Prevalence and Risk Factors Among Patients with Alcohol Use Disorder During COVID-19: National Survey on Drug Use and Health Analysis
Main Article Content
Abstract
Background: Recent guidelines recommend improved treatments for alcohol use disorder (AUD), yet little is known about the factors associated with alcohol use treatment, especially during the COVID-19 pandemic, which has been linked to stronger alcoholic cravings.
Objective: This study examines the use of treatments among US adults with AUD and assesses the factors associated with their use.
Methods: We used 2021 National Survey on Drug Use and Health data for the study. Alcohol use disorder was identified using diagnostic criteria based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Age, gender, race/ethnicity, education level, employment status, health insurance type, family income, residential area, receipt of mental health care, and illicit drug use disorder were compared descriptively between treated and untreated adults with AUD. Multinomial logistic regression modeling was applied to examine associations of these factors with different treatments and no treatments.
Results: The 2021 National Survey on Drug Use and Health files included 47,291 adults (55.8% female). The past-year prevalence of AUD among US adults was 11.4% in 2021. In 2021, 3.7% of adults with AUD received non-medication treatment, and 0.9% received medication treatment. Male adults receiving mental health care and those engaged in illicit drug use were more likely to receive treatment for AUD. Age and education level were also significant factors. Living in a non-metropolitan area was more likely associated with non-medication treatment. We found no evidence of treatment disparities by race/ethnicity, employment status, family income, or health insurance type.
Conclusions: Effective medication and non-medication-based treatments for AUD are consistently underutilized despite several recent guideline recommendations that encourage treatments.
Keywords:
Alcohol use disorder, Risk factors, Treatment, Pandemic
Article Details
How to Cite
BASER, Onur; ZENG, Yixuan; BASER, Isabel Eda.
Prevalence and Risk Factors Among Patients with Alcohol Use Disorder During COVID-19: National Survey on Drug Use and Health Analysis.
Medical Research Archives, [S.l.], v. 13, n. 2, feb. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6329>. Date accessed: 16 mar. 2025.
doi: https://doi.org/10.18103/mra.v13i2.6329.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Watkins KE, Ober AJ, Lamp K, et al. Collaborative care for opioid and alcohol use disorders in primary care: the SUMMIT randomized clinical trial. JAMA Intern Med. 2017;177(10):1480-1488.
2. National Institute on Alcohol Abuse and Alcoholism. Understanding alcohol use disorder. Accessed July 31, 2023. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
3. National Survey on Drug Use and Health. Alcohol use disorder in past year: Among people aged 12 or older. SAMHSA, Center for Behavioral Health Statistics and Quality,. Accessed July 31, 2023.
4. National Institute on Alcohol Abuse and Alcoholism. Alcohol use disorder (AUD) in the United States: Age groups and demographic characteristics. Accessed July 31, 2023. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics#:~:text=According%20to%20the%202021%20NSDUH,AUD%20in%20the%20past%20year.&text=1%2C2-,This%20includes%3A,2.2%25%20in%20this%20age%20group)&text=596%2C000%20girls%20ages%2012%20to,4.7%25%20in%20this%20age%20group)
5. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prevent Med. 2015;49(5):e73-e79.
6. US Centers for Disease Control and Prevention. Excessive alcohol use continues to be drain on American economy. Accessed July 31, 2023. https://www.cdc.gov/media/releases/2015/p1015-excessive-alcohol.html
7. Committee on Substance Abuse, Committee on Children with Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics. 2000;106(2):358-361.
8. Rehm J, Baliunas D, Borges GL, et al. The relation between different dimensions of alcohol consumption and burden of disease: An overview. Addiction. 2010;105(5):817-843.
9. American Psychological Association. Understanding alcohol use disorders and their treatment. Accessed July 31, 2023. https://www.apa.org/topics/substance-use-abuse-addiction/alcohol-disorders#:~:text=Drinking%20problems%20also%20have%20a,memory%20loss%2C%20depression%20or%20anxiety.
10. Kranzler HR, Soyka M. Diagnosis and pharmacotherapy of alcohol use disorder: A review. JAMA. 2018;320(8):815-824.
11. Mattson ME, Lynch S. Medication prescribing and behavioral treatment for substance use disorders in physician office settings. Accessed July 31, 2023. https://www.samhsa.gov/data/sites/default/files/report_1976/ShortReport-1976.html
12. Agency for Healthcare Research and Quality. Pharmacotherapy for adults with alcohol use disorder in outpatient settings. Accessed July 31, 2023. https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/policymaker
13. Mark TL, Kranzler HR, Song X. Understanding us addiction physicians’ low rate of naltrexone prescription. Drug Alcohol Depend. 2003;71(3):219-228.
