Steve Sussman

• PhD, FAAHB, FAPA FSPR
• Professor at University of Southern California

Background: Most studies that have examined the association of addiction with cardiovascular diseases (CVDs) have been completed regarding substances. However, behavioral addictions may indirectly or directly negatively impact one’s health. We engaged in a scoping review on the associations of behavioral addictions (i.e., sex, exercise, love, Inte...

This cross-sectional study investigates rates of nicotine concentrations vaped by US youths and associated substance use characteristics.

Background: While the empirical data on the role of environmental factors in work addiction (WA) is steadily growing, little is known about the extent to which the workaholic environment contributes to the increased risk of WA and what are the relative contributions of direct supervisor's and colleagues' WA to one's own workaholism. Methods: The Pe...

Background and aims: Despite the last decade’s significant development in the scientific study of work addiction/workaholism, this area of research is still facing a fundamental challenge, namely the need for a valid and reliable measurement tool that shows cross-cultural invariance and, as such, allows for worldwide studies on this phenomenon. Met...

Quality of life (QoL) is a wide-ranging construct and includes one’s level of physical function or disability, economic security, availability of leisure/flexible time, social belongingness, physical safety, human rights/freedom, and one’s general sense of wellness. Several studies have been conducted on the QoL of persons suffering from drug use a...

While recognized as central to recovery in persons with substance use disorders (SUDs), quality of life (QoL) remains an understudied area concerning substitute behaviors and behavioral addictions. Substitution is here defined as the acquisition of potentially addictive compensatory behaviors while abstaining from an SUD. To aid researchers and pra...

Background Dual use (DU) of conventional cigarettes (CC) and e-cigarettes (EC) has emerged as a common pattern among youth and adult populations. This review aims to investigate whether dual use can promote smoking cessation. Methods A systematic search was conducted in accordance with PRISMA guidelines, and all longitudinal studies reporting tran...

Background We tested whether snus marketing with modified risk tobacco product (MRTP) claims: (a) promotes accurate knowledge about snus’s health effects in young adults and (b) encourages use intentions in only those who use combustible tobacco without attracting other young adult populations. Methods A randomised between-subjects experiment was...

Electronic cigarette (e-cigarette) use has increased since e-cigarettes were introduced to the market nearly 20 years ago. Researchers continue to conduct studies to understand the health risks and benefits of e-cigarettes to inform health education and promotion efforts as well as public policy. Studies funded by the tobacco industry examining the...

INTRODUCTION Brick-and-mortar vape shops specialize in the sale of e-cigarettes and remain a primary source for purchasing emerging e-cigarette products. New regulatory policies have been implemented at local-, state- and federal-level; the retail environment at vape shops and product preferences among vape shop customers shifted accordingly. METH...

Residential substance use disorder (SUD) treatment programs are challenged by the differing values of the problem-solving court (PSC) and child welfare (CW) systems, along with communication barriers between staff. This study aimed to understand, from the viewpoints of SUD treatment providers, how divergent values and communication barriers adverse...

BACKGROUND AND OBJECTIVES Disposable electronic cigarettes (e-cigarettes) are widely used by adolescents and young adults (AYAs). Whether using disposable devices is associated with future e-cigarette use patterns is unknown but important for informing e-cigarette regulation. METHODS Prospective longitudinal study combining data from adolescent (1...

Objective Synthetic nicotine (SN) e-cigarettes emerged on the market as an alternative to tobacco-derived nicotine (TDN) vaping products. It is critical to understand the harm perceptions, purchase, and use of SN vs. TDN e-cigarettes. Methods From November 2021 to February 2023, we conducted intercept interviews with 263 adult customers at 37 vape...

This is the first scoping review of gossip addiction.. See: https://www.omicsonline.org/open-access/gossiping-between-social-interaction-and-behavioral-addiction.pdf

“Substitute addiction” refers to the process of achieving abstinence or resolution of one addictive behavior and subsequently engaging in one or more additional addictive behaviors in its place. Substitute addiction, a concept in the abstinence-based recovery field for decades, is viewed as a cause for concern because resolving one addictive behavi...

Background: The 2018 Farm Bill led to new types of derived psychoactive cannabis products (DPCPs) being sold throughout the United States. This study describes the new types and brands of DPCPs sold online. Materials and Methods: In May 2023, data were recorded from three top-trafficked U.S.-based DPCP retail websites, including information about e...

