Learn how SAMHSA’s programs, initiatives, and resources work to improve the behavioral health of age- and gender-based populations.
Gender and age are important factors to consider when examining patterns of behavioral health. Patterns of substance use vary by age, with these rates generally declining as people grow older.
Children, Youth, and Families
Improving access to behavioral health services for children, youth, and their families is one of SAMHSA’s core missions. Half of adult mental illness begins before the age of 14, and three-fourths before age 24. More than 40% of youth ages 13 to 17 have experienced a behavioral health problem by the time they reach seventh grade. In addition, suicide is the third leading cause of death among youth ages 15 to 24 after accidents and homicide.
Compared with their peers, people within this age group with mental disorders are more likely to experience homelessness, be arrested, drop out of school, and be underemployed. Compared to all other chronic health conditions, mental disorders produce the greatest disability impact within this age group.
Youth transitioning into adulthood have some of the highest rates of alcohol and substance abuse. For instance, rates of binge drinking (drinking five or more drinks on a single occasion) in 2014 were:
- 28.5% for people ages 18 to 20
- 43.3% for people ages 21 to 25
Learn more about SAMHSA programs that address underage drinking at the Underage Drinking topic.
An estimated 1.3 million U.S. adolescents ages 12 to 17 had a substance use disorder in 2014 (5% of all adolescents). The 2014 rate of past-month illicit drug use was 3.4% among those ages 12 to 13, 7.9% among youth ages 14 to 15, and 16.5% among youth ages 16 to 17. The highest rate of current illicit drug use was among youth ages 18 to 20 (22.7%), with the next highest rate occurring among people ages 21 to 25 (21.5%).
Adolescents and young adults also face challenges with mental health issues:
- In 2014, about 1 in 10 youth ages 12 to 17 (11.4%) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, 41.2% received treatment or counseling for depression in the past year.
- Combined 2010–2012 data from SAMHSA’s National Survey on Drug Use and Health (NSDUH) indicate that 1 in 5 young adults ages 18 to 25 (18.7%) reported a mental illness in the past year and 3.9% were diagnosed with a serious mental illness.
- In 2014, 1.4% of adolescents had a co-occurring MDE and a substance use disorder.
Children and youth are viewed and understood in the context of their families, their communities, and their cultures. SAMHSA works to promote systems of care that involve parents in treatment planning and decisions for children:
- Building Blocks for a Healthy Future is a website where parents, caregivers, and educators can find great tips and tools that help children make healthy decisions as they grow up.
- National Children’s Mental Health Awareness Day raises awareness about the importance of emphasizing positive mental health as part of a child’s overall development from birth.
- The Safe Schools/Healthy Students initiative is a program designed to prevent violence and substance abuse among our nation's youth, schools, and communities.
SAMHSA is working to increase the number of practitioners in the United States who work with children, adolescents, and youth ages 16-25. Project Advancing Wellness and Resilience in Education (AWARE), a component of the president’s Now Is The Time initiative, is designed to help local educational agencies train school personnel and other adults who interact with children and youth in school and community settings to detect and respond to mental illness. In another component of the Now Is The Time initiative, SAMHSA is funding a special Minority Fellowship Program to develop professionals who specialize in working with youth.
In addition, in partnership with HRSA, SAMHSA is funding over $30 million to support over 100 new Behavioral Health Workforce Education and Training (BHWET) grants to expand the mental health and substance abuse workforce that will treat children, adolescents, and young adults with, or at risk for, a recognized behavior disorder. Visit HRSA’s FY 2014 Awardswebpage for a list of award winners.
Behavioral Health Workforce Education and Training (BHWET) for Professionals
Funds support pre-degree clinical internships and field placements for master’s-level social workers, psychologists, professional counselors, psychiatric-mental health nurse practitioners, and marriage and family therapists; and, doctoral-level psychologists.
Behavioral Health Workforce Education and Training (BHWET) for Paraprofessionals
Funds support education and training of students in community and technical colleges, including tribal colleges and universities, who are seeking to obtain a certificate in a paraprofessional field focusing on the behavioral health needs of at-risk youth and families. Paraprofessional certificate programs may include community health workers, outreach workers, social services aides, mental health workers, substance abuse/addictions workers, youth workers, promotoras, and peer paraprofessionals.