14. Harris AH, Ellerbe L, Reeder RN, et al. Pharmacotherapy for alcohol dependence: Perceived treatment barriers and action strategies among veterans health administration service providers. Psychol Serv. 2013;10(4):410.
15. Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatr. 2018;175(1):86-90.
16. Knopf A. SAMHSA awards $18.9 million for services to youth and families. Alcoholism & Drug Abuse Weekly. 2023;35(29):6-7.
17. Helle AC, Sher KJ, Masters J, Washington K, Hawley KM. A mixed-method evaluation of the adoption and implementation of the college alcohol intervention matrix among prevention experts: A study protocol. Implement Sci Comm. 2021;2:1-8.
18. Torous J, Myrick KJ, Rauseo-Ricupero N, Firth J. Digital mental health and COVID-19: Using technology today to accelerate the curve on access and quality tomorrow. JMIR Mental Health. 2020;7(3):e18848.
19. Volkow ND, Poznyak V, Saxena S, Gerra G, Network UWIIS. Drug use disorders: Impact of a public health rather than a criminal justice approach. World Psychiatry. 2017;16(2):213.
20. Villani J, Ganoza L, Sims BE, et al. Substance use prevention research funded by the NIH. Drug Alcohol Depend. 2020;206:107724.
21. Grucza RA, Sher KJ, Kerr WC, et al. Trends in adult alcohol use and binge drinking in the early 21st‐century United States: A meta‐analysis of 6 national survey series. Alcoholism Clin Exp Res. 2018;42(10):1939-1950.
22. Pollard MS, Tucker JS, Green HD. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Netw Open. 2020;3(9):e2022942-e2022942.
23. Rodriguez LM, Litt DM, Stewart SH. Covid-19 psychological and financial stress and their links to drinking: A dyadic analysis in romantic couples. Psychol Addict Behav. 2021;35(4):377.
24. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. Accessed July 21, 2023.
25. Lu J, Yang Y, Cui J, et al. Alcohol use disorder and its association with quality of life and mortality in Chinese male adults: A population-based cohort study. BMC Public Health. 2022;22(1):1-11.
26. National Institute on Alcohol Abuse and Alcoholism. Alcohol-related emergencies and deaths in the United States. Accessed July 31, 2023. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states#:~:text=It%20is%20estimated%20that%20more,physical%20inactivity%2C%20and%20illegal%20drugs.
27. Substance Abuse and Mental Health Services Administration. Medications for substance use disorders. Accessed July 31, 2023. https://www.samhsa.gov/medications-substance-use-disorders
28. Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: A systematic review and meta-analysis. JAMA. 2014;311(18):1889-1900.
29. Rösner S, Hackl‐Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M. Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010;(9)
30. Fuller RK, Gordis E. Does disulfiram have a role in alcoholism treatment today? Addiction (Abingdon, England). 2004;99(1):21-24.
31. Johnson BA, Rosenthal N, Capece JA, et al. Topiramate for treating alcohol dependence: A randomized controlled trial. JAMA. 2007;298(14):1641-1651.
32. Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: A randomized clinical trial. JAMA Intern Med. 2014;174(1):70-77.
33. Hartung DM, McCarty D, Fu R, Wiest K, Chalk M, Gastfriend DR. Extended-release naltrexone for alcohol and opioid dependence: A meta-analysis of healthcare utilization studies. J Subst Abuse Treat. 2014;47(2):113-121.
34. Probst C, Manthey J, Martinez A, Rehm J. Alcohol use disorder severity and reported reasons not to seek treatment: A cross-sectional study in european primary care practices. Subst Abuse Treat Prev Policy. 2015;10(1):1-10.
35. Green CA, Polen MR, Lynch FL, Dickinson DM, Bennett MD. Gender differences in outcomes in an hmo—based substance abuse treatment program. J Addict Dis. 2004;23(2):47-70.
36. Marsh JC, Cao D, D’Aunno T. Gender differences in the impact of comprehensive services in substance abuse treatment. J Subst Abuse Treat. 2004;27(4):289-300.
37. Brady KT, Randall CL. Gender differences in substance use disorders. Psychiatr Clin North Am. 1999;22(2):241-252.
38. Timko C, Moos BS, Moos RH. Gender differences in 16-year trends in assault-and police-related problems due to drinking. Addict Behav. 2009;34(9):744-750.
