Mental Health – Tarrant County Physician Online

Physician Suicide: Addressing the Crisis

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the September/October 2026 issue of Tarrant County Physician.

It’s time to break the silence on physician suicide. This may be an exceedingly difficult topic for many of you; perhaps you have experience with losing a colleague or a loved one to suicide. Some of you may even have your own struggles. Unfortunately, physicians still have one of the highest suicide rates of any profession, with 300 to 400 physicians a year dying by suicide in the US.^3,7 Here are some staggering facts: one in six physicians has thought about or attempted suicide.⁴ Physicians in total die by suicide at twice the rate of the general population.^2,11 Suicide is the leading cause of death among male residents and the second leading cause of death among female residents.³ Medical students are three times more likely to die by suicide than their peers of the same age.^3,7 Our residents are suffering. Our students are suffering. And we are suffering.

“Physician, heal thyself” is a biblical proverb that is often taken out of context. It does not mean we should treat our own illnesses. Rather, it reminds us that physicians, too, must care for our mental and physical health by getting support from those who have the knowledge and training to help us. Too often, physicians continue caring for others while ignoring or delaying care for themselves—whether for something as minor as a cold or as serious as heart disease or suicidal thoughts. Even today, society often assumes physicians do not get sick or struggle with mental illness. Many of us were trained to believe that acknowledging illness could be seen as weakness, so we press on without seeking care, even as we expect our patients to do otherwise. Physicians who seek help may also fear consequences with licensure, credentialing, or patient trust.^3,7,13 Our self-reliance and perfectionism can make asking for help even harder. And although we are trained to recognize risk factors in our patients, we may miss them in ourselves or our colleagues. This potential blind spot is especially concerning because physicians share many of the same suicide risk factors as the general population, including mental health disorders, impaired relationships, and self-criticism.^1,5,7

Burnout from high workloads, time pressures, moral distress, and relationship discord is a real issue for physicians. There are additional institutional and regulatory pressures as well, often associated with administrative burden and an increased sense that autonomy is being lost.^3,6,7 Decreased efficiency and errors may also occur.^4,6 There is a perceived lack of psychological safety for physicians. Let’s face it, our cultural norms discourage vulnerability and seeking help for ourselves.^7,9,13 Yet the relationships we hold, the identities we carry, and the quiet pressures we internalize all play a role in suicide risk. So how can we help? I have a couple of ideas.

Last year at Burnett School of Medicine at TCU, several faculty, staff, and medical students had a fantastic session with the program manager for the Jordan Elizabeth Harris Foundation. She told the story of the foundation’s young namesake, Jordan Harris, who died by suicide shortly before graduating from college. Her parents created this foundation to help prevent others from experiencing the loss of a loved one dying by suicide. Not only was this educational, but it was also a training session on how to respond in these situations. Anyone can help prevent suicide. Just observing a physician, or anyone for that matter, in distress, and reaching out, can save a life. This training program is called QPR, which stands for Question, Persuade, and Refer. Like CPR, any person can be trained to effectively provide QPR—they do not have to be a healthcare professional. The American Hospital Association developed an entire guidebook that looked not only at data regarding healthcare worker suicide but also data about effective prevention strategies that hospitals could implement.12

Thursday, September 17, is National Physician Suicide Awareness Day (#NPSADay). This is now an annual opportunity to break the silence and raise awareness of mental health issues and suicide in physicians. A partnership between The Physicians Foundation, All In: Wellbeing First for Healthcare, and the Dr. Lorna Breen Foundation was formed to address physician suicide with a particular campaign called Vital Signs. This campaign is designed to train organizations, clinics, and even individuals in suicide prevention. In this campaign, Vital Signs refers to warning signs of impending physician decompensation or suicide. This partnership recommends a variety of prevention measures including recognizing warning signs, encouraging mental health reflection, sharing suicide prevention resources, checking in with physicians who do not appear to be doing well, removing intrusive mental health questions to licensure and hospital privilege applications, and creating a culture of well-being in organizations. They also have toolkits and even training slides for organizations to use (for free).^12,13,14

And let’s not forget our own TCMS wellness program, which I mentioned in my first President’s Paragraph. Our Tarrant County Medical Society Physician Wellness Program facilitates confidential, non-reportable help with coaching sessions and four complimentary counseling visits for members OR spouses, including couples counseling. The website is listed with the mental health resources I have shared below; it is sponsored by Tarrant County Academy of Medicine.

