Drug use has been stigmatized for more than 140 years. This stigma has influenced public policy, school curriculum, and treatment for drug addiction. Additionally, the US has a historical pattern of shaming and excluding people who use drugs, which is especially concerning as opioid overdose death rates have risen every year. This research aims to analyze this historical, morally centered stigma and its effects on people who use drugs, while exploring the role of epigenetics (i.e., gene expression changes) in opioid addiction and opioid addiction treatment. This Literature Review examined textbooks, journal articles, blog posts, book sections, and government websites. This review analyzes historical timelines relating to societal stigma, public policy, and addiction treatment, as well as how the epigenetic mechanisms of opioids relate to those of popular opioid addiction treatments. This research indicates that how popular treatments alter the gene expression changes seen in opioid addiction is unclear due to a lack of research in this area. My analysis of historical timelines shows that the “maintenance” model of treatment, seen with methadone and buprenorphine today, was created approximately 50 years before discoveries that shaped the science of modern epigenetics. Thus, today’s leading treatments were incapable of considering the role of epigenetics in opioid addiction during their development because they were introduced before the science was fully developed. This research suggests a possibility for future use of precision medicine methods for gene editing, like CRISPR-Cas9, as a treatment modality for drug addiction. This analysis also points towards a role of epigenetics in psychiatric conditions like Borderline Personality Disorder and altering gene expression changes associated with successful psychotherapy treatment, suggesting a possibility of precision medicine in a mental health setting as well.

In this study, Interpretive Phenomenological Analysis (IPA) is utilized as a framework to examine the experiences of hospital social workers who care for unhoused patients. Past research suggests that hospital social workers feel unprepared to appropriately support unhoused patients; this study aims to expand upon that research by introducing a type of intervention that supports the care of this population (based on Relational-Cultural Intervention or RCT) as a way of equipping social workers with additional tools to address this perception. Existing literature indicates that RCT can be a meaningful, reparative intervention to help unhoused individuals find affirmation and support through relational re-engagement. Through the provision of information about relational-cultural techniques, as well as advice on how to utilize these techniques, this research seeks to consider hospital social workers’ impressions of RCT’s potential usefulness as well as increase respondents’ perceptions that interventions performed with unhoused patients can offer meaning and value to both the patient and the social worker. Existing research suggests that meaningful relational exchanges have value for increasing an individual’s confidence in others' support and willingness to engage with services, programs, and other individuals, even in the absence of immediate options for accessing housing.