Documented substance use became much more common among stroke patients during the study period, but researchers could not determine whether substance use or any other measured factor caused the increase.

The study, published in Neurology, examined first strokes among adults ages 20 to 54 in Greater Cincinnati and Northern Kentucky. Researchers identified 2,076 cases between 1993 and 2020.

Because the analysis lacked a comparison group of people who did not have strokes, its findings cannot be applied to establish causation.

Stroke Rates Among Younger Adults

The overall stroke rate in this age group increased from 33.9 cases per 100,000 person-years in 1993-1994 to 62.2 cases per 100,000 person-years in 2020.

Person-years account for both the number of people observed and the length of observation, allowing researchers to compare rates across periods.

Ischemic strokes accounted for most of the increase. These strokes occur when a blocked blood vessel cuts off oxygen and nutrients to part of the brain.

Among younger adults, the ischemic stroke rate rose from 23.8 cases per 100,000 person-years to 47.3, nearly doubling.

The researchers did not find comparable increases in intracerebral hemorrhage, which involves bleeding within the brain. They also did not find comparable increases with subarachnoid hemorrhage, which involves bleeding in the space around the brain.

“While stroke has traditionally been considered a disease of older adults, our findings show that stroke is becoming increasingly common in younger adults,” said study author Emily R. Fisher, MD, of the University of Cincinnati.

Addiction Treatment and Documented Substance Use

Researchers also tracked health conditions and behaviors documented among the patients. High blood pressure, diabetes, atrial fibrillation and substance use became more common during the study period. Atrial fibrillation is an irregular heartbeat that can allow clots to form and travel to the brain.

Documented substance use showed one of the largest changes. It appeared in 4.6% of younger adult stroke cases in 1993-1994 and 40.2% in 2020. Much of that increase was associated with marijuana use.

Those figures do not show that marijuana or substance use caused strokes. The researchers did not have comparable health information from people without strokes, so they could not calculate how much any of these factors contributed to the rising rates.

The study also does not establish that everyone with documented substance use had a substance use disorder or needed rehab.

Survival Improved as Cases Increased

Younger adults were somewhat more likely to survive a stroke in 2020 than in 1993-1994. After accounting for age, race, and sex, the proportion who died within 30 days declined from 11.7% to 9.4%. The improvement was most apparent for the two types of bleeding strokes examined.

Survival does not always mean full recovery. Depending on the location and severity of the brain injury, survivors may have lasting problems with movement, speech, memory, or other abilities. As cases increase among younger adults, more people may manage those effects for decades.

“At the same time, more people are surviving these strokes, which means more younger adults may be living with the long-term effects of stroke,” Fisher said.

What This Means for Treatment Seekers

For people researching addiction treatment, the study supports discussing substance use and broader medical history with qualified clinicians.

High blood pressure, diabetes, and atrial fibrillation deserve attention in their own right, and treatment providers should understand any existing medical conditions when planning care.

The findings do not provide a basis for choosing a program or assuming that substance use explains an individual stroke. Personal treatment decisions require an individual assessment. Fisher said additional research is needed to identify what is driving the trend and how it can be reversed.

Exploring Treatment Options

If substance use is affecting your health or daily life, compare treatment options based on your needs rather than on one regional study.

When contacting rehab centers, ask how they assess substance use. You can also ask about how they coordinate with medical providers and address mental health treatment when relevant.

Rehab.com’s directory can help you compare programs and review their services. Call 800-985-8516 ( Question iconSponsored Helpline ) to speak with a treatment advisor about available options.

Quentin Blount Written By: Quentin Blount Content Director
Quentin brings over a decade of experience in writing, editing, and digital publishing to his role as Content Director at Rehab.com, where he leads a full-scale content operation across addiction treatment, mental health, and behavioral health verticals. He has experience managing large editorial teams, executing content strategy for clients, and building the workflows and systems that keep high-volume publishing operations running efficiently. Quentin is committed to making treatment information accessible, trustworthy, and easy to navigate for people seeking help for themselves or their loved ones. Outside of work, he enjoys spending time with his wife, friends, family, and dog, Coop.