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Serious Mental Illness and Its Co-Occurrence with Substance Use  

Serious Mental Illness and Its
Co-Occurrence with Substance Use
Disorders, 2002

Joan Epstein
Peggy Barker
Michael Vorburger
Christine Murtha

 

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Office of Applied Studies

Acknowledgments

This report was prepared by the Division of Population Surveys, Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA), and by RTI International, a trade name of Research Triangle Institute, of Research Triangle Park, North Carolina, under Contract No. 283–98–9008. At SAMHSA, Joan Epstein and Peggy Barker authored the report. Joseph Gfroerer provided review comments. At RTI, Christine Murtha was the task leader for its production and coauthored the report with Michael Vorburger. Mary Ellen Marsden reviewed the report; other contributors and reviewers at RTI include Jeremy Aldworth, Katherine R. Bowman, Walter R. Boyle, James R. Chromy, Andrew Clarke, Steven L. Emrich, Jennie L. Harris, David C. Heller, Jennifer J. Kasten, Larry A. Kroutil, Brian Newquist, Lisa E. Packer, Michael R. Pemberton, Michael A. Penne, Jill Webster, and Li-Tzy Wu. At RTI, Richard S. Straw edited the report; Diane G. Caudill and Dayle Johnson prepared the graphics; Brenda K. Porter formatted the tables; Joyce Clay-Brooks, Debbie F. Bond, and Loraine G. Monroe formatted and word processed the report; and Pamela Couch Prevatt, Teresa F. Gurley, Kim Cone, Sonja E. Douglas, and Shari B. Lambert prepared its Web and press versions. Final report production was provided by Beatrice A. Rouse, Coleen Sanderson, and Jane Feldmann at SAMHSA.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration. However, this publication may not be reproduced or distributed for a fee without specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services. Citation of the source is appreciated. Suggested citation:

Epstein J., Barker, P., Vorburger, M., & Murtha, C. (2004). Serious mental illness and its co-occurrence with substance use disorders, 2002 (DHHS Publication No. SMA 04–3905, Analytic Series A-24). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

Obtaining Copies of Publications from SAMHSA's Office of Applied Studies

Web Access:  http://oas.samhsa.gov/

Originating Office:  SAMHSA, Office of Applied Studies
 

June 2004

 

Table of Contents

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List of Figures

List of Tables

Highlights

1. Introduction
     1.1. Purpose of This Report
     1.2. Background on the Definition of Serious Mental Illness
     1.3. Prior Estimates of Serious Mental Illness and Its Co-Occurrence with a Substance Use Disorder and Treatment
     1.4. Prior Estimates of Co-Occurring Disorders
     1.5. Organization of This Report

2. Data and Methods
     2.1. Summary of National Survey on Drug Use and Health
     2.2. Limitations of the Data
     2.3. Measures and Statistical Methods
          2.3.1 Definition and Measurement of Serious Mental Illness
          2.3.2 Definition of Substance Use Disorder and Nicotine (Cigarette) Dependence
          2.3.3 Definitions of Mental Health Treatment and Substance Use Treatment
          2.3.4 Social and Demographic Variables
          2.3.5 Use of Alcohol, Cigarettes, Tobacco, and Illicit Drugs
     2.4. Statistical Methods
          2.4.1 Descriptive Analysis
          2.4.2 Model-Based Analysis

3. Serious Mental Illness
     3.1. Characteristics of Adults With and Without Serious Mental Illness
     3.2. Prevalence of Serious Mental Illness among Demographic and Socioeconomic Subgroups
     3.3. Serious Mental Illness and Substance Use
          3.3.1 Serious Mental Illness and Illicit Drug Use
               3.3.1.1 Characteristics of Adults with Serious Mental Illness and Illicit Drug Use
               3.3.1.2 Prevalence of Serious Mental Illness among Illicit Drug Users
          3.3.2 Serious Mental Illness among Cigarette and Alcohol Users
     3.4. Serious Mental Illness and a Co-Occurring Substance Use Disorder
          3.4.1 Characteristics of Adults with Co-Occurring Serious Mental Illness and a Substance Use Disorder
          3.4.2 Prevalence of Serious Mental Illness among Adults with a Substance Use Disorder
     3.5. Multiple Logistic Regression Models for Serious Mental Illness

4. Mental Health Treatment and Substance Use Treatment
     4.1. Mental Health Treatment among Adults with Serious Mental Illness
          4.1.1 Characteristics of Adults with Serious Mental Illness, by Receipt of Mental Health Treatment in the Past Year
          4.1.2 Rates of Mental Health Treatment among Adults with Serious Mental Illness, by Sociodemographic
             Characteristics
          4.1.3 Mental Health Treatment among Adults with Serious Mental Illness Who Did and Did Not Use Illicit Drugs
     4.2. Use of Treatment Services among Adults with Serious Mental Illness and/or a Co-Occurring Substance Use Disorder
     4.3. Multiple Logistic Regression Models
     4.4. Discussion

5. Summary and Conclusions

References

Appendix

A Description of the Survey, Limitations of the Data, and Statistical Methods

B Selected Tables

List of Figures

1. Serious Mental Illness among Adults Aged 18 or Older, by Age and Gender: 2002

2. Serious Mental Illness among Adults Aged 18 or Older, by Perceived Health Status: 2002

3. Serious Mental Illness among Adults Aged 18 or Older, by Social Support: 2002

4. Serious Mental Illness among Adults Aged 26 to 49, by Marital Status: 2002

5. Serious Mental Illness among Adults Aged 26 to 49, by Family Income: 2002

6. Serious Mental Illness among Adults Aged 26 to 49, by Health Insurance Status: 2002

7. Serious Mental Illness among Adults Aged 26 to 49, by Current Employment Status: 2002

8. Serious Mental Illness and Past Year Illicit Drug Use among Adults Aged 18 or Older: 2002

9. Serious Mental Illness, by Type of Substance Used among Adults Aged 18 or Older: 2002

10. Co-Occurrence of Serious Mental Illness and Substance Use Disorders among Adults Aged 18 or Older: 2002

11. Type of Substance Use Disorder among Adults Aged 18 or Older with Both Serious Mental Illness and a Co-Occurring Substance Use Disorder: Numbers in Thousands, 2002

12. Substance Use Disorders and Illicit Drug Use among Adults Aged 18 or Older with Serious Mental Illness: Numbers in Thousands, 2002

13. Serious Mental Illness among Adults Aged 18 or Older, by Substance Dependence or Abuse: 2002

14. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by Age: 2002

15. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by Gender: 2002

16. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by Race/Ethnicity: 2002

17. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by Perceived Health Status: 2002

18. Mental Health Treatment among Adults Aged 26 to 49 with Serious Mental Illness, by Health Insurance Status: 2002

19. Mental Health Treatment among Adults Aged 26 to 49 with Serious Mental Illness, by Marital Status: 2002

20. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by County Type: 2002

21. Mental Health Treatment and Substance Use Treatment at a Specialty Facility among Adults Aged 18 or Older with Serious Mental Illness and/or a Substance Use Disorder: 2002

22. Mental Health and Specialty Substance Use Treatment among Adults Aged 18 or Older with Both Serious Mental Illness and a Substance Use Disorder: 2002

A.1 Required Effective Sample as a Function of the Proportion Estimated

List of Tables

A.1 Summary of 2002 NSDUH Suppression Rules

A.2 Weighted Percentages and Sample Sizes for 2002 NSDUH, by Screening Result Code

A.3 Weighted Percentages and Sample Sizes for 2002 NSDUH, by Final Interview Code

A.4 Response Rates and Sample Sizes for 2002 NSDUH, by Demographic Characteristics

B.1a Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Numbers in Thousands, 2002

B.1b Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Percentage Distributions, 2002

B.2a Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Numbers in Thousands, 2002

B.2b Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Percentage Distributions, 2002

B.3a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Demographic Characteristics: Numbers in Thousands, 2002

B.3b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Demographic Characteristics: Percentages, 2002

B.4a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Geographic Characteristics: Numbers in Thousands, 2002

B.4b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Geographic Characteristics: Percentages, 2002

B.5a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and by Socioeconomic and Health Characteristics: Numbers in Thousands, 2002

B.5b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and by Socioeconomic and Health Characteristics: Percentages, 2002

B.6a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and Demographic Characteristics: Numbers in Thousands, 2002

B.6b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and Demographic Characteristics: Percentage Distributions, 2002

B.7a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and Geographic Characteristics: Numbers in Thousands, 2002

B.7b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and Geographic Characteristics: Percentage Distributions, 2002

B.8a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and by Socioeconomic and Health Characteristics: Numbers in Thousands, 2002

B.8b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and by Socioeconomic and Health Characteristics: Percentages, 2002

B.9a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and Demographic Characteristics: Numbers in Thousands, 2002

B.9b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and Demographic Characteristics: Percentages, 2002

B.10a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Use of Illicit Drugs: Numbers in Thousands, 2002

B.10b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Use of Illicit Drugs: Percentages, 2002

B.11a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year and Past Month Tobacco and Alcohol Use: Numbers in Thousands, 2002

B.11b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year and Past Month Tobacco and Alcohol Use: Percentages, 2002

B.12a Serious Mental Illness and/or a Substance Use Disorder among Persons Aged 18 or Older with a Serious Mental Illness or a Substance Use Disorder in the Past Year: Numbers in Thousands, 2002

B.12b Serious Mental Illness and/or a Substance Use Disorder among Persons Aged 18 or Older with a Serious Mental Illness or a Substance Use Disorder in the Past Year: Percentage Distributions, 2002

B.13a Substance Dependence or Abuse in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness: Numbers in Thousands, 2002

B.13b Substance Dependence or Abuse in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness: Percentages, 2002

B.14a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder and Demographic Characteristics: Numbers in Thousands, 2002

B.14b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder and Demographic Characteristics: Percentage Distributions, 2002

B.15a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder and Geographic Characteristics: Numbers in Thousands, 2002

B.15b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder and Geographic Characteristics: Percentage Distributions, 2002

B.16a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Use Disorder, Gender, and Age Group: Numbers in Thousands, 2002

B.16b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Use Disorder, Gender, and Age Group: Percentages, 2002

B.17a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Dependence or Abuse: Numbers in Thousands, 2002

B.17b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Dependence or Abuse: Percentages, 2002

B.18a Persons Aged 18 or Older with Serious Mental Illness, by Receipt of Mental Health Treatment/Counseling and Demographic or Geographic Characteristics: Numbers in Thousands, 2002

B.18b Persons Aged 18 or Older with Serious Mental Illness, by Receipt of Mental Health Treatment/Counseling and Demographic or Geographic Characteristics: Percentage Distributions, 2002

B.19a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Numbers in Thousands, 2002

B.19b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Percentages, 2002

B.20a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Age Group and by Socioeconomic and Health Characteristics: Numbers in Thousands, 2002

B.20b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Age Group and by Socioeconomic and Health Characteristics: Percentages, 2002

B.21a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Numbers in Thousands, 2002

B.21b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Percentages, 2002

B.22a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Past Year Any Illicit Drug Use and Demographic Characteristics: Numbers in Thousands, 2002

B.22b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Past Year Any Illicit Drug Use and Demographic Characteristics: Percentages, 2002

B.23a Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment at a Specialty Facility in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Numbers in Thousands, 2002

B.23b Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment at a Specialty Facility in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Percentages, 2002

B.24a Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Numbers in Thousands, 2002

B.24b Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Percentages, 2002

B.25a Receipt of Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Type of Past Year Substance Use Disorder: Numbers in Thousands, 2002

B.25b Receipt of Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Type of Past Year Substance Use Disorder: Percentages, 2002

B.M1 Adjusted Odds Ratios from Logistic Regression Models for Past Year Serious Mental Illness among Adults Aged 18 or Older, by Sociodemographic and Substance Use Characteristics: 2002

B.M2 Adjusted Odds Ratios from Logistic Regression Models for Receipt of Mental Health Treatment/Counseling in the Past Year among Adults Aged 18 or Older with Past Year Serious Mental Illness, by Sociodemographic and Substance Use Characteristics: 2002

Highlights

This report presents information on the prevalence and treatment of serious mental illness (SMI) and their association with substance use and co-occurring substance use disorders based on the 2002 National Survey on Drug Use and Health (NSDUH). The survey, formerly known as the National Household Survey on Drug Abuse (NHSDA), is a project of the Substance Abuse and Mental Health Services Administration (SAMHSA). For this report, a substance use disorder is defined as dependence on or abuse of alcohol or illicit drugs.

NSDUH is an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. Conducted by the Federal Government since 1971, it is the primary source of statistical information on the use of illegal drugs by the U.S. population. Estimates in this report are based on data from the 2002 survey for adults aged 18 or older. Because of changes to the 2002 survey, this report's estimates should not be compared with estimates from previous survey years.

National estimates for the prevalence and treatment of SMI are presented. The prevalence of treatment for substance use and mental health disorders among persons with SMI and co-occurring substance use disorders also is examined by demographic, socioeconomic, substance use, and substance dependence or abuse characteristics.

Serious Mental Illness

Co-Occurrence of Serious Mental Illness and Substance Use Disorder

Treatment for Mental Health and Substance Use Problems

 

1. Introduction

 

1.1. Purpose of This Report

Estimates of the prevalence of serious mental illness (SMI) provide a measure of the population with the most severe mental health problems and indicate those persons who are most in need of treatment. SMI is defined in this report as having at some time in the past year a diagnosable mental, behavioral, or emotional disorder that met the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994), that resulted in functional impairment that substantially interfered with or limited one or more major activities. Studies have shown that mental disorders co-occurring with substance use disorders are more chronic than mental disorders alone and that the co-occurrence between a mental disorder and a substance use disorder can create serious complications for treatment (Kranzler & Liebowitz, 1988). Adults with SMI and a co-occurring substance use disorder may have a greater need for treatment than adults with a less severe mental disorder co-occurring with a substance use disorder.

This report presents national estimates from the 2002 National Survey on Drug Use and Health (NSDUH)1 of the prevalence and treatment of SMI and of co-occurring SMI and substance use disorders (dependence on or abuse of illicit drugs or alcohol) among adults aged 18 or older. The prevalence of treatment for substance use and mental health problems among persons with co-occurring SMI and substance use disorders also is examined by socioeconomic and demographic characteristics. The following is a list of the major research questions addressed by this report.

 

1.2. Background on the Definition of Serious Mental Illness

Public Law (P.L.) 102–321, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act, established a block grant for States to fund community mental health services for adults with SMI. The law required States to include incidence and prevalence estimates in their annual applications for block grant funds. The law also required SAMHSA to develop an operational definition of SMI and to establish an advisory group of technical experts to develop an estimation methodology based on this definition for use by the States. The definition of SMI stipulated in P.L. 102–321 requires the person to have at least one 12–month disorder, other than a substance use disorder, that met DSM-IV criteria (APA, 1994) and to have "serious impairment." A SAMHSA advisory group suggested that the term "serious impairment" be defined as impairment equivalent to a Global Assessment of Functioning (GAF) score of less than 60 (Endicott, Spitzer, Fleiss, & Cohen, 1976).

 

1.3. Prior Estimates of Serious Mental Illness and Its Co-Occurrence with a Substance Use Disorder and Treatment

Based on the definition presented in Section 1.2, a group of technical experts developed a methodology for estimating SMI (Kessler et al., 1996a) that used data from the National Comorbidity Survey (NCS) and the Baltimore Epidemiologic Catchment Area (ECA) survey. Using this methodology, they estimated that 10.0 million adults aged 18 or older had SMI in 1990 (5.4 percent of adults). Furthermore, they estimated that 1.1 percent of adults had both SMI and a substance use disorder. This represents 14.7 percent of all adults with SMI and 17.2 percent of all adults with a substance use disorder. They also estimated that 46.6 percent of the persons with SMI used professional services for a mental health problem in the 12 months prior to the interview.

Questions to measure SMI were added by SAMHSA to the NSDUH for the first time in 2001 (Office of Applied Studies [OAS], 2002). These questions, which asked respondents how frequently they experienced symptoms of psychological distress, were based on a methodological study designed to evaluate several screening scales for measuring SMI in the NSDUH. Based on this study, which included clinical assessments on survey respondents, these questions were shown to be a valid indicator of SMI (Kessler et al., 2003). Although estimates of SMI were produced for 2001, due to changes in the study, the 2001 estimates cannot be compared with estimates from 2002, which are presented in this report. (See Section 2.1 for further details on the reasons why they cannot be compared.)

 

1.4. Prior Estimates of Co-Occurring Disorders

Although this report focuses on the population with the most severe mental problems, there also is interest in the larger population with any mental disorder and the co-occurrence of substance use disorders among its members. According to a U.S. Surgeon General's report, co-occurring disorders have been estimated to affect from 7 million to 10 million adult Americans in any year (U.S. Department of Health and Human Services [DHHS], 1999; see also SAMHSA National Advisory Council, 1998). An estimated 41 to 65 percent of persons with a lifetime substance use disorder have a lifetime history of at least one mental disorder, and about 51 percent of those with one or more lifetime mental disorders also have a lifetime history of at least one substance use disorder (U.S. DHHS, 1999). Studies in both clinical samples (Ross, Glaser, & Germanson, 1988; Rounsaville et al., 1991; Wolf et al., 1988) and general population studies (Boyd et al., 1984; Helzer & Pryzbeck, 1988; Kessler et al., 1994; Regier et al., 1990) show that comorbidity is highly prevalent among individuals with mental disorders.

Data on co-occurring disorders can be obtained from the NCS, the ECA, and the NHSDA. These surveys define mental disorders and substance use disorders based on meeting specific DSM-IV criteria (APA, 1994). The NCS, carried out between 1990 and 1992, surveyed a nationally representative sample of persons aged 15 to 54. It found that 42.7 percent of individuals with a 12–month addictive disorder had at least one mental disorder, and 14.7 percent of individuals with a mental disorder had at least one 12–month addictive disorder (Kessler et al., 1996b). The ECA was carried out between 1980 and 1984 in five geographic areas and included adults aged 18 or older living in the community and various institutional settings. It reported that 47 percent of persons with schizophrenia also had a substance use disorder in their lifetime and 61 percent of individuals with a bipolar disorder also had a substance use disorder in their lifetime (Regier et al., 1990). The 1994 through 1997 NHSDAs included questions on four mental disorders in addition to questions to measure dependence on alcohol or illicit drugs. The 1994 survey found that 19 million adults in the population had dependence on illicit drugs or alcohol, and among these individuals, 13 percent had a major depressive episode disorder, 5.9 percent had a panic attack, 3.8 percent had a generalized anxiety disorder, and 3.7 percent had agoraphobia in the past year (OAS, 1996).

 

1.5. Organization of This Report

This report is divided into five chapters. NSDUH measures and statistical methods are described in Chapter 2. Chapter 3 presents findings on the prevalence and correlates of SMI among adults, including substance use and substance use disorders. Chapter 4 presents findings on the prevalence of mental health treatment and substance use treatment among adults with SMI and a substance use disorder. A summary and conclusions are presented in Chapter 5. Appendices provide technical details on the survey methodology and selected tables.

 

2. Data and Methods

 

2.1. Summary of National Survey on Drug Use and Health

This report uses data on adults aged 18 or older from the 2002 National Survey on Drug Use and Health (NSDUH). NSDUH is an annual survey of the civilian, noninstitutionalized population of the United States aged 12 or older. Prior to 2002, the survey was called the National Household Survey on Drug Abuse (NHSDA).

