Trends in Substance Abuse Preceding Stroke Among Young Adults: A Population-Based Study
Open accessAbstract
Background and Purpose—: Approximately 5% of strokes occur in adults aged 18 to 44 years. Substance abuse is a prevalent risk factor for stroke in young adults. We sought to identify trends in substance abuse detection among stroke patients. Methods—: Using a population-based design, we sought to identify all patients aged 18 to 54 years experiencing a stroke (ischemic or hemorrhagic) in the Greater Cincinnati and Northern Kentucky Study region during 1993 to 1994, 1999, and 2005. Demographic and clinical characteristics and substance use data were obtained retrospectively from chart review and adjudicated by physicians. Results—: The number of young patients identified with a stroke increased from 1993 to 1994 (297) to 2005 (501). Blacks (61% vs 51%; P <0.02) and men (61% vs 47%; P <0.002) reported substance abuse (current smoking, alcohol, or illegal drug use) more frequently than did whites and women. Overall use of substances increased across study periods, 45% in 1993 versus 62% in 2005 ( P =0.003). The trend was significant for illegal drug use (3.8% in 1993 vs 19.8% in 2005) and ever smoking (49% in 1993 vs 66% in 2005). Documentation of both cocaine and marijuana use increased over time. In 2005, half of young adults with a stroke were current smokers, and 1 in 5 abused illegal drugs. Conclusions—: Substance abuse is common in young adults experiencing a stroke. The observed increase in substance abuse is contributing to the increased incidence of stroke in young adults. Patients aged younger than 55 years who experience a stroke should be routinely screened and counseled regarding substance abuse.
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Because of the worldwide diabetes epidemic and increasing prevalence of other cardiovascular risk factors in young adults and overall, especially in low-income and middle-income countries, the shift in stroke burden towards younger populations is likely to continue globally unless effective preventive strategies are urgently implemented.
“In view of the worldwide epidemic of diabetes38 and increasing prevalence of other cardiovascular risk factors in young adults39,40 and overall,41–45 especially in low-income and middle-income countries, the shift in stroke burden towards younger populations is likely to continue globally unless effective preventive strategies are urgently implemented.”
From Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010 (2014) · cites this paper as [40]
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“8%).(10,13,16,19) The exact time between the last use of cannabis and the presentation of stroke was not reported in any study.”
BackgroundOpium Addiction and Ischemic Stroke in Isfahan, Iran: A Case-Control Study
Ebrahimi, H., Haghjoo-Javanmard, S., Asgary, S., Dehghani, L., Amiri, M., & Saadatnia, M. (2017) · European Neurology · doi:10.1159/000485098 · Cited by 20
Epidemiology and risk factors for stroke in young individuals: implications for prevention
Hussain, A., Lee, M. T., Rana, J., & Virani, S. (2021) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000894 · Cited by 19 · see citing works
“The proportion of ICH and SAH is 17% and 16–22% respectively [28,29,30] which is higher compared to the overall population, where 10% and 3% of strokes are caused by ICH and SAH, respectively [1].”
