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UNODC showed the annual prevalence for marijuana is 3.5 percent, amphetamine-type stimulants 2.8 percent, and ecstasy . 01 percent of the population above 15 years of age.

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Young adults aged 18 to 25 had the highest percentage of marijuana users (34.5%), followed by adults aged 26 and older (16.3%) and adolescents aged 12 to 17 (10.1%). (2020 NSDUH)

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Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), under Contract No. HHSS283201700002C with RTI International. Beth Han was the SAMHSA author. Kathryn Piscopo served as the government project officer and as the contracting officer representative.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Printed Copies

This publication may be downloaded or ordered at https://store.samhsa.gov/. Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Recommended Citation

Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

Originating Office

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Room 15-E09D, Rockville, MD 20857. For questions about this report, please e-mail CBHSQrequest@samhsa.hhs.gov.

Nondiscrimination Notice

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Populations Survey Branch

Publication Number PEP20-07-01-001
September 2020

Summary

This report summarizes key findings from the 2019 National Survey on Drug Use and Health (NSDUH) for national indicators of substance use and mental health among the civilian, noninstitutionalized population aged 12 or older in the United States. In this report, overall statements use terms such as "increased," "decreased," or "declined" to describe a trend from the baseline year to 2019 that was statistically significant (at the .05 level) based on results of linear or quadratic trend tests. Pairwise t tests also were conducted to compare the estimates in 2019 with corresponding estimates in prior years.

Substance Use

Among people aged 12 or older in 2019, 60.1 percent (or 165.4 million people) used a substance (i.e., tobacco, alcohol, kratom, or an illicit drug) in the past month. In particular, 50.8 percent (or 139.7 million people) drank alcohol in the past month, 21.1 percent (or 58.1 million people) used a tobacco product in the past month, and 13.0 percent (or 35.8 million people) used an illicit drug in the past month. In addition, 0.3 percent (or 825,000 people) used kratom in the past month.

Tobacco Use

Among people aged 12 or older in 2019 who used any tobacco product in the past month, 65.3 percent smoked cigarettes but did not use other tobacco products, 13.8 percent smoked cigarettes and used some other type of tobacco product, and 21.0 percent used only noncigarette tobacco products (i.e., other tobacco products but not cigarettes). Thus, most of the past month tobacco users in the United States were cigarette users.

Among past month tobacco product users in 2019, the percentage who used only cigarettes increased with age (35.4 percent of adolescents aged 12 to 17, 49.6 percent of young adults aged 18 to 25, and 68.5 percent of adults aged 26 or older), but the percentage who used only noncigarette tobacco products decreased with age (39.6 percent of adolescents, 27.9 percent of young adults, and 19.5 percent of adults aged 26 or older).

Among people aged 12 or older, the percentage who were past month cigarette users declined from 26.0 percent (or 61.1 million people) in 2002 to 16.7 percent (or 45.9 million people) in 2019.

Among past month cigarette smokers aged 12 or older, the percentage who smoked cigarettes daily declined from 63.4 percent in 2002 (or 38.7 million people) to 58.4 percent (or 26.8 million people) in 2019.

Alcohol Use

Among the 139.7 million current alcohol users aged 12 or older in 2019, 65.8 million people (47.1 percent) were past month binge drinkers. Among past month binge drinkers, 16.0 million people (24.4 percent of current binge drinkers and 11.5 percent of current alcohol users) were past month heavy drinkers.

Among adolescents aged 12 to 17, the percentage who were past month alcohol users declined from 17.6 percent (or 4.4 million people) in 2002 to 9.4 percent (or 2.3 million people) in 2019. The percentage who were past month binge alcohol users declined from 5.8 percent (or 1.4 million people) in 2015 to 4.9 percent (or 1.2 million people) in 2019.

Among young adults aged 18 to 25, the percentage who were past month alcohol users declined from 61.4 percent (or 19.5 million people) in 2003 to 54.3 percent (or 18.3 million people) in 2019. The percentage who were past month binge alcohol users declined from 39.0 percent (or 13.6 million people) in 2015 to 34.3 percent (or 11.6 million people) in 2019.

Among people aged 12 to 20, the percentage who were past month alcohol users declined from 28.8 percent (or 10.7 million people) in 2002 to 18.5 percent (or 7.0 million people) in 2019. The percentage who were past month binge alcohol users declined from 13.4 percent (or 5.1 million people) in 2015 to 11.1 percent (or 4.2 million people) in 2019, and the percentage who were past month heavy alcohol users declined from 3.3 percent (or 1.3 million people) in 2015 to 2.2 percent (or 825,000 people) in 2019.

Illicit Drug Use

Among people aged 12 or older, the percentage who were past year marijuana users increased from 11.0 percent (or 25.8 million people) in 2002 to 17.5 percent (or 48.2 million people) in 2019. Over this same period, the percentage who were past year cocaine users decreased from 2.5 percent (or 5.9 million people) to 2.0 percent (or 5.5 million people).

Among people aged 12 or older, the percentage who were past year misusers of prescription pain relievers declined from 4.7 percent (or 12.5 million people) in 2015 to 3.5 percent (or 9.7 million people) in 2019.

Among people aged 12 or older, the percentage who were past year misusers of prescription benzodiazepines declined from 2.1 percent (or 5.5 million people) in 2015 to 1.8 percent (or 4.8 million people) in 2019. Among young adults aged 18 to 25, the percentage who were past year misusers of prescription benzodiazepines declined from 5.2 percent (or 1.8 million people) in 2015 to 3.8 percent (or 1.3 million people) in 2019.

Among adults aged 26 or older, the percentage who were past year marijuana users increased from 7.0 percent (or 12.6 million people) in 2002 to 15.2 percent (or 33.0 million people) in 2019. The percentage who were past year hallucinogen users increased from 0.8 percent (or 1.7 million people) in 2015 to 1.5 percent (or 3.1 million people) in 2019. The percentage who were past year methamphetamine users increased from 0.5 percent (or 1.1 million people) in 2016 to 0.8 percent (or 1.7 million people) in 2019.

Initiation of Substance Use

Among people aged 12 or older, the number of past year initiates of marijuana use increased from 2.2 million people in 2002 to 3.5 million people in 2019. The number of past year initiates of cocaine use decreased from 1.0 million in 2002 to 671,000 in 2019.

Among people aged 12 or older, the number of past year initiates of prescription pain reliever misuse declined from 2.1 million people in 2015 to 1.6 million people in 2019. Over this period, the number of past year initiates of prescription tranquilizer misuse declined from 1.4 million people to 949,000 people, and the number of past year initiates of prescription stimulant misuse declined from 1.3 million people to 901,000 people.

Among adolescents aged 12 to 17, the number of past year initiates of cigarette smoking declined from 1.2 million people in 2002 to 541,000 people in 2019. Over this same period, the number of past year initiates of alcohol use declined from 2.6 million adolescents to 2.3 million adolescents, and the number of past year initiates of cocaine use decreased from 310,000 adolescents to 59,000 adolescents. The number of adolescents who were past year initiates of prescription pain reliever misuse declined from 415,000 in 2015 to 245,000 in 2019.

Among young adults aged 18 to 25, the number of past year initiates of alcohol use increased from 1.2 million people in 2002 to 2.4 million people in 2019. Over this same period, the number of past year initiates of marijuana use increased from 733,000 young adults to 1.2 million young adults. The number of young adults who were past year initiates of prescription pain reliever misuse declined from 596,000 in 2015 to 404,000 in 2019.

Among adults aged 26 or older, the number of past year initiates of marijuana use increased from 90,000 people in 2002 to 887,000 people in 2019, but the number of past year initiates of prescription pain reliever misuse remained stable between 2015 and 2019.

Perceived Risk from Substance Use

Substance Use Disorders

Among people aged 12 or older, the percentage with a past year substance use disorder (SUD) (i.e., alcohol use disorder, illicit drug use disorder, or both) remained stable between 2015 and 2019. Among the 20.4 million people aged 12 or older with a past year SUD in 2019, 71.1 percent (or 14.5 million people) had a past year alcohol use disorder, 40.7 percent (or 8.3 million people) had a past year illicit drug use disorder, and 11.8 percent (or 2.4 million people) had both an alcohol use disorder and an illicit drug use disorder in the past year.

Among people aged 12 or older, the percentage with a past year alcohol use disorder declined from 7.7 percent (or 18.1 million people) in 2002 to 5.3 percent (or 14.5 million people) in 2019. Over that same period, the percentage with a past year cocaine use disorder declined from 0.6 percent (or 1.5 million people) to 0.4 percent (or 1.0 million people).

Among people aged 12 or older, the percentage with a past year prescription pain reliever use disorder decreased from 0.8 percent (or 2.0 million people) in 2015 to 0.5 percent (or 1.4 million people) in 2019. Over that same period, the percentage with a past year opioid use disorder also decreased from 0.9 percent (or 2.4 million people) to 0.6 percent (or 1.6 million people).

Among adolescents aged 12 to 17, the percentage with a past year marijuana use disorder declined from 4.3 percent (or 1.1 million people) in 2002 to 2.8 percent (or 699,000 people) in 2019. Among adults aged 26 or older, however, the percentage with a past year marijuana use disorder increased from 0.8 percent (or 1.4 million people) in 2002 to 1.0 percent (or 2.2 million people) in 2019.

Among adults aged 26 or older, the percentage with a past year methamphetamine use disorder increased from 0.3 percent (or 539,000 people) in 2016 to 0.4 percent (or 904,000 people) in 2019. The percentage with a past year prescription pain reliever use disorder decreased from 0.7 percent (or 1.5 million people) in 2015 to 0.5 percent (or 1.1 million people) in 2019.

Major Depressive Episode

Mental Illness among Adults

Co-Occurring Mental Health Issues and Substance Use Disorder

Substance Use among People with Mental Health Issues

In 2019, adolescents with a past year MDE were more likely than adolescents without a past year MDE to be past year illicit drug users (31.9 vs. 14.4 percent), past year marijuana users (24.6 vs. 11.1 percent), past year opioid misusers (i.e., heroin users or misusers of prescription pain relievers) (4.2 vs. 1.8 percent), past month binge alcohol users (8.9 vs. 4.1 percent), or past month cigarette smokers (4.4 vs. 1.8 percent).

Among adults aged 18 or older in 2019, those with past year SMI or AMI were more likely than those without mental illness in the past year to be past year users of illicit drugs (49.4 percent for SMI and 38.8 percent for AMI vs. 16.6 percent for adults with no mental illness), past year users of marijuana (39.8 and 32.5 percent vs. 14.2 percent), past year misusers of opioids (13.8 and 8.8 percent vs. 2.5 percent), past month binge alcohol users (32.7 and 30.9 percent vs. 24.5 percent), or past month cigarette smokers (33.0 and 27.2 percent vs. 15.8 percent).

Suicidal Thoughts and Behavior among Adults

Among adults aged 18 or older, the percentage who had serious thoughts of suicide in the past year increased from 3.7 percent (or 8.3 million people) in 2008 to 4.8 percent (or 12.0 million people) in 2019. Over that same period, the percentage who made a suicide plan in the past year increased from 1.0 percent (or 2.3 million people) to 1.4 percent (or 3.5 million people). The percentage of adults in 2019 who attempted suicide in the past year did not differ from the percentages in 2008 through 2018.

Substance Use Treatment

Among people aged 12 or older in 2019, 1.5 percent (or 4.2 million people) received any substance use treatment in the past year, and 1.0 percent (or 2.6 million people) received substance use treatment at a specialty facility in the past year.

Among people aged 12 or older in 2019, 2.1 million received substance use treatment at a self-help group, 1.7 million received treatment at a rehabilitation facility as an outpatient, 1.3 million received treatment at a mental health center as an outpatient, 1.0 million received treatment at a rehabilitation facility as an inpatient, and 948,000 received treatment at a private doctor's office. The number of people who received substance use treatment at a private doctor's office increased from 2015 (686,000 people) to 2019.

Among the 21.6 million people aged 12 or older in 2019 who needed substance use treatment in the past year, 12.2 percent (or 2.6 million people) received substance use treatment at a specialty facility in the past year. This percentage in 2019 was similar to the percentages in 2015 to 2018.

Among the 18.9 million people aged 12 or older in 2019 with an SUD in the past year who did not receive treatment at a specialty facility, 95.7 percent (or 18.1 million people) did not feel that they needed treatment, 3.0 percent (or 577,000 people) felt that they needed treatment but did not make an effort to get treatment, and 1.2 percent (or 236,000 people) felt that they needed treatment and made an effort to get treatment.

Treatment for Depression

Among adolescents aged 12 to 17 with a past year MDE, receipt of treatment for depression in the past year increased from 37.8 percent (or 822,000 people) in 2005 to 43.3 percent (or 1.6 million people) in 2019.

Among the 19.4 million adults aged 18 or older in 2019 who had a past year MDE, 66.3 percent (or 12.8 million people) received treatment for depression in the past year. This percentage in 2019 was similar to the percentage in each year from 2009 through 2018.

Any Mental Health Services

Perceived Unmet Need for Mental Health Services among Adults with Mental Illness

Among the 51.5 million adults aged 18 or older in 2019 with past year AMI, 26.0 percent (or 13.3 million people) perceived an unmet need for mental health services in the past year, which was higher than the percentage in each year from 2008 through 2018.

Among the 13.1 million adults aged 18 or older in 2019 with past year SMI, 47.7 percent (or 6.2 million people) perceived an unmet need for mental health services in the past year, which was higher than the percentages in most years from 2008 through 2018.

Receipt of Services for Co-Occurring Substance Use Disorder and Mental Health Issues

Introduction

Substance use and mental health issues have significant impacts on people, families, communities, and societies.1,2,3,4 The National Survey on Drug Use and Health (NSDUH), conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides nationally representative data on use of tobacco, alcohol, and illicit drugs; substance use disorders (SUDs); receipt of substance use treatment; mental health issues; and use of mental health services among the civilian, noninstitutionalized population aged 12 or older in the United States. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation's behavioral health.

This report summarizes findings for key substance use and mental health indicators from the 2019 National Survey on Drug Use and Health (NSDUH).

Based on 2019 and earlier NSDUH data, this report contains findings on key substance use and mental health indicators and related trends in the United States. The 2019 NSDUH detailed tables showing comprehensive substance use and mental health-related estimates are available separately at https://www.samhsa.gov/data/.5 A subset of the 2019 NSDUH detailed tables to support selected estimates in the report also is included in Appendix B and may contain additional information not discussed in the report. However, detailed tables are not included in Appendix B when all percentages discussed in a report section can be found in figures in the report.

Survey Background

NSDUH is an annual survey of the civilian, noninstitutionalized population aged 12 or older in the United States. The survey is sponsored by SAMHSA within the U.S. Department of Health and Human Services (HHS). NSDUH covers residents of households and people in noninstitutional group quarters (e.g., shelters, boarding houses, college dormitories, migratory workers' camps, halfway houses). The survey excludes people with no fixed address (e.g., people who are homeless and not in shelters), military personnel on active duty, and residents of institutional group quarters, such as jails, nursing homes, mental institutions, and long-term care hospitals.

NSDUH employs a stratified multistage area probability sample designed to be representative of both the nation as a whole and for each of the 50 states and the District of Columbia. The 2019 NSDUH target sample of 67,500 people was allocated across three age groups, with 25 percent allocated to adolescents aged 12 to 17, 25 percent allocated to young adults aged 18 to 25, and 50 percent allocated to adults aged 26 or older.6

NSDUH is a face-to-face household interview survey conducted in two phases: the screening phase and the interview phase. The interviewer conducts a screening of a sampled household with an adult resident (aged 18 or older) in order to determine whether zero, one, or two household residents aged 12 or older should be selected for the interview. NSDUH collects data using audio computer-assisted self-interviewing (ACASI) in which respondents read or listen to the questions on headphones, then enter their answers directly into a NSDUH laptop computer. ACASI is designed for accurate reporting of information by providing respondents with a highly private and confidential mode for responding to questions about illicit drug use, mental health issues, and other sensitive behaviors. NSDUH also uses computer-assisted personal interviewing (CAPI) in which interviewers read less sensitive questions to respondents and enter the respondents' answers into a NSDUH laptop computer.

This report is based on data from 67,625 completed interviews from 2019 NSDUH respondents aged 12 or older.

