What If My Child Isn’t Motivated to Get Treatment for Addiction?
Suggesting Treatment to a Loved One
Intervention – a Starting Point
Drug Use, Stigma, and the Proactive Contagions to Reduce Both
- Details
- Hits: 5
Peer-led recovery communities are changing how England responds to drug and alcohol addiction. These groups, known as Lived Experience Recovery Organisations or LEROs, are run by people who have personally walked through addiction and chosen recovery. They are not clinical services. They are real people, from real communities, helping others find a way out. For families worried about a loved one, and for professionals working in prevention and education, understanding what these organisations do matters more than ever.
What Are Peer-Led Recovery Communities?
LEROs are independent organisations led by people with direct experience of drug or alcohol use and recovery. They are not run by clinicians or policy makers. People with lived experience lead them, staff them, and shape everything they do.
The College of Lived Experience Recovery Organisations, known as CLERO, formally established the term in 2020. Dame Carol Black’s 2021 independent review of drugs then recognised LEROs in national policy. The review called for thriving recovery communities to connect with every drug treatment system in England.
To qualify as a LERO, an organisation needs people with lived experience in key roles. This includes the CEO or group leader, more than half of the board of trustees, and 90 per cent of frontline staff and volunteers. That level of representation is intentional. It is what gives these groups their credibility and their power.
Why These Organisations Matter for Prevention
Families often struggle to find the right words when someone they love is at risk. Professional services can feel distant or difficult to access. Peer-led recovery communities speak a different language. They speak from experience, not from a textbook.
When someone who has been through addiction stands up and talks honestly about what it cost them, that message lands differently. It reaches people in a way that clinical advice often cannot. That is not a criticism of professionals. It is simply the truth of what lived experience brings.
For healthcare workers and educators, LEROs offer a practical resource. These groups complement prevention programmes, put a human face on recovery, and show young people and families that a different life is genuinely possible.
The numbers support this. A 2024 census found 52 LEROs operating across England. Yet 61 per cent of counties and unitary authorities still had no recognised LERO at all. Millions of people have no access to peer-led recovery support in their local area.
What Do These Groups Actually Do?
No two LEROs are identical. Each one grows from its own community and reflects what that community needs. But their core purpose stays the same: helping people build a life free from drugs and alcohol, and showing others that this life is possible.
Here is what peer-led recovery communities typically offer:
Peer support and mentoring. People in recovery connect with those earlier in their journey. They offer honest, grounded guidance that professional services alone cannot provide.
Community events and social activities. These groups create spaces where recovery feels normal. Members build new friendships rooted in sobriety, not substance use.
Recovery advocacy. LERO members speak in schools, community spaces, and professional settings. They share their stories and make the case that recovery is real and worth pursuing.
Signposting to further support. They help people and families find their way through the wider system, pointing them toward the right services at the right time.
LEROs do not accept that addiction is simply part of life. Their existence is a direct statement that people can and do recover, and that community plays a vital role in making that happen.
How These Communities Are Spreading Across England
The 2024 RAND Europe census found a clear geographic pattern. Yorkshire and the Humber leads the way, with 82 per cent of local areas having at least one LERO. The East Midlands follows at 75 per cent. The South West, by contrast, had just one LERO across the entire region.
This uneven spread has real consequences. Communities without a visible recovery presence give young people fewer reasons to believe that change is possible. Growing up somewhere where drug use is common but recovery stays invisible makes it harder to imagine a different future.
RAND Europe research also found that 41 per cent of local authority commissioners gave the wrong answer when asked whether a LERO operated in their area. Many thought they had one when they did not. Others were unaware of a LERO that was actively running. That level of confusion means resources and referrals go to the wrong places.
Peer-led recovery communities tend to develop in one of three ways. Some grow organically from within an existing local recovery community. Others receive encouragement and early support from local commissioners. A smaller number begin inside treatment services before eventually becoming independent. The grassroots model is the most common. It is also the one most deeply rooted in genuine community experience.
What Families and Professionals Should Know
Parents and family members sometimes feel powerless. Knowing that peer-led recovery communities exist, and what they offer, gives people somewhere concrete to turn. These groups carry a consistent message: recovery is possible, and community makes it more likely.
For healthcare professionals and educators, LEROs sit alongside formal services rather than replacing them. They offer something unique. A person in recovery can reach a young person or a worried parent in ways that professional training alone cannot prepare someone for.