Purpose of Review In this scoping review, we examined sex as a substitute addiction for other substance or behavioral addictions, with a particular emphasis on how it has been defined, has presented clinically, the samples and contexts studied, and the methods used. Various types of sexual behaviors were included (e.g., voyeurism, and pornography u...

INTRODUCTION Evaluating anticipated responses to flavor bans in the context of vape shops is needed to inform legislation and enforcement. This cross-sectional study examined vape shop retailers’ opinions about the potential impacts of an e-liquid flavor ban on shop sales and customer behavior-change intentions. METHODS From December 2019 to Octob...

Problematic overstudying has been conceptualized as a potential addictive disorder and an early form of work addiction. Previous studies have shown that it is a different phenomenon from healthy learning engagement and is associated with considerable functional impairments. A valid, reliable, and convenient screening measure is warranted to provide...

In book 1 of this 3-part series, we are pleased to present an extensive collection of adolescent health articles that address the diverse needs of the adolescent and young adult population as it relates to preventative health. Through a wide variety of research, we have come to a greater, more informed understanding of the vast needs of this dynami...

Introduction In December 2022, California (CA) enforced a voter-approved regulation restricting the retail sale of flavoured tobacco products, including menthol cigarettes. Shortly after, new products emerged on the market containing similar blue and green package colours yet with ‘non-menthol’ descriptors. Using chemical analyses, we measured the...

Background Much remains unknown about the dynamics of substitute behaviors during addiction recovery among persons attending recovery support groups. Insight into the nature, motives for, and course of substitute behaviors could help to shape recovery support and harm reduction services. Methods Twenty-three semi-structured in-depth interviews (n...

The objective was to examine pandemic-related changes in depression and anxiety symptoms in adolescents and young adults in Germany considering pre-existing depression and anxiety problems. In this cross-sectional study, 11,523 adolescents and young adults aged 14–21 years who perceived an impact of the Coronavirus disease (COVID-19) pandemic on th...

Introduction E-cigarette retail/marketing surveillance is needed during regulatory changes, like the US increasing minimum legal sales age to 21 (T21) and flavor restrictions (2019 and 2020) and certain state/localities increasing related restrictions. Methods We examined regulatory compliance (e.g., minimum-age signage), promotional strategies (e...

Tobacco use among cancer patients is associated with an increased mortality and poorer outcomes, yet two-thirds of patients continue using following diagnosis, with disproportionately higher use among racial/ethnic minority and low socioeconomic status patients. Tobacco treatment services that are effectively tailored and adapted to population char...

The potential impact of the COVID-19 pandemic on young people’s mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schoo...

Globally little is known regarding substance use service providers' perceptions of substitute behaviours and this significant gap could hinder service provision and recovery outcomes. Semi-structured focus group discussions (including 22 service providers across five sites) were conducted in residential treatment facilities in the Western Cape, Sou...

Objective To estimate the extent to which drinking to cope with the COVID-19 pandemic and experiencing pandemic-related life stressors are associated with alcohol use escalation among young adults. Methods Respondents in Los Angeles, CA, USA (N = 2,130) completed prospective cohort study surveys before (baseline; October 2018–November 2019; mean a...

Adverse childhood experiences (ACE) have a strong association with alcohol and drug use; however, more research is needed to identify protective factors for this association. The present study assesses the longitudinal impact of ACE on problematic alcohol and drug use and the potential moderating effect of perceived social support. Data (n = 1404)...

Background and Aims Delta‐8 tetrahydrocannabinol (THC) is a psychoactive substance from the Cannabis plant that has been rising in popularity in the United States since the 2018 US Farm Bill implicitly legalized it. This study reviewed research from peer‐reviewed and non‐peer‐reviewed (e.g. anecdotal and news) reports related to delta‐8 THC to summ...

Background: Young adults often derive self-identity from affiliation with peer crowds, which may be defined as reputation-based peer groups centered around characterizable lifestyle norms. Little is known about peer crowds prevalent among Asian American, Native Hawaiian, and other Pacific Islander (AANHPI) populations and the peer crowds' normativ...

Substitute addictions – addictions that replace terminated substance use disorders (SUDs) – involving addictive behaviours such as a new substance, food/eating, gambling, shopping, or sex, have implications for recovery but remain poorly understood. While extant studies suggest a multifaceted aetiology, research is needed to illuminate the nature,...

There is evidence that smoking prevalence rates are related to acculturation, education, and gender among Asian Americans. However, no studies have examined how smoking rates among Asian Americans vary based on acculturation, education, and gender together. This study used National Health Interview Survey (NHIS) data (2010–2018) to examine cigarett...