In 2019, screening was completed at 148,023 addresses, and 67,625 completed interviews were obtained, including 16,894 interviews from adolescents aged 12 to 17 and 50,731 interviews from adults aged 18 or older. Weighted response rates for household screening and for interviewing were 70.5 and 64.9 percent, respectively, for an overall response rate of 45.8 percent for people aged 12 or older. The weighted interview response rates were 72.1 percent for adolescents and 64.2 percent for adults.7 Further information about the 2019 NSDUH design and methods can be found on the web at https://www.samhsa.gov/data/.8

Data Presentation and Interpretation

This report focuses on substance use and mental health indicators and related trends in the United States based on NSDUH data from 2019 and earlier years.9 Estimates of substance use and related treatment are presented for people aged 12 or older, adolescents, and adults.10 However, estimates of mental health issues and mental health service use are presented separately for adolescents aged 12 to 17 and adults aged 18 or older because the two groups completed different sets of questions regarding mental health and mental health service utilization. All estimates (e.g., percentages and numbers) presented in the report are derived from survey data that are subject to sampling errors and have met the criteria for statistical precision.11

One of NSDUH's strengths is the stability in the sample and survey design. This stability allows for the examination of trends across time. However, the benefit of using NSDUH data to assess trends has to be balanced with the periodic need to revise or add content to better address behavioral health issues or to timely assess emerging issues.12 Consequently, the number of years for which comparisons can be made varies across measures depending on when content was revised or added for NSDUH. For example, the perceived recovery items were added in 2018; as a result, these items established a baseline that started in 2018. The misuse measures of prescription drugs that were revised in 2015 have 5 years of trend data between 2015 and 2019 ( 2019 detailed table [DT] 7.2 ). In contrast, the marijuana use measures, which have been the same since 2002, have 18 years of trend data between 2002 and 2019 ( 2019 DT 7.2 ).

Analyses of trends in this report focus on long-term trends in substance use and mental health issues. Trends for 2015 to 2019 also are presented for selected measures.

Statistical tests were conducted for comparisons appearing in the text of this report. Based on results of linear and quadratic tests of trends involving 5 or more years of data, the report summarizes whether an outcome of interest showed a statistically significant change from the baseline year (e.g., 2002 for cigarette smoking in the past month) through 2019. Linear trend testing indicates whether estimates have decreased, increased, or remained steady over the period of interest. Quadratic trend testing indicates whether estimates have leveled off or changed direction over the period of interest. Statistically significant differences are described using terms such as "higher," "lower," "increased," "decreased," or "declined." Statements use terms such as "similar," "remained steady," or "stable" when a difference was not statistically significant. Discussion of trends in this report also includes whether the 2019 estimates differ from or are similar to estimates in other years13 but minimizes the discussion of differences between any 2 consecutive years.14

Substance Use in the Past Month

This section provides an overview of estimates according to whether respondents aged 12 or older reported using any tobacco product, alcohol, illicit drug, or kratom in the 30 days before the NSDUH interview (i.e., in the past month, also referred to as "current use"). Additional information on the use of tobacco products, alcohol, and illicit drugs is provided in other sections of this report.

Figure 1. Past Month Substance Use among People Aged 12 or Older: 2019

D

Rx = prescription.
Note: Substance Use includes any illicit drug, kratom, alcohol, and tobacco use.
Note: The estimated numbers of current users of different substances are not mutually exclusive because people could have used more than one type of substance in the past month.

Tobacco Use in the Past Month

Among people aged 12 or older in 2019 who used any tobacco product in the past month, 65.3 percent smoked cigarettes but did not use other tobacco products, 13.8 percent smoked cigarettes and used some other type of tobacco product, and 21.0 percent used only noncigarette tobacco products (i.e., other tobacco products but not cigarettes) ( Table A.2B ). Among past month tobacco product users, the percentage who used only cigarettes increased with age (35.4 percent of adolescents aged 12 to 17, 49.6 percent of young adults aged 18 to 25, and 68.5 percent of adults aged 26 or older), but the percentage who used only noncigarette tobacco products decreased with age (39.6 percent of adolescents, 27.9 percent of young adults, and 19.5 percent of adults aged 26 or older). Regardless of age, however, the majority of past month tobacco users used cigarettes, either as the only tobacco product or in addition to other tobacco products.

The remainder of this section on tobacco use focuses on cigarette smoking because most current tobacco users were cigarette smokers. More information on the use of cigars, pipe tobacco, and smokeless tobacco in the past month by people aged 12 or older can be found in Table A.1B and in the 2019 detailed tables by age (i.e., 2019 DT 7.6 , DT 7.12 , and DT 7.15 , respectively).

Cigarette Use

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Daily Cigarette Use

Aged 12 to 17

Among current cigarette smokers aged 12 to 17 in 2019, 13.2 percent (or 75,000 people) smoked cigarettes daily in the past month (2019 DT 7.27). This percentage was lower than the percentages in 2002 to 2015, but it was similar to the percentages in 2016 to 2018. The percentage of adolescent daily smokers who smoked one or more packs of cigarettes per day was not reported for 2019 due to low statistical precision.11

Aged 18 to 25

Among current cigarette smokers aged 18 to 25 in 2019, 35.4 percent (or 2.1 million people) smoked cigarettes daily in the past month (2019 DT 7.29). The 2019 percentage was lower than the percentages in 2002 to 2016, but it was similar to the percentages in 2017 and 2018. Among current daily cigarette smokers aged 18 to 25 in 2019, the percentage who smoked one or more packs of cigarettes per day (25.0 percent) was lower than the percentages in 2002 to 2009, but it was similar to the percentages in 2010 to 2018 ( Figure 5 ).

Aged 26 or Older

Among current cigarette smokers aged 26 or older in 2019, 62.5 percent (or 24.6 million people) smoked cigarettes daily in the past month (2019 DT 7.30). This percentage was lower than the percentages in 2002 to 2013, but it was similar to the percentages in 2014 to 2018. Among current daily cigarette smokers aged 26 or older in 2019, the percentage who smoked one or more packs of cigarettes per day (42.0 percent) was lower than the percentages in 2002 to 2012, but it was similar to the percentages in 2013 to 2018 ( Figure 5 ).

Alcohol Use in the Past Month

As noted in the section on Substance Use in the Past Month , the 2019 NSDUH asked respondents aged 12 or older about their alcohol use in the 30 days before the interview. In addition to asking about any alcohol use, NSDUH collected information on past month binge alcohol use and heavy alcohol use. Binge drinking for males was defined as drinking five or more drinks18 on the same occasion on at least 1 day in the past 30 days, which has remained unchanged from the threshold prior to 2015. Since 2015, binge alcohol use for females has been defined as drinking four or more drinks on the same occasion on at least 1 day in the past 30 days.19 This definition of binge alcohol use is consistent with federal definitions.20 Heavy alcohol use was defined as binge drinking on 5 or more days in the past 30 days based on the thresholds described previously for males and females.

Any Alcohol Use

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Binge Alcohol Use

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Heavy Alcohol Use

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Underage Alcohol Use

Among people aged 12 to 20, the percentage who were past month alcohol users in 2019 was lower than the percentages in 2002 through 2015, but it was similar to the percentages in 2016 through 2018 ( 2019 DT 7.16 ). The percentage who were past month binge alcohol users in 2019 was lower than the percentage in 2015, but it was similar to the percentages in 2016 through 2018. The percentage who were past month heavy alcohol users in 2019 was lower than the percentages in 2015 and 2016, but it was similar to the percentages in 2017 and 2018.

Kratom Use in the Past Month

Kratom is an herbal extract from the leaves of the Mitragyna speciosa tree that is native to Southeast Asia. The leaves contain chemicals with mind-altering effects. Kratom can come in forms such as powders, pills, or leaves.23,24 The 2019 NSDUH asked respondents aged 12 or older about their use of kratom in the 30 days before the interview. Among people aged 12 or older in 2019, 0.3 percent (or 825,000 people) used kratom in the past month ( Figure 1 and Table A.1B ). In addition, 0.1 percent of adolescents aged 12 to 17 (or 26,000 people), 0.5 percent of young adults aged 18 to 25 (or 171,000 people), and 0.3 percent of adults aged 26 or older (or 629,000 people) used kratom in the past month (2019 DT 1.123).

Illicit Drug Use in the Past Year

This report presents estimates of past year (rather than past month) illicit drug use to help detect changes in low-prevalence illicit drug use (e.g., heroin use) over time. Moreover, the 2019 NSDUH collected only past year (rather than past month) data on the misuse of benzodiazepines and specific subtypes of prescription pain relievers (e.g., fentanyl products).

Figure 10. Past Year Illicit Drug Use among People Aged 12 or Older: 2019

D

Rx = prescription.
Note: The estimated numbers of past year users of different illicit drugs are not mutually exclusive because people could have used more than one type of illicit drug in the past year.

Any Illicit Drug Use

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Marijuana Use

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Cocaine Use

Percentages for past year crack use among people aged 12 or older decreased from 0.7 percent (or 1.6 million people) in 2002 to 0.3 percent (or 778,000 people) in 2019 ( 2019 DT 7.2 ). The percentage of people in 2019 who used crack in the past year was lower than the percentages in 2002 to 2009, but it was similar to the percentages in 2010 to 2018.

Aged 12 to 17

Percentages for past year crack use among adolescents decreased from 0.4 percent (or 100,000 people) in 2002 to less than 0.1 percent (or 11,000 people) in 2019 ( 2019 DT 7.5 ). The percentage of adolescents in 2019 who were past year crack users was lower than the percentages in 2002 to 2008, but it was similar to the percentages in 2009 to 2018.

Aged 18 to 25

Percentages for past year crack use among young adults decreased from 0.9 percent (or 266,000 people) in 2002 to 0.2 percent (or 61,000 people) in 2019 ( 2019 DT 7.11 ). The percentage of young adults in 2019 who used crack in the past year was lower than the percentages in most years from 2002 to 2015, but it was similar to the percentages in 2016 to 2018.

Aged 26 or Older

Heroin Use

Aged 12 to 17

Among adolescents aged 12 to 17 in 2019, the estimates of past year heroin use were not reported due to low statistical precision ( Figure 14 and 2019 DT 7.5 ).11 However, the estimate of past year heroin use among adolescents in 2018 was lower than the estimates for most years from 2002 through 2014, but it was similar to the estimates in 2015 to 2017.27 About 0.1 to 0.2 percent of adolescents used heroin in any year from 2002 to 2017.

Aged 18 to 25

Aged 26 or Older

Methamphetamine Use

Prior to 2015, questions about methamphetamine use were asked in the context of questions about the misuse of prescription stimulants because methamphetamine is legally available by prescription (Desoxyn ®). However, most methamphetamine used in the United States is produced and distributed illicitly rather than through the pharmaceutical industry. Beginning in 2015, therefore, NSDUH questionnaires have included separate sections for methamphetamine use and the use and misuse of prescription stimulants.

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Hallucinogen Use

Several drugs are grouped under the category of hallucinogens, including LSD, PCP, peyote, mescaline, psilocybin mushrooms, "Ecstasy" (MDMA or "Molly"), ketamine, DMT/AMT/"Foxy," and Salvia divinorum.28 Among people aged 12 or older, the percentage who were past year hallucinogen users increased from 1.8 percent (or 4.7 million people) in 2015 to 2.2 percent (or 6.0 million people) in 2019 ( Figure 16 and 2019 DT 7.2 ). These estimates in 2019 were higher than those in 2015 to 2017, but they were similar to those in 2018.

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Inhalant Use

Inhalants include volatile solvents (e.g., paint thinners and removers, dry cleaning fluids, degreasers, gasoline, glues, shoe polish, correction fluids, felt-tip markers), aerosols (e.g., spray paints, deodorant and hair sprays, fabric protector sprays, computer keyboard cleaner), gases (e.g., ether, halothane, nitrous oxide, butane, propane), and nitrites (e.g., amyl nitrite, "poppers," locker room deodorizers, "rush"). NSDUH respondents were asked to report the use of inhalants to get high but not to include accidental inhalation of a substance.

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Misuse of Psychotherapeutic Drugs

The 2019 NSDUH assessed the use and misuse of psychotherapeutic drugs currently or recently available by prescription in the United States, including prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines), and pain relievers. In NSDUH, misuse of prescription drugs was defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Misuse of over-the-counter drugs was not included.

Among people aged 12 or older, the percentage who misused prescription psychotherapeutic drugs in the past year declined from 7.1 percent (or 18.9 million people) in 2015 to 5.9 percent (or 16.3 million people) in 2019 ( 2019 DT 7.2 ). These estimates in 2019 were lower than those in 2015 to 2017, but they were similar to those in 2018.

Of the prescription drugs presented in this report, prescription pain relievers were the most commonly misused by people aged 12 or older. The 16.3 million people in 2019 who misused prescription psychotherapeutic drugs in the past year included 9.7 million people who misused prescription pain relievers, 4.9 million people who misused prescription stimulants, and 5.9 million people who misused prescription tranquilizers or sedatives (including 4.8 million past year misusers of benzodiazepines) ( Figure 10 ).

Stimulant Misuse

The 2019 NSDUH assessed the misuse of prescription stimulants in the following categories: amphetamine products, methylphenidate products, anorectic (weight-loss) stimulants, Provigil ®, or any other prescription stimulant. The amphetamine and methylphenidate products included in the NSDUH questionnaire are primarily prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD). Since 2015, methamphetamine has not been included as a prescription stimulant, unless respondents specified the prescription form of methamphetamine (Desoxyn ®) as some other stimulant they had misused in the past year.29

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Tranquilizer or Sedative Misuse

Estimates of the misuse of prescription tranquilizers or sedatives are presented together because prescription drugs in both categories have a common effect on specific activity in the brain. Prescription tranquilizers include benzodiazepine tranquilizers (e.g., as alprazolam, lorazepam, clonazepam, or diazepam products), muscle relaxants, or any other prescription tranquilizer. Prescription sedatives include zolpidem products, eszopiclone products, zaleplon products, benzodiazepine sedatives (e.g., as flurazepam and temazepam products or triazolam products), barbiturates, or any other prescription sedative.

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Benzodiazepine Misuse

Prescription benzodiazepines are a subcategory of drugs that may be prescribed either as tranquilizers for the relief of anxiety or as sedatives for the relief of insomnia. Benzodiazepines prescribed as tranquilizers are typically metabolized more slowly than benzodiazepines prescribed as sedatives.30 Nevertheless, benzodiazepines are chemically similar, regardless of whether they are prescribed as tranquilizers or sedatives.

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Pain Reliever Misuse

The 2019 NSDUH assessed the misuse of prescription pain relievers in the following categories: products containing hydrocodone, oxycodone, tramadol, codeine, morphine, prescription fentanyl,31 buprenorphine, oxymorphone, and hydromorphone, as well as Demerol ®, methadone, or any other prescription pain reliever. This section provides estimates of the misuse of any prescription pain reliever and specific subtypes of prescription pain relievers, the main reason for the most recent misuse of prescription pain relievers, and where people obtained the prescription pain relievers that they most recently misused in the past year.

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Misuse of Subtypes of Pain Relievers

The 2019 NSDUH asked respondents to identify specific prescription pain relievers they used in the past year, then asked whether they misused those pain relievers in the past year. The specific pain relievers people misused in the past year were categorized into subtypes, such as hydrocodone products. For example, respondents who reported misusing the pain relievers Vicodin ® or hydrocodone were classified as misusers of hydrocodone products.

This section presents two ways of examining the misuse of subtypes of pain relievers. First, it presents estimates of the misuse of subtypes among the total population aged 12 or older. Then it presents estimates of the misuse of subtypes of pain relievers among people who used that subtype in the past year.

Among people aged 12 or older in 2019, 1.8 percent (or 5.1 million people) misused hydrocodone products in the past year ( Figure 22 and 2019 DT 1.98). Hydrocodone products were the most commonly misused subtype of prescription pain relievers in 2019, including Vicodin ®, Lortab ®, Norco ®, Zohydro ® ER, and generic hydrocodone. In addition, 1.2 percent (or 3.2 million people) misused oxycodone products in the past year, including OxyContin ®, Percocet ®, Percodan ®, Roxicodone ®, and generic oxycodone. Also, 0.2 percent of people aged 12 or older (or 686,000 people) misused buprenorphine products in the past year.

An estimated 0.1 percent (or 269,000 people) of people aged 12 or older misused prescription fentanyl products ( Figure 22 and 2019 DT 1.98). Because NSDUH respondents were asked only about the misuse of prescription forms of fentanyl, estimates of fentanyl misuse in 2019 may underrepresent people who used illicitly manufactured fentanyl (IMF) from clandestine laboratories (i.e., as opposed to the misuse of diverted prescription fentanyl produced by the pharmaceutical industry) and may not include those who used IMF mixed with heroin or sold as heroin (but contained only IMF).