Closing the awareness gap matters. When professionals know these organisations exist and understand what they do, they refer people more effectively. They become better at pointing families toward the right support at the right moment.
Making Recovery Visible in Every Community
Communities that make recovery visible change the story around addiction. When people who have been through it are present, open, and supported, they shift what feels possible for everyone around them.
Peer-led recovery communities do exactly that. The people who build and run them refused to let addiction define their story. They chose recovery. Now they use that experience to help others do the same.
Supporting these groups, learning what they do, and including them in prevention conversations is not just helpful. It is necessary.
(Source: WRD News)
- Details
- Hits: 39
A New Lens: Research Domain Criteria
Researchers from UCLA took a different approach. Rather than relying solely on clinical diagnoses in the NVDRS, they used the Research Domain Criteria (RDoC) framework. Developed by the National Institute of Mental Health, RDoC looks at psychological functioning across six broad domains:
- Negative valence (distress, hopelessness, anxiety)
- Positive valence (motivation, reward, substance use patterns)
- Social processes (relationships, belonging)
- Arousal processes (agitation, sleep disturbance)
- Cognitive systems (attention, memory, decision-making)
- Sensorimotor systems
Rather than asking “does this person have a diagnosis?”, RDoC asks: “in what ways was this person’s psychological functioning disrupted?”
To extract this from NVDRS death narratives, the researchers applied two machine learning methods. One was a token-based scoring system. The other was a large language model (LLM), the technology behind modern AI tools. Both had previously been validated against psychiatric inpatient records.
What the Research Found About Psychological Dysfunction and Suicide
The study analysed death records for 72,585 people who died by suicide in 2020 and 2021. These came from all 50 US states. The results were striking.
Using the LLM scoring method, more than 90% of suicide decedents showed at least one clinically significant RDoC domain score. This means evidence of dysfunction serious enough to require treatment. It was true in both law enforcement and coroner narratives.
Compare that to what the NVDRS had recorded: only 44.4% with any mental health disorder and only 27.9% described as currently depressed.
The domains most frequently elevated were negative valence and arousal processes. These capture hopelessness, distress, anxiety, and agitation. These are emotional states that do not always lead to a formal diagnosis. Yet they are deeply relevant to suicide risk and mental health outcomes.
Female decedents and younger decedents showed consistently higher levels of dysfunction across most domains. Among younger adults aged 25 to 44, clinically relevant arousal process dysfunction appeared in around 65% of law enforcement narratives. Among those aged 65 and over, this figure dropped to around 41%. Even so, dysfunction remained widespread in that older group.
Substance Use and Psychological Dysfunction and Suicide
One finding deserves particular attention. The RDoC framework links positive valence dysfunction directly to substance use patterns and their effects on reward processing. This dysfunction was significantly more common among decedents than standard NVDRS alcohol and drug measures suggested.
The standard NVDRS measure recorded problematic alcohol or drug use in 27.5% of decedents. But RDoC positive valence dysfunction, which captures disrupted reward and motivation, showed clinically relevant levels in around 31 to 41% of decedents.
Substance use does not just create health risks in isolation. It fundamentally alters how people experience reward, motivation, and relief from distress. It reshapes emotional life in ways that heighten vulnerability. That connection is essential to understand.
Why This Changes the Conversation
The traditional approach to suicide prevention has often focused on identifying people with a clinical diagnosis. If someone has a recorded diagnosis of depression or an anxiety disorder, systems are more likely to flag them for intervention. But a large proportion of people who die by suicide do not have that flag.
The RDoC approach offers a different way in. By looking at how someone is actually functioning, it is possible to detect risk that a diagnosis alone would miss.
This is especially relevant for men. Men made up 80.6% of decedents in this study. They were consistently less likely than women to have formal mental health diagnoses recorded. The suffering was still there. It was simply less likely to have been named.
(Complete Research: JAMA Network)
- Details
- Hits: 114
Young people struggling with youth drug treatment needs have long been underserved by a system built around adults. That is now changing. The American Society of Addiction Medicine (ASAM) has published a landmark framework dedicated entirely to substance use disorder care for adolescents and young adults under 25, separating their standards from adult guidance for the first time.
The new volume, titled the Adolescent and Transition-Aged Youth edition of The ASAM Criteria, sets out the full range of services that should be available to every young patient. Previously, adolescent addiction treatment standards sat buried within adult-focused criteria, a setup that many clinicians had criticised for years.
Brain development continues well into a person’s mid-twenties. That biological reality shapes the entire framework. Young people are not simply smaller adults, and the risks they face from substance use reflect that difference.