We entered this profession to heal—to listen to comfort, to save lives. Yet somewhere along the way, many of us learned to silence our own pain. We learned to wear resilience like armor, to treat vulnerability as weakness, and to fear that asking for help might cost us our careers. But silence has a cost. And too often, that cost is a life. Breaking the silence is not just an act of courage—it is an act of care. It is how we honor those we have lost, protect those still struggling, and reshape the culture of medicine into one that heals its healers. The question is no longer whether we should speak up. It is how we create spaces where speaking up is safe, supported, and sustained.

“The journey of a thousand miles begins with a single step.”
– Lao Tzu

References:

H. Makhija, J. E. Davidson, K. C. Lee, A. Barnes, A. Choflet, and S. Zisook, “National Incidence of Physician Suicide and Associated Features,” JAMA Psychiatry 82, no. 5 (2025): 451–458, https://doi.org/10.1001/jamapsychiatry.2024.4816.
D. Duarte, M. M. El-Hagrassy, T. C. E. Couto, W. Gurgel, F. Fregni, and H. Correa, “Male and Female Physician Suicidality: A Systematic Review and Meta-analysis,” JAMA Psychiatry 77, no. 6 (2020): 587–597, https://doi.org/10.1001/jamapsychiatry.2020.0011.
H. H. McClafferty, D. K. Hubbard, D. Foradori, et al., “Physician Health and Wellness,” Pediatrics 150, no. 5 (2022): e2022059665, https://doi.org/10.1542/peds.2022-059665.
Jon McKenna, “Medscape Physicians and Suicide Report 2025: ‘A Lot More Still Needs to Be Done,’” Medscape, February 21, 2025.
K. J. Gold, T. L. Schwenk, and A. Sen, “Physician Suicide in the United States: Updated Estimates from the National Violent Death Reporting System,” Psychology, Health & Medicine 27, no. 7 (2022): 1563–1575, https://doi.org/10.1080/13548506.2021.1903053.
Constance Guille and Srijan Sen, “Burnout, Depression, and Diminished Well-Being among Physicians,” New England Journal of Medicine 391 (2024): 1519–1527, https://doi.org/10.1056/NEJMra2302878.
S. B. Harvey, R. M. Epstein, N. Glozier, K. Petrie, J. Strudwick, A. Gayed, K. Dean, and M. Henderson, “Mental Illness and Suicide among Physicians,” The Lancet 398, no. 10303 (2021): 920–930, https://doi.org/10.1016/S0140-6736(21)01596-8.
US Preventive Services Task Force, “Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement,” JAMA 329, no. 23 (2023): 2057–2067, https://doi.org/10.1001/jama.2023.9297.
M. A. Oquendo and A. Porras-Segovia, “Barriers for the Research, Prevention, and Treatment of Suicidal Behavior,” Current Topics in Behavioral Neurosciences 46 (2020): 25–40, https://doi.org/10.1007/7854_2020_159.
S. K. Doupnik, B. Rudd, T. Schmutte, et al., “Association of Suicide Prevention Interventions with Subsequent Suicide Attempts, Linkage to Follow-up Care, and Depression Symptoms for Acute Care Settings: A Systematic Review and Meta-analysis,” JAMA Psychiatry 77, no. 10 (2020): 1021–1030, https://doi.org/10.1001/jamapsychiatry.2020.1586.
C. Zimmermann, S. Strohmaier, H. Herkner, N. Niederkrotenthaler, and E. Schernhammer, “Suicide Rates among Physicians Compared with the General Population in Studies from 20 Countries: Gender-Stratified Systematic Review and Meta-analysis,” BMJ 386 (2024): e078964, https://doi.org/10.1136/bmj-2023-078964.
American Hospital Association, “Suicide Prevention in the Health Care Workforce,” accessed August 10, 2026, https://www.aha.org/suicideprevention/health-care-workforce.
American Medical Association, “Preventing Physician Suicide,” updated August 7, 2025, https://www.ama-assn.org/practice-management/physician-health/preventing-physician-suicide.
The Physicians Foundation, “Campaign: Vital Signs,” accessed August 10, 2026, https://physiciansfoundation.org/research/campaign-vital-signs/.