NSDUH is the primary source of statistical information on the use of illegal drugs by the U.S. population. Conducted by the Federal Government since 1971, the survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at the respondents' places of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is planned and managed by SAMHSA's Office of Applied Studies (OAS). The data collection is conducted by RTI International. This section briefly describes the survey methodology. A more complete description is provided in Appendix A.

NSDUH collects information from residents of households, noninstitutional group quarters (e.g., shelters, rooming houses, dormitories), and civilians living on military bases. Persons excluded from the survey include homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails and hospitals.

Since 1999, the NSDUH interview has been carried out using computer-assisted interviewing (CAI). The survey uses a combination of computer-assisted personal interviewing (CAPI) conducted by an interviewer and audio computer-assisted self-interviewing (ACASI). Use of ACASI is designed to provide a respondent with a highly private and confidential means of responding to questions and to increase the level of honest reporting of illicit drug use and other sensitive behaviors.

Consistent with the 1999 through 2001 surveys, the 2002 NSDUH employed a 50–State sample design with an independent, multistage area probability sample for each of the 50 States and the District of Columbia. The eight States with the largest population (which together account for 48 percent of the total U.S. population aged 12 or older) were designated as large sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas). For these States, the design provided a sample sufficient to support direct State estimates. For the remaining 42 States and the District of Columbia, smaller, but adequate, samples were selected to support State estimates using small area estimation (SAE) techniques. The design also oversampled youths and young adults, so that each State's sample was approximately equally distributed among three major age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.

Nationally, 136,349 addresses were screened for the 2002 survey, and 68,126 completed interviews were obtained. Among adults aged 18 or older, 54,351 persons were selected, with 44,467 interviews completed. The survey was conducted from January through December 2002. Weighted response rates for household screening and for interviewing were 90.7 and 78.9 percent, respectively; the weighted interview response rate for adults aged 18 or older was 77.2 percent.

Although the design of the 2002 NSDUH is similar to the design of the 1999 through 2001 surveys, important methodological differences in the 2002 survey affect the 2002 estimates. Besides the name change, each NSDUH respondent was given an incentive payment of $30. These changes, both implemented in 2002, resulted in a substantial improvement in the survey response rate. The changes also affected respondents' reporting of many critical items that are the basis of prevalence measures reported by the survey each year. Further, the 2002 data could have been affected by improved data collection quality control procedures that were introduced in the survey beginning in 2001. In addition, new population data from the 2000 decennial census recently became available for use in NSDUH sample weighting procedures, resulting in another discontinuity between the 2001 and 2002 estimates. Analyses of the effects of each of these factors on NSDUH estimates have shown that 2002 data should not be compared with 2001 and earlier NHSDA data to assess changes over time.

 

2.2. Limitations of the Data

All data from NSDUH are based on retrospective reports by survey respondents and are subject to recall and reporting biases. First, some degree of underreporting on drug use, mental health problems, and mental health treatment measures might occur because of the social unacceptability of drug use and the stigma of mental health problems and treatment. Self-reported data also are influenced by memory and recall errors, including recall decay (tendency to forget events occurring long ago) and forward telescoping (tendency to report that an event occurred more recently than it actually did).

Second, the NSDUH target population focuses on civilian, noninstitutionalized household residents. Although it includes almost 98 percent of the U.S. population aged 12 or older, some population subgroups that may have different drug-using patterns are excluded, such as active military personnel, people living in institutional group quarters, and homeless persons not living in identifiable shelters. Thus, generalization of the findings to the excluded subgroups is limited. Further, the estimates for drug use should be considered conservative.

See Appendix A for additional discussion of data limitations, including the effect of nonresponse on analyses presented in this report.

 

2.3. Measures and Statistical Methods

 

2.3.1 Definition and Measurement of Serious Mental Illness

Serious mental illness, or SMI, is defined in this report according to the definition stipulated in Public Law (P.L.) 102–321, that is, having at some time during the past year a diagnosable mental, behavioral, or emotional disorder that met the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994) and resulted in functional impairment that substantially interfered with or limited one or more major life activities.

SMI was assessed in the 2002 NSDUH using the six-item K6 scale (Kessler et al., 2003) that was used for the first time in 2001. These six questions ask respondents how frequently they experienced symptoms of psychological distress during the 1 month in the past year when they were at their worst emotionally. This scale has been shown to be a valid indicator of SMI, based on clinical assessments done on survey respondents (Kessler et al., 2003). The six questions and a discussion of the scale are given in Appendix A.

 

2.3.2 Definition of Substance Use Disorder and Nicotine (Cigarette) Dependence

In this study, an adult is defined as having a substance use disorder in the past year if he or she was dependent on or abused alcohol or an illicit drug in the past year. The 2002 NSDUH included a series of questions to assess dependence on or abuse of an illicit drug or alcohol based on DSM-IV criteria (APA, 1994). The seven substance dependence criteria are (1) tolerance; (2) withdrawal or avoidance of withdrawal; (3) persistent desire or unsuccessful attempts to cut down or stop substance use; (4) spending a lot of time using the substance, obtaining the substance, or recovering from its effects; (5) reducing or giving up occupational, social, or recreational activities in favor of substance use; (6) impaired control over substance use; and (7) continuing to use the substance despite physical or psychological problems. A respondent was considered to be dependent on a substance when he or she reported having at least three of the dependence criteria.

The four substance abuse criteria are (1) having serious problems due to substance use at home, work, or school; (2) the use of that substance putting the respondent in physical danger; (3) substance use causing the respondent to be in trouble with the law; and (4) continuing to use the substance despite having substance use-related problems with family and friends. A respondent was classified with abuse when he or she reported having at least one of the four abuse criteria.

The 2002 NSDUH included a series of questions to assess nicotine (cigarette) dependence based on the Nicotine Dependence Syndrome Scale (NESS) (Hoffman, Hick Cox, Gnus, Patty, & Tassel, 1995; Hoffman, Patty, Tassel, Gnus, & Settler-Segal, 1994; Hoffman, Waters, & Hick Cox, 2003) and the Firestorm Test of Nicotine Dependence (FIND) (Heatherton, Kozlowski, Wrecker, & Firestorm, 1991). A respondent was classified with nicotine (cigarette) dependence based on criteria derived from the NESS and the FIND.

 

2.3.3 Definitions of Mental Health Treatment and Substance Use Treatment

Mental health treatment is defined as treatment or counseling for problems with emotions, nerves, or mental health in any inpatient or outpatient setting or use of prescription medication to treat a mental or emotional condition in the 12 months prior to the interview.

Specialty substance use treatment (for alcohol or illicit drug use) is treatment received at a specialty substance abuse facility to reduce or stop drug or alcohol use, or for medical problems associated with the use of drugs or alcohol in the past 12 months. "Specialty" substance abuse facilities include rehabilitation facilities (inpatient or outpatient), hospitals (inpatient services only), or mental health centers. "Any treatment" refers to treatment received to reduce or stop drug or alcohol use, or for medical problems associated with the use of drugs or alcohol in the past 12 months at any location, including specialty facilities and emergency rooms, private doctor's offices, self-help groups, or prison/jails.

 

2.3.4 Social and Demographic Variables

 

2.3.5 Use of Alcohol, Cigarettes, Tobacco, and Illicit Drugs

Use of alcohol refers to any use of alcohol in the past 12 months. Binge alcohol use is defined as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days. Heavy alcohol use is defined as drinking five or more drinks on the same occasion on at least 5 days in the past 30 days.

Cigarette use refers to the use of cigarettes on at least 1 day in the 12 months preceding the interview date.

Illicit drug use is defined as any use in the past year of the following drugs: marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any nonmedical use of a prescription-type psychotherapeutic. Psychotherapeutics includes pain relievers, tranquilizers, stimulants, or sedatives and does not include any over-the-counter drugs.

 

2.4. Statistical Methods

The statistical analysis used descriptive statistics to characterize the prevalence and distribution of SMI and of treatment for SMI, and logistic regression models were used to predict SMI and treatment for SMI. The descriptive analysis produced prevalence rates and percent distributions by various explanatory variables, while the logistic regression modeling produced odds ratios (Ores) in the prevalence rates for each of the explanatory variables. All estimates were weighted, and all standard errors (Sees) were calculated using Taylor series linearization for nonlinear statistics and an approach that recognized the sample structure. The software package used was SUDAAN® (RTI, 2001). In the modeling, an explanatory variable was identified as a statistically significant predictor of SMI if the associated Chi-square test was significant at the 0.05 level. In the descriptive analyses, log-linear Chi-square tests of independence of the explanatory variables and SMI were conducted first to control the error level for multiple comparisons. If the Chi-square test indicated overall significant differences, comparisons between specific levels of the classification variables then were made using t tests.

 

2.4.1 Descriptive Analysis

Demographic and socioeconomic characteristics were compared for the following groups of adults: (1) those with and without SMI in the past year; (2) those who did and did not use illicit drugs among adults with SMI; (3) those with and without a substance use disorder among adults with SMI; and (4) those who received and did not receive mental health treatment in the past year among adults with SMI.

To examine how the prevalence of SMI in the past year varied among subgroups of adults, prevalence rates of SMI by demographic and socioeconomic characteristics are presented. To examine how the prevalence of SMI in the past year varied by use of substances, as well as by substance use disorders, prevalence rates of SMI are compared for use of alcohol, tobacco, any illicit drugs, and specific illicit drugs; dependence on or abuse of alcohol and/or illicit drugs; and cigarette dependence. Significant differences in rates among subgroups of persons also were identified with Chi-square tests and t tests.

To examine how the prevalence of mental health treatment in the past year varied among subgroups of adults with SMI, prevalence rates of mental health treatment in the past year among adults with SMI by demographic and socioeconomic characteristics are presented. To examine how the prevalence of mental health treatment varied by illicit drug use and by a substance use disorder among adults with SMI, rates of mental health treatment among adults with past year SMI were compared for those using and not using illicit drugs and for those with and without a substance use disorder. Rates of specialty substance use treatment among adults with a substance use disorder were compared for those with and without SMI to examine how the prevalence of substance use treatment among adults with a substance use disorder varied by SMI.

 

2.4.2 Model-Based Analysis

Two logistic regression models were run using the SUDAAN LOGISTIC procedure. The first model was developed for all adults aged 18 or older to examine the Ores for each of the characteristics believed to be associated with SMI after controlling for confounding variables. For the first model, past year SMI was the dependent variable, and the independent variables included each of the characteristics believed to be associated with SMI. The second model was developed for all adults with past year SMI to determine the odds of receiving mental health treatment for characteristics believed to be associated with the receipt of treatment and controlling for potential confounding variables. For this model, receipt of mental health treatment was the dependent variable.

 

3. Serious Mental Illness

This chapter presents national estimates from the 2002 National Survey on Drug Use and Health (NSDUH) of the prevalence of past year serious mental illness (SMI) by demographic and socioeconomic characteristics among adults aged 18 or older in 2002, and it examines the relationship of SMI to substance use and substance use disorders. Characteristics of adults with and without SMI in the past year are compared. Estimates of the past year prevalence of SMI are presented among demographic and socioeconomic subgroups, as well as by the type of substance used in the past year. Among adults with SMI, the characteristics of those using and not using illicit drugs are compared, and the characteristics of those with and without a substance use disorder are compared.

 

3.1. Characteristics of Adults With and Without Serious Mental Illness

In 2002, there were 17.5 million adults aged 18 or older with SMI during the 12 months prior to being interviewed. This represents 8.3 percent of all adults in the United States. On average, adults with SMI were younger, less educated, and more likely to be female than adults without SMI. The percentage of young adults aged 18 to 25 was higher among persons with SMI (23.4 percent) than among those without SMI (14.0 percent). In contrast, the percentage of older adults (aged 50 or older) was lower among those with SMI (22.1 percent) than among those without SMI (39.0 percent) (Table B.1b).

Among those with SMI, 65.4 percent were female, which was higher than the percentage of females among those without SMI (50.8 percent). Adults with SMI were more likely to have not completed high school (20.5 percent) than those without SMI (17.4 percent) and less likely to have graduated from college (17.5 percent) than those without SMI (25.7 percent). Although a similar proportion of adults with and without SMI were employed full or part time, persons with SMI were more likely to be unemployed or not in the labor force (36.4 percent) than were persons without SMI (31.2 percent).

Adults with SMI were less likely to be from large metropolitan areas (45.7 percent) than adults who did not have SMI (50.2 percent) (Table B.2b). There were no differences observed by geographic region.

 

3.2. Prevalence of Serious Mental Illness among Demographic and Socioeconomic Subgroups

Rates of SMI in the adult U.S. population varied by age and gender. Of the three age groups considered here, adults aged 18 to 25 had the highest rate of SMI (13.2 percent), followed by adults aged 26 to 49 (9.5 percent) and adults aged 50 or older (4.9 percent) (Table B.3b). Overall, the rate of SMI was almost twice as high among females (10.5 percent) as it was among males (6.0 percent). The rate of SMI by age and gender was highest for females aged 18 to 25 (16.3 percent) (Figure 1).

 

Figure 1. Serious Mental Illness among Adults Aged 18 or Older, by Age and Gender: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

Among racial and ethnic groups, adults reporting more than one race and American Indians and Alaska Natives had the highest prevalence of SMI (13.6 and 12.5 percent, respectively) (Table B.3b).

Prevalence rates of SMI did not vary significantly by geographic region. The rate was 8.5 percent in the Northeast and Midwest, 8.4 percent in the South, and 7.8 percent in the West (Table B.4b).

The prevalence of SMI varied by perceived health status and social support (Table B.5b). Adults who perceived their overall health as fair or poor were more than 3 times as likely to have SMI (16.9 percent) than those who perceived their health to be excellent (5.1 percent) (Figure 2). Likewise, those who reported no social support were about twice as likely to have SMI as those who reported social support (15.2 vs. 7.6 percent, respectively) (Figure 3).

Estimates of SMI by health insurance, marital status, and family income are only presented for persons aged 26 to 49. Among adults aged 26 to 49, divorced or separated adults were more than twice as likely to have SMI in the past year (16.0 percent) as married adults (7.1 percent) (Table B.5b, Figure 4).

 

Figure 2. Serious Mental Illness among Adults Aged 18 or Older, by Perceived Health Status: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Figure 3. Serious Mental Illness among Adults Aged 18 or Older, by Social Support: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Figure 4. Serious Mental Illness among Adults Aged 26 to 49, by Marital Status: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

SMI also varied with socioeconomic status (SES) among adults aged 26 to 49. In this age group, adults with lower SES were more likely to have SMI than those with higher SES (Table B.5b). The prevalence of SMI was highest among those with the lowest family income level (less than $20,000) at 16.3 percent and lowest among those with the highest income level ($75,000 or more) at 6.4 percent (Figure 5). Also, among adults aged 26 to 49, the prevalence of SMI was higher among persons with Medicaid coverage (20.7 percent) and lower among persons with private health insurance (8.1 percent) (Figure 6). Similarly, the SMI rate was higher among persons who were unemployed or had "other" employment status (i.e., not in the labor force)3 (14.2 and 15.5 percent, respectively) than among persons who worked full time (7.9 percent) (Table B.3b, Figure 7).

 

Figure 5. Serious Mental Illness among Adults Aged 26 to 49, by Family Income: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Figure 6. Serious Mental Illness among Adults Aged 26 to 49, by Health Insurance Status: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Figure 7. Serious Mental Illness among Adults Aged 26 to 49, by Current Employment Status: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

3.3. Serious Mental Illness and Substance Use

In this section, the characteristics of persons with SMI who used and did not use illicit drugs are compared. In addition, the prevalence rates of SMI are presented for persons using specific types of illicit drugs, heavy alcohol users, and cigarette users.

 

3.3.1 Serious Mental Illness and Illicit Drug Use

 

3.3.1.1 Characteristics of Adults with Serious Mental Illness and Illicit Drug Use

In 2002, there were 5 million adults aged 18 or older who had SMI and used an illicit drug in the past year (Table B.6a, Figure 8). This represented 28.9 percent of all persons with SMI. Adults with SMI who used illicit drugs were younger than those with SMI who did not use illicit drugs. Among adults with SMI and illicit drug use, 38.8 percent were 18 to 25 years old compared with 17.1 percent of persons with SMI but no illicit drug use; also, 7.2 percent of adults with SMI and illicit drug use were aged 50 or older compared with 28.2 percent with SMI but no illicit drug use (Table B.6b).

Adults with SMI who used illicit drugs in the past year were more likely to be male than those with SMI who did not use illicit drugs (45.1 vs. 30.3 percent). They also were more likely to be in the labor force than those with SMI but no illicit drug use: 67.0 percent of adults with SMI and past year illicit drug use were employed full or part time compared with 62.2 percent of those with SMI only, and 10.8 percent were unemployed compared with 4.3 percent of adults with SMI only. Consequently, adults with SMI only were more likely to be out of the labor force (33.5 percent) than those who had SMI and used an illicit drug in the past year (22.2 percent).

 

Figure 8. Serious Mental Illness and Past Year Illicit Drug Use among Adults Aged 18 or Older: 2002

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Note: Circles are not drawn to scale.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

3.3.1.2 Prevalence of Serious Mental Illness among Illicit Drug Users

SMI is correlated with illicit drug use. The prevalence of SMI was more than twice as high among those who used an illicit drug during the past year than it was among those who did not (17.1 vs. 6.9 percent). This relationship was observed across most demographic and socioeconomic subgroups (Tables B.8b and B.9b).

The prevalence of SMI varied by the type of substance used. The rate of SMI was 16.7 percent among those who used marijuana, 20.5 percent among those who used any illicit drug other than marijuana, 22.0 percent among those who used cocaine, and 29.9 percent among those who used crack cocaine (Table B.10b, Figure 9). For those who used hallucinogens, the SMI rate was 19.7 percent, and for inhalants, it was 20.6 percent. For all nonmedical use of psychotherapeutics, the rate of SMI was 21.8 percent; the rate of SMI was 33.6 percent for those who used sedatives, 28.8 percent for those who used stimulants, 26.5 percent for those who used tranquilizers, and 22.4 for those who used pain relievers. The rate for those who used methamphetamine was 31.8 percent.

 

3.3.2 Serious Mental Illness among Cigarette and Alcohol Users

The prevalence of SMI varied between past year cigarette smokers and nonsmokers, but no differences were observed between past year alcohol users and nonusers. The rate of SMI was 13.0 percent among adults who smoked cigarettes in the past year and 6.1 percent among those who did not smoke (Table B.11b, Figure 9). Although the rate of SMI did not vary by past year alcohol use (8.5 percent for users vs. 8.0 percent for nonusers), adults who were heavy alcohol users in the past month were more likely to have SMI than those who were not heavy alcohol users in the past month (11.1 vs. 8.1 percent).

 

Figure 9. Serious Mental Illness, by Type of Substance Used among Adults Aged 18 or Older: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

3.4. Serious Mental Illness and a Co-Occurring Substance Use Disorder

In this section, adults with SMI are classified by whether or not they had a substance use disorder, that is, whether they were dependent on or abused alcohol or illicit drugs. Those with SMI and a substance use disorder are further classified by whether they were dependent on or abused alcohol only, illicit drugs only, or both illicit drugs and alcohol.

In 2002, there were 33.2 million adults aged 18 or older with SMI or a substance use disorder (Table B.12a). Of these adults, 13.4 million (40.4 percent) had SMI but no substance use disorder (SMI only), 15.7 million (47.4 percent) had a substance use disorder but no SMI (substance use disorder only), and 4.0 million (12.2 percent) had both SMI and a substance use disorder (i.e., co-occurring disorders) (Table B.12b, Figure 10).

