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Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health

Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), under Contract No. HHSS283201700002C with RTI International. Douglas Richesson and Jennifer M. Hoenig were the SAMHSA authors. Rong Cai served as the government project officer and as the contracting officer representative.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Printed Copies

This publication may be downloaded or ordered at https://store.samhsa.gov/. Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Recommended Citation

Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

Originating Office

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Room 15-E09D, Rockville, MD 20857. For questions about this report, please e-mail CBHSQrequest@samhsa.hhs.gov.

Nondiscrimination Notice/Aviso de no discriminación

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Populations Survey Branch

Publication Number PEP21-07-01-003
October 2021

Table of Contents

Summary

Introduction

Survey Background
Data Collection in the First Quarter of 2020
Changes to Data Collection Methods Because of the COVID-19 Pandemic

Data Presentation and Interpretation
Presentation of National Estimates for 2020
Interpretation of Estimates for 2020

General Substance Use in the Past Month

Tobacco Use or Nicotine Vaping in the Past Month
Tobacco Product Use
Cigarette Use
Daily Cigarette Use
Nicotine Vaping
Underage Tobacco Use or Nicotine Vaping

Alcohol Use in the Past Month
Any Alcohol Use
Binge Alcohol Use
Heavy Alcohol Use
Underage Alcohol Use

Illicit Drug Use in the Past Year
Any Illicit Drug Use
Marijuana Use
Cocaine Use
Heroin Use
Methamphetamine Use
Hallucinogen Use
Inhalant Use
Misuse of Psychotherapeutic Drugs
Stimulant Misuse
Tranquilizer or Sedative Misuse
Benzodiazepine Misuse
Pain Reliever Misuse
Misuse of Subtypes of Pain Relievers
Main Reasons for the Last Misuse of Pain Relievers
Source of the Last Pain Reliever That Was Misused
Opioid Misuse
Central Nervous System Stimulant Misuse

Other Substance Use in the Past Year
GHB Use
Nonprescription Cough and Cold Medicine Misuse
Kratom Use
Synthetic Marijuana Use
Synthetic Stimulant Use

Initiation of Substance Use
Initiation of Cigarette Use
Initiation of Alcohol Use
Initiation of Marijuana Use
Initiation of Cocaine Use
Initiation of Heroin Use
Initiation of Methamphetamine Use
Initiation of Hallucinogen Use
Initiation of Inhalant Use
Initiation of Prescription Stimulant Misuse
Initiation of Prescription Tranquilizer or Sedative Misuse
Initiation of Prescription Tranquilizer Misuse
Initiation of Prescription Sedative Misuse
Initiation of Prescription Pain Reliever Misuse

Perceived Risk from Substance Use

Substance Use Disorders in the Past Year
Alcohol Use Disorder
Illicit Drug Use Disorder
Marijuana Use Disorder
Cocaine Use Disorder
Heroin Use Disorder
Methamphetamine Use Disorder
Prescription Stimulant Use Disorder
Prescription Tranquilizer Use Disorder or Sedative Use Disorder
Prescription Pain Reliever Use Disorder
Opioid Use Disorder
Central Nervous System Stimulant Use Disorder

Major Depressive Episode in the Past Year
MDE and MDE with Severe Impairment among Adolescents
MDE and MDE with Severe Impairment among Adults

Any Mental Illness among Adults in the Past Year

Serious Mental Illness among Adults in the Past Year

Co-Occurring MDE and SUD among Adolescents

Substance Use among Adolescents with MDE

Co-Occurring Mental Health Issues and SUD among Adults
Co-Occurring AMI and SUD
Co-Occurring SMI and SUD

Substance Use among Adults, by Mental Illness Status

Suicidal Thoughts and Behaviors among Adults
Serious Thoughts of Suicide among Adults
Suicide Plans among Adults
Suicide Attempts among Adults
Suicidal Thoughts and Behaviors among Adults Because of COVID-19

Suicidal Thoughts and Behaviors among Adolescents

Substance Use Treatment in the Past Year
Need for Substance Use Treatment
Receipt of Substance Use Treatment
Receipt of Any Substance Use Treatment
Receipt of Any Substance Use Treatment among People with a Past Year SUD
Receipt of Substance Use Treatment at a Specialty Facility
Receipt of Substance Use Treatment at a Specialty Facility among People Who Needed Substance Use Treatment
Receipt of Virtual (Telehealth) Services for Substance Use Treatment
Perceived Need for Substance Use Treatment
Reasons for Not Receiving Substance Use Treatment
Medication-Assisted Treatment for Alcohol Use or Opioid Misuse
Medication-Assisted Treatment for Alcohol Use
Medication-Assisted Treatment for Opioid Misuse

Mental Health Service Use in the Past Year
Treatment for Depression among Adolescents
Treatment for Depression among Adults
Mental Health Service Use among Adolescents
Receipt of Mental Health Services in Specialty and Nonspecialty Settings among Adolescents
Receipt of Virtual (Telehealth) Mental Health Services among Adolescents
Mental Health Service Use among Adults
Receipt of Inpatient or Outpatient Mental Health Services or Prescription Medication among Adults
Receipt of Virtual (Telehealth) Mental Health Services among Adults
Mental Health Service Use among Adults with AMI
Receipt of Inpatient or Outpatient Mental Health Services or Prescription Medication among Adults with AMI
Receipt of Virtual (Telehealth) Mental Health Services among Adults with AMI
Mental Health Service Use among Adults with SMI
Receipt of Inpatient or Outpatient Mental Health Services or Prescription Medication among Adults with SMI
Receipt of Virtual (Telehealth) Mental Health Services among Adults with SMI
Perceived Unmet Need for Mental Health Services among Adults with Mental Illness
Perceived Unmet Need for Mental Health Services among Adults with AMI
Perceived Unmet Need for Mental Health Services among Adults with SMI
Reasons for Not Receiving Mental Health Services among Adults with Mental Illness and a Perceived Unmet Need

Receipt of Services for Co-Occurring Substance Use Disorder and Mental Health Issues
Receipt of Services among Adolescents with Co-Occurring SUD and an MDE
Receipt of Services among Adults with Co-Occurring SUD and AMI
Receipt of Services among Adults with Co-Occurring SUD and SMI

Perceived Recovery

Substance Use, Mental Health Issues, and the COVID-19 Pandemic
Perceived Negative Effects on Mental Health Because of the COVID-19 Pandemic
Perceived Negative Effects on Mental Health Because of the COVID-19 Pandemic among Adolescents Aged 12 to 17
Perceived Negative Effects on Mental Health Because of the COVID-19 Pandemic among Adults Aged 18 or Older
Perceived Effects on Substance Use Because of the COVID-19 Pandemic
Perceived Effects on Alcohol Use
Perceived Effects on the Use of Drugs Other than Alcohol
Perceived Effects on Access to Services Because of the COVID-19 Pandemic
Access to Substance Use Treatment
Access to Mental Health Services
Access to Medical Services

Endnotes

Appendix A: Special Tables of Estimates for Substance Use and Mental Health Indicators in the United States

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Summary

The National Survey on Drug Use and Health (NSDUH) underwent some major methodological changes for 2020, including a shift to web-based interviewing in Quarter 4 (i.e., October to December). In addition, 2020 marked the first year in which substance use disorders (SUDs) were evaluated using criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), as opposed to criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Additional changes were made to the questionnaire itself. Therefore, care must be taken when attempting to disentangle the effects on estimates due to real changes in the population (e.g., the coronavirus disease 2019 [COVID-19] pandemic and other events) from the effects of these methodological changes.

Substance Use

Tobacco Product Use or Nicotine Vaping

Alcohol Use

Illicit Drug Use

Initiation of Substance Use

Perceived Risk from Substance Use

Substance Use Disorders in the Past Year

Major Depressive Episode

Mental Illness among Adults

Co-Occurring Mental Health Issues and Substance Use Disorder

Substance Use among People with Mental Health Issues

Suicidal Thoughts and Behavior

Substance Use Treatment

Treatment for Depression

Mental Health Services

Perceived Unmet Need for Mental Health Services among Adults with Mental Illness

Receipt of Services for Co-Occurring Substance Use Disorder and Mental Health Issues

Substance Use, Mental Health Issues, and the COVID-19 Pandemic

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Introduction

Substance use and mental health issues have significant impacts on people, families, communities, and societies.1,2,3,4 The National Survey on Drug Use and Health (NSDUH), conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides nationally representative data on use of tobacco, alcohol, and illicit drugs; substance use disorders (SUDs); receipt of substance use treatment; mental health issues; and use of mental health services among the civilian, noninstitutionalized population aged 12 or older in the United States. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation's behavioral health.

Based on 2020 and earlier NSDUH data, this report contains findings on key substance use and mental health indicators in the United States. The 2020 NSDUH detailed tables showing comprehensive substance use and mental health-related estimates are available separately at https://www.samhsa.gov/data/.5

Survey Background

NSDUH is an annual survey sponsored by SAMHSA within the U.S. Department of Health and Human Services (HHS). NSDUH covers residents of households and people in noninstitutional group settings (e.g., shelters, boarding houses, college dormitories, migratory workers' camps, halfway houses). The survey excludes people with no fixed address (e.g., people who are homeless and not in shelters), military personnel on active duty, and residents of institutional group settings, such as jails, nursing homes, mental health institutions, and long-term care hospitals.

Data Collection in the First Quarter of 2020

NSDUH employs a stratified multistage area probability sample designed to be representative of both the nation as a whole and for each of the 50 states and the District of Columbia. The 2020 NSDUH target sample of 67,500 people was allocated across three age groups, with 25 percent allocated to adolescents aged 12 to 17, 25 percent allocated to young adults aged 18 to 25, and 50 percent allocated to adults aged 26 or older.6

From January to March 2020 (i.e., the first quarter of 2020), NSDUH was a face-to-face household interview survey conducted in two phases: the screening phase and the interview phase. Interviewers conducted a screening of a sampled household with an adult resident (aged 18 or older) in order to determine whether zero, one, or two household residents aged 12 or older should be selected for the interview. NSDUH collected in-person data using audio computer assisted self interviewing (ACASI), in which respondents read or listened to the questions on headphones and entered their answers directly into a NSDUH laptop computer. ACASI was designed for accurate reporting of information by providing respondents with a highly private and confidential mode for responding to questions about illicit drug use, mental health issues, and other sensitive behaviors. For certain sections of the survey, in-person NSDUH interviews also used computer assisted personal interviewing (CAPI), in which interviewers read less sensitive questions to respondents and entered the respondents' answers into a NSDUH laptop computer.

From January to March 2020, screening was completed at 35,304 addresses, and 15,628 completed interviews were obtained, including 3,936 interviews from adolescents aged 12 to 17 and 11,692 interviews from adults aged 18 or older. Weighted response rates for household screening and for interviewing were 67.8 and 63.2 percent, respectively, for an overall response rate of 42.9 percent for people aged 12 or older. The weighted interview response rates were 70.5 percent for adolescents and 62.5 percent for adults.7 In-person data collection was suspended on March 16, 2020, because of the coronavirus disease 2019 (COVID-19) pandemic.

Changes to Data Collection Methods Because of the COVID-19 Pandemic

To protect the safety of field staff and survey participants during the COVID-19 pandemic, SAMHSA decided to suspend in-person NSDUH data collection on March 16, 2020. With administrative approval, a small-scale data collection effort was conducted from July 16 to 22, 2020, to assess the feasibility of safely resuming in-person data collection. The small-scale data collection effort was conducted in selected counties of two states where data collection was deemed safe based on state- and county-level COVID-19 metrics collected by Johns Hopkins University.8 For the remainder of 2020, however, it became clear that conventional in-person data collection would be severely limited due to the COVID-19 pandemic.

To reduce the impact on NSDUH data collection due to the COVID-19 pandemic, SAMHSA approved the addition of web-based data collection on September 11, 2020. In Quarter 4 of 2020 (i.e., October to December), web-based screening and interviewing became the primary forms of NSDUH data collection. Conventional in-person data collection was carried out wherever it was considered safe to do so based on county- and state-level COVID-19 metrics.6

In July 2020 for a small number of interviews, and principally in October to December 2020, screening was completed for 55,633 addresses, and 20,656 completed interviews were obtained, including 2,401 interviews from adolescents aged 12 to 17 and 18,255 interviews from adults aged 18 or older. Weighted response rates for household screening and for interviewing were 11.1 and 59.5 percent, respectively, for an overall response rate of 6.6 percent for people aged 12 or older. The weighted interview response rates were 25.6 percent for adolescents and 62.9 percent for adults.7 Approximately 93 percent of these interviews were completed via the web because of limitations on where it was considered safe to conduct interviews in person.

Altogether for 2020, then, screening was completed for 90,937 addresses, and the final sample consisted of 36,284 completed interviews. There were 6,337 interviews from adolescents aged 12 to 17 and 29,947 interviews from adults aged 18 or older. Weighted response rates for household screening and for interviewing were 25.7 and 60.4 percent, respectively, for an overall response rate of 15.5 percent for people aged 12 or older. The weighted interview response rates were 36.8 percent for adolescents and 62.8 percent for adults.7,9

Further information about the 2020 NSDUH design and methods can be found on the web at https://www.samhsa.gov/data/.10

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Data Presentation and Interpretation

This report focuses on substance use and mental health indicators in the United States based on NSDUH data from 2020 and earlier years.11 Estimates of substance use and related treatment are presented for people aged 12 or older, including adolescents and adults.12 However, estimates of mental health issues and mental health service use are presented separately for adolescents aged 12 to 17 and adults aged 18 or older because the two groups completed different sets of questions regarding mental health and mental health service utilization. All estimates (e.g., percentages and numbers) presented in the report are derived from survey data that are subject to sampling errors and have met the criteria for statistical precision.13

Presentation of National Estimates for 2020

Appendix A contains special tables of estimates, including estimates not found in the 2020 NSDUH detailed tables. Because some estimates in Appendix A may not be found in the detailed tables, Appendix A's tables include standard errors for the associated estimates.14

The COVID-19 pandemic has made 2020 a unique year within the history of NSDUH. Estimates for most measures have been calculated using data from Quarters 1 and 4 of 2020. As mentioned previously, except for a very brief data collection effort that tested increased safety measures in July, no data were collected in Quarters 2 and 3 (i.e., April to September). The difference in data collection methods between Quarter 1 and Quarter 4 affected the procedures for weighting the 2020 data to produce national estimates.6

With the introduction of web-based interviewing, data processing took into account the potential effects of survey mode15 on responses.10 In addition, questions were developed to assess the specific effects of the COVID-19 pandemic on respondents. Because these questions were asked of respondents only in Quarter 4, only data from Quarter 4 are available for these estimates. Sections of the report indicate when estimates use data from Quarter 4 only. Otherwise, the default for the report is to present estimates using data from Quarters 1 and 4.16

Interpretation of Estimates for 2020

NSDUH underwent some major methodological changes for 2020. As noted previously, the COVID-19 pandemic necessitated the introduction of web-based interviewing. In addition, 2020 marked the first year in which SUDs were evaluated using criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5),17 as opposed to criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).18 There were additional changes to the questionnaire itself (e.g., new questions about vaping and the use of synthetic marijuana or synthetic stimulants, additional questions to measure SUDs based on the DSM-5 criteria, new questions in Quarter 4 to assess the impact of COVID-19 on people's lives). Finally, there was a significant gap in data collection that might have missed seasonality effects on some estimates. Therefore, care must be taken when attempting to disentangle the effects on estimates due to real changes in the population (e.g., the COVID-19 pandemic, other events) from these methodological changes.

Researchers have raised concerns that the COVID-19 pandemic could have negative effects on substance use and mental health outcomes.19,20,21 However, the methodological changes for the 2020 NSDUH also can affect the 2020 estimates. Therefore, direct comparison of NSDUH estimates in 2020 with those from prior years can be misleading. An additional caveat is that events in the United States related to the COVID-19 pandemic were not the only ones in 2020 that could have affected people's substance use and mental health. To that end, NSDUH estimates principally describe conditions in the population but may not explain the reasons behind the estimates.

Statistical tests for comparisons are presented in this report where appropriate. Of note, statistical testing was performed for comparisons of estimates across age groups within 2020.22 In these instances, statistically significant differences resulting from this testing are described using terms such as “higher” or “lower.” Statements use terms such as “similar” or “the same” when a difference was not statistically significant. However, the methodological changes in 2020 because of the COVID-19 pandemic have created major challenges for survey researchers and other data users in interpreting estimates from the 2020 NSDUH. Particular caution must be taken for multiyear trend analysis and the comparison of the results from 2020 with those from any prior survey years. Efforts were made to present the results by defining measures for 2020 consistently with measures in previous years wherever possible. Meanwhile, efforts were also made to point out the uniqueness of 2020 and the need for caution when making comparisons.

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General Substance Use in the Past Month

This section provides an overview of estimates according to whether respondents aged 12 or older reported using nicotine products (using tobacco products or nicotine vaping), alcohol, or illicit drugs in the 30 days before the NSDUH interview (i.e., in the past month, also referred to as “current use”). Due to the very small amount of data that are available from April to September 2020, caution must be taken when interpreting estimates of substance use in the past month. Additional information on the use of tobacco products, alcohol, and illicit drugs is provided in other sections of this report.14

Past month tobacco use includes any use of the four tobacco products in NSDUH: cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, and pipe tobacco. Past month nicotine vaping refers to the use of an e-cigarette or other vaping device to vape nicotine or tobacco. Past month alcohol use refers to having more than a sip or two of any type of alcoholic drink (e.g., a can or a bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it). Past month illicit drug use includes any use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine, as well as misuse of prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines), or pain relievers. (See the section on the Misuse of Psychotherapeutic Drugs for the definition of “misuse.”)

Tables in Appendix A also include estimates of past month use for the following other substances: gamma hydroxybutyrate (GHB), the misuse of nonprescription cold and cough medicine, kratom, synthetic marijuana (fake weed, K2, or Spice), and synthetic stimulants (“bath salts” or flakka). Estimates for the use or misuse of these other substances are discussed later in the report for the past year (rather than the past month) because of low prevalence estimates in the past month for many of these substances.

Among people aged 12 or older in 2020, 58.7 percent (or 162.5 million people) used tobacco, alcohol, or an illicit drug in the past month, 50.0 percent (or 138.5 million people) drank alcohol in the past month, 18.7 percent (or 51.7 million people) used a tobacco product in the past month, and 13.5 percent (or 37.3 million people) used an illicit drug in the past month (Figure 1 and Table A.1B). Estimates for tobacco, alcohol, or illicit drugs are not mutually exclusive because respondents could have used more than one type of substance (e.g., tobacco products and alcohol) in the past month.

Figure 1. Past Month General Substance Use and Nicotine Vaping: Among People Aged 12 or Older; 2020

Figure 1     D

Rx = prescription.
Note: General Substance Use includes any illicit drug, alcohol, and tobacco product use. Tobacco products are defined as cigarettes, smokeless tobacco, cigars, and pipe tobacco.
Note: The estimated numbers of current users of different substances are not mutually exclusive because people could have used more than one type of substance in the past month.

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Tobacco Use or Nicotine Vaping in the Past Month

Before 2020, NSDUH assessed tobacco use but did not include questions on nicotine vaping. However, recent increases in nicotine vaping have resulted in changes in adolescent tobacco use. Findings from the 2019 National Youth Tobacco Survey (NYTS) and the 2019 Monitoring the Future (MTF) study indicated increases in nicotine vaping.23,24,25 NYTS data indicate that e-cigarettes have been the most commonly used nicotine product among youths since 2014, including in 2020, and that e-cigarette use has reached epidemic proportions among youths.25 In addition, vaping of nicotine products among adolescents has been identified as a risk factor for future cigarette use,24 which may affect long-term cigarette use trends. However, the 2020 MTF study found similar estimates between 2019 and 2020 in nicotine vaping in the past month among 8th, 10th, and 12th graders.26 The 2020 NYTS also indicated a reversal of previous trends, with e-cigarette use among adolescents declining from 2019 to 2020 and returning to levels similar to those in 2018. Nevertheless, e-cigarette use remained the most common form of nicotine product use among adolescents in the 2020 NYTS. Despite the decline in e-cigarette use between 2019 and 2020, NYTS researchers stressed the need for continued effort to sustain this apparent progress.27 An issue with the MTF and NYTS data for 2020 is that sample sizes were smaller in 2020. School closures in the spring in response to the COVID-19 pandemic led to the early conclusion of data collection for both surveys.26,27

The 2020 NSDUH included questions to assess the use of nicotine vaping in both adolescents and adults. As noted previously, however, caution must be taken when interpreting estimates in this section due to the very small amount of data that are available from April to September.

As noted in the section on General Substance Use in the Past Month, past month tobacco use in NSDUH includes any use of four tobacco products: cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, and pipe tobacco. Past month nicotine vaping refers to the use of an e-cigarette or other vaping device to vape nicotine or tobacco. Aggregate estimates for the past month use of tobacco or nicotine vaping (also referred to as current use of nicotine products) are presented for people who used any of these tobacco products or vaped nicotine in the past month (or both).

Among people aged 12 or older in 2020, 20.7 percent (or 57.3 million people) used tobacco products or vaped nicotine in the past month (Figure 2 and Table A.1B). The percentage of people who used tobacco products or vaped nicotine in the past month was highest among young adults aged 18 to 25 (25.1 percent or 8.4 million people), followed by adults aged 26 or older (21.6 percent or 47.2 million people), then by adolescents aged 12 to 17 (6.5 percent or 1.6 million people) (Tables A.2B to A.4B).

Figure 2. Past Month Tobacco Use and Nicotine Vaping: Among People Aged 12 or Older; 2020

Figure 2     D

Note: The estimated numbers of current users of different tobacco products or nicotine vaping are not mutually exclusive because people could have used more than one type of tobacco product or used tobacco products and vaped nicotine in the past month.

Among current nicotine product users, the use of specific nicotine products varied by age group. Nearly two thirds of adolescents aged 12 to 17 who used nicotine products in the past month (63.1 percent) vaped nicotine but did not use tobacco products (Table A.5B). An additional 15.7 percent of adolescents who used nicotine products in the past month vaped nicotine and used tobacco products. About half of young adults aged 18 to 25 who used nicotine products in the past month (53.4 percent) used tobacco products but did not vape nicotine, 23.6 percent vaped nicotine but did not use tobacco products, and 22.9 percent vaped nicotine and used tobacco products. Among adults aged 26 or older who used nicotine products in the past month, however, 88.9 percent used only tobacco products.

Tobacco Product Use

In 2020, of the 51.7 million current (i.e., past month) tobacco users (Figure 1), the majority were current cigarette smokers (41.4 million; Figure 2). This pattern has been the case historically.28 Additionally, 10.6 million people were current cigar smokers, 7.0 million people were current smokeless tobacco users, and 1.8 million people were current pipe tobacco smokers.

Among people aged 12 or older in 2020 who used any tobacco product in the past month (regardless of whether they vaped nicotine), 65.3 percent smoked cigarettes but did not use other tobacco products, 14.8 percent smoked cigarettes and used some other type of tobacco product, and 19.9 percent used only noncigarette tobacco products (i.e., other tobacco products but not cigarettes) (Table A.6B). Among adults who used tobacco products in the past month, adults aged 26 or older were more likely than young adults aged 18 to 25 to have used only cigarettes in the past month (68.0 vs. 49.3 percent). However, the majority of young adults who were past month tobacco users smoked cigarettes, either as the only tobacco product they used or in addition to other tobacco products. Estimates among adolescents aged 12 to 17 who used tobacco products in the past month could not be calculated with sufficient precision for the use of only cigarettes or the use of only noncigarette tobacco products.