Your Attention, Please! A Commentary on the Delayed Diagnosis of ADHD in Female Patients

TCOM Student Article

By Cassandra Miller, OMS-II

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

Are you prone to losing things? Are you frequently absentminded or easily distracted? These tendencies may seem like the byproducts of a busy lifestyle or personality traits. However, they may also reflect an underlying condition such as an undiagnosed neurodevelopmental disorder like Attention-Deficit/Hyperactivity Disorder (ADHD). Historically, ADHD has been regarded as a predominantly male disorder, leading to gender-based bias in diagnostic criteria and clinical recognition.^1,2 As a result, many female patients remain undiagnosed during childhood. Recent literature suggests that the increasing rate of ADHD diagnoses in women later in life may be linked to differences in symptom presentation, the development of compensatory masking behaviors that obscure clinical detection, and symptom overlap between various psychiatric conditions.^3,4 Addressing diagnostic gaps is of paramount importance to improving early identification of ADHD in female patients and optimizing long-term treatment outcomes.

Despite increasing awareness of ADHD’s prevalence, it remains underrecognized in younger females. Original ADHD diagnostic criteria were derived from studies of hyperactive boys and placed emphasis on behaviors such as impulsivity.¹ As a result, patients with primarily inattentive symptoms are less likely to be diagnosed in childhood. This disparity in diagnosis contributes to the pattern of women being diagnosed in adulthood, as they tend to exhibit primarily inattentive symptoms such as difficulties with time management, overall task completion, and frequent mistakes during routine activities.³

Another contributor to the delayed diagnosis of ADHD in women is the phenomenon of masking. Masking is defined as “a key component of social camouflaging and refers to the concealment of neurodivergent traits and the adoption of alternate social personas.”^5,6 Although more heavily studied in the context of Autism Spectrum Disorder, masking can have positive social effects in overcoming societal stigma associated with ADHD.6 However, this method of meeting external expectations can prove challenging for clinicians as key symptoms may be obscured. Additionally, masking can be exhausting for patients and, over time, lead to poor self-esteem and burnout.^5,6 This, coupled with a disproportionate rate of psychiatric comorbidity in women, represents another factor in ADHD misdiagnosis.

Moreover, women with ADHD are more likely to be diagnosed with a mood or anxiety disorder prior to receiving an ADHD diagnosis.⁷ The overlap in symptoms across these psychiatric conditions can lead clinicians to attribute symptoms such as impaired concentration, restlessness, and emotional dysregulation to mood disorders rather than a neurodevelopmental disorder.7 As a result of delayed diagnosis, ineffective and potentially unnecessary treatments may ensue.

Delayed diagnosis has also been attributed to sociocultural and hormonal factors.³ Regardless, the consequences of delayed diagnosis are substantial. Women with a late ADHD diagnosis report higher levels of academic underachievement, interpersonal difficulties, and feelings of shame.⁶ Clinical education to reduce diagnostic bias and refinement of screening tools is vital to bridging this gender-based gap and reducing the long-term burden of untreated ADHD in young women.

References:

Stephen P. Hinshaw, Phuc T. Nguyen, Sinclaire M. O’Grady, and Emily A. Rosenthal, “Annual Research Review: Attention-Deficit/Hyperactivity Disorder in Girls and Women: Underrepresentation, Longitudinal Processes, and Key Directions,” Journal of Child Psychology and Psychiatry 63, no. 4 (2022): 484–496, https://doi.org/10.1111/jcpp.13480.
Patricia O. Quinn and Manisha Madhoo, “ADHD in Women and Girls: Uncovering This Hidden Diagnosis,” Primary Care Companion for CNS Disorders 16, no. 3 (2014), https://pubmed.ncbi.nlm.nih.gov/25317366/.
Susan Young et al., “Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/Hyperactivity Disorder in Girls and Women,” BMC Psychiatry 20, no. 1 (2020): 404, https://pubmed.ncbi.nlm.nih.gov/32787804/.
Joanna C. Agnew-Blais, “Hidden in Plain Sight: Delayed ADHD Diagnosis in Girls and Women,” Journal of Child Psychology and Psychiatry 65, no. 9 (2024): 1018–1020, https://pubmed.ncbi.nlm.nih.gov/38798101/.
Patricia Wurth et al., “Masking in Adults with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Systematic Review,” Frontiers in Psychiatry 16 (2025), https://doi.org/10.3389/fpsyt.2025.1668780.
Emily Holden and Helen Kobayashi-Wood, “The Adverse Life Experiences of Women with Undiagnosed Attention-Deficit/Hyperactivity Disorder: A Qualitative Study,” Scientific Reports 15 (2025), https://doi.org/10.1038/s41598-025-04782-y.
Darby E. Attoe and Emma A. Climie, “Miss. Diagnosis: A Systematic Review of ADHD in Adult Women,” Journal of Attention Disorders 27, no. 7 (2023): 645–657, https://doi.org/10.1177/10870547231161533.