Although prescription pain reliever misuse was the second most common form of illicit drug use in 2019 ( Figure 10 ), most past year users of prescription pain relievers did not misuse them in the past year ( Figure 22 ). For example, among past year users of hydrocodone products, 11.6 percent misused them in the past year. Among past year users of buprenorphine products, 27.8 percent misused them. Among past year users of oxymorphone products (e.g., Opana ®), 27.3 percent misused them. Stated another way, more than two thirds of past year users of buprenorphine products or oxymorphone products did not misuse them in that period.

Main Reasons for the Last Misuse of Pain Relievers

Respondents in the 2019 NSDUH who reported prescription pain reliever misuse in the past year were asked to report the reasons for misusing the last prescription pain reliever they misused. Respondents who reported more than one reason for misusing the last prescription pain reliever were asked to report their main reason for misusing it.

Among people aged 12 or older in 2019 who misused prescription pain relievers in the past year, the most common main reason for their last misuse of a pain reliever was to relieve physical pain (65.7 percent) ( 2019 DT 6.13 ). Based on the NSDUH definition, use without a prescription of one's own or overuse of prescribed medication (e.g., use at a higher dosage or more often than prescribed) are both classified as misuse even if the use was for the purpose of pain relief.

Other common main reasons for misuse were to feel good or get high (11.3 percent) and to relax or relieve tension (10.0 percent) ( 2019 DT 6.13 ). Less common main reasons among past year misusers of pain relievers included to help with feelings or emotions (3.8 percent), to help with sleep (3.7 percent), to experiment or see what the drug was like (2.2 percent), because they were "hooked" or needed to have the drug (1.9 percent), and to increase or decrease the effects of other drugs (0.8 percent).

Source of the Last Pain Reliever That Was Misused

Among people aged 12 or older in 2019 who misused prescription pain relievers in the past year, the most common source for the last pain reliever they misused was from a friend or relative in some way (i.e., being given them, buying them, or taking them without asking) ( Figure 23 ). More than half (50.8 percent) of people who misused pain relievers in the past year obtained the pain relievers the last time from a friend or relative in some way. Specifically, 37.0 percent of people who misused pain relievers in the past year obtained pain relievers the last time by getting them from a friend or relative for free, 9.2 percent bought their last pain reliever from a friend or relative, and 4.6 percent took their last pain reliever from a friend or relative without asking. More than one third of people who misused pain relievers in the past year (37.5 percent) obtained pain relievers the last time through prescription(s) or stole pain relievers from a health care provider, typically getting the pain relievers through a prescription from one doctor (35.7 percent). About 1 in 15 people who misused pain relievers in the past year (6.2 percent) bought the last pain reliever they misused from a drug dealer or other stranger.

Figure 23. Source Where Pain Relievers Were Obtained for Most Recent Misuse among People Aged 12 or Older Who Misused Pain Relievers in the Past Year: 2019

D

Note: Respondents with unknown data for the Source for Most Recent Misuse or who reported Some Other Way but did not specify a valid way were excluded.
¹ The percentages from the subcategories do not add to the total percentage for the category due to rounding.

Opioid Misuse

Opioids are a group of chemically similar drugs that include heroin and prescription opioids, such as hydrocodone (e.g., Vicodin ®), oxycodone (e.g., OxyContin ®), and morphine. In this report, opioid misuse includes the misuse of prescription pain relievers or the use of heroin. Prescription pain relievers could include some nonopioids because respondents could occasionally specify the misuse of other prescription pain relievers that are not opioids.

In 2019, an estimated 404,000 people had misused prescription pain relievers and used heroin in the past year, and 341,000 people had used heroin in the past year but had not misused prescription pain relievers. Compared with the 4.2 percent of prescription pain reliever misusers who also used heroin in the past year, 54.2 percent of heroin users also misused pain relievers in the past year.21

The percentage of people aged 12 or older in 2019 who misused opioids in the past year was lower than the percentages in 2015 to 2017, but it was similar to the percentage in 2018 ( Figure 25 ). The decline in past year opioid misuse among the population between 2015 and 201827 was consistent with decreases between 2017 and 2018 in overdose deaths in the United States involving opioids overall, prescription opioids, or heroin.32

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Initiation of Substance Use

The 2019 NSDUH included questions to measure the initiation of substance use, that is, use of particular substances for the first time during a person's lifetime.33 This report presents the estimated number of recent substance use initiates or prescription drug misuse initiates.34 Recent initiates were substance users or prescription drug misusers who reported first using or misusing, respectively, a particular substance in the 12 months before the NSDUH interview.35,36

In particular, this report presents estimates for past year initiation of heroin use, prescription pain reliever misuse, prescription tranquilizer misuse, and prescription sedative misuse, separately. In contrast, the report does not present estimates for past year initiation of any opioid (heroin or prescription pain reliever) misuse, any illicit drug use (including prescription drug misuse), and any prescription tranquilizer or sedative misuse because respondents may not report the misuse of prescription drugs that occurred more than 12 months before the interview. Consequently, these estimates could be biased. Estimates for the past year initiation of benzodiazepine misuse are not presented because NSDUH did not capture information on lifetime misuse of benzodiazepines.37

Figure 26. Past Year Initiates of Substances among People Aged 12 or Older: 2019

D

Rx = prescription.
Note: Estimates for prescription pain relievers, prescription tranquilizers, prescription stimulants, and prescription sedatives are for the initiation of misuse.

Initiation of Cigarette Smoking

Initiation of Alcohol Use

Initiation of Marijuana Use

Initiation of Cocaine Use

Among people aged 12 or older, the number of past year initiates of cocaine use decreased from 1.0 million in 2002 to 671,000 in 2019 ( Figure 29 and 2019 DT 7.40 ).39 This number in 2019 was lower than the numbers in 2002 to 2007 and in 2015 to 2018, but it was similar to the numbers in 2008 to 2014. The number of people aged 12 or older in 2019 who initiated cocaine use averaged to about 1,800 people each day ( Table A.3A ). Continued monitoring of trends for initiation of cocaine use is important for assessing progress in preventing people from trying cocaine.

Initiation of Heroin Use

Among people aged 12 or older in 2019, 50,000 people initiated heroin use in the past year, which was lower than the numbers in most years from 2002 through 2018 ( Figure 30 and 2019 DT 7.40 ). The number of people aged 12 or older in 2019 who initiated heroin use in the past year averaged to about 140 people each day ( Table A.3A ). However, caution is advised in interpreting fluctuations in the numbers of heroin use initiates in single years. The relatively small numbers of recent initiates per year can contribute to these fluctuations, especially when the estimated numbers are presented for specific age groups, described as follows.40

Among adolescents aged 12 to 17 in 2019, the number of past year initiates of heroin use was not reported due to low statistical precision ( Figure 30 and 2019 DT 7.41 ). Among young adults aged 18 to 25 in 2019, 19,000 initiated heroin use in the past year ( 2019 DT 7.43 ), which was lower than the number in each year from 2002 through 2016 but was similar to the numbers in 2017 and 2018. Among young adults in 2019, an average of 50 young adults initiated heroin use each day ( Table A.3A ). Among adults aged 26 or older, the number of past year initiates of heroin use in 2019 (31,000 people) was similar to the number in most years from 2002 through 2018 ( 2019 DT 7.44 ). In 2019, an average of about 90 adults aged 26 or older initiated heroin use each day.

Initiation of Methamphetamine Use

Initiation of Hallucinogen Use

Among people aged 12 or older in 2019, 1.2 million people initiated hallucinogen use in the past year ( Figure 26 and 2019 DT 7.40 ), or an average of about 3,300 new hallucinogen users each day ( Table A.3A ).39 The number of past year initiates of hallucinogen use remained stable among this population between 2015 and 2019.

Initiation of Inhalant Use

Initiation of Prescription Stimulant Misuse

Initiation of Prescription Tranquilizer or Sedative Misuse

Although this report includes combined estimates for the past year misuse of prescription tranquilizers or sedatives, estimates for the initiation of misuse of these substances are presented separately in this section. As noted previously, it cannot be determined unambiguously whether respondents were past year initiates for the aggregate category of any tranquilizer or sedative misuse because of the potential for respondents to underreport the misuse of prescription drugs that occurred more than 12 months ago.

Initiation of Prescription Tranquilizer Misuse

Initiation of Prescription Sedative Misuse

Among people aged 12 or older, the number of past year initiates of prescription sedative misuse declined from 425,000 people in 2015 to 239,000 people in 2019 ( Figure 26 and 2019 DT 7.40 ). This number in 2019 was lower than the number in 2015, but it was similar to the numbers in 2016 to 2018. The number of people aged 12 or older in 2019 who initiated prescription sedative misuse in the past year averaged to about 650 people each day ( Table A.3A ). However, caution is advised in interpreting changes in the numbers of initiates of prescription sedative misuse in single years. The relatively small numbers of recent initiates per year can contribute to these fluctuations, especially when the estimated numbers are presented for specific age groups, described as follows.40

Initiation of Prescription Pain Reliever Misuse

Perceived Risk from Substance Use

One factor that can influence whether people will use tobacco, alcohol, or illicit drugs is the extent to which they believe that using these substances might cause harm. In 2019, NSDUH respondents were asked how much they thought people risk harming themselves physically and in other ways when they use various substances in certain amounts or frequencies. Response choices for these items were "great risk," "moderate risk," "slight risk," or "no risk." Depending on the substance, respondents were asked about their perceived risk of harm from using a substance daily or using a substance once or twice a week (i.e., weekly use).

Among people aged 12 or older, the percentage who perceived great risk of harm from smoking marijuana once or twice a week declined from 36.3 percent in 2015 to 29.2 percent in 2019 ( Figure 33 and 2019 DT 7.33). This percentage in 2019 was lower than the percentage in each year from 2015 through 2018.

Among people aged 12 or older from 2015 to 2019, percentages who perceived great risk of harm from substance use also declined slightly for weekly cocaine use (from 87.4 to 85.7 percent) and for smoking one or more packs of cigarettes per day (from 72.8 to 71.2 percent) ( Figure 33 and 2019 DT 7.33). The percentage who perceived great risk of harm from weekly heroin use ranged from 93.8 percent in 2019 to 94.5 percent in 2017.

Among people aged 12 or older, the percentages who perceived great risk of harm from having four or five drinks of alcohol nearly every day ranged from 67.9 percent in 2019 to 68.9 percent in 2017 ( Figure 33 and 2019 DT 7.33). For brevity, this level of alcohol consumption on a single day is subsequently referred to as "daily binge drinking."19

Perceived Risk from Substance Use among Adolescents

Among adolescents aged 12 to 17, perceived great risk of harm from smoking marijuana weekly declined from 40.6 percent in 2015 to 34.6 percent in 2019 ( Figure 34 and 2019 DT 7.34). Adolescents' perceptions of great risk of harm from substance use also declined slightly from 2015 to 2019 for smoking one or more packs of cigarettes per day (from 68.2 to 65.0 percent) and weekly cocaine use (from 80.2 to 78.7 percent). In addition, the perceived great risk of harm declined slightly from 2016 to 2019 for daily binge drinking (from 65.5 to 63.5 percent) and weekly heroin use (from 83.4 to 82.1 percent).

Perceived Risk from Substance Use among Young Adults

Among young adults aged 18 to 25, perceived great risk of harm from smoking marijuana weekly declined from 19.1 percent in 2015 to 15.0 percent in 2019 ( Figure 35 and 2019 DT 7.36). Perceptions of great risk of harm from substance use among young adults declined slightly from 2015 to 2019 for smoking one or more packs of cigarettes per day (from 68.0 to 66.2 percent), weekly cocaine use (from 84.3 to 82.6 percent), and weekly heroin use (from 94.0 to 93.3 percent). However, the perceived great risk of harm from daily binge drinking remained stable between 2015 (62.1 percent) and 2019 (62.4 percent).

Perceived Risk from Substance Use among Adults Aged 26 or Older

Among adults aged 26 or older between 2015 and 2019, perceived great risk of harm from smoking marijuana weekly declined from 38.7 percent in 2015 to 30.8 percent in 2019 ( Figure 36 and 2019 DT 7.37). Perceptions of great risk of harm among adults aged 26 or older declined slightly from 2015 to 2019 for daily binge drinking (from 70.4 to 69.3 percent), smoking one or more packs of cigarettes per day (from 74.2 to 72.7 percent), and weekly cocaine use (from 88.8 to 86.9 percent). In addition, the perceived great risk of harm from weekly heroin use among this population declined slightly from 2017 (95.8 percent) to 2019 (95.2 percent).

Age Comparisons for Perceived Risk from Substance Use

In 2019, perceptions of great risk of harm from substance use varied by substance and age. For example, adults aged 26 or older were more likely than adolescents aged 12 to 17 or young adults aged 18 to 25 to perceive great risk of harm from smoking one or more packs of cigarettes per day ( Figures 34 , 35 , and 36 and 2019 DT 7.34, 7.36, and 7.37).

Moreover, young adults aged 18 to 25 were less likely than adolescents aged 12 to 17 or adults aged 26 or older to perceive great risk of harm from smoking marijuana weekly ( Figures 34 , 35 , and 36 and 2019 DT 7.34, 7.36, and 7.37). Recent research has identified associations among adults between decreases in perceptions of great risk of harm from smoking marijuana weekly and increases in marijuana use.42,43 Nevertheless, people can experience adverse effects from marijuana use, such as marijuana use disorder or injury resulting from operating a motor vehicle while impaired by marijuana.44,45 Therefore, it is necessary to educate young adults about adverse effects of marijuana use.

Finally, adolescents aged 12 to 17 were less likely than young adults aged 18 to 25 or adults aged 26 or older to perceive great risk from using heroin or cocaine weekly ( Figures 34 , 35 , and 36 and 2019 DT 7.34, 7.36, and 7.37). Additional data on finer age group categories that can be found in the 2019 detailed tables (available at https://www.samhsa.gov/data/) indicate that the lower likelihood of adolescents than adults to perceive great risk of harm from cocaine and heroin use may be attributable to a general lack of knowledge about these substances among adolescents because younger adolescents aged 12 or 13 tended to have lower perceptions of the risk of harm compared with older adolescents or adults. Thus, age-specific communications are imperative from a public health perspective to help people fully understand important harms associated with the use of specific substances.

Substance Use Disorders in the Past Year

Substance use disorders (SUDs) are characterized by impairment caused by the recurrent use of alcohol or other drugs (or both), including health problems, disability, and failure to meet major responsibilities at work, school, or home. The 2019 NSDUH included a series of questions to estimate the percentage of the population aged 12 or older who had at least one SUD in the past 12 months (subsequently referred to as "an SUD" or "a past year SUD," except when "SUDs" refer to more than one substance, such as SUDs for the misuse of specific prescription drugs). The SUD questions classify people as having an SUD in the past 12 months based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).46,47 Respondents were asked SUD questions if they previously reported use of alcohol or illicit drugs in the past 12 months. Illicit drugs include the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, and methamphetamine, as well as the misuse of prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines), and pain relievers.

Alcohol Use Disorder

Alcohol use disorder was defined as meeting DSM-IV criteria for either dependence or abuse for alcohol. Respondents who used alcohol on 6 or more days in the past 12 months were classified as having dependence if they met three or more of the seven dependence criteria and as having abuse if they did not meet the criteria for alcohol dependence but met one or more of the four abuse criteria. Relevant definitions for alcohol use disorder can be found in a glossary of key definitions for the 2019 NSDUH.8

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Illicit Drug Use Disorder

This section presents overall estimates for illicit drug use disorder, then provides SUD estimates for selected specific illicit drugs. Illicit drug use disorder was defined as meeting DSM-IV criteria for either dependence or abuse for one or more of the following illicit drugs: marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, or prescription psychotherapeutic drugs that were misused (i.e., stimulants, tranquilizers or sedatives, and pain relievers).48 Respondents were classified as having an opioid use disorder if they met DSM-IV criteria for heroin use disorder or pain reliever use disorder (or both). Relevant definitions for SUDs for specific illicit drugs can be found in a glossary of key definitions for the 2019 NSDUH.8

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Marijuana Use Disorder

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Cocaine Use Disorder

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Heroin Use Disorder

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Methamphetamine Use Disorder

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Prescription Stimulant Use Disorder

Among people aged 12 or older, the percentage with a past year prescription stimulant use disorder remained stable between 2015 and 2019 ( 2019 DT 7.46 ). Among this population in 2019, 0.2 percent (or 558,000 people) had a prescription stimulant use disorder in the past year.

