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. Acute ischemic stroke hospitalization is higher among cannabis users (OR, 1.41 [95% and the US Centers for Disease Control and Prevention179 identified that young adults (age, 18 44 years) with recent cannabis use have higher odds of stroke compared with nonus- ers (adjusted OR, 1.82 [95% CI, 1.08 3.10]), which increases among frequent cannabis users (>10 d/ mo; adjusted OR, 2.45 [95% CI, 1.31 4.60]). 3. An alcohol or drug use disorder is a chronic relaps- ing brain disease characterized by compulsive use, loss of control over intake, and a negative emo- tional state when not using. Therefore, special- ized care is required to manage the substance dependency. In alcohol use disorders, established screening and counseling strategies such as those described in the 2004 US Preventive Services Task Force update are recommended. Long-term treatment strategies, including medication, psy- chological counseling, and community-based pro- grams, are effective in the management of drug Lifestyle Knowledge Gaps and Future Research Lifestyle recommendations in stroke secondary pre- vention draw from convincing primary prevention data and broader CVD populations. 