This glossary is a resource to provide definitions for many of the commonly used measures and terms in national tables and reports from the 2023 National Survey on Drug Use and Health (NSDUH). Where relevant, cross-references to details in the 2023 National Survey on Drug Use and Health (NSDUH): Methodological Summary and Definitions report also are provided.1 In addition, some definitions contain cross-references (indicated by “SEE”) to refer data users to the correct entry in the glossary or to aid data users in understanding the meaning of the current definition. For example, if data users search on “Any Mental Illness” or “AMI,” they are referred to the “Mental Illness” definition for the definition of any mental illness. As an example of the second kind of cross-reference, the “Alcohol Use Disorder (AUD)” definition includes cross-references to “Alcohol Use” and “Substance Use Disorder (SUD)” to aid data users in understanding the AUD definition. However, these cross-references to other definitions are not intended to provide an exhaustive index of all related terms that might apply.
For some key terms, specific question wording is provided for clarity. In some situations, information also is included about specific gate questions. In many instances, a gate question is the first question in a series of related questions. How a respondent answers the gate question affects whether the respondent is asked additional questions in that section of the interview or is routed to the next section of the interview. In some sections of the interview, respondents may be asked more than one gate question to determine whether they are asked additional questions in that section or are routed to the next section.2
A
Abbreviated WHODAS
ACASI
Age
Alcohol Use
Alcohol Use Disorder (AUD)
Alcohol Use in Combination with Illicit Drug Use
American Indian or Alaska Native (AIAN)
Analysis Weight
Any Mental Illness (AMI)
Any Use of Prescription Psychotherapeutics
Asian
At Risk for Initiation
B
Benzodiazepine Use or Misuse
Binge Use of Alcohol
Black
C
CAPI
CBD or Hemp Products
Central Nervous System Stimulant Use or Misuse
Central Nervous System Stimulant Use Disorder
Cigar Use
Cigarette Use
Cigarillo Use
Classified as Needing Substance Use Treatment
Cocaine Use
Cocaine Use Disorder
College Enrollment Status
Considered Themselves to Be in Recovery from Mental Health Issues
Considered Themselves to Be in Recovery from Substance Use Problems
County Type
Crack Use
Current Use or Misuse
D
Daily Cigarette Use
Daily or Almost Daily Use
Delinquent Behavior
Depression
Distress
DMT, AMT, or 5-MeO-DIPT (“Foxy”) Use
Driving Under the Influence
Drug Use
Drug Use Disorder
E
Ecstasy Use
Education Level
Employment Status
Ethnicity
Ever Used
Exposure to Drug Education and Prevention
F
Fentanyl Use or Misuse
Functional Impairment
G
Gate Question
Geographic Division
GHB Use
Global Assessment of Functioning (GAF)
H
Hallucinogen Use
Hallucinogen Use Disorder
Health Insurance
Heavy Use of Alcohol
Heroin Use
Heroin Use Disorder
Hispanic or Latino
I
Illegally Made Fentanyl (IMF) Use
Illicit Drugs
Illicit Drugs Other Than Marijuana
Inhalant Use
Inhalant Use Disorder
Initiation of Substance Use or Misuse
Inpatient Mental Health Treatment
Inpatient Substance Use Treatment
Interview Mode
K
Kessler-6 (K6) Scale
Ketamine Use
Kratom Use
L
Large Metro
Latino
Lifetime Use or Misuse
Location of Most Recent Underage Alcohol Use
Locations and Types of Mental Health Treatment
Locations and Types of Substance Use Treatment
Low Precision
LSD Use
M
Major Depressive Episode (MDE)
Major Depressive Episode (MDE) with Severe Impairment
Marijuana Use
Marijuana Use Disorder
Marijuana Vaping
Medicaid
Medicare
Medication-Assisted Treatment (MAT) for Alcohol Use
Medication-Assisted Treatment (MAT) for Opioid Misuse
Mental Health Treatment
Mental Health Treatment in Prison, Jail, or Juvenile Detention Center
Mental Health Treatment or Other Services
Mental Illness
Methamphetamine Use
Methamphetamine Use Disorder
Midwest Region
Misuse of Prescription Psychotherapeutics
Mode
Modes of Marijuana Use
Module
Multiracial
N
Native Hawaiian or Other Pacific Islander (NHOPI)
Need for Substance Use Treatment
Needle Use
Nicotine Dependence
Nicotine Vaping
Nonmetro
Nonphysical Delinquent Behavior
Nonprescription Cough or Cold Medicine Use
Northeast Region
O
Opioid Use or Misuse
Opioid Misuse Including IMF
Opioid Use Disorder
Other Mental Health Services
Other Substance Use Services
Outpatient Mental Health Treatment
Outpatient Substance Use Treatment
OxyContin® Use or Misuse
P
Pain Reliever Use Disorder
Pain Reliever Use or Misuse
Past Month Use or Misuse
Past Year Use or Misuse
PCP Use
Perceived Availability
Perceived Risk/Harmfulness
Perceived Unmet Need for Mental Health Treatment
Perceived Unmet Need for Substance Use Treatment
Percentages
Physical Delinquent Behavior
Pipe Tobacco Use
Poverty Level
Prescription Medication Used as a Mental Health Treatment
Prescription Fentanyl Products
Prescription Psychotherapeutic Drugs
Prescription Psychotherapeutic Drug Use Disorder
Probation/Parole
Psychotherapeutic Drugs
R
Race/Ethnicity
Reasons for Misusing Prescription Psychotherapeutics
Reasons for Not Receiving Mental Health Treatment
Reasons for Not Receiving Substance Use Treatment
Received Mental Health Treatment through Prescription Medication
Received Telehealth Substance Use Treatment
Received Treatment for Alcohol Use
Received Treatment for Both Alcohol and Drug Use
Received Treatment for Drug Use
Received Treatment for Substance Unspecified
Recency of Use or Misuse
Recovery from Mental Health Issues
Recovery from Substance Use Problems
Region
Religious Service Attendance
Rounding
S
Salvia divinorum Use
Sedative Use Disorder
Sedative Use or Misuse
Serious Mental Illness (SMI)
Serious Psychological Distress (SPD)
Sex
Sexual Identity
Sheehan Disability Scale (SDS)
Small Metro
Smokeless Tobacco Use
Social Context of Most Recent Underage Alcohol Use
Source of Alcohol for Most Recent Underage Alcohol Use
Source of Prescription Psychotherapeutic Drugs
South Region
Statistical Significance
Stimulant Use Disorder
Stimulant Use or Misuse
Substance Use Disorder (SUD)
Substance Use Disorder Severity
Substance Use Treatment
Substance Use Treatment or Other Services
Substances for Which Other Substance Use Services Were Received
Substances for Which Treatment Was Received
Suicidal Thoughts and Behaviors among Adults
Suicidal Thoughts and Behaviors among Youths
Suppression of Estimates
Synthetic Cannabinoids
Synthetic Cathinones
Synthetic Marijuana
Synthetic Stimulants
T
Telehealth Mental Health Treatment
Telehealth Substance Use Treatment
Tobacco Product Use
Tobacco Product Use or Nicotine Vaping
Tranquilizer or Sedative Use Disorder
Tranquilizer or Sedative Use or Misuse
Tranquilizer Use Disorder
Tranquilizer Use or Misuse
Treatment for a Substance Use Problem
Treatment for Alcohol Use
Treatment for Both Alcohol and Drug Use
Treatment for Drug Use
Treatment for Unspecified Substances
Two or More Races
Type of Mental Health Treatment
U
Underage Alcohol Use
Underage Tobacco Use or Nicotine Vaping
W
West Region
White
World Health Organization Disability Assessment Schedule (WHODAS)
SEE: World Health Organization Disability Assessment Schedule (WHODAS).
ACASI stands for audio computer-assisted self-interviewing and applies to in-person NSDUH data collection. ACASI questions appear on a laptop computer screen while an audio recording of the questions plays on headphones. Respondents enter their answers directly into the computer without the interviewer knowing how they answered. ACASI is designed to provide the respondent with a highly private and confidential mode for responding to questions about illicit drug use and other sensitive behaviors. The audio also is helpful for respondents with limited reading skills. For information on in-person interview sections administered using ACASI, see the list of the content of the 2023 NSDUH in-person instruments.3
SEE: CAPI and Interview Mode.
Age of the respondent was defined as “age at time of interview.” The interview program calculated the respondent’s age from the interview date and the date of birth reported to the interviewer. The interview program prompts the interviewer to confirm the respondent’s age after it has been calculated.
Measures of use of alcohol in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the alcohol section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, had a drink of any type of alcoholic beverage?” and “How long has it been since you last drank an alcoholic beverage?”). The question about recency of use was asked if respondents previously reported any use of alcohol in their lifetime.
The following definitional information preceded the question about lifetime alcohol use: “The next questions are about alcoholic beverages, such as beer, wine, brandy, and mixed drinks. Listed on the next screen are examples of the types of beverages we are interested in. Please review this list carefully before you answer these questions. These questions are about drinks of alcoholic beverages. Throughout these questions, by a ‘drink,’ we mean a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. We are not asking about times when you only had a sip or two from a drink.”
SEE: Binge Use of Alcohol, Current Use or Misuse, Heavy Use of Alcohol, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, and Underage Alcohol Use.
Alcohol use disorder (AUD) was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-54). Respondents who used alcohol on 6 or more days in the past 12 months were classified as having an AUD if they met two or more of the following criteria: (1) used alcohol in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on alcohol use; (3) spent a great deal of time in activities to obtain, use, or recover from alcohol use; (4) felt a craving or strong desire to use alcohol; (5) engaged in recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use alcohol despite social or interpersonal problems caused by the effects of alcohol; (7) gave up or reduced important social, occupational, or recreational activities because of alcohol use; (8) continued to use alcohol in physically hazardous situations; (9) continued to use alcohol despite physical or psychological problems caused by alcohol use; (10) increased the amount of alcohol needed to achieve same effect or noticed that the same amount of alcohol use had less effect than before; and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping alcohol use or (11b) used alcohol or a related substance to get over or avoid alcohol withdrawal symptoms. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Alcohol Use and Substance Use Disorder (SUD).
Respondents who used alcohol in the past 30 days were classified as using alcohol in combination with illicit drugs if they reported in the consumption of alcohol section of the questionnaire that they used one or more of six illicit drugs with their most recent use of alcohol or within a couple of hours of drinking alcohol. The specific illicit drugs respondents were asked about using in combination with alcohol were marijuana, cocaine or crack, heroin, hallucinogens, inhalants, and methamphetamine. Respondents were asked only about use of alcohol in combination with the illicit drugs they reported using in the past 30 days. Respondents who used both alcohol and illicit drugs in the past month were asked about this behavior. Respondents could report the use of more than one illicit drug in combination with alcohol. The definition does not include alcohol use in combination with prescription pain relievers, prescription tranquilizers, prescription stimulants, or prescription sedatives because respondents were asked about misuse of these prescription psychotherapeutic drugs in combination with alcohol at any point in the past 30 days (i.e., not just the last time they used alcohol).
SEE: Alcohol Use, Cocaine Use, Crack Use, Hallucinogen Use, Heroin Use, Inhalant Use, Marijuana Use, and Methamphetamine Use.
American Indian or Alaska Native only, not of Hispanic, Latino, or Spanish origin, including North American, Central American, or South American Indian as reported in the front-end demographics section. This definition does not include respondents reporting two or more races. Respondents reporting they were American Indians or Alaska Natives and of Hispanic, Latino, or Spanish origin were classified as Hispanic.
SEE: Hispanic or Latino, Race/Ethnicity, and Two or More Races.
Person-level analysis weights were created for analyses of NSDUH data so that the estimates from respondents’ data represented the national population of interest for a given survey year. In each year, person-level analysis weights reflected probabilities of selection, adjustment for nonresponse, poststratification to known population control totals, and controls for extreme weights when necessary. Person-level weighting procedures for 2022 through 2023 also took into account variations in the proportions of interviews that were completed in each mode of data collection (i.e., via the web or in person). See Chapter 2 in the 2023 Methodological Summary and Definitions report for additional details on how the weights are created, including adjustment to further account for multimode data collection.
For 2023, two person-level weights were produced. In addition to the main analysis weight, a person-level break-off analysis weight was produced to adjust for the relatively high number of web respondents who did not complete the interview (i.e., break-offs). The break-off analysis weight was used to analyze unimputed outcomes based on questions that occurred in the mental health or later sections of the questionnaire. See Chapters 2 and 3 in the 2023 Methodological Summary and Definitions report for details on when the break-off analysis weights were used to produce estimates for 2023.
SEE: Interview Mode.
SEE: Mental Illness.
Any use of psychotherapeutics refers to use of prescription psychotherapeutic medication (pain relievers, tranquilizers, stimulants, or sedatives) for any reason. This could include use of prescriptions of one’s own as directed by a doctor or misuse of these medications. Respondents were asked in the respective questionnaire sections whether they used a series of specific prescription psychotherapeutic drugs in the past 12 months. For pain relievers, stimulants, and sedatives, respondents were instructed not to include the use of over-the-counter (OTC) drugs (e.g., aspirin, Tylenol®, Advil®, Aleve®, Dexatrim®, No-Doz®, Hydroxycut®, 5-Hour Energy®, Sominex®, Unisom®, Nytol®, Benadryl®). This instruction not to include OTC drugs was not included for tranquilizers because all tranquilizers in the United States currently require a prescription. The questions about any use in the past 12 months included electronic images of pills or other forms of the drugs (where applicable) to aid respondents in recalling whether they used a specific prescription drug in the past 12 months. Respondents who did not report use in the past 12 months of any specific prescription psychotherapeutic drug within a category (e.g., prescription pain relievers) were asked whether they ever, even once, used any prescription psychotherapeutic drug within that category (e.g., any prescription pain reliever). Respondents were not asked about any use of prescription psychotherapeutic drugs in the past 30 days.
SEE: Benzodiazepine Use or Misuse, Lifetime Use or Misuse, Misuse of Prescription Psychotherapeutics, Pain Reliever Use or Misuse, Past Year Use or Misuse, Psychotherapeutic Drugs, Recency of Use or Misuse, Sedative Use or Misuse, Stimulant Use or Misuse, Tranquilizer or Sedative Use or Misuse, and Tranquilizer Use or Misuse.
Asian only, not of Hispanic, Latino, or Spanish origin, in accordance with federal standards for reporting race and ethnicity data.5 This definition is based on reports in the front-end demographics section in which respondents described themselves as being Asian. The definition does not include respondents reporting two or more races. Respondents reporting they were Asian and of Hispanic, Latino, or Spanish origin were classified as Hispanic. Specific Asian groups asked about were Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian.
SEE: Hispanic or Latino, Race/Ethnicity, and Two or More Races.
Individuals were classified as being at risk for initiation in the past 12 months if they did not use a given substance in their lifetime or if they used it for the first time in the past year. Individuals who first used the substance more than 12 months ago were no longer considered to be at risk for initiation. NSDUH can identify individuals at risk for initiation of use of marijuana, cocaine, crack, heroin, hallucinogens, lysergic acid diethylamide (LSD), phencyclidine (PCP), Ecstasy, inhalants, methamphetamine, cigarettes, nicotine vaping, smokeless tobacco, cigars, and alcohol and also those at risk for initiation of daily cigarette use based on responses from the respective substance use questionnaire sections.
NSDUH cannot identify individuals at risk for initiation of use for the aggregate categories of either tobacco products or tobacco products or nicotine vaping because respondents were not asked when they first used pipe tobacco. NSDUH also cannot identify individuals at risk for initiation of illicit drug use, use of illicit drugs other than marijuana, misuse of prescription psychotherapeutic drugs (i.e., pain relievers, tranquilizers, stimulants, or sedatives), benzodiazepines, misuse of opioids, misuse for the aggregate category for tranquilizers or sedatives, and misuse of central nervous system (CNS) stimulants. For these measures, the Results from the 2023 National Survey on Drug Use and Health: Detailed Tables do not show percentages for initiation among those at risk for initiation because of the structure of the prescription drug questions. With the focus of questions on the past year misuse of specific psychotherapeutic drugs, respondents who last misused any prescription psychotherapeutic drug in a category (e.g., pain relievers) more than 12 months ago may underreport misuse. These respondents who did not report misuse that occurred more than 12 months ago would be misclassified as still being at risk for initiation. This question structure also has an effect on aggregate risk for initiation measures such as those listed earlier in this paragraph (e.g., illicit drugs) that include prescription psychotherapeutic drugs.
In addition, respondents are not asked questions about the initiation of use or misuse of gamma hydroxybutyrate (GHB), nonprescription cough and cold medicines, kratom, modes of marijuana use, vaping of flavoring, illegally made fentanyl (IMF), synthetic marijuana, or synthetic stimulants. Therefore, there are no risk for initiation measures for these substances.
See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Initiation of Substance Use or Misuse.
Measures of the use or misuse of benzodiazepines in the past year were derived from questions in the tranquilizer and sedative sections of the questionnaire that asked respondents about any use (i.e., for any reason) in the past 12 months of specific prescription tranquilizers or sedatives classified as benzodiazepines (see below). Respondents who reported they used specific benzodiazepines were asked for each drug whether they used it in the past 12 months in any way not directed by a doctor. Examples of use in any way a doctor did not direct respondents to use prescription tranquilizers or sedatives (including benzodiazepines) were presented to respondents and included (1) use without a prescription of the respondent’s own; (2) use in greater amounts, more often, or longer than told to take a drug; or (3) use in any other way a doctor did not direct the respondent to use a drug.
Questions about the past year use and misuse of benzodiazepines covered the following subcategories of benzodiazepines prescribed as tranquilizers: alprazolam products (Xanax®, Xanax® XR, generic alprazolam, or generic extended-release alprazolam), lorazepam products (Ativan® or generic lorazepam), clonazepam products (Klonopin® or generic clonazepam), or diazepam products (Valium® or generic diazepam). Questions covered the following subcategories of benzodiazepines prescribed as sedatives: flurazepam (also known as Dalmane®), temazepam products (Restoril® or generic temazepam), or triazolam products (Halcion® or generic triazolam). These drugs were specified in the questionnaire but are not an exhaustive list of benzodiazepines. The benzodiazepine category also includes benzodiazepines that respondents specified that they misused as other tranquilizers or sedatives.
Respondents were asked about their use and misuse of benzodiazepines only for the past year; therefore, there are no lifetime or past month measures for benzodiazepines. See Chapter 4 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Past Year Use or Misuse, Sedative Use or Misuse, and Tranquilizer Use or Misuse.
Binge use of alcohol was defined for females as drinking four or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) and for males as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days. Respondents were asked in the alcohol section of the questionnaire about the number of days they had five or more drinks (for males) or four or more drinks (for females) on the same occasion if they reported last using any alcohol in the past 30 days based on the following question: “How long has it been since you last drank an alcoholic beverage?”
SEE: Alcohol Use and Heavy Use of Alcohol.
Black/African American only, not of Hispanic, Latino, or Spanish origin. This definition is based on reports in the front-end demographics section in which respondents described themselves as being Black or African American. The definition does not include respondents reporting two or more races. Respondents reporting they were Black or African American and of Hispanic, Latino, or Spanish origin were classified as Hispanic.
SEE: Hispanic or Latino, Race/Ethnicity, and Two or More Races.
CAPI stands for computer-assisted personal interviewing and applies to in-person NSDUH data collection. CAPI questions in NSDUH are interviewer administered. Interviewers read these questions to respondents, then enter the respondents’ answers into a laptop computer. For information on interview sections administered in person using CAPI, see the list of the content of the 2023 NSDUH in-person instrument.6
SEE: ACASI and Interview Mode.
