Addiction & Demographics: Evaluating an Individual’s Treatment Needs


Addiction is a disease that doesn’t discriminate; its impact is felt in all of society’s demographic groupings. This chronic, yet treatable, medical condition affects individuals from all walks of life, regardless of their gender, age, race, socioeconomic status, or occupation. Yet within these demographic groups, it is possible to discover patterns of substance use and abuse that reflects how addiction affects the lives and health of individuals in all of these groups.

In the admission stage of rehab, and throughout the treatment process, an evaluation of the patient’s needs can make the difference between effective, individualized care and a cookie-cutter approach to rehab.

What Makes Addiction Universal?

Living with addiction is a very personal experience affecting everyone differently, but the core characteristics of addiction are universal:

  • It involves compulsive drug use. Unlike recreational drug use or social drinking, which users can typically control, addiction is unmanageable. Addiction is marked by continued, compulsive drug-seeking despite the harmful consequences.1
  • It is progressive. Without treatment, the disease will likely continue to get worse. Addiction can ultimately end in death, either by overdose, violence, injury, or drug-related illness.2
  • It changes the brain. Addiction involves changes in the brain that make it extremely challenging to stop using without treatment. Among the parts of the brain affected by addiction include those relating to judgment, memory, impulse control, and decision-making.3
  • It is treatable. There is a wealth of scientific research and medical evidence accumulating every day to inform healthcare professionals who help those with the disease of addiction. Like other chronic medical diseases, it can be managed and there are many people who have found recovery who now live a very healthy, fulfilling life.1

Treatment Guides

How Does Addiction Change the Brain?

Addiction used to be viewed widely as a moral failing or a problem that largely pertained to certain groups. But now addiction is understood as a chronic brain disorder and treatable medical condition.4 When you start to understand that addiction actually changes the brain, it becomes easier to see that addiction is not a problem of willpower and that anyone can be impacted.

Most drugs that people abuse impact the brain’s reward circuit. The brain has a built-in reward system that reinforces healthy, life-sustaining behaviors, such as the pursuit of food, warmth, sexual activity, and physical intimacy. Drugs of abuse over-activate this circuit, causing a euphoric “high” and providing an unnaturally large release of dopamine. These repeated dopamine surges lead the brain to associate drug-taking with feeling good while at the same time interfering with the ability to experience pleasure via natural rewards, leading a person to repeat using the substance again and again.1

When you start to understand that addiction actually changes the brain, it becomes easier to see that addiction is not a problem of willpower and that anyone can be impacted.

Drug use is voluntary to start with; however, when the brain changes associated with repeated drug use progress over time, the person’s ability to control their use diminishes significantly. Eventually, when a person decides they want to stop using, they find they have extreme difficulty doing so, and sobriety may seem impossible to achieve. Addiction is considered a relapsing disease because the changes that happen in the brain are persistent and create a high risk of returning to substance use even in those who’ve been in recovery for years.1

Addiction by the Numbers: How Demographic Groups Compare

While addiction can happen to anyone, we’ll discuss the unique ways substance abuse impacts society across a variety of demographic groups.

Statistics from the 2018 National Survey of Drug Use and Health, a nationwide report that tracks substance abuse and treatment across many demographic groups in American society, help provide a current picture of addiction in the U.S. In 2018:5

  • More than 20 million Americans 12 years old or older suffered from a substance use disorder.
  • An estimated one in five Americans had engaged in illicit drug use in the past year. Marijuana and opioid painkillers were the most common drugs that were used illicitly that year.

A few statistics from specific demographic groups are provided below. You can find more detailed information on our Addiction Among Different Races page.

Women6

  • In 2018, more than 32 million American women suffered from a mental disorder and/or substance use disorder.
  • Nearly 9% of young adult women between 18 and 25 years old in the U.S. had an alcohol use disorder in 2018.
  • Nearly 10% of pregnant women drank alcohol in 2018.
  • There was a significant rise in marijuana use disorder rates (from 3.4% to 4.4%) in young adult women from 2015 to 2018.

