What is Medicalization?
Researchers Conrad and Schneider first introduced the term “medicalization” in their studies of deviance during the 1980s. In a general sense, medicalization refers to how human conditions and behaviors are defined in medical terms, usually as an illness or disorder. For instance, consider the classic case of alcohol dependence. Once seen as a deviant behavior that some individuals chose to engage in, the American Psychological Association (APA) now defines it as alcohol use disorder (AUD) – a genetically heritable, medical illness. Since the APA, and consequently society, medicalizes deviance displayed by subcultural groups (such as goths, gamers, or bodybuilders) in terms of mental illness, this page chooses to examine medicalization of subcultural deviance by focusing on the medical model of psychology – a model that assumes abnormal (or deviant) thoughts and behaviors are the result of physical, biological problems and should be treated medically.
A Brief Historical Context
Nowadays, medicine is a prestigious, lucrative, and powerful industry. Historically, however, scholars studied medicine in conjunction with philosophy and theology. As a result, medicine only relatively recently emerged as its own distinct field of study. In the 17th century, medicine was not scientific by today’s standards, as physicians relied on the patient’s description of symptoms and behavior to assess illness, very rarely conducting an actual physical examination of the body (Conrad & Schneider 1992). By the end of the Colonial period, doctors established the first American hospital in Philadelphia in 1752. By 1765, Philadelphia opened the first medical school in the US. Up until this point, individuals could only become physicians through a apprenticeships with doctors. In fact, historians estimate that in 1775 there were 3500 physicians in the country but only 400 held a university medical degree. (Ackerknecht 2016). By 2014, the US census estimated over 900,000 licensed physicians (Young et al. 2015) and, according to Inc. 5000, the healthcare industry had a total revenue of $21.8 billion in 2013. Specifically, in the field of mental health care, the Bureau of Labor Statistics reports 166,600 people working as psychologists as of 2016 with an above-average estimated job growth of 14%. These statistics illustrate how medicine slowly became a legitimized industry and, as the next section explains, gained the power to define deviant behaviors – a form of social control.
Medicalization as Social Control
- Social control: the control of deviance and the promotion of conformity. The means by which society secures adherence to social norms; specifically how it minimizes, eliminates, or normalizes deviant behavior (Conrad & Schneider, p. 7)
“The greatest social control power comes from having the authority to define certain behaviors, persons, and things” (Conrad & Schneider, p. 8)
With healthcare being the second largest industry in America, it has the power and authority to define deviant behaviors, persons, and things. The American Psychiatric Association (APA), for instance, has the power to define and classify all mental illnesses currently recognized by the most updated version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, even the DSM-5, the “Bible of Psychology” is surrounded by controversy and criticism from some of the most prominent scholars in the field (e.g. Phillips et al. 2012) because of all the intended and unintended consequences of labeling a mental condition as a disease.
On the one hand, when the APA labels specific behavior as a disease or disorder, it removes some of the stigma from the individual experiencing the condition. For instance, if a person has the mental illness of generalized anxiety disorder, calling it an illness removes the blame from the individual because the term illness implies that the individual’s anxiety is not due to a personal failing, but is brought about by a biological “malfunction” out of the individual’s control. Additionally, including a mental condition as an illness in the DSM has practical advantages in that it helps the individual diagnosed with the disorder receive insurance coverage to get the treatment they need to alleviate negative symptoms. Likewise, the label can help individuals find support from others who have the same condition.
On the other hand, when medical professionals label something as a disease or illness, it can have unintended consequences because it assumes that the behaviors exhibited by the individual are inherently abnormal or wrong. Take for example gender dysphoria, a disorder defined by the DSM as an internal “conflict between a person’s physical or assigned gender and the gender with which they identify.” This is where the issue of social power and social control becomes relevant. The APA and, more generally, the healthcare industry, holds the power to label certain behaviors and, consequently, people, as deviant or abnormal. Thus, some sociologists consider mental health professionals agents of social control whose function is to enforce conformity to the existing social order through the differential application of diagnostic labels (Becker, 1963; Schur, 1984).
