INS and substance abuse: Studies have reported a connection through mediational factors such as social (unemployment, substance abuse, social isolation, and low education), biological (autonomic dysregulation, platelet factors, endothelial function, circulating neurohormones, insulin resistance, inflammatory cytokines), and behavioral mechanisms (obesity, smoking, low physical activity, poor diet, and medical noncompliance) both in large prospective surveys (Song et al., 2019) and in systematic reviews (Albasheer et al., 2024; Bradley and Rumsfeld, 2015; Gaffey et al., 2022).