Vape shops specialize in sales of e-cigarettes and related products. This study examines whether vape shops adapted their products and services in response to changes in federal and state policies that affect the tobacco retail environment between 2014–2022. In this multicohort study, four waves of study data were used to examine the trends in prod...

Background Lack of education and training on caring for patients with substance use disorder (SUD) is common among healthcare providers, often resulting in clinicians feeling unprepared to treat patients with SUD. Objectives This study explored resident physicians’ experiences with SUD education throughout medical school and residency and qualitat...

Behavioral addictions are highly comorbid with substance use disorders, presenting in as many as 54% of service users receiving substance use treatment. Few studies have examined whether treatment centers are attentive to such other addictions, which may undermine treatment. This study examined the mention and treatment of behavioral addictions on...

Background: Previous research in high-income countries (HICs) has shown that smokers reduce their cognitive dissonance through two types of justifications over time: risk minimizing and functional beliefs. To date, however, the relationship between these justifications and smoking behaviors over time has limited evidence from low- and middle-incom...

BACKGROUND AND OBJECTIVES Flavored non-tobacco oral nicotine products (eg, nicotine pouches and nontherapeutic nicotine gum, lozenges, tablets, gummies), are increasingly marketed in the United States. Prevalence of non-tobacco oral nicotine product use among adolescents is unknown. METHODS We calculated prevalence of ever and past 6-month use of...

Introduction Exposure to E-cigarette marketing and media advertisements is prevalent among adolescents. A validated vaping media literacy scale is needed to inform effective vaping prevention programs. Methods A 6-item vaping media literacy scale was adapted from validated smoking and general media literacy scales with an emphasis on marketing inf...

Sometimes in health behavior research, purportedly novel theoretical models are offered that may help move thinking about behavior change forward, and may be well-received by clinicians, but over time end up being a subject of continual scientific disconfirmation. The transtheoretical model is one rather popular example. The five stages of change a...

American Indian Alaska Native (AIAN) youth have disproportionately higher rates of commercial tobacco product use compared to other racial and ethnic groups in the U.S. These rates underscore a need for commercial tobacco product cessation interventions that are culturally informed. This project studied the development, implementation, and some imp...

Vape shops specialize in the sales of e-cigarettes and other vaping products. In recent studies, young adults who use e-cigarettes have tended to identify with at-risk peer crowds. This is the first study to examine vape shop customers' clientele. Composed primarily of young adults and persons in early middle adulthood, we speculated that a relativ...

“Vulnerable populations” in health behavior research, practice and policy is generally used to refer to groups that, due to their life circumstances, may require extra consideration, reasonable accommodation, and legitimized protection [...]

This essay seeks to illuminate the shifting definitions of addiction over time by providing a brief, anecdotal history of addiction as well as a review of how it has been conceptualized by the American Psychiatric Association’s DSM classification system. While all addictions have in common the attempt to experience an appetitive effect (satiety), p...

Background: Tobacco regulations and COVID-19 state orders have substantially impacted vape retail. This study assessed vape retailers' perspectives regarding regulations and future retail activities. Methods: In March-June 2021, 60 owners or managers of vape or vape-and-smoke shops (n = 34 vs. n = 26) in six US metropolitan areas completed an on...

Background and objectives: While inadequate nutrition can weaken the immune system and lead to negative health sequelae for vulnerable populations, little is known about nutritional intake among people who inject drugs (PWID). We aimed to quantify nutritional intake among PWID and to explore associations between protein intake and drug use. Metho...

Background Adverse childhood experiences (ACE), including maltreatment and household dysfunction, are consistent predictors of health compromising behaviors in adulthood. While most ACE studies have focused on adults, there is an emerging body of research focusing on young adulthood. Methods This review describes research focused on the relationsh...

Oral nicotine pouches may appeal to young adult current nicotine/tobacco users interested in alternative forms of nicotine that lack pulmonary exposure, but may also appeal to young adult non-users of nicotine/tobacco products. We used data from a 2020 remote digital survey of an ongoing cohort study of young adults from Southern California (aged 1...

The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residen...

Objectives In February 2020, the US Food and Drug Administration issued a guidance restricting the sales and distribution of cartridge-based e-cigarettes with flavours other than tobacco and menthol. Disposable devices were exempt from this guidance. This study examined the prevalence of disposable pod use and flavour preference compared with refil...