Men7,8

  • Men are more likely than women to use marijuana and misuse prescription drugs.
  • Illicit drug use is more likely to result in an overdose death for men than for women.
  • Nearly ¼ of adult American men report binge drinking about 5 times per month.
  • Men show consistently higher rates of alcohol-related hospitalizations and deaths.
  • Men are more likely than women to use alcohol before committing suicide.

Adolescents and Young Adults5

  • More than 2 million adolescents used alcohol, and 1.2 million binge drank.
  • Young adults had the highest rates of illicit drug use disorder, with 7.6% of those between 18 and 25 years old having this type of disorder in 2018.

Lesbian/Bisexual/Gay (LBG) and Transgender Individuals9,10

  • Two in 5 LBG adults 18 years old or older suffered from a serious mental illness in 2018.
  • 5 million LBG adults suffered from both a substance use disorder and a mental illness in 2018.
  • 2% of LBG adults over age 25 had an alcohol use disorder (AUD) in 2018, while 12.4% of young LBG adults had an AUD that year.
  • Marijuana was the most used drug in 2018 by LBG individuals, with nearly 5 million using in the past year.
  • Rates of painkiller misuse exceeded the national average for both young adults and adults over 25 years old in the LBG population in 2018.
  • Methamphetamine use among LBG adults over 25 years old jumped from 1.5% in 2017 to 2.9% in 2018, compared to 0.7% in the overall U.S. population.
  • In a 2015 report, the rate past-month illicit drug use, marijuana use, or nonmedical prescription opioid use among transgender individuals was nearly 3x that of the general population at close to 30%.

African Americans11

  • Marijuana was the most commonly used drug among African Americans.
  • African American young adults between 18 and 25 suffered from alcohol use disorder at much lower rates than the overall U.S. young adult population (5.6% compared to 10.1%).
  • 2 million African-Americans struggled with opioid misuse in 2018.

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Asian Americans/Native Hawaiians and Other Pacific Islanders (NHOPI)12

  • There was a significant increase in marijuana use among Asian-Americans/NHOPI adults 26 years and older from 2017 to 2018, with past month users rising from 3.1% to 4.8% and daily users rising from 0.3% to 1.1% of this population.
  • The numbers of young Asian-American/NHOPI adults between 18 and 25 who misused prescription stimulants jumped by 56k from 2017 to 2018.
  • There was a significant rise in alcohol use disorders in young Asian-American/NHOPI adults between 2017 and 2018 from 6.6% to 9.9%.

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American Indians/Alaska Natives13

  • More than 22% of American Indians/Alaska Natives 18 years and older had a mental illness in 2018.
  • Nearly 11% of American Indians/Alaska Natives 18 and older had a substance use disorder.
  • Rates of alcohol use disorder in American Indian/Alaskan Native adults over 25 exceeded the national average (7.2% vs. 5.1%) in 2018.
  • Marijuana was the most used drug in this population in 2018, with 23% of those 12 and older using it in the previous year.
  • Close to 10% of young adults between 18 and 25 in this group suffered from marijuana use disorder in 2018.

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Hispanic/Latino Americans14

  • Marijuana was the most used drug by Hispanic Americans in 2018.
  • There was a significant increase in marijuana use in Hispanic adults over 25 years old from 2017 to 2018 (from 5.6% to 6.5%).
  • There was a significant decrease in misuse of opioids among 18+ individuals in this population between 2015 and 2018.
  • Nearly 57% of young Hispanic adults between 28 and 25 with a serious mental illness in 2018 got no treatment.
  • More than 36% of Hispanic adults 18 and older with a mental illness engaged in past-month binge drinking.

White Americans15

  • Almost a quarter of white Americans 12 years and over reported binge drinking in the past month in the 2018 National Survey on Drug Use and Health.
  • 20% of white Americans 12 and older engaged in illicit drug use in 2018, while 6.4% engaged in past-month heavy alcohol use.
  • Nearly 17% of white Americans age 12 and older used marijuana in 2018.