 

Figure 10. Co-Occurrence of Serious Mental Illness and Substance Use Disorders among Adults Aged 18 or Older: 2002

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Note: Circles are not drawn to scale.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

The 4.0 million adults with SMI and a co-occurring substance use disorder represented 23.2 percent of all adults with SMI (Table B.13b) and 20.4 percent of all adults with a substance use disorder in 2002 (Table B.16b). Among these adults with SMI and a substance use disorder, 0.9 million were dependent on or abused illicit drugs only, 2.4 million were dependent on or abused alcohol only, and 0.8 million were dependent on or abused alcohol and illicit drugs (Table B.13a, B.13b, and B.16b, Figure 11).

The 17.5 million adults with SMI in 2002 can be examined as to whether they had a substance use disorder in the past year and by whether they used illicit drugs. As previously mentioned, there were 4.0 million adults with SMI who had a substance use disorder. Thus, 13.4 million adults with SMI (76.8 percent) did not have a substance use disorder. Among these adults with SMI but without a substance use disorder, 2.3 million used an illicit drug in the past 12 months and 11.1 million did not (Figure 12).

 

3.4.1 Characteristics of Adults with Co-Occurring Serious Mental Illness and a Substance Use Disorder

In 2002, adults with SMI and a substance use disorder were more likely to be younger and more likely to be male than adults with SMI but no substance use disorder. Among adults with SMI and a substance use disorder, 36.3 percent were aged 18 to 25 compared with 19.5 percent among adults with SMI but no substance use disorder. The percentage of males among adults with SMI and a substance use disorder was higher than the corresponding percentage among adults with SMI but no substance use disorder (52.1 vs. 29.3 percent) (Table B.14b).

 

Figure 11. Type of Substance Use Disorder among Adults Aged 18 or Older with Both Serious Mental Illness and a Co-Occurring Substance Use Disorder: Numbers in Thousands, 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

Adults with SMI and a substance use disorder were more likely to be in the labor force than those with SMI only: 69.0 percent of adults with SMI and a substance use disorder were employed full or part time compared with 62.0 percent of those with SMI but no substance use disorder, and 10.1 percent were unemployed compared with 5.0 percent of adults with SMI but no substance disorder. Thus, adults with SMI but no substance disorder were more likely to be out of the labor force (33.1 percent) than adults with SMI and a substance use disorder (20.9 percent) (Table B.14b).

Among adults with SMI, the comparison of the socioeconomic and demographic characteristics between those with and without a substance use disorder is strikingly similar to the comparison in Section 3.3.1.1 between those who used and did not use illicit drugs (Table B.6b).

 

Figure 12. Substance Use Disorders and Illicit Drug Use among Adults Aged 18 or Older with Serious Mental Illness: Numbers in Thousands, 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

3.4.2 Prevalence of Serious Mental Illness among Adults with a Substance Use Disorder

The prevalence of SMI among adults with a substance use disorder varied by age and gender. Among persons with any illicit drug or alcohol dependence or abuse, women had a higher prevalence of SMI than men (30.3 vs. 15.7 percent), and women aged 26 to 49 had the highest rate of SMI (32.2 percent) (Table B.16b).

Rates of SMI were relatively low (7.0 percent) among adults who did not have a substance use disorder (Table B.17b, Figure 13). The rate was much higher among those with alcohol dependence or abuse (19.0 percent) and was even higher among those with illicit drug dependence or abuse (29.1 percent). The rate of SMI was highest among adults who met the criteria for both drug and alcohol dependence or abuse (30.1 percent).

The rate of SMI among adults with dependence on or abuse of an illicit drug other than marijuana (33.4 percent) was higher than the rate for those with illicit drug dependence or abuse (29.1 percent) and the rate for those with marijuana dependence or abuse (27.3 percent) (Table B.17b).

 

Figure 13. Serious Mental Illness among Adults Aged 18 or Older, by Substance Dependence or Abuse: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

3.5. Multiple Logistic Regression Models for Serious Mental Illness

The estimated strength of the associations between past year SMI with past year use of illicit drugs, illicit drug dependence or abuse, alcohol dependence or abuse, and socioeconomic and demographic characteristics was determined via a multiple logistic regression model. SMI was the dependent variable, and the other characteristics were the independent variables.

Possible confounding variables are variables in the model other than the independent variable of interest that are believed to be associated with both the dependent variable and the independent variables of interest. Adjusted odds ratios (Ores) denote the estimated association between SMI and a particular category of a variable while controlling for possible confounding variables. This section discusses the associations between SMI and characteristics believed to be associated with SMI in terms of their Ores. (See Appendix A, Section A.5.4, for a discussion of logistic modeling and the interpretation of adjusted Ores.)

Several sociodemographic variables were associated with SMI according to the descriptive analyses that also were associated with SMI based on their adjusted Ores. These variables included age, gender, race/ethnicity, marital status, perceived overall health, and social support. The Ores indicated that compared with adults aged 50 or older, adults aged 18 to 25 and adults aged 26 to 49 were more likely to have SMI in the past year (OR = 2.5 and 2.3, respectively) (Table B.M1). Females were more than twice as likely as males to have SMI. Compared with non-Hispanic whites, non-Hispanic blacks (OR = 0.7) and Hispanics (OR = 0.6) were less likely to have had SMI (Table B.M1).

The Ores for the levels of perceived health demonstrate that the more poorly persons perceived their health to be, the more likely they were to have had SMI. Compared with adults who perceived their health as excellent, adults who perceived their health as fair or poor (OR = 4.1), those who perceived their health as good (OR = 1.9), and those who perceived their health as very good (OR = 1.3) were more likely to have had SMI (Table B.M1).

SMI was highly correlated with illicit drug dependence or abuse and with alcohol dependence or abuse. It also was significantly associated with nicotine (cigarette) dependence. The Ores for use and for dependence on or abuse of illicit drugs show that adults with any illicit drug dependence or abuse in the past year were more likely to have SMI than adults with no illicit drug use in the past year (OR = 2.8) and than adults with illicit drug use but no dependence or abuse (OR = 1.9 calculated by dividing 2.75 by 1.43) (Table B.M1). Adults with past year illicit drug use who were not dependent on or abusing illicit drugs were more likely to have SMI in the past year than adults with no illicit drug use (OR = 1.4). The Ores for alcohol use and for dependence on or abuse of alcohol show that adults with alcohol dependence or abuse were more likely to have SMI than adults with no alcohol use (OR = 1.8) and more likely to have SMI than adults who used alcohol but who had no dependence or abuse (OR = 2.0 calculated by dividing 1.77 by 0.89). Adults with nicotine (cigarette) dependence in the past year had higher odds of having SMI than those without nicotine (cigarette) dependence (OR = 1.5).

 

4. Mental Health Treatment and Substance Use Treatment

This chapter presents national estimates from the 2002 National Survey on Drug Use and Health (NSDUH) of the past year prevalence of mental health treatment and substance use treatment among adults with serious mental illness (SMI) and a substance use disorder. The social and demographic characteristics of adults with SMI who received mental health treatment are compared with those who did not receive mental health treatment. Prevalence rates of mental health treatment among adults with SMI by social and demographic characteristics also are presented. Estimates of mental health treatment are given for adults with SMI according to whether they used illicit drugs. Estimates of the prevalence of mental health treatment and/or specialty substance use treatment in 2002 also are presented for adults aged 18 or older with SMI and a substance use disorder, with SMI but no substance use disorder, and with a substance use disorder but no SMI. The prevalence of mental health treatment for those with SMI co-occurring with a substance use disorder is compared with the prevalence among those with SMI but no substance use disorder. Similarly, the prevalence of specialty substance use treatment for those with SMI co-occurring with a substance use disorder is compared with those having a substance use disorder but no SMI.

 

4.1. Mental Health Treatment among Adults with Serious Mental Illness

 

4.1.1 Characteristics of Adults with Serious Mental Illness, by Receipt of Mental Health Treatment in the Past Year

In 2002, an estimated 8.4 million of the 17.5 million adults with SMI received mental health treatment in the 12 months prior to their interview (Table B.18a). When compared with adults with SMI who did not receive treatment, those who did receive treatment were more likely to belong to the following sociodemographic groups: aged 26 or older, female, non-Hispanic whites, and college graduates. About 62 percent of adults with SMI who received treatment were 26 to 49 years of age compared with about 48 percent of those who did not receive treatment. Females accounted for 71.6 percent of those who received treatment and 59.9 percent of those who did not receive treatment. Non-Hispanic whites made up 78.4 percent of those who received treatment and 66.6 percent of those who did not (Table B.18b). An estimated 21 percent of adults with SMI who received treatment were college graduates compared with 14 percent of those who had not received treatment. Adults with SMI who received treatment were more likely than those who did not to be from small metropolitan counties (34.5 vs. 29.3 percent, respectively), but there were no significant differences by geographic region.

 

4.1.2 Rates of Mental Health Treatment among Adults with Serious Mental Illness, by Sociodemographic Characteristics

In 2002, an estimated 47.9 percent of adults with SMI received mental health treatment in the 12 months prior to their interview (Table B.19b). The prevalence of mental health treatment among adults with SMI varied by demographic, social, and health characteristics. Among adults with SMI, those aged 26 to 49 had the highest rate of mental health treatment of any age group (54.4 percent) (Figure 14). The rates of mental health treatment among adults with SMI were 46.4 percent for adults aged 50 or older and 34.2 percent for those aged 18 to 25. Females with SMI were more likely than males with SMI to receive mental health treatment (52.3 vs. 39.5 percent, respectively) (Figure 15). More than half of white non-Hispanics with SMI received mental health treatment (51.9 percent) (Figure 16). In comparison, fewer than 40 percent of black non-Hispanics and Hispanics with SMI received mental health treatment (36.9 and 37.8 percent, respectively).

 

Figure 14. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by Age: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

In 2002, the prevalence of mental health treatment was 48.7 percent for adults with SMI who received social support and 44.0 percent for adults with SMI who did not receive social support (Table B.20b). Adults with SMI who perceived their health as poorer had higher rates of mental health treatment than those who perceived their health to be better. The rate of mental health treatment was highest at 56.0 percent for those with SMI who perceived their health as fair/poor and lowest at 38.7 percent for those who perceived their health as excellent (Figure 17).

Estimates of treatment by health insurance and marital status are presented for persons aged 26 to 49. Among adults aged 26 to 49 years of age with SMI in the past 12 months, rates of mental health treatment varied by health insurance and by marital status (Table B.20b). Those who received Medicaid were more likely to have received mental health treatment in the past 12 months (65.1 percent) than those who had no insurance coverage (37.1 percent) (Figure 18).

 

Figure 15. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by Gender: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Figure 16. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by Race/Ethnicity: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Figure 17. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by Perceived Health Status: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

The rate of mental health treatment among persons aged 26 to 49 who were divorced or separated (61.9 percent) was higher than the rate among those who were never married (42.9 percent) (Figure 19).

There was very little regional variation in the prevalence of mental health treatment among adults aged 18 or older with SMI. Rates by geographic region were 50.7 percent in the Northeast, 47.5 percent in the Midwest and South, and 46.3 percent in the West (Table B.21b). By county type, rates of treatment were highest among persons from small metropolitan areas (52.0 percent); rates were similar for large metropolitan areas and nonmetropolitan areas (46.1 and 45.7 percent, respectively) (Figure 20).

 

Figure 18. Mental Health Treatment among Adults Aged 26 to 49 with Serious Mental Illness, by Health Insurance Status: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Figure 19. Mental Health Treatment among Adults Aged 26 to 49 with Serious Mental Illness, by Marital Status: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Figure 20. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental Illness, by County Type: 2002

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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

4.1.3 Mental Health Treatment among Adults with Serious Mental Illness Who Did and Did Not Use Illicit Drugs

Among adults with SMI in 2002, the prevalence of mental health treatment did not differ significantly by illicit drug use in the past 12 months. Among the 17.5 million adults who had SMI, 46.0 percent of those using an illicit drug and 48.7 percent of those not using an illicit drug received mental health treatment in the past 12 months (Tables B.22a and B.22b).

 

4.2. Use of Treatment Services among Adults with Serious Mental Illness and/or a Co-Occurring Substance Use Disorder

This section discusses the prevalence of mental health treatment and specialty substance use treatment received in the past 12 months by three groups: adults who had SMI but no substance use disorder (SMI only), adults who had a substance use disorder but no SMI (substance use disorder only), and adults who had both SMI and a substance use disorder in 2002. Persons with a substance use disorder are those classified as dependent on or abusing alcohol and/or illicit drugs. Mental health treatment for adults with only SMI is described first. Specialty substance use treatment for adults with only a substance use disorder is described next, followed by mental health and specialty substance use treatment for those with both SMI and a substance use disorder. Comparisons of the rates of mental health treatment are made between those with only SMI and those with both SMI and a substance use disorder. Similar comparisons are made for receipt of specialty substance use treatment between adults with only a substance use disorder and with both SMI and a substance use disorder.

As previously noted in Section 3.4, there were 33.2 million adults with either SMI or a substance use disorder in 2002. This includes 13.4 million adults who had only SMI, 4.0 million adults with both SMI and a substance use disorder, and 15.7 million adults who had only a substance use disorder (Figure 10). Among adults with only SMI, almost half (48.4 percent) received mental health treatment in the past year (mental health treatment only, or both mental health and substance use treatment) (Tables B.23a and B.23b). Among adults with SMI and a substance use disorder, 46.0 percent (1.9 million) received mental health treatment, and 13.7 percent (0.6 million) received specialty substance use treatment. An estimated 11.8 percent of adults with SMI and a substance use disorder (0.5 million) received both types of treatment (Figure 21). The prevalence of specialty substance use treatment among adults with only a substance use disorder was 5.3 percent.

 

Figure 21. Mental Health Treatment and Substance Use Treatment at a Specialty Facility among Adults Aged 18 or Older with Serious Mental Illness and/or a Substance Use Disorder: 2002

     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

As previously described in Section 3.4 and Figure 11, among the 4.0 million adults with SMI and a substance use disorder, there were 0.9 million adults who were dependent on or abused illicit drugs only, 2.4 million who were dependent on or abused alcohol only, and 0.8 million who were dependent on or abused alcohol and illicit drugs. The prevalence of mental health treatment was 53.6 percent among those adults who had both SMI and were dependent on or abused only illicit drugs, but not alcohol (Table B.25b). This was higher than the prevalence of mental health treatment among those with SMI and dependence on or abuse of alcohol only (42.6 percent), but it was not significantly different from the prevalence of mental health treatment among adults with SMI and no substance use disorder (48.4 percent).

There was very little difference in the prevalence of mental health treatment in the past 12 months among adults with SMI who did or did not have a substance use disorder. Although not significant, the prevalence of mental health treatment was lower among adults with SMI and any substance use disorder than among those with only SMI (46.0 vs. 48.4 percent, respectively) (Table B.25b). However, the prevalence of past year specialty substance use treatment was higher among adults with SMI and a substance use disorder than among adults with only a substance use disorder (13.7 vs. 5.3 percent, respectively) (Figure 21).

The results also indicate that the rate of mental health treatment among adults with only SMI was roughly 9 times higher than the rate of specialty substance use treatment among adults with only a substance use disorder (48.4 vs. 5.4 percent) (Figure 21). Although about 48 percent of adults with both disorders received some type of treatment (mental health or specialty substance use treatment), only 11.8 percent of adults with both disorders received both types of services (Figures 21 and 22, Tables B.23a and B.23b). These results highlight the importance of treating more people who have co-occurring substance use and mental health disorders for both disorders. Similar results were obtained when the analysis was performed using any substance use treatment instead of specialty substance use treatment (Tables B.24a and B.24b).

 

Figure 22. Mental Health and Specialty Substance Use Treatment among Adults Aged 18 or Older with Both Serious Mental Illness and a Substance Use Disorder: 2002

     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

4.3. Multiple Logistic Regression Models

The estimated strength of the association between the receipt of mental health treatment among adults with SMI in the past year and various characteristics believed to influence receipt of mental health treatment was determined via multiple logistic regression procedures. Past year receipt of mental health treatment was the dependent variable in the model; any illicit drug or alcohol dependence or abuse, cigarette (nicotine) dependence, and various sociodemographic characteristics were among the independent variables in the model. Adjusted odds ratios (Ores) are presented. (See Appendix A, Section A.5.4, for a discussion of logistic modeling and the interpretation of adjusted Ores.)

The adjusted Ores from the logistic regression models, which controlled for confounding variables, confirmed that, among adults with SMI, the odds of receiving mental health treatment varied by age, gender, Hispanic origin and race, education, employment status, marital status, health insurance coverage, and perception of overall health. However, the odds of receiving mental health treatment among this group did not vary significantly based on geographic region, county type, family income, receipt of social support, nicotine dependence, or any illicit drug/alcohol dependence or abuse.

Examining the adjusted Ores from these models of receiving mental health treatment demonstrates that among adults with SMI, adults aged 26 to 49 were more likely to receive treatment than those aged 50 or older (OR = 1.7) (Table B.M2). No other age groups showed significant differences. With regard to gender and race/ethnicity, females were more likely to receive mental health treatment than men, with an OR of 1.6, and non-Hispanic whites were more likely to receive mental health treatment than any other category of Hispanic origin and race. (The Ores for each of these groups compared with whites are as follows: black or African American, 0.5; Hispanic or Latino, 0.7; and other or more than two races, 0.6.)

When comparisons were made with adults with SMI who graduated from college, those with SMI who did not graduate from high school were less likely to receive mental health treatment (OR = 0.44), as were those with SMI who were high school graduates but had no further education (OR = 0.55). However, the odds of receiving treatment did not vary significantly between adults with SMI who had some college and those who graduated from college.

Among adults with SMI, these models indicate that employment status had an effect on the odds of receiving mental health treatment. Those who were either employed part time or not in the labor force were more likely than those working full time to receive mental health treatment (Ores = 1.6 and 1.5, respectively). However, the odds of receiving treatment for those who were unemployed were not significantly different from those who were employed full time. Adults with SMI who were either divorced or separated were more likely to receive mental health treatment than those who were married (OR = 1.6) and those who had never married (OR = 2.0 calculated by dividing 1.60 by 0.81).

Among adults with SMI, those with private health insurance had twice the odds of receiving mental health treatment as those with no insurance. Similar results were obtained when comparing adults who received Medicaid or adults in the Children's Health Insurance Program (CHIP) with adults having no insurance.

These models also indicated that the perception of overall health status affected the odds of receiving mental health treatment for adults with SMI. When comparisons were made with adults with SMI who perceived their overall health as excellent, all other persons with SMI were more likely to receive mental health treatment. Those who perceived their health as fair or poor had an OR of 2.6, whereas those who perceived their overall health as either good or very good had Ores of 1.6 and 1.4, respectively.

The results of the modeling also showed that when controlling for confounding variables, illicit drug or alcohol dependence or abuse was not associated with receipt of mental health treatment among adults with SMI (image representing chi2 = 6.0).

 

4.4. Discussion

Results from the 2002 NSDUH signifying that individuals with a substance use disorder are more likely to receive specialty substance use treatment if they have a co-occurring SMI are consistent with results from the National Comorbidity Survey-Replication (NCS-R) and Communities Survey (U.S. Department of Health and Human Services, 1999).