Objective The 2016 FDA’s “Deeming Rule” prohibited free samples of vaping products. The purpose of this study was to investigate compliance with or adaptation to this newly established FDA policy. Methods Vape shops were recruited in Southern California between November 2017 and December 2018. Data collectors interviewed 121 vape shop employees, w...

Objectives. To evaluate disparities in youth e-cigarette use patterns and flavor use by race/ethnicity over time. Methods. We used data from the US 2014–2019 National Youth Tobacco Survey (NYTS) to examine trends in dual use (co-use of e-cigarettes and cigarettes or other tobacco products), occasional (≤ 5 days) versus frequent use (≥ 20 days) in t...

Although Asian/Pacific Islanders are considered a single ethnic/racial category in national studies, Native Hawaiians and other Pacific Islanders (NHOPIs) and Asians show marked disparities in health outcomes and risk behaviors, including substance use. Currently, knowledge regarding the psychosocial mechanisms by which NHOPI ethnicity is associate...

We conducted an analysis of the prevalence of substance and behavioral addictions across different transgender and gender diverse (TGD) subgroups. We performed a scoping review using MEDLINE and Google Scholar databases and examined 12 addictions, including alcohol, nicotine, cannabis, illicit drugs, gambling, eating/food, internet, sex, love, exer...

Background ‘Ice’ e-cigarette flavours—marketed as a combination of fruity/sweet and cooling flavours (eg, ‘blueberry ice’ or ‘melon ice’)—recently entered the US market. The prevalence and correlates of ice flavoured e-cigarette use in young adults are unknown. Methods This cross-sectional study of a Los Angeles, California, USA, cohort analysed d...

Introduction E-cigarette users typically initiate vaping with flavoured e-liquids. People who vape flavours tend to underestimate the harm of vaping. We examined the inter-relationship between flavour preference, vaping for cessation purposes, e-cigarette dependence, e-cigarette harm perception and purchase/use intention, given a hypothetical flavo...

Background: College students are among the heaviest users of smartphones and the Internet, and there is growing concern regarding problematic Internet (PIU) and smartphone use (PSU). A subset of adverse childhood experiences, household dysfunction [(HHD) e.g.; parental substance use, mental illness, incarceration, suicide, intimate partner violenc...

The addictions are subject to a great deal of stigma, the constituents of which include negative attributions such as being immoral, weak-willed, or sick. Negative outcomes include exclusion from positive life opportunities. In this commentary, I briefly discuss the definition of stigma, descriptors of addiction-related stigma, and negative consequ...

We provide a conceptual framework for considering how an individual’s identity is influenced by social groups and an empirical exploration of how identity is related to cigarette smoking and e-cigarette use. We report findings on e-cigarette use and cigarette smoking from studies of adolescents and young adults. Mediation analyses focused on (a) pa...

The present study investigated the prevalence and co-occurrence of addictions to tobacco, alcohol, other drugs, food/eating, the internet, texting, video games, shopping, love, sex, exercise, work, and gambling among American Indian (AI) youth in California. As with previous work in other cultural groups, the most prevalent addictions were love, in...

Background Addictions share common etiological factors associated with personality vulnerabilities such as narcissism or emotional instability. Also, there are gender differences in the type of and risk for addiction (e.g., men may be more prone to addictions, overall). These are considerably less understood in relation to behavioral addictions (BA...

Background: Substitute addictions, addictive behaviors that sequentially replace each other’s functions, have implications for recovery trajectories but remain poorly understood. We sought to scope the extent, range, and characteristics of research on substitute addictions in persons with substance use disorders. Method: Using Arksey and O’Malley’s...

Background There has been a tremendous increase in the use of smartphones among college students and alongside the benefits there is growing concern over problematic/addictive smartphone use (PSU). Among the most robust predictors of behavioral and substance use disorders are a subset of adverse childhood experiences conceptualized as household dys...

The overall aim of this study is to examine vape shop business operations during COVID-19 among a cohort of 88 vape shops in the Greater Los Angeles area in Southern California, located in ethnically diverse communities. A total of six web- and/or phone-based assessments were conducted over a 12-week period (April 1, 2020–June 10, 2020), extending...

Objectives: Given the need to understand e-cigarette retail and its impact, we examined sociodemographic, tobacco and marijuana use, and e-cigarette retail experiences as correlates of (1) past 30-day e-cigarette use, (2) past 30-day advertising/media exposure, and (3) point-of-sale age verification among young adults. Methods: We analyzed basel...