The remainder of this section on tobacco use focuses on cigarette smoking because most current tobacco users aged 12 or older were cigarette smokers. Information on the use of cigars, pipe tobacco, and smokeless tobacco in the past month among people aged 12 or older and by age group can be found in Tables A.1B to A.4B in Appendix A.

Cigarette Use

Among people aged 12 or older in 2020, 15.0 percent (or 41.4 million people) smoked cigarettes in the past month (Figure 3). The percentage of people who smoked cigarettes in the past month was highest among adults aged 26 or older (16.7 percent or 36.4 million people), followed by young adults aged 18 to 25 (13.9 percent or 4.7 million people), then by adolescents aged 12 to 17 (1.4 percent or 350,000 people).

Figure 3. Past Month Cigarette Use: Among People Aged 12 or Older; 2002-2020

Figure 3     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 3 Table. Past Month Cigarette Use: Among People Aged 12 or Older; 2002-2020
Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
≥12 26.0 25.4 24.9 24.9 25.0 24.3 24.0 23.3 23.0 22.1 22.1 21.3 20.8 19.4 19.1 17.9 17.2 16.7 15.0
12-17 13.0 12.2 11.9 10.8 10.4 9.9 9.2 9.0 8.4 7.8 6.6 5.6 4.9 4.2 3.4 3.2 2.7 2.3 1.4
18-25 40.8 40.2 39.5 39.0 38.5 36.2 35.7 35.8 34.3 33.5 31.8 30.6 28.4 26.7 23.5 22.3 19.1 17.5 13.9
≥26 25.2 24.7 24.1 24.3 24.7 24.1 23.8 23.0 22.8 21.9 22.4 21.6 21.5 20.0 20.2 18.9 18.5 18.2 16.7
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Daily Cigarette Use

Among the 41.4 million current cigarette smokers aged 12 or older in 2020 (see the section on Cigarette Use), 24.9 million people (or 60.1 percent) were daily cigarette smokers (Figure 4), and 9.4 million people (or 37.8 percent) smoked 16 or more cigarettes per day (i.e., approximately one pack or more per day). Among current cigarette smokers, adults aged 26 or older were more likely than young adults aged 18 to 25 to be daily smokers (64.1 vs. 33.1 percent) (Tables A.3B and A.4B).

Figure 4. Daily Cigarette Use: Among Past Month Cigarette Smokers Aged 12 or Older; Smoking of One or More Packs of Cigarettes per Day: Among Current Daily Smokers; 2020

Figure 4     D

Note: Current daily smokers with unknown data about the number of cigarettes smoked per day were excluded from the pie chart on the right.

Nicotine Vaping

In 2020, 10.4 million people aged 12 or older (or 3.8 percent) used an e-cigarette or other vaping device to vape nicotine in the past month (Figures 2 and 5). The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (11.7 percent or 3.9 million people), followed by adolescents aged 12 to 17 (5.1 percent or 1.3 million people), then by adults aged 26 or older (2.4 percent or 5.2 million people).

Figure 5. Past Month Nicotine Vaping: Among People Aged 12 or Older; 2020

Figure 5     D

Underage Tobacco Use or Nicotine Vaping

Legislation in December 2019 amending the Federal Food, Drug, and Cosmetic Act raised the federal minimum age for sale of tobacco products (including e-cigarettes) from 18 to 21 years.29 All 50 states and the District of Columbia now prohibit the sale of tobacco products to people younger than 21.

Among people aged 12 to 20, 11.8 percent (or 4.4 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine (Table A.7B). Among people in this age group, 7.7 percent (or 2.9 million people) vaped nicotine, 6.7 percent (or 2.5 million people) used tobacco products, and 4.1 percent (or 1.5 million people) smoked cigarettes in the past month.

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Note: Binge Alcohol Use is defined as drinking five or more drinks (for males) or four or more drinks (for females) on the same occasion on at least 1 day in the past 30 days. Heavy Alcohol Use is defined as binge drinking on the same occasion on 5 or more days in the past 30 days; all heavy alcohol users are also binge alcohol users.

Alcohol Use in the Past Month

As noted in the section on General Substance Use in the Past Month, the 2020 NSDUH asked respondents aged 12 or older about their alcohol use in the 30 days before the interview. In addition to asking about any alcohol use, NSDUH collected information on past month binge alcohol use and heavy alcohol use. Binge drinking for males was defined as drinking five or more drinks30 on the same occasion on at least 1 day in the past 30 days, which has remained unchanged from the threshold prior to 2015. Since 2015, binge alcohol use for females has been defined as drinking four or more drinks on the same occasion on at least 1 day in the past 30 days.31 This definition of binge alcohol use is consistent with federal definitions.32 Heavy alcohol use was defined as binge drinking on 5 or more days in the past 30 days based on the thresholds described previously for males and females. Also, as noted previously, caution must be taken when interpreting estimates of alcohol use in the past month due to the very small amount of data that are available from April to September.

Among the 138.5 million current alcohol users aged 12 or older in 2020, 61.6 million people (or 44.4 percent) were past month binge drinkers (Figure 6). Among past month binge drinkers, 17.7 million people (28.8 percent of current binge drinkers and 12.8 percent of current alcohol users) were past month heavy drinkers.33

Figure 6. Current, Binge, and Heavy Alcohol Use: Among People Aged 12 or Older; 2020

Figure 6     D

Note: Binge Alcohol Use is defined as drinking five or more drinks (for males) or four or more drinks (for females) on the same occasion on at least 1 day in the past 30 days. Heavy Alcohol Use is defined as binge drinking on the same occasion on 5 or more days in the past 30 days; all heavy alcohol users are also binge alcohol users.

Any Alcohol Use

Among people aged 12 or older in 2020, 50.0 percent (or 138.5 million people) drank alcohol in the past month (Figure 6 and Table A.1B). The percentage was highest among adults aged 26 or older (54.6 percent or 119.2 million people), followed by young adults aged 18 to 25 (51.5 percent or 17.3 million people), then by adolescents aged 12 to 17 (8.2 percent or 2.1 million people) (Tables A.2B to A.4B).

Binge Alcohol Use

Among people aged 12 or older in 2020, 22.2 percent (or 61.6 million people) were binge alcohol users in the past month (Figures 6 and 7). The percentage was highest among young adults aged 18 to 25 (31.4 percent or 10.5 million people), followed by adults aged 26 or older (22.9 percent or 50.0 million people), then by adolescents aged 12 to 17 (4.1 percent or 1.0 million people).

Figure 7. Past Month Binge Alcohol Use: Among People Aged 12 or Older; 2015-2020

Figure 7     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 7 Table. Past Month Binge Alcohol Use: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 24.9 24.2 24.5 24.5 23.9 22.2
12 to 17 5.8 4.9 5.3 4.7 4.9 4.1
18 to 25 39.0 38.4 36.9 34.9 34.3 31.4
26 or Older 24.8 24.2 24.7 25.1 24.5 22.9
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Heavy Alcohol Use

Among people aged 12 or older in 2020, 6.4 percent (or 17.7 million people) were heavy alcohol users in the past month (Figures 6 and 8). The percentage was highest among young adults aged 18 to 25 (8.6 percent or 2.9 million people), followed by adults aged 26 or older (6.7 percent or 14.7 million people), then by adolescents aged 12 to 17 (0.6 percent or 140,000 people).

Figure 8. Past Month Heavy Alcohol Use: Among People Aged 12 or Older; 2015-2020

Figure 8     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 8 Table. Past Month Heavy Alcohol Use: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 6.5 6.0 6.1 6.1 5.8 6.4
12 to 17 0.9 0.8 0.7 0.5 0.8 0.6
18 to 25 10.9 10.1 9.6 9.0 8.4 8.6
26 or Older 6.4 6.0 6.2 6.2 6.0 6.7
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Underage Alcohol Use

As of 2020, all 50 states and the District of Columbia prohibited the possession of alcoholic beverages by people younger than 21 (although some states may have had exceptions). Most states also prohibited underage consumption (i.e., consumption of alcoholic beverages prior to the age of 21).34 Among people aged 12 to 20 in 2020, 16.1 percent (or 6.0 million people) were past month alcohol users (Table A.7B). Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 9.2 percent (or 3.4 million people) and 1.8 percent (or 669,000 people), respectively.

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Illicit Drug Use in the Past Year

The 2020 NSDUH obtained illicit drug use information for the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, and methamphetamine, as well as for the misuse of prescription stimulants, tranquilizers, sedatives,35 and pain relievers (see the section on the Misuse of Psychotherapeutic Drugs for the definition of “misuse”). This report presents estimates of past year (rather than past month) illicit drug use because of low prevalence estimates for some illicit drugs (e.g., heroin). Moreover, the 2020 NSDUH collected only past year (rather than past month) data on the misuse of benzodiazepines and specific subtypes of prescription pain relievers (e.g., fentanyl products).

Among people aged 12 or older in 2020, 59.3 million people used illicit drugs in the past year (Figure 9). The most commonly used illicit drug in the past year was marijuana, which was used by 49.6 million people. The second most common type of illicit drug use in the past year was the misuse of prescription pain relievers, which were misused by 9.3 million people. Smaller numbers of people were past year users of other illicit drugs, as shown in Figure 9.36

Figure 9. Past Year Illicit Drug Use: Among People Aged 12 or Older; 2020

Figure 9     D

Rx = prescription.
Note: The estimated numbers of past year users of different illicit drugs are not mutually exclusive because people could have used more than one type of illicit drug in the past year.

Any Illicit Drug Use

Among people aged 12 or older in 2020, 21.4 percent (or 59.3 million people) used illicit drugs in the past year (Figures 9 and 10). The percentage was highest among young adults aged 18 to 25 (37.0 percent or 12.4 million people), followed by adults aged 26 or older (19.9 percent or 43.4 million people), then by adolescents aged 12 to 17 (13.8 percent or 3.4 million people).

Figure 10. Past Year Illicit Drug Use: Among People Aged 12 or Older; 2015-2020

Figure 10     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 10 Table. Past Year Illicit Drug Use: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 17.8 18.0 19.0 19.4 20.8 21.4
12 to 17 17.5 15.8 16.3 16.7 17.2 13.8
18 to 25 37.5 37.7 39.4 38.7 39.1 37.0
26 or Older 14.6 15.0 16.1 16.7 18.3 19.9
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Marijuana Use

In 2020, 17.9 percent of people aged 12 or older (or 49.6 million people) used marijuana in the past year (Figures 9 and 11). The percentage was highest among young adults aged 18 to 25 (34.5 percent or 11.6 million people), followed by adults aged 26 or older (16.3 percent or 35.5 million people), then by adolescents aged 12 to 17 (10.1 percent or 2.5 million people).

Figure 11. Past Year Marijuana Use: Among People Aged 12 or Older; 2002-2020

Figure 11     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 11 Table. Past Year Marijuana Use: Among People Aged 12 or Older; 2002-2020
Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
≥12 11.0 10.6 10.6 10.4 10.3 10.1 10.4 11.4 11.6 11.5 12.1 12.6 13.2 13.5 13.9 15.0 15.9 17.5 17.9
12-17 15.8 15.0 14.5 13.3 13.2 12.5 13.1 13.7 14.0 14.2 13.5 13.4 13.1 12.6 12.0 12.4 12.5 13.2 10.1
18-25 29.8 28.5 27.8 28.0 28.1 27.5 27.8 30.8 30.0 30.8 31.5 31.6 31.9 32.2 33.0 34.9 34.8 35.4 34.5
≥26 7.0 6.9 7.0 6.9 6.9 6.8 7.0 7.7 8.0 7.9 8.6 9.2 10.1 10.4 11.0 12.2 13.3 15.2 16.3
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Cocaine Use

Cocaine use includes the use of crack cocaine. Estimates of crack use are presented separately as well. Among people aged 12 or older in 2020, 1.9 percent (or 5.2 million people) used cocaine in the past year (Figure 9 and Table A.12B). The percentage was highest among young adults aged 18 to 25 (4.3 percent or 1.4 million people), followed by adults aged 26 or older (1.7 percent or 3.6 million people), then by adolescents aged 12 to 17 (0.3 percent or 84,000 people) (Tables A.13B to A.15B).

In 2020, an estimated 0.2 percent of people aged 12 or older (or 657,000 people) used crack in the past year. The percentage was lowest among adolescents aged 12 to 17 (less than 0.1 percent or 2,000 people). This percentage increased with age (0.1 percent of young adults aged 18 to 25 or 49,000 people; 0.3 percent of adults aged 26 or older or 606,000 people).

Heroin Use

Among people aged 12 or older in 2020, 0.3 percent (or 902,000 people) used heroin in the past year (Figure 9 and Table A.12B). Estimates of past year heroin use were 0.2 percent (or 62,000 people) among young adults aged 18 to 25 and 0.4 percent (or 840,000 people) among adults aged 26 or older (Tables A.14B and A.15B). Estimates of past year heroin use among adolescents aged 12 to 17 could not be calculated with sufficient precision (Table A.13B).

Methamphetamine Use

Although methamphetamine is legally available by prescription (Desoxyn®), most methamphetamine used in the United States is produced and distributed illicitly rather than through the pharmaceutical industry. Therefore, the 2015 to 2020 NSDUHs have included separate sections for methamphetamine use and the use and misuse of prescription stimulants.

Among people aged 12 or older in 2020, 0.9 percent (or 2.5 million people) used methamphetamine in the past year (Figures 9 and 12). Adolescents aged 12 to 17 had the lowest estimate of past year methamphetamine use (0.1 percent or 21,000 people). Percentages increased with age (0.5 percent of young adults aged 18 to 25 or 171,000 people; 1.1 percent of adults aged 26 or older or 2.4 million people).

Figure 12. Past Year Methamphetamine Use: Among People Aged 12 or Older; 2015-2020

Figure 12     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 12 Table. Past Year Methamphetamine Use: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 0.6 0.5 0.6 0.7 0.7 0.9
12 to 17 0.2 0.1 0.2 0.2 0.2 0.1
18 to 25 0.9 0.8 1.1 0.8 0.8 0.5
26 or Older 0.6 0.5 0.6 0.7 0.8 1.1
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Hallucinogen Use

Several drugs are grouped under the category of hallucinogens, including LSD, PCP, peyote, mescaline, psilocybin mushrooms, “Ecstasy” (MDMA or “Molly”), ketamine, DMT/AMT/“Foxy,” and Salvia divinorum.37 In 2020, 2.6 percent of people aged 12 or older (or 7.1 million people) used hallucinogens in the past year (Figures 9 and 13). The percentage among young adults aged 18 to 25 (7.3 percent or 2.4 million people) was higher than the percentages among adolescents aged 12 to 17 (1.5 percent or 370,000 people) or adults aged 26 or older (2.0 percent or 4.3 million people).

Figure 13. Past Year Hallucinogen Use: Among People Aged 12 or Older; 2015-2020

Figure 13     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 13 Table. Past Year Hallucinogen Use: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 1.8 1.8 1.9 2.0 2.2 2.6
12 to 17 2.1 1.8 2.1 1.5 1.8 1.5
18 to 25 7.0 6.9 7.0 6.9 7.2 7.3
26 or Older 0.8 1.0 1.0 1.3 1.5 2.0
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Inhalant Use

Inhalants include volatile solvents (e.g., paint thinners and removers, dry cleaning fluids, degreasers, gasoline, glues, shoe polish, correction fluids, felt-tip markers), aerosols (e.g., spray paints, deodorant and hair sprays, fabric protector sprays, computer keyboard cleaner), gases (e.g., ether, halothane, nitrous oxide, butane, propane), and nitrites (e.g., amyl nitrite, “poppers,” locker room deodorizers, “rush”). NSDUH respondents were asked to report the use of inhalants to get high but not to include accidental inhalation of a substance.

Among people aged 12 or older in 2020, 0.9 percent (or 2.4 million people) used inhalants in the past year (Figures 9 and 14). Unlike other illicit drug use estimates, the percentage was highest among adolescents aged 12 to 17 (2.7 percent or 683,000 people). Percentages decreased with age (1.5 percent of young adults aged 18 to 25 or 507,000 people; 0.5 percent of adults aged 26 or older or 1.2 million people).

Figure 14. Past Year Inhalant Use: Among People Aged 12 or Older; 2015-2020

Figure 14     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 14 Table. Past Year Inhalant Use: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 0.7 0.6 0.6 0.7 0.8 0.9
12 to 17 2.7 2.2 2.3 2.7 3.0 2.7
18 to 25 1.4 1.4 1.6 1.5 1.7 1.5
26 or Older 0.3 0.3 0.3 0.4 0.4 0.5
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Misuse of Psychotherapeutic Drugs

The 2020 NSDUH assessed the use and misuse of psychotherapeutic drugs currently or recently available by prescription in the United States, including prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines), and pain relievers. In NSDUH, misuse of prescription drugs was defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Misuse of over-the-counter (OTC) drugs was not included.

Among people aged 12 or older in 2020, 5.8 percent (or 16.1 million people) misused prescription psychotherapeutic drugs in the past year (Table A.12B). The percentage was highest among young adults aged 18 to 25 (9.5 percent or 3.2 million people), followed by adults aged 26 or older (5.6 percent or 12.2 million people), then by adolescents aged 12 to 17 (2.8 percent or 688,000 people) (Tables A.13B to A.15B).

Of the prescription drugs presented in this report, prescription pain relievers were the most commonly misused by people aged 12 or older. The 16.1 million people in 2020 who misused prescription psychotherapeutic drugs in the past year included 9.3 million people who misused prescription pain relievers, 6.2 million people who misused prescription tranquilizers or sedatives (including 4.8 million past year misusers of benzodiazepines), and 5.1 million people who misused prescription stimulants (Figure 9).

Stimulant Misuse

The 2020 NSDUH assessed the misuse of prescription stimulants in the following categories: amphetamine products, methylphenidate products, anorectic (weight-loss) stimulants, Provigil®, or any other prescription stimulant. The amphetamine and methylphenidate products included in the NSDUH questionnaire are primarily prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD). Since 2015, methamphetamine has not been included as a prescription stimulant, unless respondents specified the prescription form of methamphetamine (Desoxyn®) as some other stimulant they had misused in the past year.38

Among people aged 12 or older in 2020, 1.8 percent (or 5.1 million people) misused prescription stimulants in the past year (Figures 9 and 15). The percentage was higher among young adults aged 18 to 25 (4.8 percent or 1.6 million people) than among adolescents aged 12 to 17 (1.2 percent or 288,000 people) or adults aged 26 or older (1.5 percent or 3.2 million people).

Figure 15. Past Year Prescription Stimulant Misuse: Among People Aged 12 or Older; 2015-2020

Figure 15     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 15 Table. Past Year Prescription Stimulant Misuse: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 2.0 2.1 2.1 1.9 1.8 1.8
12 to 17 2.0 1.7 1.8 1.5 1.7 1.2
18 to 25 7.3 7.5 7.4 6.5 5.8 4.8
26 or Older 1.1 1.3 1.3 1.2 1.2 1.5
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Tranquilizer or Sedative Misuse

Estimates of the misuse of prescription tranquilizers or sedatives are presented together because prescription drugs in both categories have a common effect on specific activity in the brain. Prescription tranquilizers include benzodiazepine tranquilizers (e.g., as alprazolam, lorazepam, clonazepam, or diazepam products), muscle relaxants, or any other prescription tranquilizer. Prescription sedatives include zolpidem products, eszopiclone products, zaleplon products, benzodiazepine sedatives (e.g., as flurazepam and temazepam products or triazolam products), barbiturates, or any other prescription sedative.

Among people aged 12 or older in 2020, 2.2 percent (or 6.2 million people) misused tranquilizers or sedatives in the past year (Figure 9 and Table A.12B). The percentage was highest among young adults aged 18 to 25 (3.7 percent or 1.2 million people), followed by adults aged 26 or older (2.2 percent or 4.7 million people), then by adolescents aged 12 to 17 (0.9 percent or 226,000 people) (Tables A.13B to A.15B).

Benzodiazepine Misuse

Prescription benzodiazepines are a subcategory of drugs that may be prescribed either as tranquilizers for the relief of anxiety or as sedatives for the relief of insomnia. Benzodiazepines prescribed as tranquilizers are typically metabolized more slowly than benzodiazepines prescribed as sedatives.39 Nevertheless, benzodiazepines are chemically similar, regardless of whether they are prescribed as tranquilizers or sedatives.

Among people aged 12 or older in 2020, 1.7 percent (or 4.8 million people) misused prescription benzodiazepines in the past year (Table A.12B). The percentage was highest among young adults aged 18 to 25 (3.3 percent or 1.1 million people), followed by adults aged 26 or older (1.6 percent or 3.5 million people), then by adolescents aged 12 to 17 (0.6 percent or 157,000 people) (Tables A.13B to A.15B).

Pain Reliever Misuse

The 2020 NSDUH assessed the misuse of prescription pain relievers in the following categories: products containing hydrocodone, oxycodone, tramadol, codeine, morphine, prescription fentanyl,40 buprenorphine, oxymorphone, and hydromorphone, as well as Demerol®, methadone, or any other prescription pain reliever. This section provides estimates of the misuse of any prescription pain reliever and specific subtypes of prescription pain relievers, the main reason for the most recent misuse of prescription pain relievers, and where people obtained the prescription pain relievers that they most recently misused in the past year.

Among people aged 12 or older in 2020, 3.3 percent (or 9.3 million people) misused prescription pain relievers in the past year (Figures 9 and 16). The percentage was highest among young adults aged 18 to 25 (4.1 percent or 1.4 million people), followed by adults aged 26 or older (3.4 percent or 7.5 million people), then by adolescents aged 12 to 17 (1.6 percent or 396,000 people).

Figure 16. Past Year Prescription Pain Reliever Misuse: Among People Aged 12 or Older; 2015-2020

Figure 16     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 16 Table. Past Year Prescription Pain Reliever Misuse: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 4.7 4.3 4.1 3.6 3.5 3.3
12 to 17 3.9 3.5 3.1 2.8 2.3 1.6
18 to 25 8.5 7.1 7.2 5.5 5.2 4.1
26 or Older 4.1 3.9 3.7 3.4 3.4 3.4
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Misuse of Subtypes of Pain Relievers

The 2020 NSDUH asked respondents to identify specific prescription pain relievers they used in the past year, then asked whether they misused those pain relievers in the past year. The specific pain relievers people misused in the past year were categorized into subtypes, such as hydrocodone products. For example, respondents who reported misusing the pain relievers Vicodin® or hydrocodone were classified as misusers of hydrocodone products.

This section presents two ways of examining the misuse of subtypes of pain relievers. First, it presents estimates of the misuse of subtypes among the total population aged 12 or older. Then it presents estimates of the misuse of subtypes of pain relievers among people who used that subtype in the past year.

Among people aged 12 or older in 2020, 1.7 percent (or 4.7 million people) misused hydrocodone products in the past year (Figure 17). Hydrocodone products were the most commonly misused subtype of prescription pain relievers for 2020, including Vicodin®, Lortab®, Norco®, Zohydro® ER, and generic hydrocodone. In addition, 1.1 percent (or 3.2 million people) misused oxycodone products in the past year, including OxyContin®, Percocet®, Percodan®, Roxicodone®, and generic oxycodone. Also, 0.2 percent of people aged 12 or older (or 690,000 people) misused buprenorphine products in the past year.

Figure 17. Past Year Prescription Pain Reliever Misuse: Among People Aged 12 or Older; by Selected Pain Reliever Subtype, 2020

Figure 17     D

* Low precision; no estimate reported.

An estimated 0.1 percent of people aged 12 or older (or 356,000 people) misused prescription fentanyl products. Because NSDUH respondents were asked only about the misuse of prescription forms of fentanyl, estimates of fentanyl misuse for 2020 may underrepresent people who used illicitly manufactured fentanyl (IMF) from clandestine laboratories (i.e., as opposed to the misuse of diverted prescription fentanyl produced by the pharmaceutical industry) and may not include those who used IMF mixed with heroin or sold as heroin (but contained only IMF).