 

5. Summary and Conclusions

According to the 2002 National Survey on Drug Use and Health (NSDUH), there were 17.5 million adults estimated to have a serious mental illness (SMI) in 2002, representing 8.3 percent of all adults in the United States. Adults with SMI were more likely to have each of the following demographic characteristics when compared with adults without SMI: they were younger, female, less educated, non-Hispanic white, unemployed, and not in the labor force. The prevalence of SMI was shown to vary by age, gender, race, education, and employment, as well as by perceived health, social support, marital status, and the use of specific substances. SMI was correlated with illicit drug use, and the prevalence of SMI varied by the type of illicit drug used.

Among adults with SMI, almost 30 percent (5.0 million adults) used illicit drugs. Adults with SMI who used illicit drugs in the past year were more likely than those not using illicit drugs to have each of the following characteristics: male, some college, and employed full or part time. Among adults with SMI who used illicit drugs in the past year, 2.3 million had no substance use disorder.

An estimated 4 million adults had SMI and a substance use disorder in 2002. There were 13.4 million adults with only SMI and 15.7 million adults with only a substance use disorder. The characteristics of adults with SMI and a substance use disorder were similar to the characteristics of adults with SMI and illicit drug use.

The adjusted odds ratios (Ores) from the modeling also showed that SMI is correlated with past year alcohol dependence or abuse, past year illicit drug dependence or abuse, and past year illicit drug use with no substance use disorder. The Chi-square tests of association from the modeling indicated that SMI also is associated with the following characteristics: age, gender, race/ethnicity, education, marital status, health insurance, perceived health, social support, and nicotine (cigarette) dependence.

Almost 50 percent of adults with SMI received mental health treatment. When compared with adults with SMI who did not receive treatment, adults with SMI who received treatment were more likely to belong to each of the following demographic subgroups: aged 26 to 49, female, non-Hispanic white, and college graduates. The past year prevalence of mental health treatment among adults with SMI was highest in each of the following subgroups: aged 26 to 49, female, non-Hispanic white, college graduates, and perceived health fair or poor. For adults aged 26 to 49 with SMI, the prevalence of mental health treatment was highest among those who received Medicaid and among those who were divorced or separated.

The prevalence of mental health treatment in the past year among adults with SMI but no substance use disorder was shown to be much higher than the prevalence of substance use treatment among adults with a substance use disorder but no SMI. In addition, adults with SMI but no substance use disorder were just as likely to receive mental health treatment as those with both SMI and a substance use disorder. However, adults with a substance use disorder and SMI were more likely to receive specialty substance use treatment than adults with a substance use disorder but no SMI. Only a small proportion of persons with SMI and a substance use disorder received both specialty substance use treatment and mental health treatment.

The modeling showed that, among adults with SMI, mental health treatment is associated with each of the following characteristics: age, gender, race, education, current employment, marital status, health insurance, and perceived health, after controlling for possible confounding variables.

 

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Appendix A: Description of the Survey, Limitations of the Data, and Statistical Methods

 

A.1. Sample Design

The 2002 National Survey on Drug Use and Health (NSDUH) sample design was part of a coordinated 5–year sample design that will provide estimates for all 50 States plus the District of Columbia for the years 1999 through 2003. The coordinated design facilitates 50 percent overlap in first-stage units (area segments) between each 2 successive years.

For the 5–year 50–State design, 8 States were designated as large sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas) with samples large enough to support direct State estimates. Sample sizes in these States ranged from 3,554 to 3,792. For the remaining 42 States and the District of Columbia, smaller, but adequate, samples were selected to support State estimates using small area estimation (SAE)4 techniques. Sample sizes in these States ranged from 6745 to 977 in 2002.

States were first stratified into a total of 900 field interviewer (FI) regions (48 regions in each large sample State and 12 regions in each small sample State). These regions were contiguous geographic areas designed to yield the same number of interviews on average. Within FI regions, adjacent census blocks were combined to form the first-stage sampling units, called area segments. A total of 96 segments per FI region were selected with probability proportional to population size in order to support the 5–year sample and any supplemental studies that the Substance Abuse and Mental Health Services Administration (SAMHSA) may choose to field.6 Eight sample segments per FI region were fielded during the 2002 survey year.

These sampled segments were allocated equally into four separate samples, one for each 3–month period during the year, so that the survey was essentially continuous in the field. In each of these area segments, a listing of all addresses was made, from which a sample of 178,013 addresses was selected. Of the selected addresses, 150,162 were determined to be eligible sample units. In these sample units (which could be either households or units within group quarters), sample persons were randomly selected using an automated screening procedure programmed in a handheld computer carried by the interviewers. The number of sample units completing the screening was 136,349. Youths (aged 12 to 17 years) and young adults (aged 18 to 25 years) were oversampled at this stage. Because of the large sample size associated with this sample, there was no need to oversample racial/ethnic groups, as was done on surveys7 prior to 1999. A total of 80,581 persons were selected nationwide. Consistent with previous surveys, the final respondent sample of 68,126 persons was representative of the U.S. general population (since 1991, the civilian, noninstitutionalized population) aged 12 or older. In addition, State samples were representative of their respective State populations. More detailed information on these topics can be found in the appendices of the 2002 NSDUH results report (Office of Applied Studies [OAS], 2003) as follows: (a) additional information on the disposition of the national screening and interview sample can be found in Appendix B, and (b) additional tables showing sample sizes and estimated population counts for various demographic and geographic subgroups are presented in Appendix G.

The survey covered residents of households (living in houses/townhouses, apartments, condominiums, etc.), noninstitutional group quarters (e.g., shelters, rooming/boarding houses, college dormitories, migratory workers' camps, halfway houses), and civilians living on military bases. Although the survey covered these types of units (they were given a nonzero probability of selection), sample sizes of most specific groups were too small to provide separate estimates. Persons excluded from the survey included homeless people who did not use shelters, active military personnel, and residents of institutional group quarters, such as correctional facilities, nursing homes, mental institutions, and long-term hospitals.

 

A.2. Data Collection Methodology

The data collection method used in NSDUH involved in-person interviews with sample persons, incorporating procedures that would be likely to increase respondents' cooperation and willingness to report honestly about their illicit drug use behavior. Confidentiality was stressed in all written and oral communications with potential respondents, respondents' names were not collected with the data, and computer-assisted interviewing (CAI) methods, including audio computer-assisted self-interviewing (ACASI), were used to provide a private and confidential setting to complete the interview.

Introductory letters were sent to sampled addresses, followed by an interviewer visit. A 5–minute screening procedure conducted using a handheld computer involved listing all household members along with their basic demographic data. The computer used the demographic data in a preprogrammed selection algorithm to select zero to two sample person(s), depending on the composition of the household. This selection process was designed to provide the necessary sample sizes for the specified population age groupings.

Interviewers attempted to immediately conduct the NSDUH interview with each selected person in the household. The interviewer requested the selected respondent to identify a private area in the home away from other household members to conduct the interview. The interview averaged about an hour and included a combination of CAPI (computer-assisted personal interviewing) and ACASI. The interview began in CAPI mode with the FI reading the questions from the computer screen and entering the respondent's replies into the computer. The interview then transitioned to the ACASI mode for the sensitive questions. In this mode, the respondent could read the questions silently on the computer screen and/or listen to the questions read through headphones and enter his or her responses directly into the computer. At the conclusion of the ACASI section, the interview returned to the CAPI mode with the interviewer completing the questionnaire. Each respondent who completed a full interview was given a $30 cash payment as a token of appreciation for his or her time.

No personal identifying information was captured in the CAI record for the respondent. At the end of the day when an interviewer had completed one or more interviews, he or she transmitted the data to RTI in Research Triangle Park, North Carolina, via home telephone lines.

 

A.3. Data Processing

Interviewers initiated nightly data transmissions of interview data and call records on days when they worked. Computers at RTI directed the information to a raw data file that consisted of one record for each completed interview. Even though editing and consistency checks were done by the CAI program during the interview, additional, more complex edits and consistency checks were completed at RTI. Cases were retained only if respondents provided data on lifetime use of cigarettes and at least nine other substances. An important aspect of subsequent editing routines involved assignment of codes when respondents legitimately skipped out of questions that definitely did not apply to them (e.g., if respondents never used a drug of interest). For key drug use measures, the editing procedures identified inconsistencies between related variables. Inconsistencies in variables pertaining to the most recent period that respondents used a drug were edited by assigning an "indefinite" period of use (e.g., use at some point in the lifetime, which could mean use in the past 30 days or past 12 months). Inconsistencies in other key drug use variables were edited by assigning missing data codes. These inconsistencies then were resolved through statistical imputation procedures, as discussed below.

 

A.3.1 Statistical Imputation

For some key variables that still had missing or ambiguous values after editing, statistical imputation was used to replace ambiguous or missing data with appropriate response codes. For example, the response was ambiguous if the editing procedures assigned a respondent's most recent use of a drug to "use at some point in the lifetime," with no definite period within the lifetime. In this case, the imputation procedures assigned a definite value for when the respondent last used the drug (e.g., in the past 30 days, more than 30 days ago but within the past 12 months, more than 12 months ago). Similarly, if the response was completely missing, the imputation procedures replaced missing values with nonmissing ones.

Missing or ambiguous values were imputed using a methodology called predictive mean neighborhoods (PMN), which was developed specifically for the survey in 1999. PMN is a combination of a model-assisted imputation methodology and a random nearest neighbor hot-deck procedure. Whenever feasible, the imputation of variables using PMN is multivariate, in which imputation is accomplished on several response variables at once. Variables requiring imputation were the core demographic variables, core drug use variables (recency of use, frequency of use, and age at first use), income, health insurance, and a variety of roster-derived variables. Variables such as treatment, dependence, abuse, and serious mental illness (SMI) were not imputed.

In the modeling stage of PMN, the model chosen depends on the nature of the response variable Y. In the 2002 NSDUH, the models included binomial logistic regression, multinomial logistic regression, Poisson regression, and ordinary linear regression, where the models incorporate the design weights.

In general, hot-deck imputation replaces a missing or ambiguous value taken from a "similar" respondent who has complete data. For random nearest neighbor hot-deck imputation, the missing or ambiguous value is replaced by a responding value from a donor randomly selected from a set of potential donors. Potential donors are those defined to be "close" to the unit with the missing or ambiguous value, according to a predefined function, called a distance metric. In the hot-deck stage of PMN, the set of candidate donors (the "neighborhood") consists of respondents with complete data who have a predicted mean close to that of the item nonrespondent. In particular, the neighborhood consists of either the set of the closest 30 respondents, or the set of respondents with a predicted mean (or means) within 5 percent of the predicted mean(s) of the item nonrespondent, whichever set is smaller. If no respondents are available who have a predicted mean (or means) within 5 percent of the item nonrespondent, the respondent with the predicted mean(s) closest to that of the item nonrespondent is selected as the donor.

In the univariate case, the neighborhood of potential donors is determined by calculating the relative distance between the predicted mean for an item nonrespondent and the predicted mean for each potential donor, then choosing those means defined by the distance metric. The pool of donors is further restricted to satisfy logical constraints whenever necessary (e.g., age at first crack use must not be younger than age at first cocaine use).

Whenever possible, missing or ambiguous values for more than one response variable are considered at a time. In this (multivariate) case, the distance metric is a Mahalanobis distance (Manly, 1986) rather than a relative Euclidean distance. Whether the imputation is univariate or multivariate, only missing or ambiguous values are replaced, and donors are restricted to be logically consistent with the response variables that are not missing. Furthermore, donors are restricted to satisfy "likeness constraints" whenever possible. That is, donors are required to have the same values for variables highly correlated with the response. If no donors are available that meet these conditions, these likeness constraints can be loosened. For example, donors for the age at first use variable are required to be of the same age as recipients, if at all possible. Further details on the PMN methodology are provided in RTI (2003) and Singh, Grau, and Folsom (2001, 2002).

Although statistical imputation could not proceed separately within each State due to insufficient pools of donors, information about each respondent's State of residence was incorporated in the modeling and hot-deck steps. For most drugs, respondents were separated into three "State usage" categories as follows: respondents from States with high usage of a given drug were placed in one category, respondents from States with medium usage into another, and the remainder into a third category. This categorical "State rank" variable was used as one set of covariates in the imputation models. In addition, eligible donors for each item nonrespondent were restricted to be of the same State usage category (i.e., the same "State rank") as the nonrespondent.

 

A.3.2 Development of Analysis Weights

The general approach to developing and calibrating analysis weights involved developing design-based weights, dk, as the inverse of the selection probabilities of the households and persons. Adjustment factors, ak (image representing lambda), then were applied to the design-based weights to adjust for nonresponse, to poststratify to known population control totals, and to control for extreme weights when necessary. In view of the importance of State-level estimates with the 50–State design, it was necessary to control for a much larger number of known population totals. Several other modifications to the general weight adjustment strategy that had been used in past surveys also were implemented for the first time beginning with the 1999 CAI sample.

Weight adjustments were based on a generalization of Deville and Särndal's (1992) logit model. This generalized exponential model (GEM) (Folsom & Singh, 2000) incorporates unit-specific bounds (image representing script lk, uk), kimage representing elements, for the adjustment factor ak (image representing lambda) as follows:

 

     D

where ck are prespecified centering constants, such that image representing script lk < ck < uk and Ak = (uk - image representing script lk) / (uk - ck)(ck - image representing script lk). The variables image representing script lk, ck, and uk are user-specified bounds, and image representing lambda is the column vector of p model parameters corresponding to the p covariates x. The image representing lambda-parameters are estimated by solving

 

     D

where image representing cap T tilde sub x denotes control totals that could be either nonrandom, as is generally the case with poststratification, or random, as is generally the case for nonresponse adjustment.

The final weights wk = dkak(image representing lambda) minimized the distance function delta(w,d) defined as

 

     D

This general approach was used at several stages of the weight adjustment process, including (1) adjustment of household weights for nonresponse at the screener level, (2) poststratification of household weights to meet population controls for various demographic groups by State, (3) adjustment of household weights for extremes, (4) poststratification of selected person weights, (5) adjustment of person weights for nonresponse at the questionnaire level, (6) poststratification of person weights, and (7) adjustment of person weights for extremes.

Every effort was made to include as many relevant State-specific covariates (typically defined by demographic domains within States) as possible in the multivariate models used to calibrate the weights (nonresponse adjustment and poststratification steps). Because further subdivision of State samples by demographic covariates often produced small cell sample sizes, it was not possible to retain all State-specific covariates (even after meaningful collapsing of covariate categories) and still estimate the necessary model parameters with reasonable precision. Therefore, a hierarchical structure was used in grouping States with covariates defined at the national level, at the census division level within the Nation, at the State-group within census division, and, whenever possible, at the State level. In every case, the controls for total population within State and the six age groups (12–17, 18–25, 26–34, 35–49, 50–64, 65+) within State were maintained. Census control totals by age, race, gender, and Hispanicity were required for the civilian, noninstitutionalized population of each State. The Population Estimates Branch of the U.S. Bureau of the Census produced the necessary population estimates in response to a special request based on the 2000 census. Because of the additional multiple race category in the 2000 census, it was possible to include an extra level for the race variable used in weight calibration both at the household and person levels.

Consistent with the surveys from 1999 onward, control of extreme weights through separate bounds for adjustment factors was incorporated into the GEM calibration processes for both nonresponse and poststratification. This is unlike the traditional method of winsorization in which extreme weights are truncated at prespecified levels and the trimmed portions of weights are distributed to the nontruncated cases. In GEM, it is possible to set bounds around the prespecified levels for extreme weights, and then the calibration process provides an objective way of deciding the extent of adjustment (or truncation) within the specified bounds. A step was added to poststratify the household-level weights to obtain census-consistent estimates based on the household rosters from all screened households; these household roster-based estimates then provided the control totals needed to calibrate the respondent pair weights for subsequent planned analyses. An additional step poststratified the selected person sample to conform to the adjusted roster estimates. This additional step took advantage of the inherent two-phase nature of the NSDUH design. The final step poststratified the respondent person sample to external census data (defined within State whenever possible as discussed above). For more detailed information, see the 2001 NHSDA Methodological Resource Book (RTI, 2003).

 

A.4. Target Population

An important limitation of estimates of drug use prevalence from NSDUH was that they were only designed to describe the target population of the survey—the civilian, noninstitutionalized population aged 12 or older. Although this population included almost 98 percent of the total U.S. population aged 12 or older, it excluded some important and unique subpopulations that may have very different drug use patterns. For example, the survey excluded active military personnel, who have been shown to have significantly lower rates of illicit drug use. Persons living in institutional group quarters, such as prisons and residential drug treatment centers, were not included in NSDUH and have been shown in other surveys to have higher rates of illicit drug use. Also excluded were homeless persons not living in a shelter on the survey date, another population shown to have higher than average rates of illicit drug use.

 

A.5. Sampling Error and Statistical Significance

The national estimates, along with the associated variance components, were computed using a multiprocedure package, SUrvey DAta ANalysis (SUDAAN®) Software for Statistical Analysis of Correlated Data, which was designed for the statistical analysis of sample survey data from stratified, multistage cluster samples (RTI, 2001). The final, nonresponse-adjusted, and poststratified analysis weights were used to compute unbiased design-based drug use estimates.

The sampling error (i.e., the standard error [SE]) of an estimate is the error caused by the selection of a sample instead of conducting a census of the population. Sampling error is reduced by selecting a large sample and by using efficient sample design and estimation strategies, such as stratification, optimal allocation, and ratio estimation.

With the use of probability sampling methods in NSDUH, it was possible to develop estimates of sampling error from the survey data. These estimates were calculated in SUDAAN for all estimates presented in this report using a Taylor series linearization approach that takes into account the effects of the complex NSDUH design features. The sampling errors were used to identify unreliable estimates and to test for the statistical significance of differences between estimates.

 

A.5.1 Variance Estimation for Totals

Estimates of proportions, image representing P hat sub d, such as prevalence rates for serious mental illness (SMI), take the form of nonlinear statistics where the variances cannot be expressed in closed form. Variance estimation for nonlinear statistics in SUDAAN is performed using a first-order Taylor series approximation of the deviations of estimates from their expected values.

Corresponding to proportion estimates, image representing P hat sub d, the number of persons with SMI, image representing cap Y hat sub d, could be estimated as

 

     D

where image representing cap N hat sub d is the estimated population total for domain d, and image representing P hat sub d is the estimated proportion for domain d. The SE for the total estimate was obtained by multiplying the SE of the proportion by image representing cap N hat sub d, that is,

 

     D

This approach is theoretically correct when the domain size estimates, image representing cap N hat sub d, are among those forced to U.S. Bureau of the Census population projections through the weight calibration process. In these cases, image representing cap N hat sub d is clearly not subject to sampling error. For a more detailed explanation of the weight calibration process, see Section A.3.2.

For domain totals, image representing cap Y hat sub d, where image representing cap N hat sub d is not fixed, this formulation may still provide a good approximation if it can be reasonably assumed that the sampling variation in image representing cap N hat sub d is negligible relative to the sampling variation in image representing P hat sub d. This is a reasonable assumption in most cases.

For a subset of the tables produced from the 2002 data, it was clear that the above approach yielded an underestimate of the variance of a total because image representing cap N hat sub d was subject to considerable variation. In these cases, a different method was used to estimate variances. SUDAAN provides an option to directly estimate the variance of the linear statistic that estimates a population total. Using this option did not affect the SE estimates for the corresponding proportions presented in the same sets of tables.

