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ADHD in adults: what it’s like living with the condition – and why many still struggle to get diagnosed

Many of us think of ADHD (attention deficit hyperactivity disorder) as a childhood condition – which is typically when it’s diagnosed. But a growing number of people are sharing their experiences of being diagnosed with ADHD in adulthood. Social media has even played a role in this, with reports of people going to see their doctor after first learning about symptoms on TikTok. In fact, around 2.5% of adults are thought to live with ADHD – including us. Yet despite this growing awareness, many adults continue to struggle to get a diagnosis. ADHD is a genetic neurodevelopmental disorder, in which the brain grows differently, lacking action from specific chemicals involved in pleasure and reward. This means ADHD brains often search for ways to stimulate these chemicals, which is why people can experience inattentiveness, hyperactivity and impulsivity. Common traits of ADHD include: Not following through on longer tasks (or not starting them) Getting distracted by other tasks or thoughts Seeking out risk or activities that provide immediate reward Restlessness (either outwardly or internally) Interrupting other people (without wanting to) Symptoms are similar for both adults and children, although elements of them differ or change as we age. For example, inattention is the most persistent symptom in adults. ADHD can be debilitating and is associated with higher likelihood of lower quality of life, substance use issues, unemployment, accidental injuries, suicide and premature death. In addition, ADHD can cost adults around £18,000 per year because of things like medical care or paying for social support. It’s also commonly associated with a wide range of co-existing conditions in adults. For example, depression is almost three times more prevalent in adults with ADHD. And nearly half of all adults with ADHD also have bipolar spectrum disorder. Around 70% of adults with ADHD also experience emotional dysregulation, which can make it more difficult to control emotional responses. It’s also thought that almost all adults with ADHD have rejection sensitive dysphoria, a condition where perceived rejection or criticism can cause extreme emotional sensitivity or pain. On top of this, adults with ADHD may have poor working memory – such as being unable to remember a simple shopping list – and “time blindness” (the inability to perceive time). Some may also have oppositional defiant disorder, which means they often react poorly to perceived orders or rules. While none of these co-existing conditions are used to diagnose ADHD, they can make ADHD feel all the more difficult to live with. Being diagnosed Getting an ADHD diagnosis as an adult in the UK is notoriously difficult – with reports of some people waiting up to five years. Waiting for a diagnosis is common for adults with ADHD. Roman Kosolapov/ Shutterstock This is because you can only be diagnosed by a specialist psychiatrist. But even with a referral to a specialist, a person has to show clear evidence of almost all ADHD traits, having had these traits since childhood, and that they’re having a serious affect on their life – such as causing issues with work, education, or maintaining relationships. For us, our experiences of being diagnosed with ADHD aren’t all that different from what other adults have gone through. Like many people I (Alex) was only diagnosed with ADHD “by accident” after being referred to an NHS psychiatrist to get help with (what I now know to be) alcohol self-medication. Because of my ADHD, my brain demands quite extreme inputs most of the time. Ironically, I’ve published scientific papers on ADHD and – probably due to a classic ADHD lack of self-awareness – it didn’t cross my mind that I could have it. The “label” has since helped me move away from feeling broken toward an understanding of my behaviour. My main challenges remain prioritising tasks based on importance (instead of excitement) and quite extreme anti-authority behaviour (sometimes called oppositional defiance). I am also a terrible spectator, struggling to attend conference talks or sit still at the theatre – it can feel like physical pain. On the other hand, I (James) was diagnosed pretty quickly because I used a private clinic – though there was still a long wait for medication. Yet I’d known for five years before this that I probably had ADHD, but coped with it well until the pandemic. The added pressure of isolation and increased workload impacted my mental health, so I sought a diagnosis. Now diagnosed and medicated, life is getting easier to cope with – although there are still many challenges every day. I frequently get anxiety about the silliest things, like talking to a friend, but appearing on television is fine. On a daily basis I forget many simple things, such as where I left my keys, or that I am running a bath. I struggle immensely with controlling my emotions and with rejection especially. For example, when no one responded to a joke I made about my ADHD on a senior management messaging group I was tempted to quit my job. I am utterly unable to pay full attention in meetings or seminars and cannot control my impulse purchasing. While there’s a growing recognition of ADHD in adults, many people still live with it undiagnosed for any number of reasons – sometimes even because they’re unaware that what they experience is actually different from other people. Understanding the condition in adults, taking it more seriously as a disorder, raising awareness of it, and investing in services to improve diagnosis times are key. Diagnosis opens the door to treatment, which can have a marked impact on living with the disorder – such as improving self-esteem, productivity and quality of life. This article was co-written by Dr James Brown (Aston University) and Dr Alex Connor (University of Birmingham)

