The findings add urgency to a growing concern in the addiction treatment field: are the men most at risk for substance use disorder also the least likely to access rehab?
Who These Men Are
The study, published in Substance Abuse: Research and Treatment and co-authored by Stanford psychiatry researcher Wayne Kepner and drug policy expert Dr. Keith Humphreys, drew on federal National Survey on Drug Use and Health (NSDUH) data from more than 27,000 men ages 18 to 64.
Even in 2022, when the national unemployment rate sat at just 3.6%, more than one in ten working-age men surveyed were not working, attending school or participating in any training program.
The majority of these men, 57.7%, are non-Hispanic white, and nearly half (46.6%) fall between the ages of 50 and 64. Financially, 46% earn $20,000 a year or less, compared to the majority of employed men who earn $75,000 or more annually.
Addiction Risk Is Severe and Wide-Ranging
The substance use data reveal a population with significant unmet addiction treatment need.
Roughly a quarter of these unemployed men are tobacco-dependent (24.4%), more than double the rate among employed men (10.1%), and a similar share, 26.6%, use marijuana, with 56.5% of those users consuming it 20 to 30 days per month.
Beyond cannabis and tobacco, these men meet clinical diagnostic criteria for addiction to methamphetamine, prescription pain pills, prescription tranquilizers, and illicit opioids at significantly higher rates than employed men.
For treatment providers, these figures point toward a population with complex, polysubstance needs, one that may require medically supervised detox, residential care, or medication-assisted treatment (MAT) using FDA-approved medications like buprenorphine or methadone.
A Cycle That Reinforces Itself
The researchers describe a likely feedback loop between unemployment and substance use disorder. While the data are cross-sectional and cannot establish causation, the authors find it plausible that joblessness and substance use reinforce each other.
Staying intoxicated makes it harder to hold a job or perform in school, and being out of work removes the structure and incentive to stay sober.
Daily tobacco and marijuana use also transfer several thousand dollars annually from these already low-income men to the industries that profit from those products, deepening financial instability and making recovery harder to sustain.
The Medicaid Question
The most pressing implication for addiction treatment access involves insurance coverage. The researchers note that Medicaid is likely the primary insurer for most of these unemployed men, and that coverage for working-age adults who are not employed is currently being sharply curtailed.
Without that coverage, most evidence-based rehab options, including inpatient treatment, intensive outpatient programs, and MAT, would be financially out of reach.
The authors suggest that drug courts, which use legal leverage rather than voluntary treatment-seeking, may represent one viable pathway, alongside broader policy interventions such as restrictions on marijuana potency and advertising, and higher taxes on tobacco and cannabis products.
What This Means for Treatment Seekers
For unemployed men in this situation, or family members seeking help on their behalf, understanding insurance coverage and available treatment options is a critical first step. Many rehab centers accept Medicaid and offer sliding-scale fees for patients without private insurance.
Peer support programs, including mutual aid groups like Narcotics Anonymous, may also serve as accessible entry points for men not yet ready for formal treatment.
Finding the Right Rehab
If you or someone you love is struggling with substance use, treatment options exist at every level of care, from outpatient counseling to residential drug rehab.
- Compare rehab centers by location, specialty, and insurance accepted
- Ask facilities specifically about MAT programs for opioid or stimulant addiction
- Verify whether a center offers co-occurring mental health treatment alongside addiction care
Rehab.com’s directory includes thousands of verified rehab centers nationwide. Call
800-985-8516
( 
Sponsored Helpline )
to speak with a treatment advisor.