 

A.5.2 Suppression Criteria for Unreliable Estimates

As has been done in past reports from the survey, direct survey estimates from the 2002 NSDUH considered to be unreliable due to unacceptably large sampling errors are not shown in this report and are noted by asterisks (*) in the tables containing such estimates. The criteria used for suppressing all direct survey estimates were based on the relative standard error (RSE), which is defined as the ratio of the standard error (SE) over the estimate, as well as on nominal sample size and on effective sample size.

Proportion estimates (image representing p hat) within the range [0 < image representing p hat < 1], rates, and corresponding estimated number of users were suppressed if

RSE[-ln(image representing p hat)] > 0.175 when image representing p hat less than or equal to 0.5

or

RSE[-ln(1 - image representing p hat)] > 0.175 when image representing p hat > 0.5.     D

Using a first-order Taylor series approximation to estimate RSE[-ln(image representing p hat)] and RSE[-ln(1 - image representing p hat)], the following was obtained and used for computational purposes:

 

Equation

or

     D

The separate formulas for image representing p hat image representing less than or equal to 0.5 and image representing p hat > 0.5 produce a symmetric suppression rule (i.e., if image representing p hat is suppressed, then 1 - image representing p hat will be as well). This ad hoc rule requires an effective sample size in excess of 50. When 0.05 < image representing p hat < 0.95, the symmetric property of the rule produces a local maximum effective sample size of 68 at image representing p hat = 0.5. Thus, estimates with these values of image representing p hat along with effective sample sizes falling below 68 were suppressed. See Figure A.1 for a graphical representation of the required minimum effective sample sizes as a function of the proportion estimated.

A minimum nominal sample size suppression criterion (n = 100) that protects against unreliable estimates caused by small design effects and small nominal sample sizes was employed. Prevalence estimates also were suppressed if they were close to 0 or 100 percent (i.e., if image representing p hat < .00005 or if image representing p hat greater than or equal to .99995).

Figure A.1 Required Effective Sample as a Function of the Proportion Estimated

     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

The suppression criteria for NSDUH estimates used in this report are summarized in Table A.1 at the end of this appendix.

 

A.5.3 Statistical Significance of Differences

This section describes the methods used to compare prevalence estimates in this report. Customarily, the observed difference between estimates is evaluated in terms of its statistical significance. "Statistical significance" refers to the probability that a difference as large as that observed would occur due to random error in the estimates if there were no difference in the prevalence rates for the population groups being compared. The significance of observed differences in this report was generally reported at the 0.05 and 0.01 levels. When comparing prevalence estimates, the null hypothesis (no difference between prevalence rates) was tested against the alternative hypothesis (there is a difference in prevalence rates) using the standard difference in proportions test expressed as follows:

 

     D

where image representing P hat sub 1 = first prevalence estimate, image representing P hat sub 2 = second prevalence estimate, var(image representing P hat sub 1) = variance of first prevalence estimate, var(image representing P hat sub 2) = variance of second prevalence estimate, and cov(image representing P hat sub 1, image representing P hat sub 2) = covariance between image representing P hat sub 1 and image representing P hat sub 2.

Under the null hypothesis, Z is asymptotically distributed as a normal random variable. Calculated values of Z can therefore be referred to as the unit normal distribution to determine the corresponding probability level (i.e., p value). The covariance term in the formula for Z will not always be 0. Estimates of Z, along with its p value, were calculated in SUDAAN, using the analysis weights and accounting for the sample design as described in Section A.1. A similar procedure and formula for Z were used for estimated totals.

When comparing prevalence measures between population subgroups, a image representing chi2 test of independence of the subgroup and the prevalence variable was conducted first to control the error level for multiple comparisons. If the image representing chi2 test indicated some significant differences, the significance of each particular subgroup comparison discussed in the report was tested using SUDAAN. Using the published estimates and Sees to perform independent t tests for the difference of proportions will usually provide the same results as tests performed in SUDAAN. However, where the significance level is borderline, results may differ for two reasons: (1) the covariance term is included in SUDAAN tests whereas it is not included in independent t tests, and (2) the reduced number of significant digits shown in the published estimates may cause rounding errors in the independent t tests.

 

A.5.4 Logistic Regression Models and Statistical Significance of Odds Ratios

Because SMI is a binary response variable, one approach to investigate the relationship between SMI and several potential predictor variables (e.g., age, race) is through a logistic regression model. Consider an example where Y is a binary response variable (i.e., coded as 0 or 1) and there are two predictor variables, one continuous and one categorical (consisting of k + 1 groups). Then a logistic regression model expressing the relationship between Y (specifically, the proportion of times that Y = 1) and the two predictor variables can be written as

 

     D

where p(x) represents the probability that Y = 1, given x = (image representing chi1, image representing chi21,...,image representing chi2k)′, x1 represents the continuous predictor variable with its corresponding parameter image representing beta, and x21,...,x2k represent the k contrasts of the categorical predictor variable with their corresponding parameters image representing gamma1,...,image representing gammak.

A simple transformation of the response variable changes this model to the more convenient form of a linear model, as follows:

 

     D

Thus, in the transformed (or logit) scale, this model has many of the properties associated with linear models, although the interpretation of the parameters is not as straightforward. The "intercept" parameter alpha, is typically not of much interest. The "slope" parameter image representing beta, corresponding to the continuous predictor variable image representing chi1, represents the change in logit (p(x)) for a unit increase in image representing chi1 (with image representing chi21,...,image representing chi2k held constant), but this does not have immediate intuitive appeal. However, it can be shown that

 

     D

which is a ratio of the odds that Y = 1, given image representing chi1 + 1,image representing chi21,...,image representing chi2k, over the odds that Y = 1, given image representing chi1,image representing chi21,...,image representing chi2k. So, for example, if Y represents SMI and image representing chi1 represents the continuous variable age, then the odds of SMI occurring are increased/decreased by the odds ratio, exp(image representing beta) for each year of increase in age (with all other variables held constant). The odds are increased if image representing beta > 0 (i.e., exp(image representing beta) > 1) and are decreased if image representing beta < 0 (i.e., exp(image representing beta) < 1).

The categorical contrast parameters image representing gamma1,...,image representing gammak, require a slightly different interpretation. The contrast variables, image representing chi21,...,image representing chi2k, are first constructed as follows: A reference group is specified from among the k +1 groups of the categorical predictor variable. Then k contrast variables are created so that the ith contrast variable represents a contrast between the ith nonreference group and the reference group, for i = 1,…,k. The odds ratio, exp(image representing gammai), then represents the increase or decrease in the odds that Y = 1 given nonreference group i, over the odds that Y = 1 given the reference group (with all other variables held constant). In addition, for any categorical predictor variable for which k greater than or equal to 2, a Wald F-statistic (with k degrees of freedom) is also used to test the overall effect of this predictor variable. For example, if Y represents SMI, the predictor variable race is categorized into four groups (i.e., k = 3), and whites are specified as the reference group, then the model will have three contrast variables representing contrasts between the three nonwhite race groups and whites. And, the odds of SMI occurring are increased or decreased by the odds ratio, exp(image representing gammai), as the ith nonwhite race group is compared against the white race group (with all other variables held constant). Because k = 3, a Wald F-statistic (with three degrees of freedom) also will be used to test the overall effect of the race predictor variable.

Several of the logistic regression models fitted with SMI as a response variable included multiple predictor variables, most of them categorical. For categorical predictor variables with two or more contrasts, individual contrasts were reported only if the overall Wald F-test of that predictor variable was significant at the 0.05 level. The purpose of this was to attempt to keep the Type I (i.e., false positive) error rate as close as possible to the nominal level of alpha = 0.05.

 

A.6. Nonsampling Error

Nonsampling errors can occur from nonresponse, coding errors, computer processing errors, errors in the sampling frame, reporting errors, and other errors not due to sampling. Nonsampling errors are reduced through data editing, statistical adjustments for nonresponse, close monitoring and periodic retraining of interviewers, and improvement in various quality control procedures.

Although nonsampling errors often can be much larger than sampling errors, measurement of most nonsampling errors is difficult or impossible. However, some indication of the effects of some types of nonsampling errors can be obtained through proxy measures, such as response rates and from other research studies.

 

A.6.1 Screening and Interview Response Rate Patterns

In 2002, response rates were improved over prior years by providing respondents with a $30 incentive. Of the 150,162 eligible households sampled for the 2002 NSDUH main study, 136,349 were successfully screened, for a weighted screening response rate of 90.7 percent (Table A.2). In these screened households, a total of 80,581 sample persons were selected, and completed interviews were obtained from 68,126 of these sample persons, for a weighted interview response rate of 78.6 percent (Table A.3). A total of 7,583 (13.3 percent) sample persons were classified as refusals or parental refusals, 3,252 (4.5 percent) were not available or never at home, and 1,620 (3.7 percent) did not participate for various other reasons, such as physical or mental incompetence or language barrier (see Table A.3, which also shows the distribution of the selected sample by interview code and age group). The weighted interview response rate was highest among 12 to 17 year olds (90.0 percent), females (80.0 percent), blacks and Hispanics (82.2 and 80.9 percent, respectively), in nonmetropolitan areas (81.4 percent), and among persons residing in the Midwest and the South (both at 80.0 percent) (Table A.4).

The overall weighted response rate, defined as the product of the weighted screening response rate and weighted interview response rate, was 71.3 percent in 2002. Nonresponse bias can be expressed as the product of the nonresponse rate (1–R) and the difference between the characteristic of interest between respondents and nonrespondents in the population (Pr - Pnr). Thus, assuming the quantity (Pr - Pnr) is fixed over time, the improvement in response rates in 2002 over prior years will result in estimates with lower nonresponse bias.

 

A.6.2 Inconsistent Responses and Item Nonresponse

Among survey participants, item response rates were above 99 percent for most questionnaire items. However, inconsistent responses for some items, including the drug use items, were common. Estimates of substance use from NSDUH are based on responses to multiple questions by respondents, so that the maximum amount of information is used in determining whether a respondent is classified as a drug user. Inconsistencies in responses were resolved through a logical editing process that involved some judgment on the part of survey analysts and can be a potential source of nonsampling error.

 

A.6.3 Validity of Self-Reported Use

NSDUH estimates are based on self-reports of drug use, and their value depends on respondents' truthfulness and memory. Although many studies have generally established the validity of self-report data and the NSDUH procedures were designed to encourage honesty and recall, some degree of underreporting is assumed (Harrell, 1997; Harrison & Hughes, 1997; Rouse, Kozel, & Richards, 1985). No adjustment to NSDUH data is made to correct for this. The methodology used in NSDUH has been shown to produce more valid results than other self-report methods (e.g., by telephone) (Aquilino, 1994; Turner, Lessler, & Gfroerer, 1992). However, comparisons of NSDUH data with data from surveys conducted in classrooms suggest that underreporting of drug use by youths in their homes may be substantial (Gfroerer, 1993; Gfroerer, Wright, & Kopstein, 1997).

 

A.7. Serious Mental Illness Estimates

For the 2002 survey, mental health among adults was measured using a scale to ascertain serious mental illness (SMI). This scale consisted of six questions that ask respondents how frequently they experienced symptoms of psychological distress during the 1 month in the past year when they were at their worst emotionally. The use of this scale is based on a methodological study designed to evaluate several screening scales for measuring SMI in NSDUH. These scales consisted of a truncated version of the World Health Organization (WHO) Composite International Diagnostic Interview Short Form (CIDI-SF) scale (Kessler, Andrews, Mroczek, Üstün, & Wittchen, 1998), the K10/K6 scale of nonspecific psychological distress (Furukawa, Kessler, Slade, & Andrews, 2003), and the WHO Disability Assessment Schedule (WHO-DAS) (Rehm et al., 1999).

The methodological study to evaluate the scales consisted of 155 respondents selected from a first-stage sample of 1,000 adults aged 18 or older. First-stage respondents were selected from the Boston metropolitan area and screened on the telephone to determine whether they had any emotional problems. Respondents reporting emotional problems at the first stage were oversampled when selecting the 155 respondents at the second stage. The selected respondents were interviewed by trained clinicians in respondents' homes using both the NSDUH methodology and a structured clinical interview. The first interview included the three scales described above using audio computer-assisted self-interviewing (ACASI). Respondents completed the ACASI portion of the interview without discussing their answers with the clinician. After completing the ACASI interview, respondents then were interviewed using the 12–month nonpatient version of the Structured Clinical Interview for DSM-IV (SCID) (First, Spitzer, Gibbon, & Williams, 1997) and the Global Assessment of Functioning (GAF) (Endicott, Spitzer, Fleiss, & Cohen, 1976) to classify respondents as either having or not having SMI.

The data from the 155 respondents were analyzed using logistic regression analysis to predict SMI from the scores on the screening questions. Analysis of the model fit indicated that each of the scales alone and in combination were significant predictors of SMI and the best fitting models contained either the CIDI-SF or the K10/K6 alone. Receiver operating characteristic (ROC) curve analysis was used to evaluate the precision of the scales to discriminate between respondents with and without SMI. This analysis indicated that the K6 was the best predictor. The results of the methodological study are described in more detail in a paper describing the K10/K6 scale of nonspecific psychological distress (Kessler et al., 2003).

To score the items on the K6 scales, they were first coded from 0 to 4 and summed to yield a number between 0 and 24. This involved transforming response categories for the six questions (DSNERV1, DSHOPE, DSFIDG, DSNOCHR, DSEFFORT, and DSDOWN) given below so that "all of the time" was coded 4, "most of the time" was coded 3, "some of the time" 2, "a little of the time" 1, and "none of the time" 0, with "don't know" and "refuse" also coded 0. Summing across the transformed responses resulted in a score with a range from 0 to 24. Respondents with a total score of 13 or greater were classified as having a past year SMI. This cutpoint was chosen to equalize false positives and false negatives.

The questions comprising the K6 scale are given as follows:

DSNERV1
Most people have periods when they are not at their best emotionally. Think of one month in the past 12 months when you were the most depressed, anxious, or emotionally stressed. If there was no month like this, think of a typical month.

During that month, how often did you feel nervous?

  1. All of the time
  2. Most of the time
  3. Some of the time
  4. A little of the time
  5. None of the time
DK/REF

Response categories are the same for the following questions:

DSHOPE
During that same month when you were at your worst emotionally . . . how often did you feel hopeless?

DSFIDG
During that same month when you were at your worst emotionally . . . how often did you feel restless or fidgety?

DSNOCHR
During that same month when you were at your worst emotionally . . . how often did you feel so sad or depressed that nothing could cheer you up?

DSEFFORT
During that same month when you were at your worst emotionally . . . how often did you feel that everything was an effort?

DSDOWN
During that same month when you were at your worst emotionally . . . how often did you feel down on yourself, no good, or worthless?

 

Table  A.1 Summary of 2002 NSDUH Suppression Rules
EstimateSuppress if:
Prevalence rate, image representing p hat, with nominal sample size, n, and design effect, deff(1) The estimated prevalence rate, image representing p hat, is < 0.00005 or greater than or equal to 0.99995, or

(2) Suppression rule when image representing p hat less than or equal to 0.5, or     D

     Suppression rule when image representing p hat > 0.5, or     D

(3) Effective n<68, where Effective n = Effective n equals n divided by the design effect, or

(4) n < 100.

Note: The rounding portion of this suppression rule for prevalence rates will produce some estimates that round at one decimal place to 0.0 or 100.0 percent but are not suppressed from the tables.

Estimated number
(numerator of image representing p hat)
The estimated prevalence rate, image representing p hat, is suppressed.

Note: In some instances when image representing p hat is not suppressed, the estimated number may appear as a 0 in the tables; this means that the estimate is > 0 but < 500 (estimated numbers are shown in thousands).

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Table  A.2 Weighted Percentages and Sample Sizes for 2002 NSDUH, by Screening Result Code
 Sample
Size
Weighted
Percentage
Total Sample of Dwelling Units178,013100.00
   Ineligible cases27,85115.27
   Eligible cases150,16284.73
Ineligibles27,85115.27
   Vacant14,41751.55
   Not a primary residence4,58017.36
   Not a dwelling unit2,4038.16
   Resident < 1/2 of quarter00.00
   All military personnel2891.08
   Other, ineligible6,16221.86
Eligible Cases150,16284.73
   Screening complete136,34990.72
      No one selected80,55753.14
      One selected30,73820.58
      Two selected25,05417.00
   Screening not complete13,8139.28
      No one home3,0312.02
      Respondent unavailable4110.26
      Physically or mentally incompetent3070.20
      Language barrier—Hispanic660.05
      Language barrier—other4610.35
      Refusal8,5565.86
      Other, access denied4710.30
      Other, eligible120.01
      Segment not accessible00.00
      Screener not returned150.01
      Fraudulent case4790.21
      Electronic screening problem40.00
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Table  A.3 Weighted Percentages and Sample Sizes for 2002 NSDUH, by Final Interview Code
Final Interview CodePersons Aged
12 or Older
Persons Aged
12 to 17
Persons Aged
18 or Older
Sample SizeWeighted PercentageSample SizeWeighted PercentageSample SizeWeighted Percentage
Total80,581100.0026,230100.0054,351100.00
Interview Complete68,12678.5623,65989.9944,46777.20
No One at Dwelling Unit1,3591.811820.701,1771.94
Respondent Unavailable1,8932.713291.201,5642.89
Break-Off480.1090.04390.11
Physically/Mentally Incompetent6921.751610.575311.89
Language Barrier - Spanish1380.1990.041290.21
Language Barrier - Other3271.09240.133031.21
Refusal6,27612.734641.815,81214.03
Parental Refusal1,3070.551,3075.1500.00
Other4150.52860.383290.53
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Table  A.4 Response Rates and Sample Sizes for 2002 NSDUH, by Demographic Characteristics
 Selected
Persons
Completed
Interviews
Weighted
Response Rate
Total80,58168,12678.56%
Age in Years   
   12–1726,23023,65989.99%
   18–2527,21623,27185.16%
   26 or older27,13521,19675.81%
Gender   
   Male39,45332,76677.06%
   Female41,12835,36079.99%
Race/Ethnicity   
   Hispanic10,2508,69280.93%
   White55,59446,83478.23%
   Black9,3858,14382.24%
   All other races5,3524,45770.50%
Region   
   Northeast16,49013,70675.57%
   Midwest22,58819,18080.01%
   South24,53020,90079.99%
   West16,97314,34077.33%
County Type   
   Large metropolitan32,29426,79276.85%
   Small metropolitan28,12123,94479.50%
   Nonmetropolitan20,16617,39081.38%
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

Appendix B: Selected Tables

 

31212 (6A)

Table  B.1a Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Numbers in Thousands, 2002
Demographic CharacteristicTotalSERIOUS MENTAL ILLNESS1
YesNo
TOTAL210,39017,483192,906
AGE   
   18–2531,0244,08526,939
   26–49100,2879,53490,753
   50 or Older79,0793,86575,214
GENDER   
   Male100,9556,04194,914
   Female109,43511,44297,992
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino185,24115,760169,481
      White149,86012,639137,221
      Black or African American23,1912,03221,159
      American Indian or Alaska Native1,2901611,129
      Native Hawaiian or Other Pacific Islander73140692
      Asian8,0486007,448
      Two or More Races2,1202891,832
   Hispanic or Latino25,1491,72423,425
EDUCATION   
   < High School37,2263,59133,634
   High School Graduate67,9855,83962,147
   Some College52,5744,99147,583
   College Graduate52,6053,06249,543
CURRENT EMPLOYMENT   
   Full-Time116,5088,453108,055
   Part-Time27,4422,66424,778
   Unemployed7,5851,0786,507
   Other258,8545,28953,566
*Low precision; no estimate reported.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (6B)