Gun violence expert on Biden gun violence plan

Jonathan Metzl, Frederick B. Rentschler II Professor of Sociology and Medicine, Health, and Society, is available for analysis on President Biden's gun violence plan. A recognized author and expert source in the wake of gun incidents and mass shootings, Metzl can speak from a balanced perspective on the legacy of mass shootings, gun violence, gun legislation and reform and narratives around mental health. Dr. Metzl is the author of the book, Dying of Whiteness, which examines the stereotypes of race and mental illness surrounding gun violence, and recent research, which lays out a five-part agenda for future research into mass shootings and multiple-victim homicides.

Tennis Pro Naomi Osaka Elevates the Conversation on Athletes and Mental Health

Though Naomi Osaka's announcement of her dropping out of the French Open and German Open tournaments came as a surprise to many of her followers, there has been plenty of support from fans and corporations for the 23-year-old tennis pro who chose to take time off because of mental health concerns. One company, the Calm App, offered to pay fines for tennis players skipping press briefings. And Formula 1 champion Lewis Hamilton—who, when he was 22 years old, found it difficult to deal with media commitments—offered encouragement to Osaka. "When you’re young and you're thrown into the limelight, it weighs heavily, and most of us are not prepared," Hamilton told The New York Times. Guy Weissinger, PhD, an assistant professor in Villanova's M. Louise Fitzpatrick College of Nursing whose research focuses on mental health, says, "Elite athletes are people. They have mental health struggles—good days and bad days—and it's important that we recognize that mental health is complicated, not just 'doing well' or 'not doing well.'  One may be capable of doing one thing (i.e., playing tennis) but not other things (i.e., being peppered by reporters with questions). It saddens me that she needed to withdraw from the tournament rather than the tournament organizers reaching out to find ways to accommodate her mental health needs." He noted that the 23-year-old Osaka is an amazing athlete who rose to global prominence beating Serena Williams in a match that got a lot of negative attention. "While no one was saying that she did not deserve her victory, the conversation was mostly focused on Serena, and Osaka was a teenager caught in a media firestorm. I could see how that would create a high level of baseline anxiety around the Opens and media interactions for her, in addition to the already stressful situation of participating at that elite level of sports. Combine that with the high level of stress that everyone has been experiencing over the last year and a half, with COVID, I'm surprised that she isn't the only person who has said that they would be unable to do media appearances." He says this is a great opportunity for discussion of mental health and how it's a concern for everybody. "Too often, we think of people that are successful as being immune to mental health struggles, but we have to acknowledge that people can be both successful and struggling. Sometimes they will be able to manage (as Naomi has in many circumstances), but sometimes even their best coping mechanisms are not enough." Weissinger hopes that we can find ways for people to 'tap out' of the things that overwhelm their ability to cope. "It's not fair or ethical to only wait until people are not just struggling but completely drowning before trying to support or accommodate them. Like with physical health, prevention before things get bad is better for everyone than trying to fix things when they get really bad."

