Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings

Substance use and mental health issues (i.e., "behavioral health issues") affect millions of adolescents and adults in the United States. Behavioral health problems, particularly depression, contribute to the burden of disease worldwide.¹ The Substance Abuse and Mental Health Services Administration (SAMHSA) supports preventing behavioral health problems and finding the pathway to recovery for those with behavioral health conditions. SAMHSA's message is that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover. Recovery support is one of the strategic initiatives identified by SAMHSA to improve the nation's behavioral health, reduce the burden of substance use disorders and mental illness in the United States, and help those with behavioral health conditions reclaim their lives. Knowing the percentage of people with substance use disorders and mental health issues in the United States is an important starting point for promoting the prevention of behavioral health problems and supporting recovery for those with behavioral health problems. Data from the 2013 National Survey on Drug Use and Health (NSDUH) provide a recent look at behavioral health in the United States. This issue of The NSDUH Report contains the first release of 2013 NSDUH estimates; it focuses on the percentage of individuals with behavioral health problems in the United States, as well as on the percentage receiving treatment or counseling for behavioral health problems.

NSDUH is an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. Data from NSDUH provide information on illicit drug use, alcohol use, substance use disorder (SUD), substance use treatment, reasons for not receiving substance use treatment, mental health issues (including mental health service use), and co-occurring SUD and mental health issues.

Estimates of substance use are presented for individuals aged 12 or older, adolescents, and adults. Estimates of substance use treatment and reasons for not receiving substance use treatment also are presented for individuals aged 12 or older. However, estimates of mental health issues are presented separately for adolescents aged 12 to 17 and adults aged 18 or older because the NSDUH mental health questions varied by age group.

With one exception, estimates are based on 2013 NSDUH data. Estimates of reasons for not receiving substance use treatment are based on combined 2010 to 2013 NSDUH data to increase precision.

NSDUH asks respondents aged 12 or older about their illicit drug use in the 30 days before the interview (i.e., current use). Illicit drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs (i.e., pain relievers, tranquilizers, stimulants, or sedatives) that were used nonmedically. Nonmedical use is defined as the use of prescription-type drugs that were not prescribed for the respondent or use only for the experience or feeling they caused. Nonmedical use of any prescription-type drug does not include over-the-counter drugs. Nonmedical use of stimulants and of any prescription-type drug includes methamphetamine use.

• In 2013, an estimated 24.6 million Americans aged 12 or older were current (past month) illicit drug users. This represents 9.4 percent of the population aged 12 or older (Table 1). Marijuana was the most commonly used illicit drug, with 19.8 million current users aged 12 or older (7.5 percent). There were 6.5 million nonmedical users of prescription-type drugs (2.5 percent), including 4.5 million nonmedical users of prescription pain relievers (1.7 percent). There were 1.5 million current cocaine users aged 12 or older, or 0.6 percent of the population. An estimated 1.3 million individuals aged 12 or older in 2013 (0.5 percent) used hallucinogens in the past month. An estimated 496,000 individuals aged 12 or older were current inhalant users, which represents 0.2 percent of the population. There were about 289,000 current heroin users aged 12 or older, or 0.1 percent of the population.
• In 2013, there were 2.2 million adolescents aged 12 to 17 who were current illicit drug users. This represents 8.8 percent of adolescents. In 2013, 7.1 percent of adolescents were current users of marijuana, 2.2 percent were current nonmedical users of prescription-type drugs (including 1.7 percent who were current nonmedical users of pain relievers), 0.6 percent were current users of hallucinogens, 0.5 percent were current users of inhalants, 0.2 percent were current users of cocaine, and 0.1 percent were current users of heroin.
• There were 22.4 million adults aged 18 or older who currently used illicit drugs in 2013. This represents 9.4 percent of adults. In 2013, 7.6 percent of adults were current users of marijuana, 2.5 percent were current nonmedical users of prescription-type drugs (including 1.7 percent who were current nonmedical users of pain relievers), 0.5 percent were current users of hallucinogens, 0.6 percent were current users of cocaine, 0.2 percent were current users of inhalants, and 0.1 percent were current users of heroin.

NSDUH asks respondents aged 12 or older about their alcohol use in the 30 days before the interview. Current alcohol use is defined as any use of alcoholic beverages such as beer, wine, liquor, brandy, or mixed drinks and cocktails in the past 30 days. Occasions when the respondent only had a sip or two from an alcoholic beverage are not included. Binge alcohol use is defined here 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 5 or more days in the past 30 days.