Why Youth Drug Treatment Needs Its Own Framework
The numbers make a sobering case. Around 80% of adults living with substance use disorder started using substances before the age of 18. Those who begin before 15 are 6.5 times more likely to develop a dependency than those who wait until 21 or older. Early exposure does not just raise risk. It can reshape development, delay the acquisition of life skills, and set a difficult course for decades to come.
“Ongoing brain development during these formative years puts youth at a greater risk of developing the disease of addiction, which can lead to poor health outcomes and delayed life skill development,” said Dr Corey Waller, editor-in-chief of the new volume.
The ASAM now recommends early intervention for any young person already using substances and showing signs of rapid escalation. Waiting for a formal diagnosis before acting is no longer the preferred approach.
Adolescent Addiction Treatment: A Holistic, Family-Centred Model
The updated standards place the young person firmly at the centre, but they also widen the lens considerably. The framework promotes a model that brings in mental health services, connects with schools and community networks, and treats prevention as seriously as treatment itself.
This matters because youth drug treatment challenges rarely travel alone. Most adolescents dealing with substance-related difficulties also carry co-occurring mental health conditions. The new guidance pushes clinicians to address both at the same time, not in sequence.
The continuum of care expands too. New service levels include ongoing remission monitoring and integrated withdrawal management within youth-specific programmes. These are areas that existing guidance had largely overlooked.
Rising Risks Make the Case for Change
The clinical picture for young people has grown more complex in recent years. Fentanyl and other high-potency substances now reach adolescents far more readily than before. Clinicians report encountering levels of risk in young patients that would have been uncommon a decade ago.
“While there will be challenges to overcome to make this vision a reality, we must commit to building systems and payment models capable of delivering effective interventions and treatments for all young people who need them,” said Dr Waller.
Putting the New Standards Into Practice
ASAM presented the new criteria on 25 March at the Joint Meeting on Youth Prevention, Treatment, and Recovery. The Hazelden Betty Ford Foundation published the complete volume online and will release a print edition in June.
The Foundation also built a digital interface to help clinicians across the full care team put adolescent addiction treatment into practice without friction.
“The ASAM Criteria’s new adolescent treatment standards represent a tremendous opportunity to further elevate and individualise care for our nation’s children and young adults,” said Dr Joseph Lee, president and chief executive of the Hazelden Betty Ford Foundation.
The framework asks more than clinicians to act. It calls on commissioners, policymakers and system leaders to fund and build the infrastructure these standards require. With the evidence pointing clearly to adolescence as the window where intervention matters most, getting that infrastructure right carries consequences that stretch well beyond the clinic.
(Source: WRD News)
- Details
- Hits: 182
There is a well-established and often underestimated connection between trauma and substance use disorders. For many individuals struggling with addiction, the roots of their substance use trace back not to a simple choice, but to a nervous system shaped by painful, unresolved experiences. Understanding this connection is no longer optional for those working in behavioural health. It is foundational.
On 16 April 2026, Dr Denis Antoine II, a board-certified psychiatrist and addiction medicine specialist at Johns Hopkins Bayview Medical Center, will lead a live training session exploring precisely this topic. The session, How Trauma Impacts SUD and Subsequent Treatment Efforts, is open to clinicians, counsellors, peer recovery specialists, social workers, and programme administrators, and offers up to 1.25 contact hours.
The Neurobiological Link Between Trauma and Substance Use Disorders
Trauma does not simply leave emotional scars. It physically alters the brain. When a person experiences chronic or acute trauma, particularly during childhood, the stress response systems become dysregulated. The hypothalamic-pituitary-adrenal (HPA) axis, which governs cortisol release, can become either hyperactive or blunted. The prefrontal cortex, responsible for decision-making and impulse control, loses some of its capacity to regulate the amygdala, the brain’s alarm centre.
This neurobiological disruption creates fertile ground for substance use. Research consistently shows that individuals with a history of adverse childhood experiences (ACEs) are significantly more likely to develop substance use disorders in adulthood. A landmark study published in the American Journal of Preventive Medicine found that individuals with four or more ACEs were five to twelve times more likely to use illicit substances compared to those with no adverse childhood experiences.
Substances, in this context, are not random choices. They become functional tools for managing an overwhelmed nervous system. Alcohol may dampen hypervigilance. Opioids may numb emotional pain. Stimulants may help individuals feel present and alive when dissociation takes hold. The substance use, however problematic, is often an attempt at self-regulation in the absence of healthier coping resources.