Six reasons why potatoes are good for you

The humble potato has been given a bad rap. What was once a cheap staple of many countries’ diets has instead been branded in recent years an “unhealthy” food best avoided. Eating too much of any type or group of food (like carbohydrates) isn’t healthy, and some research suggests eating too many potato products in particular might be associated with higher blood pressure. But it’s typically the way we prepare and consume potatoes (like frying them) that cause negative effects. In fact, potatoes contain a lot of vitamins and other nutrients that are important for health. Here’s six reasons why potatoes are good for you. 1. Vitamin C People typically associate vitamin C with oranges and citrus fruit. But an important source of vitamin C in British diets for most of the 20th century actually came from potatoes. On average, a small (150g) potato provides us with about 15% of our daily vitamin C. Get your news from people who know what they’re talking about. Vitamin C is important as not only does it support immune function and contain antioxidants, it plays an essential role in forming connective tissue, which helps our joints work – and holds our teeth in place. This is why vitamin C deficiency (scurvy) is linked to teeth falling out. Read more: How the humble potato fuelled the rise of liberal capitalism – podcast 2. Vitamin B6 Vitamin B6 is an essential co-factor (a small molecule) in the body. It helps over 100 enzymes in the body function properly, allowing them to break down proteins – a process key to good nerve function. This may also be why B6 is linked to good mental health. Typically, a small potato will contain around a quarter of an adult’s recommended daily intake of B6. 3. Potassium Having potassium in our cells is important for regulating the electrical signalling in muscles and nerves. So, if potassium gets too high or low, it can stop our heart working. Roast, baked and fried potatoes contain higher levels of potassium than boiled or mashed potatoes, with a jacket potato containing around a third of the recommended daily intake. This is because boiling diced potatoes can cause around half of the potassium to leak out into the water. However, people with kidney disease – which can limit the ability to remove excess potassium from the body – may need to limit the number of potatoes they eat. And if you do roast or fry your potatoes, be careful how much oil you use. 4. Choline Choline is a small compound which attaches to fat to make phospholipids, the buildings blocks of cell walls, as well as the neurotransmitter acetylcholine (which helps us contract muscles, dilate blood vessels, and slow heart rate). Potatoes contain the second highest levels of choline, next to protein-rich foods, like meat and soya. It’s vital to consume enough choline as it’s essential for a healthy brain, nerves, and muscles. And subtle differences in our genes may mean some of us are naturally more deficient in making choline. A jacket potato contains around 10% of a person’s daily choline requirements. Choline is particularly important in pregnancy, as the growing baby is making lots of new cells and organs. 5. Good for our stomach Cooking and cooling potatoes before eating them allows resistant starch to form. This healthy starch helps our bodies in many ways, including by acting as a prebiotic (which are important for a healthy gut microbiome). The cooling of fluffy, cooked starches causes them to collapse. While this actually makes them harder to digest, this means that the bacteria in our colon then ferments them, producing compounds similar to vinegar called short-chain fatty acids. These fatty acids nourish our guts and keep it healthy. Short-chain fatty acids can also alter our metabolism in a good way, helping lower blood fat and blood sugar levels. This – together with their high water and low-fat content – makes boiled and steamed potatoes a low calorie, nutrient dense and filling food. 6. Naturally gluten free Potatoes are also naturally gluten free, so are a great option for people with coeliac disease or who need to avoid gluten. The same is true for sweet potatoes, which also have a lower glycaemic index – which means they don’t cause a sharp spike in blood sugar, which may help control weight and appetite. However, sweet potatoes are slightly higher in calories and carbohydrates than regular potatoes – though they contain more beta carotene (a form of vitamin A). Potatoes on your plate Some people may choose to avoid potatoes due to concerns about weight gain – but a typical boiled potato is only around 130 calories, which is actually fewer calories than a banana of the same size. But it’s important to remember how potatoes are prepared and what they’re eaten with. Boiling or steaming (possibly with cooling to increase the resistant starch) is the best way to keep the number of calories per gram low. Baking will increase calories per gram (as water is lost), as can mashing with butter or cream. The least healthy way to eat potatoes is as chips or crisps, as they soak up oil like a sponge. You’ll also want to avoid green potatoes. This happens when the potato has been stored in light and produces a toxin which can irritate our gut. Otherwise, for most people including potatoes as part of a healthy and varied diet may actually be a good thing. And alongside being healthy, potatoes also have environmental advantages. They require less water than rice to produce, and less greenhouse gases than both rice and wheat – which may be yet another good reason to include potatoes in your diet. Originally posted on The Conversation - Six reasons why potatoes are good for you

Rare and complex syndromes in children to be investigated by new research network

