Men and women experience different kinds of mental health problems. While women exceed men in internalizing disorders such as depression and anxiety, men exhibit more externalizing disorders such as substance abuse and antisocial behavior, which are problematic for others. These differences also vary by race and social class: for example, African Americans possess better mental health and, thus, a smaller gender gap in psychiatric problems. What explains these differences? We concentrate on conceptions of gender and gender practices. Research on gender and mental health suggests that conceptions of masculinity and femininity affect major risk factors for internalizing and externalizing problems, including the stressors men and women are exposed to, the coping strategies they use, the social relationships they engage in, and the personal resources and vulnerabilities they develop. This chapter investigates explanations in these areas for gender differences both in general and by race and class.

Gender and mental health.

The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already exist—like evidence-based medications—are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.

Medications for Opioid Use Disorder Save Lives

https://www.nber.org/system/files/working_papers/w21345/w21345.pdf

Do medical marijuana laws reduce addictions and deaths related to pain killers

The chapter addresses the stigma associated with mental illnesses. It begins by summarizing the development of thinking about labeling and stigma over the past half century within the field of the sociology of mental health. This background leads to our consideration of recent advances in the conceptualization of stigma as we ask: What is stigma? How do different stigmatizing circumstances (mental illness, obesity, facial disfigurement) resemble and differ from one another? We also ask: Why do people stigmatize? In keeping with the Handbook’s emphasis on social class and socioeconomic status (SES), we introduce the concept of “stigma power” and apply this new concept to the questions of “What do people gain by stigmatizing others?” and “How is stigma power exercised?” Finally, we consider the steps people take to avoid, mitigate, or overcome stigma, drawing in particular on Thoits’ (Soc Psychol Q 74:6–28, 2011) theoretical statements about this issue. The conceptual growth that has taken place over time opens enormous possibilities for advancing the sociological understanding of mental illness stigma and by doing so helps to illuminate ways in which the effects of stigma might be mitigated.

Labeling and Stigma

More than one-third of the approximately two million people entering publicly funded substance abuse treatment in the United States do not complete treatment. Additionally, racial and ethnic minorities with addiction disorders, who constitute approximately 40 percent of the admissions in publicly funded substance abuse treatment programs, may be particularly at risk for poor outcomes. Using national data, we found that blacks and Hispanics were 3.5-8.1 percentage points less likely than whites to complete treatment for alcohol and drugs, and Native Americans were 4.7 percentage points less likely to complete alcohol treatment. Only Asian Americans fared better than whites for both types of treatment. Completion disparities for blacks and Hispanics were largely explained by differences in socioeconomic status and, in particular, greater unemployment and housing instability. However, the alcohol treatment disparity for Native Americans was not explained by socioeconomic or treatment variables, a finding that warrants further investigation. The Affordable Care Act could reduce financial barriers to treatment for minorities, but further steps, such as increased Medicaid funding for residential treatment and better cultural training for providers, would improve the likelihood of completing treatment and increase treatment providers' cultural competence.

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Blacks and Hispanics are less likely than whites to complete addiction treatment, largely due to socioeconomic factors.

Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and stand-alone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered.

The Looming Expansion And Transformation Of Public Substance Abuse Treatment Under The Affordable Care Act

The United States invests a sizable amount of money on treatments for mental health and substance abuse: $135 billion in 2005, or 1.07 percent of the gross domestic product. We provide treatment spending estimates from the period 1986–2005 to build understanding of past trends and consider future possibilities. We find that the growth rate in spending on mental health medications—a major driver of mental health expenditures in prior years—declined dramatically. As a result, mental health and substance abuse spending grew at a slightly slower rate than gross domestic product in 2004 and 2005, and it continued to shrink as a share of all health spending. Of note, we also find that Medicaid’s share of total spending on mental health grew from 17 percent in 1986 to 27 percent in 2002 to 28 percent in 2005. The recent recession, the full implementation of federal parity law, and such health reform-related actions as the planned expansion of Medicaid all have the potential to improve access to mental health and...

Jeffrey A. Buck

Papers

The Looming Expansion And Transformation Of Public Substance Abuse Treatment Under The Affordable Care Act

Changes In US Spending On Mental Health And Substance Abuse Treatment, 1986–2005, And Implications For Policy