How Trauma Complicates Treatment Engagement
One of the most clinically significant consequences of trauma is its effect on how individuals engage with treatment. Trust, which is the very foundation of a therapeutic relationship, is often one of the first casualties of trauma. For someone whose traumatic experiences involved a caregiver, authority figure, or institution, entering a treatment programme can feel not like a refuge but a re-exposure to dynamics they have learned to fear.
This is why trauma and substance use disorders must be considered together, not sequentially. A clinician who addresses only the substance use without understanding its traumatic underpinnings may find a patient disengaging, missing appointments, or leaving treatment prematurely. These are not signs of poor motivation. They are often signs of an unaddressed trauma response.
Research supports this: individuals with co-occurring post-traumatic stress disorder (PTSD) and substance use disorders show significantly lower treatment retention rates compared to those without PTSD. They are also more likely to experience relapse, particularly when trauma symptoms are triggered during the recovery process.
Common Clinical Presentations to Recognise
Trauma does not always present in obvious ways within an addiction treatment setting. Clinicians who are familiar with the spectrum of trauma-related presentations are far better positioned to respond with empathy and precision.
Some of the most common presentations include persistent emotional dysregulation, difficulty tolerating distress, shame-based thinking, avoidance of therapeutic topics, dissociation during sessions, and a pattern of escalating substance use in response to environmental stressors. Individuals may appear guarded, hostile, or erratic, not because they are unwilling to engage, but because their nervous system has learned that vulnerability is dangerous.
Physical health complaints without clear medical explanation, sleep disturbances, and a history of multiple treatment episodes without sustained recovery are also common markers worth exploring with a trauma-informed lens.
Applying Trauma-Informed Principles in Addiction Care
Recognising trauma is only the first step. The real clinical challenge lies in embedding trauma-informed principles into the day-to-day fabric of addiction treatment. This means shifting from a model that asks “what is wrong with this person?” to one that asks “what happened to this person, and how has it shaped the way they are showing up today?”
Practically, this looks like creating physical and relational environments that feel predictably safe. It means being transparent about treatment expectations, offering choice wherever possible, and actively building collaborative rather than hierarchical therapeutic relationships. It also means training all staff, not only therapists, but intake workers, reception staff, and peer support specialists, to understand how trauma responses can manifest across every point of contact.
Screening for trauma early in the treatment process, and using validated tools such as the ACE questionnaire or the Trauma Screening Questionnaire, allows clinicians to tailor treatment plans that account for underlying trauma histories.
Integrated approaches that address trauma and substance use disorders simultaneously, such as Seeking Safety or Trauma-Focused Cognitive Behavioural Therapy adapted for addiction settings, have shown promising outcomes in improving both retention and recovery.
Why This Matters Now
The intersection of trauma-informed addiction treatment and public health has never been more urgent. In the United States alone, over 46 million people aged 12 or older met the criteria for a substance use disorder in 2021, according to the National Survey on Drug Use and Health. Simultaneously, population-level trauma exposure, including the lasting effects of the COVID-19 pandemic, community violence, and systemic inequality, continues to rise.
Clinicians and programme leaders who invest in deepening their understanding of trauma and substance use disorders are not simply improving individual outcomes. They are building systems that are more responsive, more humane, and ultimately more effective.
Dr Antoine’s upcoming session offers a structured opportunity to do exactly this. Whether you are a seasoned clinician seeking to refine your practice or a programme leader looking to embed trauma-informed principles across your service, this training provides a meaningful conceptual and practical foundation. (Source: WRD News)
- Details
- Hits: 142
Based on the World Youth Report 2025 (Insights from 3,000 youth across 137 countries)
One in seven young people aged 10 to 19 experiences a mental health condition. That’s millions navigating anxiety, depression, and other challenges whilst trying to figure out life.
The World Youth Report 2025, based on consultations with nearly 3,000 youth from 137 countries, examines how to support young people in building resilience through prevention, support systems, and evidence-based interventions.
This isn’t another lecture about being ‘tough’ or ‘resilient’. It’s about the real factors shaping mental health outcomes, from substance use to economic pressures, and creating systems that genuinely support us.
“If best practice isn’t sought and in place, then a lesser system will emerge and young
people will subscribe to the dominant cultural voice in the absence of the best practice.
Identifying and deploying these best practice principles must at least be in the offering to
develop community wellbeing.”