Aged 12 to 17

Among adolescents aged 12 to 17, the percentage with a past year prescription stimulant use disorder remained stable between 2015 and 2019 ( 2019 DT 7.47 ). In 2019, 0.3 percent of adolescents (or 66,000 people) had a prescription stimulant use disorder in the past year.

Aged 18 to 25

Among young adults aged 18 to 25, the percentage with a past year prescription stimulant use disorder remained stable between 2015 and 2019 ( 2019 DT 7.49 ). In 2019, 0.6 percent of young adults (or 188,000 people) had a prescription stimulant use disorder in the past year.

Aged 26 or Older

Among adults aged 26 or older, the percentage with a past year prescription stimulant use disorder remained stable between 2015 and 2019 ( 2019 DT 7.50 ). In 2019, 0.1 percent of adults aged 26 or older (or 303,000 people) had a prescription stimulant use disorder in the past year.

Prescription Tranquilizer or Sedative Use Disorder

Among people aged 12 or older, the percentage with a past year prescription tranquilizer or sedative use disorder remained stable between 2015 and 2019 ( 2019 DT 7.46 ). Among this population in 2019, 0.2 percent (or 681,000 people) had a prescription tranquilizer or sedative use disorder in the past year.

Aged 12 to 17

Among adolescents aged 12 to 17, the percentage with a past year prescription tranquilizer or sedative use disorder remained stable between 2015 and 2019 ( 2019 DT 7.47 ). In 2019, 0.4 percent of adolescents (or 96,000 people) had a prescription tranquilizer or sedative use disorder in the past year.

Aged 18 to 25

Among young adults aged 18 to 25 in 2019, 0.5 percent (or 161,000 people) had a prescription tranquilizer or sedative use disorder in the past year ( 2019 DT 7.49 ). These estimates in 2019 were lower than the estimates in 2015 and 2017, but they were similar to the estimates in 2016 and 2018.

Aged 26 or Older

Among adults aged 26 or older, the percentage with a past year prescription tranquilizer or sedative use disorder remained stable between 2015 and 2019 ( 2019 DT 7.50 ). In 2019, 0.2 percent of adults aged 26 or older (or 424,000 people) had a prescription tranquilizer or sedative use disorder in the past year.

Prescription Pain Reliever Use Disorder

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Opioid Use Disorder

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Substance Use Disorder (Alcohol or Illicit Drugs)

Aged 12 to 17

Aged 18 to 25

Aged 26 or Older

Major Depressive Episode in the Past Year

In the 2019 NSDUH, respondents were classified as having had a major depressive episode (MDE) in the past 12 months if (1) they had at least one period of 2 weeks or longer in the past year when for most of the day nearly every day, they felt depressed, or lost interest or pleasure in daily activities; and (2) they also had problems with sleeping, eating, energy, concentration, self-worth, or having recurrent thoughts of death or recurrent suicidal ideation. The MDE questions are based on diagnostic criteria from DSM-5, which require the presence of five or more symptoms during the same 2-week period.49 Wordings for some depression questions asked of adolescent respondents aged 12 to 17 differed from wordings for similar questions asked of adult respondents aged 18 or older. Therefore, the MDE estimates for adults and youths are not directly comparable and are presented separately.50,51

The 2019 NSDUH also collected data on whether an MDE in the past year caused respondents to experience severe impairment in four major life activities or role domains. These domains were defined separately for youths aged 12 to 17 and adults aged 18 or older to reflect the different roles associated with the two age groups. Adolescents were classified as having an MDE with severe impairment if their depression caused severe problems with their ability to do chores at home, do well at work or school, get along with their family, or have a social life.52 Adults were classified as having an MDE with severe impairment if their depression caused severe problems with their ability to manage at home or work, have relationships with others, or have a social life.53

MDE and MDE with Severe Impairment among Adolescents

Among adolescents aged 12 to 17, the percentage with a past year MDE increased from 9.0 percent (or 2.2 million people) in 2004 to 15.7 percent (or 3.8 million people) in 2019 ( Figure 48 and 2019 DT 11.2). These estimates in 2019 were higher than the estimates in each year from 2004 through 2018.

N/A = not available.
⁺ Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.

Among adolescents aged 12 to 17, the percentage who had a past year MDE with severe impairment increased from 5.5 percent (or 1.4 million people) in 2006 to 11.1 percent (or 2.7 million people) in 2019 ( Figure 48 and 2019 DT 11.3). These estimates in 2019 were higher than the estimates in each year from 2006 through 2018.

These increasing trends in the prevalence of MDE and MDE with severe impairment among adolescents are consistent with the increasing trend in suicide attempts and deaths by suicide among adolescents.54,55 These trends for MDE, MDE with severe impairment, and suicidal behaviors among adolescents are major public health concerns in the United States.56,57 These trends also suggest the importance of depression care and suicide prevention among this population.

MDE and MDE with Severe Impairment among Adults

Among adults aged 18 or older, the percentage with a past year MDE increased from 6.6 percent (or 14.2 million people) in 2005 to 7.8 percent (or 19.4 million people) in 2019 ( Figure 49 and 2019 DT 10.32). These estimates in 2019 were higher than the estimates in each year from 2005 through 2018.

Among adults aged 18 or older, the percentage who had a past year MDE with severe impairment increased from 4.0 percent (or 8.9 million people) in 2009 to 5.3 percent (or 13.1 million people) in 2019 ( Figure 50 and 2019 DT 10.33). These estimates in 2019 were higher than the estimates in each year from 2009 through 2018.

The increasing national trends in the prevalence of MDE and MDE with severe impairment among adults are consistent with the significant increase in deaths by suicide among U.S. adults from 2006 through 2018.58 These increases in the prevalence of both MDE and suicides among the adult population have become major public health concerns in the United States.

Aged 18 to 25

Among young adults aged 18 to 25, the percentage with a past year MDE increased from 8.8 percent (or 2.8 million people) in 2005 to 15.2 percent (or 5.0 million people) in 2019 ( Figure 49 and 2019 DT 10.32). These estimates in 2019 were higher than the estimates in each year from 2005 through 2018.

Among young adults aged 18 to 25, the percentage who had a past year MDE with severe impairment increased from 5.2 percent (or 1.7 million people) in 2009 to 10.3 percent (or 3.4 million people) in 2019 ( Figure 50 and 2019 DT 10.33). These estimates in 2019 were higher than the estimates in each year from 2009 through 2018.

Aged 26 to 49

Among adults aged 26 to 49, the percentage with a past year MDE increased from 7.6 percent (or 7.5 million people) in 2005 to 8.9 percent (or 8.9 million people) in 2019 ( Figure 49 and 2019 DT 10.32). These estimates in 2019 were higher than the estimates in each year from 2005 through 2018.

Among adults aged 26 to 49, the percentage who had a past year MDE with severe impairment increased from 4.8 percent (or 4.8 million people) in 2009 to 6.1 percent (or 6.1 million people) in 2019 ( Figure 50 and 2019 DT 10.33). These estimates in 2019 were higher than the estimates in each year from 2009 through 2018.

Aged 50 or Older

Among adults aged 50 or older, the percentage with a past year MDE was stable from 2005 (4.5 percent) to 2019 (4.7 percent) ( Figure 49 and 2019 DT 10.32). In 2019, 5.4 million adults aged 50 or older had a past year MDE.

Among adults aged 50 or older in 2019, 3.2 percent (or 3.6 million people) had a past year MDE with severe impairment ( Figure 50 and 2019 DT 10.33). These estimates in 2019 were similar to the estimates in most years from 2009 to 2018.

Any Mental Illness among Adults in the Past Year

The 2019 NSDUH provided estimates of any mental illness (AMI) and serious mental illness (SMI) for adults aged 18 or older. Adults aged 18 or older were classified as having AMI if they had any mental, behavioral, or emotional disorder in the past year of sufficient duration to meet DSM-IV criteria (excluding developmental disorders and SUDs).46 Adults who were classified as having AMI were classified as having SMI if they had any mental, behavioral, or emotional disorder that substantially interfered with or limited one or more major life activities. Statistical prediction models that were developed using clinical interview data from a subset of NSDUH adult respondents in 2008 to 2012 were used to classify whether respondents in the 2008 to 2019 adult samples had AMI or SMI in the past year.59

Among adults aged 18 or older, the percentage with past year AMI increased from 17.7 percent (or 39.8 million people) in 2008 to 20.6 percent (or 51.5 million people) in 2019 ( Figure 51 and 2019 DT 10.1). These estimates in 2019 were higher than the estimates in each year from 2008 through 2018.

Aged 18 to 25

Among young adults aged 18 to 25, the percentage with past year AMI increased from 18.5 percent (or 6.1 million people) in 2008 to 29.4 percent (or 9.9 million people) in 2019 ( Figure 51 and 2019 DT 10.1). These estimates in 2019 were higher than the estimates in each year from 2008 through 2018.

Aged 26 to 49

Among adults aged 26 to 49, the percentage with past year AMI increased from 20.7 percent (or 20.7 million people) in 2008 to 25.0 percent (or 25.3 million people) in 2019 ( Figure 51 and 2019 DT 10.1). These estimates in 2019 were higher than the estimates in each year from 2008 through 2018.

Aged 50 or Older

Among adults aged 50 or older in 2019, 14.1 percent (or 16.3 million people) had AMI in the past year ( Figure 51 and 2019 DT 10.1). This percentage in 2019 was similar to the percentages in most years from 2008 through 2018.

Serious Mental Illness among Adults in the Past Year

Aged 18 to 25

Among young adults aged 18 to 25, the percentage with past year SMI increased from 3.8 percent (or 1.2 million people) in 2008 to 8.6 percent (or 2.9 million people) in 2019 ( Figure 52 and 2019 DT 10.3). These estimates in 2019 were higher than the estimates in each year from 2008 through 2018.

Aged 26 to 49

Among adults aged 26 to 49, the percentage with past year SMI increased from 4.8 percent (or 4.8 million people) in 2008 to 6.8 percent (or 6.8 million people) in 2019 ( Figure 52 and 2019 DT 10.3). These estimates in 2019 were higher than the estimates in each year from 2008 through 2018.

Aged 50 or Older

Among adults aged 50 or older in 2019, 2.9 percent (or 3.4 million people) had SMI in the past year ( Figure 52 and 2019 DT 10.3). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Co-Occurring MDE and SUD among Adolescents

Adolescents aged 12 to 17 who had both a past year MDE and a past year SUD (i.e., illicit drug use disorder, alcohol use disorder, or both) were classified as having co-occurring MDE and SUD. The order of the onset of an SUD relative to the onset of an MDE among adolescents cannot be established based on the NSDUH data (e.g., whether the onset of an SUD preceded the onset of an MDE, or vice versa).

In addition, among adolescents aged 12 to 17 in 2019, 1.4 percent (or 332,000 people) had both an MDE with severe impairment and an SUD in the past year ( Figure 54 and 2019 DT 11.12). These estimates in 2019 were similar to the estimates in each year from 2015 through 2018.

Substance Use among Adolescents with MDE

Adolescents aged 12 to 17 who had a past year MDE were more likely to use substances compared with their counterparts who did not have an MDE in the past year. In 2019, adolescents with a past year MDE were more likely than adolescents without a past year MDE to be past year illicit drug users (31.9 vs. 14.4 percent), past year marijuana users (24.6 vs. 11.1 percent), or past year opioid misusers (i.e., heroin users or misusers of prescription pain relievers) (4.2 vs. 1.8 percent) ( Figure 55 ). Adolescents with a past year MDE also were more likely than those without a past year MDE to be past month binge alcohol users (8.9 vs. 4.1 percent) or past month cigarette users (4.4 vs. 1.8 percent).

Figure 55. Substance Use among Youths Aged 12 to 17, by Past Year Major Depressive Episode (MDE) Status: 2019

D

⁺ Difference between this estimate and the estimate for youths without MDE is statistically significant at the .05 level.
Note: Youth respondents with unknown MDE data were excluded.

Co-Occurring Mental Health Issues and SUD among Adults

Among adults aged 18 or older, having AMI and an SUD in the past year is referred to as having co-occurring AMI and SUD. Adults having SMI and an SUD in the past year are referred to as having co-occurring SMI and SUD. However, the order of the onset of SUDs relative to the onset of mental disorders cannot be established based on the NSDUH data for adults (e.g., whether the onset of SUDs preceded the onset of mental disorders, or vice versa).

Co-Occurring AMI and SUD

Among adults aged 18 or older, the percentage with both AMI and an SUD increased from 3.3 percent (or 8.1 million people) in 2015 to 3.8 percent (or 9.5 million people) in 2019 ( Figure 57 and 2019 DT 10.6). These estimates in 2019 were higher than the estimates in 2015 to 2017, but they were similar to the estimates in 2018.

Among young adults aged 18 to 25, the percentage with both AMI and an SUD increased from 5.9 percent (or 2.1 million people) in 2015 to 7.6 percent (or 2.6 million people) in 2019 ( Figure 57 and 2019 DT 10.6). This percentage in 2019 was higher than the percentages in 2015 to 2017, but it was similar to the percentage in 2018.

Among adults aged 26 to 49, the percentage with both AMI and an SUD increased from 4.3 percent (or 4.3 million people) in 2015 to 5.2 percent (or 5.2 million people) in 2019 (2019 DT 10.6). These estimates in 2019 were higher than the estimates in 2015 to 2017, but they were similar to the estimates in 2018.

Among adults aged 50 or older in 2019, 1.5 percent (or 1.7 million people) had both AMI and an SUD in the past year (2019 DT 10.6). The percentage with both AMI and an SUD remained stable among this population between 2015 and 2019.

Co-Occurring SMI and SUD

Among adults aged 18 or older, the percentage with both SMI and an SUD increased from 1.0 percent (or 2.3 million people) in 2015 to 1.4 percent (or 3.6 million people) in 2019 ( Figure 57 and 2019 DT 10.6). The percentage in 2019 was higher than the percentages in 2015 and 2016, but it was similar to the percentages in 2017 and 2018.

Among young adults aged 18 to 25, the percentage with both SMI and an SUD increased from 1.7 percent (or 593,000 people) in 2015 to 2.8 percent (or 958,000 people) in 2019 ( Figure 57 and 2019 DT 10.6). These estimates in 2019 were higher than the estimates in 2015 and 2016, but they were similar to the estimates in 2017 and 2018.

Among adults aged 26 to 49, the percentage with both SMI and an SUD increased from 1.3 percent (or 1.3 million people) in 2015 to 2.0 percent (or 2.0 million people) in 2019 (2019 DT 10.6). These estimates in 2019 were higher than the estimates in 2015 to 2017, but they were similar to the estimates in 2018.

Among adults aged 50 or older in 2019, 0.5 percent (or 607,000 people) had both SMI and an SUD in the past year (2019 DT 10.6). The percentage with both SMI and an SUD remained stable among this population between 2015 and 2019.

Substance Use among Adults, by Mental Illness Status

This section discusses how the prevalence of substance use among adults aged 18 or older differed based on past year mental illness status. Among adults aged 18 or older in 2019, those with past year SMI or AMI were more likely than those without mental illness in the past year to be past year users of illicit drugs (49.4 percent for SMI and 38.8 percent for AMI vs. 16.6 percent for adults with no mental illness), past year users of marijuana (39.8 and 32.5 percent vs. 14.2 percent), or past year misusers of opioids (i.e., heroin users or misusers of prescription pain relievers) (13.8 and 8.8 percent vs. 2.5 percent) ( Figure 59 and 2019 DT 8.42). In addition, adults with SMI or AMI were more likely than adults with no past year mental illness to be past month binge alcohol users (32.7 and 30.9 percent vs. 24.5 percent) or past month cigarette smokers (33.0 and 27.2 percent vs. 15.8 percent).