Measures of the use of CBD (cannabidiol) or hemp products in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the marijuana section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used any CBD or hemp product?” and “How long has it been since you last used any form of CBD or hemp product?”). The question about recency of use was asked if respondents previously reported any use of CBD in their lifetime.
The following definitional information preceded the question about lifetime CBD use: “The next questions are about CBD or hemp products made from hemp plants. CBD and hemp products have no or small amounts of THC (delta 9-tetrahydrocannabinol) and are not intended to cause a ‘high.’ They come in many forms including oils, lotions, edibles, and isolate. People sometimes use them to relieve pain, to reduce anxiety, or to help them sleep.”
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Central nervous system (CNS) stimulants in NSDUH refer to cocaine, methamphetamine, or prescription stimulants. Measures were created for any use of CNS stimulants and misuse of CNS stimulants. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
Respondents were classified as using CNS stimulants for any reason in the past year (i.e., any use) if they reported using cocaine or methamphetamine in the past year or they reported any use of prescription stimulants in the past year (i.e., not necessarily misuse). (Respondents were not asked about any use of prescription stimulants in the past month.)
Respondents were classified as misusing CNS stimulants in the past year or past month if they reported using cocaine or methamphetamine or misusing prescription stimulants in these periods. (Respondents who reported the misuse of specific prescription stimulants in the past year were asked if they misused any prescription stimulant in the past month.)
SEE: Current Use or Misuse, Cocaine Use, Methamphetamine Use, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, and Stimulant Use or Misuse.
Respondents were classified as having a central nervous system (CNS) stimulant use disorder if they met criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-57). Respondents were classified as having a CNS stimulant use disorder if they met criteria for cocaine use disorder, methamphetamine use disorder, or prescription stimulant use disorder (or more than one of these disorders). Respondents who reported any use of prescription stimulants in the past year and met DSM-5 criteria for stimulant use disorder were classified as having a prescription stimulant use disorder.
Respondents were not counted as having a CNS stimulant use disorder if they did not meet the full substance use disorder criteria individually for cocaine, methamphetamine, or prescription stimulants. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Cocaine Use, Cocaine Use Disorder, Methamphetamine Use, Methamphetamine Use Disorder, Stimulant Use Disorder, and Stimulant Use or Misuse.
Measures of use of cigars, including cigarillos, big cigars, and little cigars that look like cigarettes, in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the nicotine section of the questionnaire about lifetime cigar use, use in the past 30 days, and the recency of use (if not in the past 30 days) (i.e., “Have you ever, even once, smoked part or all of a cigar or cigarillo?” “During the past 30 days, have you smoked part or all of any type of cigar or cigarillo?” and “How long has it been since you last smoked part or all of any type of cigar or cigarillo?”). Responses to questions in a later section about use of cigars with marijuana in them (blunts) were not included in these measures to maintain the comparability of estimates over time. Questions about use of cigars or cigarillos in the past 30 days or the most recent use of cigars or cigarillos (if not in the past 30 days) were asked if respondents previously reported any use of cigars or cigarillos in their lifetime.
SEE: Cigarette Use, Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Measures of use of cigarettes in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the nicotine section of the questionnaire about lifetime cigarette use, use in the past 30 days, and the recency of use (if not in the past 30 days) (i.e., “Have you ever smoked part or all of a cigarette?” “During the past 30 days, have you smoked part or all of a cigarette?” and “How long has it been since you last smoked part or all of a cigarette?”). Questions about use of cigarettes in the past 30 days or the most recent use of cigarettes (if not in the past 30 days) were asked if respondents previously reported they smoked part or all of a cigarette in their lifetime.
SEE: Cigar Use, Current Use or Misuse, Daily Cigarette Use, Lifetime Use or Misuse, Nicotine Dependence, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
SEE: Cigar Use.
Respondents were classified as needing substance use treatment (i.e., treatment for the use of alcohol or drugs) if they met the criteria for a substance use disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-58), or they 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. Respondents who reported using alcohol or drugs in their lifetime were asked the substance use treatment questions. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Substance Use Disorder (SUD) and Substance Use Treatment.
Measures of use of cocaine, including powder, crack, free base, and coca paste, in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the cocaine section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used any form of cocaine?” and “How long has it been since you last used any form of cocaine?”). The question about recency of use was asked if respondents previously reported any use of cocaine in their lifetime.
SEE: Crack Use, Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Cocaine use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-59). Respondents who used cocaine in the past 12 months (including those who reported using crack or cocaine with a needle in that period) were classified as having a cocaine use disorder in that period if they met two or more of the following criteria: (1) used cocaine in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on cocaine use; (3) spent a great deal of time in activities to obtain, use, or recover from cocaine use; (4) felt a craving or strong desire to use cocaine; (5) engaged in recurrent cocaine use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use cocaine despite social or interpersonal problems caused by the effects of cocaine; (7) gave up or reduced important social, occupational, or recreational activities because of cocaine use; (8) continued to use cocaine in physically hazardous situations; (9) continued to use cocaine despite physical or psychological problems caused by cocaine use; (10) increased the amount of cocaine needed to achieve same effect or noticed that the same amount of cocaine use had less effect than before; and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping cocaine use or (11b) used cocaine or a related substance to get over or avoid cocaine withdrawal symptoms. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Cocaine Use and Crack Use.
This measure was developed only for respondents aged 18 to 22 based on answers to questions in the education section later in the interview about current or upcoming enrollment in school and (if applicable) about whether respondents were full- or part-time students and the year of school they were or will be attending. Respondents in this age group were classified either as full-time college students or as some other status, which included respondents not enrolled in school, enrolled in college part time, enrolled in other grades either full time or part time, or enrolled with no other information available. Respondents were classified as full-time college students if they reported they were attending or will be attending their first through fifth or higher year of college or university and they were or will be a full-time student. Respondents whose current enrollment status was unknown were excluded from this measure.
SEE: Recovery from Mental Health Issues.
SEE: Recovery from Substance Use Problems.
County type was based on the “Rural/Urban Continuum Codes” developed in 2013 by the U.S. Department of Agriculture (USDA).10 All U.S. counties and county equivalents were grouped based on revised definitions of metropolitan statistical areas (MSAs) and definitions of micropolitan statistical areas as defined by the Office of Management and Budget (OMB) as of February 2013.11
The classifications are partially based on population counts from the 2010 census representing the resident population. Data from the 2006 to 2010 American Community Surveys were also used by OMB and USDA to define these county type levels. Large MSAs (large metro) have a total population of 1 million or more. Small MSAs (small metro) have a total population of fewer than 1 million and are classified further as having either a total population of 250,000 to 1 million or less than 250,000. Nonmetropolitan (nonmetro) counties were classified according to the aggregate size of their urban population and whether they were adjacent to a metro area.
Nonmetropolitan areas include counties in micropolitan statistical areas as well as counties outside of both metropolitan and micropolitan statistical areas and are classified into three overall categories: (1) urban population of 20,000 or more are classified as “urbanized” for counties adjacent to a metro area or not adjacent to a metro area, (2) urban population of at least 2,500 but fewer than 20,000 are classified as “less urbanized” for counties adjacent to a metro area or not adjacent to a metro area, and (3) rural area with population fewer than 2,500 are classified as “completely rural” for counties adjacent to a metro area or not adjacent to a metro area. The terms “urbanized,” “less urbanized,” and “completely rural” for counties are not based on the relative proportion of the county population in urbanized areas but rather on the absolute size of the population in urbanized areas. For example, some counties classified as “less urbanized” had over 50 percent of the county population residing in urbanized areas, but this represented fewer than 20,000 people in the county. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
Crack was defined as cocaine used in rock or chunk form. Measures of use of crack cocaine in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the cocaine section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used ‘crack’?” and “How long has it been since you last used ‘crack’?”). The question about recency of use was asked if respondents previously reported use of cocaine in any form and specifically any use of crack in their lifetime. Respondents who reported they never used any form of cocaine were logically classified as never having used crack.
SEE: Cocaine Use, Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
For substances other than prescription psychotherapeutic drugs (pain relievers, tranquilizers, stimulants, or sedatives), current use refers to any reported use of a specific substance in the past 30 days (also referred to as “past month use”). For prescription psychotherapeutic drugs, current misuse refers to misuse of psychotherapeutics in the past 30 days. Respondents were not asked about any use of psychotherapeutics in the past 30 days.
SEE: Lifetime Use or Misuse, Misuse of Prescription Psychotherapeutics, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Respondents who smoked cigarettes in the past 30 days were classified as being past month daily cigarette users if they reported in the nicotine section of the questionnaire that they smoked part or all of a cigarette on all 30 days in that period. Respondents were classified as being lifetime daily cigarette users if they reported daily cigarette use in the past month or they reported a period in their lifetime when they smoked cigarettes every day for at least 30 days.
SEE: Cigarette Use.
Respondents who used or misused a substance other than cigarettes on 20 or more days in the past month were classified as daily or almost daily users in the past month. Respondents who reported in the respective substance use questionnaire sections that they used a substance on 300 or more days in the past year were classified as daily or almost daily users in the past year. Those who met the criterion for being a daily or almost daily user in the past year may not have met the criterion for being a daily or almost daily user in the past month. Respondents were not asked about the number of days in the past year they used tobacco products, vaped nicotine, or misused prescription psychotherapeutic drugs (pain relievers, tranquilizers, stimulants, or sedatives). Those who reported smoking cigarettes on each of the past 30 days were classified as daily smokers.
SEE: Daily Cigarette Use.
Youths aged 12 to 17 were asked a series of six questions in the youth experiences section of the questionnaire: “During the past 12 months, how many times have you … gotten into a serious fight at school or work?” “taken part in a fight where a group of your friends fought against another group?” “carried a handgun?” “sold illegal drugs?” “stolen or tried to steal anything worth more than $50?” and “attacked someone with the intent to seriously hurt them?” Response options were (1) 0 times, (2) 1 or 2 times, (3) 3 to 5 times, (4) 6 to 9 times, or (5) 10 or more times. Respondents were classified as having engaged in a specific delinquent behavior if they reported engaging in that behavior at least one time in the past 12 months. In addition, respondents were classified as having engaged in physical delinquent behaviors if they reported they got in a serious fight at school or work, took part in a fight against another group, or attacked someone with the intent to seriously hurt them at least one time in the past 12 months. Respondents were classified as having engaged in nonphysical delinquent behaviors if they reported they carried a handgun, sold illegal drugs, or stole or tried to steal anything worth more than $50 at least one time in the past 12 months.
SEE: Major Depressive Episode (MDE).
SEE: Kessler-6 (K6) Scale and Serious Psychological Distress (SPD).
Measures of the use of dimethyltryptamine (DMT), alpha-methyltryptamine (AMT), or N, N-diisopropyl-5-methoxytryptamine (5-MeO-DIPT or “Foxy”) in the respondent’s lifetime, the past year, and the past month were derived from responses to questions in the hallucinogens section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used any of the following: DMT, also called dimethyltryptamine; AMT, also called alpha-methyltryptamine; or Foxy, also called 5-MeO-DIPT)?” and “How long has it been since you last used DMT, AMT, or Foxy?”).
SEE: Current Use or Misuse, Hallucinogen Use, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Respondents who reported the use of alcohol or specific illicit drugs in the past 12 months were asked individual questions in the special topics section of the questionnaire about driving a vehicle in the past 12 months while under the influence of alcohol, marijuana, cocaine or crack, heroin, hallucinogens, inhalants, or methamphetamine. Respondents who reported driving under the influence of alcohol and one or more of these illicit drugs were asked an additional question about driving under the influence of only alcohol.
Respondents were classified as driving under the influence of one or more illicit drugs if they reported driving under the influence of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Respondents were classified as driving under the influence of one or more illicit drugs other than marijuana if they reported driving under the influence of cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine, regardless of whether they also reported driving under the influence of marijuana.
SEE: Alcohol Use, Cocaine Use, Crack Use, Hallucinogen Use, Heroin Use, Inhalant Use, Marijuana Use, and Methamphetamine Use.
Drug use includes marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, methamphetamine use in the past year, or any use in the past 12 months of prescription psychotherapeutics, which include pain relievers, tranquilizers, stimulants, and sedatives. This definition differs from the illicit drug use definition because it includes any use of prescription drugs. NSDUH does not consider the use (but not misuse) of prescription psychotherapeutic drugs to be illicit drug use.
SEE: Drug Use Disorder and Illicit Drugs.
Drug use disorder is defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-512), for one or more of the following drugs: marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, or any use of prescription psychotherapeutic drugs (i.e., pain relievers, tranquilizers, stimulants, and sedatives). The DSM-5 SUD criteria for prescription drugs applies to people who used prescription drugs for any reason in the past year (i.e., not just misuse). A reduced set of criteria are used to define prescription drug use disorder for respondents who used prescription drugs but did not misuse them in the past year. See Chapter 3 and Table 3.7 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Cocaine Use Disorder, Hallucinogen Use Disorder, Heroin Use Disorder, Drug Use, Inhalant Use Disorder, Marijuana Use Disorder, Methamphetamine Use Disorder, Pain Reliever Use Disorder, Sedative Use Disorder, Stimulant Use Disorder, Substance Use Disorder (SUD), and Tranquilizer Use Disorder.
Measures of use of Ecstasy or MDMA (methylenedioxy-methamphetamine) in the respondent’s lifetime, the past year, and the past month were derived from responses to questions in the hallucinogens section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used ‘Ecstasy’ or ‘Molly’, also known as MDMA?” and “How long has it been since you last used ‘Ecstasy’ or ‘Molly’, also known as MDMA?”). The question about recency of use was asked if respondents previously reported any use of Ecstasy or MDMA in their lifetime.
SEE: Current Use or Misuse, Hallucinogen Use, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Educational attainment among adult respondents aged 18 or older was based on respondents’ reports in the core demographics section at the beginning of the interview about the highest grade or level of school they completed, including the highest degree they completed. Response options for respondents who completed the 11th grade or lower were presented in terms of single years of education, ranging from 0 if respondents never attended school up to the 11th grade. Response options for higher levels of education than the 11th grade indicated whether respondents received a high school diploma, completed the 12th grade without receiving a diploma, received a general educational development (GED) certificate, obtained some college credit but did not receive a degree, or received some kind of college degree (i.e., associate’s, bachelor’s, master’s, doctoral, or professional).
Adult respondents were classified into four categories based on their answers: (1) less than high school, (2) high school graduate, (3) some college or associate’s degree, and (4) college graduate. Adults who indicated they completed the 12th grade but did not receive a high school diploma were classified as having less than a high school education. Adults who indicated they received a high school diploma or GED were classified as high school graduates. Adults who received an associate’s degree were classified in the “some college” category, along with adults who received some college credit but had not obtained a degree. Adults who indicated they received a bachelor’s degree or higher were classified as being college graduates.
Respondents were asked to report in the employment section of the questionnaire whether they worked in the week prior to the interview and, if not, whether they had a job despite not working in the past week. Respondents who worked in the past week or who reported having a job despite not working were asked whether they usually work 35 hours or more per week. Respondents who did not work in the past week but had a job were asked to report why they did not work in the past week despite having a job. Respondents who did not have a job in the past week were asked to report why they did not have a job in the past week.
Full-time employment includes respondents who usually work 35 or more hours per week and who worked in the past week or had a job despite not working in the past week.
Part-time employment includes respondents who usually work fewer than 35 hours per week and who worked in the past week or had a job despite not working in the past week.
Unemployed refers to respondents who did not have a job and were looking for work or who were on layoff. For consistency with the Current Population Survey definition of unemployment, respondents who reported they did not have a job but were looking for work needed to report making specific efforts to find work in the past 30 days, such as sending out resumes or applications, placing ads, or answering ads.
Other employment includes all responses defined as not being in the labor force, including being a student, keeping house or caring for children full time, retired, disabled, or other miscellaneous work statuses. Respondents who reported they did not have a job and did not want one also were classified as not being in the labor force. Similarly, respondents who reported not having a job and looking for work also were classified as not being in the labor force if they did not report making specific efforts to find work in the past 30 days. Those respondents who reported having no job and provided no additional information could not have their labor force status determined and were therefore assigned to the Other employment category.
SEE: Hispanic or Latino and Race/Ethnicity.
SEE: Lifetime Use or Misuse.
The following measures were created for exposure to drug education and prevention among youths aged 12 to 17: (1) exposure to prevention messages in school, (2) participation in a prevention program outside of school, (3) seeing or hearing prevention messages from sources outside of school, and (4) conversations with parents about the dangers of substance use.
Youths who reported in the youth experiences section of the questionnaire that they attended any type of school at any time in the past 12 months were asked: “During the past 12 months … Have you had a special class about drugs or alcohol in school?” “Have you had films, lectures, discussions, or printed information about drugs or alcohol in one of your regular classes such as health or physical education?” “Have you had films, lectures, discussions, or printed information about drugs or alcohol outside of one of your regular classes such as in a special assembly?” Youths who reported having had any of these were classified as having seen or heard prevention messages in school.
Youths who reported they were home schooled in the past 12 months also were asked these questions. Youths who reported they were home schooled were instructed to think about their home schooling as “school.”
Youths also were asked: “During the past 12 months … Have you participated in an alcohol, tobacco or drug prevention program outside of school, where you learn about the dangers of using, and how to resist using, alcohol, tobacco, or drugs?” “Have you seen or heard any alcohol or drug prevention messages from sources outside school such as posters, pamphlets, radio, or TV?” “Have you talked with at least one of your parents about the dangers of tobacco, alcohol, or drug use?” Youths who answered these questions as “yes” were classified as having been exposed to prevention messages from these sources outside of school.
Respondents were classified as having used fentanyl in the past year if they reported any use of prescription fentanyl or the use of illegally made fentanyl (IMF) in that period. Respondents were classified as having misused fentanyl in the past year if they reported misuse of prescription fentanyl or any use of IMF in that period.
SEE: Illegally Made Fentanyl (IMF) Use, Pain Reliever Use or Misuse, Past Year Use or Misuse, and Prescription Fentanyl Products.
Functional impairment refers to interference in a person’s daily functioning or limitations in carrying out one or more major life activities. The Global Assessment of Functioning (GAF) allows mental health clinicians to assess a person’s level of impairment because of a diagnosable mental, behavioral, or emotional disorder.13 In follow-up interviews conducted in 2008 to 2012 with a subset of adult NSDUH respondents, mental health clinicians used the GAF and rated respondents’ worst period of functioning in the past 12 months because of a mental disorder. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details about how functional impairment is assessed for adults in NSDUH.
SEE: Global Assessment of Functioning (GAF), Mental Illness, Sheehan Disability Scale (SDS), and World Health Organization Disability Assessment Schedule (WHODAS).
A gate question is an initial question that asks whether the behavior or characteristic of interest is applicable to the respondent. Thus, these questions function to open or close a “gate” in the interview by governing whether respondents are asked additional questions about the topic of interest or skip remaining questions about that topic. Sections of the questionnaire about specific topics may include a single gate question or more than one gate question (e.g., hallucinogens, inhalants). An affirmative response to a question leads to respondents being asked a series of other related questions. A response other than an affirmative one (or no affirmative responses to all gate questions in sections with more than one gate question) results in respondents skipping additional questions on that topic and being routed to the next set of topics in the interview.14
SEE: Module.
In the United States, nine geographic divisions are within four geographic regions based on classifications developed by the U.S. Census Bureau.15 Within the Northeast Region are the New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) and the Middle Atlantic Division (New Jersey, New York, Pennsylvania). Within the Midwest Region are the East North Central Division (Illinois, Indiana, Michigan, Ohio, Wisconsin) and the West North Central Division (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota). Within the South Region are the South Atlantic Division (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia), the East South Central Division (Alabama, Kentucky, Mississippi, Tennessee), and the West South Central Division (Arkansas, Louisiana, Oklahoma, Texas). Within the West Region are the Mountain Division (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming) and the Pacific Division (Alaska, California, Hawaii, Oregon, Washington).