Assessing Unique Treatment Needs

If addiction is a disease that transcends the boundaries among demographic groups, why is it so important to consider the needs of a specific client in treating this disorder? To some degree, addictive behaviors can be addressed as universal, but when it comes to resolving the problems that affect an individual, then the factors that contribute to addiction, which may be genetic, environmental, or experiential, must be addressed. Otherwise, the client may be more likely to feel alienated, isolated, or lonely in treatment — and more likely to drop out early.

Years of research in the areas of mental health and substance abuse treatment have guided treatment providers toward personalized, culturally sensitive care that reflects the needs of the individual. Personalized assessment and evaluation at the beginning of the treatment process, and at various stages throughout rehab and recovery, are critical components when aiming for long-term sobriety. Listed below are some demographic considerations that are taken into consideration when a treatment provider evaluates a patient.

Men

According to the Substance Abuse and Mental Health Services Administration, the majority of clients in drug abuse treatment are men.16 American men face the pressure to live up to an image of strength, competence, and self-sufficiency that’s associated with masculinity, yet in rehab, they may need to confront their own weaknesses and vulnerabilities as they face the consequences of addiction. This can be very difficult, and these cultural norms around masculinity can create barriers to recovery. For example, men may have trouble analyzing their problems and the feelings they have about them.16

Men who’ve been raised to be competitive and aggressive may act in these ways toward peers in treatment as well as staff.  Good rehab programs will take into account the ways that male clients have been socialized and incorporate them into their approaches. For example, men who are action-oriented may respond well to a treatment plan with clear steps that build upon one another. This may boost their sense of confidence and control. 16

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Women

Substance use in women often progresses more quickly to addiction than it does in men. 7 Unfortunately, women will often delay seeking treatment due to work, childcare, and family/home responsibilities. 17 Support services such as onsite childcare can help relieve these burdens for women who need treatment. 17

When women do enter treatment, they tend to have more severe behavioral, psychological, medical and social problems than men who first enter treatment. Withdrawal symptoms may also be more severe for women than men and women’s bodies may respond differently to some medications, according to the National Institute on Drug Abuse.7 Good rehab programs will take into account the unique needs of their female patients.

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Pregnant Women

Substance use during pregnancy can have short-term as well as long-lasting effects on a baby because many drugs can pass through the placenta and onto the fetus. Some drugs, notably opioids like heroin or prescription painkillers, can cause dependence in the fetus which results in a child having to go through minor or even major withdrawal after birth.18 Other risks from opioids and other drugs range from birth defects to stillbirth and sudden infant death syndrome (SIDS).

Pregnant women and new mothers have very different medical needs from most patients in treatment and require programs that can provide the appropriate care for mother and baby. For example, pregnant women may need medical management of withdrawal, especially when withdrawal puts the baby at risk.18 For opioid-dependent mothers, methadone and buprenorphine combined with additional prenatal healthcare efforts can help pregnant women overcome opioid dependence and prevent or minimize the effects of neonatal withdrawal.18

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Parents in Need of Rehab

Substance abuse by a parent may have a profoundly negative impact on children and the entire family. Children living with a substance-abusing parent are more at risk of maltreatment and of becoming substance abusers themselves.19 In many cases, households where one or both parents are abusing drugs or alcohol often face other stressors such as mental illness or domestic violence, so treatment for addicted parents often needs to be comprehensive and extend out beyond substance use treatment to include support services for the entire family.19

The family is an ecosystem where one person’s substance use can throw everything out of balance, and family therapy can help all members of the family find new and healthier ways of functioning as the parent gets treatment for addiction.20 Programs that incorporate family therapy can be beneficial for parents struggling with addiction.