Suicidal Thoughts and Behavior among Adults

Death by suicide is an important public health problem in the United States and a tragedy for all involved-the people and their families, friends, neighbors, colleagues, and communities. In 2018, 48,344 people in the United States died by suicide, including 46,510 adults aged 18 or older.60 Moreover, suicide rates increased in most states between 1999 and 2016, including increases by more than 30 percent in 25 states over this period.61 Furthermore, suicide rates continued to increase nationally from 2016 to 2018.62,63 However, people who die by suicide represent a fraction of those who consider or attempt suicide.64 Out of every 31 adults in 2008 to 2011 in the United States who attempted suicide in the past 12 months, there was 1 death by suicide.65

Since 2008, NSDUH respondents aged 18 or older have been asked if at any time during the past 12 months they had thought seriously about trying to kill themselves (serious thoughts of suicide). Adults who had serious thoughts of suicide in the past 12 months were asked whether they made a plan to kill themselves (suicide plan) or tried to kill themselves (suicide attempt) in that period. This information helps guide suicide prevention programs and clinical intervention efforts.

Among adults aged 18 or older in 2019, 4.8 percent (or 12.0 million people) thought seriously about trying to kill themselves in the past year ( Figures 60 and 61 and 2019 DT 10.36), 1.4 percent (or 3.5 million people) made a suicide plan ( Figure 62 and 2019 DT 10.39), 0.6 percent (or 1.4 million people) made a nonfatal suicide attempt ( Figure 63 and 2019 DT 10.41), and 0.1 percent (or 217,000 people) attempted suicide without a suicide plan.21

Had Serious Thoughts of Suicide

Among adults aged 18 or older, the percentage who had serious thoughts of suicide in the past year increased from 3.7 percent (or 8.3 million people) in 2008 to 4.8 percent (or 12.0 million people) in 2019 ( Figure 61 and 2019 DT 10.36). These estimates in 2019 were higher than the estimates in each year from 2008 through 2018.

Aged 18 to 25

Among young adults aged 18 to 25, the percentage who had serious thoughts of suicide in the past year increased from 6.8 percent (or 2.2 million people) in 2008 to 11.8 percent (or 3.9 million people) in 2019 ( Figure 61 and 2019 DT 10.36). These estimates in 2019 were higher than the estimates in 2008 through 2017, but they were similar to the estimates in 2018.

Aged 26 to 49

Among adults aged 26 to 49, the percentage who had serious thoughts of suicide in the past year increased from 4.0 percent (or 4.0 million people) in 2008 to 5.3 percent (or 5.3 million people) in 2019 ( Figure 61 and 2019 DT 10.36). These estimates in 2019 were higher than the estimates in each year from 2008 through 2018.

Aged 50 or Older

Among adults aged 50 or older in 2019, 2.4 percent (or 2.7 million people) had serious thoughts of suicide in the past year ( Figure 61 and 2019 DT 10.36). The percentage who had serious thoughts of suicide in the past year remained stable among this population between 2008 and 2019.

Made a Suicide Plan

Among adults aged 18 or older, the percentage who made a suicide plan in the past year increased from 1.0 percent (or 2.3 million people) in 2008 to 1.4 percent (or 3.5 million people) in 2019 ( Figure 62 and 2019 DT 10.39). These estimates in 2019 were higher than the estimates in each year from 2008 through 2016, but they were similar to the estimates in 2017 and 2018.

Aged 18 to 25

Among young adults aged 18 to 25, the percentage who made a suicide plan in the past year increased from 2.0 percent in 2008 (or 643,000 people) to 3.9 percent (or 1.3 million people) in 2019 ( Figure 62 and 2019 DT 10.39). These estimates in 2019 were higher than the estimates in each year from 2008 through 2016, but they were similar to the estimates in 2017 and 2018.

Aged 26 to 49

Among adults aged 26 to 49, the percentage who made a suicide plan in the past year increased from 1.1 percent (or 1.1 million people) in 2008 to 1.5 percent (or 1.5 million people) in 2019 ( Figure 62 and 2019 DT 10.39). These estimates in 2019 were higher than the estimates in most years from 2008 through 2015, but they were similar to the estimates in 2016 to 2018.

Aged 50 or Older

Among adults aged 50 or older in 2019, 0.6 percent (or 676,000 people) made a suicide plan in the past year ( Figure 62 and 2019 DT 10.39). The percentage who made a suicide plan in the past year remained stable among this population between 2008 and 2019.

Attempted Suicide

Among adults aged 18 or older in 2019, 0.6 percent (or 1.4 million people) attempted suicide in the past year ( Figure 63 and 2019 DT 10.41). The percentage of adults aged 18 or older in 2019 who attempted suicide in the past year did not differ from the percentage in each year from 2008 through 2018.

Aged 18 to 25

Among young adults aged 18 to 25, the percentage who attempted suicide in the past year increased from 1.2 percent (or 395,000 people) in 2008 to 1.8 percent (or 604,000 people) in 2019 ( Figure 63 and 2019 DT 10.41). These estimates in 2019 were higher than the estimates in most years from 2008 through 2014, but they were similar to the estimates in 2015 to 2018.

Aged 26 to 49

Among adults aged 26 to 49 in 2019, 0.6 percent (or 579,000 people) attempted suicide in the past 12 months ( Figure 63 and 2019 DT 10.41). The percentage in 2019 who attempted suicide in the past year was similar to the percentages in most years from 2008 to 2018.

Aged 50 or Older

Among adults aged 50 or older in 2019, 0.2 percent (or 195,000 people) attempted suicide in the past 12 months ( Figure 63 and 2019 DT 10.41). The percentage who attempted suicide in the past year remained stable among this population between 2008 and 2019.

Substance Use Treatment in the Past Year

Substance use treatment is intended to help people address problems associated with their use of alcohol or illicit drugs (i.e., not counting tobacco use), including medical problems associated with the use of alcohol or illicit drugs.66 The 2019 NSDUH provided two principal measures related to substance use treatment in the past year: (a) the need for substance use treatment and (b) the receipt of substance use treatment. The survey also collected information on the types of settings where people received treatment and issues associated with people needing substance use treatment but not receiving it.

Need for Substance Use Treatment

SAMHSA classifies people as having a need for substance use treatment if they had an SUD in the past year or if they received substance use treatment at a specialty facility67 in the past year.68,69

Among people aged 12 or older in 2019, 7.8 percent (or 21.6 million people) needed substance use treatment in the past year ( Figure 64 and 2019 DT 7.62). These estimates in 2019 were similar to the estimates in 2015 through 2018.

Aged 12 to 17

Among adolescents aged 12 to 17 in 2019, 4.6 percent (or 1.1 million people) needed substance use treatment in the past year ( Figure 64 and 2019 DT 7.62). These estimates in 2019 were similar to the estimates in 2015 to 2017, but they were higher than the estimates in 2018.

Aged 18 to 25

Among young adults aged 18 to 25 in 2019, 14.4 percent (or 4.8 million people) needed substance use treatment in the past year ( Figure 64 and 2019 DT 7.62). This percentage in 2019 was lower than the percentages in most years from 2015 to 2018.

Aged 26 or Older

Among adults aged 26 or older in 2019, 7.2 percent (or 15.6 million people) needed substance use treatment in the past year ( Figure 64 and 2019 DT 7.62). This percentage in 2019 was similar to the percentages in 2015 to 2018.

Receipt of Substance Use Treatment

NSDUH respondents who used alcohol or illicit drugs in their lifetime were asked whether they ever received substance use treatment, and those who received substance use treatment in their lifetime were asked whether they received treatment in the 12 months prior to the survey interview (i.e., in the past year). Receipt of any substance use treatment includes substance use treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or self-help group (e.g., Alcoholics Anonymous or Narcotics Anonymous).

The 2019 NSDUH also collected information on the receipt of substance use treatment at a specialty facility. Substance use treatment at a specialty facility is included in the estimates of any substance use treatment because a subset of the treatment locations was categorized as specialty facilities. Receipt of substance use treatment at a specialty facility was defined as substance use treatment received by a respondent at a hospital (only as an inpatient), a drug or alcohol rehabilitation facility (as an inpatient or outpatient), or a mental health center.

Receipt of Any Substance Use Treatment

Among people aged 12 or older in 2019, 1.5 percent (or 4.2 million people) received any substance use treatment in the past year ( Figure 65 and 2019 DT 7.51). This percentage in 2019 was similar to the percentage in each year from 2015 to 2018.

In 2019, 2.1 million people aged 12 or older received substance use treatment at a self-help group, 1.7 million received treatment at a rehabilitation facility as an outpatient, 1.3 million received treatment at a mental health center as an outpatient, 1.0 million received treatment at a rehabilitation facility as an inpatient, and 948,000 received treatment at a private doctor's office. Smaller numbers of people received treatment at a hospital as an inpatient, in an emergency room, or in a prison or jail ( Figure 66 and 2019 DT 7.55). The number of people who received substance use treatment at a private doctor's office increased from 686,000 people in 2015 to 948,000 people in 2019. Otherwise, these numbers in 2019 for locations where people received substance use treatment were similar to the numbers in each year from 2015 to 2018.

Aged 12 to 17

Among adolescents aged 12 to 17 in 2019, 0.7 percent (or 172,000 people) received any substance use treatment in the past year ( Figure 65 and 2019 DT 7.51). These estimates in 2019 were similar to the estimates in 2015 to 2018.

Aged 18 to 25

Among young adults aged 18 to 25 in 2019, 1.7 percent (or 578,000 people) received any substance use treatment in the past year ( Figure 65 and 2019 DT 7.51). These estimates in 2019 were similar to the estimates in 2015 to 2018.

Aged 26 or Older

Among adults aged 26 or older in 2019, 1.6 percent (3.4 million people) received any substance use treatment in the past year ( Figure 65 and 2019 DT 7.51). This percentage in 2019 was similar to the percentages in most years from 2015 to 2018.

Receipt of Any Substance Use Treatment among People Who Had a Past Year SUD

Among people aged 12 or older in 2019 who had a past year SUD, 10.3 percent (or 2.1 million people) received any substance use treatment in the past year ( Figure 67 and 2019 DT 7.56). These estimates in 2019 were similar to the estimates in each year from 2015 to 2018.

Aged 12 to 17

Among adolescents aged 12 to 17 in 2019 who had a past year SUD, 8.3 percent (or 93,000 people) received any substance use treatment in the past year ( Figure 67 and 2019 DT 7.56). These estimates in 2019 were similar to the estimates in each year from 2015 to 2018.

Aged 18 to 25

Among young adults aged 18 to 25 in 2019 who had a past year SUD, 8.7 percent (or 415,000 people) received any substance use treatment in the past year ( Figure 67 and 2019 DT 7.56). These estimates in 2019 were similar to the estimates in each year from 2015 to 2018.

Aged 26 or Older

Among adults aged 26 or older in 2019 who had a past year SUD, 11.0 percent (or 1.6 million people) received any substance use treatment in the past year ( Figure 67 and 2019 DT 7.56). These estimates in 2019 were similar to the estimates in each year from 2015 to 2018.

Receipt of Substance Use Treatment at a Specialty Facility

Among people aged 12 or older in 2019, 1.0 percent (or 2.6 million people) received substance use treatment at a specialty facility in the past year ( Figure 68 and 2019 DT 7.57). This percentage in 2019 was similar to the percentages in 2015 to 2018.

Aged 12 to 17

Among adolescents aged 12 to 17 in 2019, 0.3 percent (or 68,000 people) received substance use treatment at a specialty facility in the past year ( Figure 68 and 2019 DT 7.57). These estimates in 2019 were similar to the estimates in 2015 to 2018.

Aged 18 to 25

Among young adults aged 18 to 25 in 2019, 1.1 percent (or 357,000 people) received substance use treatment at a specialty facility in the past year ( Figure 68 and 2019 DT 7.57). These estimates in 2019 were similar to the estimates in 2015 to 2018.

Aged 26 or Older

Among adults aged 26 or older in 2019, 1.0 percent (or 2.2 million people) received substance use treatment at a specialty facility in the past year ( Figure 68 and 2019 DT 7.57). These estimates in 2019 were similar to the estimates in most years from 2015 to 2018.

Receipt of Substance Use Treatment at a Specialty Facility among People Who Needed Substance Use Treatment

Among the 21.6 million people aged 12 or older in 2019 who needed substance use treatment in the past year (2019 DT 7.62), 12.2 percent (or 2.6 million people) received substance use treatment at a specialty facility in the past year ( Figure 69 and 2019 DT 7.63). This percentage in 2019 was similar to the percentages in 2015 to 2018.

Aged 12 to 17

Among the 1.1 million adolescents aged 12 to 17 in 2019 who needed substance use treatment in the past year (2019 DT 7.62), 6.0 percent (or 68,000 people) received substance use treatment at a specialty facility in the past year ( Figure 69 and 2019 DT 7.63). These estimates in 2019 were similar to the estimates in 2015 to 2018.

Aged 18 to 25

Among the 4.8 million young adults aged 18 to 25 in 2019 who needed substance use treatment in the past year (2019 DT 7.62), 7.4 percent (or 357,000 people) received substance use treatment at a specialty facility in the past year ( Figure 69 and 2019 DT 7.63). These estimates in 2019 were similar to the estimates in 2015 to 2018.

Aged 26 or Older

Among the 15.6 million adults aged 26 or older in 2019 who needed substance use treatment in the past year (2019 DT 7.62), 14.2 percent (or 2.2 million people) received substance use treatment at a specialty facility in the past year ( Figure 69 and 2019 DT 7.63). This percentage in 2019 was similar to the percentages in 2015 to 2018.

Perceived Need for Substance Use Treatment

NSDUH respondents were classified as having a perceived need for substance use treatment (i.e., treatment for problems related to their use of alcohol or illicit drugs) if they indicated that they felt they needed substance use treatment in the past year. Respondents may have a perceived need for substance use treatment, regardless of whether they had an SUD in the past year. In this report, estimates for the perceived need for substance use treatment are discussed only for people aged 12 or older who were classified as having an SUD in the past year70 but did not receive substance use treatment at a specialty facility.68,69

Among the 18.9 million people aged 12 or older in 2019 with an SUD in the past year who did not receive treatment at a specialty facility, 95.7 percent (or 18.1 million people) did not feel that they needed treatment, 3.0 percent (or 577,000 people) felt that they needed treatment but did not make an effort to get treatment, and 1.2 percent (or 236,000 people) felt that they needed treatment and made an effort to get treatment ( Figure 70 and 2019 DT 7.66).71 Among people aged 12 or older in 2019 with a past year SUD who did not receive substance use treatment at a specialty facility, 4.3 percent perceived that they needed treatment.71 This percentage in 2019 was similar to the percentages in most years from 2015 to 2018.

Figure 70. Perceived Need for Substance Use Treatment among People Aged 12 or Older with a Past Year Substance Use Disorder (SUD) Who Did Not Receive Substance Use Treatment at a Specialty Facility in the Past Year: 2019

D

Note: People who had an SUD were classified as needing substance use treatment.
Note: The percentages do not add to 100 percent due to rounding.

Aged 12 to 17

Among the 1.1 million adolescents aged 12 to 17 in 2019 with an SUD in the past year who did not receive substance use treatment at a specialty facility (2019 DT 7.63), 98.5 percent (or 1.1 million people) did not feel that they needed treatment, 0.9 percent (or 10,000 people) felt that they needed treatment but did not make an effort to get treatment, and 0.6 percent (or 6,000 people) felt that they needed treatment and made an effort to get treatment (2019 DT 7.66). Among adolescents in 2019 with a past year SUD who did not receive substance use treatment at a specialty facility, 1.5 percent perceived that they needed treatment. This percentage in 2019 was similar to the percentages in 2015 to 2018.

Aged 18 to 25

Among the 4.5 million young adults aged 18 to 25 in 2019 with an SUD in the past year who did not receive substance use treatment at a specialty facility (2019 DT 7.63), 96.5 percent (or 4.3 million people) did not feel that they needed treatment, 2.6 percent (or 119,000 people) felt that they needed treatment but did not make an effort to get treatment, and 0.9 percent (or 40,000 people) felt that they needed treatment and made an effort to get treatment (2019 DT 7.66). Among young adults in 2019 with a past year SUD who did not receive substance use treatment at a specialty facility, 3.5 percent perceived that they needed treatment. This percentage in 2019 was similar to the percentages in 2015 to 2018.

Aged 26 or Older

Among the 13.4 million adults aged 26 or older in 2019 with an SUD in the past year who did not receive substance use treatment at a specialty facility (2019 DT 7.63), 95.2 percent (or 12.7 million people) did not feel that they needed treatment, 3.4 percent (or 448,000 people) felt that they needed treatment but did not make an effort to get treatment, and 1.4 percent (or 190,000 people) felt that they needed treatment and made an effort to get treatment (2019 DT 7.66). Among adults aged 26 or older in 2019 with a past year SUD who did not receive substance use treatment at a specialty facility, 4.8 percent perceived that they needed treatment. This percentage in 2019 was similar to the percentages in most years from 2015 to 2018.