New and improved ways of supporting children with rare and complex syndromes are to be investigated by Cerebra’s pioneering collaborative research network – a unique academic team that integrates knowledge, expertise and resources across universities in the Midlands and Surrey; including Aston University, University of Surrey, University of Birmingham and University of Warwick. Cerebra Network Co-Director Dr Jo Moss, University of Surrey said: “The Network is a true collaboration that is integrated from the ground up to deliver a higher impact from its work and its funding than any individual approach could offer.” Funded by the charity Cerebra, the Cerebra Network continues and expands upon the work of the Cerebra Centre for Neurodevelopmental Disorders and aims to improve the lives of individuals with rare genetic syndromes and other neurodevelopmental conditions associated with intellectual disability and their families. A cornerstone of the Network’s approach is the collaboration between researchers at the four different universities, which can better reflect the multifaceted presentation of children with rare and complex disorders such as fragile X syndrome, Smith-Magenis syndrome, Tuberous Sclerosis Complex, Prader-Willi syndrome, Down syndrome, and Cornelia de Lange syndrome. Cerebra Network Co-Director Dr Caroline Richards, University of Birmingham, said: “Our aim is to improve the evidence that underpins better assessment and interventions and leads to improved outcomes for these children and their families. This area of research is underrepresented in modern academic circles.” Cerebra Network Co-Director Dr Hayley Crawford, University of Warwick said: “A Network that can work with families and children across a number of characteristics within a single team will yield better, more accurate assessments, evidence and ultimately therefore intervention guidance and solutions for clinicians and families.” The Cerebra Network for Neurodevelopmental Disorders will be launched at a public event on Thursday 3 June by academics and clinicians from the University of Warwick (Dr Hayley Crawford), University of Surrey (Dr Jo Moss), University of Birmingham (Dr Caroline Richards) and Aston University (Dr Jane Waite). The virtual event will showcase its upcoming research into the challenges faced by children with rare genetic syndromes associated with intellectual disability in everyday settings, as well as the close work the team does with their families. Cerebra Network Co-Director Dr Jane Waite, Aston University said: “The launch event will be an opportunity to hear about the work that is being conducted by the Network and how this sits in the wider field of intellectual disability research.” The day will be split into a Family Focus Session from 10am – 12.15pm and a Research Focus Session from 1pm – 3.45pm, both open to members of the public. The Family Focus Session will be of particular interest to parents and carers of people with neurodevelopmental disorders and their families, and will cover the research the network aims to do, family experiences of that research, and question and answer sessions. The Research Focus Session will focus on the research behind the Network’s three key themes: Autism, Sleep and behaviour, and Mental health. Of particular interest to academics and professionals working with people with neurodevelopmental disorders, it will include talks by researchers and clinicians in the field with the opportunity for a live Q&A session. Tracy Elliot, Head of Research and Information at Cerebra, said: “We are investing in this collaborative and vibrant network of researchers with the combined aim of improving the lives of individuals with multiple and complex needs. This is an exciting new development in the way we fund research, one we believe will yield impactful and lasting outcomes for families.”

Baylor Consumerism Expert Shares Five Tips to Make the Most of Your Stimulus Check

With President Joe Biden’s $1.9 trillion American Rescue Plan Act, citizens nationwide received a second round of stimulus checks in the form of $1,400 per person and an additional $1,400 per dependent. The Rescue Plan also brought increased child tax credits and unemployment benefits. James Roberts, Ph.D., The Ben H. Williams Professor of Marketing in the Hankamer School of Business, is an internationally recognized expert on consumerism and the author of “Shiny Objects: Why We Spend Money We Don’t Have in Search of Happiness We Can't Buy.” He said the latest round of stimulus funds offer consumers bright opportunities, but he also cautioned against pitfalls in uncertain times. Roberts said that people should first consider building up their emergency savings funds – a step, he said, more Americans seem to be taking during this time of pandemic and economic fluctuation . “Over the last 20 years or so, Americans have not saved much. However, in the first nine months of the pandemic, the U.S. savings rate increased by a whopping 100 percent. By some estimates we are at a national savings rate that hovers around 20 percent – which is incredible,” Roberts said. Roberts shared a few tips on how to get the best value for your stimulus check and prepare for times ahead: 1. Enhance your savings. Save a portion of your stimulus check for the inevitable rainy days ahead. Start with $1,000 to your short-term emergency fund. If possible, every family should have a $2,500 emergency fund. This provides peace of mind and avoids having to borrow from friends or family, or even worse, max out your credit cards or take out a “payday” loan, which I strongly advised against. 2. Invest in experiences. Given that a lot of Americans have significantly increased their savings and lowered their credit card debt, I say people should splurge a little on something for themselves or their families with the remaining $400. Remember, experiences bring more lasting happiness than buying stuff. Good mental health is critical to our well-being. 3. Start early. Don’t forget that the $1,400 stimulus check is only a small part of the money that may come your way. The child tax credits are a great opportunity to save for your children’s college. The earlier you start saving, the better. This is the beauty of compounding interest. 4. Save while unemployed I suggest any extra boost you might get in your unemployment check be saved for the days ahead. Don’t let money burn a hole in your pocket. 5. Plan ahead. Every family’s goal should be to set aside six months in living expenses so if you do lose your job, it doesn’t put you and your family into an immediate financial death spiral. ABOUT DR. JAMES ROBERTS James Roberts, Ph.D., is The Ben H. Williams Professor of Marketing in Baylor University’s Hankamer School of Business. He is a nationally recognized expert on consumer behavior and has been quoted extensively in the media and has appeared on the CBS Early Show, ABC World News Tonight, ABC Good Morning America, NBC The Today Show, Yahoo.com’s “The Daily Ticker,” and has been quoted and/or featured in The New York Times, The Wall Street Journal, National Public Radio, USA TODAY, TIME, FOX News, The Doctors on CBS, US News & World Report, Cosmopolitan, Glamour, and many other media. His books include “Shiny Objects: Why We Spend Money We Don’t Have in Search of Happiness We Can't Buy” and “Too Much of a Good Thing: Are You Addicted to your Smartphone?” ABOUT BAYLOR UNIVERSITY Baylor University is a private Christian University and a nationally ranked research institution. The University provides a vibrant campus community for more than 19,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating University in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 90 countries to study a broad range of degrees among its 12 nationally recognized academic divisions. ABOUT HANKAMER SCHOOL OF BUSINESS AT BAYLOR UNIVERSITY At Baylor University’s Hankamer School of Business, top-ranked programs combine rigorous classroom learning, hands-on experience in the real world, a solid foundation in Christian values and a global outlook. Making up approximately 25 percent of the University’s total enrollment, undergraduate students choose from 16 major areas of study. Graduate students choose from full-time, executive or online MBA or other specialized master’s programs, and Ph.D. programs in Information Systems, Entrepreneurship or Health Services Research. The Business School also has campuses located in Austin and Dallas, Texas. Visit baylor.edu/business.