Table  B.1b Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Percentage Distributions, 2002
Demographic CharacteristicTotalSERIOUS MENTAL ILLNESS1
YesNo
TOTAL100.0100.0100.0
AGE   
   18–2514.723.414.0
   26–4947.754.547.0
   50 or Older37.622.139.0
GENDER   
   Male48.034.649.2
   Female52.065.450.8
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino88.090.187.9
      White71.272.371.1
      Black or African American11.011.611.0
      American Indian or Alaska Native0.60.90.6
      Native Hawaiian or Other Pacific Islander0.30.20.4
      Asian3.83.43.9
      Two or More Races1.01.70.9
   Hispanic or Latino12.09.912.1
EDUCATION   
   < High School17.720.517.4
   High School Graduate32.333.432.2
   Some College25.028.524.7
   College Graduate25.017.525.7
CURRENT EMPLOYMENT   
   Full-Time55.448.456.0
   Part-Time13.015.212.8
   Unemployed3.66.23.4
   Other228.030.227.8
*Low precision; no estimate reported.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (7A)

Table  B.2a Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Numbers in Thousands, 2002
Geographic CharacteristicTotalSERIOUS MENTAL ILLNESS1
YesNo
TOTAL210,39017,483192,906
GEOGRAPHIC DIVISION   
   Northeast40,6043,44137,163
      New England10,6491,0079,642
      Middle Atlantic29,9552,43427,521
   Midwest47,7374,04843,689
      East North Central33,4282,83130,597
      West North Central14,3091,21713,092
   South74,9966,32568,671
      South Atlantic39,3643,35336,011
      East South Central12,7291,19511,535
      West South Central22,9031,77721,126
   West47,0523,66943,383
      Mountain13,6071,11712,490
      Pacific33,4452,55230,893
COUNTY TYPE   
   Large Metro104,8677,99596,872
   Small Metro63,4485,55457,894
      250K - 1 Mil. Pop.46,2163,98342,233
      < 250K Pop.17,2321,57115,661
   Nonmetro42,0753,93438,140
      Urbanized13,3111,11712,194
      Less Urbanized24,1102,40821,702
      Completely Rural4,6544104,244
*Low precision; no estimate reported.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (7B)

Table  B.2b Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Percentage Distributions, 2002
Geographic CharacteristicTotalSERIOUS MENTAL ILLNESS1
YesNo
TOTAL100.0100.0100.0
GEOGRAPHIC DIVISION   
   Northeast19.319.719.3
      New England5.15.85.0
      Middle Atlantic14.213.914.3
   Midwest22.723.222.6
      East North Central15.916.215.9
      West North Central6.87.06.8
   South35.636.235.6
      South Atlantic18.719.218.7
      East South Central6.16.86.0
      West South Central10.910.211.0
   West22.421.022.5
      Mountain6.56.46.5
      Pacific15.914.616.0
COUNTY TYPE   
   Large Metro49.845.750.2
   Small Metro30.231.830.0
      250K - 1 Mil. Pop.22.022.821.9
      < 250K Pop.8.29.08.1
   Nonmetro20.022.519.8
      Urbanized6.36.46.3
      Less Urbanized11.513.811.2
      Completely Rural2.22.32.2
*Low precision; no estimate reported.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30804 (6.2A)

Table  B.3a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Demographic Characteristics: Numbers in Thousands, 2002
Demographic CharacteristicTotalAGE GROUP (Years)
18–2526–4950 or Older
TOTAL17,4834,0859,5343,865
GENDER    
   Male6,0411,5603,3221,159
   Female11,4422,5256,2112,706
HISPANIC ORIGIN AND RACE    
   Not Hispanic or Latino15,7603,4868,6673,607
      White12,6392,7447,0102,885
      Black or African American2,0324661,089477
      American Indian or Alaska Native1613569*
      Native Hawaiian or Other Pacific Islander40***
      Asian600154344*
      Two or More Races28963139*
   Hispanic or Latino1,724599867258
EDUCATION    
   < High School3,5919441,5061,142
   High School Graduate5,8391,3633,0271,449
   Some College4,9911,3622,751878
   College Graduate3,0624162,250396
CURRENT EMPLOYMENT    
   Full-Time8,4531,7955,733925
   Part-Time2,6641,0421,210412
   Unemployed1,078395557*
   Other15,2898532,0332,402
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30804 (6.2B)

Table  B.3b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Demographic Characteristics: Percentages, 2002
Demographic CharacteristicTotalAGE GROUP (Years)
18–2526–4950 or Older
TOTAL8.313.29.54.9
GENDER    
   Male6.010.06.73.2
   Female10.516.312.26.3
HISPANIC ORIGIN AND RACE    
   Not Hispanic or Latino8.513.710.14.9
      White8.414.210.44.6
      Black or African American8.811.59.26.6
      American Indian or Alaska Native12.516.111.1*
      Native Hawaiian or Other Pacific Islander5.4***
      Asian7.511.27.5*
      Two or More Races13.615.713.8*
   Hispanic or Latino6.910.96.14.8
EDUCATION    
   < High School9.613.710.96.9
   High School Graduate8.612.99.85.5
   Some College9.513.910.65.2
   College Graduate5.811.07.62.0
CURRENT EMPLOYMENT    
   Full-Time7.312.47.93.1
   Part-Time9.713.211.44.6
   Unemployed14.216.114.2*
   Other19.013.815.56.1
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.3A)

Table  B.4a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Geographic Characteristics: Numbers in Thousands, 2002
Geographic CharacteristicTotalAGE GROUP (Years)
18–2526–4950 or Older
TOTAL17,4834,0859,5343,865
GEOGRAPHIC DIVISION    
   Northeast3,4417841,943714
      New England1,007215524268
      Middle Atlantic2,4345691,419446
   Midwest4,0489262,209913
      East North Central2,8316191,588624
      West North Central1,217307621289
   South6,3251,3753,3571,593
      South Atlantic3,3536471,763943
      East South Central1,195255695245
      West South Central1,777473900405
   West3,6691,0002,024645
      Mountain1,117317578222
      Pacific2,5526831,446423
COUNTY TYPE    
   Large Metro7,9951,8694,6561,470
   Small Metro5,5541,4532,9771,124
      250K - 1 Mil. Pop.3,9839792,151853
      <250K Pop.1,571474827271
   Nonmetro3,9347631,9001,271
      Urbanized1,117276546294
      Less Urbanized2,4084231,138847
      Completely Rural41063216130
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.3B)

Table  B.4b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Geographic Characteristics: Percentages, 2002
Geographic CharacteristicTotalAGE GROUP (Years)
18–2526–4950 or Older
TOTAL8.313.29.54.9
GEOGRAPHIC DIVISION    
   Northeast8.514.210.14.5
      New England9.515.010.36.5
      Middle Atlantic8.114.010.13.8
   Midwest8.512.99.85.1
      East North Central8.512.410.04.9
      West North Central8.513.89.45.3
   South8.412.59.55.6
      South Atlantic8.512.09.56.1
      East South Central9.413.411.75.0
      West South Central7.812.78.15.0
   West7.813.78.83.9
      Mountain8.214.58.94.5
      Pacific7.613.48.73.6
COUNTY TYPE    
   Large Metro7.612.78.84.0
   Small Metro8.813.910.24.7
      250K - 1 Mil. Pop.8.613.210.04.9
      <250K Pop.9.115.610.64.2
   Nonmetro9.413.110.67.0
      Urbanized8.413.09.05.7
      Less Urbanized10.013.411.47.7
      Completely Rural8.812.211.35.9
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40316 (12A)

Table  B.5a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and by Socioeconomic and Health Characteristics: Numbers in Thousands, 2002
Socioeconomic/Health CharacteristicTotalAGE GROUP (Years)
18–2526–4950 or Older
MARITAL STATUS    
   Married6,6815624,4491,670
   Widowed842*107729
   Divorced or Separated3,7161732,560984
   Never Married6,2443,3432,419482
FAMILY INCOME    
   Less Than $20,0005,4151,4672,4051,544
   $20,000 to $49,9996,7671,5373,7071,523
   $50,000 to $74,9992,6125301,684397
   $75,000 or More2,6895511,738400
HEALTH INSURANCE1    
   Private10,5622,3176,0712,173
   Medicaid/CHIP22,3564771,242637
   Other31,176181396599
   No Coverage3,3891,1101,824455
OVERALL HEALTH    
   Excellent2,6647621,632271
   Very Good5,1831,6752,985524
   Good5,3031,2752,9191,109
   Fair/Poor4,3313731,9961,962
SOCIAL SUPPORT4    
   Yes14,2993,4917,9052,903
   No3,1725901,621961
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Private category only.
2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan.
3 Medicare, CHAMPUS, TRIAGE, CHAMPAK, the VA, military health care, or any other type of health insurance.
4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concerns, spend time on shared interests and activities, or who really like and care about them.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40316 (12B)

Table  B.5b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and by Socioeconomic and Health Characteristics: Percentages, 2002
Socioeconomic/Health CharacteristicTotalAGE GROUP (Years)
18–2526–4950 or Older
MARITAL STATUS    
   Married5.611.47.13.3
   Widowed6.2*9.85.8
   Divorced or Separated13.025.516.08.3
   Never Married12.713.211.913.9
FAMILY INCOME    
   Less Than $20,00013.114.316.39.5
   $20,000 to $49,9998.413.09.94.8
   $50,000 to $74,9996.912.38.13.1
   $75,000 or More5.412.06.42.2
HEALTH INSURANCE1    
   Private6.812.28.13.6
   Medicaid/CHIP217.215.520.713.7
   Other38.116.311.26.1
   No Coverage12.214.311.710.2
OVERALL HEALTH    
   Excellent5.18.05.81.9
   Very Good6.713.47.72.1
   Good9.617.111.74.8
   Fair/Poor16.923.624.612.3
SOCIAL SUPPORT4    
   Yes7.612.58.84.1
   No15.219.615.612.9
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Private category only.
2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan.
3 Medicare, CHAMPUS, TRIAGE, CHAMPAK, the VA, military health care, or any other type of health insurance.
4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concerns, spend time on shared interests and activities, or who really like and care about them.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (8A)

Table  B.6a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and Demographic Characteristics: Numbers in Thousands, 2002
Demographic CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
TOTAL17,4835,06112,423
AGE   
   18–254,0851,9652,120
   26–499,5342,7306,804
   50 or Older3,8653663,499
GENDER   
   Male6,0412,2823,759
   Female11,4422,7798,663
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino15,7604,49211,268
      White12,6393,7518,888
      Black or African American2,0325471,485
      American Indian or Alaska Native16139122
      Native Hawaiian or Other Pacific Islander401623
      Asian60053546
      Two or More Races28986203
   Hispanic1,7245691,155
EDUCATION   
   < High School3,5911,1152,476
   High School Graduate5,8391,5164,323
   Some College4,9911,7243,267
   College Graduate3,0627052,357
CURRENT EMPLOYMENT   
   Full-Time8,4532,5625,891
   Part-Time2,6648291,834
   Unemployed1,078548530
   Other25,2891,1224,167
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (8B)

Table  B.6b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and Demographic Characteristics: Percentage Distributions, 2002
Demographic CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
TOTAL100.0100.0100.0
AGE   
   18–2523.438.817.1
   26–4954.553.954.8
   50 or Older22.17.228.2
GENDER   
   Male34.645.130.3
   Female65.454.969.7
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino90.188.890.7
      White72.374.171.5
      Black or African American11.610.812.0
      American Indian or Alaska Native0.90.81.0
      Native Hawaiian or Other Pacific Islander0.20.30.2
      Asian3.41.14.4
      Two or More Races1.71.71.6
   Hispanic9.911.29.3
EDUCATION   
   < High School20.522.019.9
   High School Graduate33.430.034.8
   Some College28.534.126.3
   College Graduate17.513.919.0
CURRENT EMPLOYMENT   
   Full-Time48.450.647.4
   Part-Time15.216.414.8
   Unemployed6.210.84.3
   Other230.222.233.5
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (9A)

Table  B.7a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and Geographic Characteristics: Numbers in Thousands, 2002
Geographic CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
TOTAL17,4835,06112,423
GEOGRAPHIC DIVISION   
   Northeast3,4411,0932,348
      New England1,007326681
      Middle Atlantic2,4347671,667
   Midwest4,0481,0542,994
      East North Central2,8317572,074
      West North Central1,217297920
   South6,3251,6624,664
      South Atlantic3,3538472,506
      East South Central1,195288907
      West South Central1,7775271,251
   West3,6691,2522,417
      Mountain1,117329787
      Pacific2,5529231,629
COUNTY TYPE   
   Large Metro7,9952,4745,521
   Small Metro5,5541,7593,795
      250K - 1 Mil. Pop.3,9831,2262,757
      < 250K Pop.1,5715341,038
   Nonmetro3,9348283,107
      Urbanized1,117266851
      Less Urbanized2,4085001,908
      Completely Rural41062348
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (9B)

Table  B.7b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and Geographic Characteristics: Percentage Distributions, 2002
Geographic CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
TOTAL100.0100.0100.0
GEOGRAPHIC DIVISION   
   Northeast19.721.618.9
      New England5.86.45.5
      Middle Atlantic13.915.113.4
   Midwest23.220.824.1
      East North Central16.215.016.7
      West North Central7.05.97.4
   South36.232.837.5
      South Atlantic19.216.720.2
      East South Central6.85.77.3
      West South Central10.210.410.1
   West21.024.719.5
      Mountain6.46.56.3
      Pacific14.618.213.1
COUNTY TYPE   
   Large Metro45.748.944.4
   Small Metro31.834.830.5
      250K - 1 Mil. Pop.22.824.222.2
      < 250K Pop.9.010.58.4
   Nonmetro22.516.425.0
      Urbanized6.45.26.9
      Less Urbanized13.89.915.4
      Completely Rural2.31.22.8
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40316 (13A)

Table  B.8a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and by Socioeconomic and Health Characteristics: Numbers in Thousands, 2002
Socioeconomic/Health CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
MARITAL STATUS   
   Married6,6811,2585,423
   Widowed842*806
   Divorced or Separated3,7161,1802,537
   Never Married6,2442,5863,658
FAMILY INCOME   
   Less Than $20,0005,4151,6833,732
   $20,000 to $49,9996,7672,0364,731
   $50,000 to $74,9992,6126511,961
   $75,000 or More2,6896911,998
HEALTH INSURANCE2   
   Private10,5622,7147,848
   Medicaid/CHIP32,3565951,761
   Other41,176268908
   No Coverage3,3891,4831,905
OVERALL HEALTH   
   Excellent2,6647571,907
   Very Good5,1831,6793,504
   Good5,3031,5733,730
   Fair/Poor4,3311,0513,279
SOCIAL SUPPORT5   
   Yes14,2994,17410,125
   No3,1728832,290
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Private category only.
3 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan.
4 Medicare, CHAMPUS, TRIAGE, CHAMPAK, the VA, military health care, or any other type of health insurance.
5 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concerns, spend time on shared interests and activities, or who really like and care about them.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40316 (13B)

Table  B.8b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and by Socioeconomic and Health Characteristics: Percentages, 2002
Socioeconomic/Health CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
MARITAL STATUS   
   Married5.613.64.9
   Widowed6.2*6.1
   Divorced or Separated13.024.910.7
   Never Married12.716.910.8
FAMILY INCOME   
   Less Than $20,00013.121.511.1
   $20,000 to $49,9998.418.06.8
   $50,000 to $74,9996.913.65.9
   $75,000 or More5.412.14.5
HEALTH INSURANCE2   
   Private6.814.55.8
   Medicaid/CHIP317.223.515.7
   Other48.123.86.8
   No Coverage12.220.69.2
OVERALL HEALTH   
   Excellent5.111.44.2
   Very Good6.714.65.4
   Good9.619.17.9
   Fair/Poor16.932.414.7
SOCIAL SUPPORT5   
   Yes7.615.66.3
   No15.230.412.7
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Private category only.
3 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan.
4 Medicare, CHAMPUS, TRIAGE, CHAMPAK, the VA, military health care, or any other type of health insurance.
5 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concerns, spend time on shared interests and activities, or who really like and care about them.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.8A)

Table  B.9a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and Demographic Characteristics: Numbers in Thousands, 2002
Demographic CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
TOTAL17,4835,06112,423
AGE   
   18–254,0851,9652,120
   26–499,5342,7306,804
   50 or Older3,8653663,499
GENDER   
   Male6,0412,2823,759
   Female11,4422,7798,663
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino15,7604,49211,268
      White12,6393,7518,888
      Black or African American2,0325471,485
      American Indian or Alaska Native161*122
      Native Hawaiian or Other Pacific Islander40*23
      Asian60053546
      Two or More Races289*203
   Hispanic or Latino1,7245691,155
EDUCATION   
   < High School3,5911,1152,476
   High School Graduate5,8391,5164,323
   Some College4,9911,7243,267
   College Graduate3,0627052,357
CURRENT EMPLOYMENT   
   Full-Time8,4532,5625,891
   Part-Time2,6648291,834
   Unemployed1,078548530
   Other25,2891,1224,167
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.8B)

Table  B.9b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and Demographic Characteristics: Percentages, 2002
Demographic CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
TOTAL8.317.16.9
AGE   
   18–2513.217.910.6
   26–499.517.08.1
   50 or Older4.914.04.6
GENDER   
   Male6.013.34.5
   Female10.522.28.9
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino8.517.27.1
      White8.417.96.9
      Black or African American8.814.37.7
      American Indian or Alaska Native12.5*11.4
      Native Hawaiian or Other Pacific Islander5.4*3.9
      Asian7.59.37.3
      Two or More Races13.6*12.0
   Hispanic or Latino6.916.05.3
EDUCATION   
   < High School9.619.87.8
   High School Graduate8.616.07.4
   Some College9.519.97.4
   College Graduate5.811.95.0
CURRENT EMPLOYMENT   
   Full-Time7.314.66.0
   Part-Time9.716.28.2
   Unemployed14.224.79.9
   Other29.023.37.7
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.4A)

Table  B.10a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Use of Illicit Drugs: Numbers in Thousands, 2002
DrugILLICIT DRUG USE
YesNo
Any Illicit Drug15,06112,423
   Marijuana and Hashish3,65313,830
   Cocaine1,18716,296
      Crack43517,049
   Heroin*17,389
   Hallucinogens75116,732
      LSD12717,356
      PCP*17,447
      Ecstasy54016,943
   Inhalants20717,276
   Nonmedical Use of Any Psychotherapeutic22,70714,777
      Pain Relievers2,04015,444
      Tranquilizers1,13616,347
      Stimulants73016,753
         Methamphetamine41817,066
      Sedatives28317,200
   Any Illicit Drug Other Than Marijuana13,50013,983
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; does not include over-the-counter drugs.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.4B)

Table  B.10b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Use of Illicit Drugs: Percentages, 2002
DrugILLICIT DRUG USE
YesNo
Any Illicit Drug117.16.9
   Marijuana and Hashish16.77.3
   Cocaine22.07.9
      Crack29.98.2
   Heroin*8.3
   Hallucinogens19.78.1
      LSD18.68.3
      PCP*8.3
      Ecstasy20.68.2
   Inhalants20.68.3
   Nonmedical Use of Any Psychotherapeutic221.87.5
      Pain Relievers22.47.7
      Tranquilizers26.57.9
      Stimulants28.88.1
         Methamphetamine31.88.2
      Sedatives33.68.2
   Any Illicit Drug Other Than Marijuana120.57.2
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; does not include over-the-counter drugs.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.6A)