SEE: Region.
Measures of use of gamma hydroxybutyrate (GHB) in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the special drugs section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used GHB?” and “How long has it been since you last used GHB?”).
The following definitional information preceded the question about lifetime use of GHB: “The next question is about GHB, also called ‘G,’ ‘Georgia Home Boy,’ ‘Grievous Bodily Harm,’ ‘Liquid G,’ or gamma hydroxybutyrate.”
SEE: Current Use or Misuse, Illicit Drugs, Illicit Drugs Other Than Marijuana, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
As indicated in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV16), mental health clinicians use the Global Assessment of Functioning (GAF) to consider a person’s psychological, social, and occupational functioning on a hypothetical continuum. Clinicians do not include impairment in functioning due to physical or environmental limitations. When adequate information is available, numeric ratings for the GAF range from 1 to 100. Lower values on the rating scale indicate a greater extent of impairment due to the presence of a diagnosable mental, behavioral, or emotional disorder. In follow-up interviews conducted in 2008 to 2012 with a subset of adult NSDUH respondents, mental health clinicians used the GAF and rated respondents’ worst period of functioning in the past 12 months because of a mental disorder. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Mental Illness, Sheehan Disability Scale (SDS), and World Health Organization Disability Assessment Schedule (WHODAS).
Measures of use of hallucinogens in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the hallucinogens section of the questionnaire about lifetime and recency of use (e.g., “How long has it been since you last used any hallucinogen?”).17 The question about recency of use was asked if respondents previously reported any use of hallucinogens in their lifetime (see below).
Respondents were asked a series of gate questions about any use of specific hallucinogens in their lifetime. These gate questions were preceded by the following definitional information about hallucinogens: “The next questions are about substances called hallucinogens. These drugs often cause people to see or experience things that are not real.”
Gate questions asked whether respondents ever used the following hallucinogens, even once: (1) LSD, also called “acid”; (2) PCP, also called “angel dust” or phencyclidine; (3) peyote; (4) mescaline; (5) psilocybin, found in mushrooms; (6) “Ecstasy” or “Molly,” also called MDMA; (7) ketamine, also called “Special K” or “Super K”; (8) DMT, also called dimethyltryptamine, AMT, also called alpha-methyltryptamine, or Foxy, also called 5-MeO-DIPT; (9) Salvia divinorum; and (10) any other hallucinogen besides the ones that have been listed.
SEE: Current Use or Misuse, DMT, AMT, or 5-MeO-DIPT (“Foxy”) Use, Ecstasy Use, Gate Question, Ketamine Use, Lifetime Use or Misuse, LSD Use, Past Month Use or Misuse, Past Year Use or Misuse, PCP Use, Recency of Use or Misuse, and Salvia divinorum Use.
Hallucinogen use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition(DSM-518). Respondents who used hallucinogens in the past 12 months were classified as having a hallucinogen use disorder in that period if they met two or more of the following criteria: (1) used hallucinogens in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on hallucinogen use; (3) spent a great deal of time in activities to obtain, use, or recover from hallucinogen use; (4) felt a craving or strong desire to use hallucinogens; (5) engaged in recurrent hallucinogen use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use hallucinogens despite social or interpersonal problems caused by the effects of hallucinogens; (7) gave up or reduced important social, occupational, or recreational activities because of hallucinogen use; (8) continued to use hallucinogens in physically hazardous situations; (9) continued to use hallucinogens despite physical or psychological problems caused by hallucinogen use; and (10) increased the amount of hallucinogens needed to achieve same effect or noticed that the same amount of hallucinogen use had less effect than before. Hallucinogen use disorder does not have a withdrawal criterion. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Hallucinogen Use.
A series of questions was asked in the health insurance section of the questionnaire to identify whether respondents currently were covered by Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), military health care (such as TRICARE or CHAMPUS), private health insurance, or any kind of health insurance (if respondents reported not being covered by any of the above). If respondents did not currently have health insurance coverage, questions were asked to determine the length of time they were without coverage and the reasons for not being covered.
NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the health insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about health insurance and income.
SEE: Medicaid and Medicare.
Heavy use of alcohol was defined for males 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) and for females as drinking four or more drinks on the same occasion on each of 5 or more days in the past 30 days. Heavy alcohol users also were classified as binge users of alcohol. Respondents were asked in the alcohol section of the questionnaire about the number of days they had five or more drinks (for males) or four or more drinks (for females) on the same occasion if they reported last using any alcohol in the past 30 days based on the following question: “How long has it been since you last drank an alcoholic beverage?”
SEE: Alcohol Use and Binge Use of Alcohol.
Measures of use of heroin in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the heroin section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used heroin?” and “How long has it been since you last used heroin?”). The question about recency of use was asked if respondents previously reported any use of heroin in their lifetime.
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Heroin use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-519). Respondents who used heroin in the past 12 months (including those who reported smoking, sniffing, or using heroin with a needle in that period) were classified as having a heroin use disorder in that period if they met two or more of the following criteria: (1) used heroin in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on heroin use; (3) spent a great deal of time in activities to obtain, use, or recover from heroin use; (4) felt a craving or strong desire to use heroin; (5) engaged in recurrent heroin use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use heroin despite social or interpersonal problems caused by the effects of heroin; (7) gave up or reduced important social, occupational, or recreational activities because of heroin use; (8) continued to use heroin in physically hazardous situations; (9) continued to use heroin despite physical or psychological problems caused by heroin use; (10) increased the amount of heroin needed to achieve same effect or noticed that the same amount of heroin use had less effect than before; and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping heroin use or (11b) used heroin or a related substance to get over or avoid heroin withdrawal symptoms. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Heroin Use.
Hispanic or Latino was defined as anyone of Hispanic, Latino, or Spanish origin. Respondents were classified as Hispanic or Latino in the race/ethnicity measure regardless of race, in accordance with federal standards for reporting race and ethnicity data.20 This definition is based on reports in the front-end demographics section that respondents were of Hispanic, Latino, or Spanish origin or descent.
SEE: American Indian or Alaska Native (AIAN), Asian, Black, Native Hawaiian or Other Pacific Islander (NHOPI), Race/Ethnicity, Two or More Races, and White.
Measures of use of illegally made fentanyl (IMF) in the respondent’s lifetime, the past year, and the past month were derived from the questions in the emerging issues section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used illegally made fentanyl?” and “How long has it been since you last used illegally made fentanyl?”). The question on recency of use was asked if respondents previously reported any use of IMF in their lifetime.
The following definitional information preceded the question about lifetime use of IMF: “Earlier, you were asked whether you had used prescription fentanyl, also known as Duragesic or Fentora, in the past 12 months. This next question is about illegally made fentanyl, which is fentanyl that people can’t get from a doctor or pharmacy. Illegally made fentanyl can come in forms such as powder, pills, or blotter paper. It can also be mixed with heroin or other drugs.”
SEE: Current Use or Misuse, Fentanyl Use or Misuse, Lifetime Use or Misuse, Needle Use, and Past Year Use or Misuse.
Illicit drugs include marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, methamphetamine, or prescription psychotherapeutics that were misused, which include pain relievers, tranquilizers, stimulants, and sedatives. Illicit drug use refers to use of any of these drugs based on responses to questions for these substances in the respective questionnaire. NSDUH does not consider the use (but not misuse) of prescription psychotherapeutic drugs to be illicit drug use. Responses to questions about the use of the following drugs were not included in these measures: GHB (gamma hydroxybutyrate), kratom, nonprescription cough or cold medicines, synthetic marijuana, synthetic stimulants, illegally made fentanyl (IMF), and CBD or hemp products.
SEE: CBD or Hemp Products, Cocaine Use, Crack Use, Current Use or Misuse, Hallucinogen Use, Heroin Use, Illegally Made Fentanyl (IMF) Use, Inhalant Use, Lifetime Use or Misuse, Marijuana Use, Methamphetamine Use, Pain Reliever Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, Sedative Use or Misuse, Stimulant Use or Misuse, and Tranquilizer Use or Misuse.
These drugs include cocaine (including crack), heroin, hallucinogens, inhalants, methamphetamine, or prescription psychotherapeutics that were misused, which include pain relievers, tranquilizers, stimulants, and sedatives. This measure includes marijuana users who used any of the above drugs in addition to using marijuana, as well as users of those drugs who have not used marijuana. This measure excludes respondents who used only marijuana. The measure for illicit drugs other than marijuana is defined based on responses to questions for these substances in the respective questionnaire. NSDUH does not consider the use (but not misuse) of prescription psychotherapeutic drugs to be illicit drug use. Responses to questions about the use of the following drugs also were not included in these measures: GHB (gamma hydroxybutyrate), kratom, nonprescription cough or cold medicines, synthetic marijuana, synthetic stimulants, illegally made fentanyl (IMF), and CBD or hemp products.
SEE: CBD or Hemp Products, Cocaine Use, Crack Use, Current Use or Misuse, Hallucinogen Use, Heroin Use, Illegally Made Fentanyl (IMF) Use, Inhalant Use, Lifetime Use or Misuse, Methamphetamine Use, Pain Reliever Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Psychotherapeutic Drugs, Recency of Use or Misuse, Sedative Use or Misuse, Stimulant Use or Misuse, and Tranquilizer Use or Misuse.
Measures of use of inhalants in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the inhalants section of the questionnaire about lifetime and recency of use (e.g., “How long has it been since you last used any inhalant for kicks or to get high?”). The question about recency of use was asked if respondents previously reported any use of inhalants in their lifetime (see below).
Respondents were asked a series of gate questions about any use of specific inhalants in their lifetime. These gate questions were preceded by the following definitional information about inhalants: “These next questions are about liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good. We are not interested in times when you inhaled a substance accidentally—such as when painting, cleaning an oven, or filling a car with gasoline.”
Gate questions asked whether respondents ever inhaled the following substances, even once, for kicks or to get high: (1) amyl nitrite, “poppers,” locker room odorizers, or “rush”; (2) correction fluid, degreaser, or cleaning fluid; (3) gasoline or lighter fluid; (4) glue, shoe polish, or toluene; (5) halothane, ether, or other anesthetics; (6) lacquer thinner or other paint solvents; (7) lighter gases, such as butane or propane; (8) nitrous oxide or “whippits”; (9) felt-tip pens, felt-tip markers, or magic markers; (10) spray paints; (11) computer keyboard cleaner, also known as air duster; (12) some other aerosol spray; and (13) any other inhalant besides the ones that have been listed.
SEE: Current Use or Misuse, Gate Question, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Inhalant use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-521). Respondents who used inhalants in the past 12 months were classified as having an inhalant use disorder in that period if they met two or more of the following criteria: (1) used inhalants in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on inhalant use; (3) spent a great deal of time in activities to obtain, use, or recover from inhalant use; (4) felt a craving or strong desire to use inhalants; (5) engaged in recurrent inhalant use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use inhalants despite social or interpersonal problems caused by the effects of inhalants; (7) gave up or reduced important social, occupational, or recreational activities because of inhalant use; (8) continued to use inhalants in physically hazardous situations; (9) continued to use inhalants despite physical or psychological problems caused by inhalant use; and (10) increased the amount of inhalants needed to achieve same effect, developed tolerance, or noticed that the same amount of inhalant use had less effect than before. Inhalant use disorder does not have a withdrawal criterion. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Inhalant Use.
Substance use initiation refers to the use of a substance for the first time (new use).22 Initiation statistics in NSDUH reflect first use or misuse occurring within the 12 months prior to the interview. This is referred to as “past year initiation.”
Initiation estimates were based on retrospective questions asked of lifetime users in the respective substance use questionnaire sections about the age at first use of substances and the year and month of first use for recent initiates, along with the respondent’s date of birth and the interview date. However, questions about first misuse of prescription psychotherapeutic drugs were asked only of respondents who reported they misused prescription psychotherapeutic drugs in the past 12 months. Respondents who misused prescription psychotherapeutic drugs in the past 12 months were classified as past year initiates if they reported only past year initiation of the drugs they misused in that period in the respective substance use sections and they reported they did not misuse any prescription psychotherapeutic drug in that category prior to the past 12 months.
Past year initiates can be identified in NSDUH for the use of marijuana, cocaine, crack, heroin, hallucinogens, lysergic acid diethylamide (LSD), phencyclidine (PCP), Ecstasy, inhalants, methamphetamine, cigarettes (including daily cigarette use), nicotine vaping, smokeless tobacco, cigars, and alcohol. Past year initiates also can be identified for the specific misuse of prescription pain relievers, tranquilizers, stimulants, and sedatives. Past year initiates cannot be identified in NSDUH for the aggregate substance use measures that include use of illicit drugs, use of illicit drugs other than marijuana, misuse of any prescription psychotherapeutic drug, the aggregate category for tranquilizers or sedatives, benzodiazepines, opioids, or central nervous system (CNS) stimulants. Additionally, estimates cannot be identified for past year initiation of use of any tobacco product or for the aggregate category for tobacco products or nicotine vaping because respondents are not asked an initiation question for pipe tobacco. For all initiation estimates, respondents who are immigrants were included regardless of whether their first use or misuse occurred inside or outside the United States.
Respondents are not asked initiation questions about the use or misuse of gamma hydroxybutyrate (GHB), nonprescription cough and cold medicines, kratom use, marijuana vaping, vaping of flavoring, illegally made fentanyl (IMF), synthetic marijuana use, or synthetic stimulant use. Therefore, respondents cannot be identified as past year initiates for the use of these substances.
See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: At Risk for Initiation.
SEE: Mental Health Treatment.
SEE: Substance Use Treatment.
Interview mode refers to the method for collecting NSDUH data. For 2023, there were two interview modes used for data collection. See Chapter 2 in the 2023 Methodological Summary and Definitions report for additional details on the two interview modes.
For in-person data collection, field interviewers (FIs) visited households to determine whether zero, one, or two individuals aged 12 or older would be selected for the interview. If household members were selected, FIs conducted interviews in person with respondents either in their homes or at another suitable location (e.g., outdoors in a private setting). Questions about less sensitive topics were administered by FIs using computer-assisted personal interviewing (CAPI), but most NSDUH questions for in-person data collection were self-administered using audio computer-assisted self- interviewing (ACASI).
Web-based data collection in NSDUH involved the use of the Internet to select and interview eligible household members, without FIs visiting households. Hence, all questions for web-based data collection were self-administered.
SEE: ACASI and CAPI.
The Kessler-6 (K6) scale consists of six questions that gather information on how frequently adult respondents experienced symptoms of psychological distress during the past month or the one month in the past year when they were at their worst emotionally.23 These questions ask about the frequency of feeling (1) nervous, (2) hopeless, (3) restless or fidgety, (4) sad or depressed, (5) that everything was an effort, and (6) no good or worthless. Adult respondents are first asked in the mental health section of the questionnaire about these symptoms for the past 30 days. Adults are then asked if they had a period in the past 12 months when they felt more depressed, anxious, or emotionally stressed than they felt during the past 30 days. If so, they are asked the K6 questions for the 1 month in the past 12 months when they felt the worst.
Imputation-revised responses to these six questions for the past 30 days and (if applicable) the past 12 months are recoded and summed to produce a score ranging from 0 to 24. If respondents are asked the K6 questions for both the past 30 days and past 12 months, the higher of the two scores is chosen as the final score for the past year reference period. Higher K6 total scores indicate greater distress. The K6 scale provides a measure of psychological distress and does not directly measure the presence of a diagnosable mental, behavioral, or emotional disorder, nor does it capture information on functional impairment due to having psychological distress or a mental disorder. The K6 and scales for measuring functional impairment using the World Health Organization Disability Assessment Schedule [WHODAS]24,25 are used in models that predict whether a respondent can be categorized as having serious mental illness (SMI). See Chapter 3 in the 2023 Methodological Summary and Definitions report for more information about the K6 and its scoring, as well as the development of SMI prediction models.
SEE: Global Assessment of Functioning (GAF), Mental Illness, Serious Psychological Distress (SPD), Sheehan Disability Scale (SDS), and World Health Organization Disability Assessment Schedule (WHODAS).
Measures of the use of ketamine in the respondent’s lifetime, the past year, and the past month were derived from responses to the hallucinogen section questions about lifetime and recency of use (i.e., “Have you ever, even once, used Ketamine, also called ‘Special K’ or ‘Super K’?” and “How long has it been since you last used Ketamine?”).
SEE: Current Use or Misuse, Hallucinogen Use, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Measures of use of kratom in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the emerging issues section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used kratom?” and “How long has it been since you last used kratom?”). The questions about kratom in the emerging issues section of the questionnaire were not incorporated in estimates of use of illicit drugs or illicit drugs other than marijuana because kratom is not a controlled substance nationally.26
The following definitional information preceded the question about lifetime use of kratom: “This next question is about kratom, which can come in forms such as powder, pills, or leaf.”
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
SEE: County Type.
SEE: Hispanic or Latino.
These measures indicate use or misuse of a specific substance at least once in the respondent’s lifetime and include respondents who also reported last using substances other than prescription psychotherapeutic drugs (pain relievers, tranquilizers, stimulants, or sedatives) or last misusing prescription psychotherapeutic drugs in the past 30 days or past 12 months. For prescription psychotherapeutic drugs, any lifetime use includes respondents who also reported any use in the past 12 months.
SEE: Any Use of Prescription Psychotherapeutics, Current Use or Misuse, Misuse of Prescription Psychotherapeutics, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Respondents aged 12 to 20 who reported in the alcohol section of the questionnaire drinking at least one alcoholic beverage within the past 30 days were asked in the consumption of alcohol section to indicate where they drank alcoholic beverages the last time they drank. The possible locations were (1) in a car or other vehicle; (2) at the respondent’s home; (3) at someone else’s home; (4) at a park, on a beach, or in a parking lot; (5) in a restaurant, bar, or club; (6) at a concert or sports game; (7) at school; or (8) some other place. Those who reported “some other place” were asked to type in a response indicating the specific location. Estimates for commonly reported other locations are included in the 2023 Detailed Tables. Respondents could report more than one location.
SEE: Alcohol Use and Underage Alcohol Use.
SEE: Mental Health Treatment.
SEE: Substance Use Treatment.
Estimates based on a relatively small number of respondents or with relatively large standard errors were not presented in NSDUH national tables and reports; they have been replaced with an asterisk (*) and noted as “low precision.” These estimates have been omitted because one cannot place a high degree of confidence in their accuracy. Table 3.2 in the 2023 Methodological Summary and Definitions report includes a complete list of the rules used to determine low precision.
SEE: Suppression of Estimates.
Measures of use of lysergic acid diethylamide (LSD) in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the hallucinogens section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used LSD, also called ‘acid’?” and “How long has it been since you last used LSD?”). The question about recency of use was asked if respondents previously reported any use of LSD in their lifetime.
SEE: Current Use or Misuse, Hallucinogen Use, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Individuals were classified as having had a lifetime major depressive episode (MDE) if they reported in the adult or adolescent depression sections of the questionnaire at least five or more of the following nine symptoms nearly every day (except where noted) in the same 2-week period in their lifetime, in which at least one of the symptoms was a depressed mood or loss of interest or pleasure in daily activities: (1) depressed mood most of the day; (2) markedly diminished interest or pleasure in all or almost all activities most of the day; (3) significant weight loss when not dieting or weight gain or decrease or increase in appetite; (4) insomnia or hypersomnia; (5) psychomotor agitation or retardation; (6) fatigue or loss of energy; (7) feelings of worthlessness; (8) diminished ability to think or concentrate or indecisiveness; and (9) recurrent thoughts of death or recurrent suicide ideation. Unlike the other symptoms listed previously, recurrent thoughts of death or suicidal ideation did not need to have occurred nearly every day.