Ask the Expert: Five tips for going back into the real world

This story is part of a Mental Health Awareness Month series highlighting Michigan State University research and expert knowledge. In honor of May as Mental Health Awareness Month, MSU's Claudia Finkelstein, associate professor of family medicine at MSU’s College of Human Medicine, offers tips on how each of us can reenter “normal” life. After a long year of change and adjusting to ever shifting goal posts of “the new normal,” we seem to be heading out of the worst of it. There is cautious optimism about the months ahead based on current trends. Along with optimism, there is a vague pervasive anxiety about how to navigate the times ahead. Even Saturday Night Live is aware of the anxiety and awkwardness of this long-awaited stage of the pandemic. Here are five tips to help you in your reemergence. 1. Do not forget joy, whimsy and laughter. People have suffered. People are suffering. In our desire to help, sometimes we lose focus on some simple joyful things that can restore us. A good laugh — even at a blooper reel can be restorative. Snuggling — a baby, a puppy, or a vaccinated loved one will send oxytocin through the roof. And remember these paraphrased words from Aron Sousa, dean of MSU’s College of Human Medicine, “If you’re going to be exhausted, you might as well have a little whimsy.” So, do laugh, snuggle and do something whimsical. 2. Don’t be a jerk. Seems self-evident doesn’t it? However, whether in traffic, in public or in the comments sections of whatever we read, there is no lack of evidence that there is a lot of pent-up anger going around. It is so normal to prefer anger — which is energizing and helps us feel self-righteous — to sadness or grief. However, allowing the sadness and grief (and anything else) to arise will help us to move on. So, do become aware of signs of your own anger arising, and ask yourself what is the emotion behind the anger? See if allowing that emotion to exist will also help it to pass. 3. Remember what is “my business, your business, universal business” and respond accordingly. Being annoyed that other people in your work group or family are not living their lives according to your standards is rarely (actually never) fruitful. The fact that “Shirley” doesn’t do things the way you would have is her business unless you supervise her. The fact that you did a great job and are happy with the outcome is your business. The fact that it’s 39 degrees in May is universal business – fruitless to be mad – just put on a sweater. 4. Try to find common ground. This one may seem like a huge challenge. These days we are certainly divided. However, usually there is some basic value that we can agree on. The common ground may be as simple as “we hope for safety and good health for our whole community.” 5. Keep an eye on yourself and each other. Although some of these tips are lighthearted, it is a challenging time for many. We often have no idea what burdens others are carrying. You never know what power a kind word carries. During this mental health awareness month, remember to heed the words of Bill and Ted: “Be excellent to each other.” If you're a journalist looking to cover Mental Health Awareness Month and would like to book an interview with Claudia - then let us help. Claudia Finkelstein, associate professor of family medicine at MSU’s College of Human Medicine is available to speak with media - simply click on her icon now to arrange an interview.

