Although behavioral interventions, for example, the STOP (secondary stroke prevention) trial, can show decreased alcohol consumption levels,141 their impact on recurrent stroke is not delineated. High alcohol intake (>60 g/d), however, has been identified as an independent risk factor for stroke recurrence at 90 days in minor stroke/TIA.161 In ischemic stroke, low to moderate alcohol con- sumption is protective, but increased risk at higher exposure levels exists. The EPIC-CVD observa- tional case-cohort study (European Prospective Investigation into Cancer and Nutrition-CVD) (N>32 000) identified an ischemic stroke HR of in alcohol consumption. Compared with a refer- ence value of 0.1 to 4.9 g/d, HRs for ischemic to 29.9, 30.0 to 59.9, and 60 g/d total alcohol In both men and women, compared with lifetime abstainers, alcohol con- sumption of <12 g/d ( 1 drink a day based on US conversions) is associated with the lowest risk for mortality. 2. No data confirm drug use and recurrent stroke risk. Current users of amphetamine-type stimu- lants have a higher ischemic stroke risk adjusted and adjusted HR (any) for TIA of 3.4 (95% CI, A systematic review of cocaine identified an increased likelihood of ischemic and stroke (type unspecified; all-female study) for powder/paste cocaine (adjusted OR, 13.9 [95% CI, 2.8 69.0]) and crack cocaine (adjusted OR, 11.2 Khat use is associated with Although the CARDIA study (Coronary Artery Risk Development in Young Adults) identified no significant risk for stroke/TIA as a result of cumulative lifetime can- nabis use of 5 years or recent use,177 increasing evidence of an association is emerging in younger- onset stroke. 