Reasons for Not Receiving Substance Use Treatment

NSDUH respondents who did not receive substance use treatment in the past 12 months but felt they needed treatment were asked to report the reasons for not receiving treatment. As noted in the previous section, among people aged 12 or older in 2019 who were classified as having an SUD and did not receive substance use treatment at a specialty facility, only 4.3 percent perceived that they needed treatment (2019 DT 7.66). For people who perceived a need for treatment, information on common reasons for not receiving substance use treatment is important for identifying and addressing barriers to treatment receipt.

In 2019, common reasons for not receiving substance use treatment among people aged 12 or older with a past year SUD who did not receive treatment at a specialty facility and perceived a need for treatment were as follows: not being ready to stop using (39.9 percent), not knowing where to go for treatment (23.8 percent), and having no health care coverage and not being able to afford the cost of treatment (20.9 percent) ( 2019 DT 7.67 ). The percentage who did not receive substance use treatment at a specialty facility because they were not ready to stop using remained stable between 2015 and 2019. However, the percentage in 2019 for people who did not receive substance use treatment at a specialty facility because they did not know where to go for treatment was higher than the percentages in 2015 (12.5 percent) and 2017 (10.9 percent), but it was similar to the percentages in 2016 and 2018. The percentage in 2019 for people who did not receive treatment at a specialty facility because they had no health care coverage and could not afford the cost was lower than the percentage in 2018 (32.5 percent), but it was similar to the percentages in 2015 to 2017.

Medication-Assisted Treatment for Alcohol Use or Opioid Misuse

Questions were added to the 2019 NSDUH interview to assess the receipt of medication-assisted treatment (MAT) for problems with alcohol use or opioid misuse. NSDUH respondents aged 12 or older who reported receiving any treatment in the past year for problems related to their use of alcohol were asked to report whether a doctor or other health professional prescribed them medication in the past year to help reduce or stop their use of alcohol. Questions on MAT for opioid misuse were asked if respondents aged 12 or older reported ever using heroin or ever misusing prescription pain relievers and reported receiving any treatment in the past year for illicit drug use problems. These respondents were asked whether a doctor or other health professional prescribed them medication in the past year to help reduce or stop their use of heroin, misuse of prescription pain relievers, or both. Respondents also were informed that MAT for opioid misuse was different from medications given to stop a drug overdose.

Medication-Assisted Treatment for Alcohol Use

Medication-Assisted Treatment for Opioid Misuse

Mental Health Service Use in the Past Year

The 2019 NSDUH included questions to estimate the use of mental health services in the United States among the adolescent and adult populations. In addition to estimating the use of mental health services among the overall adolescent and adult populations, these questions allowed the estimation of the use of mental health services among adolescents and adults with mental health issues (i.e., MDE, AMI, and SMI).

Treatment for Depression among Adolescents

Adolescents aged 12 to 17 who had met the criteria for having a past year MDE were asked whether they had received treatment for their depression in the past year. Adolescents who reported seeing or talking to a health professional or taking prescribed medication for their depression were classified as having received treatment for their depression in the past year.72

Among adolescents aged 12 to 17 with a past year MDE, receipt of treatment for depression in the past year increased from 37.8 percent (or 822,000 people) in 2005 to 43.3 percent (or 1.6 million people) in 2019 ( Figure 71 and 2019 DT 11.4). This percentage in 2019 was higher than the percentages in most years from 2005 to 2015 but was similar to the percentages from 2016 to 2018.

Among adolescents aged 12 to 17 who had a past year MDE with severe impairment, receipt of treatment for depression in the past year increased from 43.9 percent (or 601,000 people) in 2007 to 49.7 percent (or 1.3 million people) in 2019 ( Figure 71 and 2019 DT 11.5). This percentage in 2019 was higher than the percentage in each year from 2007 to 2015 but was similar to the percentages from 2016 to 2018.

Treatment for Depression among Adults

Adults aged 18 or older who had met the criteria for having a past year MDE were asked whether they had received treatment for their depression in the past year. Treatment for depression in adults was defined as seeing or talking to a health professional or other professional or using prescription medication for depression in the past year.72

Among the 19.4 million adults aged 18 or older in 2019 who had a past year MDE, 66.3 percent (or 12.8 million people) received treatment for depression in the past year ( Figure 72 and 2019 DT 10.32 and 10.34). This percentage in 2019 was similar to the percentage in each year from 2009 through 2018.

Among the 13.1 million adults aged 18 or older in 2019 who had a past year MDE with severe impairment, 72.2 percent (or 9.5 million people) received treatment for depression in the past year (2019 DT 10.33 and 10.35 ). This percentage in 2019 was similar to the percentages in most years from 2009 through 2018.

Aged 18 to 25

Among the 5.0 million young adults aged 18 to 25 in 2019 who had a past year MDE, 50.9 percent (or 2.6 million people) received treatment for depression in the past year ( Figure 72 and 2019 DT 10.32 and 10.34). This percentage in 2019 was similar to the percentages in most years from 2009 through 2018.

Among the 3.4 million young adults aged 18 to 25 in 2019 who had a past year MDE with severe impairment, 56.4 percent (or 1.9 million people) received treatment for depression in the past year (2019 DT 10.33 and 10.35 ). This percentage in 2019 was similar to the percentages in most years from 2009 through 2018.

Aged 26 to 49

Among the 8.9 million adults aged 26 to 49 in 2019 who had a past year MDE, 68.9 percent (or 6.1 million people) received treatment for depression in the past year ( Figure 72 and 2019 DT 10.32 and 10.34). This percentage in 2019 was similar to the percentage in each year from 2009 to 2017, but it was higher than the percentage in 2018.

Among the 6.1 million adults aged 26 to 49 in 2019 who had a past year MDE with severe impairment, 74.4 percent (or 4.5 million people) received treatment for depression in the past year (2019 DT 10.33 and 10.35 ). This percentage in 2019 was similar to the percentage in each year from 2009 to 2017, but it was higher than the percentage in 2018.

Aged 50 or Older

Among the 5.4 million adults aged 50 or older in 2019 who had a past year MDE, 76.5 percent (or 4.1 million people) received treatment for depression in the past year ( Figure 72 and 2019 DT 10.32 and 10.34). This percentage in 2019 was similar to the percentage in each year from 2009 to 2018.

Among the 3.6 million adults aged 50 or older who had a past year MDE with severe impairment, 83.6 percent (or 3.0 million people) received treatment for depression in the past year (2019 DT 10.33 and 10.35 ). This percentage in 2019 was similar to the percentages in most years from 2009 to 2018.

Any Mental Health Service Use among Adolescents

In addition to asking adolescents aged 12 to 17 about treatment for depression, the 2019 NSDUH included questions for adolescents that asked about the receipt of any service for emotional or behavioral problems (i.e., not just depression) not caused by substance use. The youth mental health service utilization section of the interview asked respondents aged 12 to 17 whether they received any treatment or counseling within the 12 months prior to the interview for problems with emotions or behavior in the following settings: (a) specialty mental health settings,73 (b) education settings (talked with a school social worker, psychologist, or counselor about an emotional or behavioral problem; participated in a program for students with emotional or behavioral problems while in a regular school; or attended a school for students with emotional or behavioral problems), (c) general medical settings (care from a pediatrician or family physician for emotional or behavioral problems), (d) juvenile justice settings (services for an emotional or behavioral problem in a detention center, prison, or jail), or (e) child welfare settings (foster care or therapeutic foster care).74

The percentage of adolescents aged 12 to 17 who received mental health services in a specialty mental health setting (inpatient or outpatient care) in the past year increased from 11.8 percent (or 2.9 million people) in 2002 to 16.7 percent (or 4.1 million people) in 2019 ( Figure 73 and 2019 DT 11.1). This percentage in 2019 was higher than the percentage in each year from 2002 to 2017 but was similar to the percentage in 2018.

The percentage of adolescents aged 12 to 17 who received mental health services in an education setting in the past year increased from 12.1 percent (or 2.9 million people) in 2009 to 15.4 percent (or 3.7 million people) in 2019 ( Figure 73 and 2019 DT 11.1). This percentage in 2019 was higher than the percentage in each year from 2009 to 2018.

The percentage of adolescents aged 12 to 17 who received mental health services in a general medical setting in the past year increased from 2.7 percent (or 657,000 people) in 2002 to 3.7 percent (or 902,000 people) in 2019 ( Figure 73 and 2019 DT 11.1). This percentage in 2019 was higher than the percentages in most years from 2002 through 2018.

In contrast, the percentage of adolescents aged 12 to 17 who received mental health services in a child welfare setting in the past year decreased from 0.6 percent (or 157,000 people) in 2002 to 0.4 percent (or 97,000 people) in 2019 ( Figure 73 and 2019 DT 11.1). This percentage in 2019 was lower than the percentages in 2002 to 2004, but it was similar to the percentages from 2005 to 2018.

Also, the percentage of adolescents aged 12 to 17 who received mental health services in a juvenile justice setting in the past year decreased from 0.4 percent (or 109,000 people) in 2009 to 0.2 percent (or 49,000 people) in 2019 ( Figure 73 and 2019 DT 11.1). This percentage in 2019 was lower than the percentages from 2009 to 2012, but it was similar to the percentages from 2013 to 2018.

Any Mental Health Service Use among Adults

Adult respondents aged 18 or older were asked whether they received treatment or counseling for any problem with emotions, "nerves," or mental health in the past year in any inpatient or outpatient setting or if they used prescription medication in the past year for a mental or emotional condition. All adult respondents were asked these questions about their use of mental health services (i.e., not just those with mental illness). Respondents were asked not to include treatment for their use of alcohol or illicit drugs. Unlike the previously discussed questions about treatment for depression, general questions for the receipt of treatment or counseling for mental health issues among adults did not ask about treatment for a particular mental disorder. Consequently, references in this section to treatment or counseling for any problem with emotions, nerves, or mental health are described broadly as "mental health services" or "mental health care."

The percentage of adults aged 18 or older who received any mental health services in the past year increased from 13.0 percent (or 27.2 million people) in 2002 to 16.1 percent (or 40.2 million people) in 2019 ( Figure 74 and 2019 DT 10.7). These estimates in 2019 were higher than the estimates in each year from 2002 through 2018.

The percentage of adults aged 18 or older who received inpatient mental health services in the past year increased from 0.7 percent (or 1.5 million people) in 2002 to 1.0 percent (or 2.4 million people) in 2019 ( Figure 74 and 2019 DT 10.16). However, this percentage in 2019 was similar to the percentages in most years from 2003 to 2018.

The percentage of adults aged 18 or older who received outpatient mental health services in the past year increased from 7.4 percent (or 15.5 million people) in 2002 to 8.3 percent (or 20.6 million people) in 2019 ( Figure 74 and 2019 DT 10.16). These estimates in 2019 were higher than the estimates in most years from 2002 through 2018.

The percentage of adults aged 18 or older who received prescription medication in the past year for a mental health issue increased from 10.5 percent (or 22.0 million people) in 2002 to 13.1 percent (or 32.6 million people) in 2019 ( Figure 74 and 2019 DT 10.16). This percentage in 2019 was higher than the percentages in most years from 2002 through 2018.

Aged 18 to 25

Among young adults aged 18 to 25, the percentage who received mental health services in the past year increased from 10.5 percent (or 3.3 million people) in 2002 to 17.2 percent (or 5.8 million people) in 2019 (2019 DT 10.7). These estimates in 2019 were higher than the estimates in each year from 2002 through 2018. In 2019, 12.4 percent of young adults received prescription medication in the past year for a mental health issue, 10.3 percent received outpatient mental health services, and 1.7 percent received inpatient mental health services (2019 DT 10.16).

Both the percentage of young adults in 2019 who received prescription medication in the past year for a mental health issue and the percentage who received outpatient mental health services were higher than the corresponding percentages in each year from 2002 to 2018 (2019 DT 10.16). The percentage of young adults in 2019 who received inpatient mental health services in the past year was higher than the percentage in each year from 2002 to 2014, but it was similar to the percentages in 2015 to 2018.

Aged 26 to 49

Among adults aged 26 to 49, the percentage who received mental health services in the past year increased from 14.5 percent (or 14.5 million people) in 2002 to 17.8 percent (or 17.9 million people) in 2019 (2019 DT 10.7). These estimates in 2019 were higher than the estimates in each year from 2002 through 2018. In 2019, 14.3 percent of adults in this age group received prescription medication in the past year for a mental health issue, 9.8 percent received outpatient mental health services, and 0.9 percent received inpatient mental health services (2019 DT 10.16).

Both the percentage of adults aged 26 to 49 in 2019 who received prescription medication in the past year for a mental health issue and the percentage who received outpatient mental health services were higher than the corresponding percentages in each year from 2002 to 2018 (2019 DT 10.16). The percentage in 2019 who received inpatient mental health services in the past year was similar to the percentages in most years from 2002 through 2018.

Aged 50 or Older

Among adults aged 50 or older, the percentage who received mental health services in the past year increased from 12.0 percent (or 9.5 million people) in 2002 to 14.4 percent (or 16.5 million people) in 2019 (2019 DT 10.7). This percentage in 2019 was higher than the percentages in most years from 2002 through 2009, but it was similar to the percentages from 2010 through 2018. In 2019, 12.3 percent of adults in this age group received prescription medication in the past year for a mental health issue, 6.3 percent received outpatient mental health services, and 0.7 percent received inpatient mental health services (2019 DT 10.16).

The percentage of adults aged 50 or older in 2019 who received prescription medication in the past year for a mental health issue was higher than the percentages in 2002 to 2006, but it was similar to the percentages in most years from 2007 to 2018 (2019 DT 10.16). The percentage of adults in this age group in 2019 who received outpatient mental health services in the past year was similar to the percentages in most years from 2002 to 2018. The percentage of adults in this age group in 2019 who received inpatient mental health services was similar to the percentages from 2002 to 2018.

Any Mental Health Service Use among Adults with AMI

Among adults aged 18 or older with past year AMI, receipt of mental health services in the past year increased from 40.9 percent (or 16.2 million people) in 2008 to 44.8 percent (or 23.0 million people) in 2019 ( Figure 75 and 2019 DT 10.9). This percentage in 2019 was higher than the percentages in 2008 to 2012, but it was similar to the percentages in most years from 2013 through 2018.

Aged 18 to 25

Among young adults aged 18 to 25 with past year AMI, receipt of mental health services in the past year increased from 30.3 percent (or 1.8 million people) in 2008 to 38.9 percent (or 3.8 million people) in 2019 ( Figure 75 and 2019 DT 10.9). This percentage in 2019 was higher than the percentages in 2008 to 2016, but it was similar to the percentages in 2017 and 2018.

Aged 26 to 49

Among adults aged 26 to 49 with past year AMI, receipt of mental health services in the past year increased from 41.4 percent (or 8.6 million people) in 2008 to 45.4 percent (or 11.5 million people) in 2019 ( Figure 75 and 2019 DT 10.9). This percentage in 2019 was higher than the percentages in most years from 2008 to 2012, but it was similar to the percentages in 2013 to 2018.

Aged 50 or Older

Among the 16.3 million adults aged 50 or older in 2019 with past year AMI (2019 DT 10.1), 47.2 percent (or 7.7 million people) received mental health services in the past year ( Figure 75 and 2019 DT 10.9). This percentage in 2019 was similar to the percentages in most years from 2008 to 2018.

Any Mental Health Service Use among Adults with SMI

Among the 13.1 million adults aged 18 or older in 2019 with past year SMI (2019 DT 10.3), 65.5 percent (or 8.6 million people) received mental health services in the past year ( Figure 76 and 2019 DT 10.11). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Aged 18 to 25

Among young adults aged 18 to 25 in 2019 with past year SMI, receipt of mental health services in the past year increased from 45.9 percent (or 567,000 people) in 2008 to 56.4 percent (or 1.6 million people) in 2019 ( Figure 76 and 2019 DT 10.11). This percentage in 2019 was higher than the percentage in 2008, but it was similar to the percentages in most years from 2009 to 2018.

Aged 26 to 49

Among the 6.8 million adults aged 26 to 49 in 2019 with past year SMI (2019 DT 10.3), 65.1 percent (or 4.5 million people) received mental health services in the past year ( Figure 76 and 2019 DT 10.11). This percentage in 2019 was similar to the percentage in each year from 2008 to 2018.