BackgroundA review of methamphetamine use and stroke in the young
Hemphill, K. R., Tierney, S., Tirschwell, D., & Davis, A. P. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1397677 · Cited by 18 · see citing works
Racial disparities in methamphetamine-associated intracerebral hemorrhage
Nakagawa, K., Vento, M., Ing, M., & Seto, T. (2015) · Neurology · doi:10.1212/wnl.0000000000001339 · Cited by 18
Rathfoot, C., Edrissi, C., Sanders, C., Knisely, K., Poupore, N. S., & Nathaniel, T. (2021) · BMC Neurology · doi:10.1186/s12883-021-02214-8 · Cited by 17 · see citing works
Powell, E. S., Westgate, P., Goldstein, L., & Sawaki, L. (2019) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2019.100023 · Cited by 17
IV thrombolysis in patients with ischemic stroke and alcohol abuse
Gattringer, T., Enzinger, C., Fischer, R., Seyfang, L., Niederkorn, K., Khalil, M., Ferrari, J., Lang, W., Brainin, M., Willeit, J., et al. (2015) · Neurology · doi:10.1212/wnl.0000000000002078 · Cited by 16 · see citing works
“Alcohol and substance abuse are important concomitant factors in acute cerebrovascular disease and are frequent and increasing problems preceding ischemic or hemorrhagic stroke.(19) This is confirmed by our data showing that 9% of patients chronically consumed alcohol or had acute intoxication with a substantial codep…”
BackgroundCatalina-romero, C., Ruilope, L., Sánchez-chaparro, M., Valdivielso, P., Cabrera-Sierra, M., Fernández-labandera, C., Ruiz-Moraga, M., González-Quintela, A., & Calvo-Bonacho, E. (2015) · European Journal of Preventive Cardiology · doi:10.1177/2047487314544961 · Cited by 15 · see citing works
Post-stroke limitations in daily activities: experience from a tertiary care hospital in Ethiopia
Mohammed, S., Haidar, J., Ayele, B., & Yifru, Y. M. (2023) · BMC Neurology · doi:10.1186/s12883-023-03419-9 · Cited by 13 · see citing works
“Scores ranging from 0 − 15 correspond to severe restriction.”
Stroke hospitalization trends of the working-aged in Finland
Sipilä, J., Posti, J., Ruuskanen, J. O., Rautava, P., & Kytö, V. (2018) · PLoS ONE · doi:10.1371/journal.pone.0201633 · Cited by 13 · see citing works
Chang, B., Wira, C., Miller, J. B., Akhter, M., Barth, B., Willey, J., Nentwich, L., & Madsen, T. E. (2017) · Academic Emergency Medicine · doi:10.1111/acem.13243 · Cited by 13 · see citing works
Retho, E., Tasseng, Y., Consigny, M., Bourhis, L. L. L., Leblanc, A., Jourdain, A., Merrien, F., Rouhart, F., Viakhireva-Dovganyuk, I., Goas, P., et al. (2023) · Revue neurologique (Paris) · doi:10.1016/j.neurol.2023.08.017 · Cited by 11 · see citing works
Chelikam, N., Mohammad, Z., Tavrawala, K., Krishnakumar, A. N., Varghese, A., Shrivastav, T. Y., Tarimci, B., Kumar, S., Francis, S. Z., Venkata, V. R. S., et al. (2022) · Cureus · doi:10.7759/cureus.31826 · Cited by 11 · see citing works
Feigin, V., & Krishnamurthi, R. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-29544-4.00013-x · Cited by 11 · see citing works
Amatangelo, M. P. (2020) · Critical Care Nursing Clinics of North America · doi:10.1016/j.cnc.2019.11.008 · Cited by 10 · see citing works
Histopathological lesions induced by stroke in the encephalon
Păun, O., Cercel, R. A., Radu, R., Raicea, V., Pîrșcoveanu, D., Honțaru, S., Zorilă, M., & Mogoantă, L. (2023) · Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie · doi:10.47162/rjme.64.3.10 · Cited by 9 · see citing works
“If until a few decades ago the disease mainly affected the elderly, now there is a tendency to stroke in younger people, especially in low and middle-income countries [20– 22].”
BackgroundFatal hemorrhage complicated with methamphetamine poisoning and its post-mortem CT features
Yoshida, M., Makino, Y., Hoshioka, Y., Chiba, F., Inokuchi, G., Torimitsu, S., Yamaguchi, R., Motomura, A., Abe, H., Yajima, D., et al. (2020) · Forensic Science, Medicine, and Pathology · doi:10.1007/s12024-020-00294-5 · Cited by 9
Jamil, M., Zafar, A., Faizi, S. A., & Zawar, I. (2016) · Case Reports in Neurological Medicine · doi:10.1155/2016/5313795 · Cited by 9
Barber, P. A. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-800756-3.00059-4 · Cited by 3 · see citing works
Stroke in Young Adults in Spain: Epidemiology and Risk Factors by Age
Pascasio, L. A., Ruiz, M. B., Pinilla, R. M., Torrecillas, J. M. G., Arjona-Padillo, A., Pérez, C. D. T., & Martínez-Sánchez, P. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13050768 · Cited by 8
Madsen, T. E., Cummings, O. W., Rosa, F. D. L. R. L., Khoury, J., Alwell, K. S., Woo, D., Ferioli, S., Martini, S., Adeoye, O., Khatri, P., et al. (2022) · Stroke · doi:10.1161/strokeaha.121.038311 · Cited by 8 · see citing works
Self-citationGender disparity in a cohort of stroke patients with incidence of obstructive sleep apnea.