Labels link people to a set of undesirable characteristics that form stereotypes. A labeled person experiences status loss and discrimination (Link and Phelan, 2001). Previous studies have shown that stigmatized groups are disadvantaged when it comes to life outcomes like income, education, psychological well-being, housing status, medical treatment, and health (Druss et al., 2000, Link 1987). The linking of labels to unwanted characteristics rationalizes the belief that negatively labeled (deviant) people are fundamentally different and can have a cascade of negative effects on all manner of opportunities. For example, a significant proportion of the public considers people with mental health problems such as depression or schizophrenia as unpredictable, dangerous, and less likely to be employed (Wang & Lai, 2008; Reavley & Jorm, 2011).
The bias of individuals can manifest in larger, societal “othering” of stigmatized groups of people, such as the mentally ill. This is evident in the way that the individuals with mental disorders are talked about: a person has cancer or the flu, but an undesirable person is schizophrenic (Link and Phelan, 2001). Furthermore, patients who are diagnosed as mentally unstable are sent to treatment facilities that tend to be either isolated, or confined to some of the most disadvantaged neighborhoods that do not have the power to exclude this stigmatized group from their midst (Dear and Lewis, 1986). For example, there was a specific sect of the Not In My Back-Yard (NIMBY) movement that resulted in treatment facilities for people with mental illnesses to be relocated in relatively poor and powerless areas of cities that were crime ridden and dangerous.
On the opposite side of the spectrum, the most successful mental health professionals tend to generate more status and money by treating less serious illnesses in private offices in affluent areas, further removing themselves from unwanted circumstances. Their ability to pick and choose who they treat and where highlights the unequal power dynamic between patient and professional. In other words, clinicians with a medical perspective treat departures from norms as an illness, which justifies coercive treatment and institutionalization of offenders (Levine and Troiden, 1988). One of the most vocal critics of psychiatry, Thomas Szasz, wrote in 1970: “Among the medical specialties, psychiatry is the only one whose job is to stigmatize people with moral judgments camouflaged as diagnoses and to imprison them under the guise of treatment.”
Stigma
“Stigma” has traditionally been defined as an “attribute that is deeply discrediting,” and designates the labeled individual as “tainted,” or “discounted” (Goffman, 1963). People who are stigmatized often experience negative psychological and social consequences such as stereotyping. A stereotype is a preconceived notion about specific types of individuals or certain ways of behavior that are thought to be representative of a group as a whole. For example, it is commonly thought that people who are Goth are depressed, self-harm and do drugs. According to Erving Goffman, an important scholar on the topic, there are three types of stigma: (1) “tribal identities” (i.e. sex, religion, race), (2): “blemishes of individual character” (i.e. addiction, unemployment, mental illness), and (3): “abominations of the body” (i.e. deformities).
According Link and Phelan there are five components that conceptualize stigma: (1) people distinguish and label human differences, (2) dominant cultural beliefs link labeled persons to negative stereotypes, (3) labeled persons are categorized and separated, (4) labeled individuals experience status loss and discrimination that leads to unequal life outcomes, and (5) stigmatization is entirely contingent on access to social, economic, and political power and the full execution of disapproval, rejection, exclusion and discrimination (Link and Phelan, 2001).
Connecting Medicalization and Subcultural Deviance: Expanding the Jurisdiction of the Medical Field
Over time, the medical field has expanded its jurisdiction to encompass broader deviant behavior – behavior that most often has been socially characterized as morally reprehensible and abnormal for one reason or another (Levine & Troiden, 1988). Through defining certain deviant behaviors as deviant, medical institutions with juridical power are able to effectively control and “cure” those who fail to project the ideal qualities of the hegemonic norm. The DSM particularly holds power in creating these definitions, and as it continues to expand, it holds more and more legitimate precedence over deviant behavior.
Alcoholism has been effectively medicalized and now is listed in the DSM as a medical illness. There exist various treatment programs, along with Alcoholics Anonymous meetings to reward “alcoholics” for abstaining as well as to hold them accountable. The criteria for it qualifying it as a disease results from drinking in an “excessive, deviant manner” and due to factors of lack of control (Schneider, 1978).
These definitions involve politics and ideology, as they are relative terms. What is deemed to be “excessive” is related to its level of disruptiveness. Legislation tends to reflect ideology and vice versa in order to inform people what is and isn’t too far. Due to these imposed standards, we place a stigma upon those who do not meet said guidelines, and we effectively marginalize them. One of the major informants to these standards is religion. Alcoholism is defined as “sinful behavior” by the Church, leading to an ideology in which alcohol abuse exists as deviant. In fact, much of the rhetoric used in the first manifestations of A.A. (1939) were religious in nature, such “repentance” and “turning our will and our lives over to the care of God” (Schneider, 1978).
