2022 National Survey on Drug Use and Health (NSDUH) Releases

Many (but not all) NSDUH estimates from 2022 are comparable with estimates from 2021, as long as updated 2021 estimates, presented in the 2022 Detailed Tables, are used. When the NSDUH moved from in-person only survey administration to a multi-mode approach (with both in-person and web modes), it was determined that mode of administration had an effect on the resulting estimates. The proportion of interviews that were completed in-person was lower in 2021 than it was in 2022, likely due to the COVID-19 pandemic. In response to this, estimates for 2021 were updated using adjusted weights to account for changes in proportions of web vs. in-person interviews. The resulting updated 2021 estimates set the contributions of respondents for each mode to the same proportions as the 2022 estimates, thus removing the potential for bias in estimates of change due to shifts from web to in-person interviewing. See section 3.3.3 of the 2022 NSDUH Methodological Summary and Definitions for more details.

Additionally, necessary changes were made to the survey’s questions for certain outcomes in the 2022 NSDUH, including vaping, substance use treatment, and mental health treatment. Therefore, some outcomes in the 2022 NSDUH are not comparable with the updated 2021 NSDUH data. See What’s New/What’s Changed below for more details.

• The 2022 NSDUH data may be combined with 2021 data for pooled estimates. When creating pooled estimates, the 2021 updated weights and the 2022 weights should each be divided by the number of years being combined (two, in this case). The pooled estimates should use the new weights for 2021 that have been adjusted to the same mode proportions as the 2022 weights (see answer to FAQ #1).When the 2022 NSDUH public-use file (PUF) is released, the 2021 PUF will also be updated with adjusted weights to allow for comparison between the two years. The 2021 restricted-use file (RUF) will also include the adjusted weights.
• As with the 2021 NSDUH data, the 2022 NSDUH data should not be combined with data from 2020 or prior years for a variety of methodological reasons. A full description of the analyses that were conducted can be found in chapter 6 of the 2021 Methodological Summary and Definitions report.

• Both the substance use treatment and mental health treatment questions underwent considerable revisions in the 2022 NSDUH. The purpose of the updates was to better reflect current approaches to the delivery of treatment services based on extensive literature review, subject matter expert input, and cognitive testing. Due to these changes, 2022 estimates for substance use treatment and mental health treatment should not be compared with estimates from 2021. For this reason, estimates for substance use treatment and mental health treatment in 2021 are not shown in the 2022 NSDUH data products.
• The 2022 NSDUH defined substance use treatment as treatment received in the past year for the use of alcohol or drugs in an inpatient location; in an outpatient location; via telehealth; or in a prison, jail, or juvenile detention center; or the receipt of medication-assisted treatment (MAT) for alcohol use or opioid use. The 2022 NSDUH also collected information on the receipt of other services, including substance use services from any of the following: a support group, a peer support specialist or recovery coach who works with a substance use treatment program or other treatment provider, services in an emergency room or emergency department, or detoxification or withdrawal support services from a healthcare professional. These other services were not classified as “substance use treatment.” However, they were included in a separate aggregate measure created to cover the receipt of substance use treatment or other services.
• In addition, SAMHSA historically has included substance use treatment at a “specialty facility” in the past. With the changes to the questionnaire in 2022, the term “specialty facility” was dropped from 2022 NSDUH data products. In 2022, respondents were classified as needing substance use treatment if they had a substance use disorder in the past year or received treatment for their alcohol or drug use through inpatient treatment or counseling, outpatient treatment or counseling, medication-assisted treatment, telehealth treatment, or treatment received in a prison, jail, or juvenile detention center.
• The 2022 NSDUH defined mental health treatment as receipt of treatment or counseling for any problem with mental health, emotions, or behavior in the past year. Respondents were asked to report whether they received mental health treatment in the past 12 months in an inpatient location; in an outpatient location; through the use of prescription medication; via telehealth treatment; or in a prison, jail, or juvenile detention center. The 2022 NSDUH also collected information on the receipt of other mental health services, including participation in a support group, being seen in an emergency room or emergency department, or receiving help from a peer support specialist or recovery coach who works with a mental health treatment program or other treatment provider. These other services were not classified as “mental health treatment.” However, they were included in a separate aggregate measure created to cover the receipt of mental health treatment or other services.
• Sections 3.4.5 and 3.4.6 of the 2022 NSDUH Methodological Summary and Definitions discuss changes made to the substance use treatment and mental health treatment sections of the 2022 NSDUH questionnaire.

• Starting with the 2022 NSDUH, questions on vaping of nicotine were included in the nicotine section of the questionnaire instead of in the later emerging issues section. These changes affected the comparability of estimates of nicotine vaping between 2021 and 2022. For this reason, estimates for nicotine vaping in 2021 are not shown in the 2022 NSDUH data products.
• Additionally, questions about marijuana vaping were added to the marijuana section of the 2022 NSDUH questionnaire (marijuana vaping questions were previously only asked in the emerging issues section). The questions about marijuana vaping in the marijuana use section of the questionnaire were used to create the 2022 marijuana vaping estimates. Because questions on lifetime marijuana vaping are not asked in the marijuana section of the 2022 questionnaire, the estimates for lifetime marijuana vaping are not available for the 2022 NSDUH. Because of these changes to how marijuana vaping was measured for the 2022 NSDUH, estimates for marijuana vaping are not comparable between 2021 and 2022, and estimates for marijuana vaping in 2021 are not shown in the 2022 NSDUH data products.
• See section 3.4.11 of the 2022 NSDUH Methodological Summary and Definitions for details on changes made to the nicotine vaping measure in 2022, and 3.4.15 for more information on the marijuana vaping measure in 2022.

• Beginning in 2023, all variables for the ways in which respondents used marijuana in the past year and past month (smoking; vaping; dabbing waxes, shatter, or concentrates; eating or drinking; putting drops, strips, lozenges, or sprays in their mouth or under their tongue; applying lotion, cream, or patches to their skin; taking pills; or some other way) were statistically imputed to replace missing data. For estimates of modes of marijuana use that were presented in 2022 NSDUH reports and tables, only the variables for marijuana vaping were statistically imputed.
• For the 2023 NSDUH, these revised methods were also applied to produce imputed variables for all modes of marijuana use for 2022, including revised marijuana vaping variables. Therefore, the 2022 estimates for modes of marijuana use in the 2023 Detailed Tables may differ from previously published estimates. However, the revised 2022 estimates for modes of marijuana use may be compared with estimates in 2023.

• Starting with the 2022 NSDUH, questions were added to the emerging issues section of the questionnaire to assess the use of illegally made fentanyl (IMF). Because the questions about IMF came after the questions assessing substance use disorder and substance use treatment, it is not possible to assess SUDs or substance use treatment that arose solely from the use of IMF.
• Because data on IMF were not available in prior NSDUH years, some summary drug measures, such as illicit drug use and opioid misuse, did not include IMF in prior years. To enable comparisons with 2021, these measures also did not include IMF in 2022. However, new measures were produced in 2022 that included the use of IMF. These new measures included the use and misuse of fentanyl (i.e., pharmaceutical fentanyl or IMF) and the use and misuse of opioids including IMF.
• See section 4.3.4, 4.3.7, and 4.3.8 of the 2022 NSDUH Methodological Summary and Definitions for details on data collection and management for these measures as well as a discussion of which summary measures of opioids include IMF and which do not.
• It should be noted that because people who used IMF may have been unaware that they used it, caution must be taken in interpreting estimates of IMF use; these estimates are most likely an underestimate of true IMF use.