This definition is based on the definition found in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-527). Individuals were classified as having an MDE in the past year if they (1) had a lifetime MDE, (2) had a period of time in the past 12 months when they felt depressed or lost interest or pleasure in daily activities for 2 weeks or longer, and (3) reported during this period of 2 weeks or longer in the past 12 months they had “some of the other problems” they reported for a lifetime MDE. Consistent with the DSM-5 criteria, NSDUH does not exclude MDEs that occurred exclusively in the context of bereavement.
To make the questions developmentally appropriate for youths, some questions in the adolescent depression section are worded differently than the question in the adult depression section. Therefore, the adult and youth measures for MDE should not be combined or compared. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Major Depressive Episode (MDE) with Severe Impairment.
Severe impairment was defined by the level of role interference for adults or the level of problems for youths with a past year major depressive episode (MDE) when their depression symptoms were most severe (for adults) or worst (for youths). Impairment was defined based on the role domains for adults aged 18 or older and for youths aged 12 to 17 in the Sheehan Disability Scale (SDS). Respondents with a past year MDE and ratings of 7 or greater for interference (for adults) or problems (for youths) in one or more role domains were classified as having an MDE with severe impairment. The severe impairment measures asked about in the respective depression questionnaire sections are defined using different role domains for adults and youths. Therefore, the adult and youth measures should not be combined or compared. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Major Depressive Episode (MDE) and Sheehan Disability Scale (SDS).
Measures of use of marijuana in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the marijuana section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used marijuana or any cannabis product?” and “How long has it been since you last used marijuana or any cannabis product?”). The question about recency of use was asked if respondents previously reported any use of marijuana or cannabis products in their lifetime. Responses to separate questions about use of cigars with marijuana in them (blunts) were not included in these measures. Creation of these measures did not take into account responses to questions about use of marijuana in the past 12 months that was recommended by a doctor or other healthcare professional.
The following definitional information preceded the question about lifetime use of marijuana: “The next questions are about marijuana and any cannabis products, sometimes called pot, weed, hashish, or concentrates. Some of the ways these products can be used are smoking (such as in joints, pipes, bongs, blunts, or hookahs), vaping (using vape pens, dab pens, tabletop vaporizers, or portable vaporizers), dabbing, eating or drinking, or applying as a lotion.”
Additional questions about marijuana vaping were asked in the emerging issues section of the questionnaire, but the overall marijuana measures for 2023 did not take these marijuana vaping data into account. See Chapter 3 in the 2023 Methodological Summary and Definitions report for more information.
SEE: CBD or Hemp Products, Current Use or Misuse, Lifetime Use or Misuse, Modes of Marijuana Use, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Marijuana use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-528). Respondents who used marijuana on 6 or more days in the past 12 months were classified as having a marijuana use disorder in that period if they met two or more of the following criteria: (1) used marijuana in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on marijuana use; (3) spent a great deal of time in activities to obtain, use, or recover from marijuana use; (4) felt a craving or strong desire to use marijuana; (5) engaged in recurrent marijuana use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use marijuana despite social or interpersonal problems caused by the effects of marijuana; (7) gave up or reduced important social, occupational, or recreational activities because of marijuana use; (8) continued to use marijuana in physically hazardous situations; (9) continued to use marijuana despite physical or psychological problems caused by marijuana use; (10) increased the amount of marijuana needed to achieve same effect or noticed that the same amount of marijuana use had less effect than before; and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping marijuana use or (11b) used marijuana or a related substance to get over or avoid marijuana withdrawal symptoms. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Marijuana Use.
SEE: Modes of Marijuana Use.
Medicaid is a public assistance program that pays for medical care for low-income and disabled people. Respondents were asked in the health insurance section of the questionnaire specifically about the Medicaid program in the state where they lived. Respondents aged 12 to 19 were asked specifically about the Children’s Health Insurance Program (CHIP) in their state. Respondents aged 12 to 19 who reported they were covered by the CHIP in their state also were classified as being covered by Medicaid. Respondents aged 65 or older who reported they were covered by Medicaid were asked to verify their answer was correct.
NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the health insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about health insurance and income.
SEE: Health Insurance and Medicare.
Medicare is a health insurance program for people aged 65 or older and for certain disabled people. Respondents younger than the age of 65 who reported in the health insurance section of the questionnaire they were covered by Medicare were asked to verify their answer was correct.
NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the health insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about health insurance and income.
SEE: Health Insurance and Medicaid.
Respondents who reported that they ever used alcohol were asked in the alcohol and drug treatment section of the questionnaire whether they used medication prescribed to them in the past 12 months to help cut back or stop the use of alcohol. Medications shown to respondents as examples included acamprosate, also known as Campral®; disulfiram, also known as Antabuse®; naltrexone pills, also known as ReVia® or Trexan®; and injectable naltrexone, also known as Vivitrol®. Respondents who reported using any prescription medication to help cut back or stop their use of alcohol were classified as having received medication-assisted treatment (MAT) in the past year for alcohol use. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
The following definitional information preceded the question about the receipt of MAT for alcohol: “The next question is about prescription medication you may have used to cut back or stop your alcohol use. These medications are different from medications given to stop an overdose.”
SEE: Alcohol Use and Substance Use Treatment.
Respondents who reported having ever used heroin or prescription pain relievers were asked in the alcohol and drug treatment section of the questionnaire whether they used medication prescribed to them in the past 12 months to help cut back or stop the use of “drugs.” However, this question applied only to respondents who reported lifetime use of opioids (i.e., heroin or prescription pain relievers). Medications shown to respondents as examples included methadone; buprenorphine or buprenorphine-naloxone pills or film taken by mouth, also known as Suboxone®, Zubsolv®, Bunavail®, or Subutex®; injectable buprenorphine, also known as Sublocade®; a buprenorphine implant placed under the skin, also known as Probuphine®; naltrexone pills, also known as ReVia® or Trexan®; and injectable naltrexone, also known as Vivitrol®.
Respondents who reported lifetime use of heroin or prescription pain relievers and reported using any prescription medication to help reduce or stop their use of drugs (i.e., opioids) were classified as having received medication-assisted treatment (MAT) in the past year for opioid misuse.
The following definitional information preceded the question about the receipt of MAT for drugs (i.e., opioids): “The next question is about prescription medication you may have used to cut back or stop your drug use. These medications are different from medications given to stop a drug overdose.”
See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Heroin Use, Opioid Use or Misuse, Pain Reliever Use or Misuse, Past Year Use or Misuse, and Substance Use Treatment.
Mental health treatment in the past year was defined as the receipt of treatment or counseling for any problem with mental health, emotions, or behavior in the 12 months prior to the interview. Respondents were asked in the mental health services utilization section of the questionnaire 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. Respondents could report that they received all five of these types of mental health treatment. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details. Types or locations of mental health treatment were defined as follows:
Respondents were classified as having received mental health treatment as an inpatient in the past 12 months if they reported staying overnight or longer in any of the following locations to receive professional counseling, medication, or other treatment for their mental health, emotions, or behavior in that period: (1) a hospital as an inpatient, (2) a residential mental health treatment center, (3) a residential drug or alcohol rehab or treatment center, or (4) some other place where they stayed overnight or longer. Respondents who reported “some other place” were asked to type in a description of this other place. Respondents could report receiving treatment in more than one inpatient location.
Respondents were classified as having received mental health treatment as an outpatient in the past 12 months if they reported receiving professional counseling, medication, or other treatment for their mental health, emotions, or behavior in that period in any of the following locations where they did not need to stay overnight: (1) a mental health treatment center as an outpatient; (2) a drug or alcohol rehab or treatment center as an outpatient; (3) the office of a therapist, psychologist, psychiatrist, or mental health professional; (4) a general medical clinic or doctor’s office; (5) a hospital as an outpatient; (6) a school health or counseling center; or (7) some other place as an outpatient. Respondents who reported “some other place” were asked to type in a description of this other place. Respondents could report receiving treatment in more than one outpatient location.
Respondents were classified as having used prescription medication as mental health treatment in the past year if they reported taking any medication in that period that was prescribed to them to help with their mental health, emotions, or behavior.
Respondents were classified as having received mental health treatment in a prison, jail, or juvenile detention center in the past 12 months if they reported receiving any professional counseling, medication, or other treatment for their mental health, emotions, or behavior in that period while they were in a prison, jail, or juvenile detention center.
Respondents were classified as having received mental health treatment via telehealth if they reported receiving any professional counseling, medication, or treatment for their mental health, emotions, or behavior from a therapist or other healthcare professional over the phone or through video in that period.
The receipt of telehealth treatment was not associated with a specific provider or location. Respondents also were not asked whether the prescription medication that they took for their mental health, emotions, or behavior was prescribed to them through via telehealth. Therefore, receipt of telehealth treatment was kept separate from the measures for inpatient or outpatient mental health treatment or the use of prescription medication to help with mental health, emotions, or behavior.
SEE: Inpatient Mental Health Treatment, Mental Health Treatment or Other Services, Outpatient Mental Health Treatment, and Reasons for Not Receiving Mental Health Treatment.
SEE: Mental Health Treatment.
Respondents were classified as having received mental health treatment or other services in the past year for their mental health, emotions, or behavior if they reported that they received (1) 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 or (2) other services in that period including the following: participation in a support group, being seen in an emergency room or emergency department, or help from a peer support specialist or recovery coach who works with a mental health treatment program or other treatment provider. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Mental Health Treatment and Other Mental Health Services.
The definition of mental illness among adults aged 18 or older has two dimensions: (1) the presence of a diagnosable mental, behavioral, or emotional disorder in the past year (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV29); and (2) the level of interference with or limitation of one or more major life activities resulting from a disorder (functional impairment). A statistical model predicting the likelihood of having mental illness was developed based on a subsample of adult NSDUH respondents from 2008 to 2012 who completed a clinical follow-up interview after the main NSDUH interview. The follow up interviews consisted of detailed mental health assessments administered by trained mental health clinicians. The dependent variable for mental illness in the model was established through the clinical interviews using modules from the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP)30 for the following past year disorders or symptoms: major depressive disorder (including major depressive episode [MDE]), dysthymic disorder, bipolar I disorder (including manic episode), specific phobia, social phobia, generalized anxiety disorder, panic disorder (with and without agoraphobia), agoraphobia (without history of panic disorder), obsessive-compulsive disorder, posttraumatic stress disorder, anorexia nervosa, bulimia nervosa, adjustment disorder, and psychotic symptoms (i.e., hallucinations or delusions). The clinical interviews also included the Global Assessment of Functioning scale to measure functional impairment. This model was used to predict adult NSDUH respondents’ mental illness status based on their responses to questions in the main NSDUH interview on psychological distress (Kessler-6 scale), functional impairment (an abbreviated version of the World Health Organization Disability Assessment Schedule), past year MDE, past year suicidal thoughts, and age. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details on the model and specifications.
Mental illness, differentiated by the level of functional impairment, was defined as follows for adults:
Any mental illness (AMI) among adults was defined as adults aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder as defined above, regardless of the level of impairment in carrying out major life activities. AMI was estimated based on a statistical model of a clinical diagnosis and responses to questions in the main NSDUH interview on distress (Kessler-6 scale), impairment (truncated version of the World Health Organization Disability Assessment Schedule), past year major depressive episode, past year suicidal thoughts, and age.
Any mental illness (AMI) excluding serious mental illness (SMI) was defined to include adults aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder as defined above and resulting in less than substantial impairment in carrying out major life activities, based on clinical interview Global Assessment of Functioning scores of greater than 50. AMI excluding SMI was estimated based on a statistical model of a clinical diagnosis and responses to questions in the main NSDUH interview on distress (Kessler-6 scale), impairment (truncated version of the World Health Organization Disability Assessment Schedule), past year major depressive episode, past year suicidal thoughts, and age.
Serious mental illness (SMI) among adults was defined in Public Law 102-321 as adults aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder and resulting in substantial impairment in carrying out major life activities.31 In NSDUH, a diagnosable mental, behavioral, or emotional disorder was defined as for the other mental illness categories described previously (i.e., based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV32] and excluding developmental and substance use disorders); substantial impairment was defined based on clinical interview Global Assessment of Functioning scores of 50 or below. SMI was estimated based on a statistical model of a clinical diagnosis and responses to questions in the main NSDUH interview on distress (Kessler 6 scale), impairment (truncated version of the World Health Organization Disability Assessment Schedule), past year major depressive episode, past year suicidal thoughts, and age. All adults with SMI were also classified as having AMI.
SEE: Global Assessment of Functioning (GAF), Kessler-6 (K6) Scale, Major Depressive Episode (MDE), Suicidal Thoughts and Behavior, and World Health Organization Disability Assessment Schedule (WHODAS).
Measures of use of methamphetamine in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the methamphetamine section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used methamphetamine?” and “How long has it been since you last used methamphetamine?”). The question about recency of use was asked if respondents previously reported any use of methamphetamine in their lifetime.
The following definitional information preceded the question about lifetime use of methamphetamine: “Methamphetamine, also known as crank, ice, crystal meth, speed, glass, and many other names, is a stimulant that usually comes in crystal or powder forms. It can be smoked, ‘snorted,’ swallowed or injected.” The methamphetamine section does not include the prescription form of methamphetamine (Desoxyn®) as an example.
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, and Stimulant Use or Misuse.
Methamphetamine use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-533). Respondents who used methamphetamine in the past 12 months (including those who reported using methamphetamine with a needle in that period) were classified as having a methamphetamine use disorder in that period if they met two or more of the following criteria: (1) used methamphetamine in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on methamphetamine use; (3) spent a great deal of time in activities to obtain, use, or recover from methamphetamine use; (4) felt a craving or strong desire to use methamphetamine; (5) engaged in recurrent methamphetamine use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use methamphetamine despite social or interpersonal problems caused by the effects of methamphetamine; (7) gave up or reduced important social, occupational, or recreational activities because of methamphetamine use; (8) continued to use methamphetamine in physically hazardous situations; (9) continued to use methamphetamine despite physical or psychological problems caused by methamphetamine use; (10) increased the amount of methamphetamine needed to achieve same effect or noticed that the same amount of methamphetamine use had less effect than before); and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping methamphetamine use or (11b) used methamphetamine or a related substance to get over or avoid methamphetamine withdrawal symptoms. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Methamphetamine Use.
The states included are those in the East North Central Division (Illinois, Indiana, Michigan, Ohio, and Wisconsin) and the West North Central Division (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota).
SEE: Geographic Division and Region.
Misuse of prescription psychotherapeutics (prescription pain relievers, prescription tranquilizers, prescription stimulants, or prescription sedatives) was defined as use “in any way a doctor did not direct you to use [it or them]” and focused on behaviors that constitute misuse of prescription drugs. Examples of misuse were presented to respondents and included (1) use without a prescription of the respondent’s own; (2) use in greater amounts, more often, or longer than told to take a drug; or (3) use in any other way a doctor did not direct the respondent to use a drug.
Respondents who reported in the respective prescription drug questionnaire sections that they used specific prescription psychotherapeutic drugs for any reason in the past 12 months were shown a list of the drugs they used in the past 12 months and were asked for each drug whether they used it (or them) in the past 12 months in any way not directed by a doctor. Respondents were reminded not to include over-the-counter drugs when they were asked whether they used any other prescription pain reliever, stimulant, or sedative in the past 12 months in any way not directed by a doctor. This reminder was not included for prescription tranquilizers because no tranquilizers were available over the counter.
If respondents reported misuse of one or more specific drugs within a category in the past 12 months, they were asked whether they used any drug in that category (e.g., prescription pain relievers) in the past 30 days in any way a doctor did not direct the respondent to use it or them. Respondents who reported any use of prescription psychotherapeutics in the past 12 months but did not report misuse in the past 12 months or who reported any use in their lifetime but not in the past 12 months were asked whether they ever, even once, used any prescription psychotherapeutic drug within that category (e.g., any prescription pain reliever) in a way a doctor did not direct them to use it. Consequently, estimates of misuse in the lifetime or past month periods were available only for an overall prescription psychotherapeutic drug category (e.g., pain relievers) and not for specific prescription drugs within that category.
SEE: Any Use of Prescription Psychotherapeutics, Benzodiazepine Use or Misuse, Current Use or Misuse, Lifetime Use or Misuse, Pain Reliever Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Psychotherapeutic Drugs, Recency of Use or Misuse, Sedative Use or Misuse, Stimulant Use or Misuse, Tranquilizer or Sedative Use or Misuse, and Tranquilizer Use or Misuse.
SEE: Interview Mode.
Measures of mode of marijuana use in the past year and past month were derived from responses to the questions in the marijuana section of the questionnaire about the ways in which respondents used marijuana in these periods (i.e., “During the past 12 months, in which of the following ways did you use marijuana or any cannabis product?” and “During the past 30 days, in which of the following ways did you use marijuana or any cannabis product?”).
Ways in which respondents could report using marijuana or cannabis were by (1) smoking; (2) vaping; (3) dabbing waxes, shatter, or concentrates; (4) eating or drinking; (5) putting drops, strips, lozenges, or sprays in their mouth or under their tongue; (6) applying lotion, cream, or patches to their skin; (7) taking pills; or (8) some other way. Respondents who reported using marijuana in “some other way” were asked to type in a response indicating the other ways they used marijuana or cannabis products. Respondents could report more than one of these eight ways of using marijuana or cannabis products.
Respondents also were asked in the emerging issues section of the questionnaire whether they ever vaped marijuana with a vaping device and, if so, when they last vaped marijuana with a vaping device. However, estimates for marijuana vaping for 2023 in NSDUH national tables and reports did not take these data into account. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Marijuana Use.
In some NSDUH publications, modules in the NSDUH questionnaire refer to sections of the interview that are organized together by content and interviewing logic for determining which questions respondents were asked. For in-person interviews, sections also were organized according to whether they were interviewer administered (i.e., using computer-assisted personal interviewing [CAPI]) or self-administered (i.e., using audio computer-assisted self-interviewing [ACASI]).
SEE: ACASI, CAPI, Gate Question, and Interview Mode.
SEE: Two or More Races.
Native Hawaiian, Guamanian or Chamorro, Samoan, or Other Pacific Islander, not of Hispanic, Latino, or Spanish origin, in accordance with federal standards for reporting race and ethnicity data.34 This definition is based on reports in the front-end demographics section in which respondents described themselves as being Native Hawaiian or Other Pacific Islander. The definition does not include respondents reporting two or more races. Respondents reporting they were Native Hawaiian or Other Pacific Islander and of Hispanic, Latino, or Spanish origin were classified as Hispanic. Specific Native Hawaiian or Other Pacific Islander groups asked about were Guamanian or Chamorro, Native Hawaiian, Samoan, or Other Pacific Islander.
SEE: Hispanic or Latino, Race/Ethnicity, and Two or More Races.
SEE: Classified as Needing Substance Use Treatment.
Measures of using a needle to inject a drug in the respondent’s lifetime and the past year were derived from responses to the questions in (1) the special drugs section of the questionnaire about the lifetime and recency of use of cocaine, heroin, methamphetamine, and any other drug with a needle and (2) the emerging issues section of the questionnaire about the lifetime and recency of use of illegally made fentanyl (IMF). Regardless of where these questions appeared, they had the following format: “Have you ever, even once, used a needle to inject the specific drug?” and “How long has it been since you last used a needle to inject the specific drug?” Questions for the use of cocaine, heroin, methamphetamine, and IMF with a needle were asked only of respondents who reported ever using these substances in any way. Respondents were asked in the special drugs section whether they ever used “any other drug” with a needle (if they previously reported the use of some drug with a needle) or whether they ever used “any drug” with a needle (if they did not previously report needle use). Questions about the recency of use of drugs with a needle were asked if respondents previously reported using a needle to inject a specific drug (or any other drug) in their lifetime.