Although prescription pain reliever misuse was the second most common form of illicit drug use for 2020 (Figure 9), most past year users of prescription pain relievers did not misuse them in the past year (Figure 17). For example, among past year users of hydrocodone products, 12.6 percent misused them in the past year. Among past year users of buprenorphine products, 26.5 percent misused them. Stated another way, almost three fourths of past year users of buprenorphine products did not misuse them in that period.

Main Reasons for the Last Misuse of Pain Relievers

Respondents in the 2020 NSDUH who reported prescription pain reliever misuse in the past year were asked to report the reasons for misusing the last prescription pain reliever they misused. Respondents who reported more than one reason for misusing the last prescription pain reliever were asked to report their main reason for misusing it.

Among people aged 12 or older in 2020 who misused prescription pain relievers in the past year, the most common main reason for their last misuse of a pain reliever was to relieve physical pain (64.6 percent) (Table A.16B). Based on the NSDUH definition, use without a prescription of one's own or overuse of prescribed medication (e.g., use at a higher dosage or more often than prescribed) are both classified as misuse even if the use was for the purpose of pain relief.

Other common main reasons for misuse were to feel good or get high (11.3 percent) and to relax or relieve tension (8.1 percent). Less common main reasons among past year misusers of pain relievers included to help with feelings or emotions (5.6 percent), to help with sleep (4.5 percent), because they were “hooked” or needed to have the drug (2.3 percent), to experiment or see what the drug was like (1.4 percent), and to increase or decrease the effects of other drugs (0.9 percent).

Source of the Last Pain Reliever That Was Misused

Among people aged 12 or older in 2020 who misused prescription pain relievers in the past year, the most common source for the last pain reliever they misused was from a friend or relative in some way (i.e., being given them, buying them, or taking them without asking) (Figure 18). A little less than half (47.2 percent) of people who misused pain relievers in the past year obtained the pain relievers the last time from a friend or relative in some way. Specifically, 34.4 percent of people who misused pain relievers in the past year obtained pain relievers the last time by getting them from a friend or relative for free, 9.2 percent bought their last pain reliever from a friend or relative, and 3.7 percent took their last pain reliever from a friend or relative without asking. About two fifths of people who misused pain relievers in the past year (43.6 percent) obtained pain relievers the last time through prescription(s) or stole pain relievers from a health care provider, typically getting the pain relievers through a prescription from one doctor (42.0 percent). About 1 in 16 people who misused pain relievers in the past year (6.2 percent) bought the last pain reliever they misused from a drug dealer or other stranger.

Figure 18. Source Where Pain Relievers Were Obtained for Most Recent Misuse: Among People Aged 12 or Older Who Misused Pain Relievers in the Past Year; 2020

Figure 18     D

Note: Respondents with unknown data for the Source for Most Recent Misuse or who reported Some Other Way but did not specify a valid way were excluded.
Note: The percentages do not add to 100 percent due to rounding.

Opioid Misuse

Opioids are a group of chemically similar drugs that include heroin and prescription opioids, such as hydrocodone (e.g., Vicodin®), oxycodone (e.g., OxyContin®), and morphine. In this report, opioid misuse includes the misuse of prescription pain relievers or the use of heroin. Prescription pain relievers could include some nonopioids because respondents could occasionally specify the misuse of other prescription pain relievers that are not opioids.

Among people aged 12 or older in 2020, 3.4 percent (or 9.5 million people) misused opioids in the past year (Figure 19 and Table A.12B). The percentage was highest among young adults aged 18 to 25 (4.1 percent or 1.4 million people), followed by adults aged 26 or older (3.5 percent or 7.7 million people), then by adolescents aged 12 to 17 (1.6 percent or 396,000 people) (Tables A.13B to A.15B).

Figure 19. Past Year Opioid Misuse: Among People Aged 12 or Older; 2020

Figure 19     D

The vast majority of people who misused opioids in the past year misused prescription pain relievers (Figure 19). Specifically, 9.3 million people aged 12 or older misused prescription pain relievers in the past year compared with 902,000 people who used heroin. In 2020, the majority of the 9.3 million misusers of prescription pain relievers misused only prescription pain relievers in the past year (8.6 million people), but they had not used heroin. An estimated 667,000 people misused prescription pain relievers and used heroin in the past year, and 235,000 people had used heroin in the past year but had not misused prescription pain relievers.

Central Nervous System Stimulant Misuse

Central nervous system (CNS) stimulants are a group of drugs that include cocaine, methamphetamine, and prescription stimulants. These drugs act in similar ways to stimulate the brain. They produce stimulant effects, such as increased alertness, wakefulness, or energy. They also can produce physical side effects of rapid or irregular heartbeat or increased blood pressure and body temperature.41,42,43 In this report, CNS stimulant misuse includes the use of cocaine or methamphetamine or the misuse of prescription stimulants.

Among people aged 12 or older in 2020, 3.7 percent (or 10.3 million people) misused CNS stimulants in the past year (Figure 20 and Table A.12B). The percentage was highest among young adults aged 18 to 25 (7.7 percent or 2.6 million people), followed by adults aged 26 or older (3.4 percent or 7.4 million people), then by adolescents aged 12 to 17 (1.4 percent or 346,000 people) (Tables A.13B to A.15B).

Figure 20. Past Year Central Nervous System (CNS) Stimulant Misuse: Among People Aged 12 or Older; 2020

Figure 20     D

Of the 10.3 million people in 2020 who misused CNS stimulants in the past year, 353,000 used or misused all three CNS stimulants in the past year (3.4 percent of people who misused CNS stimulants) (Figure 20).13 About one third of people who misused CNS stimulants in the past year used only cocaine (32.4 percent of CNS stimulant misusers or 3.3 million people), about one third misused only prescription stimulants (32.3 percent of CNS stimulant misusers or 3.3 million people), and about 1 in 7 used only methamphetamine (14.4 percent of CNS stimulant misusers or 1.5 million people). In addition to the 353,000 people who used or misused all three CNS stimulants in the past year, 1.1 million people used cocaine and misused prescription stimulants but did not use methamphetamine (10.5 percent of CNS stimulant misusers), 391,000 used cocaine and methamphetamine but did not misuse prescription stimulants (3.8 percent of CNS stimulant misusers), and 326,000 used methamphetamine and misused prescription stimulants but did not use cocaine (3.2 percent of CNS stimulant misusers).

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Other Substance Use in the Past Year

The 2020 NSDUH obtained information for the use and misuse of additional substances that can produce mind-altering effects. Not including these substances in estimates from prior years has allowed the creation of consistent illicit drug use measures over time. These substances include GHB, the misuse of nonprescription cold and cough medicine, kratom, synthetic marijuana (fake weed, K2, or Spice), and synthetic stimulants (“bath salts” or flakka). The 2020 NSDUH marks the first time that information was collected on the use of synthetic cannabinoids (referred to in the NSDUH questionnaire as “synthetic marijuana”) and synthetic cathinones (referred to in the questionnaire as “synthetic stimulants”).

GHB Use

Gamma hydroxybutyrate (GHB, also called “G,” “Georgia Home Boy,” “Grievous Bodily Harm,” or “Liquid G,”) is a CNS depressant. GHB can produce hallucinations, euphoria, drowsiness, decreased anxiety, and excited and aggressive behavior. It also is addictive. GHB that is not produced as a pharmaceutical product with approval from the U.S. Food and Drug Administration is classified as a Schedule I controlled substance in the United States.44,45

Among people aged 12 or older in 2020, 0.1 percent (or 183,000 people) used GHB in the past year (Table A.8B). In addition, 0.1 percent each of young adults aged 18 to 25 and adults aged 26 or older used GHB in the past year (Tables A.10B and A.11B). Corresponding estimated numbers of people who used GHB in the past year were 24,000 young adults and 158,000 adults aged 26 or older. Estimates for adolescents aged 12 to 17 could not be calculated with sufficient precision (Table A.9B).

Nonprescription Cough and Cold Medicine Misuse

The cough suppressant dextromethorphan (DXM) is found in many cough and cold medicines. These medicines are available without a prescription (i.e., OTC) in the United States and are generally considered safe when used appropriately. When taken in large amounts, however, DXM can produce hallucinations or dissociative, “out-of-body” experiences. These effects are similar to those caused by the hallucinogens PCP and ketamine. Other drugs found in OTC cough and cold medicines also can have psychoactive effects. For example, the OTC antihistamine diphenhydramine (found in the brand-name drug Benadryl®) can produce sedative side effects, such as drowsiness.46 The OTC decongestant phenylephrine (found in the brand name drug Sudafed PE®) can produce stimulant side effects, such as nervousness and sleeplessness.47

The 2020 NSDUH questionnaire asked respondents aged 12 or older about their use of nonprescription cough or cold medicines in the past 12 months for the purpose of getting high (i.e., “misuse”). Respondents who reported that they used nonprescription (i.e., OTC) cough or cold medicines to get high in the past 12 months could specify the names of up to five OTC medicines that they had misused.

Among people aged 12 or older in 2020, 0.9 percent (or 2.4 million people) misused nonprescription cough and cold medicines in the past year (Table A.8B). Similar percentages of people in each age group misused cough and cold medicines in the past year (0.9 percent of adolescents aged 12 to 17, 1.2 percent of young adults aged 18 to 25, and 0.8 percent of adults aged 26 or older) (Tables A.9B to A.11B). Corresponding estimated numbers of people who misused cough and cold medicines in the past year were 223,000 adolescents, 389,000 young adults, and 1.8 million adults aged 26 or older.

Kratom Use

Kratom is an herbal extract from the leaves of the Mitragyna speciosa tree that is native to Southeast Asia. The leaves contain chemicals with mind-altering effects. Kratom can come in forms such as powders, pills, or leaves.48,49 The 2020 NSDUH asked respondents aged 12 or older about their use of kratom in the 12 months before the interview.

Among people aged 12 or older in 2020, 0.8 percent (or 2.1 million people) used kratom in the past year (Table A.8B). The percentage was lower among adolescents aged 12 to 17 (0.2 percent or 48,000 people) than among young adults aged 18 to 25 (0.9 percent or 286,000 people) or adults aged 26 or older (0.8 percent or 1.8 million people) (Tables A.9B to A.11B).

Synthetic Marijuana Use

Synthetic cannabinoids are human-made chemicals that are similar to chemicals found in the marijuana plant. For this reason, these drugs are sometimes called “synthetic marijuana” or “fake weed.” They can be contained in plant material that is later smoked. They are also sold as liquids to be vaporized (i.e., vaped) and inhaled in e-cigarettes and other devices.44,50 Several synthetic cannabinoids have been categorized as Schedule I controlled substances.45

For simplicity, the 2020 NSDUH questionnaire asked respondents about their use of “synthetic marijuana” and included the slang terms “fake weed,” “K2,” and “Spice.” The 2020 NSDUH asked respondents aged 12 or older about their use of synthetic marijuana or fake weed in the 12 months before the interview.

Among people aged 12 or older in 2020, 0.4 percent (or 1.1 million people) used synthetic marijuana in the past year (Table A.8B). The percentage was lower among adults aged 26 or older (0.3 percent or 546,000 people) than among adolescents aged 12 to 17 (0.8 percent or 207,000 people) or young adults aged 18 to 25 (0.9 percent or 313,000 people) (Tables A.9B to A.11B).

Synthetic Stimulant Use

Synthetic cathinones are human-made CNS stimulants that are chemically related to cathinone, a substance found in the khat plant. These substances can be marketed as “bath salts” or “flakka.” 44,51 Several synthetic cathinones have been categorized as Schedule I controlled substances.45

For simplicity, the 2020 NSDUH questionnaire asked respondents about their use of “synthetic stimulants” and included the slang terms “bath salts” and “flakka.” The 2020 NSDUH asked respondents aged 12 or older about their use of synthetic stimulants, also called “bath salts” or flakka, in the 12 months before the interview.

Among people aged 12 or older in 2020, less than 0.1 percent (or 118,000 people) used synthetic stimulants in the past year (Table A.8B). Similar percentages of people in each age group used synthetic stimulants (less than 0.1 percent each of adolescents aged 12 to 17 and adults aged 26 or older; 0.1 percent of young adults aged 18 to 25) (Tables A.9B to A.11B). In each age group, 75,000 or fewer people used synthetic stimulants.

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Initiation of Substance Use

The 2020 NSDUH included questions to measure the initiation of substance use, that is, use of particular substances for the first time during a person's lifetime.52 This report presents the estimated number of recent substance use initiates or prescription drug misuse initiates.53 Recent initiates were substance users or prescription drug misusers who reported first using or misusing, respectively, a particular substance in the 12 months before the NSDUH interview.14,54,55

In particular, this report presents estimates for past year initiation of heroin use, prescription pain reliever misuse, prescription tranquilizer misuse, and prescription sedative misuse, separately. The report does not present estimates for past year initiation of any opioid (heroin or prescription pain reliever) misuse, any illicit drug use (including prescription drug misuse), and any prescription tranquilizer or sedative misuse because respondents who underreported lifetime (but not past year) misuse of prescription drugs might not truly be past year initiates of the use or misuse of any drug in these aggregate categories.56 Estimates for the past year initiation of benzodiazepine misuse are not presented because some benzodiazepines in NSDUH were included as tranquilizers, and others were included as sedatives.57

Because only limited data were collected from April to September 2020, this report does not present estimates for 2020 for the average numbers of initiates per day. In prior years, these averages were calculated by dividing the total number of past year initiates by 365 days and assumed generally continuous data collection across the entire 12 months. Estimates from the 2020 NSDUH for the average number of initiates per day also could be misleading because 2020 included periods when people in certain states and localities were under increased restrictions to contain the spread of COVID-19. These periods of restrictions could have changed the opportunities to initiate substance use among members of certain subgroups.

Figure 21 provides an overview of the numbers of people aged 12 or older in 2020 who were past year initiates for the substances discussed in this section. In the past 12 months, 4.1 million people initiated alcohol use and 1.3 million people tried a cigarette for the first time in their lifetime.58 There also were 2.8 million new marijuana users, 1.4 million new hallucinogen users, 1.2 million new misusers of prescription pain relievers, 950,000 new misusers of prescription tranquilizers, and 734,000 new misusers of prescription stimulants.

Figure 21. Past Year Initiates of Substances: Among People Aged 12 or Older; 2020

Figure 21     D

Rx = prescription.
Note: Estimates for prescription pain relievers, prescription tranquilizers, prescription stimulants, and prescription sedatives are for the initiation of misuse.

Initiation of Cigarette Use

Among people aged 12 or older in 2020, 1.3 million people initiated cigarette smoking in the past year (i.e., never smoked cigarettes before the past 12 months) (Figure 21). Relatively few people (approximately 10 percent of past year initiates) tried cigarettes for the first time after age 25. Corresponding numbers of initiates of cigarette smoking by age group were 385,000 adolescents aged 12 to 17, 752,000 young adults aged 18 to 25, and 127,000 adults aged 26 or older (Tables A.19A to A.21A).

Initiation of Alcohol Use

Among people aged 12 or older in 2020, 4.1 million people initiated alcohol use in the past year, not counting sips from another person's drink (Figure 22). Among young adults aged 18 to 25 in 2020, 2.1 million people initiated alcohol use in the past year. Corresponding numbers for initiation of alcohol use for adolescents aged 12 to 17 and adults aged 26 or older were 1.8 million people and 176,000 people, respectively (Table A.21A). Consistent with the pattern of cigarette smoking initiation, relatively few people in 2020 started to use alcohol after age 25.

Figure 22. Past Year Alcohol Initiates: Among People Aged 12 or Older; 2002-2020

Figure 22     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 22 Table. Past Year Alcohol Initiates: Among People Aged 12 or Older (in Millions); 2002-2020
Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
≥12 3.9 4.1 4.4 4.3 4.4 4.6 4.5 4.6 4.7 4.7 4.6 4.6 4.7 4.8 4.6 4.9 4.9 4.9 4.1
12-17 2.6 2.6 2.7 2.7 2.7 2.7 2.6 2.7 2.5 2.6 2.4 2.4 2.3 2.4 2.3 2.3 2.4 2.3 1.8
18-25 1.2 1.4 1.5 1.4 1.6 1.7 1.7 1.8 2.0 2.0 1.9 2.1 2.2 2.2 2.2 2.4 2.4 2.4 2.1
≥26 0.1 0.1 0.2 0.1 0.1 0.1 0.2 0.1 0.2 0.1 0.2 0.1 0.1 0.2 0.2 0.1 0.1 0.2 0.2
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Initiation of Marijuana Use

Among people aged 12 or older in 2020, 2.8 million people initiated marijuana use in the past year (Figure 23). Among adolescents aged 12 to 17, 1.0 million people initiated marijuana use in the past year. Corresponding numbers for young adults aged 18 to 25 and adults aged 26 or older were 1.1 million people and 664,000 people, respectively (Table A.21A). Unlike people who initiated cigarette or alcohol use, almost 25 percent of people in 2020 who initiated marijuana use in the past year were aged 26 or older.

Figure 23. Past Year Marijuana Initiates: Among People Aged 12 or Older; 2002-2020

Figure 23     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 23 Table. Past Year Marijuana Initiates: Among People Aged 12 or Older (in Millions); 2002-2020
Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
≥12 2.2 2.0 2.1 2.1 2.1 2.1 2.2 2.4 2.4 2.6 2.4 2.4 2.6 2.6 2.6 3.0 3.1 3.5 2.8
12-17 1.4 1.2 1.3 1.1 1.2 1.2 1.2 1.3 1.3 1.4 1.3 1.2 1.2 1.2 1.2 1.2 1.3 1.4 1.0
18-25 0.7 0.7 0.7 0.7 0.7 0.8 0.8 1.0 0.9 1.1 1.0 1.0 1.1 1.0 1.0 1.3 1.2 1.2 1.1
≥26 0.1 0.1 0.2 0.3 0.1 0.1 0.2 0.0 0.2 0.2 0.2 0.2 0.3 0.4 0.4 0.5 0.5 0.9 0.7
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.
Note: Estimates of less than 0.05 million round to 0.0 million when shown to the nearest tenth of a million.

Initiation of Cocaine Use

Among people aged 12 or older in 2020, 489,000 people initiated cocaine use in the past year (Figure 21).59 Approximately 70 percent of past year initiates tried cocaine for the first time between ages 18 and 25. Among young adults aged 18 to 25, 341,000 people initiated cocaine use (Table A.20A). Corresponding numbers of initiates for adolescents aged 12 to 17 and adults aged 26 or older were 82,000 people and 66,000 people, respectively (Tables A.19A and A.21A).

Initiation of Heroin Use

Among people aged 12 or older in 2020, 103,000 people initiated heroin use in the past year (Figure 21). Among adolescents aged 12 to 17, the number of people who initiated heroin use in the past year was not reported due to low statistical precision (Table A.19A). Nearly 90 percent of past year initiates in 2020 tried heroin for the first time after age 25. Among young adults aged 18 to 25, 12,000 people initiated heroin use in the past year (Table A.20A). Among adults aged 26 or older, 91,000 people initiated heroin use in the past year (Table A.21A).

Initiation of Methamphetamine Use

Among people aged 12 or older in 2020, 153,000 people initiated methamphetamine use in the past year (Figure 21). Relative to people in other age groups, few adolescents aged 12 to 17 initiated methamphetamine use in the past year. Numbers of initiates of methamphetamine use by age group were 6,000 adolescents aged 12 to 17, 51,000 young adults aged 18 to 25, and 97,000 adults aged 26 or older (Tables A.19A to A.21A).

Initiation of Hallucinogen Use

Among people aged 12 or older in 2020, 1.4 million people initiated hallucinogen use in the past year (Figure 21).59 Corresponding numbers of initiates of hallucinogen use by age group were 251,000 adolescents aged 12 to 17, 785,000 young adults aged 18 to 25, and 376,000 adults aged 26 or older (Tables A.19A to A.21A).

Initiation of Inhalant Use

Among people aged 12 or older in 2020, 678,000 people initiated inhalant use in the past year (Figure 21). About half of past year initiates tried inhalants for the first time between age 12 and 17. Numbers of initiates of inhalant use by age group were 360,000 adolescents aged 12 to 17, 201,000 young adults aged 18 to 25, and 117,000 adults aged 26 or older (Tables A.19A to A.21A).

Initiation of Prescription Stimulant Misuse

Among people aged 12 or older in 2020, 734,000 initiated prescription stimulant misuse in the past year (Figure 21). Among adults aged 26 or older, 324,000 people initiated prescription stimulant misuse in the past year (Table A.21A). Corresponding numbers for young adults aged 18 to 25 and adolescents aged 12 to 17 were 294,000 people and 116,000 people, respectively (Tables A.19A and A.20A).

Initiation of Prescription Tranquilizer or Sedative Misuse

Although this report includes combined estimates for the past year misuse of prescription tranquilizers or sedatives, estimates for the initiation of misuse of these substances are presented separately in this section. As noted previously, it cannot be determined unambiguously whether respondents were past year initiates for the aggregate category of any tranquilizer or sedative misuse because of the potential for respondents to underreport the misuse of prescription drugs that occurred more than 12 months ago.

Initiation of Prescription Tranquilizer Misuse

Among people aged 12 or older in 2020, 950,000 people initiated prescription tranquilizer misuse in the past year (Figure 21). Among adults aged 26 or older, 557,000 people initiated prescription tranquilizer misuse (Table A.21A). Among young adults aged 18 to 25 and adolescents aged 12 to 17, 290,000 and 103,000 people initiated prescription tranquilizer misuse in the past year, respectively (Tables A.19A and A.20A).

Initiation of Prescription Sedative Misuse

Among people aged 12 or older in 2020, 343,000 people initiated prescription sedative misuse (Figure 21). Nearly three fourths of past year initiates tried prescription sedatives for the first time after age 25. Corresponding numbers of initiates of prescription sedative misuse by age group were 18,000 adolescents aged 12 to 17, 77,000 young adults aged 18 to 25, and 249,000 adults aged 26 or older (Tables A.19A to A.21A).

Initiation of Prescription Pain Reliever Misuse

Among people aged 12 or older in 2020, 1.2 million people initiated prescription pain reliever misuse in the past year (Figure 24). Nearly two thirds of past year initiates tried prescription pain relievers for the first time after age 25. Among adults aged 26 or older, 774,000 people initiated prescription pain reliever misuse. Among young adults aged 18 to 25 and adolescents aged 12 to 17, the numbers of people who initiated prescription pain reliever misuse in the past year were 290,000 people and 158,000 people, respectively.

Figure 24. Past Year Prescription Pain Reliever Misuse Initiates: Among People Aged 12 or Older; 2015-2020

Figure 24     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 24 Table. Past Year Prescription Pain Reliever Misuse Initiates: Among People Aged 12 or Older; 2015-2020
Age 2015 2016 2017 2018 2019 2020
12 or Older 2,126 2,139 2,010 1,908 1,607 1,223
12 to 17 415 423 316 310 245 158
18 to 25 596 585 465 464 404 290
26 or Older 1,114 1,130 1,229 1,134 958 774
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

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Perceived Risk from Substance Use

One factor that can influence whether people will use tobacco, alcohol, or illicit drugs is the extent to which they believe that using these substances might cause harm. In 2020, NSDUH respondents were asked how much they thought people risk harming themselves physically and in other ways when they use various substances in certain amounts or frequencies. Response choices for these items were “great risk,” “moderate risk,” “slight risk,” or “no risk.” Depending on the substance, respondents were asked about their perceived risk of harm from using a substance daily or using a substance once or twice a week (i.e., weekly use).