• Slightly more than half (52.2 percent) of Americans aged 12 or older were current alcohol users, which translates to an estimated 136.9 million current drinkers in 2013. Nearly one quarter (22.9 percent) of individuals aged 12 or older in 2013 were binge alcohol users. This translates to about 60.1 million people. In 2013, heavy drinking was reported by 6.3 percent of the population aged 12 or older, or 16.5 million people (Figure 1).
• In 2013, 11.6 percent of adolescents aged 12 to 17 were current alcohol users, representing 2.9 million adolescents. Many of these adolescents reported past month binge drinking (6.2 percent or 1.6 million adolescents) and 1.2 percent (293,000 adolescents) were heavy alcohol users.
• In 2013, 56.4 percent of adults aged 18 or older were current drinkers of alcohol, which translates to an estimated 134 million current adult drinkers. Nearly one quarter (24.6 percent) of adults aged 18 or older in 2013 (58.5 million adults) were binge alcohol users. The percentage of adults engaging in heavy drinking was 6.8 percent (16.2 million adults).

NSDUH includes a series of questions to assess dependence on or abuse of alcohol or illicit drugs in the past year. These questions are designed to measure dependence and abuse based on criteria specified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).² Individuals with alcohol or illicit drug dependence or abuse are defined as having an SUD.

• In 2013, an estimated 21.6 million individuals aged 12 or older had an SUD in the past year (8.2 percent of the population aged 12 or older) (Figure 2).
• An estimated 1.3 million adolescents aged 12 to 17 had an SUD in 2013 (5.2 percent of adolescents).
• An estimated 20.3 million adults aged 18 or older in 2013 had a past year substance use disorder, which translates to 8.5 percent of adults.

NSDUH collects information about the receipt of substance use treatment at a specialty facility,³ the need for substance use treatment, and the receipt of services among those who needed treatment. NSDUH classifies respondents as needing substance use treatment if they met the criteria for SUD or if they received substance use treatment at a specialty facility in the past year.

• In 2013, an estimated 22.7 million individuals aged 12 or older in 2013 needed treatment for an illicit drug or alcohol use problem (8.6 percent of the population aged 12 or older).
• Among the 22.7 million individuals 12 or older who needed treatment for an illicit drug or alcohol use problem, an estimated 2.5 million received treatment at a specialty facility for an illicit drug or alcohol problem.
• This means that 20.2 million individuals needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty facility in the past year.

NSDUH includes questions that ask respondents about their perceived need for substance use treatment (i.e., whether they felt they needed substance use treatment or counseling for illicit drug use or alcohol use). In this report, estimates for perceived need for substance use treatment are discussed only for individuals who were classified as needing treatment (based on DSM-IV criteria)⁴ but did not receive treatment at a specialty facility. Individuals who perceived a need for treatment but did not receive treatment at a specialty facility also were asked their reasons for not receiving illicit drug or alcohol use treatment.⁵

• Among the 20.2 million individuals aged 12 or older in 2013 who were classified as needing substance use treatment but who did not receive treatment at a specialty facility in the past year, 908,000 (4.5 percent) reported that they perceived a need for treatment for their illicit drug or alcohol use problem.
• Of the 908,000 individuals in 2013 who felt they needed treatment but did not receive treatment at a specialty facility, 316,000 (34.8 percent) reported that they made an effort to get treatment, and 592,000 (65.2 percent) reported making no effort to get treatment.
• Based on 2010-2013 combined data, commonly reported reasons for not receiving treatment among individuals aged 12 or older who needed but did not receive illicit drug or alcohol use treatment, felt a need for treatment, and made an effort to receive treatment, were (1) no health coverage/could not afford cost (37.3 percent), (2) not ready to stop using (24.5 percent), (3) did not know where to go for treatment (9.0 percent), (4) had health coverage but it did not cover treatment or did not cover cost (8.2 percent), and (5) no transportation or inconvenient hours (8.0 percent) (Table 2).

Although NSDUH does not contain an overall indicator of mental health among adolescents aged 12 to 17, NSDUH provides estimates of having a past year major depressive episode (MDE) for this age group. MDE is defined using the diagnostic criteria from DSM-IV. Adolescents were defined as having MDE if they had a period of 2 weeks or longer in the past 12 months when they experienced a depressed mood or loss of interest or pleasure in daily activities, and they had at least four of seven additional symptoms, such as problems with sleep, eating, energy, concentration, and self-worth.⁶ Adolescents were defined as having MDE with severe impairment if their depression caused severe problems with their ability to do chores at home, do well at work or school, get along with their family, or have a social life.

• In 2013, approximately 1 in 10 adolescents aged 12 to 17 in the United States (10.7 percent) had MDE in the past year. This represents 2.6 million adolescents in this country.
• An estimated 7.7 percent of adolescents aged 12 to 17 (1.9 million adolescents) had past year MDE with severe impairment.

NSDUH provides estimates of any mental illness (AMI) and serious mental illness (SMI) for adults aged 18 or older. AMI is defined as an individual having any mental, behavioral, or emotional disorder in the past year that met DSM-IV criteria⁴ (excluding developmental and substance use disorders). Adults were defined as having SMI if they had any mental, behavioral, or emotional disorder that substantially interfered with or limited one or more major life activities.⁷ Adult respondents were also asked whether they had thought seriously about trying to kill themselves at any time during the past 12 months; those who reported having had serious thoughts of suicide were then asked whether, in the past 12 months, they had made any plans to kill themselves and whether they had tried to kill themselves.

