Substance use and treatment utilization patterns of working-age American men who were not in employment, education, or training (NEET) during the COVID-19 pandemic

BACKGROUND: A growing population of working-aged men are not in employment, education, or training (NEET). The COVID-19 pandemic has been associated with changes in rates of substance use disorders (SUDs) and treatment seeking in the general population, but COVID-era substance use patterns among NEET men are unknown. METHODS: We estimated the prevalence and correlates of NEET status among working-aged (18-64) men using data from the 2022 National Survey on Drug Use and Health, a nationally representative survey of non-institutionalized individuals in the United States. We developed logistic regression models to examine associations between NEET status and substance use behaviors and treatment engagement, adjusted for sociodemographic factors. RESULTS: An estimated 11.1% of working-aged men were NEET in 2022 representing 10.6 million individuals. Compared to non-NEET men, NEET men were significantly overrepresented among older age groups, lower income brackets, unmarried individuals, those with lower educational attainment, and Non-Hispanic Black men. After adjusting for sociodemographic factors, NEET status was significantly associated with higher odds of prescription tranquilizer/sedative use disorder (aOR = 3.54, 95% CI: 1.97-6.37), methamphetamine use disorder (aOR = 3.10, 95% CI: 1.82-5.28), and prescription pain‑reliever use disorder (aOR = 2.88, 95% CI: 1.82-4.53), while being inversely associated with alcohol use disorder (aOR = 0.68, 95% CI: 0.54-0.85). CONCLUSION: More than 1 in 10 working-aged men were NEET in 2022. Adjusted models showed higher odds of past-year SUDs but lower odds of alcohol use disorder. Targeted interventions should include age-appropriate, culturally tailored, and substance-specific treatment programs to improve public health.