39. Covington SS. Women and addiction: A trauma-informed approach. J Psychoact Drugs. 2008;40(sup5):377-385.
40. Gilbert PA, Pro G, Zemore SE, Mulia N, Brown G. Gender differences in use of alcohol treatment services and reasons for nonuse in a national sample. Alcoholism Clin Exp Res 2019;43(4):722-731.
41. McGovern J, Sarabia S. Substance abuse among older adults: Context, assessment, and treatment. New Directions in Treatment, Education, and Outreach for Mental Health and Addiction. 2018:111-124.
42. Blazer DG, Wu L-T. The epidemiology of substance use and disorders among middle aged and elderly community adults: National survey on drug use and health. Am J Geriatr Psychiatry 2009;17(3):237-245.
43. Han BH, Moore AA, Sherman S, Keyes KM, Palamar JJ. Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005–2014. Drug Alcohol Depend. 2017;170:198-207.
44. Oslin DW, Pettinati H, Volpicelli JR. Alcoholism treatment adherence: Older age predicts better adherence and drinking outcomes. Am J Geriatr Psychiatr 2002;10(6):740-747.
45. Schmidt LA, Ye Y, Greenfield TK, Bond J. Ethnic disparities in clinical severity and services for alcohol problems: Results from the National Alcohol Survey. Alcoholism Clin Exp Res 2007;31(1):48-56.
46. Yusuf Ransome DCC, Courtney D. Cogburn, and David R. Williams. Racial disparities in the association between alcohol use disorders and health in black and white women. National Library of Medicine. Accessed July 31, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045433/
47. Wells K, Klap R, Koike A, Sherbourne C. Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. Am J Psychiatr. 2001;158(12):2027-2032.
48. Guerrero E, Andrews CM. Cultural competence in outpatient substance abuse treatment: Measurement and relationship to wait time and retention. Drug Alcohol Depend. 2011;119(1-2):e13-e22.
49. Weisner C, Schmidt L. Alcohol and drug problems among diverse health and social service populations. Am J Public Health. 1993;83(6):824-829.
50. Priester MA, Browne T, Iachini A, Clone S, DeHart D, Seay KD. Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: An integrative literature review. J Subst Abuse Treat. 2016;61:47-59.
51. Blanco C, Iza M, Rodríguez-Fernández JM, Baca-García E, Wang S, Olfson M. Probability and predictors of treatment-seeking for substance use disorders in the us. Drug Alcohol Depend. 2015;149:136-144.
52. Harris AH, Kivlahan DR, Bowe T, Humphreys KN. Pharmacotherapy of alcohol use disorders in the veterans health administration. Psychiatr Serv. 2010;61(4):392-398.
53. Stinson FS, Grant BF, Dawson DA, Ruan WJ, Huang B, Saha T. Comorbidity between dsm-iv alcohol and specific drug use disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2005;80(1):105-116.
54. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689-1695.
55. Kelly TM, Daley DC, Douaihy AB. Treatment of substance abusing patients with comorbid psychiatric disorders. Addict Behav. 2012;37(1):11-24.
56. Joseph Gfroerer JE, and James Chromy. Redesiging an ongoing national household survey: Methodological issues. Substance Abuse and Mental Health Services Administration; 2002.
57. Chromy JR FM, Gfoerer J. Reliability of key measures in the national survey on drug use and mental health. Substance Abuse and Mental Health Services Administration; 2010.
58. Powers RA, Severson R. Bureau of Justice Statistics. The Encyclopedia of Research Methods in Criminology and Criminal Justice. 2021;2:780-782.
2. National Institute on Alcohol Abuse and Alcoholism. Understanding alcohol use disorder. Accessed July 31, 2023. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
3. National Survey on Drug Use and Health. Alcohol use disorder in past year: Among people aged 12 or older. SAMHSA, Center for Behavioral Health Statistics and Quality,. Accessed July 31, 2023.
4. National Institute on Alcohol Abuse and Alcoholism. Alcohol use disorder (AUD) in the United States: Age groups and demographic characteristics. Accessed July 31, 2023. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics#:~:text=According%20to%20the%202021%20NSDUH,AUD%20in%20the%20past%20year.&text=1%2C2-,This%20includes%3A,2.2%25%20in%20this%20age%20group)&text=596%2C000%20girls%20ages%2012%20to,4.7%25%20in%20this%20age%20group)
5. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prevent Med. 2015;49(5):e73-e79.
6. US Centers for Disease Control and Prevention. Excessive alcohol use continues to be drain on American economy. Accessed July 31, 2023. https://www.cdc.gov/media/releases/2015/p1015-excessive-alcohol.html
7. Committee on Substance Abuse, Committee on Children with Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics. 2000;106(2):358-361.