• In 2013, an estimated 43.8 million adults aged 18 or older in the United States had AMI in the past year. This represents nearly one in five adults in this country (18.5 percent of all adults) (Figure 3). There were an estimated 10.0 million adults aged 18 or older with SMI in the past year. This represented 4.2 percent of all adults in this country.
• An estimated 9.3 million adults (3.9 percent) aged 18 or older in 2013 had serious thoughts of suicide in the past year. In 2013, 2.7 million adults aged 18 or older (1.1 percent) made suicide plans in the past year, and 1.3 million adults (0.6 percent) attempted suicide in the past year (Table 3).

Figure 3. Mental health issues in the past year among adolescents aged 12 to 17 and adults aged 18 or older: 2013

Figure 3 Table. Mental health issues in the past year among adolescents aged 12 to 17 and adults aged 18 or older: 2013

Age	Mental Health Issue	Percent	Number (in millions)
Aged 12 to 17	Major depressive episode	10.7%	2.6
	Major depressive episode with severe impairment	7.7%	1.9
Aged 18 or older	Any mental illness	18.5%	43.8
	Serious mental illness	4.2%	10.0

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health (NSDUH), 2013.

NSDUH includes questions that ask respondents if they received help for their mental health issues. Adolescents who have MDE are asked about receipt of treatment for depression, which is defined as seeing or talking to a medical doctor or other professional or using prescription medication for depression in the past year. All adult respondents are asked whether they received treatment or counseling for any problem with emotions, "nerves," or mental health in any inpatient or outpatient setting or whether they used prescription medication in the past year. These questions excluded treatment for the use of alcohol or illicit drugs.

• Of the 2.6 million adolescents in 2013 with past year MDE, 977,000 received treatment for depression (Figure 4). This represented 38.1 percent of adolescents with past year MDE. Among adolescents in 2013 who had past year MDE with severe impairment in carrying out responsibilities, 45.0 percent (832,000) received treatment for depression.
• In 2013, 34.6 million adults aged 18 or older (14.6 percent of the population aged 18 or older) received mental health care during the past 12 months (data not shown).

Individuals with both SUD and a mental health issue are defined as having a co-occurring mental health issue and SUD. This section presents estimates of past year co-occurring SUD and MDE among adolescents aged 12 to 17. It also includes estimates of past year co-occurring SUD and mental health issues among adults aged 18 or older.

• In 2013, 1.4 percent of adolescents aged 12 to 17 (359,000 adolescents) in the United States had both SUD and MDE in the past year (Figure 5).
• In 2013, 3.2 percent of all adults aged 18 or older (7.7 million adults) had both SUD and AMI. In 2013, 1.0 percent of all adults aged 18 or older (2.3 million adults) had co-occuring SUD and SMI.

As recovery support is part of SAMHSA's strategic initiatives, it is essential to SAMHSA's mission to understand the magnitude of substance use and mental health issues in the United States. This report indicates that in 2013, an estimated 24.6 million Americans aged 12 or older were current illicit drug users, 60.1 million were binge alcohol users, and 21.6 million had a past year SUD. An estimated 43.8 million adults aged 18 or older had AMI in the past year, and 10.0 million had SMI. An estimated 2.6 million adolescents aged 12 to 17 had MDE during the past year, including 1.9 million who had past year MDE with severe impairment.

For many, behavioral health treatment is an important component of recovery and is one of multiple strategies to facilitate recovery.^8,9 Treatment or counseling can also decrease risk of relapse and promote recovery and remission of mental disorders.¹⁰ According to 2013 NSDUH data, 34.6 million adults aged 18 or older received treatment or counseling for mental health issues during the past 12 months. With regards to adolescents, 38.1 percent of adolescents with a past year MDE and 45.0 percent of those who had MDE with severe impairment received treatment or counseling for depression. Also, 22.7 million individuals aged 12 or older needed treatment for an illicit drug or alcohol use problem. However, 20.2 million individuals in this group did not receive treatment at a specialty facility in the past year. Based on combined 2010 to 2013 NSDUH data, individuals who felt the need for substance use treatment but did not receive it despite making an effort to obtain treatment reported they did not receive treatment because they did not have health coverage and could not afford cost (37.3 percent) or they were not ready to stop using (24.5 percent).

Resources to help parents, teachers, and caregivers recognize the signs and symptoms of mental health issues and locate mental health services are available from http://www.mentalhealth.gov/. Information on locating substance use treatment is available from http://findtreatment.samhsa.gov/TreatmentLocator/faces/quickSearch.jspx. Resources and information on the societal benefits of prevention, treatment, and recovery for mental health issues and substance use disorders is also available on SAMHSA's Recovery Month Web site: http://www.recoverymonth.gov/.

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