Respondents were classified as having used a needle to inject a drug in their lifetime if they reported ever using a needle to inject any of these drugs. Respondents were classified as having used a needle to inject a drug in the past year if the recency questions for use of any of these drugs with a needle indicated use with a needle at some point within the past 12 months.
SEE: Cocaine Use, Heroin Use, Illegally Made Fentanyl (IMF) Use, and Methamphetamine Use.
Respondents who reported they smoked cigarettes in the past month were classified as having nicotine dependence if they met either the dependence criteria derived from the Nicotine Dependence Syndrome Scale (NDSS)35,36 or the Fagerstrom Test of Nicotine Dependence (FTND).37,38 Nicotine dependence is based only on the use of cigarettes according to questions in the substance dependence or abuse section of the questionnaire. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
Questions about nicotine vaping were not used to create estimates for nicotine dependence.
SEE: Cigarette Use.
Measures of nicotine vaping in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the nicotine section of the questionnaire about lifetime nicotine vaping, nicotine vaping in the past 30 days, and the recency of nicotine vaping (if not in the past 30 days) (i.e., “Have you ever, even once, vaped nicotine with an e-cigarette or other vaping device?” “During the past 30 days, have you vaped nicotine with an e-cigarette or other vaping device?” and “How long has it been since you last vaped nicotine with an e-cigarette or other vaping device?”). Questions about nicotine vaping in the past 30 days or the most recent nicotine vaping (if not in the past 30 days) were asked if respondents reported that they vaped nicotine in their lifetime. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
The following definitional information preceded the question about lifetime nicotine vaping: “The next questions are about vaping nicotine with e-cigarettes or other vaping devices. These devices may be called vapes, vape pens, or mods. When answering, please include any device that heats a liquid containing nicotine into a vapor.”
SEE: County Type.
SEE: Delinquent Behavior.
Measures of use of nonprescription cough or cold medicine to get high in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the special drugs section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, taken a non-prescription cough or cold medicine just to get high?” and “How long has it been since you last took one of these cough or cold medicines to get high?”). The questions about nonprescription cough or cold medicine use are not incorporated in estimates of either use of illicit drugs or use of illicit drugs other than marijuana.
The following definitional information preceded the question about lifetime use: “The next question is about non-prescription cough or cold medicines, also known as ‘over-the-counter’ medicines.”
SEE: Current Use or Misuse, Illicit Drugs, Illicit Drugs Other Than Marijuana, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
The states included are those in the New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and the Middle Atlantic Division (New Jersey, New York, and Pennsylvania).
SEE: Geographic Division and Region.
Opioids in NSDUH refer to heroin and prescription pain relievers. Measures were created for both any use of opioids and misuse of opioids. To allow comparison with estimates of any use and misuse of opioids, these measures did not include the use of illegally made fentanyl (IMF). Opioid misuse measures also were created for 2022 and 2023 that included IMF. See Chapter 4 in the 2023 Methodological Summary and Definitions report for additional details.
Respondents were classified as using opioids for any reason in the past year (i.e., any use) if they reported using heroin in the past year or they reported any use of prescription pain relievers in the past year (i.e., not necessarily misuse). (Respondents were not asked about any use of prescription pain relievers in the past month.)
Although the majority of any past year use of prescription pain relievers in 2023 consisted of the use of prescription opioids in the NSDUH questionnaire, respondents who reported any use of only “other” prescription pain relievers in the past year may not necessarily have used prescription opioids. Respondents who reported any past year use of only “other” pain relievers and also reported past year heroin use were unambiguously opioid users by virtue of their reported heroin use. However, respondents who reported any past year use of only “other” prescription pain relievers were still classified as past year opioid users, even if they did not report heroin use in the past year.
Respondents were classified as misusing opioids in the past year or past month if they reported using heroin or misusing prescription pain relievers in these periods. (Respondents who reported the misuse of specific prescription pain relievers in the past year were asked whether they misused any prescription pain reliever in the past month.)
Although most misuse of prescription pain relievers in 2023 consisted of the use of prescription opioids (either prescription opioids in the NSDUH questionnaire or other opioids that respondents specified that they misused), respondents who reported the misuse of only “other” prescription pain relievers in the past year may not necessarily have misused prescription opioids. Respondents who reported the past year misuse of only “other” pain relievers and also reported past year heroin use were unambiguously opioid misusers by virtue of their reported heroin use. However, respondents who reported the past year misuse of only “other” prescription pain relievers were still classified as past year opioid users, even if they did not report heroin use in the past year.
SEE: Current Use or Misuse, Heroin Use, Opioid Misuse Including IMF, Pain Reliever Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Respondents were classified as having misused opioids including illegally made fentanyl (IMF) in the past year or past month if they reported using heroin, misusing prescription pain relievers, or using IMF in these periods.
SEE: Current Use or Misuse, Heroin Use, Illegally Made Fentanyl (IMF) Use, Opioid Use or Misuse, Pain Reliever Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Respondents were classified as having an opioid use disorder if they met criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-539). Respondents were classified if they met the criteria for having a heroin use disorder or a prescription pain use disorder. Respondents who reported any use of prescription pain relievers in the past year and met DSM-5 criteria for pain reliever use disorder were classified as having a prescription pain reliever use disorder.
Respondents were not counted as having an opioid use disorder if they did not meet the full substance use disorder criteria individually for heroin or prescription pain relievers. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Heroin Use, Heroin Use Disorder, Pain Reliever Use Disorder, and Pain Reliever Use or Misuse.
Respondents were asked in the mental health services utilization section of the questionnaire whether they received help in the past 12 months for their mental health, emotions, or behavior from any of the following sources: (1) support groups, (2) an emergency room or emergency department, or (3) a peer support specialist or recovery coach who works with a mental health treatment program or other treatment provider. Respondents who reported receiving any of these services were classified as having received other mental health services in the past year. These other services were not classified as mental health treatment. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Mental Health Treatment and Mental Health Treatment or Other Services.
Respondents who reported lifetime use of alcohol or drugs were asked in the alcohol and drug treatment section of the questionnaire whether they received help in the past 12 months for their alcohol or drug use from any of the following sources: (1) support groups, (2) an emergency room or emergency department, (3) detoxification services (or detox) from a health care professional to manage symptoms of withdrawal from alcohol or drug use, or (4) a peer support specialist or recovery coach who works with a substance use treatment program or other treatment provider. These other services were not classified as substance use treatment. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Substance Use Treatment and Substance Use Treatment or Other Services.
SEE: Mental Health Treatment.
SEE: Substance Use Treatment.
Information about any use and misuse of the prescription pain reliever OxyContin® was obtained for the past year. Measures of use or misuse of OxyContin® were derived from reports in the pain relievers section of the questionnaire for any use and misuse of this specific pain reliever in the past 12 months. If respondents reported any use of OxyContin® in the past 12 months, they were asked the following question: “In the past 12 months, did you use OxyContin in any way a doctor did not direct you to use it?”
SEE: Pain Reliever Use or Misuse and Past Year Use or Misuse.
Pain reliever use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-540). Respondents who reported any use of prescription pain relievers in the past 12 months were asked questions about the following criteria for pain reliever use disorder: (1) used pain relievers in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on pain reliever use; (3) spent a great deal of time in activities to obtain, use, or recover from pain reliever use; (4) felt a craving or strong desire to use pain relievers; (5) engaged in recurrent pain reliever use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use pain relievers despite social or interpersonal problems caused by the effects of pain relievers; (7) gave up or reduced important social, occupational, or recreational activities because of pain reliever use; (8) continued to use pain relievers in physically hazardous situations; (9) continued to use pain relievers despite physical or psychological problems caused by pain reliever use; (10) increased the amount of pain relievers needed to achieve same effect or noticed that the same amount of pain reliever use had less effect than before; and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping pain reliever use or (11b) used prescription pain relievers or a related substance to get over or avoid pain reliever withdrawal symptoms.
The number of criteria for classifying respondents who reported any use of prescription pain relievers in the past 12 months differed according to whether (1) respondents misused pain relievers, or (2) they used pain relievers but did not misuse them in that period. The overall measure of pain reliever use disorder was based on whether respondents in either of these two groups were classified as having a pain reliever use disorder in the past year. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
Respondents who misused prescription pain relievers in the past 12 months were classified as having a pain reliever use disorder if they had 2 or more of the 11 criteria mentioned previously.
Respondents who used prescription pain relievers in the past 12 months but did not misuse them were classified as having a pain reliever use disorder if they met two or more of the first nine criteria mentioned previously. Criteria 10 and 11 do not apply to people who did not misuse prescription pain relievers because these criteria can occur as normal physiological adaptations when people use pain relievers appropriately under medical supervision.41
SEE: Opioid Use Disorder and Pain Reliever Use or Misuse.
Measures of use or misuse of prescription pain relievers in the respondent’s lifetime and past year were derived from a series of questions in the screener and main sections of the questionnaire for pain relievers that first asked respondents about any use (i.e., for any reason) of specific prescription pain relievers in the past 12 months. Respondents were instructed not to include the use of over-the-counter (OTC) pain relievers, such as aspirin, Tylenol®, Advil®, or Aleve®. Respondents who did not report use of any pain reliever in the past 12 months were asked whether they ever, even once, used prescription pain relievers.
Respondents who reported they used specific prescription pain relievers in the past 12 months for any reason were shown a list reminding them of the drugs they used in the past 12 months. For each of these drugs, respondents were asked whether they misused it (or them) in the past 12 months (i.e., use in any way a doctor did not direct them to use it). Examples of misuse were presented to respondents and included (1) use without a prescription of the respondent’s own; (2) use in greater amounts, more often, or longer than told to take a drug; or (3) use in any other way a doctor did not direct the respondent to use a drug. Respondents were reminded not to include OTC drugs when they were asked if they misused any other prescription pain reliever in the past 12 months. If respondents reported misuse of one or more specific prescription pain relievers in the past 12 months, they were asked whether they misused prescription pain relievers in the past 30 days. Respondents who reported any use of prescription pain relievers in the past 12 months but did not report misuse in the past 12 months or who reported any use in their lifetime but not in the past 12 months were asked whether they ever, even once, misused any prescription pain reliever. Consequently, lifetime and past month estimates of the misuse of prescription pain relievers are available only for the overall pain reliever category and not for specific pain relievers.
Questions about past year use and misuse in the 2023 NSDUH covered the following subcategories of pain relievers: hydrocodone products (Vicodin®, Lortab®, Norco®, Zohydro® ER, or generic hydrocodone); oxycodone products (OxyContin®, Percocet®, Percodan®, Roxicodone®, or generic oxycodone); tramadol products (Ultram®, Ultram® ER, Ultracet®, generic tramadol, or generic extended-release tramadol); codeine products (Tylenol® with codeine 3 or 4, or generic codeine pills); morphine products (Avinza®, Kadian®, MS Contin®, generic morphine, or generic extended-release morphine); prescription fentanyl products (Duragesic®, Fentora®, or generic fentanyl); buprenorphine products (Suboxone®, generic buprenorphine, or generic buprenorphine plus naloxone); oxymorphone products (Opana®, Opana® ER, generic oxymorphone, or generic extended-release oxymorphone); Demerol®; hydromorphone products (Dilaudid® or generic hydromorphone, or Exalgo® or generic extended-release hydromorphone); methadone; or any other prescription pain reliever. Other prescription pain relievers could include products similar to the specific pain relievers listed previously. Questions were not asked about past month pain reliever use or misuse for the specific subtype categories.
Because the specific pain relievers listed above are classified as opioids, use or misuse of any of these specific pain relievers indicates prescription opioid use or misuse. If respondents reported the use or misuse of only “other” pain relievers, however, respondents could have used or misused drugs that are not opioids. If respondents reported that they used or misused other pain relievers in the past year, they may not have known the specific other pain relievers they used or misused. Some of these other pain relievers could have been prescription opioids. See Chapter 4 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Fentanyl Use or Misuse, Lifetime Use or Misuse, Opioid Use or Misuse, OxyContin® Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
These measures indicate use of a substance other than prescription psychotherapeutic drugs (pain relievers, tranquilizers, stimulants, or sedatives) or misuse of prescription psychotherapeutic drugs in the 30 days prior to the interview. Respondents were not asked about any use of prescription psychotherapeutic drugs in the past 30 days. Respondents who indicated past month use or misuse of a specific substance also were classified as lifetime and past year users or misusers.
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
These measures indicate use or misuse of a specific substance in the 12 months prior to the interview. For prescription psychotherapeutic drugs (pain relievers, tranquilizers, stimulants, or sedatives), measures include any use or misuse in the past 12 months. Measures for prescription psychotherapeutic drugs are determined from respondents’ answers to questions about any use or misuse in the past 12 months. For tobacco products and nicotine vaping, past year use measures were determined from respondents’ answers to questions about use in the past 30 days or most recent use. For all other substances not mentioned, past year use measures were determined from questions about respondents’ most recent use of that substance. Respondents who indicated past year use or misuse of a specific substance also were classified as lifetime users or misusers.
SEE: Any Use of Prescription Psychotherapeutics, Current Use or Misuse, Lifetime Use or Misuse, Misuse of Prescription Psychotherapeutics, Nicotine Vaping, Past Month Use or Misuse, Recency of Use or Misuse, and Tobacco Product Use.
Measures of use of phencyclidine (PCP) in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the hallucinogens section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used PCP, also called ‘angel dust’ or phencyclidine?” and “How long has it been since you last used PCP?”). The question about recency of use was asked if respondents previously reported any use of PCP in their lifetime.
SEE: Current Use or Misuse, Hallucinogen Use, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Respondents were asked in the risk and availability section of the questionnaire to assess how difficult or easy it would be for them to get various illicit drugs if they wanted these drugs. The drugs include marijuana, lysergic acid diethylamide (LSD), cocaine, crack, and heroin. Response options were (1) probably impossible, (2) very difficult, (3) fairly difficult, (4) fairly easy, and (5) very easy.
SEE: Cocaine Use, Crack Use, Heroin Use, LSD Use, and Marijuana Use.
Respondents were asked in the risk and availability section of the questionnaire to report how much they thought people risk harming themselves physically and in other ways when they use various illicit drugs, alcohol, and cigarettes with various levels of frequency. Response options were (1) no risk, (2) slight risk, (3) moderate risk, and (4) great risk.
Respondents aged 12 or older were classified as having a perceived unmet need for mental health treatment if they did not report the receipt of mental health treatment in the past year and they either (1) sought treatment or thought they should get treatment for their mental health in the past year or (2) received other mental health services but not mental health treatment in the past year (i.e., support group, emergency room/department, or peer support specialist or recovery coach) and sought or thought they should get additional professional counseling, medication, or other treatment for their mental health, emotions, or behavior in the past year.
Respondents who did not report that they received mental health treatment in the past year were asked, “During the past 12 months, did you seek professional counseling, medication, or other treatment for your mental health, emotions, or behavior?” Respondents who reported receiving services from other sources but did not report the receipt of mental health treatment were asked, “Other than the help you already reported receiving, did you seek additional professional counseling, medication, or other treatment for your mental health, emotions, or behavior in the past 12 months?”
Respondents who did not report that they sought mental health treatment in the past year were asked, “During the past 12 months, did you think you should get professional counseling, medication, or other treatment for your mental health, emotions, or behavior?” Respondents who did not report that they sought additional help in the past year were asked, “Other than the help you already reported receiving, did you think you should get additional professional counseling, medication, or other treatment for your mental health, emotions, or behavior in the past 12 months?” See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Mental Health Treatment and Other Mental Health Services.
Respondents aged 12 or older were classified as having a perceived unmet need for substance use treatment if they did not report the receipt of substance use treatment in the past year and they either (1) sought substance use or thought they should get substance use treatment in the past year or (2) received other services for substance use but not substance use treatment in the past year (i.e., support group, emergency room/department, detoxification/withdrawal support services, or peer support specialist or recovery coach) and sought or thought they should get additional professional counseling, medication, or other substance use treatment in the past year.
Respondents who reported alcohol or drug use in their lifetime but did not report receiving substance use treatment in the past year were asked, “During the past 12 months, did you seek professional counseling, medication, or other treatment for your alcohol or drug use?” Respondents who reported lifetime alcohol or drug use in their lifetime and reported receiving other substance use services were asked, “Other than the help you already reported receiving, did you seek additional professional counseling, medication, or other treatment for your alcohol or drug use in the past 12 months?” Respondents who reported lifetime use of both alcohol and drugs were further asked for each question whether the treatment they sought was for alcohol use only, drug use only, or both alcohol and drug use.
Respondents who did not report that they sought substance use treatment in the past year were asked, “During the past 12 months, did you think you should get professional counseling, medication, or other treatment for your alcohol or drug use?” Respondents who did not report that they sought additional substance use treatment in the past year were asked, “Other than the help you already reported receiving, did you think you should get additional professional counseling, medication or other treatment for your alcohol or drug use in the past 12 months?” Respondents who reported lifetime use of both alcohol and drugs were further asked for each question whether the treatment they thought they should get was for alcohol use only, drug use only, or both alcohol and drug use. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
Estimates in NSDUH national tables and reports are presented separately for the perceived unmet need for substance use treatment among adolescents aged 12 to 17 and among adults aged 18 or older. Factors affecting the perception of need for substance use treatment, including how people interpret whether they sought substance use treatment, could differ for adolescents and adults, even if adolescent and adult respondents were asked the same questions about perceived unmet need.
SEE: Substance Use Treatment.
Estimated percentages presented in NSDUH tables and reports are based on weighted data. Analysis weights are created so that estimates are representative of the target population. See Chapter 2 in the 2023 Methodological Summary and Definitions report for additional details about the development of analysis weights in NSDUH.
SEE: Analysis Weight and Rounding.
SEE: Delinquent Behavior.
Measures of use of pipe tobacco in the respondent’s lifetime and the past month were derived from responses to the questions in the nicotine section of the questionnaire about lifetime pipe tobacco use and use in the past 30 days (i.e., “Have you ever, even once, smoked tobacco in a pipe?” and “During the past 30 days, have you smoked tobacco in a pipe, even once?”).
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, and Recency of Use or Misuse.
Poverty level was defined by comparing a respondent’s total family income with the U.S. Census Bureau’s poverty thresholds (both measured in dollar amounts) in order to determine the poverty status of the respondent and the respondent’s family. Information on family income, size, and composition (e.g., number of children) was used to determine the respondent’s poverty level. The poverty level was calculated as a percentage of the poverty threshold by dividing a respondent’s reported total family income by the appropriate poverty threshold amount. Three categories for poverty level were defined relative to the poverty threshold: (1) less than 100 percent (i.e., total family income was less than the poverty threshold); (2) 100 to 199 percent (i.e., total family income was at or above the poverty threshold but less than twice the poverty threshold); and (3) 200 percent or more (i.e., total family income was twice the poverty threshold or greater). In addition, the measure for poverty level excluded respondents aged 18 to 22 who were living in a college dormitory.
SEE: Mental Health Treatment.
Respondents who reported in the pain relievers screener section of the questionnaire that they used Duragesic®, Fentora®, or generic fentanyl in the past 12 months were classified as having used a prescription fentanyl product in the past year.
Respondents who reported that they used Duragesic®, Fentora®, or generic fentanyl in the past 12 months for any reason were asked in the main pain relievers section whether they misused it (or them) in the past 12 months (i.e., use in any way a doctor did not direct them to use it). Respondents who reported misuse of any of these fentanyl products were classified as having misused a prescription fentanyl product in the past year. Examples of misuse were presented to respondents and included (1) use without a prescription of the respondent’s own; (2) use in greater amounts, more often, or longer than told to take a drug; or (3) use in any other way a doctor did not direct the respondent to use a drug.