Table  B.11a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year and Past Month Tobacco and Alcohol Use: Numbers in Thousands, 2002
DrugTOBACCO/ALCOHOL USE
YesNo
PAST YEAR  
   Any Tobacco19,3578,127
      Cigarettes8,6288,856
      Smokeless Tobacco82516,658
      Cigars2,60414,880
      Pipes----
   Alcohol12,4285,055
      Binge Alcohol Use2----
         Heavy Alcohol Use2----
PAST MONTH  
   Any Tobacco18,4289,055
      Cigarettes7,8869,598
      Smokeless Tobacco57516,908
      Cigars1,28716,196
      Pipes21917,265
   Alcohol9,2348,250
      Binge Alcohol Use25,03712,446
         Heavy Alcohol Use21,69615,788
*Low precision; no estimate reported.
-- Not available.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Tobacco product includes cigarettes, smokeless tobacco (i.e., chewing tobacco or snuff), cigars, or pipe tobacco. Any Tobacco use in the past year excludes past year pipe tobacco use, but includes past month pipe tobacco use.
2 Binge Alcohol Use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days. Heavy Alcohol Use is defined as drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days; all Heavy Alcohol Users are also Binge Alcohol Users.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.6B)

Table  B.11b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year and Past Month Tobacco and Alcohol Use: Percentages, 2002
DrugTOBACCO/ALCOHOL USE
YesNo
PAST YEAR  
   Any Tobacco111.96.2
      Cigarettes13.06.1
      Smokeless Tobacco8.78.3
      Cigars11.18.0
      Pipes----
   Alcohol8.58.0
      Binge Alcohol Use2----
         Heavy Alcohol Use2----
PAST MONTH  
   Any Tobacco112.46.3
      Cigarettes13.66.3
      Smokeless Tobacco7.98.3
      Cigars11.18.1
      Pipes13.08.3
   Alcohol8.08.7
      Binge Alcohol Use29.87.8
         Heavy Alcohol Use211.18.1
*Low precision; no estimate reported.
-- Not available.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Tobacco product includes cigarettes, smokeless tobacco (i.e., chewing tobacco or snuff), cigars, or pipe tobacco. Any Tobacco use in the past year excludes past year pipe tobacco use, but includes past month pipe tobacco use.
2 Binge Alcohol Use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days. Heavy Alcohol Use is defined as drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days; all Heavy Alcohol Users are also Binge Alcohol Users.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40205 (33A)

Table  B.12a Serious Mental Illness and/or a Substance Use Disorder among Persons Aged 18 or Older with a Serious Mental Illness or a Substance Use Disorder in the Past Year: Numbers in Thousands, 2002
Serious Mental Illness/Substance Use DisorderNumber
Serious Mental Illness or Substance Use Disorder1,233,232
   Serious Mental Illness Only113,435
   Substance Use Disorder Only215,749
   Serious Mental Illness and Substance Use Disorder1,24,048
*Low precision; no estimate reported.
NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40205 (33B)

Table  B.12b Serious Mental Illness and/or a Substance Use Disorder among Persons Aged 18 or Older with a Serious Mental Illness or a Substance Use Disorder in the Past Year: Percentage Distributions, 2002
Serious Mental Illness/Substance Use DisorderPercentage
Serious Mental Illness or Substance Use Disorder1,2100.0
   Serious Mental Illness Only140.4
   Substance Use Disorder Only247.4
   Serious Mental Illness and Substance Use Disorder1,212.2
*Low precision; no estimate reported.
NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.11A)

Table  B.13a Substance Dependence or Abuse in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness: Numbers in Thousands, 2002
Dependence/AbuseTotalSERIOUS MENTAL ILLNESS1
YesNo
DEPENDENCE OR ABUSE2   
   Any Illicit Drug35,7401,6714,069
      Marijuana3,2398832,356
      Any Illicit Drug Other Than Marijuana33,1461,0502,097
   Alcohol16,6473,15513,491
   Any Illicit Drug or Alcohol319,7974,04815,749
   Any Illicit Drug and Alcohol32,5907791,811
DEPENDENCE2   
   Any Illicit Drug33,8551,2602,594
      Marijuana2,0065731,433
      Any Illicit Drug Other Than Marijuana32,0527901,261
   Alcohol7,6952,0135,682
   Any Illicit Drug or Alcohol310,4252,8367,589
   Any Illicit Drug and Alcohol31,125438687
*Low precision; no estimate reported.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
3 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.11B)

Table  B.13b Substance Dependence or Abuse in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness: Percentages, 2002
Dependence/AbuseTotalSERIOUS MENTAL ILLNESS1
YesNo
DEPENDENCE OR ABUSE2   
   Any Illicit Drug32.79.62.1
      Marijuana1.55.11.2
      Any Illicit Drug Other Than Marijuana31.56.01.1
   Alcohol7.918.07.0
   Any Illicit Drug or Alcohol39.423.28.2
   Any Illicit Drug and Alcohol31.24.50.9
DEPENDENCE2   
   Any Illicit Drug31.87.21.3
      Marijuana1.03.30.7
      Any Illicit Drug Other Than Marijuana31.04.50.7
   Alcohol3.711.52.9
   Any Illicit Drug or Alcohol35.016.23.9
   Any Illicit Drug and Alcohol30.52.50.4
*Low precision; no estimate reported.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
3 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (10A)

Table  B.14a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder and Demographic Characteristics: Numbers in Thousands, 2002
Demographic CharacteristicTotalSubstance Use Disorder1
YesNo
TOTAL17,4834,04813,435
AGE   
   18–254,0851,4712,614
   26–499,5342,2207,313
   50 or Older3,8653573,508
GENDER   
   Male6,0412,1093,932
   Female11,4421,9399,503
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino15,7603,61312,146
      White12,6392,9229,717
      Black or African American2,0325161,515
      American Indian or Alaska Native16131129
      Native Hawaiian or Other Pacific Islander40733
      Asian60069531
      Two or More Races28968221
   Hispanic or Latino1,7244351,289
EDUCATION   
   < High School3,5919102,681
   High School Graduate5,8391,3494,490
   Some College4,9911,1763,815
   College Graduate3,0626132,449
CURRENT EMPLOYMENT   
   Full-Time8,4532,1146,340
   Part-Time2,6646791,985
   Unemployed1,078410668
   Other25,2898454,444
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (10B)

Table  B.14b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder and Demographic Characteristics: Percentage Distributions, 2002
Demographic CharacteristicTotalSubstance Use Disorder1
YesNo
TOTAL100.0100.0100.0
AGE   
   18–2523.436.319.5
   26–4954.554.854.4
   50 or Older22.18.826.1
GENDER   
   Male34.652.129.3
   Female65.447.970.7
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino90.189.390.4
      White72.372.272.3
      Black or African American11.612.811.3
      American Indian or Alaska Native0.90.81.0
      Native Hawaiian or Other Pacific Islander0.20.20.2
      Asian3.41.74.0
      Two or More Races1.71.71.6
   Hispanic or Latino9.910.79.6
EDUCATION   
   < High School20.522.520.0
   High School Graduate33.433.333.4
   Some College28.529.128.4
   College Graduate17.515.118.2
CURRENT EMPLOYMENT   
   Full-Time48.452.247.2
   Part-Time15.216.814.8
   Unemployed6.210.15.0
   Other230.220.933.1
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (11A)

Table  B.15a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder and Geographic Characteristics: Numbers in Thousands, 2002
Geographic CharacteristicTotalSubstance Use Disorder1
YesNo
TOTAL17,4834,04813,435
GEOGRAPHIC DIVISION   
   Northeast3,4419052,535
      New England1,007291716
      Middle Atlantic2,4346141,819
   Midwest4,0488783,170
      East North Central2,8316322,199
      West North Central1,217246971
   South6,3251,4874,838
      South Atlantic3,3537182,636
      East South Central1,195286909
      West South Central1,7774841,294
   West3,6697772,892
      Mountain1,117261855
      Pacific2,5525162,036
COUNTY TYPE   
   Large Metro7,9951,8596,136
   Small Metro5,5541,3694,185
      250K - 1 Mil. Pop.3,9839403,043
      < 250K Pop.1,5714291,142
   Nonmetro3,9348203,114
      Urbanized1,117240877
      Less Urbanized2,4085281,879
      Completely Rural41052358
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (11B)

Table  B.15b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder and Geographic Characteristics: Percentage Distributions, 2002
Geographic CharacteristicTotalSubstance Use Disorder1
YesNo
TOTAL100.0100.0100.0
GEOGRAPHIC DIVISION   
   Northeast19.722.418.9
      New England5.87.25.3
      Middle Atlantic13.915.213.5
   Midwest23.221.723.6
      East North Central16.215.616.4
      West North Central7.06.17.2
   South36.236.736.0
      South Atlantic19.217.719.6
      East South Central6.87.16.8
      West South Central10.212.09.6
   West21.019.221.5
      Mountain6.46.56.4
      Pacific14.612.715.2
COUNTY TYPE   
   Large Metro45.745.945.7
   Small Metro31.833.831.1
      250K - 1 Mil. Pop.22.823.222.6
      < 250K Pop.9.010.68.5
   Nonmetro22.520.323.2
      Urbanized6.45.96.5
      Less Urbanized13.813.114.0
      Completely Rural2.31.32.7
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (3A)

Table  B.16a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Use Disorder, Gender, and Age Group: Numbers in Thousands, 2002
Gender/AgeTotalSubstance Use Disorder1
YesNo
TOTAL17,4834,04813,435
   18–254,0851,4712,614
   26–499,5342,2207,313
   50 or Older3,8653573,508
MALE6,0412,1093,932
   18–251,560700860
   26–493,3221,1382,184
   50 or Older1,159270888
FEMALE11,4421,9399,503
   18–252,5257701,754
   26–496,2111,0825,129
   50 or Older2,706*2,619
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31212 (3B)

Table  B.16b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Use Disorder, Gender, and Age Group: Percentages, 2002
Gender/AgeTotalSubstance Use Disorder1
YesNo
TOTAL8.320.47.0
   18–2513.221.810.8
   26–499.521.28.1
   50 or Older4.913.84.6
MALE6.015.74.5
   18–2510.016.37.7
   26–496.716.05.2
   50 or Older3.213.62.6
FEMALE10.530.39.2
   18–2516.331.713.4
   26–4912.232.210.8
   50 or Older6.3*6.2
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.10A)

Table  B.17a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Dependence or Abuse: Numbers in Thousands, 2002
Dependence/AbuseTotalDEPENDENCE1DEPENDENCE OR ABUSE1
YesNoYesNo
Any Illicit Drug217,4831,26016,2231,67115,812
   Marijuana17,48357316,91088316,600
   Any Illicit Drug Other Than Marijuana217,48379016,6931,05016,433
Alcohol17,4832,01315,4713,15514,328
Any Illicit Drug or Alcohol217,4832,83614,6484,04813,435
Any Illicit Drug and Alcohol217,48343817,04677916,705
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
2 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30812 (6.10B)

Table  B.17b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Dependence or Abuse: Percentages, 2002
Dependence/AbuseTotalDEPENDENCE1DEPENDENCE OR ABUSE1
YesNoYesNo
Any Illicit Drug28.332.77.929.17.7
   Marijuana8.328.68.127.38.0
   Any Illicit Drug Other Than Marijuana28.338.58.033.47.9
Alcohol8.326.27.619.07.4
Any Illicit Drug or Alcohol28.327.27.320.47.0
Any Illicit Drug and Alcohol28.338.98.130.18.0
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
2 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31205 (30A)

Table  B.18a Persons Aged 18 or Older with Serious Mental Illness, by Receipt of Mental Health Treatment/Counseling and Demographic or Geographic Characteristics: Numbers in Thousands, 2002
Demographic/Geographic CharacteristicMENTAL HEALTH TREATMENT/COUNSELING1
ReceivedNot Received
TOTAL8,3559,091
AGE  
   18–251,3942,685
   26–495,1734,340
   50 or Older1,7872,065
GENDER  
   Male2,3763,647
   Female5,9785,444
HISPANIC ORIGIN AND RACE  
   Not Hispanic or Latino7,7038,019
      White6,5476,057
      Black or African American7501,281
   Hispanic or Latino6511,072
EDUCATION  
   < High School1,4042,172
   High School Graduate2,6313,199
   Some College2,5762,410
   College Graduate1,7431,309
CURRENT EMPLOYMENT  
   Full-Time3,7964,641
   Part-Time1,3461,310
   Unemployed457621
   Other22,7562,519
GEOGRAPHIC DIVISION  
   Northeast1,7451,695
   Midwest1,9122,112
   South2,9993,315
   West1,6991,969
COUNTY TYPE  
   Large Metro3,6814,299
   Small Metro2,8792,660
   Nonmetro1,7952,132
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31205 (30B)

Table  B.18b Persons Aged 18 or Older with Serious Mental Illness, by Receipt of Mental Health Treatment/Counseling and Demographic or Geographic Characteristics: Percentage Distributions, 2002
Demographic/Geographic CharacteristicMENTAL HEALTH TREATMENT/COUNSELING1
ReceivedNot Received
TOTAL100.0100.0
AGE  
   18–2516.729.5
   26–4961.947.7
   50 or Older21.422.7
GENDER  
   Male28.440.1
   Female71.659.9
HISPANIC ORIGIN AND RACE  
   Not Hispanic or Latino92.288.2
      White78.466.6
      Black or African American9.014.1
   Hispanic or Latino7.811.8
EDUCATION  
   < High School16.823.9
   High School Graduate31.535.2
   Some College30.826.5
   College Graduate20.914.4
CURRENT EMPLOYMENT  
   Full-Time45.451.0
   Part-Time16.114.4
   Unemployed5.56.8
   Other233.027.7
GEOGRAPHIC DIVISION  
   Northeast20.918.6
   Midwest22.923.2
   South35.936.5
   West20.321.7
COUNTY TYPE  
   Large Metro44.147.3
   Small Metro34.529.3
   Nonmetro21.523.5
*Low precision; no estimate reported.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30804 (6.20A)

Table  B.19a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Numbers in Thousands, 2002
Demographic CharacteristicTotalSERIOUS MENTAL ILLNESS1
YesNo
TOTAL27,3228,35518,968
AGE   
   18–253,2831,3941,888
   26–4914,5565,1739,383
   50 or Older9,4831,7877,696
GENDER   
   Male8,7842,3766,408
   Female18,5385,97812,560
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino25,2777,70317,574
      White22,0146,54715,467
      Black or African American1,9737501,223
      American Indian or Alaska Native228*134
      Native Hawaiian or Other Pacific Islander29*24
      Asian682*486
      Two or More Races352*240
   Hispanic or Latino2,0456511,394
EDUCATION   
   < High School4,3111,4042,907
   High School Graduate7,9122,6315,281
   Some College7,5282,5764,952
   College Graduate7,5711,7435,828
CURRENT EMPLOYMENT   
   Full-Time13,0903,7969,295
   Part-Time3,9011,3462,554
   Unemployed1,077457620
   Other29,2552,7566,499
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

2 Retired person, disabled person, homemaker, student, or other person not in the labor force.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30804 (6.20B)

Table  B.19b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Percentages, 2002
Demographic CharacteristicTotalSERIOUS MENTAL ILLNESS1
YesNo
TOTAL13.047.99.9
AGE   
   18–2510.634.27.0
   26–4914.654.410.4
   50 or Older12.046.410.3
GENDER   
   Male8.739.56.8
   Female17.052.312.8
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino13.749.010.4
      White14.751.911.3
      Black or African American8.536.95.8
      American Indian or Alaska Native17.8*11.9
      Native Hawaiian or Other Pacific Islander3.9*3.5
      Asian8.5*6.6
      Two or More Races16.6*13.1
   Hispanic or Latino8.237.86.0
EDUCATION   
   < High School11.739.38.7
   High School Graduate11.745.18.5
   Some College14.351.710.4
   College Graduate14.457.111.8
CURRENT EMPLOYMENT   
   Full-Time11.345.08.6
   Part-Time14.250.710.3
   Unemployed14.242.49.6
   Other215.852.212.2
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40316 (26A)

Table  B.20a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Age Group and by Socioeconomic and Health Characteristics: Numbers in Thousands, 2002
Socioeconomic/Health CharacteristicTotalAGE GROUP (Years)
18–2526–4950 or Older
MARITAL STATUS    
   Married3,3712082,486677
   Widowed****
   Divorced or Separated2,272*1,583*
   Never Married2,4041,0901,037*
FAMILY INCOME    
   Less Than $20,0002,4574961,310*
   $20,000 to $49,9993,2705201,970*
   $50,000 to $74,9991,345162950*
   $75,000 or More1,283217943*
HEALTH INSURANCE1    
   Private5,3548753,4081,071
   Medicaid/CHIP21,297191808*
   Other359869**
   No Coverage1,105258674*
OVERALL HEALTH    
   Excellent1,026240685*
   Very Good2,4085761,606*
   Good2,5024261,690*
   Fair/Poor2,4161521,1911,073
SOCIAL SUPPORT4    
   Received Social Support6,9601,2114,3931,356
   Did Not Receive Social Support1,386183772*
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Private category only.
2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan.
3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance.
4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concerns, spend time on shared interests and activities, or who really like and care about them.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40316 (26B)

Table  B.20b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Age Group and by Socioeconomic and Health Characteristics: Percentages, 2002
Socioeconomic/Health CharacteristicTotalAGE GROUP (Years)
18–2526–4950 or Older
MARITAL STATUS    
   Married50.637.056.140.6
   Widowed****
   Divorced or Separated61.1*61.9*
   Never Married38.532.742.9*
FAMILY INCOME    
   Less Than $20,00045.433.854.5*
   $20,000 to $49,99948.533.953.3*
   $50,000 to $74,99951.530.556.4*
   $75,000 or More47.839.454.5*
HEALTH INSURANCE1    
   Private50.837.856.349.5
   Medicaid/CHIP255.140.165.1*
   Other350.838.4**
   No Coverage32.723.337.1*
OVERALL HEALTH    
   Excellent38.731.542.3*
   Very Good46.534.454.0*
   Good47.233.457.9*
   Fair/Poor56.041.259.755.0
SOCIAL SUPPORT4    
   Received Social Support48.734.755.746.7
   Did Not Receive Social Support44.031.047.8*
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Private category only.
2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan.
3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance.
4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concerns, spend time on shared interests and activities, or who really like and care about them.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30813 (6.21A)

Table  B.21a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Numbers in Thousands, 2002
Geographic CharacteristicTotalSERIOUS MENTAL ILLNESS1
YesNo
TOTAL27,3228,35518,968
GEOGRAPHIC DIVISION   
   Northeast5,5971,7453,852
      New England1,8286531,175
      Middle Atlantic3,7691,0922,677
   Midwest6,2081,9124,297
      East North Central4,1921,3302,861
      West North Central2,0175811,435
   South9,2392,9996,239
      South Atlantic4,8461,5943,252
      East South Central1,7476361,110
      West South Central2,6467691,877
   West6,2781,6994,580
      Mountain1,8105071,303
      Pacific4,4681,1913,276
COUNTY TYPE   
   Large Metro12,8853,6819,204
   Small Metro8,9532,8796,074
      250K - 1 Mil. Pop.6,6282,0274,601
      <250K Pop.2,3258521,473
   Nonmetro5,4851,7953,690
      Urbanized2,0516251,426
      Less Urbanized2,9901,0451,945
      Completely Rural443*319
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