Figure 25 presents the percentages of people aged 12 or older in 2015 to 2020 who perceived great risk of harm from the use of various substances. Risk perceptions across substances are not compared because of variations in the quantity and frequency of use across these substances.60 The 2020 NSDUH detailed tables include additional measures of risk perceptions from substance use.

Figure 25. Perceived Great Risk from Substance Use: Among People Aged 12 or Older; 2015-2020

Figure 25     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 25 Table. Perceived Great Risk from Substance Use: Among People Aged 12 or Older; 2015-2020
Substance Use 2015 2016 2017 2018 2019 2020
Smoking Marijuana Once or Twice a Week 36.3 34.0 31.9 30.6 29.2 27.4
Using Cocaine Once or Twice a Week 87.4 87.1 86.8 86.5 85.7 84.7
Using Heroin Once or Twice a Week 94.2 94.1 94.5 94.3 93.8 93.2
Having 4 or 5 Drinks of Alcohol Nearly Every Day 68.7 68.3 68.9 68.5 67.9 68.7
Smoking One or More Packs of Cigarettes per Day 72.8 72.8 71.6 71.8 71.2 70.7
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Among people aged 12 or older in 2020, 70.7 percent of people perceived great risk of harm from smoking one or more packs of cigarettes a day, and 68.7 percent perceived great risk from having four or five alcoholic drinks nearly every day. (For brevity, this level of alcohol consumption on a single day is subsequently referred to as “daily binge drinking.”) Percentages of people who perceived great risk from cocaine or heroin use once or twice a week were 84.7 and 93.2 percent, respectively. In contrast, about one fourth of people (27.4 percent) perceived great risk from smoking marijuana once or twice a week.

In 2020, perceptions of great risk of harm from substance use varied by substance and age. For example, adults aged 26 or older were more likely than adolescents aged 12 to 17 or young adults aged 18 to 25 to perceive great risk of harm from smoking one or more packs of cigarettes per day or to perceive great risk of harm from daily binge drinking (Tables A.23B to A.25B).

Young adults aged 18 to 25 in 2020 were less likely than adolescents aged 12 to 17 or adults aged 26 or older to perceive great risk of harm from smoking marijuana weekly. Research has identified associations among adults between decreases in perceptions of great risk of harm from smoking marijuana weekly and increases in marijuana use.61,62 Nevertheless, people can experience adverse effects from marijuana use, such as marijuana use disorder or injury resulting from operating a motor vehicle while impaired by marijuana.63,64 Therefore, it is necessary to educate young adults about adverse effects of marijuana use.

Finally, adolescents aged 12 to 17 in 2020 were less likely than young adults aged 18 to 25 or adults aged 26 or older to perceive great risk from using heroin or cocaine weekly. Additional data on finer age group categories that can be found in the 2020 detailed tables (available at https://www.samhsa.gov/data/) indicate that the lower likelihood of adolescents than adults to perceive great risk of harm from cocaine and heroin use may be attributable to a general lack of knowledge about these substances among adolescents because younger adolescents aged 12 or 13 tended to have lower perceptions of the risk of harm compared with older adolescents or adults. Thus, age-specific communications are imperative from a public health perspective to help people fully understand important harms associated with the use of specific substances.

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Substance Use Disorders in the Past Year

Substance use disorders (SUDs) are characterized by impairment caused by the recurrent use of alcohol or other drugs (or both), including health problems, disability, and failure to meet major responsibilities at work, school, or home. The 2020 NSDUH included a series of questions to estimate the percentage of the population aged 12 or older who had at least one SUD in the past 12 months (subsequently referred to as “an SUD” or “a past year SUD,” except when “SUDs” refer to more than one substance, such as SUDs for the misuse of specific prescription drugs). The SUD questions assess the presence of an SUD in the past 12 months based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).17,65 Respondents were asked SUD questions for any alcohol or illicit drugs they used in the 12 months prior to the survey. Illicit drugs include marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, and methamphetamine, as well as the misuse of prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines), and pain relievers.14

The 2020 NSDUH marked the first year in which SUDs were assessed using the DSM-5 criteria as opposed to the DSM-IV criteria.18,66,67 In DSM-IV, the criteria are grouped into the diagnoses of dependence and abuse. Respondents were categorized as having an SUD if they met either of the following: (1) the presence of three or more of the diagnostic criteria of dependence for a given substance or substance class (e.g., prescription tranquilizers), or (2) they met one or more criteria of abuse for that substance or substance class. Although DSM-5 assesses many of the same criteria as DSM-IV, it does not include the diagnoses of dependence and abuse. A DSM-5 SUD diagnosis requires the presence of two or more of the following criteria (as measured in the 2020 NSDUH) in a 12-month period:

  1. The substance is often taken in larger amounts or over a longer period than intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  4. There is a craving, or a strong desire or urge, to use the substance.
  5. There is recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. There is continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance.
  7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
  8. There is recurrent substance use in situations in which it is physically hazardous.
  9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. There is a need for markedly increased amounts of the substance to achieve intoxication or the desired effect, or markedly diminished effect with continued use of the same amount of the substance (i.e., tolerance).
  11. There are a required number of withdrawal symptoms that occur when substance use is cut back or stopped following a period of prolonged use.68 (Hallucinogen use disorder and inhalant use disorder do not have a withdrawal syndrome associated with discontinued use. Therefore, withdrawal is not a criterion of either of these two disorders.)

Questions were added to the 2020 NSDUH questionnaire to assess craving, marijuana withdrawal, and tranquilizer withdrawal. Craving and marijuana withdrawal were not assessed in prior surveys because they are not part of the DSM-IV SUD criteria. Although tranquilizer withdrawal is part of the DSM-IV criteria, this symptom had not been assessed in prior NSDUHs because some substances previously included in the questionnaire that were classified as tranquilizers do not have a withdrawal component.

This change from DSM-IV to DSM-5 criteria for assessing SUDs led to breaks in the comparability of 2020 SUD estimates with estimates from prior years. Consequently, this section presents SUD estimates for 2020 only. Readers are cautioned that apparent differences between 2020 SUD estimates based on DSM-5 criteria and published SUD estimates from prior years based on DSM-IV criteria could reflect changes in definitions and measurement rather than real changes in SUD in the population.

For example, Goldstein and colleagues demonstrated the lack of concordance between estimates of SUD derived using the DSM-IV criteria and those derived using the DSM-5 criteria.69 Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) that were scored using both the DSM-IV and DSM-5 criteria, the authors found that the past year prevalence estimates for DSM-5 alcohol use disorder, sedative/tranquilizer use disorder, opioid use disorder, and heroin use disorder were higher than the corresponding DSM-IV prevalence estimates for those disorders. Conversely, the past year prevalence estimates for cannabis use disorder, cocaine use disorder, and stimulant use disorder were lower than the respective DSM-IV estimates for those disorders.

In 2020, 40.3 million people aged 12 or older (or 14.5 percent of this population) had an SUD in the past year, including 28.3 million who had alcohol use disorder and 18.4 million who had an illicit drug use disorder (Figures 26 and 27). Among the 28.3 million people with past year alcohol use disorder, 21.9 million had alcohol use disorder but not an illicit drug use disorder. Among the 18.4 million people with a past year illicit drug use disorder, 11.9 million had an illicit drug use disorder but not alcohol use disorder. Among people with a past year SUD, 16.0 percent (or 6.5 million people) had both alcohol use disorder and an illicit drug use disorder in the past year (Figure 28).33

Figure 26. Substance Use Disorder, Alcohol Use Disorder, and Illicit Drug Use Disorder in the Past Year: Among People Aged 12 or Older; 2020

Figure 26     D


Figure 27. People Aged 12 or Older with a Past Year Substance Use Disorder (SUD); 2020

Figure 27     D

Note: The estimated numbers of people with substance use disorders are not mutually exclusive because people could have use disorders for more than one substance.


Figure 28. Alcohol Use Disorder (AUD) and Illicit Drug Use Disorder (IDUD) in the Past Year: Among People Aged 12 or Older with a Past Year Substance Use Disorder (SUD); 2020

Figure 28     D

The percentage of people in 2020 with a past year SUD differed by age group. The percentage was highest among young adults aged 18 to 25 (24.4 percent or 8.2 million people), followed by adults aged 26 or older (14.0 percent or 30.5 million people), then by adolescents aged 12 to 17 (6.3 percent or 1.6 million people) (Figure 26).

Alcohol Use Disorder

Respondents who used alcohol on 6 or more days in the past 12 months were classified as having alcohol use disorder if they met two or more of the DSM-5 criteria for alcohol use disorder. Relevant criteria for alcohol use disorder can be found in a glossary of key definitions for the 2020 NSDUH.10

Among people aged 12 or older in 2020, 10.2 percent (28.3 million people) had a past year alcohol use disorder (Figures 26 and 27). The percentage of people who had past year alcohol use disorder was highest among young adults aged 18 to 25 (15.6 percent or 5.2 million people), followed by adults aged 26 or older (10.3 percent or 22.4 million people), then by adolescents aged 12 to 17 (2.8 percent or 712,000 people). Age group differences in the percentage of people with alcohol use disorder in the past year were consistent with the age group differences in the 2020 detailed tables for alcohol use in the past year70 and differences described previously for binge and heavy alcohol use in the past month.

Illicit Drug Use Disorder

This section presents overall estimates for illicit drug use disorder, then provides SUD estimates for selected specific illicit drugs. Illicit drug use disorder was defined as meeting DSM-5 SUD criteria for one or more of the following illicit drugs: marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, or prescription psychotherapeutic drugs that were misused (i.e., stimulants, tranquilizers or sedatives, and pain relievers).71 Respondents were classified as having an opioid use disorder if they met DSM-5 criteria for heroin use disorder or prescription pain reliever use disorder (or both). Respondents were classified as having a central nervous system (CNS) stimulant use disorder if they met DSM-5 criteria for cocaine use disorder, methamphetamine use disorder, or prescription stimulant use disorder (or more than one of these disorders). Relevant definitions for SUDs for specific illicit drugs can be found in a glossary of key definitions for the 2020 NSDUH.10

Among people aged 12 or older in 2020, 6.6 percent (or 18.4 million people) had at least one illicit drug use disorder in the past year (Figures 26 and 27). The percentage of young adults aged 18 to 25 (14.6 percent or 4.9 million people) was higher than the percentages of adolescents aged 12 to 17 (4.9 percent or 1.2 million people) or adults aged 26 or older (5.6 percent or 12.3 million people). The higher percentage of young adults with at least one illicit drug use disorder was consistent with the higher percentage among this age group for illicit drug use in the past year.

Marijuana Use Disorder

Among people aged 12 or older in 2020, 5.1 percent (or 14.2 million people) had a marijuana use disorder in the past year (Figures 27 and 29). The percentage of young adults aged 18 to 25 (13.5 percent or 4.5 million people) was higher than the percentages of adolescents aged 12 to 17 (4.1 percent or 1.0 million people) or adults aged 26 or older (4.0 percent or 8.7 million people). The higher percentage of young adults with a marijuana use disorder was consistent with the higher percentage among this age group for marijuana use in the past year.

Figure 29. Marijuana Use Disorder, Pain Reliever Use Disorder, and Methamphetamine Use Disorder in the Past Year: Among People Aged 12 or Older; 2020

Figure 29     D

Cocaine Use Disorder

Among people aged 12 or older in 2020, 0.5 percent (or 1.3 million people) had a cocaine use disorder in the past year (Figure 27 and Table A.26B). The percentage of adolescents aged 12 to 17 (0.1 percent or 28,000 people) was lower than the percentages of young adults aged 18 to 25 (0.7 percent or 234,000 people) or adults aged 26 or older (0.5 percent or 1.0 million people).

Heroin Use Disorder

Among people aged 12 or older in 2020, 0.2 percent (or 691,000 people) had a heroin use disorder in the past year (Figure 27 and Table A.26B). Estimates for adolescents aged 12 to 17 who had a heroin use disorder in the past year could not be calculated with sufficient precision. Among young adults aged 18 to 25 in 2020, 0.1 percent (or 40,000 people) had a heroin use disorder in the past year. Among adults aged 26 or older in 2020, 0.3 percent (or 652,000 people) had a heroin use disorder in the past year.

Methamphetamine Use Disorder

Among people aged 12 or older in 2020, 0.6 percent (or 1.5 million people) had a methamphetamine use disorder in the past year (Figures 27 and 29). The percentage of people who had a methamphetamine use disorder in the past year was highest among adults aged 26 or older (0.6 percent or 1.4 million people), followed by young adults aged 18 to 25 (0.3 percent or 95,000 people), then by adolescents aged 12 to 17 (0.1 percent or 21,000 people). Age group differences in the percentage of people with a methamphetamine use disorder in the past year were consistent with the age group differences described previously for methamphetamine use in the past year.

Prescription Stimulant Use Disorder

Among people aged 12 or older in 2020, 0.3 percent (or 758,000 people) had a prescription stimulant use disorder in the past year (Figure 27 and Table A.26B). Among adolescents aged 12 to 17 in 2020, 0.2 percent (or 43,000 people) had a prescription stimulant use disorder in the past year. Among young adults aged 18 to 25 in 2020, 0.4 percent (or 141,000 people) had a prescription stimulant use disorder in the past year. Among adults aged 26 or older in 2020, 0.3 percent (or 574,000 people) had a prescription stimulant use disorder in the past year.

Prescription Tranquilizer Use Disorder or Sedative Use Disorder

Among people aged 12 or older in 2020, 0.4 percent (or 1.2 million people) had a prescription tranquilizer use disorder or sedative use disorder in the past year (Table A.26B). The percentage of young adults aged 18 to 25 (0.7 percent or 235,000 people) was higher than the percentages of adolescents aged 12 to 17 (0.3 percent or 73,000 people) or adults aged 26 or older (0.4 percent or 845,000 people). The higher percentage of young adults with a prescription tranquilizer use disorder or sedative use disorder was consistent with the higher percentage among this age group for prescription tranquilizer or sedative misuse in the past year.

Prescription Pain Reliever Use Disorder

Among people aged 12 or older in 2020, 0.8 percent (or 2.3 million people) had a prescription pain reliever use disorder in the past year (Figures 27 and 29). The percentage of adolescents aged 12 to 17 (0.3 percent or 80,000 people) was lower than the percentages of young adults aged 18 to 25 (0.8 percent or 269,000 people) or adults aged 26 or older (0.9 percent or 2.0 million people).

Opioid Use Disorder

Among people aged 12 or older in 2020, 1.0 percent (or 2.7 million people) had an opioid use disorder in the past year (Table A.26B). The percentage of adolescents aged 12 to 17 (0.3 percent or 80,000 people) was lower than the percentages of young adults aged 18 to 25 (0.9 percent or 286,000 people) or adults aged 26 or older (1.1 percent or 2.3 million people).

Central Nervous System Stimulant Use Disorder

Among people aged 12 or older in 2020, 1.1 percent (or 3.2 million people) had a CNS stimulant use disorder in the past year (Table A.26B). The percentage of adolescents aged 12 to 17 (0.4 percent or 88,000 people) was lower than the percentages of young adults aged 18 to 25 (1.3 percent or 423,000 people) or adults aged 26 or older (1.2 percent or 2.7 million people).

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Major Depressive Episode in the Past Year

In the 2020 NSDUH, respondents were classified as having had a major depressive episode (MDE) in the past 12 months if (1) they had at least one period of 2 weeks or longer in the past year when for most of the day nearly every day, they felt depressed, or lost interest or pleasure in daily activities; and (2) they also had problems with sleeping, eating, energy, concentration, self-worth, or having recurrent thoughts of death or recurrent suicidal ideation. The MDE questions are based on diagnostic criteria from the DSM-5, which require the presence of five or more symptoms during the same 2-week period.17 The wording for some depression questions asked of adolescent respondents aged 12 to 17 differed from the wording for similar questions asked of adult respondents aged 18 or older. Therefore, the MDE estimates for adults and youths are not directly comparable and are presented separately.14,72,73

The 2020 NSDUH also collected data on whether an MDE in the past year caused respondents to experience severe impairment in four major life activities or role domains. These domains were defined separately for youths aged 12 to 17 and adults aged 18 or older to reflect the different roles associated with the two age groups. Adolescents were classified as having an MDE with severe impairment if their depression caused severe problems with their ability to do chores at home, do well at work or school, get along with their family, or have a social life.74 Adults were classified as having an MDE with severe impairment if their depression caused severe problems with their ability to manage at home or work, have relationships with others, or have a social life.75

As noted in the section titled Changes to Data Collection Methods Because of the COVID-19 Pandemic, Quarter 4 of 2020 (i.e., October to December) marked the first time that NSDUH used web-based interviewing. However, the number of adult web respondents in Quarter 4 who provided usable information on their substance use76 but did not complete the mental health or later questions (i.e., “break-offs”) raised concerns about the 2020 mental health estimates for adults. Specifically, mental health estimates for adults could be biased77 if the characteristics of adult respondents who broke off the interview without completing the mental health questions differed from the characteristics of respondents who completed these questions. To reduce the potential for bias, a set of break-off analysis weights was developed for estimates of adults' mental health data for 2020, including the estimates for MDE among adults.78

MDE and MDE with Severe Impairment among Adolescents

Among adolescents aged 12 to 17 in 2020, 17.0 percent (or 4.1 million people) had a past year MDE (Figure 30). An estimated 12.0 percent of adolescents (or 2.9 million people) in 2020 had a past year MDE with severe impairment.

Figure 30. Major Depressive Episode (MDE) and MDE with Severe Impairment in the Past Year: Among Youths Aged 12 to 17; 2004-2020

Figure 30     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 30 Table. Major Depressive Episode (MDE) and MDE with Severe Impairment in the Past Year: Among Youths Aged 12 to 17; 2004-2020
MDE Status 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
MDE 9.0 8.8 7.9 8.2 8.3 8.1 8.0 8.2 9.1 10.7 11.4 12.5 12.8 13.3 14.4 15.7 17.0
MDE with Severe
   Impairment
N/A N/A 5.5 5.5 6.0 5.8 5.7 5.7 6.3 7.7 8.2 8.8 9.0 9.4 10.0 11.1 12.0
N/A = not available.
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

MDE and MDE with Severe Impairment among Adults

Among adults aged 18 or older in 2020, 8.4 percent (or 21.0 million people) had a past year MDE (Table A.28B). The percentage was highest among young adults aged 18 to 25 (17.0 percent or 5.6 million people), followed by adults aged 26 to 49 (9.1 percent or 9.2 million people), then by adults aged 50 or older (5.4 percent or 6.2 million people).

An estimated 6.0 percent of adults aged 18 or older (or 14.8 million people) in 2020 had a past year MDE with severe impairment (Figure 31). The percentage was highest among young adults aged 18 to 25 (12.1 percent or 4.0 million people), followed by adults aged 26 to 49 (6.5 percent or 6.5 million people), then by adults aged 50 or older (3.8 percent or 4.4 million people).

Figure 31. Major Depressive Episode with Severe Impairment in the Past Year: Among Adults Aged 18 or Older; 2009-2020

Figure 31     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 31 Table. Major Depressive Episode with Severe Impairment in the Past Year: Among Adults Aged 18 or Older; 2009-2020
Age 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
18 or Older 4.0 4.2 4.2 4.5 4.3 4.3 4.3 4.3 4.5 4.7 5.3 6.0
18 to 25 5.2 5.2 5.2 5.8 5.7 6.0 6.5 7.0 8.5 8.9 10.3 12.1
26 to 49 4.8 4.7 5.2 5.1 4.9 4.6 4.9 4.7 5.0 5.3 6.1 6.5
50 or Older 2.6 3.5 2.9 3.4 3.2 3.5 3.0 3.0 2.8 2.9 3.2 3.8
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

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Any Mental Illness among Adults in the Past Year

The 2020 NSDUH provided estimates of any mental illness (AMI) and serious mental illness (SMI) for adults aged 18 or older. Adults aged 18 or older were classified as having AMI if they had any mental, behavioral, or emotional disorder in the past year of sufficient duration to meet DSM-IV criteria (excluding developmental disorders and SUDs).18,79 Adults who were classified as having AMI were classified as having SMI if they had any mental, behavioral, or emotional disorder that substantially interfered with or limited one or more major life activities. Statistical prediction models that were developed using clinical interview data from a subset of NSDUH adult respondents in 2008 to 2012 were used to classify whether respondents in the 2008 to 2020 adult samples had AMI or SMI in the past year.80

As noted previously, a set of break-off analysis weights was developed for adults' mental health data for 2020. Estimates of AMI and SMI for 2020 used these break-off analysis weights. Among adults aged 18 or older in 2020, 21.0 percent (or 52.9 million people) had AMI in the past year (Table A.29B). The percentage was highest among young adults aged 18 to 25 (30.6 percent or 10.2 million people), followed by adults aged 26 to 49 (25.3 percent or 25.7 million people), then by adults aged 50 or older (14.5 percent or 16.9 million people).

Serious Mental Illness among Adults in the Past Year

Among adults aged 18 or older in 2020, 5.6 percent (or 14.2 million people) had SMI in the past year (Figure 32). Consistent with the age group pattern for AMI, the percentage of adults with SMI was highest among young adults aged 18 to 25 (9.7 percent or 3.3 million people), followed by adults aged 26 to 49 (6.9 percent or 7.0 million people), then by adults aged 50 or older (3.4 percent or 4.0 million people).

Figure 32. Serious Mental Illness in the Past Year: Among Adults Aged 18 or Older; 2008-2020

Figure 32     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 32 Table. Serious Mental Illness in the Past Year: Among Adults Aged 18 or Older; 2008-2020
Age 08 09 10 11 12 13 14 15 16 17 18 19 20
18 or Older 3.7 3.7 4.1 3.9 4.1 4.2 4.1 4.0 4.2 4.5 4.6 5.2 5.6
18 to 25 3.8 3.3 3.9 3.8 4.1 4.2 4.8 5.0 5.9 7.5 7.7 8.6 9.7
26 to 49 4.8 4.9 5.2 5.0 5.2 5.3 4.9 5.0 5.3 5.6 5.9 6.8 6.9
50 or Older 2.5 2.5 3.0 2.8 3.0 3.2 3.1 2.8 2.7 2.7 2.5 2.9 3.4
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

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Co-Occurring MDE and SUD among Adolescents

Adolescents aged 12 to 17 who had both a past year MDE and a past year SUD (i.e., illicit drug use disorder, alcohol use disorder, or both) were classified as having co-occurring MDE and SUD. The order of the onset of an SUD relative to the onset of an MDE among adolescents cannot be established based on the NSDUH data (e.g., whether the onset of an SUD preceded the onset of an MDE, or vice versa).

As noted previously, the 2020 NSDUH marked the first year in which SUDs were evaluated based on DSM-5 criteria as opposed to DSM-IV criteria.17,18 The Substance Use Disorders in the Past Year section in this report briefly describes the DSM-5 criteria and highlights key differences between the DSM-5 and DSM-IV criteria. The breaks in the comparability of 2020 SUD estimates with estimates from prior years also affected the comparability of 2020 estimates with previous years' estimates for co-occurring MDE and SUD among adolescents. Consequently, estimates of co occurring MDE and SUD among adolescents are presented for 2020 only.

Among adolescents aged 12 to 17 in 2020, 20.9 percent (or 5.1 million people) had either an SUD or an MDE in the past year, 14.4 percent (or 3.5 million people) had an MDE but not an SUD, 3.7 percent (or 900,000 people) had an SUD but not an MDE, and 2.7 percent (or 644,000 people) had both an MDE and an SUD in the past year (Figure 33 and Table A.30AB).

In addition, among adolescents aged 12 to 17 in 2020, 1.8 percent (or 447,000 people) had both an MDE with severe impairment and an SUD in the past year.