A similar definition can be applied to compulsive gambling, which is now officially also considered an illness that requires treatment in the DSM (Rosecrance, 1985). Where the lines are drawn between hobby, compulsion, and illness however, are quite fuzzy. There is evidence to suggest that gambling was in fact considered deviant for religious and moral reasons far before its medicalization (Rosecrance, 1985). Like alcoholism, especially around the time of nineteenth century temperance, gambling and its impulsive, risky nature, were considered deviant by the dominant narrative.
Gambling was especially looked down upon among the lower classes, especially as those engaging in this risky behavior unsuccessfully had little capital to spare. The coining of gambling as a problem of the lower classes made it more of an epidemic in need of curing (Ferentzy & Turner, 2013).
On the other end of the spectrum, those who fall under the category of being involved in religious “cults” (ie. Scientology, Hare Krishna) are in some cases deemed mentally ill as well. Psychiatrists consider the adherents to be essentially “disabled” and unable to acting for their own will. According to medical professionals they must be rehabilitated and undergo therapy. However, these allegations of brainwashing against cults can be seen as mental health, and consequently legal, forces exerting their influence over religious groups (Robbins & Anthony, 1982). They are effectively working to restore normative cognitive hegemony. Groups that stray from the norm are marginalized through the juridical power of medicalization by health professionals in order to veer them toward a norm equilibrium. These forces operate in parallel ways when it comes to medicalizing subculture participation.
Page by Madison Marcus, Emily Gold, and Alitza Shutt
Goths and Depression/Self Harm
The Goth subculture is often associated with all black clothing and gothic style,
preoccupation with death, and drug use – all already stigmatized behavior. The idea that Goth participation can lead a child toward depression and/or violent behavior is a narrative prevalent in the mainstream culture, especially due to religious principle. According to data collected in a longitudinal study of 14,541 children, correlations were found between Goth self-identification and both depression and self-harm. 18% of those that were goth met the criteria for depression while only 6% of those who were not goth met that same criteria. Meanwhile 37% of goths self harmed while only 10% of those who were not goth self harmed (Bowes et. al, 2015). The study, however, mentions that this correlational relationship is not necessarily causational. In fact, they list stigmatization and bullying due to their participation in the subculture as potential factors leading these individuals toward depression and self-harm, as well as genetic predispositions (Bowes et. al, 2015).
Video Game Addiction and Violent Behavior
There are many narratives concerning video game subculture participation as negatively
impacting mental health, especially where there lies a generation gap between youths exposed to video games in mass, and adults who know little about them and their effects. Concerned relatives have created a media hype around addiction as well as violent tendencies caused by play. On the matter of addiction, the moral panic surrounding addiction stands on a base provided by the DSM’s definitions of addiction, particularly its expansion to include compulsive gambling. However, its opponents argue that video games are not inherently more addictive than any other behavior. While too much of this relatively antisocial behavior is unhealthy, game play fails to demonstrate high financial stakes, increased intensity over time, as well as other qualitative requirements to equate it to gambling (Wood, 2007). Excessive game play, rather, may be a source of escape for someone with other underlying issues, rather than a substance inherently leading to addiction.
About 90% of children in the U.S. play video games, and over 90% of those games involve mature content that often includes violence (Park, 2014). Violent games, even in their being widespread, have stirred up a moral panic due to the worry that games lead to increased aggression. Especially after the Columbine shootings, parents readily frown upon violent gaming. One study of 3,034 children conducted in Singapore, found that those who played violent video games for longer periods of time per week had higher levels of aggression and violent tendencies than those who played for shorter periods (Park, 2014). One element of the tests the researcher conducted included young children’s self reporting, which isn’t always the most reliable source. However, studies such as these add fuel to the fire of the moral panic.
Bodybuilding and Bigorexia
The bodybuilding subculture uses weight lifting along with specific nutritional regimens in order to improve the physique of the body, with the explicit goal of achieving a specific muscular bodily aesthetic, rather than just focusing on health or sport (Denham, 2007). Bodybuilders are constantly surrounded by and compared to their competitors, as many enter competitions ranging from local to national stages. The taboo, yet rampant, use of anabolic steroids to boost appearance feeds into bodybuilders’ unrealistic desired aesthetic.
