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2020 National Survey on Drug Use and Health (NSDUH) Releases

These reports and detailed tables present estimates from the 2020 National Survey on Drug Use and Health (NSDUH).

Jump to: Annual National Report Detailed Tables Methodology

Highlights for 2020 National Survey on Drug Use and Health

View the highlighted population slides:

  • 2020 National Survey on Drug Use and Health: National OAS Slides (PDF | PPT) 
  • 2020 National Survey on Drug Use and Health: American Indians and Alaska Natives (AI/ANs) (PDF | PPT) 
  • 2020 National Survey on Drug Use and Health: African Americans (PDF | PPT) 
  • 2020 National Survey on Drug Use and Health: Asians/Native Hawaiians and Other Pacific Islands (NHOPI) (PDF | PPT) 
  • 2020 National Survey on Drug Use and Health: Hispanics, Latino, or Spanish Origin or Descent (PDF | PPT)
  • 2020 National Survey on Drug Use and Health: Women (PDF | PPT) 
  • 2020 National Survey on Drug Use and Health: Veterans (PDF | PPT) 
  • 2020 National Survey on Drug Use and Health: Lesbian, Gay, and Bisexual (LGB) Adults (PDF | PPT) 

2020 NSDUH Frequently Asked Questions

1. Why should 2020 estimates not be compared with prior years’ estimates?

  • The coronavirus disease 2019 (COVID-19) pandemic necessitated changes in data collection, which may have had an impact on the measurement of behaviors. Changes in estimates of behavior may be due to this impact or may be due to true changes in prevalence. The primary methodological changes were (1) limited data collection from mid-March through September 2020, (2) introduction of web data collection in October 2020 with limited in-person data collection, and (3) questionnaire changes beginning in October 2020. These changes resulted in data collection mode effects and potentially other effects on the estimates. Because these changes in data collection coincided with the COVID-19 pandemic, the effects of methodological changes cannot be completely separated from actual changes in the outcomes.
  • The comparability between 2020 estimates and previous years’ estimates was unknown when the 2020 estimates were first released in October 2021. For that reason, data users were cautioned against making comparisons between estimates from 2020 and prior years. Further research using the larger sample of multimode data (i.e., in-person or web) from the 2021 NSDUH data has confirmed that 2020 estimates should not be compared with estimates from prior years. Key contributors to the break in comparability were the loss of 2 quarters of data collection in 2020 and the introduction of web data collection in October 2020.

2. What changes were made to the definition of substance use disorder (SUD) in 2020?

  • The criteria used to categorize SUD among NSDUH respondents changed from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)1 to the fifth edition (DSM-5),2resulting in some differences in who is classified as having an SUD.
1American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
2American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

3. The DSM-IV and DSM-5 estimates for SUD are so different. Which set is right?

  • Both are “right” relative to the diagnostic criteria in their respective DSM editions. Between DSM-IV and DSM-5, the SUD criteria were changed, resulting in differences in who is classified as having an SUD.
  • Under DSM-IV, NSDUH respondents are classified as having an SUD if they meet at least one of four criteria of substance abuse (these criteria focus on behaviors that reflect consequences of misuse of the substance) and/or at least three of seven criteria of substance dependence (these criteria focus on behaviors that reflect indications that one has become dependent on the substance). The DSM-5 criteria do not distinguish between symptoms of substance abuse and those of substance dependence. Instead, a DSM-5 SUD classification requires that at least two of eleven criteria be met.
  • There are two significant differences between the DSM-IV SUD criteria and the DSM-5 SUD criteria. First, one criterion of DSM-IV substance abuse (recurrent substance-related legal problems) is not part of the DSM-5 SUD criteria. Second, a new criterion (craving or a strong desire to use the substance) has been added to DSM-5 that was not present in the DSM-IV SUD criteria. Craving is a commonly experienced symptom for several classes of substances, such as opioids and sedatives. The other ten DSM-5 criteria correspond to DSM-IV criteria.

4. How did the data collected in 2020 differ from previous years?

  • Quarter 1 (January to March) data were collected like 2019 data were collected, with all household screenings and individual interviews conducted in person.
  • Quarter 4 (October to December) data collection methodology, data processing, and data collection outcomes changed as follows:
    • Web-based data collection was introduced to avoid in-person contact during the COVID-19 pandemic.
    • Screening and overall response rates were considerably lower for web-based data collection.
    • Youth interview response rates declined because of the required procedures for obtaining parental permission for youth to complete the web-based interview.
    • Some respondents did not complete their web interview, resulting in more missing responses to questions later in the questionnaire.
    • Web respondents tended to have completed higher levels of education, on average, than in-person respondents and the general population. Weighting procedures incorporated education in an effort to correct the imbalance.
    • New questions were introduced in Quarter 4 for telehealth services, youth suicidality, and issues related to the COVID-19 pandemic.