Lifetime and past month estimates of the misuse of a prescription fentanyl product are not available because the questions for these reference periods are asked only for the overall pain reliever category, not the specific pain relievers.
SEE: Fentanyl Use or Misuse and Prescription Pain Reliever Use or Misuse.
SEE: Psychotherapeutic Drugs.
Respondents were classified as having a prescription psychotherapeutic drug use disorder if they met criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-542). The number of criteria for classifying respondents who reported any use of prescription drugs in a given category (e.g., pain relievers) in the past 12 months differed according to whether respondents misused prescription drugs in that category or they used prescription drugs in that category but did not misuse them in that period. Respondents who misused prescription drugs in a given category in the past 12 months were classified as having an SUD for that category of prescription drugs if they had 2 or more of the 11 criteria from the DSM-5 for having an SUD. Respondents who used but did not misuse prescription drugs in a given category in the past 12 months were classified as having an SUD for that category of prescription drugs if they had 2 or more of 9 criteria from the DSM-5 for having an SUD.
Respondents were not counted as having a prescription psychotherapeutic drug use disorder if they did not meet the full substance use disorder criteria individually for any of these prescription psychotherapeutic drug categories. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Pain Reliever Use Disorder, Pain Reliever Use or Misuse, Sedative Use Disorder, Sedative Use or Misuse, Stimulant Use Disorder, Stimulant Use or Misuse, Tranquilizer or Sedative Use Disorder, Tranquilizer or Sedative Use or Misuse, Tranquilizer Use Disorder, and Tranquilizer Use or Misuse.
Respondents were asked in the special topics section of the questionnaire if they were on probation at any time during the past 12 months or if they were on parole, supervised release, or other conditional release from prison at any time during the past 12 months. Respondents could indicate being on both probation and parole during the past 12 months; therefore, these questions are not mutually exclusive.
Psychotherapeutic drugs are prescription medications with legitimate medical uses as pain relievers, tranquilizers, stimulants, and sedatives. The respondent is asked to report any use and misuse of these drugs in the respective prescription drug questionnaire sections. Misuse is defined as use in any way a doctor did not direct a respondent to use the drugs, including (1) use without a prescription of the respondent’s own; (2) use in greater amounts, more often, or longer than told to take a drug; or (3) use in any other way a doctor did not direct the respondent to use a drug. Although methamphetamine remains available in prescription form and is occasionally prescribed, NSDUH does not explicitly include methamphetamine as a prescription stimulant.43
SEE: Any Use of Prescription Psychotherapeutics, Benzodiazepine Use or Misuse, Lifetime Use or Misuse, Misuse of Prescription Psychotherapeutics, Pain Reliever Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, Sedative Use or Misuse, Stimulant Use or Misuse, Tranquilizer or Sedative Use or Misuse, and Tranquilizer Use or Misuse.
Quarter is defined as one of the contiguous 3-month periods of the calendar year. Data for NSDUH are typically collected across four quarters of the year: (1) Quarter 1 from January through March, (2) Quarter 2 from April through June, (3) Quarter 3 from July through September, and (4) Quarter 4 from November through December.
Race/ethnicity was used to refer to the respondent’s self-classification of racial and ethnic origin and identification, in accordance with federal standards for reporting race and ethnicity data.44 For Hispanic origin, respondents were asked in the front-end demographics section, “Are you of Hispanic, Latino, or Spanish origin or descent?” For race, respondents were asked in the front-end demographics section, “Which of these groups describes you?” Response options for race were (1) American Indian or Alaska Native, (2) Asian, (3) Black or African American, (4) Native Hawaiian or Other Pacific Islander, and (5) White. American Indian or Alaska Native includes North American, Central American, and South American Indians. Asian includes Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese. Native Hawaiian or Other Pacific Islander includes Guamanian, Chamorro, and Samoan. Respondents were allowed to choose more than one of these groups. Categories for a combined race/ethnicity variable included Hispanic (regardless of race); non-Hispanic groups where respondents indicated only one race (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian, or Other Pacific Islander, White); and non-Hispanic groups where respondents reported two or more races. These categories were based on classifications developed by the U.S. Census Bureau.
SEE: American Indian or Alaska Native (AIAN), Asian, Black, Hispanic or Latino, Native Hawaiian or Other Pacific Islander (NHOPI), Two or More Races, and White.
Respondents who reported misuse of prescription psychotherapeutic drugs (pain relievers, tranquilizers, stimulants, and sedatives) in the past year were asked in the respective questionnaire sections to report the last drug they misused in the past year and the reasons why they misused it. Response options varied by psychotherapeutic category. Response options for the misuse of pain relievers were (1) to relieve physical pain, (2) to relax or relieve tension, (3) to experiment or to see what the drug is like, (4) to feel good or get high, (5) to help with sleep, (6) to help with feelings or emotions, (7) to increase or decrease the effect(s) of some other drug, (8) because the respondent is “hooked” or has to have the drug(s), or (9) for some other reason. The same response options were presented for tranquilizer misuse and sedative misuse, except that “to relieve physical pain” was not presented as an option; the first response option for both of these psychotherapeutic categories was “to relax or relieve tension.” Response options for the misuse of stimulants were (1) to help lose weight, (2) to help concentrate, (3) to help be alert or stay awake, (4) to help study, (5) to experiment or to see what the drug(s) is (or are) like, (6) to feel good or get high, (7) to increase or decrease the effect(s) of some other drug, (8) because the respondent is “hooked” or has to have the drug(s), or (9) for some other reason.
For each of the four psychotherapeutic drug categories, respondents could report more than one reason for their last misuse. Respondents who reported more than one reason were asked to report the main reason for their last misuse. If respondents reported only one reason for their last misuse, they were not asked to report their main reason; this reason was considered to be their main one.
SEE: Pain Reliever Use or Misuse, Sedative Use or Misuse, Stimulant Use or Misuse, and Tranquilizer Use or Misuse.
Respondents who reported in the mental health services utilization section of the questionnaire that there was a time in the past year when they had a perceived unmet need for mental health treatment were asked sets of questions for why they did not get professional counseling, medication, or other treatment for their mental health, emotions, or behavior. The following reasons were presented to these respondents: (1) thought it would cost too much; (2) did not have health insurance coverage for mental health treatment; (3) thought health insurance would not pay enough of costs for mental health treatment; (4) did not know how or where to get treatment; (5) could not find a treatment program or with the healthcare professional they wanted to go to; (6) found no openings in the treatment program or with the healthcare professional they wanted to go to; (7) had problems with things like transportation, childcare, or getting appointments at times that worked; (8) did not have enough time for treatment; (9) worried that their information would not be kept private; (10) worried about what people would think or say if they got treatment; (11) thought that if people knew they were in treatment bad things would happen like losing their job, home, or children; (12) were not ready to start treatment; (13) thought they should have been able to handle their mental health, emotions, or behaviors on their own; (14) thought their family, friends, or religious group would not like it if they got treatment; (15) were afraid of being committed to a hospital or forced into treatment against their will; (16) thought they would be told they needed to take medication; (17) did not think treatment would help them; and (18) thought no one would care if they got better. Respondents could report more than one reason for not receiving mental health treatment.
SEE: Mental Health Treatment and Perceived Unmet Need for Mental Health Treatment.
Respondents who reported in the alcohol and drug treatment section of the questionnaire that there was a time in the past year when they had a perceived unmet need for substance use treatment were asked sets of questions for why they did not get professional counseling, medication, or other treatment for their alcohol or drug use. The following reasons were presented to these respondents: (1) thought it would cost too much; (2) did not have health insurance coverage for alcohol or drug use treatment; (3) thought health insurance would not pay enough of the costs for treatment; (4) did not know how or where to get treatment; (5) could not find a treatment program or healthcare professional they wanted to go to; (6) found no openings in the treatment program or with the healthcare professional they wanted to go to; (7) had problems with things like transportation, childcare, or getting appointments at times that worked for them; (8) did not have enough time for treatment; (9) were worried that their information would not be kept private; (10) worried about what people would think or say if they got treatment; (11) thought that if people knew they were in treatment bad things would happen like losing their job, home, or children; (12) were not ready to start treatment; (13) were not ready to stop or cut back using alcohol or drugs; (14) thought they should have been able to handle their alcohol or drug use on their own; (15) thought their family, friends, or religious group would not like it if they got treatment; (16) thought they would be forced to stay in rehab or treatment against their will; (17) did not think treatment would help them; and (18) thought no one would care if they got better. Respondents could report more than one reason for not receiving substance use treatment.
SEE: Perceived Unmet Need for Substance Use Treatment and Substance Use Treatment.
SEE: Mental Health Treatment.
SEE: Substance Use Treatment.
SEE: Treatment for Alcohol Use.
SEE: Treatment for Both Alcohol and Drug Use.
SEE: Treatment for Drug Use.
SEE: Treatment for Unspecified Substance.
Respondents who previously reported any use of tobacco, alcohol, or illicit drugs other than prescription psychotherapeutic drugs in their lifetime in the respective questionnaire sections were asked about their most recent use of that substance. This information was the source for the lifetime, past year, and past month estimates of substance use or misuse. The questions “Have you ever, even once, used [substance name]?” and “How long has it been since you last used [substance name]?” were essentially the same for all substances other than tobacco products and prescription psychotherapeutic drugs.
For tobacco products (cigarettes, smokeless tobacco, cigars, or pipe tobacco) and nicotine vaping, a question first was asked about use in the past 30 days if respondents indicated ever using that tobacco product or vaping nicotine in their lifetime. Lifetime users of pipe tobacco were asked only about their use in the past 30 days. For nicotine vaping and tobacco products other than pipe tobacco, if the respondents did not use the product in the past 30 days, the recency question was asked as above, with the response options (1) more than 30 days ago but within the past 12 months, (2) more than 12 months ago but within the past 3 years, and (3) more than 3 years ago. For the remaining substances, the response options were (1) within the past 30 days, (2) more than 30 days ago but within the past 12 months, and (3) more than 12 months ago.
For prescription psychotherapeutic drugs, respondents were not asked a single question about their most recent use or misuse. Most recent use of psychotherapeutic drugs for any reason was determined first from respondents’ reports of any use of specific psychotherapeutic drugs within a category (e.g., prescription pain relievers) in the past 12 months. Any use more than 12 months ago was established from follow-up questions about lifetime use that were asked if respondents did not report use in the past 12 months of any specific prescription psychotherapeutic drug within a category. Similarly, most recent misuse of psychotherapeutic drugs (i.e., use in any way not directed by a doctor) was determined first from respondents’ reports of misuse in the past 12 months of specific psychotherapeutic drugs within a category respondents reported using in that period. If respondents reported misuse of any psychotherapeutic drug in the past 12 months, misuse within the past 30 days was determined in one of two ways: (1) if respondents initiated misuse of a specific drug in the past 30 days or (2) otherwise, from a follow-up question about misuse of any drug in that category in the past 30 days. Misuse of prescription psychotherapeutic drugs more than 12 months ago was established from follow-up questions about lifetime use asked if respondents reported (1) any use of specific prescription psychotherapeutics in the past 12 months, but they did not report misuse in the past 12 months; or (2) any use of prescription psychotherapeutic drugs in an overall category in their lifetime but not in the past 12 months.
SEE: Any Use of Prescription Psychotherapeutics, Current Use or Misuse, Lifetime Use or Misuse, Misuse of Prescription Psychotherapeutics, Nicotine Vaping, Past Month Use or Misuse, Past Year Use or Misuse, and Tobacco Product Use.
Adults aged 18 or older were classified as considering themselves to be in recovery or to have recovered from mental health issues at the time of the interview if they (1) reported they ever had a problem with their mental health and (2) considered themselves to be in recovery or recovered from their problem. Questions for recovery from mental health issues were in the emerging issues section. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
Adults aged 18 or older were classified as considering themselves to be in recovery or to have recovered from substance use problems at the time of the interview if they (1) reported they ever had a problem with their drug or alcohol use and (2) considered themselves to be in recovery or recovered from their problem. Questions for recovery from substance use problems were in the emerging issues section. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
Four regions, Northeast, Midwest, South, and West, are based on classifications developed by the U.S. Census Bureau.
SEE: Geographic Division, Midwest Region, Northeast Region, South Region, and West Region.
Respondents were asked about the number of times they attended religious services in the past year. Respondents were asked not to include special occasions, such as weddings, funerals, or other special events. Response categories included (1) 0 times, (2) 1 to 2 times, (3) 3 to 5 times, (4) 6 to 24 times, (5) 25 to 52 times, or (6) more than 52 times. Although these questions were asked of adults aged 18 or older in the social environment section of the questionnaire and of youths aged 12 to 17 in the youth experiences section, only data for youths are presented in the 2023 Detailed Tables.
The decision rules for the rounding of percentages are as follows:
Thus, an estimate of 16.55 percent will have been rounded to 16.6 percent, whereas an estimate of 16.44 percent will have been rounded to 16.4 percent. Although the percentages in the tables generally total 100 percent, the use of rounding sometimes produces a total of slightly less than or more than 100 percent. Rounding of estimates also needs to be taken into account when interpreting the results of tests for statistical significance because testing is done using unrounded estimates. Therefore, estimates rounded to the same value may not show the same results for statistical testing.
SEE: Percentages and Statistical Significance.
Measures of the use of Salvia divinorum in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the hallucinogen section of the questionnaire about lifetime and recency of use (i.e., “Have you ever, even once, used Salvia divinorum?” and “How long has it been since you last used Salvia divinorum?”).
SEE: Current Use or Misuse, Hallucinogen Use, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Sedative use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-545). Respondents who reported any use of prescription sedatives in the past 12 months were asked questions about the following criteria for sedative use disorder: (1) used sedatives in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on sedative use; (3) spent a great deal of time in activities to obtain, use, or recover from sedative use; (4) felt a craving or strong desire to use sedatives; (5) engaged in recurrent sedative use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use sedatives despite social or interpersonal problems caused by the effects of sedatives; (7) gave up or reduced important social, occupational, or recreational activities because of sedative use; (8) continued to use sedatives in physically hazardous situations; (9) continued to use sedatives despite physical or psychological problems caused by sedative use; (10) increased the amount of sedatives needed to achieve same effect or noticed that the same amount of sedative use had less effect than before; and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping sedative use or (11b) used prescription sedatives or a related substance to get over or avoid sedative withdrawal symptoms.
The number of criteria for classifying respondents who reported any use of prescription sedatives in the past 12 months differed according to whether (1) respondents misused sedatives, or (2) they used sedatives but did not misuse them in that period. The overall measure of sedative use disorder was based on whether respondents in either of these two groups were classified as having a sedative use disorder in the past year. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report.
Respondents who misused prescription sedatives in the past 12 months were classified as having a sedative use disorder if they had 2 or more of the 11 criteria mentioned previously.
Respondents who used prescription sedatives in the past 12 months but did not misuse them were classified as having a sedative use disorder if they met two or more of the first nine criteria mentioned previously. Criteria 10 and 11 do not apply to people who did not misuse prescription sedatives because these criteria can occur as normal physiological adaptations when people use sedatives appropriately under medical supervision.46
SEE: Sedative Use or Misuse and Tranquilizer or Sedative Use Disorder.
Measures of use or misuse of prescription sedatives in the respondent’s lifetime and past year were derived from a series of questions in the screener and main sections of the questionnaire for sedatives that first asked respondents about any use (i.e., for any reason) of specific prescription sedatives in the past 12 months. Respondents were informed that these drugs are also called “downers” or “sleeping pills.” Respondents also were informed that people sometimes take these drugs to help them relax or help them sleep. Respondents were instructed not to include the use of over-the-counter (OTC) sedatives, such as Sominex®, Unisom®, Benadryl®, or Nytol®. Respondents who did not report use of any sedative in the past 12 months were asked whether they ever, even once, used prescription sedatives.
Respondents who reported they used specific prescription sedatives in the past 12 months for any reason were shown a list reminding them of the drugs they used in the past 12 months. For each of these drugs, respondents were asked whether they misused it (or them) in the past 12 months (i.e., use in any way a doctor did not direct them to use it). Examples of misuse were presented to respondents and included (1) use without a prescription of the respondent’s own; (2) use in greater amounts, more often, or longer than told to take a drug; or (3) use in any other way a doctor did not direct the respondent to use a drug. Respondents were reminded not to include OTC drugs when they were asked if they misused any other prescription sedative in the past 12 months. If respondents reported misuse of one or more specific prescription sedatives in the past 12 months, they were asked whether they misused prescription sedatives in the past 30 days. Respondents who reported any use of prescription sedatives in the past 12 months but did not report misuse in the past 12 months or who reported any use in their lifetime but not in the past 12 months were asked whether they ever, even once, misused any prescription sedative. Consequently, lifetime or past month estimates of the misuse of prescription sedatives are available only for the overall prescription sedative category and not for specific sedatives.
Questions about past year use and misuse in the 2023 NSDUH covered the following subcategories of sedatives: zolpidem products (Ambien®, Ambien® CR, generic zolpidem, or generic extended-release zolpidem); eszopiclone products (Lunesta® or generic eszopiclone); zaleplon products (Sonata® or generic zaleplon); benzodiazepine sedatives (flurazepam [also known as Dalmane®], temazepam products [Restoril®, or generic temazepam], or triazolam products [Halcion® or generic triazolam]); barbiturates (Butisol®, Seconal®, or phenobarbital); or any other prescription sedative. Other prescription sedatives could include products similar to the specific sedatives listed previously. Questions were not asked about past month sedative use or misuse for the subtype categories.
SEE: Benzodiazepine Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, and Tranquilizer or Sedative Use or Misuse.
SEE: Mental Illness.
Serious psychological distress (SPD) for adults is defined as having a score of 13 or higher on the Kessler-6 (K6) scale. This scale consists of six questions that gather information on how frequently adult respondents experienced symptoms of psychological distress during the past month or the one month in the past year when they were at their worst emotionally. These questions in the mental health section of the questionnaire ask about the frequency of feeling (1) nervous, (2) hopeless, (3) restless or fidgety, (4) sad or depressed, (5) that everything was an effort, and (6) no good or worthless.47 Respondents were asked the K6 questions for the past 30 days and (if applicable) the one month in the past year when adult respondents were at their worst emotionally. Past month and past year SPD estimates are presented in the 2023 Detailed Tables.
The maximum score of the two periods (i.e., past month and past year) was used to create the total past year score. See Chapter 3 in the 2023 Methodological Summary and Definitions report for more information.
SEE: Kessler-6 (K6) Scale and Mental Illness.
Beginning with the 2023 NSDUH, respondents aged 12 or older were asked in the front-end demographics section of the questionnaire, “What sex were you assigned at birth, on your original birth certificate?” Response options were (1) male and (2) female. Respondents were informed that they were asked these questions for statistical purposes only to help in analyzing the results of the study. Separately, gender identity data were also collected beginning in the 2023 NSDUH, including whether respondents identify as male, female, transgender, or another identity.
Prior to the 2023 NSDUH, the demographics question most closely associated with these data asked, “Are you male or female?” The data collected from this question was labeled in national tables and reports as “gender.”
All respondents were asked in the back-end demographics section of the questionnaire, “Which of the following do you consider yourself to be?” Response options were (1) heterosexual, that is, straight; (2) gay or lesbian; (3) bisexual; (4) I use a different term; (5) I am not sure about my sexual identity; and (6) I do not know what this question is asking. Respondents who reported that they used a different term were asked what term they use to describe their sexual identity.
SEE: Sex.