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LGBTQ+ Individuals

Individuals in the LBGTQ+ community often face discrimination, harassment, and other difficulties that may put them at an increased risk for drug and alcohol abuse and substance use disorders (SUDs).21 Research shows that  individuals who identify as lesbian, gay, or bisexual, have an increased risk of having an SUD in their lifetimes and often enter treatment with more severe SUDs than those who identify as heterosexual or straight. 21

Lesbian, gay, or bisexual individuals with substance use disorders are also more likely than heterosexual or straight individuals with SUDs to suffer from co-occurring mental illness. 21 Children and adolescents who identify as transgender tend to have higher levels of depression, self-harm, eating disorders, and suicidal thoughts/behaviors than those who don’t. 21

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Adolescents and Young Adults

During adolescence, a teenager’s brain is still developing. The brain’s reward systems are the first to mature and yet the prefrontal cortex, or the area of the brain responsible for judgment and impulse control, is not yet developed fully.22 This makes teens more likely to take risks and makes them vulnerable to substance use disorders. 22 Those most at-risk of developing an addiction to drugs or alcohol are those who initiated substance use in their early teens. 22

Adolescents are not as likely as adults to see the need for treatment, and many need to be persuaded to enter treatment by a parent or required by the juvenile justice system. Adolescents are also less likely to have experienced a large range of adverse outcomes from their drug use and may be resistant to change. Programs aimed at treating adolescents with substance use disorders use specialized treatment approaches and well-trained staff. These programs typically emphasize behavioral treatment vs. pharmacological approaches. 22

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Older Adults

Alcohol and drug addiction often go unnoticed or untreated in the elderly population. 23 Some reasons for this include the following:

  • Identifying substance abuse in this population is often difficult because the symptoms may overlap with medical conditions that are common to aging adults.23
  • Older people often have comorbid medical conditions, and many hold legitimate prescriptions for addictive opioid medications.24
  • False beliefs that older people are immune to addiction continue to persist.23
  • Older adults may feel ashamed or guilty about substance abuse, considering it a moral failing rather than a disease.24 This may cause them to avoid seeking treatment.

Because older adults often feel a great deal of shame around addiction and because of the challenges in identifying substance use, evaluations of older individuals should be compassionate and nonstigmatizing but include direct questions about drug or alcohol use.23

When in treatment, older adults have different needs than younger patients. They often face more numerous, longer-lasting, or more serious issues that may contribute to their alcohol or drug use. These include social isolation, losing a partner or other loved one, forced retirement, transitioning to assisted living, health problems and/or chronic pain, etc.23 Recovery services should help address both the emotional distress around these issues also in addition to providing the more robust medical support required by this group.

Addiction treatment programs often rely heavily on treatment in groups, but older adults often feel a certain level of discomfort in being grouped into treatment with those who are much younger. They may feel compelled to play a parental role, expending energy supporting younger patients over their own needs.24 Treatment programs will often address this concern by offering groups made up only of other older patients.24

Racial and Cultural Diversity

The need for culturally competent treatment is paramount in a racially and socioeconimcally diverse culture like that in the United States. Individuals admitted for rehab at specialized facilities around the country represent a full range of racial groups, including White and Black Americans, Pacific Islanders, Hispanic Americans, and Asian Americans. Because cultural and racial backgrounds can have a strong influence on an individual’s drug or alcohol use, recovery services must acknowledge the effects of a client’s race and culture when developing a personalized treatment plan.

The Substance Abuse and Mental Health Services Administration (SAMHSA) stresses the importance of cultural competence in a substance abuse treatment program and provides the following definition for it:25

“A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable the system, agency, or professionals to work effectively in cross-cultural situations.”

Per SAMHSA, culturally competent rehabilitation programs will:25

  • Realize the importance of integrated services that address the needs of diverse populations.
  • Develop policies and practices that meet the needs of different demographics.
  • Provide continual refinements to policies and practices that provide constant improvement to culturally congruent services.
  • Acknowledge the impact of a patient’s cultural identity and background on their needs and incorporate them into assessment, care planning, and services.

Co-Occurring Mental Health Disorders and Medical Conditions

diagnose-a-mental-illness

Substance abuse may be accompanied by, or exacerbated by, another mental health issue or chronic medical condition. The presence of a substance use disorder along with another mental health disorder or a chronic medical condition is known as comorbidity, co-occurring disorders, or dual diagnosis.