Women’s Mental Health: The Barriers to Access

The President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

This May, I had the privilege of presenting at a workshop with psychiatric colleagues regarding women’s mental health at the annual meeting of the American Psychiatric Association. We had strong attendance and a robust discussion. But given all the questions from our audience members, it became evident to me that this is a topic deserving of additional outreach, and not just to fellow psychiatrists. However, I had a dilemma . . . a draft deadline and multiple PowerPoint slides with all the information. After a couple of hours of trying to gather everything into a cohesive article to present to you all here, I decided to seek the assistance of AI. I dumped everything I had into Copilot, gave it about four dozen or more prompts, and it coalesced all my work. I still had to edit extensively; who knew that Copilot was so fond of run-on sentences?! The following has been further edited by the people who help maintain the decorum of our Tarrant County Physician journal.

Women’s mental health is as much an access issue as a diagnostic one. Across clinical settings, it is common to see:

Depression

Anxiety

Trauma-related conditions

Perinatal Mental Health Challenges

Emotional strain associated with:
• Caregiving responsibilities
• Financial hardship
• Discrimination
• Chronic disease

Whether these concerns are recognized, disclosed, and treated is often shaped by social context, such as current physical environment and cultural and/or historical aspects of different communities. Insurance, transportation, childcare, translation services, stigma, community trust, and local behavioral health capacity all affect timely care. Women in underserved communities are at particular risk for late diagnosis and interrupted treatment because social determinants of health and health system barriers often converge. And national mental health workforce shortage areas remain widespread.¹

Underserved care is not found in a single setting but is a condition of limited access that can exist anywhere. A woman may live in a rural county with the closest psychiatrist being a long drive away. Another woman may live in an urban neighborhood with multiple hospitals yet still face long waits, unaffordable copays, language barriers, and fragmented referral pathways. In both settings, available services may not be truly usable. Women may present late, rely on urgent care, or disengage when treatment plans fail to account for barriers such as housing instability, caregiving demands, or work schedules. For physicians, treatment planning must address not only diagnosis and severity but also whether follow-up is realistic.

Rural and urban settings pose different challenges. In rural practice, barriers often include distance, limited specialist supply, service closures, privacy concerns, and broadband gaps that weaken telehealth. In urban settings, the problem is often system complexity: long wait times, fragmented care, uneven service distribution, insurance limitations, and cultural or linguistic mismatch between a patient and their physician. These differences require different responses. Rural physicians may depend more on collaborative care, telepsychiatry, and cross-system referral relationships, whereas urban physicians may focus on reducing handoff failures, improving navigation, and integrating behavioral health into primary care or women’s health clinics. Rural counties fare worse than non-rural counties on measures of clinical care and social determinants of health,² and shortage designations affect both rural and urban areas.¹

Perinatal mental health is critically important, but risks change across the lifespan. Anxiety, depression, trauma exposure, eating disorders, self-harm risk, intimate partner violence, caregiving stress, chronic illness, loneliness, grief, and cognitive concerns may present differently at each stage of life. In underserved communities, unstable housing, food insecurity, discrimination, limited preventive care, and delayed treatment can intensify symptoms and complicate care. A useful clinical framework goes beyond symptom checklists to assess safety, functioning, social stressors, and barriers to follow-up.
Routine screening is one of the strongest opportunities to improve women’s mental health care, but only when paired with a workflow that supports action. In women’s health, primary care, and perinatal settings, screening can identify depression, anxiety, trauma-related symptoms, and safety concerns before they escalate. A positive screen should trigger a risk assessment, a discussion of treatment options, a referral or warm handoff when indicated, and a plan for monitoring response and adherence. Routine screening for depression and anxiety is recommended in well-woman, pre-pregnancy, prenatal, and postpartum care. Standardized instruments and systems for timely assessment, treatment, and follow-up are also recommended.³