The Sheehan Disability Scale (SDS)48 consists of a series of four questions used in NSDUH to measure interference or problems in a person’s daily functioning caused by major depressive episode. The SDS role domains are assessed on a 0 to 10 visual analog scale with impairment categories of “none” (0), “mild” (1-3), “moderate” (4-6), “severe” (7-9), and “very severe” (10). For adults aged 18 or older, the SDS role domains are (1) home management, (2) work, (3) close relationships with others, and (4) social life. For youths aged 12 to 17, the SDS role domains are (1) chores at home, (2) school or work, (3) close relationships with family, and (4) social life. Because the SDS asks about different role domains for adults in the adult depression section of the questionnaire and for youths in the adolescent depression section, the adult and youth SDS data should not be combined or compared.
SEE: Major Depressive Episode (MDE) with Severe Impairment and World Health Organization Disability Assessment Schedule (WHODAS).
SEE: County Type.
Measures of the use of smokeless tobacco in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the nicotine section of the questionnaire about lifetime smokeless tobacco use, use in the past 30 days, and recency of use (if not in the past 30 days) (e.g., “Have you ever, even once, used ‘smokeless’ tobacco?” “During the past 30 days, have you used ‘smokeless’ tobacco, even once?” and “How long has it been since you last used ‘smokeless’ tobacco?”). Questions about use of smokeless tobacco in the past 30 days or the most recent use of smokeless tobacco (if not in the past 30 days) were asked if respondents previously reported any use of smokeless tobacco in their lifetime.
The following information preceded the question about lifetime use of smokeless tobacco: “The next questions are about your use of ‘smokeless’ tobacco such as snuff, dip, chewing tobacco, or ‘snus.’”
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Respondents aged 12 to 20 who reported drinking at least one alcoholic beverage within the past 30 days were asked in the consumption of alcohol section of the questionnaire if they were alone, with one other person, or with more than one person the last time they drank.
SEE: Alcohol Use and Underage Alcohol Use.
Respondents aged 12 to 20 who reported drinking at least one alcoholic beverage within the past 30 days were asked questions in the consumption of alcohol section of the questionnaire pertaining to the source of the alcohol for their most recent alcohol use. The sources were (1) respondent purchased it, (2) someone else purchased it, (3) received it from a parent or guardian, (4) received it from another family member aged 21 or older, (5) received it from an unrelated person aged 21 or older, (6) received it from someone under age 21, (7) took it from own home, (8) took it from someone else’s home, or (9) got it some other way. Respondents who reported “some other way” were asked to type in a response indicating the specific source. Estimates for commonly reported other sources are included in the 2023 Detailed Tables. Respondents could report more than one source.
The questions on the source of last alcohol use were presented in two categories: (1) respondents paid (they purchased the alcohol or gave someone else money to purchase the alcohol), and (2) respondents did not pay (they received the alcohol for free from someone or took the alcohol from their own or someone else’s home).
SEE: Alcohol Use and Underage Alcohol Use.
Respondents who reported misuse of prescription psychotherapeutic drugs (pain relievers, tranquilizers, stimulants, and sedatives) in the past year were asked in the respective questionnaire sections how they obtained the last drug they misused in a given category. Response options for the source of the medications were as follows: (1) got a prescription from just one doctor; (2) got prescriptions from more than one doctor; (3) stole from a doctor’s office, clinic, hospital, or pharmacy; (4) got from a friend or relative for free; (5) bought from a friend or relative; (6) took from a friend or relative without asking; (7) bought from a drug dealer or other stranger; and (8) got in some other way (includes other sources specified by respondents). Respondents who reported they obtained these drugs from a friend or relative for free were asked how the friend or relative obtained them, using the same response options 1 through 8 as the respondents’ source questions.
Respondents who reported misuse of psychotherapeutic drugs in the past 12 months were asked to report the last psychotherapeutic drug they misused in a given category and were asked the following question: “Now think again about the last time you used [fill in the name of the last prescription pain reliever, prescription tranquilizer, prescription stimulant, or prescription sedative that was misused] in any way a doctor did not direct you to use [it/them]. How did you get the [fill in the relevant drug name]? If you got the [fill in the relevant drug name] in more than one way, please choose one of these ways as your best answer.”
SEE: Pain Reliever Use or Misuse, Sedative Use or Misuse, Stimulant Use or Misuse, and Tranquilizer Use or Misuse.
The states included are those in the South Atlantic Division (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia); the East South Central Division (Alabama, Kentucky, Mississippi, and Tennessee); and the West South Central Division (Arkansas, Louisiana, Oklahoma, and Texas).
SEE: Geographic Division and Region.
Three types of statistical comparisons are presented in NSDUH national tables and reports: (1) between two different time points, (2) between members of demographic subgroups within the same year, and (3) annual averages between subgroups using pooled data. When reports include comparisons of estimates, significance levels of 0.01 and 0.05 generally are used to determine whether these estimates are statistically different. If differences do not meet the criteria for statistical significance, the values of these estimates are not considered to be different from one another. Low precision estimates are not included in statistical tests. Also, testing can indicate significant differences involving seemingly identical percentages that have been rounded to the nearest tenth of a percent. See Chapter 3 in the 2023 NSDUH Methodological Summary and Definitions report for additional details.
SEE: Low Precision and Rounding.
Stimulant use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-549). Respondents who reported any use of prescription stimulants in the past 12 months were asked questions about the following criteria for stimulant use disorder: (1) used stimulants in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on stimulant use; (3) spent a great deal of time in activities to obtain, use, or recover from stimulant use; (4) felt a craving or strong desire to use stimulants; (5) engaged in recurrent stimulant use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use stimulants despite social or interpersonal problems caused by the effects of stimulants; (7) gave up or reduced important social, occupational, or recreational activities because of stimulant use; (8) continued to use stimulants in physically hazardous situations; (9) continued to use stimulants despite physical or psychological problems caused by stimulant use; (10) increased the amount of stimulants needed to achieve same effect or noticed that the same amount of stimulant use had less effect than before; and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping stimulant use or (11b) used prescription stimulants or a related substance to get over or avoid stimulant withdrawal symptoms.
The number of criteria for classifying respondents who reported any use of prescription stimulants in the past 12 months differed according to whether (1) respondents misused stimulants, or (2) they used stimulants but did not misuse them in that period. The overall measure of stimulant use disorder was based on whether respondents in either of these two groups were classified as having a stimulant use disorder in the past year.50 See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
Respondents who misused prescription stimulants in the past 12 months were classified as having a stimulant use disorder if they had 2 or more of the 11 criteria mentioned previously.
Respondents who used prescription stimulants in the past 12 months but did not misuse them were classified as having a stimulant use disorder if they met two or more of the first nine criteria mentioned previously. Criteria 10 and 11 do not apply to people who did not misuse prescription stimulants because these criteria can occur as normal physiological adaptations when people use stimulants appropriately under medical supervision.51
SEE: Stimulant Use or Misuse.
Measures of use or misuse of prescription stimulants in the respondent’s lifetime and past year were derived from a series of questions in the screener and main sections of the questionnaire for stimulants that first asked respondents about any use (i.e., for any reason) of specific prescription stimulants in the past 12 months. Respondents were informed that people sometimes take stimulants for attention deficit disorder, to lose weight, or to stay awake. Respondents were instructed not to include the use of over-the-counter (OTC) stimulants, such as Dexatrim®, No-Doz®, Hydroxycut®, or 5-Hour Energy®. Respondents who did not report use of any prescription stimulant in the past 12 months were asked whether they ever, even once, used prescription stimulants.
Respondents who reported they used specific prescription stimulants in the past 12 months for any reason were shown a list reminding them of the drugs they used in the past 12 months. For each of these drugs, respondents were asked whether they misused it (or them) in the past 12 months (i.e., use in any way a doctor did not direct them to use it). Examples of misuse were presented to respondents and included (1) use without a prescription of the respondent’s own; (2) use in greater amounts, more often, or longer than told to take a drug; or (3) use in any other way a doctor did not direct the respondent to use a drug. Respondents were reminded not to include OTC drugs when they were asked if they misused any other prescription stimulant in the past 12 months. If respondents reported misuse of one or more specific prescription stimulants in the past 12 months, they were asked whether they misused prescription stimulants in the past 30 days. Respondents who reported any use of prescription stimulants in the past 12 months but did not report misuse in the past 12 months or who reported any use in their lifetime but not in the past 12 months were asked whether they ever, even once, misused any prescription stimulant. Consequently, lifetime or past month estimates of the misuse of prescription stimulants are available only for the overall prescription stimulant category and not for specific stimulants.
Questions about past year use and misuse in the 2023 NSDUH covered the following subcategories of stimulants: amphetamines (Adderall®, Adderall® XR, Dexedrine®, Vyvanse®, generic dextroamphetamine, generic amphetamine-dextroamphetamine combinations, or generic extended-release amphetamine-dextroamphetamine combinations); methylphenidate products (Ritalin®, Ritalin® LA, Concerta®, Daytrana®, Metadate® CD, Metadate® ER, Focalin®, Focalin® XR, generic methylphenidate, generic extended-release methylphenidate, generic dexmethylphenidate, or generic extended-release dexmethylphenidate); anorectic (weight-loss) stimulants (Didrex®, benzphetamine, Tenuate®, diethylpropion, phendimetrazine, or phentermine); Provigil®; or any other prescription stimulant. Other prescription stimulants could include products similar to the specific stimulants listed previously. Methamphetamine was not included as a prescription stimulant, unless respondents specified the prescription form of methamphetamine (Desoxyn®) as another prescription stimulant they misused. Questions were not asked about past month stimulant use or misuse for the subtype categories.
SEE: Lifetime Use or Misuse, Methamphetamine Use, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Substance use disorder (SUD) was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-552), for one or more drugs or alcohol. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Alcohol Use Disorder (AUD), Cocaine Use Disorder, Hallucinogen Use Disorder, Heroin Use Disorder, Inhalant Use Disorder, Marijuana Use Disorder, Methamphetamine Use Disorder, Pain Reliever Use Disorder, Sedative Use Disorder, Stimulant Use Disorder, Tranquilizer or Sedative Use Disorder, and Tranquilizer Use Disorder.
The severity of a substance use disorder (SUD) is determined by the number of individual criteria based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-553) recorded as positive for a particular substance (or category of substances). The number of positive criteria required for each severity level is the same for every substance. Substances include alcohol, cocaine, hallucinogens, heroin, inhalants, marijuana, methamphetamine, prescription pain relievers, prescription tranquilizers, prescription stimulants, or prescription sedatives.
People were classified in the mild category if they met two or three SUD criteria for that substance, in the moderate category if they met four or five SUD criteria for that substance, or in the severe category if they met six or more SUD criteria for that substance.
Aggregate SUD severity measures have also been created for any SUD, drug use disorder, prescription drug use disorder, prescription tranquilizers or sedatives, opioids, or central nervous system stimulants. SUD severity measures for these aggregate SUD categories were based on the maximum severity level (i.e., mild, moderate, or severe) across the multiple SUDs that were included in the aggregate category. For example, if people had a moderate alcohol use disorder and a mild marijuana (cannabis) use disorder as their only SUDs in the past year, then they were classified as having moderate SUD. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Alcohol Use Disorder (AUD), Cocaine Use Disorder, Hallucinogen Use Disorder, Heroin Use Disorder, Drug Use Disorder, Inhalant Use Disorder, Marijuana Use Disorder, Methamphetamine Use Disorder, Pain Reliever Use Disorder, Sedative Use Disorder, Stimulant Use Disorder, and Tranquilizer Use Disorder.
Respondents were classified as having received substance use treatment if they reported in the alcohol and drug treatment section of the questionnaire that they received treatment in the past 12 months for their 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 that they received medication-assisted treatment for alcohol use or opioid use.
Respondents did not have to report treatment for any specific substances to be classified as having substance use treatment. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
Substance use treatment questions were asked of respondents who used alcohol or drugs in their lifetime. Types or locations of substance use treatment were defined as follows:
Respondents were classified as having received substance use treatment as an inpatient in the past 12 months if they reported staying overnight or longer to receive professional counseling, medication, or other treatment for their alcohol or drug use in any of the following locations in that period: (1) in a hospital as an inpatient, (2) in a residential drug or alcohol rehab or treatment center, (3) in a residential mental health center, or (4) in some other place where they stayed overnight or longer.
Respondents were classified as having received substance use treatment as an outpatient in the past 12 months if they reported receiving professional counseling, medication, or other treatment for their alcohol or drug use in any of the following locations in that period where they did not need to stay overnight: (1) a drug or alcohol rehab or treatment center as an outpatient; (2) a mental health treatment center as an outpatient; (3) the office of a therapist, psychologist, psychiatrist, or other substance use treatment professional; (4) a general medical clinic or doctor’s office; (5) a hospital as an outpatient; (6) a school health or counseling center; or (7) in some other place as an outpatient.
Respondents who reported having ever used alcohol or having ever used heroin or prescription pain relievers were classified as having received MAT in the past 12 months if they used prescription medication in that period to cut back or stop their alcohol or drug use. These medications are different from the medications given to stop an overdose. Although respondents were asked about the use of medication to cut back or stop their drug use, only respondents who reported lifetime use of opioids (i.e., heroin or prescription pain relievers) were asked the MAT question for drug use.
Respondents were classified as having received substance use treatment in a prison, jail, or juvenile detention center in the past 12 months if they reported receiving any professional counseling, medication, or other treatment for their alcohol or drug use in any of these locations in that period.
Respondents were classified as having received substance use treatment via telehealth in the past 12 months for substance use if they reported receiving any professional counseling, medication, or treatment for their alcohol or drug use from a therapist or other healthcare professional over the phone or through video in that period.
SEE: Alcohol Use, Drugs, Classified as Needing Substance Use Treatment, Medication-Assisted Treatment (MAT) for Alcohol Use, Medication-Assisted Treatment (MAT) for Opioid Use, and Substances for Which Treatment Was Received.
Respondents who used alcohol or drugs in their lifetime were classified as having received substance use treatment or other services if they reported in the alcohol or drug treatment section of the questionnaire that they received substance use treatment or other services in the past 12 months for their use of alcohol or drugs. Substance use treatment included treatment from any of the following: in an inpatient location; in an outpatient location; via telehealth; or in a prison, jail, or juvenile detention center; or medication-assisted treatment for alcohol use or opioid use. Other substance use services included services from any of the following: in a support group; in an emergency room/department; via detoxification/withdrawal support services from a health care professional; or from a peer support specialist or recovery coach who works with a substance use treatment program or other treatment provider. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Other Substance Use Services and Substance Use Treatment.
Respondents who reported other substance use services (i.e., from support groups, in an emergency room or emergency department, detoxification services [or detox] from a health care professional to manage symptoms of withdrawal from alcohol or drug use, or from a peer support specialist or recovery coach who works with a substance use treatment program or other treatment provider) and who reported lifetime use of alcohol and drugs were asked whether they received services for their use of alcohol only, drugs only, or both alcohol and drugs. Respondents were not asked these follow-up questions if they reported lifetime use of only alcohol or only drugs. If respondents reported the lifetime use of alcohol, and they answered “no” to all questions about their use of drugs in their lifetime, then they could be logically inferred to have received these other services for their use of alcohol only. Similarly, if respondents reported the lifetime use of one or more drugs, and they answered “no” for their lifetime use of alcohol, then they could be logically inferred to have received these other services for their use of drugs only.
From these questions, it was possible to determine whether respondents received other services for their use of alcohol, drugs, or both alcohol and drugs. These measures retained missing values if respondents had missing data for the lifetime use of some substances. These respondents with missing data were excluded from the analyses. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Other Substance Use Services and Substance Use Treatment.
Measures for the substances for which respondents received substance use treatment differed according to whether respondents reported receiving treatment in the past year (1) in inpatient or outpatient locations or (2) via telehealth or in a prison, jail, or juvenile detention center. Receipt of medication-assisted treatment (MAT) applied specifically to the use of alcohol or opioids (i.e., heroin or prescription pain relievers). Aggregate estimates also were created for whether people received any substance use treatment in the past year for their use of alcohol, drugs, or both. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
Respondents who reported receiving substance use treatment in inpatient or outpatient locations in the past year were asked to report whether they received treatment for the specific substances that they reported using in their lifetime; respondents who did not report use of a specific substance in their lifetime were not asked whether they received treatment for the use of that substance. Respondents who reported receiving substance use treatment as an inpatient or an outpatient also were asked whether they received treatment in the respective setting for their use of “some other drug.”
Estimates were produced for the receipt of treatment as an inpatient or as an outpatient in the past year for people’s use of specific substances (e.g., alcohol, marijuana) and for the use of both drugs and alcohol. A “substance unspecified” category also was created for respondents who reported inpatient or outpatient treatment but did not report the specific substances for which they received treatment.
Respondents who reported treatment via telehealth or in a prison, jail, or juvenile detention center and who reported lifetime use of alcohol and drugs were asked whether they received treatment for their use of alcohol only, drugs only, or both alcohol and drugs. Respondents were not asked these follow-up questions if they reported lifetime use of only alcohol or only drugs. If respondents reported the lifetime use of alcohol, and they answered “no” to all questions about their use of drugs in their lifetime, then they could be logically inferred to have received treatment for their use of alcohol only. Similarly, if respondents reported the lifetime use of one or more drugs, and they answered “no” for their lifetime use of alcohol, then they could be logically inferred to have received treatment for their use of drugs only.
From these questions, it was possible to determine whether respondents received treatment via telehealth or in a prison, jail, or juvenile detention center for their use of alcohol, drugs, or both alcohol and drugs. These measures retained missing values if respondents had missing data for the lifetime use of some substances. These respondents with missing data were excluded from the analyses.
Measures for the receipt of inpatient or outpatient treatment in the past year for the use of specific substances and receipt of substance use treatment via telehealth or in a prison, jail, or juvenile detention center, or receipt of MAT for the use of alcohol, drugs, or both alcohol and drugs were used to create estimates for whether people received any substance use treatment in the past year for their use of alcohol, drugs, or both alcohol and drugs. Respondents who reported receiving MAT in the past year were classified as having received MAT for the use of alcohol, drugs, or both according to the substances for which they received MAT. Respondents with missing data were excluded from the analyses.
Adults aged 18 or older were asked in the mental health section of the questionnaire whether they had seriously thought about killing themselves, made any plans to kill themselves, or tried to kill themselves at any time during the past 12 months. Adult respondents who attempted suicide in the past 12 months were asked whether they had received medical attention from a health professional, including whether they stayed overnight in a hospital in the past 12 months because of a suicide attempt. If adult respondents reported receiving medical attention, they were asked whether they stayed overnight or longer in a hospital for their suicide attempt.
Youths aged 12 to 17 were asked in the youth experiences section of the questionnaire whether they had seriously thought about killing themselves, made any plans to kill themselves, or tried to kill themselves at any time during the past 12 months. Youths who reported that they made a suicide attempt were asked if they received medical attention or stayed overnight in the hospital because of their suicide attempt. All respondents aged 12 to 17 were asked if they made a suicide plan or attempted suicide regardless of whether they reported serious thoughts of suicide. The questions about suicidal thoughts and behavior among adolescents included response choices for “I’m not sure” and “I don’t want to answer,” in addition to respondents having other options for answering questions as “don’t know” or “refused.”
Estimates presented in NSDUH national tables and reports are run through a suppression rule that determines the suitability of the estimates for publication according to the standard errors of the estimates and the sample sizes on which the estimates are based. Estimates that do not meet the established precision criteria are suppressed (i.e., not published) in NSDUH national tables and reports. See Chapter 3 and Table 3.2 in the 2023 Methodological Summary and Definitions report for a full description and complete list of the rules used to determine low precision.
SEE: Low Precision.
SEE: Synthetic Marijuana.
SEE: Synthetic Stimulants.