Figure 33. Past Year Substance Use Disorder (SUD) and Major Depressive Episode (MDE): Among Youths Aged 12 to 17; 2020

Figure 33     D

Note: Youth respondents with unknown MDE data were excluded.

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Substance Use among Adolescents with MDE

Adolescents aged 12 to 17 who had a past year MDE were more likely to use some substances in the past year or past month compared with their counterparts who did not have an MDE in the past year. In 2020, adolescents with a past year MDE were more likely than adolescents without a past year MDE to be past year illicit drug users (28.6 vs. 10.7 percent) or past year marijuana users (22.0 vs. 7.9 percent) (Figure 34). Adolescents with a past year MDE also were more likely than those without a past year MDE to be past month binge alcohol users (6.2 vs. 3.8 percent). Adolescents with a past year MDE also were more likely than those without a past year MDE to use tobacco products or vape nicotine in the past month (12.9 vs. 5.1 percent).

Figure 34. Substance Use: Among Youths Aged 12 to 17; by Past Year Major Depressive Episode (MDE) Status, 2020

Figure 34     D

+ Difference between this estimate and the estimate for youths without MDE is statistically significant at the .05 level.
Note: Youth respondents with unknown MDE data were excluded.

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Co-Occurring Mental Health Issues and SUD among Adults

Among adults aged 18 or older, having AMI and an SUD in the past year is referred to as having co occurring AMI and SUD. Adults having SMI and an SUD in the past year are referred to as having co occurring SMI and SUD. However, the order of the onset of SUDs relative to the onset of mental disorders cannot be established based on the NSDUH data for adults (e.g., whether the onset of SUDs preceded the onset of mental disorders, or vice versa).

As noted previously, the 2020 NSDUH marked the first year in which SUDs were evaluated based on DSM-5 criteria as opposed to DSM-IV criteria.17,18 The Substance Use Disorders in the Past Year section in this report briefly describes the DSM-5 criteria and highlights key differences between the DSM-5 and DSM-IV criteria. The breaks in the comparability of 2020 SUD estimates with estimates from prior years also affected the comparability of 2020 estimates of co-occurring mental health issues and SUD among adults. Consequently, estimates of co occurring mental health issues and SUD among adults are presented for 2020 only.

Co-Occurring AMI and SUD

Among adults aged 18 or older in 2020, 29.3 percent (or 73.8 million people) had either AMI or an SUD in the past year, 14.2 percent (or 35.9 million people) had AMI but not an SUD, 8.3 percent (or 20.9 million people) had an SUD but not AMI, and 6.7 percent (or 17.0 million people) had both AMI and an SUD (Figure 35 and Table A.32B).

Figure 35. Past Year Substance Use Disorder (SUD) and Any Mental Illness (AMI): Among Adults Aged 18 or Older; 2020

Figure 35     D

Co-Occurring SMI and SUD

Among adults aged 18 or older in 2020, 18.4 percent (or 46.5 million people) had either SMI or an SUD in the past year, 3.4 percent (or 8.5 million people) had SMI but not an SUD, 12.8 percent (or 32.3 million people) had an SUD but not SMI, and 2.2 percent (or 5.7 million people) had both SMI and an SUD (Figure 36 and Table A.32B).

Figure 36. Past Year Substance Use Disorder (SUD) and Serious Mental Illness (SMI): Among Adults Aged 18 or Older; 2020

Figure 36     D

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Substance Use among Adults, by Mental Illness Status

This section discusses how the prevalence of substance use among adults aged 18 or older differed based on past year mental illness status. Among adults aged 18 or older in 2020, those with SMI or AMI in the past year were more likely than those without mental illness in the past year to be past year users of illicit drugs (47.8 percent for SMI and 39.8 percent for AMI vs. 17.0 percent for adults with no mental illness), past year users of marijuana (39.2 and 32.8 percent vs. 14.6 percent), or past year misusers of opioids (i.e., heroin users or misusers of prescription pain relievers) (11.6 and 8.1 percent vs. 2.3 percent). In addition, adults with SMI or AMI were more likely than adults with no mental illness in the past year to be past month binge alcohol users (30.9 and 28.5 percent vs. 22.8 percent). Adults with SMI or AMI were more likely to use tobacco products or vape nicotine in the past month than adults with no mental illness in the past year (37.4 and 30.9 percent vs. 19.6 percent) (Figure 37).

Figure 37. Substance Use: Among Adults Aged 18 or Older; by Mental Illness Status, 2020

Figure 37     D

+ Difference between this estimate and the estimate for adults without mental illness is statistically significant at the .05 level.

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Suicidal Thoughts and Behaviors among Adults

Suicide is a leading cause of death and an important public health problem in the United States.81 It is a tragedy for all involved—the people and their families, friends, neighbors, colleagues, and communities. Provisional data from the National Vital Statistics System indicate that in 2020, 44,834 people in the United States died by suicide.82 Moreover, suicide rates increased in most states between 1999 and 2016, including increases by more than 30 percent in 25 states over this period.83 Furthermore, suicide rates continued to increase nationally from 2016 to 2018.84,85 More than 90 percent of deaths by suicide in 2018 and 2019 were among adults aged 20 or older.86 However, people who die by suicide represent a fraction of those who consider or attempt suicide.87 Out of every 31 adults in 2008 to 2011 in the United States who attempted suicide in the past 12 months, there was 1 death by suicide.88

Since 2008, NSDUH respondents aged 18 or older have been asked if at any time during the past 12 months they had thought seriously about trying to kill themselves (serious thoughts of suicide). Adults who had serious thoughts of suicide in the past 12 months were asked whether they made a plan to kill themselves (suicide plan) or tried to kill themselves (suicide attempt) in that period. This information helps guide suicide prevention programs and clinical intervention efforts.

Serious Thoughts of Suicide among Adults

Among adults aged 18 or older in 2020, 4.9 percent (or 12.2 million people) had serious thoughts of suicide in the past year (Figures 38 and 39). The percentage was highest among young adults aged 18 to 25 (11.3 percent or 3.8 million people), followed by adults aged 26 to 49 (5.3 percent or 5.3 million people), then by adults aged 50 or older (2.7 percent or 3.1 million people).

Figure 38. Adults Aged 18 or Older with Serious Thoughts of Suicide, Suicide Plans, or Suicide Attempts in the Past Year; 2020

Figure 38     D


Figure 39. Had Serious Thoughts of Suicide, Made a Suicide Plan, or Attempted Suicide in the Past Year: Among Adults Aged 18 or Older; 2020

Figure 39     D

Suicide Plans among Adults

Among adults aged 18 or older in 2020, 1.3 percent (or 3.2 million people) made a suicide plan in the past year (Figures 38 and 39). The percentage was highest among young adults aged 18 to 25 (4.0 percent or 1.3 million people), followed by adults aged 26 to 49 (1.3 percent or 1.4 million people), then by adults aged 50 or older (0.4 percent or 519,000 people).

Suicide Attempts among Adults

Among adults aged 18 or older in 2020, 0.5 percent (or 1.2 million people) attempted suicide in the past 12 months (Figures 38 and 39). The percentage was highest among young adults aged 18 to 25 (1.9 percent or 627,000 people), followed by adults aged 26 to 49 (0.4 percent or 452,000 people), then by adults aged 50 or older (0.1 percent or 124,000 people).

Suicidal Thoughts and Behaviors among Adults Because of COVID-19

During the COVID-19 pandemic, people with mental illness may experience worsening mental health problems and associated symptoms, such as thoughts of suicide. Other people may develop new mental health problems, such as depression, anxiety, or posttraumatic stress disorder, all of which are associated with increased suicide risk.89

To better understand the potential impact of the COVID-19 pandemic on suicidal thoughts and behaviors among adults in the United States, new questions were added to the NSDUH questionnaire for Quarter 4 of 2020. Therefore, estimates are limited to data that were collected from adult respondents from October to December 2020. If adult respondents reported that they thought seriously about trying to kill themselves in the past 12 months, they were asked if they had these suicidal thoughts because of the COVID-19 pandemic. Adult respondents who reported plans to kill themselves or who tried to kill themselves were also asked if they made these plans or tried to kill themselves because of the COVID-19 pandemic.

Among adults aged 18 or older in 2020 who had serious thoughts of suicide in the past year, 21.1 percent (or 2.5 million people) had serious thoughts of suicide because of the COVID-19 pandemic. Among adults who made a suicide plan in the past year, 8.5 percent (or 266,000 people) made a suicide plan because of the COVID-19 pandemic (Table A.35B).

Among adults in 2020 who had serious thoughts of suicide in the past year, similar percentages of young adults aged 18 to 25 and adults aged 26 to 49 had serious thoughts of suicide because of the COVID-19 pandemic (22.6 percent or 802,000 young adults aged 18 to 25 and 19.1 percent or 1.0 million adults aged 26 to 49). Corresponding estimates of adults aged 50 or older with serious thoughts of suicide because of the COVID-19 pandemic are not presented due to low statistical precision.13

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Suicidal Thoughts and Behaviors among Adolescents

Trends in suicide attempts and deaths by suicide have been increasing among adolescents.90,91 These trends in suicidal behaviors among adolescents are major public health concerns in the United States.92,93 Vulnerable adolescent populations exposed to adverse childhood experiences (ACEs) are at greater risk of suicide and related behaviors.94,95,96 In the midst of the COVID-19 pandemic, preliminary data suggest a rise in suicide-related emergency department visits, particularly among adolescents.97

To better understand suicidal thoughts and behaviors among adolescents, new questions were added to the NSDUH questionnaire for Quarter 4 of 2020. Therefore, estimates are limited to data that were collected from adolescent respondents from October to December 2020. In Quarter 4, adolescent respondents were asked if they seriously thought about trying to kill themselves, if they made plans to kill themselves, and if they had tried to kill themselves in the past 12 months. Unlike the questions for adults, the questions for adolescent respondents included the response options “I'm not sure” and “I don't want to answer.”

The new follow-up questions were such that if adolescent respondents reported that they thought seriously about trying to kill themselves in the past 12 months, they were asked if they had these suicidal thoughts because of the COVID-19 pandemic. Adolescent respondents who reported plans to kill themselves or who tried to kill themselves were also asked if they had these plans or tried to kill themselves because of the COVID-19 pandemic. Due to low statistical precision, however, estimates are not presented for suicidal thoughts and behaviors because of the COVID-19 pandemic among all adolescents who reported suicidal thoughts and behaviors.13

Among adolescents aged 12 to 17 in 2020, 12.0 percent (or 3.0 million people) had serious thoughts of suicide, 5.3 percent (or 1.3 million people) made a suicide plan, and 2.5 percent (or 629,000 people) attempted suicide in the past year (Figure 40 and Table A.36B).

Figure 40. Youths Aged 12 to 17 with Serious Thoughts of Suicide, Suicide Plans, or Suicide Attempts in the Past Year; 2020

Figure 40     D

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Substance Use Treatment in the Past Year

Substance use treatment is intended to help people address problems associated with their use of alcohol or illicit drugs (i.e., not counting tobacco use), including medical problems associated with the use of alcohol or illicit drugs.98 The 2020 NSDUH provided two principal measures related to substance use treatment in the past year: (a) the need for substance use treatment and (b) the receipt of substance use treatment. The survey also collected information on the types of settings where people received treatment and issues associated with people needing substance use treatment but not receiving it.14

As noted in the Substance Use Disorders in the Past Year section, the change from DSM-IV18 to DSM-517 criteria for estimating SUD led to breaks in the comparability of 2020 SUD estimates with estimates from prior years; therefore, data prior to 2020 are not shown. Also, because some estimates for substance use treatment (e.g., need for substance use treatment) are based on whether people had an SUD in the past year, this report presents substance use treatment estimates for 2020 only.

Before the COVID-19 pandemic, substance use treatment was typically delivered in person. The COVID-19 pandemic required changes in substance use treatment to include expansion of virtual treatments. To support this need, regulations for opioid treatment were relaxed for take-home medications and requirements for in-person treatment.99,100 Although reimbursement for some virtual behavioral health services was allowed before 2020, reimbursement for additional virtual services (including substance use treatment) was expanded during the COVID-19 pandemic, including reimbursement for services delivered over the phone (i.e., using only audio).101 Virtual substance use treatment has been shown to be effective102,103 and has been proposed as an alternative to in-person services for some time, particularly in instances where access to such services is limited.104 In light of these changes to substance use treatment delivery and reimbursement, questions were added to the 2020 NSDUH questionnaire for Quarter 4 (i.e., October to December) to assess the use of virtual substance use treatment services. The Receipt of Virtual (Telehealth) Services for Substance Use Treatment section presents estimates from Quarter 4 on the receipt of virtual services for substance use treatment.

Need for Substance Use Treatment

SAMHSA classifies people as having a need for substance use treatment if they had an SUD in the past year or if they received substance use treatment at a specialty facility105 in the past year (regardless of whether they had an SUD).106,107 Among people aged 12 or older in 2020, 14.9 percent (or 41.1 million people) needed substance use treatment in the past year (Figure 41 and Table A.38AB). Consistent with SUD data, the percentage of people needing substance use treatment was highest among young adults aged 18 to 25 (24.6 percent or 8.2 million people), followed by adults aged 26 or older (14.3 percent or 31.3 million people), then by adolescents aged 12 to 17 (6.4 percent or 1.6 million people).

Figure 41. Need for Substance Use Treatment in the Past Year: Among People Aged 12 or Older; 2020

Figure 41     D

Receipt of Substance Use Treatment

NSDUH respondents who used alcohol or illicit drugs in their lifetime were asked whether they ever received substance use treatment, and those who received substance use treatment in their lifetime were asked whether they received treatment in the 12 months prior to the survey interview (i.e., in the past year). Receipt of any substance use treatment includes substance use treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or self-help group (e.g., Alcoholics Anonymous or Narcotics Anonymous). Also, respondents in Quarter 4 of 2020 who reported receiving substance use treatment in the past year were asked if they received professional counseling, medication, or treatment in the past 12 months for their alcohol or drug use over the phone, by e-mail, or through video calling (i.e., virtual or telehealth services).

The 2020 NSDUH also collected information on the receipt of substance use treatment at a specialty facility. Substance use treatment at a specialty facility is included in the estimates of any substance use treatment because a subset of the treatment locations was categorized as specialty facilities. Receipt of substance use treatment at a specialty facility was defined as substance use treatment received by a respondent at a hospital (only as an inpatient), a drug or alcohol rehabilitation facility (as an inpatient or outpatient), or a mental health center. Substance use treatment at a specialty facility did not include virtual services that Quarter 4 respondents reported receiving. Substance use treatment at a specialty facility also excluded self-help groups (regardless of when data were collected).

Receipt of Any Substance Use Treatment

Among people aged 12 or older in 2020, 1.4 percent (or 4.0 million people) received any substance use treatment in the past year (Table A.38AB). An estimated 1.8 million people aged 12 or older received substance use treatment in the past year at a self-help group, 1.8 million received treatment at a rehabilitation facility as an outpatient, 1.4 million received treatment at a mental health center as an outpatient, 1.1 million received treatment at a rehabilitation facility as an inpatient, and 1.1 million received treatment at a private doctor's office (Figure 42). Smaller numbers of people received treatment at a hospital as an inpatient, in an emergency room, or in a prison or jail.

Figure 42. Locations Where Substance Use Treatment in the Past Year Was Received: Among People Aged 12 or Older; 2020

Figure 42     D

Note: Locations where people received substance use treatment are not mutually exclusive because respondents could report that they received treatment in more than one location in the past year.

In 2020, 1.6 percent of adults aged 26 or older (or 3.4 million people) and 1.3 percent of young adults aged 18 to 25 (or 445,000 people) received any substance use treatment in the past year. These percentages were higher than the corresponding percentage among adolescents aged 12 to 17 (0.7 percent or 169,000 people).

Receipt of Any Substance Use Treatment among People with a Past Year SUD

Among people aged 12 or older in 2020 with a past year SUD, 6.5 percent (or 2.6 million people) received any substance use treatment in the past year (Figure 43 and Table A.38AB). Percentages were similar among age groups: 7.6 percent of adolescents aged 12 to 17, 4.4 percent of young adults aged 18 to 25, and 7.0 percent of adults aged 26 or older with a past year SUD. Corresponding numbers of people with a past year SUD who received any substance use treatment in the past year were 120,000 adolescents, 363,000 young adults, and 2.1 million adults aged 26 or older.

Figure 43. Received Any Substance Use Treatment in the Past Year: Among People Aged 12 or Older Who Had a Substance Use Disorder in the Past Year; 2020

Figure 43     D

Receipt of Substance Use Treatment at a Specialty Facility

Among people aged 12 or older in 2020, 1.0 percent (or 2.7 million people) received substance use treatment at a specialty facility in the past year (Table A.38AB). Among adolescents aged 12 to 17, 0.2 percent (or 55,000 people) received substance use treatment at a specialty facility in the past year. This percentage among adolescents was somewhat lower than corresponding percentages for young adults aged 18 to 25 (0.9 percent or 301,000 people) and for adults aged 26 or older (1.1 percent or 2.3 million people). As noted previously, however, adolescents were less likely than young adults or adults aged 26 or older to need substance use treatment in the past year.

Receipt of Substance Use Treatment at a Specialty Facility among People Who Needed Substance Use Treatment

Among the 41.1 million people aged 12 or older in 2020 who needed substance use treatment in the past year, 6.5 percent (or 2.7 million people) received substance use treatment at a specialty facility in the past year (Figure 44 and Table A.38AB). Adults aged 26 or older who needed substance use treatment in the past year were more likely than their counterparts aged 12 to 17 or aged 18 to 25 to have received substance use treatment at a specialty facility in the past year. Among the 31.3 million adults aged 26 or older in 2020 who needed substance use treatment in the past year, 7.4 percent (or 2.3 million people) received substance use treatment at a specialty facility in the past year. In comparison, among the 1.6 million adolescents aged 12 to 17 in 2020 who needed substance use treatment in the past year, 3.5 percent (or 55,000 people) received substance use treatment at a specialty facility in the past year. Among the 8.2 million young adults aged 18 to 25 in 2020 who needed substance use treatment in the past year, 3.7 percent (or 301,000 people) received substance use treatment at a specialty facility in the past year.

Figure 44. Received Substance Use Treatment at a Specialty Facility in the Past Year: Among People Aged 12 or Older Who Needed Substance Use Treatment in the Past Year; 2020

Figure 44     D

Receipt of Virtual (Telehealth) Services for Substance Use Treatment

Among people aged 12 or older in Quarter 4 of 2020 who received substance use treatment in the past year, 58.0 percent (or 2.2 million people) received virtual (i.e., telehealth) services for substance use treatment (Table A.39AB). In addition, 58.4 percent of adults aged 26 or older in Quarter 4 who received substance use treatment in the past year (or 1.9 million people) received virtual substance use services. Estimates for adolescents aged 12 to 17 and for young adults aged 18 to 25 who received substance use treatment in the past year could not be calculated with sufficient precision.

Perceived Need for Substance Use Treatment

NSDUH respondents were classified as having a perceived need for substance use treatment (i.e., treatment for problems related to their use of alcohol or illicit drugs) if they indicated that they felt they needed substance use treatment in the past year. Respondents may have a perceived need for substance use treatment, regardless of whether they had an SUD in the past year. In this report, estimates for the perceived need for substance use treatment are discussed only among people aged 12 or older who were classified as having an SUD in the past year108 but did not receive substance use treatment at a specialty facility.106,107

Among the 38.4 million people aged 12 or older in 2020 with an SUD in the past year who did not receive substance use treatment at a specialty facility, 97.5 percent (or 37.5 million people) did not feel they needed treatment, 1.9 percent (or 737,000 people) felt they needed treatment but did not make an effort to get treatment, and 0.5 percent (or 211,000 people) felt they needed treatment and made an effort to get treatment (Figure 45 and Table A.40AB).109 Similar patterns were observed by age group. For example, among people in different age groups in 2020 with a past year SUD who did not receive substance use treatment at a specialty facility, 98.4 percent of adolescents aged 12 to 17 (or 1.5 million people), 98.1 percent of young adults aged 18 to 25 (or 7.8 million people), and 97.3 percent of adults aged 26 or older (or 28.2 million people) did not feel they needed treatment.

Figure 45. Perceived Need for Substance Use Treatment: Among People Aged 12 or Older with a Past Year Substance Use Disorder (SUD) Who Did Not Receive Substance Use Treatment at a Specialty Facility in the Past Year; 2020

Figure 45     D

Note: People who had an SUD were classified as needing substance use treatment.
Note: The percentages do not add to 100 percent due to rounding.

Reasons for Not Receiving Substance Use Treatment

NSDUH respondents who did not receive substance use treatment in the past 12 months but felt they needed treatment were asked to report the reasons for not receiving treatment.110 As noted in the previous section, among people aged 12 or older in 2020 who were classified as having an SUD and did not receive substance use treatment at a specialty facility, only 2.5 percent perceived that they needed treatment.109 For people who perceived a need for treatment, information on common reasons for not receiving substance use treatment is important for identifying and addressing barriers to treatment receipt.

Among people aged 12 or older in 2020 with a past year SUD who did not receive treatment at a specialty facility and perceived a need for treatment, the following were common reasons for not receiving substance use treatment:

Medication-Assisted Treatment for Alcohol Use or Opioid Misuse

Beginning with the 2019 NSDUH, questions were included in the interview to assess the receipt of medication-assisted treatment (MAT) for problems with alcohol use or opioid misuse. NSDUH respondents aged 12 or older who reported receiving any treatment in the past year for problems related to their use of alcohol were asked to report whether a doctor or other health professional prescribed them medication in the past year to help reduce or stop their use of alcohol. Questions on MAT for opioid misuse were asked if respondents aged 12 or older reported ever using heroin or ever misusing prescription pain relievers and reported receiving any treatment in the past year for illicit drug use problems. These respondents were asked whether a doctor or other health professional prescribed them medication in the past year to help reduce or stop their use of heroin, misuse of prescription pain relievers, or both. Respondents also were informed that MAT for opioid misuse was different from medications given to stop a drug overdose.

Medication-Assisted Treatment for Alcohol Use

Among the 28.3 million people aged 12 or older in 2020 with a past year alcohol use disorder, 1.0 percent (or 292,000 people) received MAT in the past year for their alcohol use (Table A.45AB). Among the 2.1 million people aged 12 or older in 2020 who received alcohol use treatment at any location in the past year111 (regardless of whether they had a past year alcohol use disorder), 17.2 percent (or 362,000 people) received MAT in the past year for alcohol use. Estimates in 2020 for people who received MAT in the past year for alcohol use among those with a past year alcohol use disorder and who received alcohol use treatment at any location in the past year could not be calculated with sufficient precision.

Medication-Assisted Treatment for Opioid Misuse

Among the 2.6 million people aged 12 or older in 2020 who received illicit drug use treatment (i.e., not necessarily for opioid misuse) in the past year, 30.5 percent (or 798,000 people) received MAT in the past year for opioid misuse (Table A.46AB). Among the 2.5 million people aged 12 or older with a past year opioid use disorder, 11.2 percent (or 278,000 people) received MAT in the past year for opioid misuse.111

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Mental Health Service Use in the Past Year

The 2020 NSDUH included questions to estimate the use of mental health services in the United States among the adolescent and adult populations. In addition to estimating the use of mental health services among the overall adolescent and adult populations, these questions allowed for the estimation of the use of mental health services among adolescents and adults with mental health issues (i.e., MDE, AMI, and SMI).14

Similar to its effect on substance use treatment, the COVID-19 pandemic has affected the availability of services and the modes of mental health service delivery. Even before then, virtual (i.e., telehealth) mental health care has been proposed as an alternative to in person mental health services as a means to increase access, particularly in areas where services are limited.112 Mental health care delivered virtually has been shown to be effective.113 In light of these changes to the delivery of mental health services, questions were added to the 2020 NSDUH questionnaire for Quarter 4 (i.e., October to December) to assess the use of virtual mental health services. The following subsections present estimates of the receipt of virtual mental health services: Receipt of Virtual (Telehealth) Mental Health Services among Adolescents, Receipt of Virtual (Telehealth) Mental Health Services among Adults, Receipt of Virtual (Telehealth) Mental Health Services among Adults with AMI, and Receipt of Virtual (Telehealth) Mental Health Services among Adults with SMI.