A Neuroscientist’s Guide to Managing Post-COVID-19 Anxiety When Returning to Work

With the Centers for Disease Control and Prevention relaxing mask-wearing restrictions and many companies like Google and Goldman Sachs asking employees to return to the office after working remotely since the start of the COVID-19 pandemic, some people are nervous to re-enter society. According to Alicia Walf, a neuroscientist and senior lecturer at Rensselaer Polytechnic Institute, the most effective way to overcome fears about re-engaging with the world may simply be to get back out into it. “Positive human connections are the most powerful tool for reducing stress,” she said in a recent Reader’s Digest article. To control anxiety and improve the health of our brains, Walf also suggests some basic steps like getting sufficient sleep, eating a good diet, and removing distractions to improve focus. Ultimately, a return to normalcy after such a long period of constant stress will be an important step toward restoring brain health. “There can be lasting effects of intense stress on the brain,” Walf said. “Social isolation is an incredibly stressful event associated with increased stress hormone levels and many other long-term negative health consequences. Clinicians are rightfully concerned about the long-term effects of this pandemic on mental health, which may involve these changes in the stress response and brain circuits.” And while feeling anxious may be unpleasant, stressful experiences can be learning experiences. According to Walf, adaptability is an important part of resiliency to stress, and a useful trait to work on us we adjust to our changing world. “Although not wearing masks and returning to work are now major changes in many of our routines, producing feelings of anxiety,” Walf said, “the benefits of social interaction will likely help us return to our routines yet again and reduce the potential for long-lasting negative consequences of stress.” Walf studies the brain mechanisms of stress and reproductive hormones as they relate to behavior and cognition, brain plasticity, and brain health over the lifespan. Specific areas of her expertise are memory, emotions, and social interactions and how these functions not only arise from the brain but change the brain itself.