Measures of the use of synthetic marijuana in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the emerging issues section of the questionnaire about lifetime and recency of use of synthetic marijuana (i.e., “Have you ever, even once, used synthetic marijuana or fake weed?” and “How long has it been since you last used synthetic marijuana or fake weed?”). The question about recency of use was asked if respondents previously reported using synthetic marijuana in their lifetime.
The following definitional information preceded the question about lifetime use of synthetic marijuana: “The next question is about synthetic marijuana or fake weed, also called K2 or Spice.”
Technically, these substances are called synthetic cannabinoids because they are human-made chemicals that are similar to chemicals found in the marijuana plant. For simplicity, however, NSDUH questions referred to these substances as “synthetic marijuana.” The terms fake weed, K2, and Spice were included to help respondents differentiate between marijuana (i.e., cannabis) and synthetic marijuana.
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
Measures of the use of synthetic stimulants in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the emerging issues section of the questionnaire about lifetime and recency of use of synthetic stimulants (i.e., “Have you ever, even once, used these synthetic stimulants?” and “How long has it been since you last used these synthetic stimulants, also called “bath salts” or flakka?”). The question about recency of use was asked if respondents previously reported using synthetic stimulants in their lifetime.
The following definitional information preceded the question about lifetime use of synthetic stimulants: “The next question is about synthetic stimulants that people use to get high, also called ‘bath salts’ or flakka.”
Technically, these substances are called synthetic cathinones because they are human-made stimulants that are chemically related to cathinone, a substance found in the khat plant. For simplicity, NSDUH questions referred to these substances as “synthetic stimulants.” The terms bath salts and flakka were included to help respondents differentiate between other stimulants and these synthetic stimulants.
SEE: Current Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, and Recency of Use or Misuse.
SEE: Mental Health Treatment.
SEE: Substance Use Treatment.
This measure indicates use of any of the following tobacco products: cigarettes, smokeless tobacco, cigars, or pipe tobacco. Tobacco product use in the past year includes past month pipe tobacco use; however, it does not include use of pipe tobacco more than 30 days ago but within 12 months of the interview because the survey did not capture this information. Measures of tobacco product use in the respondent’s lifetime, the past year, or the past month also do not include reports from separate questions about use of cigars with marijuana in them (blunts). Tobacco product use does not include questions for the use of e-cigarettes or another vaping device to vape nicotine.
SEE: Cigar Use, Cigarette Use, Current Use or Misuse, Lifetime Use or Misuse, Nicotine Vaping, Past Month Use or Misuse, Past Year Use or Misuse, Pipe Tobacco Use, Recency of Use or Misuse, Smokeless Tobacco Use, and Tobacco Product Use or Nicotine Vaping.
Respondents were classified as using tobacco products or vaping nicotine in the lifetime, past year, or past month periods if they reported using tobacco products (i.e., cigarettes, smokeless tobacco, cigars, or pipe tobacco), vaping nicotine, or both in these periods.54
SEE: Nicotine Vaping and Tobacco Product Use.
Respondents were classified as having a tranquilizer or sedative use disorder if they had either a tranquilizer use disorder or a sedative use disorder based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-555).
Respondents were not counted as having a tranquilizer or sedative use disorder if they did not meet the full substance use disorder criteria individually for prescription tranquilizers or sedatives. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Sedative Use Disorder, Sedative Use or Misuse, Tranquilizer Use Disorder, and Tranquilizer Use or Misuse.
Respondents were classified as having past year or past month prescription tranquilizer or sedative use or misuse if they reported using or misusing prescription tranquilizers or prescription sedatives.
SEE: Current Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, Sedative Use or Misuse, and Tranquilizer Use or Misuse.
Tranquilizer use disorder was defined as meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-556). Respondents who reported any use of prescription tranquilizers in the past 12 months were asked questions about the following criteria for tranquilizer use disorder: (1) used tranquilizers in larger amounts or for a longer time period than intended; (2) had a persistent desire or made unsuccessful attempts to cut down on tranquilizer use; (3) spent a great deal of time in activities to obtain, use, or recover from tranquilizer use; (4) felt a craving or strong desire to use tranquilizers; (5) engaged in recurrent tranquilizer use resulting in failure to fulfill major role obligations at work, school, or home; (6) continued to use tranquilizers despite social or interpersonal problems caused by the effects of tranquilizers; (7) gave up or reduced important social, occupational, or recreational activities because of tranquilizer use; (8) continued to use tranquilizers in physically hazardous situations; (9) continued to use tranquilizers despite physical or psychological problems caused by tranquilizer use; (10) increased the amount of tranquilizers needed to achieve same effect or noticed that the same amount of tranquilizer use had less effect than before; and (11) either of the following: (11a) experienced a required number of withdrawal symptoms after cutting back or stopping tranquilizer use or (11b) used prescription tranquilizers or a related substance to get over or avoid tranquilizer withdrawal symptoms.
The number of criteria for classifying respondents who reported any use of prescription tranquilizers in the past 12 months differed according to whether (1) respondents misused tranquilizers, or (2) they used tranquilizers but did not misuse them in that period. The overall measure of tranquilizer use disorder was based on whether respondents in either of these two groups were classified as having a tranquilizer use disorder in the past year. See Chapter 3 and Table 3.6 in the 2023 Methodological Summary and Definitions report for additional details.
Respondents who misused prescription tranquilizers in the past 12 months were classified as having a tranquilizer use disorder if they had 2 or more of the 11 criteria mentioned previously.
Respondents who used prescription tranquilizers in the past 12 months but did not misuse them were classified as having a tranquilizer use disorder if they met two or more of the first nine criteria mentioned previously. Criteria 10 and 11 do not apply to people who did not misuse prescription tranquilizers because these criteria can occur as normal physiological adaptations when people use tranquilizers appropriately under medical supervision.57
SEE: Tranquilizer or Sedative Use Disorder and Tranquilizer Use or Misuse.
Measures of use or misuse of prescription tranquilizers in the respondent’s lifetime and past year were derived from a series of questions in the screener and main sections of the questionnaire for tranquilizers that first asked respondents about any use (i.e., for any reason) of specific prescription tranquilizers in the past 12 months. Respondents were informed that tranquilizers are usually prescribed to relax people, to calm people down, to relieve anxiety, or to relax muscle spasms. Respondents also were informed that some people call tranquilizers “nerve pills.” Respondents who did not report use of any tranquilizer in the past 12 months were asked whether they ever, even once, used prescription tranquilizers.
Respondents who reported they used specific prescription tranquilizers in the past 12 months for any reason were shown a list reminding them of the drugs they used in the past 12 months. For each of these drugs, respondents were asked whether they misused it (or them) in the past 12 months (i.e., in any way a doctor did not direct them to use it). Examples of misuse were presented to respondents and included (1) use without a prescription of the respondent’s own; (2) use in greater amounts, more often, or longer than told to take a drug; or (3) use in any other way a doctor did not direct the respondent to use a drug. If respondents reported misuse of one or more specific prescription tranquilizers in the past 12 months, they were asked whether they misused prescription tranquilizers in the past 30 days. Respondents who reported any use of prescription tranquilizers in the past 12 months but did not report misuse in the past 12 months or who reported any use in their lifetime but not in the past 12 months were asked whether they ever, even once, misused any prescription tranquilizer. Consequently, lifetime and past month estimates of the misuse of prescription tranquilizers are available only for the overall prescription tranquilizer category and not for specific tranquilizers.
Questions about past year use and misuse in the 2023 NSDUH covered the following subcategories of tranquilizers: benzodiazepine tranquilizers (including alprazolam products [Xanax®, Xanax® XR, generic alprazolam, or generic extended-release alprazolam], lorazepam products [Ativan® or generic lorazepam], clonazepam products [Klonopin® or generic clonazepam], or diazepam products [Valium® or generic diazepam]); muscle relaxants (cyclobenzaprine [also known as Flexeril®] or Soma®); or any other prescription tranquilizer. Other prescription tranquilizers could include products similar to the specific tranquilizers listed previously. Questions were not asked about past month tranquilizer use or misuse for the subtype categories.
SEE: Benzodiazepine Use or Misuse, Lifetime Use or Misuse, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, and Tranquilizer or Sedative Use or Misuse.
SEE: Substance Use Treatment.
Respondents were classified as having received treatment for alcohol use in the past year if they reported substance use treatment in the past year in an inpatient location for their use of alcohol, in an outpatient location for their use of alcohol, via telehealth for their use of alcohol only or their use of both alcohol and drugs, through medication-assisted treatment to cut back or stop their use of alcohol, or in a prison, jail, or juvenile detention center in the past year for their use of alcohol only or their use of both alcohol and drugs. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Alcohol Use, Substance Use Treatment, and Substances for Which Treatment Was Received.
Respondents were classified as having received treatment for both alcohol and drug use in the past year if they reported having received substance use treatment in the past year (1) for their use of both alcohol and drugs in any location (i.e., in an inpatient location, in an outpatient location, via telehealth, or in a prison, jail, or juvenile detention center) or that they received medication-assisted treatment for both alcohol use and opioid use or (2) for their use of alcohol in some locations and their use of drugs in other locations.
SEE: Alcohol Use, Drug Use, Substance Use Treatment, and Substances for Which Treatment Was Received.
Respondents were classified as having received treatment for drug use in the past year if they reported having received substance use treatment in the past year in an inpatient location, in an outpatient location, via telehealth, through use of prescription medication, or in a prison, jail, or juvenile detention center, and they reported that the treatment was for only drug use or their use of both alcohol and drugs. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Drug Use, Substance Use Treatment, and Substances for Which Treatment Was Received.
Respondents were classified as having received substance use treatment for unspecified substances if they reported they received substance use treatment in an inpatient location, in an outpatient location, via telehealth, through medication-assisted treatment, or in a prison, jail, or juvenile detention center, but they did not report the substances for which they received treatment. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Substance Use Treatment and Substances for Which Treatment Was Received.
Respondents were asked to report in the front-end demographics section of the questionnaire which racial groups describe them. Response options were (1) American Indian or Alaska Native, (2) Asian, (3) Black or African American, (4) Native Hawaiian or Other Pacific Islander, and (5) White.
Respondents were allowed to choose more than one of these groups. Respondents reporting two or more of the above groups and that they were not of Hispanic, Latino, or Spanish origin were included in a “Two or More Races” category. People reporting two or more races do not include respondents who reported more than one Asian subgroup but who reported “Asian” as their only race or respondents who reported more than one Native Hawaiian or Other Pacific Islander subgroup but who reported Native Hawaiian or Other Pacific Islander as their only race. Respondents reporting two or more races and reporting that they were of Hispanic, Latino, or Spanish origin were classified as Hispanic.
SEE: Hispanic or Latino and Race/Ethnicity.
SEE: Mental Health Treatment.
Underage alcohol use was defined as any use of alcohol by people aged 12 to 20 in the respondent’s lifetime, past year, or past month as reported in the alcohol section of the questionnaire.
SEE: Alcohol Use, Binge Use of Alcohol, Current Use or Misuse, Heavy Use of Alcohol, Lifetime Use or Misuse, Location of Most Recent Underage Alcohol Use, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, Social Context of Most Recent Underage Alcohol Use, and Source of Alcohol for Most Recent Underage Alcohol Use.
Underage tobacco use or nicotine vaping was defined as any use of tobacco products or nicotine vaping by people aged 12 to 20 in the respondent’s lifetime, past year, or past month as reported in the nicotine section of the questionnaire.
SEE: Current Use or Misuse, Lifetime Use or Misuse, Nicotine Vaping, Past Month Use or Misuse, Past Year Use or Misuse, Recency of Use or Misuse, and Tobacco Product Use.
Measures of vaping of flavoring in the respondent’s lifetime, the past year, and the past month were derived from responses to the questions in the emerging issues section of the questionnaire about lifetime and recency of vaping of flavoring (i.e., “Have you ever, even once, vaped only flavoring without nicotine or other substances added?” and “How long has it been since you last vaped only flavoring?”). The question about recency of vaping of flavoring was asked if respondents reported that they vaped flavoring in their lifetime.
The states included are those in the Mountain Division (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming) and the Pacific Division (Alaska, California, Hawaii, Oregon, and Washington).
SEE: Geographic Division and Region.
White only, not of Hispanic, Latino, or Spanish origin. This definition is based on reports in the front-end demographics section in which respondents described themselves as being White. The definition does not include respondents reporting two or more races. Respondents reporting they were White and of Hispanic, Latino, or Spanish origin were classified as Hispanic.
SEE: Hispanic or Latino, Race/Ethnicity, and Two or More Races.
The World Health Organization Disability Assessment Schedule (WHODAS) consists of a series of questions used for assessing disturbances in social adjustment and behavior (i.e., functional impairment). A reduced set of WHODAS items was used in NSDUH.58 Adult respondents were asked in the mental health section of the questionnaire whether they had difficulty doing any of the following eight activities during the one month when their emotions, nerves, or mental health interfered most with their daily activities: (1) remembering to do things they needed to do, (2) concentrating on doing something important when other things were going on around them, (3) going out of the house and getting around on their own, (4) dealing with people they did not know well, (5) participating in social activities, (6) taking care of household responsibilities, (7) taking care of daily responsibilities at work or school, and (8) getting daily work done as quickly as needed.
The eight imputation-revised items were assessed on a 0 to 3 scale ranging from “no difficulty” (coded as 0) to “severe difficulty” (coded as 3). Some items had an additional category for respondents who did not engage in a particular activity (e.g., they did not leave the house on their own). Respondents who reported they did not engage in an activity were asked a follow-up question to determine if they did not do so because of emotions, nerves, or mental health. Respondents with an imputation-revised value of “yes” to this follow-up question were subsequently assigned to the “severe difficulty” category; otherwise, respondents were assigned to the “no difficulty” category. Summing across the eight responses resulted in a total score with a range from 0 to 24. See Chapter 3 in the 2023 Methodological Summary and Definitions report for additional details.
SEE: Mental Illness, Major Depressive Episode (MDE) with Severe Impairment, and Sheehan Disability Scale (SDS).
1 See https://www.samhsa.gov/data/report/2023-methodological-summary-and-definitions.
2 The 2023 NSDUH questionnaire is available at https://www.samhsa.gov/data/report/nsduh-2023-questionnaire.
3 See https://www.samhsa.gov/data/report/nsduh-2023-questionnaire.
4 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 
5 Office of Management and Budget. (1997). Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register, 62(210), 58781-58790.
6 The 2023 NSDUH questionnaire is available at https://www.samhsa.gov/data/report/nsduh-2023-questionnaire.
7 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
8 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
9 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
10 These codes are updated approximately every 10 years and are available at https://www.ers.usda.gov/topics/rural-economy-population/rural-classifications.aspx by clicking on that page’s link to the “Rural/Urban Continuum Codes.”
11 Definitions of MSAs and micropolitan statistical areas as defined by the OMB are available by conducting a search at https://www.census.gov/programs-surveys/metro-micro.html.
12 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
13 Endicott, J., Spitzer, R. L., Fleiss, J. L., & Cohen, J. (1976). The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766-771. https://doi.org/10.1001/archpsyc.1976.01770060086012
14 The 2023 NSDUH questionnaire is available at https://www.samhsa.gov/data/report/nsduh-2023-questionnaire.
15 For more information, see https://www.census.gov/programs-surveys/economic-census/guidance-geographies/levels.html.
16 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
17 In the recency-of-use question, “any hallucinogen” is the default wording except in special situations. For more information, see the 2023 NSDUH questionnaire at https://www.samhsa.gov/data/report/nsduh-2023-questionnaire.
18 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
19 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
20 Office of Management and Budget. (1997). Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register, 62(210), 58781-58790.
21 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
22 For prescription psychotherapeutic drugs, substance use initiation refers to misusing any drug in that category for the first time in the past 12 months. Respondents were asked about any use of prescription drugs in the past 12 months or in their lifetime (i.e., not necessarily misuse). However, respondents who reported any use of prescription drugs were not asked when they first used these drugs.
23 Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S. L., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60, 184-189. https://doi.org/10.1001/archpsyc.60.2.184
24 Novak, S. P., Colpe, L. J., Barker, P. R., & Gfroerer, J. C. (2010). Development of a brief mental health impairment scale using a nationally representative sample in the USA. International Journal of Methods in Psychiatric Research, 19(Suppl. 1), 49-60.
25 Rehm, J., Üstün, T. B., Saxena, S., Nelson, C. B., Chatterji, S., Ivis, F., & Adlaf, E. (1999). On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population. International Journal of Methods in Psychiatric Research, 8, 110-123. https://doi.org/10.1002/mpr.61
26 U.S. Drug Enforcement Administration. (2020). Drugs of abuse, a DEA resource guide. https://www.campusdrugprevention.gov/sites/default/files/2022-11/2022_DOA_eBook_File_Final.pdf
27 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
28 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
29 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
30 First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). New York State Psychiatric Institute, Biometrics Research.
31 Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act, Pub. L. No. 102-321 (1992).
32 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
33 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
34 Office of Management and Budget. (1997). Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register, 62(210), 58781-58790.
35 Shiffman, S., Hickcox, M., Gnys, M., Paty, J. A., & Kassel, J. D. (1995, March). The Nicotine Dependence Syndrome Scale: Development of a new measure. Poster presented at the annual meeting of the Society for Research on Nicotine and Tobacco, San Diego, CA.
36 Shiffman, S., Waters, A. J., & Hickcox, M. (2004). The Nicotine Dependence Syndrome Scale: A multidimensional measure of nicotine dependence. Nicotine & Tobacco Research, 6, 327-348. https://doi.org/10.1080/1462220042000202481
37 Fagerstrom, K.-O. (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviors, 3-4, 235-241. https://doi.org/10.1016/0306-4603(78)90024-2
38 Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K.-O. (1991). The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction, 86, 1119-1127. https://doi.org/10.1111/j.1360-0443.1991.tb01879.x
39 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
40 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
41 Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851. https://doi.org/10.1176/appi.ajp.2013.12060782
42 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
43 In the rare situations where respondents specified the prescription form of methamphetamine as some other stimulant that they misused in the past 12 months, this prescription form is counted as a prescription stimulant. However, this prescription form was not specified as some other prescription stimulant in 2023.
44 Office of Management and Budget. (1997). Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register, 62(210), 58781-58790.
45 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
46 Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851. https://doi.org/10.1176/appi.ajp.2013.12060782
47 Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S. L., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60, 184-189. https://doi.org/10.1001/archpsyc.60.2.184
48 Leon, A. C., Olfson, M., Portera, L., Farber, L., & Sheehan, D. V. (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine, 27(2), 93-105. https://doi.org/10.2190/t8em-c8yh-373n-1uwd
49 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
50 Methamphetamine use disorder was asked about separately from prescription stimulant use disorder. Therefore, responses to methamphetamine use disorder questions were not considered in determining whether a respondent had a stimulant use disorder.
51 Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851. https://doi.org/10.1176/appi.ajp.2013.12060782
52 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
53 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
54 Data for cigarettes, smokeless tobacco, and cigars were available for the lifetime, past year, and past month periods. Data for pipe tobacco were available only for the lifetime and past month periods.
55 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
56 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
57 Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851. https://doi.org/10.1176/appi.ajp.2013.12060782
58 Novak, S. P., Colpe, L. J., Barker, P. R., & Gfroerer, J. C. (2010). Development of a brief mental health impairment scale using a nationally representative sample in the USA. International Journal of Methods in Psychiatric Research, 19(Suppl. 1), 49-60. Rehm, J., Üstün, T. B., Saxena, S., Nelson, C. B., Chatterji, S., Ivis, F., & Adlaf, E. (1999). On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population. International Journal of Methods in Psychiatric Research, 8, 110-123. https://doi.org/10.1002/mpr.61