Care models should reflect practice realities rather than assume one solution fits all. In rural settings, telehealth can reduce travel burdens and extend specialty access, especially when supported by audio-only options and coordination with local primary care. In urban settings, access may improve more through shorter referral loops, stronger safety-net capacity, co-located behavioral health services, and language-concordant care. Telehealth is most effective when patients have the privacy, reliable connectivity, digital skills, and device access needed to use it. Underserved communities may also benefit from multiple telehealth formats, including phone-based care.⁴ At the same time, rural telehealth continues to face setting-specific implementation barriers.⁵

As you can see, addressing women’s mental health requires a layered, setting-specific approach. Trauma-informed, culturally responsive care is essential. In rural settings, physicians may need to offset workforce shortages and distance through collaborative care and telehealth-enabled consultation. In urban settings, the priority is often reducing fragmentation and improving access within systems that may appear resource-rich but remain difficult to navigate.
Ultimately, the central question is not simply whether a patient lives in a rural or urban area, but whether she can obtain timely, acceptable, and practical care. That requires early identification, realistic care planning, and systems that coordinate between screening, referral, and treatment. For physicians, the implication is straightforward: overcoming social barriers is part of the care plan, not peripheral to it.

“Healing takes time, and asking for help is a courageous step.” —Mariska Hargitay

References:

Health Resources and Services Administration, “Health Workforce Shortage Areas,” accessed June 30, 2026, https://data.hrsa.gov/topics/health-workforce/shortage-areas/dashboard.
W. B. Weeks et al., “Rural-Urban Disparities in Health Outcomes, Clinical Care, Health Behaviors, and Social Determinants of Health and an Action-Oriented, Dynamic Tool for Visualizing Them,” PLOS Global Public Health 3, no. 10 (2023): e0002420, https://doi.org/10.1371/journal.pgph.0002420.
American College of Obstetricians and Gynecologists, “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum,” Clinical Practice Guideline, June 2023, https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum.
U.S. Department of Health and Human Services, “Telehealth for Underserved Communities,” August 20, 2024, https://telehealth.hhs.gov/documents/Telehealth_for_Underserved_Communities_08-20-24.pdf.
Rural Health Information Hub, “Rural Telehealth Toolkit,” last modified June 8, 2023, https://www.ruralhealthinfo.org/toolkits/telehealth.
Centers for Disease Control and Prevention, “Social Determinants of Health,” last modified May 16, 2024, https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html.

Beating the Stigma: The Challenges in Treating Substance Use Disorders

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

By the time you all read this article, I hope you will have had a chance to listen to some of Tarrant County Medical Minute’s many interesting podcast episodes. I recently had the privilege of being invited as a guest on the podcast (you can find my episode here), which TCMS launched in 2025. It was fun, and I also found it to be an opportunity to continue to highlight mental health and advocacy. As I’ve mentioned before, mental health is marginalized and stigmatized but so essential to overall health. I appreciated the opportunity to talk about this on the podcast, fulfilling one of my promises to speak openly about mental health issues.

So, today we are going to talk about an even more stigmatized mental health issue—substance use disorders. They are far more common than many of us realize. According to the Substance Abuse and Mental Health Services Administration in their National Survey on Drug Use and Health in 2023–24, nearly 48 million Americans age 12 and older, or about one in six people, meet criteria for a substance use disorder in any given year.¹

Texas mirrors this national statistic. Alcohol use disorder accounts for the largest proportion, followed by drug use disorders involving marijuana, stimulants, opioids and more. State‑level estimates from the National Survey on Drug Use and Health indicate that roughly one out of seven Texans meets criteria for a substance use disorder each year.² While this is slightly lower than the national average, it still represents millions of people across our state whose health, relationships, and economic stability are affected. In a state as large and diverse as Texas, the collective impact of these conditions is substantial: it affects healthcare utilization, workforce participation, public safety, and even community well-being.

For physicians, this data shows what is already evident in clinical practice. Substance use disorders frequently coexist with chronic medical conditions, complicating diagnoses and treatments while increasing the risk of poor health outcomes. For legislators and policymakers, the numbers highlight the scope of the issue and the importance of continuous investment in prevention, early identification, evidence‑based treatment, and long‑term recovery support. And for the general public, the message is both sobering and illuminating: substance use disorders are common, treatable medical conditions, not moral failures or character flaws.