Treatment for Depression among Adolescents

Adolescents aged 12 to 17 who had met the criteria for having a past year MDE were asked whether they had received treatment for their depression in the past year. Adolescents were classified as having received treatment for their depression in the past year if they reported seeing or talking to a health professional or taking prescription medication for their depression in that period.114

Among the 4.1 million adolescents aged 12 to 17 in 2020 who had a past year MDE, 41.6 percent (or 1.7 million people) received treatment for depression in the past year (Figure 46). Among the 2.9 million adolescents in 2020 who had a past year MDE with severe impairment, 46.9 percent (or 1.4 million people) received treatment for depression in the past year. Stated another way, however, most adolescents in 2020 who had a past year MDE or an MDE with severe impairment did not receive treatment for depression in the past year.

Figure 46. Received Treatment in the Past Year for Depression: Among Youths Aged 12 to 17 with a Past Year Major Depressive Episode (MDE) or MDE with Severe Impairment; 2004-2020

Figure 46     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 46 Table. Received Treatment in the Past Year for Depression: Among Youths Aged 12 to 17 with a Past Year Major Depressive Episode (MDE) or MDE with Severe Impairment; 2004-2020
MDE Status 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
MDE 40.3 37.8 38.8 39.0 37.7 34.6 37.8 38.4 37.0 38.1 41.2 39.3 40.9 41.5 41.4 43.3 41.6
MDE with Severe
   Impairment
N/A N/A 46.5 43.9 42.6 38.8 41.1 43.5 41.0 45.0 44.7 44.6 46.7 47.5 46.9 49.7 46.9
N/A = not available.
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Treatment for Depression among Adults

Adults aged 18 or older who had met the criteria for having a past year MDE were asked whether they had received treatment for their depression in the past year. Adults were classified as having received treatment for their depression in the past year if they reported seeing or talking to a health professional or taking prescription medication for their depression in that period.114

Among the 21.0 million adults aged 18 or older in 2020 who had a past year MDE, 66.0 percent (or 13.8 million people) received treatment for depression in the past year (Figure 47). Among the 14.8 million adults aged 18 or older in 2020 who had a past year MDE with severe impairment, 71.0 percent (or 10.5 million people) received treatment for depression in the past year (Table A.48B).

Figure 47. Received Treatment in the Past Year for Depression: Among Adults Aged 18 or Older with a Past Year Major Depressive Episode; 2009-2020

Figure 47     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 47 Table. Received Treatment in the Past Year for Depression: Among Adults Aged 18 or Older with a Past Year Major Depressive Episode; 2009-2020
Age 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
18 or Older 64.3 68.2 68.1 68.0 68.6 68.6 67.2 65.3 66.8 64.8 66.3 66.0
18 to 25 47.0 48.7 47.8 49.8 50.8 49.5 46.8 44.1 50.7 49.6 50.9 57.6
26 to 49 64.8 68.1 68.1 68.8 66.7 67.9 67.4 67.4 67.3 64.4 68.9 64.8
50 or Older 73.8 78.4 80.0 76.8 81.3 80.8 80.9 77.3 79.7 78.9 76.5 75.3
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

The percentage of adults in 2020 with a past year MDE or a past year MDE with severe impairment who received treatment for depression in the past year increased with age. Specifically, the percentage of adults with a past year MDE who received treatment for depression in the past year was highest among adults aged 50 or older (75.3 percent or 4.7 million people out of 6.2 million people with an MDE), followed by adults aged 26 to 49 (64.8 percent or 5.9 million people out of 9.2 million people with an MDE), then by young adults aged 18 to 25 (57.6 percent or 3.2 million people out of 5.6 million people with an MDE). Similarly, the percentage of adults in 2020 with a past year MDE with severe impairment who received treatment for depression in the past year was highest among adults aged 50 or older (80.9 percent or 3.5 million people out of 4.4 million people with an MDE with severe impairment), followed by adults aged 26 to 49 (68.7 percent or 4.5 million people out of 6.5 million people with an MDE with severe impairment), then by young adults (63.8 percent or 2.5 million people out of 4.0 million people with an MDE with severe impairment).

Mental Health Service Use among Adolescents

In addition to asking adolescents aged 12 to 17 about treatment for depression, the 2020 NSDUH included questions for adolescents that asked about the receipt of any service for emotional or behavioral problems (i.e., not just depression) not caused by substance use. The youth mental health service utilization section of the interview asked respondents aged 12 to 17 whether they received any treatment or counseling within the 12 months prior to the interview for problems with emotions or behavior in the following settings: (a) specialty mental health settings,115 (b) education settings (talked with a school social worker, psychologist, or counselor about an emotional or behavioral problem; participated in a program for students with emotional or behavioral problems while in a regular school; or attended a school for students with emotional or behavioral problems), (c) general medical settings (care from a pediatrician or family physician for emotional or behavioral problems), (d) juvenile justice settings (services for an emotional or behavioral problem in a detention center, prison, or jail), or (e) child welfare settings (foster care or therapeutic foster care).116

Also, adolescents in Quarter 4 of 2020 (i.e., October to December) were asked new questions on the receipt of any professional counseling, medication, or treatment in the past 12 months for their mental health, emotions, or behavior over the phone, by e-mail, or through video calling (i.e., virtual or telehealth services). Virtual mental health services were categorized separately from the mental health settings described in the preceding paragraph.

Receipt of Mental Health Services in Specialty and Nonspecialty Settings among Adolescents

In 2020, 17.3 percent of adolescents aged 12 to 17 (or 4.2 million people) received mental health services in a specialty setting, including 16.6 percent (or 4.1 million people) who received mental health treatment in an outpatient setting and 2.1 percent (or 510,000 people) who received mental health treatment in an inpatient setting (Figure 48 and Table A.49B). An estimated 15.0 percent of adolescents (or 3.7 million people) received mental health services in a nonspecialty setting, including 12.8 percent (or 3.1 million people) who received mental health services in an educational setting (such as from a school social worker, school psychologist, or school counselor, or as part of a special school or program), 3.1 percent (or 762,000 people) who received mental health services in a general medicine setting, 0.3 percent (or 66,000 people) who received mental health services in a child welfare setting, and 0.1 percent (or 22,000 people) who received mental health services in a juvenile justice setting.5 Additionally, 6.9 percent of adolescents received mental health services in a combination of specialty and nonspecialty settings.33

Figure 48. Sources of Mental Health Services in the Past Year: Among Youths Aged 12 to 17; 2002-2020

Figure 48     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 48 Table. Sources of Mental Health Services in the Past Year: Among Youths Aged 12 to 17; 2002-2020
Source 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
Specialty Mental
   Health Setting
11.8 12.4 13.4 13.4 13.0 12.4 12.7 12.0 12.1 12.6 12.7 13.6 13.7 13.3 14.7 14.8 16.0 16.7 17.3
Education Setting N/A N/A N/A N/A N/A N/A N/A 12.1 12.4 11.9 12.9 13.0 13.2 13.2 13.1 13.3 14.2 15.4 12.8
General Medical
   Setting
2.7 2.9 3.4 3.2 2.8 2.8 2.9 2.5 2.5 2.5 2.5 2.8 2.9 2.7 2.9 3.3 3.1 3.7 3.1
Child Welfare
   Setting
N/A N/A N/A N/A N/A N/A N/A 0.4 0.4 0.6 0.4 0.4 0.4 0.3 0.4 0.4 0.4 0.4 0.3
Juvenile Justice
   Setting
N/A N/A N/A N/A N/A N/A N/A 0.4 0.3 0.4 0.3 0.2 0.3 0.2 0.2 0.2 0.2 0.2 0.1
N/A = not available.
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Receipt of Virtual (Telehealth) Mental Health Services among Adolescents

In Quarter 4 of 2020, 10.1 percent of adolescents aged 12 to 17 received mental health services as virtual (i.e., telehealth) services (Table A.50B). This percentage corresponds to 2.5 million adolescents.

Mental Health Service Use among Adults

Adult respondents aged 18 or older were asked whether they received treatment or counseling for any problem with emotions, “nerves,” or mental health in the past year in any inpatient or outpatient setting or if they used prescription medication in the past year for a mental or emotional condition. All adult respondents (i.e., not just those with mental illness) were asked these questions about their use of mental health services. Respondents were asked not to include treatment for their use of alcohol or illicit drugs. Unlike the previously discussed questions about treatment for depression, general questions about the receipt of treatment or counseling for mental health issues among adults did not ask about treatment for a particular mental disorder. Consequently, references in this section to treatment or counseling for any problem with emotions, nerves, or mental health are described broadly as “mental health services” or “mental health care.”

Also, adults in Quarter 4 of 2020 (i.e., October to December) were asked if they received any professional counseling, medication, or treatment for their mental health, emotions, or behavior over the phone, by e-mail, or through video calling in the past 12 months (i.e., virtual or telehealth services). Virtual mental health services were categorized separately from services in inpatient or outpatient settings or the receipt of prescription medication.

Receipt of Inpatient or Outpatient Mental Health Services or Prescription Medication among Adults

In 2020, 16.9 percent of adults aged 18 or older (or 41.4 million people) received inpatient or outpatient mental health services or took prescription medication in the past year for a mental health issue, including 0.9 percent (or 2.2 million people) who received inpatient services, 8.8 percent (or 21.5 million people) who received outpatient services, and 13.8 percent (or 33.8 million people) who took prescription medication (Figure 49). Adults aged 50 or older were less likely than young adults aged 18 to 25 or adults aged 26 to 49 to have received any of these mental health services in the past year (Table A.51B). Specifically, 15.0 percent of adults aged 50 or older (or 17.1 million people) received any of these mental health services compared with 19.5 percent of young adults (or 6.3 million people) and 18.3 percent of adults aged 26 to 49 (or 18.0 million people).

Figure 49. Type of Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older; 2002-2020

Figure 49     D

Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription medication.
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 49 Table. Type of Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older; 2002-2020
Service Type 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
Mental Health
   Services
13.0 13.2 12.8 13.0 12.9 13.3 13.5 13.4 13.8 13.6 14.5 14.6 14.8 14.2 14.4 14.8 15.0 16.1 16.9
Inpatient 0.7 0.8 0.9 1.0 0.7 1.0 0.9 0.8 0.8 0.8 0.8 0.9 1.0 0.9 0.9 1.0 1.0 1.0 0.9
Outpatient 7.4 7.1 7.1 6.8 6.7 7.0 6.8 6.4 6.6 6.7 6.6 6.6 6.7 7.1 6.9 7.5 7.9 8.3 8.8
Prescription
   Medication
10.5 10.9 10.5 10.7 10.9 11.2 11.4 11.3 11.7 11.5 12.4 12.5 12.6 11.8 12.0 12.1 12.2 13.1 13.8
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription medication.
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Receipt of Virtual (Telehealth) Mental Health Services among Adults

In 2020, 11.0 percent of adults aged 18 or older (or 26.3 million people) received virtual (i.e., telehealth) services in the past year for a mental health issue (Table A.52B).111 Adults aged 50 or older were less likely than young adults aged 18 to 25 or adults aged 26 to 49 to have received virtual mental health services in the past year. Specifically, 7.8 percent of adults aged 50 or older (or 8.8 million people) received virtual mental health services in the past year compared with 14.9 percent of young adults (or 4.8 million people) and 13.4 percent of adults aged 26 to 49 (or 12.8 million people).

Mental Health Service Use among Adults with AMI

Receipt of Inpatient or Outpatient Mental Health Services or Prescription Medication among Adults with AMI

Among the 52.9 million adults aged 18 or older in 2020 with AMI in the past year, 46.2 percent (or 24.3 million people) received inpatient or outpatient mental health services or took prescription medication to treat a mental health condition in the past year (Figure 50). Young adults aged 18 to 25 with AMI were less likely than adults aged 26 to 49 or adults aged 50 or older with AMI to receive any of these services in the past year. An estimated 42.1 percent of young adults with AMI in the past year (or 4.3 million people) received any of these mental health services in the past year compared with 46.6 percent of adults aged 26 to 49 with AMI (or 11.9 million people) and 48.0 percent of adults aged 50 or older with AMI (or 8.1 million people).

Figure 50. Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older with Any Mental Illness in the Past Year; 2008-2020

Figure 50     D

Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription medication.
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 50 Table. Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older with Any Mental Illness in the Past Year; 2008-2020
Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
18 or Older 40.9 40.2 42.4 40.8 41.0 44.7 44.7 43.1 43.1 42.6 43.3 44.8 46.2
18 to 25 30.3 32.0 32.6 32.9 34.5 34.7 33.6 32.0 35.1 38.4 37.3 38.9 42.1
26 to 49 41.4 40.8 43.3 41.1 42.0 43.5 44.2 43.3 43.1 43.3 43.9 45.4 46.6
50 or Older 45.2 42.8 45.1 43.6 42.4 50.5 49.9 48.3 46.8 44.2 45.8 47.2 48.0
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription medication.
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Receipt of Virtual (Telehealth) Mental Health Services among Adults with AMI

In 2020, 33.7 percent of adults aged 18 or older with AMI in the past year (or 18.5 million people) received virtual (i.e., telehealth) mental health services in the past year (Table A.54B). In each age group, similar percentages of adults with AMI received virtual mental health services in the past year (35.9 percent of young adults aged 18 to 25, 34.9 percent of adults aged 26 to 49, and 30.9 percent of adults aged 50 or older).

Mental Health Service Use among Adults with SMI

Receipt of Inpatient or Outpatient Mental Health Services or Prescription Medication among Adults with SMI

Among the 14.2 million adults aged 18 or older in 2020 with SMI in the past year, 64.5 percent (or 9.1 million people) received inpatient or outpatient mental health services or took prescription medication to treat a mental health condition in the past year (Figure 51). As with adults with AMI, young adults aged 18 to 25 with SMI in the past year were less likely than adults aged 26 to 49 or adults aged 50 or older with SMI to receive any of these services in the past year. Specifically, 57.6 percent of young adults with SMI (or 1.9 million people) received any of these mental health services in the past year compared with 63.0 percent of adults aged 26 to 49 with SMI (or 4.4 million people) and 72.9 percent of adults aged 50 or older with SMI (or 2.9 million people). Adults aged 50 or older with SMI also were more likely than those aged 26 to 49 with SMI to have received any of these mental health services in the past year.

Figure 51. Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older with Serious Mental Illness in the Past Year; 2008-2020

Figure 51     D

Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription medication.
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 51 Table. Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older with Serious Mental Illness in the Past Year; 2008-2020
Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
18 or Older 65.7 66.5 67.5 64.9 62.9 68.5 68.5 65.3 64.8 66.7 64.1 65.5 64.5
18 to 25 45.9 55.0 53.7 52.1 53.1 54.0 53.9 50.7 51.5 57.4 53.8 56.4 57.6
26 to 49 67.2 64.5 67.4 63.6 63.5 68.4 66.2 66.1 66.1 66.2 63.7 65.1 63.0
50 or Older 73.2 76.1 74.0 73.2 66.3 74.9 79.2 72.2 71.5 75.6 74.4 74.3 72.9
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription medication.
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Receipt of Virtual (Telehealth) Mental Health Services among Adults with SMI

In 2020, 49.8 percent of adults aged 18 or older with SMI in the past year (or 7.2 million people) received virtual (i.e., telehealth) mental health services in the past year (Table A.56B). Similar percentages of young adults aged 18 to 25 (49.3 percent) and adults aged 26 to 49 (50.3 percent) with SMI received virtual mental health services in the past year. Estimates for adults aged 50 or older with an SMI in the past year could not be calculated with sufficient precision.

Perceived Unmet Need for Mental Health Services among Adults with Mental Illness

This section discusses estimates of the perceived unmet need for mental health services among adults aged 18 or older with AMI or SMI in the past year. The section also discusses the reasons adults with AMI or SMI did not receive these services in the past year if they had a perceived unmet need.

Perceived unmet need for mental health services among adults is estimated from a question that asked all adults aged 18 or older whether there was any time in the past 12 months when they thought they needed treatment or counseling for mental health issues but did not receive services. However, this section presents estimates of the perceived unmet need for mental health services among adults with AMI or SMI, regardless of whether they received mental health services in the past 12 months. Therefore, this measure for the perceived unmet need for mental health services includes adults with AMI or SMI who may have received some type of mental health service in the past 12 months but felt an unmet need for services before or after they received services.

Perceived Unmet Need for Mental Health Services among Adults with AMI

Among the 52.9 million adults aged 18 or older in 2020 with AMI in the past year, 30.5 percent (or 16.1 million people) perceived an unmet need for mental health services in the past year (Figure 52). Among these 16.1 million adults with AMI and a perceived unmet need for mental health services, 48.0 percent (or 7.7 million people) did not receive any mental health services in the past year (Table A.58B).

Figure 52. Perceived Unmet Need for Mental Health Services in the Past Year: Among Adults Aged 18 or Older with Any Mental Illness in the Past Year; 2008-2020

Figure 52     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020.

Figure 52 Table. Perceived Unmet Need for Mental Health Services in the Past Year: Among Adults Aged 18 or Older with Any Mental Illness in the Past Year; 2008-2020
Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
18 or Older 20.6 22.1 21.0 20.7 20.8 19.3 20.8 20.3 20.7 23.7 23.6 26.0 30.5
18 to 25 30.2 29.4 29.8 28.8 28.1 27.8 28.9 29.0 32.4 35.3 37.9 40.7 47.1
26 to 49 23.3 24.8 22.5 24.6 24.4 21.7 23.3 22.5 23.0 24.5 25.3 28.0 30.5
50 or Older 11.8 14.8 15.2 12.0 13.2 12.6 14.3 13.0 12.3 16.1 13.2 13.9 20.3
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

The percentage of adults in 2020 with AMI in the past year who had a perceived unmet need for mental health services was highest among young adults aged 18 to 25 (47.1 percent or 4.8 million people), followed by adults aged 26 to 49 (30.5 percent or 7.8 million people), then by adults aged 50 or older (20.3 percent or 3.4 million people) (Figure 52). Thus, nearly half of young adults with AMI had a perceived unmet need for mental health services. Percentages of adults in 2020 with AMI and a perceived unmet need for mental health services who did not receive any mental health services were similar across age groups (Table A.58B).

Perceived Unmet Need for Mental Health Services among Adults with SMI

Among the 14.2 million adults aged 18 or older in 2020 with SMI in the past year, 49.7 percent (or 7.0 million people) perceived an unmet need for mental health services in the past year (Figure 53). Among these 7.0 million adults with SMI and a perceived unmet need for mental health services, 37.6 percent (or 2.6 million people) did not receive any mental health services in the past year (Table A.58B).

Figure 53. Perceived Unmet Need for Mental Health Services in the Past Year: Among Adults Aged 18 or Older with Serious Mental Illness in the Past Year; 2008-2020

Figure 53     D

Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

Figure 53 Table. Perceived Unmet Need for Mental Health Services in the Past Year: Among Adults Aged 18 or Older with Serious Mental Illness in the Past Year; 2008-2020
Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
18 or Older 43.7 46.3 42.0 43.1 41.6 38.6 42.9 38.2 39.7 44.2 45.1 47.7 49.7
18 to 25 50.0 52.2 53.1 55.0 49.8 51.5 53.6 50.3 53.7 55.9 59.5 62.5 63.4
26 to 49 44.8 49.2 44.3 45.2 46.2 42.4 45.4 43.3 39.7 45.2 45.2 47.6 48.0
50 or Older 38.2 37.5 32.7 33.9 30.1 27.1 33.9 23.2 30.4 32.5 31.9 35.1 41.4
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed.

The percentage of adults in 2020 with SMI in the past year who had a perceived unmet need for mental health services was highest among young adults aged 18 to 25 (63.4 percent or 2.1 million people), followed by adults aged 26 to 49 (48.0 percent or 3.3 million people), then by adults aged 50 or older (41.4 percent or 1.6 million people) (Figure 53). Thus, nearly two thirds of young adults with SMI had a perceived unmet need for mental health services. Furthermore, nearly half of adults aged 26 to 49 with SMI and about 2 in 5 adults aged 50 or older with SMI had a perceived unmet need for mental health services. Similar percentages of young adults and adults aged 26 to 49 with SMI had a perceived unmet need for mental health services and did not receive any mental health services (Table A.58B). Estimates for adults aged 50 or older with SMI and a perceived unmet need who did not receive any mental health services could not be calculated with sufficient precision.

Reasons for Not Receiving Mental Health Services among Adults with Mental Illness and a Perceived Unmet Need

Among adults aged 18 or older in 2020 who had mental illness in the past year and a perceived unmet need for mental health services but did not receive services in the past year, the most common reason for not receiving services was they could not afford the cost of care (44.9 percent for these adults with AMI and 49.5 percent for these adults with SMI) (Table A.59B). Other common reasons for not receiving services included not knowing where to go for services (32.7 percent for these adults with AMI and 33.5 percent for these adults with SMI) and believing they could handle the problem without treatment (29.7 percent for these adults with AMI and 25.0 percent for these adults with SMI). In addition, 25.9 percent of these adults with SMI were concerned about being committed to a psychiatric hospital or having to take medication.

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Receipt of Services for Co-Occurring Substance Use Disorder and Mental Health Issues

The relationship between SUDs and mental disorders is known to be bidirectional. The presence of a mental disorder may contribute to the development or exacerbation of an SUD. Likewise, the presence of an SUD may contribute to the development or exacerbation of a mental disorder. The combined presence of SUDs and mental disorders (hereafter referred to as co-occurring disorders) results in more profound functional impairment; worse treatment outcomes; higher morbidity and mortality; increased treatment costs; and higher risk for homelessness, incarceration, and suicide than if people had only one of these disorders but not both.117,118,119 Current treatment guidelines recommend that people with co-occurring disorders receive treatment for both disorders.120,121,122

This section presents estimates of the receipt of services among adolescents and adults with co occurring SUD and mental health issues. Estimates for the receipt of virtual (i.e., telehealth) services among adolescents and adults with co-occurring SUD and mental health issues are presented separately from estimates for the receipt of other services because data on the receipt of virtual services were only added during Quarter 4 (i.e., October to December 2020).

Receipt of Services among Adolescents with Co-Occurring SUD and an MDE

Among the 644,000 adolescents aged 12 to 17 in 2020 with a co-occurring SUD and an MDE in the past year, 69.0 percent (or 438,000 people) received either substance use treatment at a specialty facility or mental health services in the past year, 66.8 percent (or 424,000 people) received only mental health services, and 0.9 percent (or 6,000 people) received both substance use treatment at a specialty facility and mental health services (Table A.60B).

Receipt of Services among Adults with Co-Occurring SUD and AMI

Among the 17.0 million adults aged 18 or older in 2020 with a co-occurring SUD and AMI in the past year, 50.5 percent (or 8.5 million people) received either substance use treatment at a specialty facility or mental health services in the past year, and 49.5 percent (or 8.4 million people) received neither service (Figure 54). Stated another way, nearly half of adults with a co occurring SUD and AMI did not receive substance use treatment at a specialty facility or mental health services for either condition. In addition, 42.3 percent of adults with a co-occurring SUD and AMI (or 7.2 million people) received only mental health services, 2.5 percent (or 423,000 people) received only substance use treatment at a specialty facility, and 5.7 percent (or 960,000 people) received both substance use treatment at a specialty facility and mental health services.