Aged 50 or Older

Among the 3.4 million adults aged 50 or older in 2019 with past year SMI (2019 DT 10.3), 74.3 percent (or 2.5 million people) received mental health services in the past year ( Figure 76 and 2019 DT 10.11). This percentage in 2019 was similar to the percentage in each year from 2008 to 2018.

Perceived Unmet Need for Mental Health Services among Adults with Mental Illness

This section discusses estimates of the perceived unmet need for mental health services among adults aged 18 or older with past year AMI or SMI. The section also discusses the reasons adults with AMI or SMI did not receive these services in the past year if they had a perceived unmet need.

Perceived unmet need for mental health services among adults is estimated from a question that asked all adults aged 18 or older whether there was any time in the past 12 months when they thought they needed treatment or counseling for mental health issues but did not receive services. However, this section presents estimates of the perceived unmet need for mental health services among adults with AMI or SMI, regardless of whether they received mental health services in the past 12 months. Therefore, this measure for the perceived unmet need for mental health services includes adults with AMI or SMI who may have received some type of mental health service in the past 12 months but felt an unmet need for services before or after they received services.

Perceived Unmet Need for Mental Health Services among Adults with AMI

Among the 51.5 million adults aged 18 or older in 2019 with past year AMI (2019 DT 10.1), 26.0 percent (or 13.3 million people) perceived an unmet need for mental health services in the past year ( Figure 77 and 2019 DT 10.23). This percentage was higher than the percentage in each year from 2008 through 2018.

Among the 13.3 million adults aged 18 or older in 2019 with past year AMI and a perceived unmet need, 43.8 percent (or 5.8 million people) did not receive mental health services in the past year ( 2019 DT 10.25 ). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Aged 18 to 25

Among the 9.9 million young adults aged 18 to 25 in 2019 with past year AMI (2019 DT 10.1), 40.7 percent (or 4.0 million people) perceived an unmet need for mental health services in the past year ( Figure 77 and 2019 DT 10.23). This percentage in 2019 was higher than the percentage in each year from 2008 through 2018.

Among the 4.0 million young adults aged 18 to 25 in 2019 with past year AMI and a perceived unmet need, 53.1 percent (or 2.1 million people) did not receive mental health services in the past year ( 2019 DT 10.25 ). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Aged 26 to 49

Among the 25.3 million adults aged 26 to 49 in 2019 with past year AMI (2019 DT 10.1), 28.0 percent (or 7.0 million people) perceived an unmet need for mental health services in the past year ( Figure 77 and 2019 DT 10.23). This percentage in 2019 was higher than the percentage in each year from 2008 through 2018.

Among the 7.0 million adults aged 26 to 49 in 2019 with past year AMI and a perceived unmet need, 42.5 percent (or 3.0 million people) did not receive mental health services in the past year ( 2019 DT 10.25 ). This percentage in 2019 was similar to the percentages in most years from 2008 through 2018.

Aged 50 or Older

Among the 16.3 million adults aged 50 or older in 2019 with past year AMI (2019 DT 10.1), 13.9 percent (or 2.3 million people) perceived an unmet need for mental health services in the past year ( Figure 77 and 2019 DT 10.23). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Among the 2.3 million adults aged 50 or older in 2019 with past year AMI and a perceived unmet need, 31.1 percent (or 700,000 people) did not receive mental health services in the past year ( 2019 DT 10.25 ). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Perceived Unmet Need for Mental Health Services among Adults with SMI

Among the 13.1 million adults aged 18 or older in 2019 with past year SMI (2019 DT 10.3), 47.7 percent (or 6.2 million people) perceived an unmet need for mental health services in the past year ( Figure 78 and 2019 DT 10.23). This percentage in 2019 was higher than the percentages in most years from 2008 through 2018.

Among the 6.2 million adults aged 18 or older in 2019 with past year SMI and a perceived unmet need, 32.8 percent (or 2.0 million people) did not receive mental health services in the past year ( 2019 DT 10.26 ). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Aged 18 to 25

Among the 2.9 million young adults aged 18 to 25 in 2019 with past year SMI (2019 DT 10.3), 62.5 percent (or 1.8 million people) perceived an unmet need for mental health services in the past year ( Figure 78 and 2019 DT 10.23). This percentage in 2019 was higher than the percentages in most years from 2008 through 2018.

Among the 1.8 million young adults aged 18 to 25 in 2019 with past year SMI and a perceived unmet need, 43.2 percent (or 778,000 people) did not receive mental health services in the past year ( 2019 DT 10.26 ). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Aged 26 to 49

Among the 6.8 million adults aged 26 to 49 in 2019 with past year SMI (2019 DT 10.3), 47.6 percent (or 3.3 million people) perceived an unmet need for mental health services in the past year ( Figure 78 and 2019 DT 10.23). This percentage in 2019 was similar to the percentages in most years from 2008 through 2018.

Among the 3.3 million adults aged 26 to 49 in 2019 with past year SMI and a perceived unmet need, 31.9 percent (or 1.0 million people) did not receive mental health services in the past year ( 2019 DT 10.26 ). This percentage in 2019 was similar to the percentage in each year from 2008 through 2018.

Aged 50 or Older

Among the 3.4 million adults aged 50 or older in 2019 with past year SMI (2019 DT 10.3), 35.1 percent (or 1.2 million people) perceived an unmet need for mental health services in the past year ( Figure 78 and 2019 DT 10.23). This percentage in 2019 was similar to the percentages in most years from 2008 through 2018.

Reasons for Not Receiving Mental Health Services among Adults with Mental Illness and a Perceived Unmet Need

Receipt of Services for Co-Occurring Substance Use Disorder and Mental Health Issues

The relationship between SUDs and mental disorders is known to be bidirectional. The presence of a mental disorder may contribute to the development or exacerbation of an SUD. Likewise, the presence of an SUD may contribute to the development or exacerbation of a mental disorder. The combined presence of SUDs and mental disorders (hereafter referred to as co-occurring disorders) results in more profound functional impairment; worse treatment outcomes; higher morbidity and mortality; increased treatment costs; and higher risk for homelessness, incarceration, and suicide than if people had only one of these disorders but not both.75,76,77 Current treatment guidelines recommend that people with co-occurring disorders receive treatment for both disorders.78,79,80 This section presents estimates of the receipt of services among adolescents and adults with co-occurring SUD and mental health issues.

Receipt of Services among Adolescents with a Co-Occurring SUD and an MDE

Figure 79. Receipt of Substance Use Treatment at a Specialty Facility and Mental Health Services in the Past Year among Youths Aged 12 to 17 with Past Year Substance Use Disorder and Major Depressive Episode: 2015-2019

D

MH = mental health; SU Tx = substance use treatment.
⁺ Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.

Receipt of Services among Adults with a Co-Occurring SUD and AMI

Among adults aged 18 or older in 2019 who had a co-occurring SUD and AMI in the past year, 1.9 percent (or 182,000 people) received only substance use treatment at a specialty facility ( 2019 DT 10.27 ). This percentage in 2019 was lower than the percentages in 2015 and 2017 but was similar to the percentages in 2016 and 2018.

Aged 18 to 25

Among the 2.6 million young adults aged 18 to 25 in 2019 who had a co-occurring SUD and AMI in the past year (2019 DT 10.6), 43.3 percent (or 1.1 million people) received either substance use treatment at a specialty facility or mental health services in the past year, and 36.7 percent (or 941,000 people) received only mental health services ( 2019 DT 10.28 ). These percentages in 2019 were higher than the percentages in 2015, but they were similar to the percentages in 2016 to 2018.

Also among young adults aged 18 to 25 in 2019 who had a co-occurring SUD and AMI in the past year, 5.0 percent (or 130,000 people) received both substance use treatment at a specialty facility and mental health services, which was similar to the percentages in 2015 to 2018 ( 2019 DT 10.28 ). Among young adults in 2019 who had a co-occurring SUD and AMI in the past year, 1.4 percent (or 35,000 people) received only substance use treatment at a specialty facility. This percentage in 2019 was lower than the percentages in 2015 to 2017 but was similar to the percentage in 2018.

Aged 26 or Older

Receipt of Services among Adults with a Co-Occurring SUD and SMI

Aged 18 to 25

Among the 958,000 young adults aged 18 to 25 in 2019 who had a co-occurring SUD and SMI in the past year (2019 DT 10.6), 60.5 percent (or 577,000 people) received either substance use treatment at a specialty facility or mental health services in the past year, 7.0 percent (or 67,000 people) received both substance use treatment at a specialty facility and mental health services, and 2.0 percent (or 19,000 people) received only substance use treatment at a specialty facility ( 2019 DT 10.28 ). These percentages in 2019 were similar to the percentages in 2015 to 2018.

Also among young adults aged 18 to 25 in 2019 who had a co-occurring SUD and SMI in the past year, 51.4 percent (or 491,000 people) received only mental health services ( 2019 DT 10.28 ). This percentage in 2019 was higher than the percentage in 2015, but it was similar to the percentages in 2016 to 2018.

Aged 26 or Older

Perceived Recovery

Since 2018, respondents aged 18 or older have been asked whether they thought they ever had a problem with their use of alcohol or other drugs or whether they ever had a problem with their mental health. Respondents who reported that they ever had a problem with their alcohol or other drug use were asked whether they considered themselves (at the time they were interviewed) to be in recovery or to have recovered from their alcohol or other drug use problem. Similarly, respondents aged 18 or older who reported that they had a problem with their mental health were asked whether they considered themselves (at the time they were interviewed) to be in recovery or to have recovered from their mental health issue.

Aged 18 to 25

Aged 26 or Older

Endnotes

5 This report occasionally presents estimated numbers of people with a specific characteristic (e.g., estimated numbers of substance users). Some of these estimated numbers are not included in figures or tables in the report but may be found in the detailed tables for the 2019 NSDUH available at https://www.samhsa.gov/data/.

7 Overall response rates are not calculated for adolescents or adults because the screening response rate is not specific to age groups.

9 For methodological reasons, the 2019 NSDUH estimates are not comparable with NSDUH data collected prior to 2002. For more details, see Appendix C in the following report for the 2004 NSDUH: Office of Applied Studies. (2005). Results from the 2004 National Survey on Drug Use and Health: National findings (HHS Publication No. SMA 05-4062, NSDUH Series H-28). Rockville, MD: Substance Abuse and Mental Health Services Administration.

10 Estimates presented in this report have been weighted to reflect characteristics of the civilian, noninstitutionalized population aged 12 or older in the United States. The calculation of NSDUH weights for analysis includes a step that yields weights consistent with population totals obtained from the U.S. Census Bureau based on the most recently available decennial census.

13 Where trends in this report involve more than 4 years of data, the term "most years" is used when the 2019 estimate is either similar to or significantly different from the estimates in at least 60 percent of years referenced in the sentence.

14 Anomalous differences between 2 years of data usually "correct" themselves with 1 or 2 additional years of data. For estimates that started a new baseline in 2015, additional years of data also will be useful for monitoring whether the trends observed for 2015 to 2019 continue to hold or to change as part of longer-term trends.

15 NSDUH does not currently ask separate questions about the vaping of nicotine.

17 Recent increases in vaping nicotine have resulted in changes in adolescent tobacco use. Findings from the 2019 National Youth Tobacco Survey (NYTS) and the 2019 Monitoring the Future study indicate increases in vaping nicotine (Johnston et al., 2020; U.S. Food and Drug Administration [FDA], 2020; Wang et al., 2019). The NYTS data indicate that e-cigarettes have been the most commonly used nicotine product among youths since 2014 and that e-cigarette use has reached epidemic proportions among youths (Wang et al., 2019). In addition, vaping of nicotine products among adolescents has been identified as a risk factor for future cigarette use (FDA, 2020), which may affect long-term cigarette use trends. See the following three references:

Johnston, L. D., Miech, R. A., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2020). Monitoring the Future national survey results on drug use 1975-2019: 2019 overview, key findings on adolescent drug use. Ann Arbor, MI: University of Michigan, Institute for Social Research. Retrieved from http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2019.pdf

U.S. Food and Drug Administration. (2020). 2019 National Youth Tobacco Survey shows youth e-cigarette use at alarming levels. Retrieved from https://www.fda.gov

Wang, T. W., Gentzke, A. S., Creamer, M. R., Cullen, K. A., Holder-Hayes, E., Sawdey, M. D., Anic, G. M., Portnoy, D. B., Hu, S., Homa, D. M., Jamal, A., & Neff, L. J. (2019). Tobacco product use and associated factors among middle and high school students - United States, 2019. Morbidity and Mortality Weekly Report Surveillance Summaries, 68(SS-12), 1-22. https://doi.org/10.15585/mmwr.ss6812a1

18 In the 2019 NSDUH, a "drink" was defined as a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. Times when respondents had only a sip or two from a drink were not considered to be alcohol consumption.

19 The threshold for determining binge alcohol use for females was lowered from five or more drinks on an occasion for the 2014 and earlier NSDUHs to four or more drinks on an occasion for the 2015 NSDUH to ensure consistency with federal definitions and other federal data collection programs. The threshold for males in 2015 remained at five or more drinks on an occasion. New baselines began in 2015 for estimates of binge and heavy alcohol use for females and for binge and heavy alcohol use for the overall population (both genders). Estimates from 2002 to 2019 for binge and heavy alcohol use among males are available in the 2019 NSDUH detailed tables at https://www.samhsa.gov/data/.

20 The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 grams per deciliter (g/dL). This typically occurs after four drinks for women and five drinks for men in about 2 hours. See the following two references:

National Institute on Alcohol Abuse and Alcoholism. (2004, Winter). NIAAA council approves definition of binge drinking. NIAAA Newsletter, 3, 3. Retrieved from https://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf

National Institute on Alcohol Abuse and Alcoholism. (2019). Drinking levels defined. Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

21 These estimates were calculated from special analyses but are not included in the appendix tables or in the 2019 detailed tables.

25 The 2019 NSDUH questionnaire included separate sections for tranquilizer misuse and sedative misuse. Data from these sections were combined to produce aggregate estimates for the misuse of any tranquilizer or sedative.

26 The estimated numbers of current users of different illicit drugs are not mutually exclusive because people could have used more than one type of illicit drug in the past month.

29 Desoxyn ® was not mentioned in 2019 as some other stimulant and has been mentioned only rarely in some years since 2015. Because Desoxyn ® is chemically similar to other prescription amphetamines (e.g., Adderall ®), it was grouped with the other amphetamines.

30 For example, the product label for Xanax ®, which is prescribed as a tranquilizer, indicates the drug has an average half-life of 11.2 hours (i.e., the length of time for half of the dosage of the drug to be metabolized), with a range of 6.3 to 26.9 hours in healthy adults. In comparison, the product label for Halcion ®, a benzodiazepine prescribed as a sedative, has a short half-life in the range of 1.5 to 5.5 hours. Product label information for these drugs is available on the U.S. Food and Drug Administration's Center for Drug Evaluation and Research website at https://www.fda.gov/Drugs/.

31 Examples of forms of fentanyl presented to NSDUH respondents are available by prescription. NSDUH respondents were not asked about the use of fentanyl illicitly manufactured in clandestine laboratories.

33 To measure initiation for most substances, NSDUH respondents who reported they ever used a particular substance were asked to report their age when they first used it. To measure initiation of prescription drug misuse (i.e., misuse of pain relievers, tranquilizers, stimulants, and sedatives), NSDUH respondents who reported they misused a particular prescription drug in the past 12 months were asked to report their age when they first misused it. Respondents who reported first use (or misuse in the case of prescription drugs) of a substance within a year of their current age also were asked to report the year and month when they first used (or misused) it.

34 Estimates relating to the periods prior to the 12-month reference period have not been considered here because of concerns about their validity resulting from recall bias. See the following reference: Gfroerer, J., Hughes, A., Chromy, J., Heller, D., & Packer, L. (2004, July). Estimating trends in substance use based on reports of prior use in a cross-sectional survey. In S. B. Cohen & J. M. Lepkowski (Eds.), Eighth Conference on Health Survey Research Methods: Conference proceedings [Peachtree City, GA] (HHS Publication No. PHS 04-1013, pp. 29-34). Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics.

35 For substances other than prescription psychotherapeutic drugs, respondents who had ever used the substance (e.g., marijuana) were asked to report when they first used the substance, and respondents who reported first use within a year of their current age were asked to report the year and month when they first used it. Thus, past year initiates of the use of substances other than prescription psychotherapeutic drugs reported their first use within 12 months of the interview date.