In treating a substance use disorder in the presence of a co-occurring mental health disorder or comorbid medical condition, it is very important that treatment be integrated. Integrated treatment means that mental and physical health care and addiction recovery services are coordinated and, ideally, provided at the same facility wherever possible by staff members who have appropriately trained. The patient’s treatment plan is also customized to reflect any additional mental health treatment needs or accommodations required by a chronic medical condition.

Individuals with comorbid medical conditions — or physical illness combined with a substance use disorder — may require more intensive monitoring during treatment, especially during the detox stage.26 Round-the-clock observation by doctors, nurses or health technicians ensures that these remain stable and as comfortable as possible as the drugs and alcohol clear their bodies.

Patients with comorbid conditions may also need support services and education to help them better maintain their physical or mental health both during and after treatment.

Learn More about Co-Occurring Mental Health Disorders

Learn More about Medical Diseases Associated with Alcohol or Drug Use

Trauma

Trauma may include exposure to natural disaster, war, sexual assault, homicide, motor vehicle accidents, abuse, or any other event that was shocking, frightening, or a threat to one’s personal safety.27 Some people who experience trauma will go on to develop posttraumatic stress disorder (PTSD), a condition that results in intrusive memories, flashbacks, and avoidance of reminders of the trauma, among other symptoms.28

Trauma and PTSD can lead to or worsen substance abuse. 28 Trauma-based therapies can help individuals who have been impacted by trauma learn ways of coping that don’t involve substance use.

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Other Demographic Considerations

Rehab Needs by Profession

Given the loss of work time, the effect on job performance, and the risk of injuries or accidents caused by substance abuse, addiction can have a sobering impact for employers and employees alike.

A person’s occupation plays a significant role in lifestyle choices, stress levels, and emotional health. All of these factors can contribute to an individual’s use of drugs or alcohol, as well as the barriers that might stand in the way of treatment. For instance, members of the medical profession are exposed to high levels of emotional stress, as well as exposure to health hazards; at the same time, they often have easy access to prescription narcotics. Yet they may be reluctant to seek treatment because they fear losing their jobs and their licenses to practice medicine.

The stressors and triggers associated with a client’s profession must be taken into account when developing an individualized treatment plan. Some rehab programs are customized to meet the needs of certain groups of professionals, such as healthcare professionals, first responders, and military servicemembers/veterans.

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Disabled Individuals

Disabled individuals may face challenges in their search for substance abuse treatment, including:

  • A shortage of facilities that accommodate the specific disability.
  • A lack of access to reliable transportation.
  • Inadequate healthcare coverage to pay for substance abuse treatment.
  • Limited support services to cover living expenses while in treatment.

Recovery services for the disabled must take into account the physical effects of the client’s disability, as well as the psychological and emotional impact of living with a condition that restricts one’s activities.

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Socioeconomic Considerations

When it comes to rehab, Americans with full-time corporate jobs are more likely to have health insurance coverage than those who have part-time jobs or contract positions, or who are unemployed. Lack of health insurance and inability to pay for treatment were cited among the top-listed reasons for not receive treatment in the 2018 National Survey on Drug Use and Health. Others felt that getting treatment would have a negative impact on their employment.5 In addition to lacking the means to pay for rehab, people living in poverty may lack access to reliable transportation or childcare, both of which are necessary to participate in certain programs.

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First Time in Rehab

Rehab is an intense experience for anyone who commits to recovery, but it can be especially intimidating for an individual going through treatment for the first time. These individuals need careful assessment, orientation to their treatment program, and additional support to achieve the best outcome.

To engage new clients in treatment and motivate them to continue, they must have a personalized treatment plan that reflects their needs, along with the support of a multidisciplinary treatment team.

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Victims of Domestic Abuse

Domestic violence victim

National Resource Center on Domestic Violence presents disturbing statistics on the relationship between addiction and domestic abuse:29

  • Between 25 and 50 percent of women who seek help for substance abuse have been the victim of domestic violence.
  • A large portion of women in intimate partner violence programs are substance abusers.
  • An estimated 50% of men in treatment for addiction have abused their partners.