5. The number of completed interviews for the 2020 NSDUH is much lower than it was in previous years. What impact does a smaller sample size have on the estimates?

  • Data was not collected from mid-March through September 2020 and thus did not capture changes in people’s behavior and mental health during an unprecedented time in history (i.e., changing COVID-19 infection rates, lockdowns, and other societal changes). The sample is representative of January to March and October to December but is not representative of the entire year in which many people experienced changes in almost every aspect of life.
  • The sample for each calendar quarter follows the same national/state design as each full-year sample, and the weights for sample records are adjusted so that the sums are consistent with known national totals. For these reasons, the combined sample from Quarters 1 and 4 is representative in terms of geography (total U.S. and states) and demographic characteristics, even though it is smaller than prior years’ samples.
  • In general, larger sample sizes yield more precise estimates. Having a smaller national sample in 2020 means that many national estimates are not as precise as estimates from prior years, although the precision for 2020 national estimates is considered to be more than adequate.
  • Compared with larger samples, smaller sample sizes are less likely to produce sufficiently precise estimates for small subpopulations and for rare behaviors. Estimates that were deemed insufficiently precise due to the small sample size were suppressed in tables and reports. More estimates were suppressed in 2020 than in prior years.

6. Did SAMHSA release state-level estimates using 2020 data?

  • Ordinarily, SAMHSA produces state-level estimates by pooling two years of NSDUH data to increase sample sizes. However, methodological investigations have found that the unusual societal circumstances in 2020 and the resulting methodological revisions to NSDUH data collection have affected the comparability of 2020 estimates with estimates from 2019 and earlier. Consequently, estimates that involve combining data from 2020 with previous years are not presented. SAMHSA regrets the inconvenience.

Annual National Report

Key Substance Use and Mental Health Indicators in the United States

NSDUH’s latest annual report focuses on substance use and mental health in the United States based on NSDUH data from 2020 and earlier years. The annual report presents estimates that meet the criteria for statistical precision and facilitate stable examination of trends over time to study changes in society and emerging issues. The 2020 Key Substance Use and Mental Health Indicators report summarizes the following:

  • Substance use (alcohol, tobacco, marijuana, cocaine, heroin, hallucinogens, and inhalants, as well as the misuse of opioids, prescription pain relievers, tranquilizers or sedatives, stimulants, and benzodiazepines)
  • Initiation of substance use
  • Perceived risk from substance use
  • Substance use disorders
  • Any mental illness, serious mental illness, and major depressive episode
  • Suicidal thoughts, plans, and non-fatal attempts for adults aged 18 or older
  • Substance use treatment and mental health service use

An errata document is available with an update to the report.

View the slides based on the Annual National Report: Key Substance Use and Mental Health Indicators in the United States (PDF | PPT).

Detailed Tables

The 2020 NSDUH Detailed Tables present national estimates of substance use and mental health. Tables in different sections present data from 2019 and 2020 and data from 2002 to 2020. These tables present information for differences across population subgroups in 2020. In addition, they present information for youths aged 12 to 17 and adults aged 18 or older (separately and combined) on drug, alcohol, and tobacco use, as well as substance use disorder (SUD), risk and availability of substance use, treatment, health topics, and the perceived effects of the Coronavirus Disease 2019 (COVID-19). Please refer to Chapters 3 and 4 of the Methodological Summary and Definitions report for more information.

Sections of the 2020 Detailed Tables:1

1. Please note that selected tables have been revised.

Please refer to the related README file for instructions on how to use the Table of Contents and download files for faster viewing.

Methodology

The 2020 Methodological Summary and Definitions report summarizes the 2020 NSDUH methods and other supporting information relevant to estimates of substance use and mental health issues. This report accompanies the annual detailed tables and provides information on key definitions for many of the measures and terms used in these detailed tables and in other 2020 NSDUH documents, along with further analytic details on these measures and the survey. The report is organized into six chapters:

  • Chapter 1 is an introduction to the report.
  • Chapter 2 describes the survey, including information about the sample design; data collection procedures; and key aspects of data processing, such as development of analysis weights.
  • Chapter 3 presents technical details on the statistical methods and measurement, such as suppression criteria for unreliable estimates, statistical testing procedures, and issues for selected substance use and mental health measures.
  • Chapter 4 covers special topics related to prescription psychotherapeutic drugs.
  • Chapter 5 describes other sources of data on substance use and mental health issues, including data sources for populations outside the NSDUH target population.
  • Chapter 6 covers Special Methodological Issues for the 2020 NSDUH.
  • Appendix A is a glossary that covers key definitions for use as a resource with the 2020 NSDUH reports and detailed tables.
  • Appendix B provides a list of contributors to the report.