This cross-sectional study estimates the association of political party affiliation with physical distancing behaviors among young adults during the coronavirus disease 2019 pandemic.

Introduction This study examined vape shop customers’ behaviors in relation to shop display practices. We hypothesized that display of signs conveying supportive attitude toward vaping at vape shops would be positively associated with customer purchasing and in-shop vaping behaviors. Methods We recruited vape shops throughout Southern California (...

Introduction: Adverse childhood experiences (ACE) predict health-compromising behaviors such as substance use. However, few studies have examined the association between ACE and prescription drug misuse among young adults—a growing public health concern. College students are especially vulnerable to prescription drug misuse due to social and academ...

Background Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective This study assesses the effectiv...

BACKGROUND Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. OBJECTIVE This study assesses the effectiv...

The global spread of COVID-19, subsequent stay-at-home requirements, spatial distancing measures, and long-term isolation present additional challenges for persons in recovery. Using an illustrative case from South Africa, we discuss COVID-19 related pornography use through the lens of relapse and substitute addiction. South Africa is the epicenter...

Many policies are enacted by the different levels of government in the United States in order to ensure a healthy population. The creators of these policies hope that they will help to also decrease the burden of disease. A successful example of this is tobacco‐related policies, which have significantly decreased tobacco use behaviors. There were s...

Introduction Adverse childhood experiences (ACE) predict health-compromising behaviors such as substance use. However, few studies have examined the association between ACE and prescription drug misuse among young adults—a growing public health concern. College students are especially vulnerable to prescription drug misuse due to social and academi...

Background This study examined smoking cessation advice offered by vape shop employees, as well as their perceived awareness of vaping research. Methods This cross-sectional study was conducted in 121 vape shops in the Greater Los Angeles area of Southern California in four multiethnic communities (Hispanic/Latino, African American, Korean/Asian,...

Introduction Vaping and vape shops pose risk for COVID-19 and its transmission. Objectives We examined vape shop non-compliance with state-ordered business closures during COVID-19, changes in their marketing and experiences among consumers. Methods As part of a longitudinal study of vape retail in six metropolitan statistical areas (MSAs; Atlant...

Over the past decade in the US there have been marked pivotal changes in the policy and retail environment regarding cannabinoids, particularly cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). Many vape shops may carry products relevant to these two markets. This study interviewed vape shop owners/managers to assess their perceptions of co...

The purpose of this study is to present current data on the prevalence and co-occurrence of 12 substance and behavioral addictions among adult cisgender sexual minorities (SM). We utilized MEDLINE, PsycINFO, and Google Scholar databases to systematically review the literature on alcohol, nicotine, cannabis, illicit drugs, gambling, eating/food, Int...

Introduction: In the US, prominent sources of vaping products are specialty vape shops, which are subject to Food and Drug Administration (FDA) regulation. This study interviewed vape shop owners/managers to assess: 1) reasons for entering into or engaging in vape shop retail; 2) personnel training, particularly with regard to FDA and state regula...

Prospective longitudinal data collection is an important way for researchers and evaluators to assess change. In school-based settings, for low-risk and/or likely-beneficial interventions or surveys, data quality and ethical standards are both arguably stronger when using a waiver of parental consent—but doing so often requires the use of anonymous...

Introduction Past studies have documented disparities in regulation compliance among tobacco retailers with respect to ethnic diversity in neighbourhoods. This study investigated the association between compliance with the Food and Drug Administration (FDA) and California state rules and neighbourhood ethnic composition of a vape shop location. Me...

The novel 2019 Coronavirus Disease (COVID-19) pandemic has led to the closing of all but essential businesses in California. However, several nonessential businesses have remained open in Southern California despite the mandated “stay at home” order issued by the governor. As part of an ongoing vape shop project involving 88 participating shops, th...

Objectives: Vape shops have proliferated in the United States (US) in recent years. As of May 2016, the US Food and Drug Administration (FDA) asserted its authority to regulate electronic nicotine delivery systems. It is critical to understand how these polices have affected the vape shop industry, as the rise and fall of vape shop proliferation h...

Introduction JUUL, a small pod-based vaping device that aerosolizes nicotine salts, is popular among adolescents and young adults. Because of JUUL’s high nicotine content, JUUL users can become nicotine dependent very quickly and have difficulty quitting. Nicotine-dependent JUUL users might turn to Twitter to seek advice, share their cessation stru...