Edrissi, C., Rathfoot, C., Knisely, K., Sanders, C., Poupore, N. S., & Nathaniel, T. (2021) · Journal of Vascular Nursing · doi:10.1016/j.jvn.2021.10.002 · Cited by 8 · see citing works
Secular Trends for Etiologies of Acute Ischemic Stroke in Young Adults.
Shaban, A., Molian, V., Garg, A., Limaye, K., Leira, E., & Adams, H. (2020) · Journal of Stroke & Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2020.105270 · Cited by 8 · see citing works
Carlo, A. D., Baldereschi, M., Bovis, F., Piccardi, B., Linoli, G., Orlandi, G., Volpi, G., Chiti, A., Tassi, R., Brescia, A., et al. (2023) · European Stroke Journal · doi:10.1177/23969873231175405 · Cited by 7 · see citing works
Man, H., Xu, Y., Zhao, Z., Zhang, S., Lv, R., Chi, X.-L., Li, X., & Zhang, Z. (2019) · Technology and Health Care · doi:10.3233/thc-199004 · Cited by 7 · see citing works
Disparities and guideline adherence in drugs of abuse screening in intracerebral hemorrhage
Tormoehlen, L., Blatsioris, A. D., Moser, E. A. S., Carter, R. J. L., Stevenson, A., Ofner, S., Hulin, A. L., O'Neill, D., Cohen-Gadol, A., Leipzig, T., et al. (2017) · Neurology · doi:10.1212/wnl.0000000000003505 · Cited by 7
“Substance abuse is increasingly detected in stroke populations.(1) Intracerebral hemorrhage (ICH) has the highest morbidity and mortality of all stroke subtypes(2) and sympathomimetic drugs have previously been associated with poorer outcomes in ICH.”
BackgroundStroke phenotype in cannabis users among young adults with ischemic stroke
Gueyraud, G., Guidolin, B., Olivot, J., Lerebours, F., Barbieux-Guillot, M., Larrue, V., & Gollion, C. (2023) · European Journal of Neurology · doi:10.1111/ene.15799 · Cited by 5 · see citing works
“Moreover, illicit drug consumption, including cannabis, has risen among young patients with ischemic stroke and could contribute to the increase in stroke incidence in young adults [6, 7].”
BackgroundPrimary Prevention of Ischemic Stroke
Sabayan, B. (2022) · Seminars in Neurology · doi:10.1055/s-0042-1758703 · Cited by 6 · see citing works
Kılıç, Ü., Elibol, B., Beker, M., Altuğ, B., Çağlayan, A. B., Beker, M. Ç., Yılmaz, B., & Kılıç, E. (2021) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2021.106105 · Cited by 4 · see citing works
Concurrent Myocardial and Cerebral Infarctions After Crystal Methamphetamine Use
Azarpira, N., Pourjafar, M., & Delavar-Kasmai, H. (2015) · Neurosurgery Quarterly · doi:10.1097/wnq.0000000000000105 · Cited by 4 · see citing works
“The drug blocks the presynaptic reuptake of the catecholamines dopamine, norepinephrine, and serotonin; these neurotransmitters remain in the synapse to trigger the postsynaptic receptors.(1,4) Acute increase in systolic blood pressure during amphetamine use leads to intracranial hemorrhage and hemorrhagic stroke.”
BackgroundMarx, M. H. M., Albright, K., Shaban, A., Boehme, A. K., Beasley, T., & Martin-Schild, S. (2014) · International Neuropsychiatric Disease Journal · doi:10.9734/indj/2014/7708 · Cited by 3
“Traditionally, screening for illicit drugs has been performed in younger stroke patients, as drug abuse may be the most common predisposing condition for stroke among patients under 35 years of age [2,3].”