Social Work is Advancing Addiction Science Research

Tens of thousands of Americans die from drug use and addiction every year, with overdoses killing over 63,000 people in America in 2016, according to the National Institute on Drug Abuse. Add in deaths linked to alcohol overuse and tobacco, and the number climbs above half a million Americans. The collective work of several researchers at the USC Suzanne Dworak-Peck School of Social Work, in collaboration with other USC faculty and outside organizations, is advancing knowledge of substance use disorders. Social work has become a hub where researchers and practitioners drive understanding and improve treatment for this disease that impacts millions of families each year. “Either as a cause or consequence, addiction relates to every problem we deal with in social work,” said John Clapp, professor and associate dean for research and faculty development at the USC Suzanne Dworak-Peck School of Social Work. Addiction’s complexity The social work field is uniquely poised to help effect change because of its holistic approach to individual well-being and the public good. According to Clapp, substance use disorder problems are inherently ecological, impacting and being impacted by individuals, families, peers, neighborhoods, communities and public policy in complex and dynamic ways. Untangling those causes and effects and interdependencies is one part of the solution. The other part is understanding that simple solutions may stay out of reach. “We will not find a one-size-fits-all answer,” said Clapp. Looking at addiction as a genetic, psychological or sociological issue only shows one piece of the overall cause. A comprehensive approach is essential, he said, especially when statistics from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) show alcohol use disorders alone as the third leading cause of preventable death in the world. A hub for addiction science The need for a transdisciplinary response to this worldwide crisis was behind the 2018 creation of the USC Institute on Addiction Science (IAS), a joint venture between social work and the Keck School of Medicine of USC, with membership from 10 different schools, colleges and hospitals. Its vision is to strengthen the discipline of addiction science and improve the lives of those touched by the disease. Clapp is co-director of the institute and one of its founding architects. IAS is quickly becoming the foremost place for a broad effort focused on addiction that brings together researchers from the fields of public health, social work, law, public policy, mathematicians, computer engineers and others in recognition of the promise of new approaches to longstanding problems. The USC Suzanne Dworak-Peck School of Social Work has eight faculty making substantial contributions to the prevention of addiction-related disorders as members of the IAS: Professor Avalardo Valdez, associate professors Julie Cederbaum and Alice Cepeda, and assistant professors Jordan Davis, Shannon Dunn, Jungeun Olivia Lee, Danielle Madden, and Hans Oh. “Social work brings one of the broadest perspectives on the underpinnings and solutions to the addiction crisis,” said Adam Leventhal, director of IAS and professor of preventive medicine and psychology at Keck. “By approaching addiction as a health condition and a social justice issue, social work brings to the table the opportunity for high-impact, multi-modal intervention and social policy approaches, which are needed to address the addiction epidemic.” A holistic approach Social work faculty are raising the bar in addiction science research, developing new and novel approaches to improving outcomes for those affected by addiction. In a study recently published in Addiction, a multidisciplinary team lead by Davis and Clapp found gender differences in the risk factors for relapse following treatment for opioid use disorder. The study was the first in this field to use machine learning techniques to process large data sets and identify risk factors for relapse, said Davis, who also serves as associate director of the USC Center for Artificial Intelligence in Society (CAIS). The findings may result in more personalized treatment for opioid use disorder with lasting results. This dovetails with additional research Davis is conducting with computer science engineers at CAIS to collect and input neighborhood and census data into their models in an effort to better understand how these macro variables affect relapse. “We are finding that data points such as crime statistics, population density and concentrated poverty tend to be some of the most important predictors of relapse, over and above individual-level predictors such as impulsivity, motivation or gender,” Davis said. These findings echo Clapp’s description of addiction as ecological and point to the need for holistic solutions. “These machine learning techniques are helping us gain an apparent picture of what the most important factors are surrounding someone’s recovery,” Davis said. “Environment matters greatly.” Davis is also collaborating closely with Eric Pedersen, associate professor at Keck School of Medicine at USC, on several research efforts examining substance use among veterans. Most recently, they have assembled a survey group of approximately 1,200 veterans whom they survey quarterly about their well-being. A recently conducted survey of the group found that veterans with PTSD prior to the COVID-19 pandemic were now managing their symptoms with more frequent alcohol and cannabis use. Another joint research endeavor between the two is examining the use of mindfulness smart phone apps to help reduce substance use in Operation Enduring Freedom/Operation Iraqi Freedom veterans with PTSD and alcohol use disorder. Where well-being and inequalities intersect Jungeun Olivia Lee also seeks to decode the network of relationships between socioeconomic status, adverse childhood experiences and drug use. Her experience as a social work practitioner working directly with clients drives her motivation to demonstrate to policymakers what she sees as a linkage between unemployment, economic stress and substance use disorders. She is lead author on a paper published in Nicotine & Tobacco Research that found unemployment may advance nicotine addiction among young adults, rather than the idea that nicotine addiction may lead to unemployment. Lee’s research interests lie at the intersection of substance use and co-occurring mental health, social inequalities (such as poverty and low socioeconomic status), and adverse childhood experiences. She is interested in combining these three areas of inquiry to explore their influence on addictive behavior that can persist over generations of at-risk families, such as adolescent mothers and their children. Her memories of working directly with clients struggling with the impact of addiction remain clear in her mind. When Lee hears policymakers and others suggest that individual willpower will solve substance use disorder problems, she has a straightforward response: “People are not born with addiction.” In her view, many factors contribute to the triggered distress, including socioeconomic status and adverse childhood experiences. Lee is exploring an idea with other IAS researchers to investigate the relationship between financial strain and employment uncertainty and addiction. “Individual circumstances, such as losing a job, certainly influence substance use, but policy-level decisions, such as the generosity of unemployment insurance, can mitigate the impact,” she said. Transdisciplinary collaboration with social scientists, psychologists and medical researchers at IAS and across the USC campus enriches and amplifies her work. “We are breaking down discipline-specific silos and bringing new and valuable perspectives to this work,” she said. “The synergy is both useful and inspiring.” Looking ahead Researchers also hope to spark interest in the field among the next generation. A new minor for undergraduate students in addiction science was introduced at USC in Fall 2020. The minor is an interdisciplinary collaboration of the Keck School of Medicine, the USC Suzanne Dworak-Peck School of Social Work, the USC School of Pharmacy and the USC Dornsife College of Letters, Arts, and Sciences. It is designed to provide students with a transdisciplinary approach to understanding and treatment of the broad spectrum of addiction-related problems. The goal of addiction science research and education is to improve the long-term effect of addiction treatment and save lives. As society’s understanding of the cause of addiction grows, researchers like those in the school of social work and the IAS strive to bridge the gap between science, practice and policy to positively impact outcomes for those affected by addiction.