More needs to be done to develop this sector of the behavioral health workforce. For instance:
- The Annapolis Coalition on the Behavioral Health Workforce reported in 2007 that by 2020, there will be a need for 12,624 child and adolescent psychiatrists, a number far exceeding the projected supply of 8,312.
- The Annapolis Coalition also found that of the 6,300 child and adolescent psychiatrists practicing nationwide in 2007, relatively few were located in rural and low-income areas.
- The Association for Addiction Professionals (NAADAC)(link is external)has identified a severe lack of credentialed staff in the United States to treat substance use disorders among adolescents. This is partly due to states’ lack of adolescent-specific provider certification.
- As identified in the January 2013 Now Is The Timeinitiative, although three-quarters of mental illnesses appear by the age of 24, less than half of children with diagnosable mental health problems receive treatment. Transitional age individuals, referring to those people ages 16-25 years old, are at high risk for mental illness, substance abuse, and suicide, but they are among the least likely to seek help. Experts often cite the shortage of behavioral health services providers as one reason it can be challenging for this population to access treatment.
Men and Women
In 2012, there were about 154.5 million men (of all ages) living in the United States compared to about 159.4 million women (of all ages). The percentage of men under the age of 65 without health insurance in 2011 was 18.5%. The rate for women was 15.4%.
Data from the 2015 NSDUH (PDF | 3.4 MB) shows that rates of substance use disorders differ between men and women. For instance:
- The percentage of women ages 18 and up who had five or more drinks in one day at least once in the past year was 17.4%. The percentage was higher for men in this age group at 32.6%.
- Men aged 12 or older are more likely than women to report illegal drug use (12.8% vs. 7.3%).
- More men than women ages 12 and up reported using marijuana (10.9% vs. 6%), cocaine (0.8% vs. 0.4%), and hallucinogens (0.6% vs. 0.3%).
- The rate of substance dependence or abuse for males ages 12 and up was greater than the rate for females (10.7% vs. 5.7%).
Women’s drinking patterns are different from men’s. They face greater risks than men because:
- Women typically start to have alcohol-related problems at lower drinking levels than men.
- Women typically weigh less than men.
- Pound for pound, women have less water in their bodies than men do, and alcohol resides predominantly in body water.
While women may have alcohol and substance abuse rates lower than men, women are more likely to have serious psychological distress than men. According to the 2015 NSDUH’s mental health findings (PDF | 3.4 MB), women aged 18 and older in 2014 were more likely than men to have serious mental illness in the past year (5% vs. 3.1%). Women between 2005 and 2008 made 29.4 million of the ambulatory care visits with a primary mental health diagnoses, compared with 18.5 million for men. However, in 2014, the percentage of adult males with a past-year co-occurring mental illness and substance use disorder was higher than that among adult females (3.6% vs. 3%). Learn more from SAMHSA’s Behavioral Health Barometer United States – 2015 (PDF | 3.9 MB) report for more point-in-time and trend data reflecting the behavioral health status of men and women in the United States.
Many of the programs and initiatives that SAMHSA offers women seek to address the barriers to mental health and substance abuse services they face compared to their male counterparts. Learn more about these programs and initiatives at the Health Disparities topic.
SAMHSA provides training and technical assistance addressing the behavioral health of women and their families at the Women, Children, and Families webpage. SAMHSA also addresses the behavioral health needs of women who experience sexual and domestic violence. Learn more at the Trauma and Violence topic.
The Protecting Our Infants Act (Public Law 114-91), enacted on Nov. 25, 2015, mandated that HHS:
- Conduct a review of planning and coordination of HHS activities related to prenatal opioid exposure and neonatal abstinence syndrome (NAS)
- Develop recommendations for the:
- Prevention of prenatal opioid exposure
- Treatment of opioid use disorder (OUD)
- Prevention, identification, and treatment of NAS, as well as any long-term consequences thereof
- Develop a strategy to address these issues, gaps, overlap, and duplication among federal programs, and coordination of federal efforts to address NAS
SAMHSA transmitted the Protecting Our Infants Act: Report – 2017 (PDF | 409 KB) to Congress on Jan. 19, 2017. The strategy proposed in this report was revised to reflect public comment on the report to Congress. The updated Protecting Our Infants Act: Final Strategy – 2017 (PDF | 124 KB) is now available.