36 Assessing whether respondents in the 2019 NSDUH had initiated misuse of a prescription psychotherapeutic drug in the past 12 months differed from assessing whether respondents had initiated the use of other substances in that period because the psychotherapeutic drug categories (e.g., prescription pain relievers) include many different types of prescription drugs in a given category (e.g., pain relievers containing hydrocodone, such as Vicodin ®, Lortab ®, Norco ®, Zohydro ® ER, or generic hydrocodone). Respondents in 2019 were asked questions about initiation of misuse only for the specific prescription drugs they misused in the past 12 months, including their age when they first misused a drug and (if the first misuse occurred within a year of the current age) the year and month of first misuse for that drug. Respondents who reported they initiated misuse in the past 12 months for all of the specific prescription drugs in a given category they misused in that period were asked a follow-up question to establish whether they had ever misused prescription drugs in that category more than 12 months before being interviewed. Respondents who answered this follow-up question as "no" were classified as being past year initiates of the misuse of any prescription drug in the overall category. This answer meant respondents had never misused any prescription drug in that category more than 12 months prior to the interview date.

39 Past year initiates of crack cocaine use are counted as past year initiates of cocaine use only if they initiated any use of cocaine in the past year. Likewise, past year initiates of LSD, PCP, or Ecstasy use are counted as past year initiates of hallucinogen use only if respondents had previously not used other hallucinogens.

41 Survey questions for the perceived risk from using different substances vary in terms of the frequency (e.g., use once or twice a week, use nearly every day or daily) and quantity of use (e.g., having five or more drinks of alcohol, any use of marijuana, cocaine, or heroin), making comparisons difficult for perceptions of risk from using different substances.

43 Because of the cross-sectional nature of NSDUH data (i.e., reports of perceived risk and substance use made at a single point in time instead of from the same individuals over multiple points in time), causal connections cannot be made between perceptions of risk and substance use.

46 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: Author.

48 Respondents who reported any use of prescription drugs in a given prescription psychotherapeutic category in the past 12 months (e.g., prescription pain relievers) but did not report misuse of any drugs in that category in the past 12 months were not asked the SUD questions for that category.

49 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Arlington, VA: Author.

50 Adolescents were first asked whether they ever had a period in their lifetime lasting several days or longer when any of the following was true for most of the day: (a) feeling sad, empty, or depressed; (b) feeling very discouraged or hopeless about how things were going in their lives; or (c) losing interest and becoming bored with most things they usually enjoy. Adolescents who reported any of these problems were asked further questions about their experience with the nine symptoms of MDE in their lifetime. Adolescents were classified as having an MDE in their lifetime if they experienced at least five of the nine symptoms in the same 2-week period in their lifetime; at least one of the symptoms needed to be having a depressed mood or loss of interest or pleasure in activities that had been enjoyable. Adolescents who reported gaining weight without trying were asked if their weight gain occurred because they were growing; this question was not asked of adult respondents. Adolescent respondents who had a lifetime MDE were asked if they had a period of 2 weeks or longer in the past 12 months when they felt depressed or lost interest or pleasure in previously enjoyable activities, and they reported having some of their other MDE symptoms. These adolescents were classified as having a past year MDE.

51 Adults were first asked whether they ever had a period in their lifetime lasting several days or longer when any of the following was true for most of the day: (a) feeling sad, empty, or depressed; (b) feeling discouraged about how things were going in their lives; or (c) losing interest in most things they usually enjoy. Adults who reported any of these problems were asked further questions about their experience with the nine symptoms of MDE in their lifetime. Adults were classified as having an MDE in their lifetime if they experienced at least five of the nine symptoms in the same 2-week period in their lifetime; at least one of the symptoms needed to be having a depressed mood or loss of interest or pleasure in activities that had been enjoyable. Adult respondents who had a lifetime MDE were asked if they had a period of 2 weeks or longer in the past 12 months when they felt depressed or lost interest or pleasure in previously enjoyable activities, and they reported having some of their other MDE symptoms. These adults were classified as having a past year MDE. Data on MDE in the past year for adults have been available in NSDUH since 2005.

52 Questions measuring adolescents' impairment in carrying out life activities because of MDE were added to the survey in 2006.

53 Data on MDE with severe impairment for adults have been available since 2009.

59 Information on the definitions and estimation methods for the mental illness estimates will be provided in Section 3.4.7 and Appendix A in the forthcoming 2019 methodological summary and definitions report. Until that report becomes available, readers can refer to the corresponding sections in the 2018 report. See the following references:

Center for Behavioral Health Statistics and Quality. (2019). 2018 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

Center for Behavioral Health Statistics and Quality. (in press). 2019 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

61 Stone, D. M., Simon, T. R., Fowler, K. A., Kegler, S. R., Yuan, K., Holland, K. M., Ivey-Stephenson, A. Z., & Crosby, A. E. (2018, June 8). Vital Signs: Trends in state suicide rates - United States, 1999-2016 and circumstances contributing to suicide - 27 states, 2015. Morbidity and Mortality Weekly Report, 67(22), 617-624. Retrieved from https://doi.org/10.15585/mmwr.mm6722a1

66 Respondents were eligible to be asked the substance use treatment questions if they reported lifetime use of alcohol, marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine, or the lifetime misuse of prescription psychotherapeutic drugs (i.e., pain relievers, tranquilizers, stimulants, or sedatives). Respondents who were lifetime users of tobacco products or other substances (e.g., kratom) but who did not report lifetime use or misuse of the substances mentioned in the previous sentence were not asked the substance use treatment questions.

67 Substance use treatment at a specialty facility refers to substance use treatment at a hospital (only as an inpatient), a drug or alcohol rehabilitation facility (as an inpatient or outpatient), or a mental health center. This NSDUH definition historically has not considered emergency rooms, private doctors' offices, prisons or jails, and self-help groups to be specialty facilities for the receipt of substance use treatment.

68 The NSDUH definition of the need for treatment does not explicitly indicate the need for treatment at a specialty facility. People who had an SUD in the past year can be considered to need some form of assistance for their problems with substance use. However, people who met DSM-IV criteria for abuse but not dependence may not necessarily need treatment at a specialty facility. For more information about the DSM-IV criteria for having an SUD, see Section 3.4.3 and the definitions for abuse and dependence in Appendix A of CBHSQ (in press). See the following references:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: Author.

Center for Behavioral Health Statistics and Quality. (in press). 2019 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

69 There were 20.4 million people aged 12 or older in 2019 with an SUD in the past year. Approximately 95 percent of the people in 2019 who needed treatment for a substance use problem were classified as such because they had an SUD in the past year, regardless of whether they received substance use treatment at a specialty facility.

70 As per the definition of the need for substance use treatment, people who had an SUD were classified as needing substance use treatment.

72 Health professionals include general practitioners or family doctors; other medical doctors (e.g., cardiologist, gynecologist, urologist); psychologists; psychiatrists or psychotherapists; social workers; counselors; other mental health professionals (e.g., mental health nurse or other therapist where type is not specified); and nurses, occupational therapists, or other health professionals.

73 The specialty mental health setting includes services in outpatient or inpatient settings. Outpatient services include those from (a) a private therapist, psychologist, psychiatrist, social worker, or counselor; (b) a mental health clinic or center; (c) a partial day hospital or day treatment program; or (d) an in-home therapist, counselor, or family preservation worker. Inpatient or residential specialty mental health services in which adolescents stayed overnight or longer include services in a hospital or a residential treatment center.

74 Due to questionnaire changes in 2009, estimates for the receipt of youth mental health services in educational settings are not comparable with estimates prior to 2009. Additionally, estimates for the receipt of youth mental health services in juvenile justice settings were not available prior to 2009.

Appendix A: Special Tables of Estimates for Substance Use
and Mental Health Indicators in the United States

TOBACCO PRODUCTS

ALCOHOL

13,367

(374)

6,189

(200)

7,178

(288)

6,615

(240)

563

(109)

ILLICIT DRUGS
* = Low precision.
NOTE: Estimates shown are unrounded averages with standard errors included in parentheses.
NOTE: Additional estimates may be found in the detailed tables for the 2019 NSDUH athttps://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2019 NSDUH detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2019.

Appendix B: Selected 2019 Detailed Tables That Support Estimates for Key Substance Use
and Mental Health Indicators in the United States

# data[].attributes.attachment_link.keywords[]
trends; behavioral health; substance use; illicit drug use; prescription drug misuse; opioid misuse; pain reliever subtypes; reasons for misusing pain relievers; source of prescription pain relievers; alcohol use; tobacco use; cigarette use; substance use initiation; perceived risk of harm; substance use disorders; sud; substance dependence or abuse; alcohol use disorder; illicit drug use disorder; opioid use disorder; need for substance use treatment; substance use treatment; specialty substance use treatment; perceived need for substance use treatment; mental illness among adults; any mental illness; ami; serious mental illness; smi; mental health service use; mental health service use among adults with mental illness; co-occurring mental health issues and substance use disorders among adults; mental health service use among people with co-occurring mental health issues and substance use disorders; major depressive episode; mde; treatment for depression; co-occurring mde and substance use disorders among adolescents; substance use and mde among adolescents; substance use and mental health issues among adults; suicidal thoughts among adults; suicide plans among adults; suicide attempts among adults; perceived unmet need for mental health services among adults

# data[].attributes.attachment_link.title
Key Substance Use and Mental Health Indicators in the United States:Results from the 2019 National Survey on Drug Use and Health

# data[].attributes.attachment_link.description
Your browser's Javascript is off. Hyperlinks on this page will not display an important message. This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), under Contract No. HHSS283201700002C with RTI International. Beth Han was the SAMHSA author.

# data[].attributes.body
Physical Effects

# data[].attributes.body
Reduces water in streams and lakes, or land subsidence.

# data[].attributes.body
Drugs can interfere with a person’s ability to make smart decisions.

# data[].attributes.body
Drug addiction can cause domestic violence feelings of frustration, anger and resentment.

# data[].attributes.body
lung disease

bronchitis

slow breathing

emphysema

# data[].attributes.body
Fertilizers uses to grow drugs like cannabis contaminates the water and soil.

# data[].attributes.body
increased heart rate

high blood pressure

heart attack

collapsed veins

irregular heartbeat

# data[].attributes.body
Illicit Drugs

# data[].attributes.body
Heavier and more frequent doses can cause long-term changes in the brain.

# data[].attributes.headline
Users tend to have distorted perceptions of reality

# data[].attributes.subject
Users tend to have distorted perceptions of reality

# data[].attributes.body
Emits a significant amount of biogenic volatile organic compounds, which could cause air quality issues.

# data[].attributes.body
Marijuana is a mind-altering (psychoactive) drug, produced by the Cannabis sativa plant.

# data[].attributes.attachment_link.title
Cannabis use during pregnancy may harm infants and mothers, research suggests

# data[].attributes.attachment_link.description
Women who used marijuana during pregnancy were more likely to give birth to babies who were preterm, had lower birth weight and had a higher rate of birth defects, according to a major study of 1.28 million Canadian births from 2012 to 2019.

# data[].attributes.body
Contains concentrations of the chemicals that cause birth defects

# data[].attributes.body
Causes dehydration-induced seizures and damage immune systems.

# data[].attributes.body
Illegal drug possession and non-medical use of medications that are sold

# data[].attributes.headline
Health problems associated with drug addiction

# data[].attributes.subject
Health problems associated with drug addiction

# data[].attributes.body
Users develop depression and anxiety disorders

# data[].attributes.body
 Psychological Effects

# data[].attributes.body
The manufacture, transportation and consumption of the drug impacts tropical forests, estuarine and freshwater ecosystems.

# data[].attributes.body
Drugs provide a certain pleasurable sensation that elevates users' moods and cognitive function and entices them to keep using them.

# data[].attributes.body
Causes the brain's opioid receptors to become active. This blocks pain perception, promotes relaxation, and creates a "out-of-body" experience. By building up a surplus of dopamine in the brain, it also promotes bliss.

# data[].attributes.body
Fills the brain with dopamine, a neurotransmitter involved in pleasure, it produces a powerful high.

# data[].attributes.body
affects impulse control

# data[].attributes.body
Large amounts of greenhouse gases are released when tropical forests are destroyed.

# data[].attributes.body
Colombia, the nation that produces the largest amount of cocaine, has had to clear portions of its rain forests in order to grow more coca.

# data[].attributes.attachment_link.readable_text
BY Gustavo Arias Retana/Diálogo|Gustavo Arias Retana/Diálogo

Crop cultivation and the chemicals used to produce drugs have a direct impact on the hemisphere's flora, soils, fauna, and rivers. Countries like Colombia and Peru are rapidly losing their natural resources and ecosystems due to narcotrafficking, which clears forests to grow marijuana, as well as coca to produce cocaine and poppy for heroin.

Toxic waste from chemicals used to extract narcotics lacks proper management and is discarded into bodies of water, polluting groundwater resources and killing thousands of species.

The Colombian National Police's (PNC, in Spanish) report Coca: Deforestation, Pollution, and Poverty indicates that "drug production destroys an average of 40,531 hectares of forest annually in the country, about 111 hectares per day, where 80 percent of the reported tree species only exist in that biome." Deforestation also entails destroying the habitat of endemic species that are unable to migrate. "In terms of fauna, the figures are: 600 birds, 170 reptiles, 100 amphibians, and more than 600 fish species," the report says.

According to the report Colombia - Survey of Territories Affected by Illicit Crops 2018 from the United Nations Office on Drugs and Crime, "47 percent of [drug] crops are located in national natural parks, indigenous reserves, or black communities [...]." The total area damaged by coca crops exceeds 225,000 hectares, the PNC adds.

Germán Márquez, professor at the National University of Colombia and researcher at the Institute of Environmental Studies, told Diálogo that the country is among the most affected by logging due to drug production. "Deforestation has been the most direct impact since marijuana crops began in the 1960s and 1970s, and then coca leaf, and to some extent the occupation of many forest areas," added Marquez.

Eliseo Talancha, head of the Peruvian Institute of Environmental Law and Cultural Heritage, told Diálogo that his country is experiencing similar damage to that of Colombia, especially in the Amazon area.

"Narcotrafficking is a local and regional environmental problem, mainly located [in the country] in the Peruvian Amazon, in the high and low jungles. It affects resources such as water, and the use of pesticides and chemicals leads to soil erosion," Talancha added. "Cocaine base paste production causes serious damage in terms of river pollution and loss of fauna."

"We can summarize the main effects as such: interference in strategic ecosystems; thinning of vegetation coverage; extinction of endemic species; reduction of natural areas; deterioration of water sources and decreased capacity to regulate them; decline in water quality due to physical, chemical, or biological degradation; rain cycle alterations; and increased carbon dioxide," the PNC report says.

Some of the chemicals released into the region's rivers due to cocaine production are kerosene, sulfuric acid, quicklime, carbide, acetone, and toluene, experts say. The production of 1 kilogram of coca base paste requires about 400 to 600 grams of chemicals, which are directly deposited into the region's water sources.

Other drug processing practices that are harmful for ecosystems, the PNC says, are open-air waste accumulation and incineration, as well as river pollution.

"Many garbage dumps potentially generate dioxins, furans, and tar, which in some cases have higher toxicity levels than the initial substance [due to decomposition]. The accumulation of open-air and untreated waste generates leachates [toxic waste liquids] that pollute the soil. Waste enters the environment in high concentrations and ends up in bodies of water, merged with soil particles and, in the worst-case scenario, is accumulated and magnified. At this point, the pressure on the habitat is not limited to the crop area alone, but gets exported to the entire ecosystem," the PNC emphasizes in the report.

# data[].attributes.attachment_link.title
Illicit Drug Production Destroys Colombian, Peruvian Ecosystems - Diálogo Américas

# data[].attributes.attachment_link.description
Crop cultivation and the chemicals used to produce drugs have a direct impact on the hemisphere's flora, soils, fauna, and rivers. Countries like Colombia and Peru are rapidly losing their natural resources and ecosystems due to narcotrafficking, which clears forests to grow marijuana, as well as coca to produce cocaine and poppy for heroin.

# data[].attributes.body
Illegal manufacturer usually disregard environmental rules and regulations.

# data[].attributes.headline
Major source of large-scale carbon emissions and pollution

# data[].attributes.subject
Major source of large-scale carbon emissions and pollution

# data[].attributes.body
Drug production leaves mark on the Environment

# data[].attributes.body
.   ADDICTIVE DRUGS .