Some medical professionals believe that this influences bodybuilders to the point that no amount of improvement is ever good enough. These individuals may turn to anabolic steroid use that can eventually lead to various health issues, and even depression due to withdrawal. In a study of bodybuilders it was found that up to 10% of them exhibited symptoms of muscle dysmorphia (Pope, Phillips, & Olivardia, 2000b; Mosley, 2009). It is, however, possible that men that gravitate toward bodybuilding already have a certain pre-existing psychopathology. Another counterargument is that the purpose of bodybuilding is to increase self esteem and better one’s self image. In fact, some studies show that bodybuilders are “more likely to have a favourable
self-evaluation of body image” (Mosley, 2009).
The books and articles listed are great academic resources for learning more about the medicalization of deviance.
Books
Conrad, Peter and Joseph W Schneider. 1992. Deviance and Medicalization: From Badness to Sickness. Philadelphia, PA: Temple University Press. Deviance and Medicalization: From Badness to Sickness on JSTOR
This classic text outlines the nature of deviance and how it relates to the medical field. The authors examine specific cases of of medicalization of deviance (ex. mental illness, addiction, homosexuality, etc.) to illustrate how medicine has become an institution of social control.
Goffman, Erving. 1986. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall.
Goffman analyzes the experience of individuals who are considered abnormal by society and are thus stigmatized. He relies extensively on autobiographies and case studies toexplore the labeled person’s feelings about themselves and the strategies they use to cope.
Szasz, Thomas. 1970. The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. Syracuse, NY: Syracuse University Press. https://www.amazon.com/Manufacture-Madness-Comparative-Inquisition-Movement/dp/0815604610
One of Szasz’ famous works, comparing the Inquisition to the growth of the mental health field, ultimately arguing his point that mental illness is socially constructed.
Articles
Bowes, Lucy, Rebecca Carnegie, Rebecca Pearson, Becky Mars, Lucy Biddle, Barbara Maughan, Glyn Lewis, Charles Fernyhough, and Jon Heron. 2015. “Risk of Depression and Self-Harm in Teenagers Identifying with Goth Subculture: A Longitudinal Cohort Study.” The Lancet Psychiatry 2(9):793-800. https://www.researchgate.net/publication/281322019_Risk_of_depression_and_self-harm_in_teenagers_identifying_with_goth_subculture_A_longitudinal_cohort_study
Link, Bruce G. and Jo C. Phelan. 2001. “Conceptualizing Stigma.” Annual Review of Sociology 27: 363-385.
http://www.annualreviews.org/doi/abs/10.1146/annurev.soc.27.1.363
Phillips, James, Allen Frances, Michael A Cerullo, John Chardavoyne, Hannah S Decker, Michael B First, Nassir Ghaemi, Gary Greenberg, Andrew C Hinderliter, Warren A Kinghorn, Steven G LoBello, Elliott B Martin, Aaron L Mishara, Joel Paris, Joseph M Pierre, Ronald W Pies, Harold A Pincus, Douglas Porter, Claire Pouncey, Michael A Schwartz, Thomas Szasz, Jerome C Wakefield, G Scott Waterman, Owen Whooley, and Peter Zachar. 2012. “The Six Most Essential Questions in Psychiatric Diagnosis: A Pluralogue Part 1: Conceptual and Definitional Issues in Psychiatric Diagnosis.” Philosophy, Ethics, and Humanities in Medicine 7(3):1-29. https://www.ncbi.nlm.nih.gov/pubmed/22243994
Media
Dungeons and Dragons: Satanic Panic (2016)
News report on how the game Dungeons and Dragons, first introduced in 1974, created a moral panic, making parents think participating in this gaming subculture would cause their children to begin worshiping the devil or have suicidal thoughts.
The Medicalization of Society (2013)
Peter Conrad, one of the experts in the field of medical deviance, lectures about the medicalization of society. He also speculates on emerging areas of medicalization and how the public will react to these in the future.
Dr. Thomas Szasz, CCHR Cofounder (2010)
In this short video clip, Thomas Szasz discusses the potential dangers of labeling deviant behavior as a mental illness.
Imagine there was No Stigma to Mental Illness (2016)
In this Tedx talk, Dr. Jeffrey Leiberman, a former president of the American Psychiatric Association, imagines a world without mental health stigma.