COVID-19 Pandemic Increasing Substance Use Among Veterans with PTSD

Nine months into the pandemic, everyone has been affected by COVID-19 in some way. However, one group that needs special attention and support is U.S. veterans who were already struggling with symptoms of posttraumatic stress disorder (PTSD). A recently conducted survey by Jordan Davis, assistant professor at the USC Suzanne Dworak-Peck School of Social Work, and Eric Pedersen, associate professor at Keck School of Medicine of USC, found evidence that veterans with PTSD prior to the pandemic were now managing their symptoms with more frequent alcohol and cannabis use. “The pandemic has not been easy on folks, especially for those that have PTSD or an alcohol use disorder (AUD),” said Davis, who also is associate director of the USC Center for Artificial Intelligence in Society (CAIS). “Some of the stories I’ve heard [from study participants] have been heart-wrenching.” An extraordinary resource of veterans not affiliated with VA services Davis and Pedersen lead several efforts examining substance use among veterans. They have assembled a survey group of about 1,200 military veterans, a percentage of whom struggle with PTSD symptoms but have not yet sought professional help via the Department of Veterans Affairs (VA) to improve their wellbeing. “We’ve decided to focus on the population of veterans who, for one reason or another, say they don’t need mental health care,” Davis said. Attitudes about care, transportation barriers or perceived stigma from others may deter them from seeking care for PTSD symptoms, and some self-medicate with alcohol, cannabis, cigarettes, or more rarely, methamphetamine or cocaine. Davis cited larger studies 1,2 that found only about half of the veterans who need some sort of mental health care receive it. Many studies of veterans recruit subjects from the VA who are likely already receiving care. The unique sample group that Davis and Pedersen have created may offer fresh insights into how to motivate these veterans outside the VA system to seek care and how best to deliver it. Tracking pandemic effects on mental health It all began with a one-time survey of young adult veterans to measure drinking habits and willingness to seek help. Pedersen and others had developed a brief intervention that had yielded some success reducing drinking in the short-term, but he knew that sustaining those reductions would be difficult unless the veterans agreed to more formal care. The one-off survey, conducted in February 2020, would set a baseline that could be used to inform the brief intervention content. Then COVID-19 cases began multiplying. Affected cities and states began to impose restrictions on public gatherings and more. Pedersen and Davis soon obtained additional funding from the Keck School of Medicine of USC COVID-19 Funding Program and the National Institute of Alcohol and Abuse to follow up with their sample group and see how these veterans were coping with the unprecedented health crisis. “The result is that we can follow up with these veterans from a pre-COVID-19 time period for the next several years, tracking their depression, anxiety and PTSD symptoms and substance use,” Pedersen said. The researchers aim to understand how the veterans are sleeping, what their stress levels are like, and how things have changed as the pandemic wears on. They hope to gain new insights about what motivates some to seek care and how that can be replicated. So far, the results point to some unfortunate, but not unexpected, news. “We’re finding that those veterans who were struggling with PTSD prior to the pandemic are actually doing worse in terms of their substance use behaviors, drinking and cannabis use, as well as their stressful reactions to the pandemic,” Pedersen said. Pedersen and Davis will continue to follow up with these veterans through at least February 2022, surveying them every three months to see how they are progressing. In addition to the survey, they also conduct in-depth qualitative interviews with a subset of the group to enrich their understanding of what their lives are like now and how things have changed for them. The interviews last about an hour, sometimes more. “We talk about the positive and negative things that have happened and what their expectations are for the future,” Davis said. The details are confidential, of course, but it is clear that the pandemic has upended people’s lives and livelihoods across the United States. The toll on those who were already experiencing mental health issues and addiction has been heavy, but Davis and Pedersen are hopeful that their insights and findings will lead to better treatment and outreach in the future. Reducing barriers to care One bright spot over the past nine months has been the quick embrace of telehealth. The VA was already leading the way to telehealth as a way to improve access to its services, and following the stay-at-home orders of the pandemic, telehealth has grown in acceptance and use. Now, online counseling sessions, Alcoholics Anonymous meetings, and medical visits are commonplace. Pedersen and Davis don’t see that changing even when face-to-face gatherings become the norm once again. It has been a promising start to the research, and Pedersen and Davis are even more excited about what the future may hold. They plan on submitting for more grants to continue to track the mental health and substance use of this group of hundreds of veterans with the goal of understanding what factors lead individuals to seek care. Down the road, they hope to use this longitudinal data to help identify profiles of people more or less likely to seek care. “Then we can tailor interventions to increase their willingness to seek care for a problem like a substance use disorder or PTSD,” Davis said. Recognizing patterns in substance use and when to seek care is very important in helping that part of the veteran population that is trying to deal with symptoms of depression, anxiety, PTSD, or substance abuse on their own. “We know that things are bad now and we can expect that there will be lingering effects for years to come,” said Pedersen. “What we hope is that these findings and our future work will help the VA and others create more effective programs and outreach to address the unique needs of veterans.” 1 Veterans Health Administration Office of Patient Care Services, Analysis of VA Health Care Utilization Among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn Veterans. Washington, DC: U.S. Department of Veterans Affairs, 2017. www.publichealth.va.gov/epidemiology/reports/oefoifond/health-care-utilization/. 2 Tanielian, Terri and Lisa H. Jaycox, eds., Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation, 2008. www.rand.org/pubs/monographs/MG720.html.