Figure 54. Receipt of Substance Use Treatment at a Specialty Facility and Mental Health Services in the Past Year: Among Adults Aged 18 or Older with Past Year Substance Use Disorder and Any Mental Illness; 2020

Figure 54     D

Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription medication.
MH = mental health; SU Tx = substance use treatment.

Among adults aged 18 or older in 2020 with a co-occurring SUD and AMI in the past year, adults aged 50 or older were more likely than young adults aged 18 to 25 or adults aged 26 to 49 to have received either substance use treatment at a specialty facility or mental health services in the past year. Specifically, 63.0 percent of adults aged 50 or older with a co occurring SUD and AMI (or 2.3 million people) received either service compared with 44.9 percent of young adults (or 1.8 million people) and 48.1 percent of adults aged 26 to 49 (or 4.4 million people) with a co occurring SUD and AMI.

In addition, young adults aged 18 to 25 in 2020 with a co-occurring SUD and AMI in the past year were less likely than corresponding adults in older age groups to have received both substance use treatment at a specialty facility and mental health services in the past year. An estimated 2.6 percent of young adults (or 104,000 people) with a co occurring SUD and AMI in the past year received both services in the past year compared with 6.0 percent of adults aged 26 to 49 (or 560,000 people) and 8.2 percent of adults aged 50 or older (or 296,000 people) with a co-occurring SUD and AMI (Table A.62B).

Receipt of Services among Adults with Co-Occurring SUD and SMI

Among the 5.7 million adults aged 18 or older in 2020 with a co-occurring SUD and SMI in the past year, 66.4 percent (or 3.7 million people) received either substance use treatment at a specialty facility or mental health services in the past year, and 33.6 percent (or 1.9 million people) received neither service (Figure 55). Stated another way, about one third of adults with a co-occurring SUD and SMI (representing nearly 2 million people) did not receive substance use treatment at a specialty facility or mental health services for either condition. In addition, 55.4 percent of adults with a co-occurring SUD and SMI (or 3.1 million people) received only mental health services, 1.6 percent (or 89,000 people) received only substance use treatment at a specialty facility, and 9.3 percent (or 529,000 people) received both substance use treatment at a specialty facility and mental health services.

Figure 55. Receipt of Substance Use Treatment at a Specialty Facility and Mental Health Services in the Past Year: Among Adults Aged 18 or Older with Past Year Substance Use Disorder and Serious Mental Illness; 2020

Figure 55     D

Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription medication.
MH = mental health; SU Tx = substance use treatment.
Note: The percentages do not add to 100 percent due to rounding.

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Perceived Recovery

Since 2018, respondents aged 18 or older have been asked whether they thought they ever had a problem with their use of alcohol or other drugs or whether they ever had a problem with their mental health. Respondents who reported that they ever had a problem with their alcohol or other drug use were asked whether they considered themselves (at the time they were interviewed) to be in recovery or to have recovered from their alcohol or other drug use problem. Similarly, respondents aged 18 or older who reported that they had a problem with their mental health were asked whether they considered themselves (at the time they were interviewed) to be in recovery or to have recovered from their mental health issue.

Among adults aged 18 or older in 2020, 11.6 percent (or 29.2 million people) perceived that they ever had a problem with their use of alcohol or other drugs (Table A.64B). As noted in prior sections of this report, young adults aged 18 to 25 in 2020 tended to be more likely than adults aged 26 or older to be binge alcohol users in the past month, to have used illicit drugs in the past year, or to have had an SUD in the past year. However, only 7.5 percent of young adults (or 2.5 million people) perceived that they ever had a problem with their use of alcohol or other drugs compared with 12.3 percent of adults aged 26 or older (or 26.7 million people).

Among the 29.2 million adults in 2020 who perceived that they ever had a substance use problem, 72.5 percent (or 21.0 million people) considered themselves to be in recovery or to have recovered from their alcohol or other drug use problem (Table A.65B). Adults aged 26 or older who perceived that they ever had a substance use problem were more likely than corresponding young adults aged 18 to 25 to consider themselves to be in recovery or to have recovered from their substance use problem. About three fourths of adults aged 26 or older who perceived that they ever had a substance use problem considered themselves to be in recovery or to have recovered (73.4 percent or 19.5 million people) compared with about two thirds of young adults who perceived that they ever had a substance use problem (63.4 percent or 1.6 million people).

In 2020, 22.0 percent of adults aged 18 or older (or 55.0 million people) perceived that they ever had a problem with their mental health (Table A.64B). Young adults aged 18 to 25 were more likely than adults aged 26 or older to perceive that they ever had a problem with their mental health (34.7 percent of young adults or 11.5 million people vs. 20.0 percent of adults aged 26 or older or 43.5 million people).

Among the 55.0 million adults in 2020 who perceived that they ever had a problem with their mental health, 65.9 percent (or 35.8 million people) considered themselves to be in recovery or to have recovered from their mental health issue (Table A.65B). Young adults aged 18 to 25 who perceived that they ever had a problem with their mental health were somewhat less likely than corresponding adults aged 26 or older to consider themselves to be in recovery or to have recovered from their mental health issue (61.8 percent of young adults or 7.1 million people vs. 66.9 percent of adults aged 26 or older or 28.8 million people).

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Substance Use, Mental Health Issues, and the COVID-19 Pandemic

The COVID-19 pandemic and the requisite measures taken to combat it created challenges in the everyday lives of Americans. To describe effects of the COVID-19 pandemic on people's substance use, mental health, and other parts of their lives, SAMHSA added questions to the 2020 NSDUH for Quarter 4 (i.e., October to December). These questions asked respondents to describe how the COVID-19 pandemic affected their mental health; substance use; financial security; housing; and access to substance use treatment, mental health services, and medical care. This section provides an overview of estimates of the effect of the COVID-19 pandemic on substance use and mental health issues according to how NSDUH respondents aged 12 or older answered these questions during Quarter 4.14

Data from most of these questions reflect respondents' subjective perceptions of how their lives changed during the COVID-19 pandemic. The questions concerning mental health and substance use asked respondents to rate the effects of the COVID-19 pandemic on their mental or emotional health using a scale of responses (“not at all,” “a little,” “some,” “quite a bit,” or “a lot”). Similarly, respondents were asked how much the COVID-19 pandemic affected their substance use, with responses for using a substance “much less,” “a little less,” “about the same,” “a little more,” or “a lot more” than they did before the COVID-19 pandemic began.

However, there are no objective indicators to define the categories on these subjective measures. For example, one respondent could define the same negative effects on mental health as having “some” negative effect, and another respondent could define these effects as negatively affecting their mental health “quite a bit.” Similarly, one respondent could define the same change in substance use as “much less,” and another respondent could define the change as “a little less.” Also, these are sensitive questions, and some respondents may have given responses they felt were more socially desirable. Some respondents may have been reluctant to report increased mental health issues, and some respondents whose substance use increased during the COVID-19 pandemic might have been reluctant to report that they were using substances more than they did before the COVID-19 pandemic began.

An additional consideration is that data from the Centers for Disease Control and Prevention showed three peaks in the number of new COVID-19 cases in the United States in 2020: (1) in March and April, (2) in July, and (3) in late November and December.123 Therefore, these NSDUH data from Quarter 4 could depend on the period(s) of the COVID-19 pandemic respondents recalled when answering the questions.

Perceived Negative Effects on Mental Health Because of the COVID-19 Pandemic

As mentioned previously, respondents were asked to rate the COVID-19 pandemic's negative effect on their mental health on a scale ranging from “not at all” to “a lot.” To facilitate analysis, responses were collapsed into three categories: “not at all,” “a little or some,” and “quite a bit or a lot.” As also noted previously, the resulting data reflect respondents' subjective perceptions and are not objective indicators of mental health issues. In addition, asking respondents how much (if at all) the COVID-19 pandemic negatively affected their mental health presupposes that the COVID-19 pandemic had a negative effect. Respondents were not offered a choice to indicate improvement in mental health (for whatever reason) since the COVID-19 pandemic began.

Perceived Negative Effects on Mental Health Because of the COVID-19 Pandemic among Adolescents Aged 12 to 17

In Quarter 4 of 2020, most adolescents aged 12 to 17 perceived a negative effect of the COVID-19 pandemic on their mental health. About 1 in 5 adolescents (18.3 percent or 4.5 million people) perceived that the COVID-19 pandemic negatively affected their mental health “quite a bit or a lot,” and an additional 50.8 percent (or 12.5 million people) perceived “a little or some” negative effect on their mental health (Figure 56). About 1 in 3 adolescents (30.8 percent or 7.6 million people) perceived no negative effect on their mental health because of the COVID-19 pandemic.

Figure 56. Perceived COVID-19 Pandemic Negative Effect on Emotional or Mental Health: Among Youths Aged 12 to 17; by Past Year Major Depressive Episode (MDE) Status, Quarter 4, 2020

Figure 56     D

Note: The percentages do not add to 100 percent due to rounding.

Adolescents aged 12 to 17 who had a past year MDE or a past year MDE with severe impairment were more likely than those without a past year MDE to perceive that the COVID-19 pandemic negatively affected their mental health “quite a bit or a lot.” Among adolescents with a past year MDE, nearly half (48.7 percent or 1.9 million people) perceived that the COVID-19 pandemic negatively affected their mental health “quite a bit or a lot,” as did more than half of adolescents who had a past year MDE with severe impairment (55.3 percent or 1.5 million people). In comparison, 12.7 percent of adolescents without a past year MDE (or 2.6 million people) perceived this level of a negative effect on their mental health because of the COVID-19 pandemic. For adolescents who had a past year MDE or a past year MDE with severe impairment, however, it is not known from these data whether they had an MDE before the COVID-19 pandemic or a new MDE that began during the COVID-19 pandemic.

In addition, about half of adolescents who did not have a past year MDE (52.2 percent or 10.6 million people), 40.8 percent (or 1.5 million people) of adolescents with a past year MDE, and 35.1 percent (or 944,000 people) of adolescents with a past year MDE with severe impairment perceived that the COVID-19 pandemic negatively affected their mental health “a little or some.” It is unclear whether these negative effects were temporary or longer lasting. Even if adolescents did not have a past year MDE, some of them could have needed mental health services during the COVID-19 pandemic.

Perceived Negative Effects on Mental Health Because of the COVID-19 Pandemic among Adults Aged 18 or Older

Similar to adolescents, most adults aged 18 or older in Quarter 4 of 2020 perceived a negative effect of the COVID-19 pandemic on their mental health. About 1 in 5 adults (18.3 percent or 45.2 million people) perceived that the COVID-19 pandemic negatively affected their mental health “quite a bit or a lot,” and another 54.7 percent (or 135.2 million people) perceived “a little or some” negative effect on their mental health (Figure 57). However, slightly more than 1 in 4 adults (27.0 percent or 66.8 million people) perceived no negative effect on their mental health because of the COVID-19 pandemic. Because these data were collected in Quarter 4, these estimates might not reflect temporary negative effects on mental health that occurred early in the COVID-19 pandemic.

Figure 57. Perceived COVID-19 Pandemic Negative Effect on Emotional or Mental Health: Among Adults Aged 18 or Older; by Past Year Mental Illness Status, Quarter 4, 2020

Figure 57     D

Note: The percentages do not add to 100 percent due to rounding.

In Quarter 4 of 2020, adults aged 18 or older with AMI or SMI in the past year were more likely than those who did not have mental illness in the past year to perceive that the COVID-19 pandemic negatively affected their mental health “quite a bit or a lot.” Among adults with AMI in the past year, 45.2 percent (or 24.3 million people) perceived the COVID-19 pandemic to have negatively affected their mental health “quite a bit or a lot,” as did more than half of adults with SMI in the past year (54.9 percent or 7.9 million people). In comparison, about 1 in 10 adults with no mental illness in the past year (10.8 percent or 20.9 million people) perceived the COVID-19 pandemic to have negatively affected their mental health “quite a bit or a lot.” However, it is not known from these data whether adults had pre-existing AMI or SMI that they perceived to have worsened or whether they had AMI or SMI for the first time during the COVID-19 pandemic. Nevertheless, these data indicate the need for adults with AMI and SMI to receive mental health services during the COVID-19 pandemic.

Perceived Effects on Substance Use Because of the COVID-19 Pandemic

Stressors and feelings of social isolation during the COVID-19 pandemic could have negatively affected Americans’ substance use. In many states, establishments that sold alcohol for off-premises consumption (e.g., liquor stores, grocery stores) remained open as “essential businesses” during periods when stay-at-home orders were in effect. During the COVID-19 pandemic, some states also changed laws to allow “to-go” drinks from bars and restaurants and loosened restrictions on home delivery of alcohol.124 Czeisler and colleagues reported estimates from June 2020 showing certain groups of adults started to use substances or increased their substance use to cope with the COVID-19 pandemic.21 Other studies conducted in May and June 2020 also showed at least short-term increases in alcohol consumption, especially among some population subgroups.125,126

However, individuals also could have decreased their substance use in the short or long term in response to the COVID-19 pandemic. For example, data from Europe indicated some temporary decreases in substance use during the COVID-19 pandemic due to disruptions in illicit drug markets, but these reductions began to disappear as social distancing measures were eased.127 Adolescents and college-aged young adults living at home may have had fewer opportunities to use substances regardless of their desire or intent to use them. It does not appear that respondents in the study by Czeisler and colleagues were asked whether they reduced their substance use or stopped using specific substances during the COVID-19 pandemic.21 Therefore, a more complete picture of how people's substance use changed during the COVID-19 pandemic also would include information on people who reduced their substance use.

As mentioned previously, new questions in Quarter 4 of the 2020 NSDUH asked respondents to rate how the COVID-19 pandemic affected their use of alcohol and other drugs. Respondents who used alcohol or other drugs in the past 12 months could report substance use ranging from “much less” to “a lot more” than use before the COVID-19 pandemic. Respondents answered separate questions about effects of the COVID-19 pandemic on their alcohol and other drug use. To facilitate analysis, responses were collapsed into three categories: “a little less or much less,” “about the same,” and “a little more or much more.”128

Perceived Effects on Alcohol Use

Among people aged 12 or older in Quarter 4 of 2020 who drank alcohol in the past year, most perceived that they drank “about the same” amount as they did before the COVID-19 pandemic began (59.4 percent or 100.0 million people) (Figure 58). In addition, 25.2 percent of past year alcohol users (or 42.5 million people) perceived that they drank “a little less or much less” alcohol than they did before the COVID-19 pandemic began, and 15.4 percent (or 25.9 million people) perceived that they drank “a little more or much more” than they did before. Because these data were collected in Quarter 4, these estimates might not reflect temporary increases in alcohol consumption early in the COVID-19 pandemic that were followed by a return to a pattern of alcohol use that was about the same as it was before the COVID-19 pandemic began.

Figure 58. Perceived COVID-19 Pandemic Effect on Alcohol Use: Among Past Year Alcohol Users Aged 12 or Older; Quarter 4, 2020

Figure 58     D

Note: The percentages do not add to 100 percent due to rounding.

About 1 in 5 young adults aged 18 to 25 in Quarter 4 of 2020 who drank alcohol in the past year (18.2 percent or 3.7 million people) perceived that they drank “a little more or much more” than they did before the COVID-19 pandemic began. The percentage of young adult alcohol users who perceived that they drank “a little more or much more” than they did before the COVID-19 pandemic was higher than the corresponding percentage among past year alcohol users aged 26 or older (15.0 percent or 21.8 million people). In addition, 14.5 percent of adolescents aged 12 to 17 who drank alcohol in the past year (or 491,000 people) perceived that they drank “a little more or much more” than they did before the COVID-19 pandemic began. People who were drinking more than they did before the COVID-19 pandemic began might not return to their earlier patterns of alcohol consumption, or their level of alcohol use could decrease over time.

In Quarter 4 of 2020, 38.7 percent of adolescents aged 12 to 17 (or 1.3 million people) and 29.3 percent of young adults aged 18 to 25 (or 5.9 million people) who drank alcohol in the past year perceived that they were drinking “a little less or much less” than they did before the COVID-19 pandemic began. These percentages were higher than the corresponding percentage among adults aged 26 or older who used alcohol in the past year (24.3 percent or 35.3 million people). It is unknown whether people who were drinking less than they did before the COVID-19 pandemic began will return to their earlier patterns of alcohol consumption. For example, college-age young adults who were living with their parents during the COVID-19 pandemic could resume their earlier patterns of alcohol consumption once they return to their campus environment, and adolescents may increase their drinking as opportunities increase for unsupervised social activities.

Perceived Effects on the Use of Drugs Other than Alcohol

Among people aged 12 or older in Quarter 4 of 2020 who used drugs other than alcohol in the past year,128 about 1 in 3 (32.2 percent or 33.9 million people) perceived that they used these drugs “a little less or much less” than they did before the COVID-19 pandemic began, and more than half (57.5 percent or 60.6 million people) perceived that they used these drugs “about the same” as they did before the COVID-19 pandemic began (Figure 59). An estimated 10.3 percent of past year users of drugs other than alcohol (or 10.9 million people) perceived that they used these drugs “a little more or much more” during the COVID-19 pandemic than they did before. It is not known, however, whether people who reduced or increased their use of these drugs will return to their earlier levels of use over time.

Figure 59. Perceived COVID-19 Pandemic Effect on Drug Use: Among Past Year Users of Drugs Other than Alcohol Aged 12 or Older; Quarter 4, 2020

Figure 59     D

Note: Use of drugs other than alcohol included the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine in the past year or any use (i.e., not necessarily misuse) of prescription pain relievers, tranquilizers, stimulants, or sedatives in the past year. Drugs other than alcohol did not include tobacco products or nicotine vaping.
Note: The percentages do not add to 100 percent due to rounding.

In Quarter 4 of 2020, nearly half of adolescents aged 12 to 17 who used drugs other than alcohol in the past year (46.4 percent or 2.0 million people) perceived that they used these drugs “a little less or much less” than they did before the COVID-19 pandemic began. This percentage among adolescents was higher than the corresponding percentages among young adults aged 18 to 25 (31.8 percent or 4.2 million people) and those aged 26 or older (31.5 percent or 27.7 million people) who used these drugs. As previously noted in relation to perceived reductions in alcohol use, these adolescents could increase their use of other drugs as they have more opportunities to engage in social activities with peers.

Adolescents and young adults in Quarter 4 of 2020 who used drugs other than alcohol in the past year were more likely than their counterparts aged 26 or older to perceive that they used these drugs “a little more or much more” than they did before the COVID-19 pandemic. Specifically, 15.2 percent of adolescents (or 665,000 people) and 18.7 percent of young adults (or 2.5 million people) perceived that they used these drugs “a little more or much more” than they did before the COVID-19 pandemic began. In comparison, 8.8 percent of adults aged 26 or older who used drugs other than alcohol in the past year (or 7.7 million people) perceived that they used these drugs “a little more or much more” than they did before the COVID-19 pandemic began. It is unknown, however, whether these will be short- or long-term increases in other drug use that persist beyond the COVID-19 pandemic. Further, because the data were collected in Quarter 4 of 2020, there may have been additional short-term increases in other drug use earlier in 2020 that are not reflected in these data.

Perceived Effects on Access to Services Because of the COVID-19 Pandemic

The COVID-19 pandemic could have affected access to substance use treatment, mental health services, and medical care in different ways. In response to the COVID-19 pandemic, for example, healthcare providers (including behavioral healthcare providers) turned to virtual (i.e., telehealth) services (i.e., delivery of healthcare services over the phone or Internet) as a means of delivering services while also limiting in-person contact that could spread COVID-19.129 As discussed in the section Substance Use Treatment in the Past Year, reimbursement for virtual services was expanded during the COVID-19 pandemic, including reimbursement for services delivered over the phone (i.e., using only audio).

To assess the various effects of the COVID-19 pandemic on access to behavioral health and medical services, NSDUH respondents in Quarter 4 were asked if they experienced the following because of the COVID-19 pandemic: (1) appointments moved from in-person to telehealth format, (2) delays or cancellations in appointments, (3) delays in getting prescriptions, and (4) inability to access needed care resulting in moderate to severe impact on health. Respondents were asked separately about each of these situations in relation to their access to substance use treatment, mental health treatment, and medical care because of the COVID-19 pandemic.

Access to Substance Use Treatment

As noted previously, people were asked whether they experienced the following in their access to substance use treatment because of the COVID-19 pandemic: (1) appointments moved from in-person to telehealth format, (2) delays or cancellations in appointments, (3) delays in getting prescriptions, and (4) inability to access needed care resulting in moderate to severe impact on health. For people in Quarter 4 of 2020 who received substance use treatment in the past year, several estimates of perceived changes in access to substance use treatment because of the COVID-19 pandemic could not be calculated with sufficient precision. In addition, 97.5 percent of people aged 12 or older in 2020 with a past year SUD who did not receive substance use treatment at a specialty facility in the past year did not think that they needed substance use treatment. The COVID-19 pandemic’s effect on access to substance use treatment would not be relevant to people who did not feel that they needed those services. For these reasons, this section of the report does not present findings from Quarter 4 of 2020 on specific effects of the COVID-19 pandemic on people's access to substance use treatment.

Access to Mental Health Services

Among adults aged 18 or older in Quarter 4 of 2020 who received mental health services in the past year, more than half (58.3 percent or 26.6 million people) had appointments moved from in person to telehealth, and 1 in 3 (38.7 percent or 17.7 million people) experienced delays or cancellations in appointments (Figure 60). The finding that more than half of adults aged 18 or older who received mental health services in the past year had appointments moved from in person to telehealth likely reflects the use of virtual (i.e., telehealth) services to continue delivering mental health services and the expansion of reimbursement for virtual services.

Figure 60. Perceived COVID-19 Pandemic Effect on Mental Health Services: Among Adults Aged 18 or Older Who Received Services; Quarter 4, 2020

Figure 60     D

In addition, about 1 in 6 adults aged 18 or older in 2020 who received mental health services in the past year (16.0 percent or 7.3 million people) experienced delays in getting prescriptions, and 1 in 10 (10.7 percent or 4.9 million people) were unable to access needed care resulting in a perceived moderate to severe impact on health. That 4.9 million adults perceived their health to have been negatively affected because they were unable to access needed mental health services is an important indicator of adverse impacts of changes in access to these services during the COVID-19 pandemic.

These patterns were consistent among adult age groups. Among adults aged 18 or older in Quarter 4 of 2020 who received mental health services in the past year, for example, 62.7 percent of young adults aged 18 to 25 (or 4.6 million people) and 57.4 percent of adults aged 26 or older (or 22.0 million people) had appointments moved from in person to telehealth. An estimated 9.7 percent of young adults (or 715,000 people) and 10.9 percent of adults aged 26 or older (or 4.2 million people) who received mental health services in the past year were unable to access needed care resulting in a perceived moderate to severe impact on health.

Access to Medical Services

Among people aged 12 or older in Quarter 4 of 2020, nearly 1 in 3 (31.3 percent or 84.6 million people) had medical appointments moved from in person to telehealth, and more than 1 in 4 (29.4 percent or 79.4 million people) experienced delays or cancellations in medical appointments or preventive services (Figure 61). About 1 in 11 people (8.9 percent or 23.9 million people) experienced delays in getting prescriptions, and 1 in 20 (5.6 percent or 15.1 million people) were unable to access needed medical care resulting in a perceived moderate to severe impact on health. That 15.1 million people whose health was negatively affected because they were unable to access needed medical care is particularly concerning. Issues discussed previously regarding access to mental health services also would apply if people's in-person medical appointments were moved to telehealth or if people experienced delays or cancellations in their medical appointments during the COVID-19 pandemic.