All Goths Are Depressed – A Harmful Stereotype. (2017)
In this youtube video, a goth social media influencer details her own personal experience with the goth community, her depression, and the intersection between the two.
Contemporary Articles
Lozada, Carlos. 2017. “Is Trump Mentally Ill? Or is America? Psychiatrists Weigh In.” The Washington Post. https://www.washingtonpost.com/news/book-party/wp/2017/09/22/is-trump-mentally-ill-or-is-america-psychiatrists-weigh-in/?utm_term=.d0565626da39
In 2017, everybody is at risk of having their deviance medicalized – even President Trump. In a book called “The Dangerous Case of Donald Trump,” various psychiatrists and mental health experts offer their diagnosis of President Trump’s erratic and unstable behavior in the White House. Possible diagnoses include narcissistic personality disorder, sociopathy, and antisocial personality disorder. While some psychiatrists call for an official evaluation of Trump’s fitness for office, others, such as psychiatrist Allen Frances take a more sociological approach, arguing that “calling trump crazy allows us to avoid confronting the craziness in our society. We can’t expect to change Trump, but we must work to undo the societal delusions that created him.” In this case, some psychologists are speaking out against using the medical model to cover up larger societal problems. For more on this topic, see the Medicalization as Social Control section of this page.
James, Sherry. 2017. “Bipolar Disorder Market is Anticipated to Reach USD 4.9 Billion By 2025.” Grand View Research. Bipolar Disorder Market Size Worth $4.9 Billion By 2025 | CAGR 2.10% (grandviewresearch.com)
Ever since the rise and commercialization of the Healthcare Industry, the frequency of mental illness diagnoses has increased substantially. It is believed that this expansion is a result of an overall increase in awareness of disorders and technological advances, such as online management tools, that promote timely detection. This article reports the results of a study done by Grand View Research Inc. The researchers predict a huge growth in the bipolar disorder market claiming that antipsychotic drugs will dominate the market within a decade.
Brown, Sherronda J. 2017. “Incels: The Vile, Extremist Community of Men Who (Really) Hate Women.” Wear Your Voice Mag, November 4. https://wearyourvoicemag.com/identities/feminism/incels-the-most-vile-people
Incels are an internet based subculture made up of men who self-identify as “involuntary celibate.” These individuals thrive on platforms such as 4-chan and Reddit, and partake in heated patriarchal and violent dialogue in which they make threats, unveil their sexual fantasies, and complain about failed sexual pursuits. There is much debate surrounding crimes that members commit, such as Elliot Rodger’s murdering six and taking his own life. The debate stands as to if these individuals say and do these heinous things because their loneliness has led to mental illness (and vice versa), or if the mental illness argument is merely an excuse to defend their wicked pathologies.
References
Books:
Ackerknecht, Erwin H. 2016. A Short History of Medicine. Baltimore, MD: Johns Hopkins University Press. https://jhupbooks.press.jhu.edu/content/short-history-medicine
Becker, H.S. (1963). Outsiders: Studies in the Sociology of Deviance. New York, NY: Free Press.
Conrad, Peter and Joseph W Schneider. 1992. Deviance and Medicalization: From Badness to Sickness. Philadelphia, PA: Temple University Press. Deviance and Medicalization: From Badness to Sickness on JSTOR
Ferentzy, Peter and Nigel E. Turner. 2013. The History of Problem Gambling: Temperance, Substance Abuse, Medicine, and Metaphors. New York: Springer. https://www.amazon.com/History-Problem-Gambling-Temperance-Substance/dp/1461466989
Szasz, Thomas. 1970. The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. Syracuse, NY: Syracuse University Press. https://www.amazon.com/Manufacture-Madness-Comparative-Inquisition-Movement/dp/0815604610
Articles:
Bowes, Lucy, Rebecca Carnegie, Rebecca Pearson, Becky Mars, Lucy Biddle, Barbara Maughan, Glyn Lewis, Charles Fernyhough, and Jon Heron. 2015. “Risk of Depression and Self-Harm in Teenagers Identifying with Goth Subculture: A Longitudinal Cohort Study.” The Lancet Psychiatry 2(9):793-800.