Substance use disorders do not exist in isolation. National data consistently demonstrates high rates of co‑occurring mental illness as well.¹ This overlap reinforces the need for integrated approaches to care that address the whole person rather than fragmented systems that separate “mental health” from “substance use.” The stigma surrounding substance use disorders mirrors the stigma that has historically marginalized mental health conditions—just as depression and anxiety were once dismissed as weaknesses rather than illnesses, substance use disorders continue to be judged rather than treated.

Stigma remains one of the most powerful barriers to care. It delays seeking help, discourages honest conversations between patients and physicians, and shapes policies that emphasize punishment over treatment. When individuals fear judgment, they are less likely to disclose substance use concerns, less likely to engage in treatment, and less likely to experience recovery. This is true no matter what walk of life you stem from, no matter what profession you are in. Reducing stigma is thus a clinical, ethical, and public health imperative.

Texas‑specific health data further illustrates the downstream effects of untreated substance use disorders, including alcohol‑related hospitalizations, drug‑related overdoses, and preventable deaths.² Even when prevalence rates are slightly lower than national averages, the absolute number of affected individuals places significant strain on healthcare systems and communities. These outcomes are not inevitable; evidence‑based prevention strategies, timely access to treatment, and sustained recovery supports have been shown to reduce morbidity, mortality, and costs.³ The key is that these initiatives have to be adequately funded and broadly accessible.

It is essential to treat substance use disorders as seriously and compassionately as other chronic illnesses. This includes speaking openly about prevalence, acknowledging the role of stigma, and advocating for systems of care that are based on scientific evidence rather than outdated assumptions. If one in six Americans—and one in seven Texans—are affected, then nearly every family, workplace, and community has a stake in how we respond. As physicians, policy advocates, and community leaders, we have both the opportunity and the responsibility to lead with data, compassion, and transparency. By reframing substance use disorders as the common, treatable health conditions they are, we can achieve these goals of reducing stigma, improving access to care, and improving the health and well-being of the populations we serve.

For physicians, the message should be clear: substance use disorders are common and addressing them as part of routine medical care should be best practice. Screening and brief, non-judgmental conversations about substance use should be normalized in our clinical settings. How we ask and how we respond do matter. Framing substance use disorders as treatable medical conditions like the evidence shows will increase patient disclosures, increase their engagement in treatment, and ultimately lead to their trust in us. We must lead the shift from judgment to treatment by insisting that substance use disorders are met with evidenced based care, equitable insurance coverage, and our compassion—not silence or shame.

“We, as a culture, have not fully acknowledged how much help is needed. The only real shame is on us for not being willing to speak openly. For continuing to deny that mental health is related to our overall health. We need to start talking, and we need to start now.”
– OPRAH WINFREY

References:

Blaire Bryant, Naomi Freel, and Emily Steckler, “SAMHSA Releases New 2024 Data on Rates of Mental Illness and Substance Use Disorder in the US,” National Association of Counties, July 28, 2025, https://www.naco.org/news/samhsa-releases-new-2024-data-rates-mental-illness-and-substance-use-disorder-us.
“Substance Use Disorder Statistics,” Drug Policy Facts, accessed May 4, 2026, https://www.drugpolicyfacts.org/node/4476.
Johanna Bellon et al., “Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US,” JAMA Network Open 5, no. 12 (2022): e2244644, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799220.
Substance Abuse and Mental Health Services Administration, “National Survey on Drug Use and Health (NSDUH): 2023 National Releases,” SAMHSA, accessed April 1, 2026, https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2023.
Substance Abuse and Mental Health Services Administration, “State Estimates of Mental Health and Substance Use,” accessed April 1, 2026, https://nsduhweb.rti.org/respweb/estimates.html.
Li-Tzy Wu, He Zhu, and Udi E. Ghitza, “Multicomorbidity of Chronic Diseases and Substance Use Disorders and Their Association with Hospitalization: Results from Electronic Health Records Data,” Drug and Alcohol Dependence 192 (2018): 316–23, https://doi.org/10.1016/j.drugalcdep.2018.08.013.
Lauren R. Ray et al., “Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis,” JAMA Network Open 3, no. 6 (2020): e208279, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358.