8. Rehm J, Baliunas D, Borges GL, et al. The relation between different dimensions of alcohol consumption and burden of disease: An overview. Addiction. 2010;105(5):817-843.
9. American Psychological Association. Understanding alcohol use disorders and their treatment. Accessed July 31, 2023. https://www.apa.org/topics/substance-use-abuse-addiction/alcohol-disorders#:~:text=Drinking%20problems%20also%20have%20a,memory%20loss%2C%20depression%20or%20anxiety.
10. Kranzler HR, Soyka M. Diagnosis and pharmacotherapy of alcohol use disorder: A review. JAMA. 2018;320(8):815-824.
11. Mattson ME, Lynch S. Medication prescribing and behavioral treatment for substance use disorders in physician office settings. Accessed July 31, 2023. https://www.samhsa.gov/data/sites/default/files/report_1976/ShortReport-1976.html
12. Agency for Healthcare Research and Quality. Pharmacotherapy for adults with alcohol use disorder in outpatient settings. Accessed July 31, 2023. https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/policymaker
13. Mark TL, Kranzler HR, Song X. Understanding us addiction physicians’ low rate of naltrexone prescription. Drug Alcohol Depend. 2003;71(3):219-228.
14. Harris AH, Ellerbe L, Reeder RN, et al. Pharmacotherapy for alcohol dependence: Perceived treatment barriers and action strategies among veterans health administration service providers. Psychol Serv. 2013;10(4):410.
15. Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatr. 2018;175(1):86-90.
16. Knopf A. SAMHSA awards $18.9 million for services to youth and families. Alcoholism & Drug Abuse Weekly. 2023;35(29):6-7.
17. Helle AC, Sher KJ, Masters J, Washington K, Hawley KM. A mixed-method evaluation of the adoption and implementation of the college alcohol intervention matrix among prevention experts: A study protocol. Implement Sci Comm. 2021;2:1-8.
18. Torous J, Myrick KJ, Rauseo-Ricupero N, Firth J. Digital mental health and COVID-19: Using technology today to accelerate the curve on access and quality tomorrow. JMIR Mental Health. 2020;7(3):e18848.
19. Volkow ND, Poznyak V, Saxena S, Gerra G, Network UWIIS. Drug use disorders: Impact of a public health rather than a criminal justice approach. World Psychiatry. 2017;16(2):213.
20. Villani J, Ganoza L, Sims BE, et al. Substance use prevention research funded by the NIH. Drug Alcohol Depend. 2020;206:107724.
21. Grucza RA, Sher KJ, Kerr WC, et al. Trends in adult alcohol use and binge drinking in the early 21st‐century United States: A meta‐analysis of 6 national survey series. Alcoholism Clin Exp Res. 2018;42(10):1939-1950.
22. Pollard MS, Tucker JS, Green HD. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Netw Open. 2020;3(9):e2022942-e2022942.
23. Rodriguez LM, Litt DM, Stewart SH. Covid-19 psychological and financial stress and their links to drinking: A dyadic analysis in romantic couples. Psychol Addict Behav. 2021;35(4):377.
24. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. Accessed July 21, 2023.
25. Lu J, Yang Y, Cui J, et al. Alcohol use disorder and its association with quality of life and mortality in Chinese male adults: A population-based cohort study. BMC Public Health. 2022;22(1):1-11.
26. National Institute on Alcohol Abuse and Alcoholism. Alcohol-related emergencies and deaths in the United States. Accessed July 31, 2023. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states#:~:text=It%20is%20estimated%20that%20more,physical%20inactivity%2C%20and%20illegal%20drugs.
27. Substance Abuse and Mental Health Services Administration. Medications for substance use disorders. Accessed July 31, 2023. https://www.samhsa.gov/medications-substance-use-disorders
28. Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: A systematic review and meta-analysis. JAMA. 2014;311(18):1889-1900.
29. Rösner S, Hackl‐Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M. Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010;(9)
30. Fuller RK, Gordis E. Does disulfiram have a role in alcoholism treatment today? Addiction (Abingdon, England). 2004;99(1):21-24.
31. Johnson BA, Rosenthal N, Capece JA, et al. Topiramate for treating alcohol dependence: A randomized controlled trial. JAMA. 2007;298(14):1641-1651.
32. Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: A randomized clinical trial. JAMA Intern Med. 2014;174(1):70-77.
33. Hartung DM, McCarty D, Fu R, Wiest K, Chalk M, Gastfriend DR. Extended-release naltrexone for alcohol and opioid dependence: A meta-analysis of healthcare utilization studies. J Subst Abuse Treat. 2014;47(2):113-121.
