptom severity. The majority of women had less than a high school level of education, were under-employed, uninsured, single/never married, and were thus a vulnerable population with a variety of medical and psychosocial problems and fewer resources than others with SUDs. It is noteworthy that in a population that generally has difficulty adhering to treatment, expressive writing was well received and regarded as helpful by the participants, themselves ( 43 ). Thus, expressive writing was found to be a brief and low cost adjunct to current residential SUD treatment. Expressive writings’ efficacy, efficiency, and cost-effectiveness, suggest that writing as a means of disclosing traumatic experiences may be a useful adjunct to traditional SUD treatment.

Acknowledgments

his research was supported by NIH grant NIDA R36 DA024021-01 and from the VCU Institute for Women’s Health

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Drug Abuse Reports Samples For Students

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Introduction - Physical activity - Overweight and Obesity

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Access to health care And Educational Plan Introduction Physical activity: - My partner NA is uses public transportation and takes daily walks for about a mile while conducting. She is not enrolled in a gym, but has a schedule of physical activities daily from which three to four are chosen every day. She loves participating in athletics

Overweight and Obesity:-

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Paula Writes

Paula puddephatt – author, writing about substance abuse in your fiction.

Drug addiction and alcoholism are challenging, controversial, and complex to write about, but I personally choose to address both, in my fiction.

I do have personal, although not recent, experience, in the areas of problem drinking and volatile substance abuse – but not of using illegal drugs.

There are many resources that can help with our research online, but definitely, a lack of material dealing specifically with how to write about these issues, in our fiction. I hope that this will change and, even though I can by no means claim to be an expert on substance abuse, I’m going to share what I am able to, at this point in time.

I did touch upon the subject of drug and alcohol abuse, in my post regarding how I address mental health issues, in my fiction . Mental illness and addiction are closely related, so I would suggest reading that post, for further insights.

Now, let’s get into the tips for writing about characters with substance abuse issues.

Just one more quick note first, though – to mention that addiction covers much more than substance abuse. I recognise that addictions to gambling, shopping, and so on, are very real. I simply can’t deal adequately with those, in the context of this one post.

Drug addiction, alcoholism, and binge drinking are also subjects that feature heavily in my WIP, making it natural that I would make it a priority to discuss these matters, here on my blog. 2020 update: The WIP, referred to here, is my novel Distorted Perceptions , which was published this year .

It’s vital to know about the physical effects of any substances your characters are abusing.

That’s the absolute minimum, so start your research there.

Know how the drug alters the personality and behaviour of your character.

If a character is introduced to readers prior to the addiction, contrast and changes will be easier to demonstrate. Early warning signs should be evident.

Know in yourself, at least, how the character was before. It may mean delving into backstory. Was there any trauma, in the character’s past, that contributed to development of the addiction?

There will be some perceived benefits.

What does the drug do for the character? Does it numb physical or/and emotional pain? Ease symptoms of anxiety? Alcohol, for instance, is often used in an attempt to self-medicate, by sufferers of social anxiety.

There will be specific ways, in which the addiction clearly controls the character. Make sure that you show some of these.

How does the person fund their habit?

Any committing of crimes, such as burglaries? Has the addict become a dealer? And, of course, to say that it is not easy to escape those networks, is an understatement. Attempting to do so could place the person, along with loved ones, in very real danger. This would be an obstacle to recovery, even if the character was able to “get clean”.

How have relationships with family members and friends, who are not themselves addicts, been affected?

People, however close, will draw the line somewhere, and most will, ultimately, walk away. So much damage will have been done, possibly over years or decades.  There can come a point, at which the strain is more than the relationship can take.

Usually, an addict will reach a crisis point – rock bottom, basically – and then decide to change.

Is your character able to give up drugs, drink, or both – as applicable? Does the individual subsequently relapse?

Do your research regarding the long-term health implications.

There could be serious, and even fatal, physical health consequences. Equally so with mental health. The addict is at an increased risk of suicide.

Access your own inner darkness.

Even if you haven’t had the precise experience that you’re describing, you can probably relate, on some level, to aspects. If you were drawn to write dark fiction , in the first place, there’s a reason.

Survivors understand survivors. Research the specifics, but beyond that, write from the heart.

Writing about drug addiction and alcoholism is no easy task, but I hope that these tips will guide and inspire you, as you attempt to realistically portray substance abuse, in your fiction.

More specific information, regarding substance abuse and addiction

Connect with me on social media .

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12 Comments

March 13, 2018 — 3:11 am

This is a great post! I’ve been juggling the idea of writing a fantasy-style work that has some elements of substance abuse in it for a bit, but I have absolutely no experience (personal or otherwise) with the topic, so I’m afraid I won’t be able to do it justice. You listed a ton of things that I never considered, and I’m feeling inspired to go back and try to flesh out the story with more details. Thanks for sharing!

Like Liked by 1 person

March 13, 2018 — 6:41 pm

Thank you, Alex. I really appreciate your positive feedback, and I’m glad I was able to help. It was one of those posts I wrote partly because I struggled myself to find anything like it online. Good luck with your project.

March 14, 2018 — 6:58 am

Thank you for this post! I have a fantasy (epic/high) that revolves around an addiction as one of the primary plot struggles for the MC. While it is not substance or alcohol but rather an animal (yes, the MC is addicted to a beast) they consequences and questions you listed still apply. It brings to light many tips and ideas that I have not yet considered. Very helpful and thank you.

March 14, 2018 — 3:21 pm

Thank you for reading and commenting, Rhia. I’m glad that my post was able to help you. I agree that much of the information can be transferable, and apply to more than drug and alcohol addictions.

June 14, 2018 — 5:26 pm

Wow interesting stuff. Check out myvaliumstory. May give you a new perspective

June 14, 2018 — 6:27 pm

Thank you. And yes, I’ll take a look.

December 12, 2022 — 2:40 am

December 12, 2022 — 9:56 am

4 Pingbacks

• How To Write An Addiction Into Your Story. | A Writer's Existence
• Writing About Substance Abuse in Your Fiction – Paula Writes - Lacrecia’s books
• How To Write An Addiction Into Your Story. - G.Edward Smith
• How I Do Research

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