30813 (6.21B)

Table  B.21b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Percentages, 2002
Geographic CharacteristicTotalSERIOUS MENTAL ILLNESS1
YesNo
TOTAL13.047.99.9
GEOGRAPHIC DIVISION   
   Northeast13.850.710.4
      New England17.264.912.2
      Middle Atlantic12.644.99.8
   Midwest13.047.59.9
      East North Central12.647.49.4
      West North Central14.147.811.0
   South12.347.59.1
      South Atlantic12.347.69.0
      East South Central13.853.39.7
      West South Central11.643.58.9
   West13.446.310.6
      Mountain13.345.410.4
      Pacific13.446.710.6
COUNTY TYPE   
   Large Metro12.346.19.5
   Small Metro14.152.010.5
      250K - 1 Mil. Pop.14.451.110.9
      <250K Pop.13.554.29.4
   Nonmetro13.145.79.7
      Urbanized15.456.111.7
      Less Urbanized12.443.59.0
      Completely Rural9.6*7.5
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31117 (23A)

Table  B.22a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Past Year Any Illicit Drug Use and Demographic Characteristics: Numbers in Thousands, 2002
Demographic CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
TOTAL8,3552,3236,032
AGE   
   18–251,394668726
   26–495,1731,4423,731
   50 or Older1,787*1,575
GENDER   
   Male2,3769171,459
   Female5,9781,4064,572
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino7,7032,1165,587
      White6,5471,8134,734
      Black or African American750*515
      American Indian or Alaska Native***
      Native Hawaiian or Other Pacific Islander***
      Asian***
      Two or More Races***
   Hispanic or Latino651*445
EDUCATION   
   < High School1,404454950
   High School Graduate2,6316511,981
   Some College2,5768191,757
   College Graduate1,7434001,344
CURRENT EMPLOYMENT   
   Full-Time3,7961,0452,751
   Part-Time1,346422925
   Unemployed457**
   Other22,7566012,155
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

31117 (23B)

Table  B.22b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Past Year Any Illicit Drug Use and Demographic Characteristics: Percentages, 2002
Demographic CharacteristicTotalANY ILLICIT DRUG USE1
YesNo
TOTAL47.946.048.7
AGE   
   18–2534.234.134.2
   26–4954.452.855.0
   50 or Older46.4*45.2
GENDER   
   Male39.540.339.0
   Female52.350.652.9
HISPANIC ORIGIN AND RACE   
   Not Hispanic or Latino49.047.249.7
      White51.948.453.5
      Black or African American36.9*34.7
      American Indian or Alaska Native***
      Native Hawaiian or Other Pacific Islander***
      Asian***
      Two or More Races***
   Hispanic or Latino37.8*38.5
EDUCATION   
   < High School39.340.838.6
   High School Graduate45.143.045.9
   Some College51.747.553.9
   College Graduate57.156.757.2
CURRENT EMPLOYMENT   
   Full-Time45.040.846.8
   Part-Time50.750.950.6
   Unemployed42.4**
   Other252.253.751.9
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
2 Retired person, disabled person, homemaker, student, or other person not in the labor force.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40317 (31A)

Table  B.23a Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment at a Specialty Facility in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Numbers in Thousands, 2002
TreatmentDISORDER
SMI or Substance Use Disorder1,2SMI Only1Substance Use Disorder Only2SMI and Substance Use Disorder1,2
Mental Health or Specialty Substance Treatment311,4166,5342,9451,937
   Mental Health Treatment Only9,8796,3992,0971,383
   Specialty Substance Treatment
     Only3
6413952578
   Mental Health and Specialty
     Substance Treatment3
89296320476
No Treatment21,7396,87212,7652,102
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing mental health treatment/counseling information are excluded, except when information can be gained from responses regarding substance treatment.
NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
3 Received Substance Use Treatment at a Specialty Facility refers to treatment received at a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or mental health center in order to reduce or stop drug or alcohol use, or for medical problems associated with drug or alcohol use.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40317 (31B)

Table  B.23b Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment at a Specialty Facility in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Percentages, 2002
TreatmentDISORDER
SMI or Substance Use Disorder1,2SMI Only1Substance Use Disorder Only2SMI and Substance Use Disorder,1,2
Mental Health or Specialty Substance Treatment334.448.718.748.0
   Mental Health Treatment Only29.847.713.334.2
   Specialty Substance Treatment
     Only3
1.90.33.31.9
   Mental Health and Specialty
     Substance Treatment3
2.70.72.011.8
No Treatment65.651.381.352.0
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing mental health treatment/counseling information are excluded, except when information can be gained from responses regarding substance treatment.
NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
3 Received Substance Use Treatment at a Specialty Facility refers to treatment received at a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or mental health center in order to reduce or stop drug or alcohol use, or for medical problems associated with drug or alcohol use.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40317 (34A)

Table  B.24a Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Numbers in Thousands, 2002
TreatmentDISORDER
SMI or Substance Use Disorder1,2SMI Only1Substance Use Disorder Only2SMI and Substance Use Disorder1,2
Mental Health or Substance Treatment311,8426,5603,3061,976
   Mental Health Treatment Only9,7226,3862,0241,311
   Substance Treatment Only31,06765886117
   Mental Health and Substance
     Treatment3
1,049109392548
No Treatment21,3136,84612,4042,063
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing mental health treatment/counseling information are excluded, except when information can be gained from responses regarding substance treatment.
NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
3 Received Substance Use Treatment refers to treatment received in order to reduce or stop drug or alcohol use, or for medical problems associated with drug or alcohol use. It includes treatment received at any location, such as a hospital, a rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor's office, self-help group, or prison/jail.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40317 (34B)

Table  B.24b Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Percentages, 2002
TreatmentDISORDER
SMI or Substance Use Disorder1,2SMI Only1Substance Use Disorder Only2SMI and Substance Use Disorder1,2
Mental Health or Substance Treatment335.748.921.048.9
   Mental Health Treatment Only29.347.612.932.5
   Substance Treatment Only33.20.55.62.9
   Mental Health and Substance
     Treatment3
3.20.82.513.5
No Treatment64.351.179.051.1
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing mental health treatment/counseling information are excluded, except when information can be gained from responses regarding substance treatment.
NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
3 Received Substance Use Treatment refers to treatment received in order to reduce or stop drug or alcohol use, or for medical problems associated with drug or alcohol use. It includes treatment received at any location, such as a hospital, a rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor's office, self-help group, or prison/jail.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40315 (32A)

Table  B.25a Receipt of Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Type of Past Year Substance Use Disorder: Numbers in Thousands, 2002
Type of Substance Use DisorderSUBSTANCE USE DISORDER1
YesNo
Any Illicit Drug or Alcohol21,8596,495
      Alcohol Only1,0097,346
      Any Illicit Drug Only24777,877
      Any Illicit Drug and Alcohol23737,981
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
2 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40315 (32B)

Table  B.25b Receipt of Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental Illness, by Type of Past Year Substance Use Disorder: Percentages, 2002
Type of Substance Use DisorderSUBSTANCE USE DISORDER1
YesNo
Any Illicit Drug or Alcohol246.048.4
      Alcohol Only42.648.7
      Any Illicit Drug Only253.647.6
      Any Illicit Drug and Alcohol248.047.9
*Low precision; no estimate reported.
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.

1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
2 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40205

Table  B.M1 Adjusted Odds Ratios from Logistic Regression Models for Past Year Serious Mental Illness among Adults Aged 18 or Older, by Sociodemographic and Substance Use Characteristics: 2002
Sociodemographic and Substance Use
Characteristic
    Beta    SE BetaP ValueOdds Ratio95% CI
Age (image representing chi2 = 83.0)†     
   18–250.90340.1166< 0.00012.47(1.96, 3.10)
   26–490.83680.0920< 0.00012.31(1.93, 2.77)
   50 or Older0.00000.0000.1.00(1.00, 1.00)
Gender (image representing chi2 = 156.0)†     
   Female0.76430.0612< 0.00012.15(1.90, 2.42)
   Male0.00000.0000.1.00(1.00, 1.00)
Hispanic Origin and Race (image representing chi2 = 32.0)†     
   Black or African American–0.42180.1035< 0.00010.66(0.54, 0.80)
   Hispanic or Latino–0.51890.1127< 0.00010.60(0.48, 0.74)
   Other or Two or More Races–0.05810.15070.69990.94(0.70, 1.27)
   White0.00000.0000.1.00(1.00, 1.00)
Education (image representing chi2 = 12.9)†     
   < High School–0.20180.09730.03830.82(0.68, 0.99)
   High School Graduate–0.07770.07940.32790.93(0.79, 1.08)
   Some College0.10370.07930.19111.11(0.95, 1.30)
   College Graduate0.00000.0000.1.00(1.00, 1.00)
Current Employment (image representing chi2 = 5.0)     
   Part-Time0.09870.07920.21261.10(0.94, 1.29)
   Unemployed0.18780.11560.10471.21(0.96, 1.51)
   Other10.13420.07600.07791.14(0.99, 1.33)
   Full-Time0.00000.0000.1.00(1.00, 1.00)
Geographic Region (image representing chi2 = 3.3)     
   Northeast0.15450.09120.09051.17(0.98, 1.40)
   Midwest0.03980.07900.61501.04(0.89, 1.22)
   South0.03690.07690.63191.04(0.89, 1.21)
   West0.00000.0000.1.00(1.00, 1.00)
County Type (image representing chi2 = 5.2)     
   Large Metro–0.17000.07680.02720.84(0.73, 0.98)
   Small Metro–0.08380.07710.27770.92(0.79, 1.07)
   Nonmetro0.00000.0000.1.00(1.00, 1.00)
Marital Status (image representing chi2 = 61.9)†     
   Widowed0.01470.20380.94261.01(0.68, 1.51)
   Divorced or Separated0.56940.0854< 0.00011.77(1.49, 2.09)
   Never Married0.46670.0825< 0.00011.59(1.36, 1.88)
   Married0.00000.0000.1.00(1.00, 1.00)
Family Income (image representing chi2 = 2.6)     
   Less Than $20,0000.16950.10520.10761.18(0.96, 1.46)
   $20,000 to $49,9990.10410.08620.22731.11(0.94, 1.31)
   $50,000 to $74,9990.08080.10020.42021.08(0.89, 1.32)
   $75,000 or More0.00000.0000.1.00(1.00, 1.00)
Health Insurance (image representing chi2 = 4.2)     
   Medicaid/CHIP20.19080.10030.05751.21(0.99, 1.47)
   Other30.11120.14130.43171.12(0.85, 1.47)
   No Coverage0.09270.08100.25261.10(0.94, 1.29)
   Private0.00000.0000.1.00(1.00, 1.00)
Overall Health (image representing chi2 = 216.6)†     
   Fair/Poor1.42130.1087< 0.00014.14(3.35, 5.13)
   Good0.64680.0783< 0.00011.91(1.64, 2.23)
   Very Good0.24250.07710.00171.27(1.10, 1.48)
   Excellent0.00000.0000.1.00(1.00, 1.00)
Social Support4 (image representing chi2 = 62.1)†     
   Not Received0.68340.0868< 0.00011.98(1.67, 2.35)
   Received0.00000.0000.1.00(1.00, 1.00)
Nicotine Dependence5 (image representing chi2 = 31.2)†     
   Yes0.42060.0754< 0.00011.52(1.31, 1.77)
   No0.00000.0000.1.00(1.00, 1.00)
Any Illicit Drug Use/Dependence or Abuse6,7 (image representing chi2 = 88.7)†     
   Any Illicit Drug Dependence or Abuse1.01120.1097< 0.00012.75(2.22, 3.41)
   Any Illicit Drug Use and No Dependence or Abuse0.35550.0721< 0.00011.43(1.24, 1.64)
   No Illicit Drug Use0.00000.0000.1.00(1.00, 1.00)
Alcohol Use/Dependence or Abuse7 (image representing chi2 = 76.4)†     
   Alcohol Dependence or Abuse0.57350.0995< 0.00011.77(1.46, 2.16)
   Alcohol Use and No Dependence or Abuse–0.11160.07090.11580.89(0.78, 1.03)
   No Alcohol Use0.00000.0000.1.00(1.00, 1.00)
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
NOTE: The number of degrees of freedom for a Wald image representing chi2 statistic is equal to the number of levels of the associated characteristic minus one.

1 Retired person, disabled person, homemaker, student, or other person not in the labor force.
2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan.
3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance.
4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concerns, spend time on shared interests and activities, or who really like and care about them (SEN11a, SEN11b, and SEN11c, respectively).
5 Nicotine (Cigarette) Dependence is based on criteria derived from the Nicotine Dependence Syndrome Scale (NDSS) or the Fagerstrom Test of Nicotine Dependence (FTND). See Section 2.3.2 of Chapter 2 of this report.
6 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.
7 Dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

† Significant at the .05 level.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 

40205

Table  B.M2 Adjusted Odds Ratios from Logistic Regression Models for Receipt of Mental Health Treatment/Counseling in the Past Year among Adults Aged 18 or Older with Past Year Serious Mental Illness, by Sociodemographic and Substance Use Characteristics: 2002
Sociodemographic and Substance Use Characteristic    Beta    SE BetaP ValueOdds Ratio95% CI
Age (image representing chi2 = 24.9)†     
   18–25–0.00630.21650.97680.99(0.65, 1.52)
   26–490.53600.19640.00651.71(1.16, 2.51)
   50 or Older0.00000.0000.1.00(1.00, 1.00)
Gender (image representing chi2 = 14.0)†     
   Female0.45570.12180.00021.58(1.24, 2.00)
   Male0.00000.0000.1.00(1.00, 1.00)
Hispanic Origin and Race (image representing chi2 = 17.9)†     
   Black or African American–0.64840.19370.00080.52(0.36, 0.76)
   Hispanic or Latino–0.40660.18970.03240.67(0.46, 0.97)
   Other or Two or More Races–0.51980.25130.03890.59(0.36, 0.97)
   White0.00000.0000.1.00(1.00, 1.00)
Education (image representing chi2 = 21.9)†     
   < High School–0.82350.2029< 0.00010.44(0.29, 0.65)
   High School Graduate–0.60000.16370.00030.55(0.40, 0.76)
   Some College–0.27550.15410.07410.76(0.56, 1.03)
   College Graduate0.00000.0000.1.00(1.00, 1.00)
Current Employment (image representing chi2 = 11.3)†     
   Part-Time0.44610.15170.00341.56(1.16, 2.10)
   Unemployed0.20990.21830.33661.23(0.80, 1.89)
   Other10.40400.16050.01201.50(1.09, 2.05)
   Full-Time0.00000.0000.1.00(1.00, 1.00)
Geographic Region (image representing chi2 = 1.5)     
   Northeast0.13630.16700.41451.15(0.83, 1.59)
   Midwest–0.04160.16260.79790.96(0.70, 1.32)
   South0.00770.15230.95991.01(0.75, 1.36)
   West0.00000.0000.1.00(1.00, 1.00)
County Type (image representing chi2 = 4.9)     
   Large Metro0.12750.14580.38211.14(0.85, 1.51)
   Small Metro0.30000.14410.03771.35(1.02, 1.79)
   Nonmetro0.00000.0000.1.00(1.00, 1.00)
Marital Status (image representing chi2 = 19.7)†     
   Widowed–0.46400.43150.28250.63(0.27, 1.47)
   Divorced or Separated0.47050.15560.00261.60(1.18, 2.17)
   Never Married–0.20680.15020.16890.81(0.61, 1.09)
   Married0.00000.0000.1.00(1.00, 1.00)
Family Income (image representing chi2 = 2.9)     
   Less Than $20,0000.02850.20050.88691.03(0.69, 1.53)
   $20,000 to $49,9990.18510.17320.28551.20(0.86, 1.69)
   $50,000 to $74,9990.24930.18750.18381.28(0.89, 1.85)
   $75,000 or More0.00000.0000.1.00(1.00, 1.00)
Health Insurance (image representing chi2 = 22.8)†     
   Medicaid/CHIP20.12640.19080.50791.13(0.78, 1.65)
   Other30.09010.26080.72981.09(0.66, 1.83)
   No Coverage–0.70940.1548< 0.00010.49(0.36, 0.67)
   Private0.00000.0000.1.00(1.00, 1.00)
Overall Health (image representing chi2 = 18.9)†     
   Fair/Poor0.94010.2246< 0.00012.56(1.65, 3.98)
   Good0.47810.18230.00891.61(1.13, 2.31)
   Very Good0.35690.17230.03871.43(1.02, 2.00)
   Excellent0.00000.0000.1.00(1.00, 1.00)
Social Support4 (image representing chi2 = 0.2)     
   Not Received–0.07930.17700.65400.92(0.65, 1.31)
   Received0.00000.0000.1.00(1.00, 1.00)
Nicotine Dependence5 (image representing chi2 = 0.0)     
   Yes–0.00040.12051.00001.00(0.79, 1.27)
   No0.00000.0000.1.00(1.00, 1.00)
Any Illicit Drug/Alcohol Dependence or Abuse6,7 (image representing chi2 = 6.0)     
   Alcohol Dependence or Abuse Only–0.03470.13560.79800.97(0.74, 1.26)
   Any Illicit Drug Dependence or Abuse Only0.51470.25470.04361.67(1.01, 2.76)
   Any Illicit Drug and Alcohol Dependence or Abuse0.30570.21380.15301.36(0.89, 2.07)
   No Dependence or Abuse0.00000.0000.1.00(1.00, 1.00)
NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are excluded.
NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report.
NOTE: The number of degrees of freedom for a Wald image representing chi2 statistic is equal to the number of levels of the associated characteristic minus one.

1 Retired person, disabled person, homemaker, student, or other person not in the labor force.
2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan.
3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance.
4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concerns, spend time on shared interests and activities, or who really like and care about them (SEN11a, SEN11b, and SEN11c, respectively).
5 Nicotine (Cigarette) Dependence is based on criteria derived from the Nicotine Dependence Syndrome Scale (NDSS) or the Fagerstrom Test of Nicotine Dependence (FTND). See Section 2.3.2 of Chapter 2 of this report.
6 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically.

7 Dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

† Significant at the .05 level.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

 


End Notes

1 Prior to 2002, NSDUH was named the National Household Survey on Drug Abuse (NHSDA).

2 CHIP is only available for persons aged 19 or younger; therefore, the term "Medicaid" is used in this report to refer to health insurance for those aged 20 or older, but "Medicaid/CHIP" is used for those aged 19 or younger.

3 "Other" includes retired persons, disabled persons, homemakers, students, or other persons not in the labor force.

4 Small area estimation (SAE) is a hierarchical Bayes modeling technique used to make State-level estimates for approximately 20 substance use-related measures. See the State Estimates of Substance Use from the 2001 National Household Survey on Drug Abuse (Wright, 2003a, 2003b) for more details.

5 This small sample size was achieved in New Mexico following the decision to drop cases conducted by several interviewers in this State, Nevada, and Mississippi who were accused of completing fraudulent work. The next two smallest sample sizes were achieved in Mississippi and New Jersey with 839 and 854 completed cases, respectively.

6 For more details on the 5–year sample, see the sample design report in the 2001 NHSDA Methodological Resource Book (Bowman, Chromy, Odom, & Penne, 2003).

7 Prior to 2002, the survey was known as the National Household Survey on Drug Abuse (NHSDA).

 

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