- Advancing the Care of Pregnant and Parenting Women with Opioid Use Disorder and Their Infants: A Foundation for Clinical Guidance
- Centers for Disease Control and Prevention (CDC) Guidelines for Prescribing Opioids for Chronic Pain
- HHS Administration for Children and Families
- Medication-assisted Treatment (MAT) information from SAMHSA
- SAMHSA National Center on Substance Abuse and Child Welfare (NCSACW)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health (NIH)
- Treating for Two from CDC
- White Paper: Opioid Use, Misuse, and Overdose in Women from the HHS Office on Women’s Health – 2016 (PDF | 1.2 MB)
Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals
LGBT people are members of every community. They are diverse, come from all walks of life, and include people of all races and ethnicities, all socioeconomic statuses, and are from all parts of the country. According to the Williams Institute’s review, conducted in 2011, an estimated 3.5% of adults in the United States identified themselves as lesbian, gay, or bisexual and an estimated 0.3% of adults are transgender. The review reported that there are approximately 9 million LGBT Americans.
Although there is a paucity of national data, more than a decade of research indicates LGBT populations have been associated with high rates of alcohol consumption and substance abuse. The American Lung Association reports that LGBT individuals are also more likely to use tobacco than the general population, with some studies estimating smoking rates as much as double the national average.
LGBT people, especially youth, also experience high levels of mental disorders such as anxiety, depression, and suicidal thoughts. LGBT youth are at high risk for suicide attempts and completions. Suicide is a particular concern for transgender people. In the largest national survey of transgender adults to date, 41% of respondents reported having attempted suicide.
SAMHSA has developed a number of training curricula for behavioral health and primary care practitioners to help them assess, treat, and refer LGBT clients in a culturally sensitive manner. In addition to this, it helps provide prevention professionals, health care providers, and educators with information on current health issues among LGBT populations
SAMHSA developed the toolkit Top Health Issues for LGBT Populations – 2012 to equip practitioners and educators on the behavioral health issues facing this population group. SAMHSA also developed a Practitioner’s Resource Guide – 2014 (PDF | 1.4 MB) to assist families in supporting their LGBT children.
According to SAMHSA’s report Behavioral Health, United States, 2012:
- Just over half of middle and high schools in the United States provide mental health services tailored to gay, lesbian, or bisexual students.
Learn more about how SAMHSA addresses health equity for LGBT people at the Health Disparities topic.
A resource kit (Top Health Issues for LGBT Populations – 2012). A Practitioner’s Resource Guide: Helping Families to Support Their LGBT Children – 2014 also offers information and resources to help practitioners throughout health and social service systems. Learn more about SAMHSA’s LGBT resources and behavioral health workforce development initiatives.
More needs to be done to develop this sector of the behavioral health workforce.
There are about 43.1 million people ages 65 and up living in the United States. This population group is expected to account for about 20% of the total U.S. population by 2030.
The prevalence of substance use disorders among older adults remains relatively constant until they reach the age of 60. After that, the rate of those disorders drops to about 6%.
Data from the 2015 NSDUH (PDF | 3.4 MB) highlights similar findings:
- Only 25.8% of people ages 65 and up in 2014 had ever used illegal drugs in their lifetime, while the lifetime rates of use were 53.8% for those ages 60 to 64 and more than 50% for each age group from ages 19 to 59.
- The prevalence of heavy alcohol use in 2014 was lower among adults ages 65 and up (2.2%) than among all other adult age groups.
Some aspects of mental health also improve with age. For example, in 2014, 13% of adults ages 65 or older had a form of mental illness while the rates were more than 15.7% for each age group from 18 to 64. In addition, 1.6% of adults aged 65 or older had serious thoughts of suicide in the past year, while the national average was 3.9%. However, many older adults still experience mental distress associated with limitations in daily activities, physical impairments, grief following loss of loved ones, caregiving or challenging living situations, or an untreated mental illness such as depression.
Depression affects more than 6.5 million Americans ages 65 and up. Depression in older adults is closely associated with substance abuse and disability. If left untreated, depression in this population increases the risks of cognitive decline and suicide.
About 25% of older adults have some type of mental health problem, such as a mood disorder not associated with normal aging. Older adults with mental disorders are less likely than those without them to be nonsmokers, to eat a healthy diet, or regularly engage in moderate physical activity.
Learn more from the Treatment of Depression in Older Adults KIT – 2011, which includes evidence-based practices.