Dear, M., and G. Lewis. 1986. “Anatomy of a decision: Recent land use zoning appeals and their effect on group home locations in Ontario.” Canadian Journal of Community Mental Health 5(1): 5-17. http://dx.doi.org/10.7870/cjcmh-1986-0001
Denham, Bryan E. 2007. “Masculinities in Hardcore Bodybuilding.” Men and Masculinities 1–8. (https://www.researchgate.net/profile/Bryan_Denham/publication/249696489_Masculinities_in_Hardcore_Bodybuilding/links/56e71f9808ae4c354b1a6d87/Masculinities-in-Hardcore-Bodybuilding.pdf).
Levine, Martin P., and Richard R. Troiden. 1988. “The Myth of Sexual Compulsivity.” The Journal of Sex Research 25(3): 347-363. http://www.jstor.org/stable/3812739
Link, Bruce G. and Jo C. Phelan. 2001. “Conceptualizing Stigma.” Annual Review of Sociology 27: 363-385. http://www.annualreviews.org/doi/abs/10.1146/annurev.soc.27.1.363
Mosley, Philip E. 2008. “Bigorexia: Bodybuilding and Muscle Dysmorphia.” European Eating Disorders Review. https://www.researchgate.net/profile/Philip_Mosley2/publication/23225701_Bigorexia_Bodybuilding_and_Muscle_Dysmorphia/links/56c62ba408ae8cf828fefb51.pdf.
Park, Alice. 2014. “Little By Little, Violent Video Games Make Us More Aggressive.” TIME, March 24. http://time.com/34075/how-violent-video-games-change-kids-attitudes-about-aggression/
Phillips, James, Allen Frances, Michael A Cerullo, John Chardavoyne, Hannah S Decker, Michael B First, Nassir Ghaemi, Gary Greenberg, Andrew C Hinderliter, Warren A Kinghorn, Steven G LoBello, Elliott B Martin, Aaron L Mishara, Joel Paris, Joseph M Pierre, Ronald W Pies, Harold A Pincus, Douglas Porter, Claire Pouncey, Michael A Schwartz, Thomas Szasz, Jerome C Wakefield, G Scott Waterman, Owen Whooley, and Peter Zachar. 2012. “The Six Most Essential Questions in Psychiatric Diagnosis: A Pluralogue Part 1: Conceptual and Definitional Issues in Psychiatric Diagnosis.” Philosophy, Ethics, and Humanities in Medicine 7(3):1-29. https://www.ncbi.nlm.nih.gov/pubmed/22243994
Reavley, N.J., and A.F. Jorm. 2011. “Recognition of mental disorders and beliefs about treatment outcome: findings from an Australian national survey of mental health literacy and stigma.” Australian and New Zealand Journal of Psychiatry 45(11): 947-956. https://www.ncbi.nlm.nih.gov/pubmed/21995330
Robbins, Thomas and Dick Anthony. 1982. “Deprogramming, Brainwashing and the Medicalization of Deviant Religious Groups.” Social Problems 29(3):283–97. http://www.jstor.org/stable/800160
Rosecrance, John. 1985. “Compulsive Gambling and the Medicalization of Deviance.” Social Problems 32(3):275–84. http://www.jstor.org/stable/800687
Schur, Edwin M. 1984. Labeling women deviant: Gender, stigma, and social control. New York, NY: McGraw-Hill.
Schneider, Joseph W. 1978. “Deviant Drinking as Disease: Alcoholism as a Social Accomplishment.” Social Problems 25(4):361–72. http://www.jstor.org/stable/800489
Wang, JianLi., and Daniel Lai. 2008. “The relationship between mental health literacy, personal contacts and personal stigma against depression.” Journal of Affective Disorders 110(1-2): 191-196. http://www.jad-journal.com/article/S0165-0327(08)00024-4/abstract
Wood, Richard T. A. 2008. “Problems with the Concept of Video Game “Addiction”: Some Case Study Examples.” International Journal of Mental Health and Addiction 6:169–78. https://pdfs.semanticscholar.org/1b3f/a5344a84a82d69b94fdfe1cd3f62398ce77a.pdf
Young, Aaron, Humayun J Chaudhry, Xiaomei Pei, Katie Halbesleben, Donald H Polk, and Michael Dugan. 2015. “A Census of Actively Licensed Physicians in the United States, 2014.” Journal of Medical Regulation 101(2):8-23. https://www.fsmb.org/media/default/pdf/census/2014census.pdf