34. Probst C, Manthey J, Martinez A, Rehm J. Alcohol use disorder severity and reported reasons not to seek treatment: A cross-sectional study in european primary care practices. Subst Abuse Treat Prev Policy. 2015;10(1):1-10.
35. Green CA, Polen MR, Lynch FL, Dickinson DM, Bennett MD. Gender differences in outcomes in an hmo—based substance abuse treatment program. J Addict Dis. 2004;23(2):47-70.
36. Marsh JC, Cao D, D’Aunno T. Gender differences in the impact of comprehensive services in substance abuse treatment. J Subst Abuse Treat. 2004;27(4):289-300.
37. Brady KT, Randall CL. Gender differences in substance use disorders. Psychiatr Clin North Am. 1999;22(2):241-252.
38. Timko C, Moos BS, Moos RH. Gender differences in 16-year trends in assault-and police-related problems due to drinking. Addict Behav. 2009;34(9):744-750.
39. Covington SS. Women and addiction: A trauma-informed approach. J Psychoact Drugs. 2008;40(sup5):377-385.
40. Gilbert PA, Pro G, Zemore SE, Mulia N, Brown G. Gender differences in use of alcohol treatment services and reasons for nonuse in a national sample. Alcoholism Clin Exp Res 2019;43(4):722-731.
41. McGovern J, Sarabia S. Substance abuse among older adults: Context, assessment, and treatment. New Directions in Treatment, Education, and Outreach for Mental Health and Addiction. 2018:111-124.
42. Blazer DG, Wu L-T. The epidemiology of substance use and disorders among middle aged and elderly community adults: National survey on drug use and health. Am J Geriatr Psychiatry 2009;17(3):237-245.
43. Han BH, Moore AA, Sherman S, Keyes KM, Palamar JJ. Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005–2014. Drug Alcohol Depend. 2017;170:198-207.
44. Oslin DW, Pettinati H, Volpicelli JR. Alcoholism treatment adherence: Older age predicts better adherence and drinking outcomes. Am J Geriatr Psychiatr 2002;10(6):740-747.
45. Schmidt LA, Ye Y, Greenfield TK, Bond J. Ethnic disparities in clinical severity and services for alcohol problems: Results from the National Alcohol Survey. Alcoholism Clin Exp Res 2007;31(1):48-56.
46. Yusuf Ransome DCC, Courtney D. Cogburn, and David R. Williams. Racial disparities in the association between alcohol use disorders and health in black and white women. National Library of Medicine. Accessed July 31, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045433/
47. Wells K, Klap R, Koike A, Sherbourne C. Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. Am J Psychiatr. 2001;158(12):2027-2032.
48. Guerrero E, Andrews CM. Cultural competence in outpatient substance abuse treatment: Measurement and relationship to wait time and retention. Drug Alcohol Depend. 2011;119(1-2):e13-e22.
49. Weisner C, Schmidt L. Alcohol and drug problems among diverse health and social service populations. Am J Public Health. 1993;83(6):824-829.
50. Priester MA, Browne T, Iachini A, Clone S, DeHart D, Seay KD. Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: An integrative literature review. J Subst Abuse Treat. 2016;61:47-59.
51. Blanco C, Iza M, Rodríguez-Fernández JM, Baca-García E, Wang S, Olfson M. Probability and predictors of treatment-seeking for substance use disorders in the us. Drug Alcohol Depend. 2015;149:136-144.
52. Harris AH, Kivlahan DR, Bowe T, Humphreys KN. Pharmacotherapy of alcohol use disorders in the veterans health administration. Psychiatr Serv. 2010;61(4):392-398.
53. Stinson FS, Grant BF, Dawson DA, Ruan WJ, Huang B, Saha T. Comorbidity between dsm-iv alcohol and specific drug use disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2005;80(1):105-116.
54. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689-1695.
55. Kelly TM, Daley DC, Douaihy AB. Treatment of substance abusing patients with comorbid psychiatric disorders. Addict Behav. 2012;37(1):11-24.
56. Joseph Gfroerer JE, and James Chromy. Redesiging an ongoing national household survey: Methodological issues. Substance Abuse and Mental Health Services Administration; 2002.
57. Chromy JR FM, Gfoerer J. Reliability of key measures in the national survey on drug use and mental health. Substance Abuse and Mental Health Services Administration; 2010.
58. Powers RA, Severson R. Bureau of Justice Statistics. The Encyclopedia of Research Methods in Criminology and Criminal Justice. 2021;2:780-782.