BackgroundNasreldein, A., Ahmed, M., Shehab, M., Abdelhaleem, M., & Lioutas, V. (2024) · Neuroepidemiology · doi:10.1159/000539778 · Cited by 2
“[28].”
Comparison Between First-Ever Ischemic Stroke in Young Adults in 1988–1997 and 2008–2017
Farah, M., Næss, H., Waje-Andreassen, U., Nawaz, B., & Fromm, A. (2023) · Vascular Health and Risk Management · doi:10.2147/vhrm.s398127 · Cited by 2
Ramírez-Moreno, J. M., Rebollo, B., Macías-Sedas, P., Valverde, N., Parejo, A., Redondo, F. J. F., Roa-Montero, A., Constantino, A. B., Gómez-Baquero, M. J., Ceberino-Muñoz, D., et al. (2022) · Neurología · doi:10.1016/j.nrl.2022.07.006 · Cited by 2 · see citing works
Efficacy of cognitive rehabilitation for patients with alcohol dependence
Kumari, D., & Kumar, P. (2020) · doi:10.25215/0803.149 · Cited by 2
“Heavy drinking not only affects the brain functions directly but also increases the higher risk of trauma, seizure and stroke which indirectly hampers the brain functions (Alterman & Tarter, 1985; Eyer et al, 2011; de los Rios et al, 2012).”
BackgroundComorbid Conditions in Relation to Controlled Substance Abuse
Fortino, M., Kulich, R. J., Kaufman, J. A., & Franca, H. (2020) · Dental Clinics of North America · doi:10.1016/j.cden.2020.03.001 · Cited by 2 · see citing works
Definition and Demographics of Addiction
Sdrulla, A., Chen, G., & Mauer, K. M. (2015) · Springer eBooks · doi:10.1007/978-1-4939-1951-2_1 · Cited by 2 · see citing works
Sex-Specific Trends and Differences in Clinical Outcomes Among Young Patients With Ischemic Stroke
Song, P.-A., Chia, J., Iglesias, J., Krittanawong, C., Tangsrivimol, J., Khalid, U., & Mukherjee, D. (2025) · Angiology · doi:10.1177/00033197251392666 · Cited by 1 · see citing works
“7,20 Notably, a study using the National Health and Nutrition Examination Survey reported that the prevalence of hypertension was 31% in males compared with 13% in females aged 18 to 39 years.”
Casey, A., Jeyaseelan, A., Byrne, L., & Reardon, M. (2024) · BMJ Case Reports · doi:10.1136/bcr-2023-256223 · Cited by 1
Brunet, B., Sauvageon, Y., Palazzo, P., Guignet, J., Mura, P., & Neau, J. (2019) · Annales de Toxicologie Analytique · doi:10.1016/j.toxac.2018.11.002 · Cited by 1
Complications cardiovasculaires de la toxicomanie
Harbaoui, B. (2017) · Archives des Maladies du Coeur et des Vaisseaux - Pratique · doi:10.1016/j.amcp.2017.01.010 · Cited by 1 · see citing works
Are we overestimating the stroke risk related to contraceptive pills?
Gompel, A., & Plu-Bureau, G. (2014) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000046 · Cited by 1
“Young Stroke” Risks Potentially Linked to the Flammer Syndrome Phenotype: Facts and Hypotheses
Polívka, J., Pešta, M., Rohan, V., Čeledová, L., Čevela, R., Topolcan, O., & Golubnitschaja, O. (2019) · Flammer Syndrome · doi:10.1007/978-3-030-13550-8_10 · Cited by 1 · see citing works
Srivastava, S., & Kanika, K. (2026) · Rehabilitación · doi:10.1016/j.rh.2026.100994
Kao, H., Liu, T.-T., Lin, W.-C., & Kao, P.-H. (2026) · Scientific Reports · doi:10.1038/s41598-026-37919-8
“Taken together, previous evidence of poorer stroke outcomes among patients with substance use disorders and our findings of elevated rehabilitation needs among AYAs with SUDs highlight the compounded challenges this group faces in achieving successful post-stroke recovery 11,12,24 .”
