Mental Health and Substance Use Challenges  (Volume 103)

Mental health (e.g., anxiety, depression) continues to be a major public health concern in the United States that impacts millions of individuals, their families, and communities. Approximately 21% of adults 18 years and older, or 55 million adults, reported symptoms of recent depression in 2022, demonstrating the wide reach of mental health challenges.  More

In this article, we provide an overview of emergent models for funding crisis systems in the United States and the policy and service contexts related to these models. Our review assesses the status of crisis system financing recommendations proposed by Hogan and Goldman proposed in 2020 and complements prior reports about financing crisis services.  More

Access to affordable, effective, timely, and appropriate behavioral health (BH) care remains elusive for most Americans despite health insurance coverage expansions.  More

The Trauma Recovery Center (TRC) model brings comprehensive care to underserved victims of crime, with improvements in PTSD symptoms and quality of life. Funding concerns were the central limitation in model implementation according to TRC staff.  More

The US overdose crisis is one of the most severe and devastating public health problems of the 21st century. Since 1999, more than one million Americans have lost their lives to accidental drug overdose.  More

People in the United States are dying at record numbers from overdose. Overdose deaths increased from fewer than 17,000 deaths in 1999 to an estimated 100,000 deaths approximately 25 years after, with a peak of almost 108,000 deaths in 2022. Racial/ethnic minoritized groups are now particularly affected: in 2023, the highest rates of overdose were among non-Hispanic Black and American Indian/Alaska Native Americans. Although overdoses increasingly involve both opioids and stimulants, opioids contribute to over three-quarters of all overdose deaths, primarily driven by illegally manufactured synthetic opioids like fentanyl.  More

See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers…  More

In the United States, substance use disorder (SUD) is a significant public health and public safety challenge. Up to two-thirds of individuals who are incarcerated meet SUD criteria, compared with 16.7% of the general population.  More

Pregnant and postpartum people who use drugs (PWUDs) live at the intersection of two of the gravest public health crises currently facing the United States: epidemics of (1) maternal morbidity and mortality, and (2) substance-related harms.  More

The United States is facing an ongoing mental health and substance use crisis. In 2023, 58.7 million US adults had a past-year mental illness, 46.3 million had a substance use disorder (SUD), and 20.4 million had both.  More

Medicaid has both greatly advanced the scope and integration of mental health and substance use disorder services among payers and remains a work in progress with respect to scaling and funding these services across the country.   More

This Perspective examines the role of Medicaid in the innovation of substance use disorder (SUD) treatment. In 2023, an estimated 49 million Americans met criteria for an SUD and more than 100,000 people died of a drug overdose. Compared with the general population, people with SUD experience worse self-rated health, a higher burden of other chronic diseases, and more hospital care.  More

Behavioral health access gaps are well documented in Medicaid, in which managed care now covers most enrollees, and for which there are typically fewer options for going out-of-network for care. Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care.  More

Starting in 2015, states could apply for section 1115 substance use disorder (SUD) waivers to strengthen their continuum of care for treatment of opioid use disorder (OUD).   More

The potential adverse effects of social media use for adolescents have received substantial attention. In response, a growing number of state-level social media regulations are emerging in the United States. These policy interventions are being implemented in the context of mixed scientific evidence, forcing policymakers to weigh the need for proactive regulation against the limitations of extant research. We explore policymakers’ publicly stated rationales for social media regulations and contextualize their claims within extant scientific literature.  More

Alcohol is a causal factor in more than 200 disease and injury conditions in the human body. The Centers for Disease Control and Prevention (CDC) define excessive drinking as binge drinking (4 or more drinks for women, 5 or more for men on one occasion in the past month), heavy drinking (8 or more drinks for women, 15 or more for men in a week), and any drinking during pregnancy or by persons younger than age 21 years.  More

The United States continues to experience a nearly unprecedented level of drug-related health harms, with over 105,000 Americans dying of overdose in 2023 alone. Although overall overdose deaths declined slightly from 2022 to 2023, rates for Black people continued to rise. Stimulants such as cocaine and methamphetamine are increasingly involved in overdose deaths, and xylazine and other contaminants continue to be prevalent in the illicit drug supply.  More

The specific nontobacco e-cigarette flavors used by US youth who exclusively vape e-cigarettes compared with youth who engage in poly-tobacco or poly-substance use can help identify the populations most likely to be impacted by e-cigarette flavor policies.   More

State medical cannabis laws, currently in place in 39 states and Washington, DC, provide an avenue for therapeutic use of cannabis to manage chronic noncancer pain stemming from conditions such as arthritis and low back pain.   More

Extreme Risk Protection Orders (ERPOs) are an effective legal tool for reducing firearm suicide by temporarily removing access to firearms for certain individuals who exhibit dangerous behavior. Unlike most state laws restricting access to firearms based on status, ERPOs are predicated on the assessment of future risk of harm to self or other, as determined by civil court file finding.   More