The National Resource Center on Domestic Violence recommends that substance abuse treatment programs screen for intimate partner violence and provide integrated treatment services for both. 29

Disabled Individuals

Disabled individuals may face challenges in their search for substance abuse treatment, including:

  • A shortage of facilities that accommodate the specific disability.
  • A lack of access to reliable transportation.
  • Inadequate healthcare coverage to pay for substance abuse treatment.
  • Limited support services to cover living expenses while in treatment.

Recovery services for the disabled must take into account the physical effects of the client’s disability, as well as the psychological and emotional impact of living with a condition that restricts one’s activities.

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Homelessness

Substance abuse can be both a cause of homelessness and an outcome of the poverty, despair, and deprivation that homeless people experience.30 Unfortunately, recovery from addiction can be especially difficult for the homeless population. Recovery may fall down the list of priorities when day-to-day survival is paramount. Also, because homelessness often involves estrangement from loved ones and social isolation, recovery can be exceedingly hard since it requires a great deal of social support.30

Further, many homeless individuals who struggle with addiction also have a mental illness, but many programs for homeless individuals with mental illness don’t accept substance abusers and conversely many addiction treatment programs don’t address mental illness.30

Other barriers to treatment include a lack of finances to pay for care, lack of documentation, and lack of transportation.30

Addiction treatment for the homeless needs to be integrated with services that provide stable housing, educational support, mental and physical health care, and financial education.30

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The Importance of Customized Care

No demographic is immune to substance abuse and addiction. Thankfully, specialized help is available for all individuals who wish to find recovery and move to a healthier future. When choosing an addiction treatment facility, it’s important to ensure that the staff has the capacity to effectively address your own unique needs.

References:

  1. National Institute on Drug Abuse. (2018). Understanding Drug Use and Addiction DrugFacts.
  2. S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
  3. American Psychological Association. (2017). What Is Addiction?
  4. National Institute on Drug Abuse. (2018). What Does It Mean When We Call Addiction a Brain Disorder?
  5. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  6. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health: Women.
  7. National Institute on Drug Abuse. (2020). Sex and Gender Differences in Substance Use.
  8. Centers for Disease Control and Prevention. (2019). Excessive Alcohol Use and Risks to Men’s Health.
  9. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health: Lesbian, Gay, & Bisexual (LGB) Adults.
  10. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
  11. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health: African Americans.
  12. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health: Asians/Native Hawaiians and Other Pacific Islanders (NHOPI).
  13. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health: American Indians and Alaska Natives (AI/ANs).
  14. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health: Hispanics, Latino or Spanish Origin or Descent.
  15. Substance Abuse and Mental Health Services Administration. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  16. Center for Substance Abuse Treatment (US). Addressing the Specific Behavioral Health Needs of Men. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013. (Treatment Improvement Protocol (TIP) Series, No. 56.) 3, Treatment Issues for Men.
  17. National Institute on Drug Abuse. (2020). Sex and Gender Differences in Substance Use Disorder Treatment.
  18. National Institute on Drug Abuse. (2020). Substance Use While Pregnant and Breastfeeding.
  19. Lipari, R.N. and Van Horn, S.L. Children living with parents who have a substance use disorderThe CBHSQ Report: August 24, 2017. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.
  20. Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2004. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 1 Substance Abuse Treatment and Family Therapy.
  21. National Institute on Drug Abuse. (n.d.). Substance Use and SUDs in LGBTQ* Populations.
  22. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
  23. Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance abuse among older adultsClinics in geriatric medicine30(3), 629–654. https://doi.org/10.1016/j.cger.2014.04.008
  24. Substance Abuse and Mental Health Services Administration. (2020). Substance Use Treatment for Older Adults.
  25. Substance Abuse and Mental Health Services Administration. Improving Cultural Competence. Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) 14-4849. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
  26. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
  27. National Center for PTSD. (n.d.). How Common is PTSD in Adults?
  28. National Institute of Mental Health. (n.d.). Post-Traumatic Stress Disorder.
  29. National Resource Center on Domestic Violence. (2008). Substance Abuse and Intimate Partner Violence.
  30. National Coalition for the Homeless. (2009). Substance Abuse and Homelessness.

About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More