Li, M., Tian, W., Cui, J., Lv, P., & Zhang, J. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2025.1653204
Hao, G.-Z., Han, Y.-W., Liang, Y., Zhang, B., Dong, Y.-S., & Liang, G. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1554952
Behavioral Variation in Individuals with a History of Alcohol Abuse
de Moraes, A. T. P., & Abreu-Rodrigues, J. (2025) · The Psychological Record · doi:10.1007/s40732-025-00648-x
Uvere, E., Akinyemi, J., Sarfo, F., Fakunle, A., Okekunle, A., Akpa, O., Akpalu, A., Wahab, K., Obiako, R., Komolafe, M., et al. (2025) · eNeurologicalSci · doi:10.1016/j.ensci.2025.100573
Subudhi, N. M., Anil, M., Mohan, M., & Bhat, J. (2024) · NeuroRehabilitation (Reading, MA) · doi:10.1177/10538135241291364
“Although not ascertained in the current research, substance abuse (De Los Ríos et al., 2012) and lifestyle variables such as reduced physical activity with a subsequent increase in body mass index could be a potential risk factor for obesity and diabetes mellitus in males (Wang et al., 2015).”
Ischemic Stroke in Men Aged 18–50 Years
Pizov, N. A., & Baranova, N. S. (2024) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-024-01646-2
Amikam, U., Badeghiesh, A. M., Baghlaf, H. A., Brown, R. N., & Dahan, M. H. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e25631
“This accords with the known demonstrated association between drug use and an increased risk of CVA in young adults [25,26].”
ResultEffect of illicit drugs and alcoholism on cardiac enzymes
(2019) · International Journal of Biosciences · doi:10.12692/ijb/15.1.542-547
Infarctus cérébraux du sujet jeune
Bodenant, M., & Leys, D. (2018) · EMC - Neurologie · doi:10.1016/s0246-0378(18)85824-9
Infarti cerebrali del soggetto giovane
Bodenant, M., & Leys, D. (2018) · EMC - Neurologia · doi:10.1016/s1634-7072(18)41288-3
Wolff, V. (2016) · doi:10.1016/s1634-7072(15)76143-x
Angiopathies cérébrales toxiques
Wolff, V. (2015) · EMC - Neurologie · doi:10.1016/s0246-0378(15)65722-0
- Authors
- de los Ríos, F., Kleindorfer, D. O., Khoury, J., Broderick, J. P., Moomaw, C. J., Adeoye, O., Flaherty, M. L., Khatri, P., Woo, D., Alwell, K., Eilerman, J., Ferioli, S., & Kissela, B. M.
- Affiliations
- From the Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, (F.R.R., D.O.K., J.P.B., O.A., M.L.F., P.K., D.W., J.E., S.F., B.M.K.); Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital, Cincinnati, OH (J.K.); and University of Cincinnati, Cincinnati, OH (C.J.M., K.A.).
- Cincinnati Children's Hospital Medical Center (US)
- ORCID
- Venue
- Stroke
- Published
- 2012-12
- Volume
- 43
- Issue
- 12
- Pages
- 3179-3183
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC3742309
- OpenAlex
- W2153399320
- Cited by
- 130
- References
- 37
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 10 · 2023: 8 · 2022: 9 · 2021: 11 · 2020: 9 · 2019: 10 · 2018: 6 · 2017: 11 · 2016: 13 · 2015: 7 · 2014: 13 · 2013: 7
- FWCI
- 6.47
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000077)
- National Institute of Neurological Disorders and Stroke (R01-NS30678, R01NS036695, T32NS047996, U01NS069763, R01 NS36695, R01NS030678, P50NS044283)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- substance abuse, young adults, drug use trends, smoking, alcohol consumption, illicit drug use, cocaine use, cannabis use, race and sex differences, stroke risk factors
- MeSH terms
- Adolescent, Adult, Cerebral Hemorrhage, Brain Ischemia, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Smoking, Incidence, Prevalence, Age Distribution, Sex Distribution, Substance-Related Disorders, Stroke, Young Adult
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