Figure 61. Perceived COVID-19 Pandemic Effect on Access to Medical Care: Among People Aged 12 or Older; Quarter 4, 2020

Figure 61     D

Adults aged 26 or older in 2020 (regardless of quarter) were more likely than adolescents and young adults to have had two or more outpatient medical visits in the past year.33 Therefore, perceptions of whether the COVID-19 pandemic affected people's access to medical care would be especially relevant to adults aged 26 or older. Among adults aged 26 or older in Quarter 4 of 2020, 34.2 percent (or 72.9 million people) had medical appointments moved from in person to telehealth, 32.0 percent (or 68.2 million people) experienced delays or cancellations in medical appointments or preventive services, 9.4 percent (or 20.1 million people) experienced delays in getting prescriptions, and 6.1 percent (or 13.0 million people) were unable to access needed medical care resulting in a perceived moderate to severe impact on health.

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Endnotes

1Hasin, D. S., & Grant, B. F. (2015). The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: Review and summary of findings. Social Psychiatry and Psychiatric Epidemiology, 50, 1609-1640. https://doi.org/10.1007/s00127-015-1088-0 exit icon

2World Health Organization. (2013). Mental health action plan 2013 – 2020. Retrieved from https://www.who.int/mental_health/publications/action_plan/en/ exit icon

3Reeves, W. C., Strine, T. W., Pratt, L. A., Thompson, W., Ahluwalia, I., Dhingra, S. S., McKnight-Eily, L. R., Harrison, L., D’Angelo, D. V., Williams, L., Morrow, B., Gould, D., & Safran, M. A. (2011). Mental illness surveillance among adults in the United States. Morbidity and Mortality Weekly Report CDC Surveillance Summaries, 60(Suppl. 3), 1-29. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/su6003a1.htm

4Murray, C. J. L., & Lopez, A. D. (2013). Measuring the global burden of disease. New England Journal of Medicine, 369, 448-457. https://doi.org/10.1056/nejmra1201534 exit icon

5This report occasionally presents estimated numbers of people with a specific characteristic (e.g., estimated numbers of substance users). Some of these estimated numbers are not included in figures or tables in the report but may be found in the detailed tables for the 2020 NSDUH available at https://www.samhsa.gov/data/.

6Details about the sample design, weighting, and interviewing results for the 2020 NSDUH are provided in Sections 2.1, 2.3.4, and 3.3.1 of CBHSQ (2021), including changes to the sample design and weighting procedures because of the COVID-19 pandemic. In particular, Tables 2.1 and 2.2 in CBHSQ (2021) provide sample design information on the targeted numbers of completed interviews by state and by age group, respectively. See the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

7Overall response rates are not calculated for adolescents or adults because the screening response rate is not specific to age groups.

8Center for Systems Science and Engineering, Johns Hopkins University. (2021). Coronavirus resource center: Global map: COVID-19 dashboard. Retrieved from https://coronavirus.jhu.edu/map.html exit icon

9Although the 2020 NSDUH sample size was smaller than the target sample size of 67,500 completed interviews, relatively few estimates in this report did not meet the criteria for publication due to low statistical precision. Numbers of final respondents in different age groups also were sufficiently large to detect statistically significant differences for several estimates presented in this report. For discussion of the criteria for suppressing (i.e., not publishing) unreliable estimates and for testing for statistical significance, see Sections 3.2.2 and 3.2.3 in the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

10Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

11For methodological reasons, the 2020 NSDUH estimates in this report are not comparable with NSDUH data collected prior to 2002. For more details, see Appendix C in the following report for the 2004 NSDUH: Office of Applied Studies. (2005). Results from the 2004 National Survey on Drug Use and Health: National findings (HHS Publication No. SMA 05-4062, NSDUH Series H-28). Rockville, MD: Substance Abuse and Mental Health Services Administration.

12Estimates presented in this report have been weighted to reflect characteristics of the civilian, noninstitutionalized population aged 12 or older in the United States. The calculation of NSDUH weights for analysis includes a step that yields weights consistent with population totals obtained from the U.S. Census Bureau based on the most recently available decennial census.

13For a discussion of the criteria for suppressing (i.e., not publishing) unreliable estimates, see Section 3.2.2 in the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

14Please refer to the 2020 NSDUH detailed tables (available at https://www.samhsa.gov/data/) for population estimates cited in this report that do not appear in the report figures, their accompanying data tables, or the appendix tables.

15Survey modes included data collection in person or through the web.

16Chapters 3 and 6 of CBHSQ (2021) discuss data quality issues for NSDUH in greater detail. See the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

17American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Arlington, VA: Author.

18American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: Author.

19Hossain, M. M., Tasnim, S., Sultana, A., Faizah, F., Mazumder, H., Zou, L., McKyer, E. L. J., Ahmed, H. U., & Ma, P. (2020). Epidemiology of mental health problems in COVID-19: A review. F1000 Research, 9, 636. https://doi.org/10.12688/f1000research.24457.1 exit icon

20Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 66(4), 317-320. https://doi.org/10.1177/0020764020915212 exit icon

21Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. W. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24-30, 2020. Morbidity and Mortality Weekly Report, 69(32), 1049-1057. https://doi.org/10.15585/mmwr.mm6932a1 exit icon

22For information on the statistical testing procedures for the 2020 NSDUH, see Section 3.2.3 in the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

23Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2020). Monitoring the Future national survey results on drug use 1975-2019: 2019 overview, key findings on adolescent drug use. Ann Arbor, MI: University of Michigan, Institute for Social Research. Retrieved from http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2019.pdf exit icon

24U.S. Food and Drug Administration. (2020). 2019 National Youth Tobacco Survey shows youth e-cigarette use at alarming levels. Retrieved from https://www.fda.gov

25Wang, T. W., Gentzke, A. S., Creamer, M. R., Cullen, K. A., Holder-Hayes, E., Sawdey, M. D., Anic, G. M., Portnoy, D. B., Hu, S., Homa, D. M., Jamal, A., & Neff, L. J. (2019). Tobacco product use and associated factors among middle and high school students — United States, 2019. Morbidity and Mortality Weekly Report Surveillance Summaries, 68(SS-12), 1-22. https://doi.org/10.15585/mmwr.ss6812a1 exit icon

26Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2021). Monitoring the Future national survey results on drug use, 1975-2020: Volume I, Secondary school students. Ann Arbor, MI: University of Michigan, Institute for Social Research. Retrieved from http://www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2020.pdf exit icon

27Gentzke, A. S., Wang, T. W., Jamal, A., Park-Lee, E., Ren, C., Cullen, K. A., & Neff, L. (2020). Tobacco product use among middle and high school students — United States, 2020. Morbidity and Mortality Weekly Report, 69, 1882-1888. https://doi.org/10.15585/mmwr.mm6950a1 exit icon

28See the following reference: Center for Behavioral Health Statistics and Quality. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 14-4863, NSDUH Series H-48). Retrieved from https://www.samhsa.gov/data/

29U.S. Food and Drug Administration. (2021). Tobacco 21. Retrieved from https://www.fda.gov/tobacco-products/retail-sales-tobacco-products/tobacco-21

30In the 2020 NSDUH, a “drink” was defined as 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. Times when respondents had only a sip or two from a drink were not considered to be alcohol consumption.

31The threshold for determining binge alcohol use for females was lowered from five or more drinks on an occasion for the 2014 and earlier NSDUHs to four or more drinks on an occasion for the 2015 NSDUH to ensure consistency with federal definitions and other federal data collection programs. The threshold for males in 2015 remained at five or more drinks on an occasion. New baselines began in 2015 for estimates of binge and heavy alcohol use for females and for binge and heavy alcohol use for the overall population (both genders). Estimates from 2002 to 2020 for binge and heavy alcohol use among males are available in the 2020 NSDUH detailed tables at https://www.samhsa.gov/data/.

32The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 grams per deciliter (g/dL). This typically occurs after four drinks for women and five drinks for men in about 2 hours. See the following two references:

National Institute on Alcohol Abuse and Alcoholism. (2004, Winter). NIAAA council approves definition of binge drinking. NIAAA Newsletter, 3, 3. Retrieved from https://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf

National Institute on Alcohol Abuse and Alcoholism. (2019). Drinking levels defined. Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

33These estimates were calculated from special analyses but are not included in the appendix tables or in the 2020 detailed tables.

34Alcohol Policy Information System, National Institute on Alcohol Abuse and Alcoholism. (n.d.). Highlight on underage drinking. Retrieved from https://alcoholpolicy.niaaa.nih.gov/underage-drinking

35The 2020 NSDUH questionnaire included separate sections for tranquilizer misuse and sedative misuse. Data from these sections were combined to produce aggregate estimates for the misuse of any tranquilizer or sedative.

36The estimated numbers of current users of different illicit drugs are not mutually exclusive because people could have used more than one type of illicit drug in the past month.

37LSD = lysergic acid diethylamide; PCP = phencyclidine; MDMA = methylenedioxy-methamphetamine; DMT = dimethyltryptamine; AMT = alpha-methyltryptamine; Foxy = N, N-diisopropyl-5-methoxytryptamine (5-MeO-DIPT). Definitions for these hallucinogens also are included in Appendix A of the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

38Desoxyn® was not mentioned in 2020 as some other stimulant and has been mentioned only rarely in some years since 2015. Because Desoxyn® is chemically similar to other prescription amphetamines (e.g., Adderall®), it was grouped with the other amphetamines.

39For example, the product label for Xanax®, which is prescribed as a tranquilizer, indicates the drug has an average half-life of 11.2 hours (i.e., the length of time for half of the dosage of the drug to be metabolized), with a range of 6.3 to 26.9 hours in healthy adults. In comparison, the product label for Halcion®, a benzodiazepine prescribed as a sedative, has a short half-life in the range of 1.5 to 5.5 hours. Product label information for these drugs is available on the U.S. Food and Drug Administration’s Center for Drug Evaluation and Research website at https://www.fda.gov/drugs/.

40Examples of forms of fentanyl presented to NSDUH respondents are available by prescription. NSDUH respondents were not asked about the use of fentanyl illicitly manufactured in clandestine laboratories.

41National Institute on Drug Abuse. (2021, April). DrugFacts: Cocaine. Retrieved from https://www.drugabuse.gov/publications/finder/t/160/drugfacts

42National Institute on Drug Abuse. (2019, May). DrugFacts: Methamphetamine. Retrieved from https://www.drugabuse.gov/publications/finder/t/160/drugfacts

43National Institute on Drug Abuse. (2018, June). DrugFacts: Prescription stimulants. Retrieved from https://www.drugabuse.gov/publications/finder/t/160/drugfacts

44Drug Enforcement Administration. (2020). Drugs of abuse, a DEA resource guide: 2020 edition. Retrieved from https://www.dea.gov/

45Schedule I controlled substances have no currently accepted medical use and have a high potential for abuse. See the following reference: Drug Enforcement Administration. (2020). Drugs of abuse, a DEA resource guide: 2020 edition. Retrieved from https://www.dea.gov/

46U.S. National Library of Medicine. (2021). Diphenhydramine. Retrieved from https://medlineplus.gov/druginformation.html

47U.S. National Library of Medicine. (2021). Phenylephrine. Retrieved from https://medlineplus.gov/druginformation.html

48National Institute on Drug Abuse. (2019, April). DrugFacts: Kratom. Retrieved from https://www.drugabuse.gov/publications/finder/t/160/drugfacts

49Although kratom is not scheduled nationally as a controlled substance, the Drug Enforcement Administration includes kratom as a drug of concern because it poses risks to people who use it. However, some states may prohibit the possession and use of kratom. See the following reference: Drug Enforcement Administration. (2020). Drugs of abuse, a DEA resource guide: 2020 edition. Retrieved from https://www.dea.gov/

50National Institute on Drug Abuse. (2020, June). DrugFacts: Synthetic cannabinoids (K2/Spice). Retrieved from https://www.drugabuse.gov/publications/finder/t/160/drugfacts

51National Institute on Drug Abuse. (2020, July). DrugFacts: Synthetic cathinones (bath salts). Retrieved from https://www.drugabuse.gov/publications/finder/t/160/drugfacts

52To measure initiation for most substances, NSDUH respondents who reported they ever used a particular substance were asked to report their age when they first used it. To measure initiation of prescription drug misuse (i.e., misuse of pain relievers, tranquilizers, stimulants, and sedatives), NSDUH respondents who reported they misused a particular prescription drug in the past 12 months were asked to report their age when they first misused it. Respondents who reported first use (or misuse in the case of prescription drugs) of a substance within a year of their current age also were asked to report the year and month when they first used (or misused) it.

53Estimates relating to the periods prior to the 12-month reference period have not been considered here because of concerns about their validity resulting from recall bias. See the following reference: Gfroerer, J., Hughes, A., Chromy, J., Heller, D., & Packer, L. (2004, July). Estimating trends in substance use based on reports of prior use in a cross-sectional survey. In S. B. Cohen & J. M. Lepkowski (Eds.), Eighth Conference on Health Survey Research Methods: Conference proceedings [Peachtree City, GA] (HHS Publication No. PHS 04-1013, pp. 29-34). Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics.

54For substances other than prescription psychotherapeutic drugs, respondents who had ever used the substance (e.g., marijuana) were asked to report when they first used the substance, and respondents who reported first use within a year of their current age were asked to report the year and month when they first used it. Thus, past year initiates of the use of substances other than prescription psychotherapeutic drugs reported their first use within 12 months of the interview date.

55Assessing whether respondents in the 2020 NSDUH had initiated misuse of a prescription psychotherapeutic drug in the past 12 months differed from assessing whether respondents had initiated the use of other substances in that period because the psychotherapeutic drug categories (e.g., prescription pain relievers) include many different types of prescription drugs in a given category (e.g., pain relievers containing hydrocodone, such as Vicodin®, Lortab®, Norco®, Zohydro® ER, or generic hydrocodone). Respondents in 2020 were asked questions about initiation of misuse only for the specific prescription drugs they misused in the past 12 months, including their age when they first misused a drug and (if the first misuse occurred within a year of the current age) the year and month of first misuse for that drug. Respondents who reported they initiated misuse in the past 12 months for all of the specific prescription drugs in a given category they misused in that period were asked a follow-up question to establish whether they had ever misused prescription drugs in that category more than 12 months before being interviewed. Respondents who answered this follow-up question as “no” were classified as being past year initiates of the misuse of any prescription drug in the overall category. This answer meant respondents had never misused any prescription drug in that category more than 12 months prior to the interview date.

56Section 3.4.2 in the following reference discusses the potential since 2015 for NSDUH respondents to underreport lifetime (but not past year) misuse of prescription psychotherapeutic drugs: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

57More information about the methods for measuring and estimating the initiation of substance use and prescription drug misuse in NSDUH can be found in Section 3.4.2 of the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

58Numbers in Figure 21 refer to people who used a specific substance for the first time in the past year, regardless of whether the initiation of use of other substances occurred prior to the past year.

59Past year initiates of crack cocaine use are counted as past year initiates of cocaine use only if they initiated any use of cocaine in the past year. Likewise, past year initiates of LSD, PCP, or Ecstasy use are counted as past year initiates of hallucinogen use only if respondents had previously not used other hallucinogens.

60Survey questions for the perceived risk from using different substances vary in terms of the frequency (e.g., use once or twice a week, use nearly every day or daily) and quantity of use (e.g., having five or more drinks of alcohol, any use of marijuana, cocaine, or heroin), making comparisons difficult for perceptions of risk from using different substances.

61Compton, W. M., Han, B., Jones, C. M., Blanco, C., & Hughes, A. (2016). Marijuana use and use disorders in adults in the USA, 2002-14: Analysis of annual cross-sectional surveys. Lancet Psychiatry, 3, 954-964. https://doi.org/10.1016/S2215-0366(16)30208-5 exit icon

62Because of the cross-sectional nature of NSDUH data (i.e., reports of perceived risk and substance use made at a single point in time instead of from the same individuals over multiple points in time), causal connections cannot be made between perceptions of risk and substance use.

63Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. B. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370, 2219-2227. https://doi.org/10.1056/NEJMra1402309 exit icon

64National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press. https://doi.org/10.17226/24625 exit icon

65For more information about the DSM-5 criteria for SUDs, see Section 3.4.3 and the definitions for abuse and dependence in Appendix A of the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

66The DSM-IV criteria for SUDs include separate criteria for dependence or abuse. People who met the criteria for abuse for a given substance (e.g., alcohol) did not meet the criteria for dependence for that substance. For more information, see Section 3.4.3 and the definitions for abuse and dependence in Appendix A of the following reference: Center for Behavioral Health Statistics and Quality. (2020). 2019 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

67A Clinical Validation Study (CVS) was conducted in early 2020 to assess NSDUH SUD questions that were revised to be consistent with the DSM-5 criteria. For more information on the CVS, see Section 3.4.3.4 in the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

68For alcohol, for example, withdrawal symptoms include (but are not limited to) trouble sleeping, hands trembling, hallucinations (seeing, feeling, or hearing things that were not really there), or feeling anxious.

69Goldstein, R. B., Chou, S. P., Smith, S. M., Jung, J., Zhang, H., Saha, T. D., Pickering, R. P., Ruan, W. J., Huang, B., & Grant, B. F. (2015). Nosologic comparisons of DSM-IV and DSM-5 alcohol and drug use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Journal of Studies on Alcohol and Drugs, 76(3), 378-388. https://doi.org/10.15288/jsad.2015.76.378 exit icon

70Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Detailed tables. Retrieved from https://www.samhsa.gov/data/

71Respondents who reported any use of prescription drugs in a given prescription psychotherapeutic category in the past 12 months (e.g., prescription pain relievers) but did not report misuse of any drugs in that category in the past 12 months were not asked the SUD questions for that category.

72Adolescents were first asked whether they ever had a period in their lifetime lasting several days or longer when any of the following was true for most of the day: (a) feeling sad, empty, or depressed; (b) feeling very discouraged or hopeless about how things were going in their lives; or (c) losing interest and becoming bored with most things they usually enjoy. Adolescents who reported any of these problems were asked further questions about their experience with the nine symptoms of MDE in their lifetime. Adolescents were classified as having an MDE in their lifetime if they experienced at least five of the nine symptoms in the same 2-week period in their lifetime; at least one of the symptoms needed to be having a depressed mood or loss of interest or pleasure in activities that had been enjoyable. Adolescents who reported gaining weight without trying were asked if their weight gain occurred because they were growing; this question was not asked of adult respondents. Adolescent respondents who had a lifetime MDE were asked if they had a period of 2 weeks or longer in the past 12 months when they felt depressed or lost interest or pleasure in previously enjoyable activities, and they reported having some of their other MDE symptoms. These adolescents were classified as having a past year MDE.

73Adults were first asked whether they ever had a period in their lifetime lasting several days or longer when any of the following was true for most of the day: (a) feeling sad, empty, or depressed; (b) feeling discouraged about how things were going in their lives; or (c) losing interest in most things they usually enjoy. Adults who reported any of these problems were asked further questions about their experience with the nine symptoms of MDE in their lifetime. Adults were classified as having an MDE in their lifetime if they experienced at least five of the nine symptoms in the same 2-week period in their lifetime; at least one of the symptoms needed to be having a depressed mood or loss of interest or pleasure in activities that had been enjoyable. Adult respondents who had a lifetime MDE were asked if they had a period of 2 weeks or longer in the past 12 months when they felt depressed or lost interest or pleasure in previously enjoyable activities, and they reported having some of their other MDE symptoms. These adults were classified as having a past year MDE. Data on MDE in the past year for adults have been available in NSDUH since 2005.

74Questions measuring adolescents’ impairment in carrying out life activities because of MDE were added to the survey in 2006.

75Data on MDE with severe impairment for adults have been available since 2009.

76Details about the criteria for defining a NSDUH interview as usable are provided in Section 2.3.1 of CBHSQ (2021). See the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

77Bias refers to error in estimates that does not occur at random.

78Details about the break-off analysis weights are provided in Sections 2.3.4, 3.4.7, and 6.2.2 of CBHSQ (2021). See the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

79Follow-up clinical interviews for classifying whether adults had a mental, behavioral, or emotional disorder in the past year used the Structured Clinical Interview for the DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). See the following reference: 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, NY: New York State Psychiatric Institute, Biometrics Research.

80Information on the definitions and estimation methods for the mental illness estimates is provided in Section 3.4.7 and Appendix A of CBHSQ (2021). See the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

81Hedegaard, H., Curtin, S. C., & Warner, M. (2021, February). Suicide mortality in the United States, 1999-2019 (NCHS Data Brief No. 398). Retrieved from https://www.cdc.gov/nchs/products/databriefs.htm

82Ahmad, F. B., & Anderson, R. N. (2021). The leading causes of death in the US for 2020. JAMA, 325, 1829-1830. https://doi.org/10.1001/jama.2021.5469 exit icon

83Stone, D. M., Simon, T. R., Fowler, K. A., Kegler, S. R., Yuan, K., Holland, K. M., Ivey-Stephenson, A. Z., & Crosby, A. E. (2018, June 8). Vital Signs: Trends in state suicide rates — United States, 1999-2016 and circumstances contributing to suicide — 27 states, 2015. Morbidity and Mortality Weekly Report, 67(22), 617-624. https://doi.org/10.15585/mmwr.mm6722a1 exit icon

84Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018, November). Mortality in the United States, 2017 (NCHS Data Brief No. 328). Retrieved from https://www.cdc.gov/nchs/products/databriefs.htm

85Xu, J., Murphy, S. L., Kochanek, K. D., & Arias, E. (2020, January). Mortality in the United States, 2018 (NCHS Data Brief No. 355). Retrieved from https://www.cdc.gov/nchs/products/databriefs.htm

86Data are from the Centers for Disease Control and Prevention WONDER (Wide-ranging ONline Data for Epidemiologic Research) Multiple Cause of Death database, 2018-2019, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. See the following reference: Centers for Disease Control and Prevention, National Center for Health Statistics. (2020). Underlying cause of death 2018-2019. Retrieved from https://wonder.cdc.gov/ucd-icd10-expanded.html

87Crosby, A. E., Han, B., Ortega, L. A. G., Parks, S. E., & Gfroerer, J. (2011, October 21). Suicidal thoughts and behaviors among adults aged ≥18 years—United States, 2008-2009. Morbidity and Mortality Weekly Report Surveillance Summaries, 60(SS13), 1-22. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6013a1.htm

88Han, B., Kott, P. S., Hughes, A., McKeon, R., Blanco, C., & Compton, W. M. (2016). Estimating the rates of deaths by suicide among adults who attempt suicide in the United States. Journal of Psychiatric Research, 77, 125-133. https://doi.org/10.1016/j.jpsychires.2016.03.002 exit icon

89Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., Khan, M., O’Connor, R. C., Pirkis, J., & COVID-19 Suicide Prevention Research Collaboration. (2020). Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry, 7, 468-471. https://doi.org/10.1016/S2215-0366(20)30171-1 exit icon

90Wang, J., Sumner, S. A., Simon, T. R., Crosby, A. E., Annor, F. B., Gaylor, E., Xu, L., & Holland, K. M. (2020). Trends in the incidence and lethality of suicidal acts in the United States, 2006 to 2015. JAMA Psychiatry, 77, 684-693. https://doi.org/10.1001/jamapsychiatry.2020.0596 exit icon

91Miron, O., Yu, K.-H., Wilf-Miron, R., & Kohane, I. S. (2019). Suicide rates among adolescents and young adults in the United States, 2000-2017. JAMA, 321, 2362-2364. https://doi.org/10.1001/jama.2019.5054 exit icon

92Mojtabai, R., & Olfson, M. (2020). National trends in mental health care for US adolescents. JAMA Psychiatry, 77, 703-714. https://doi.org/10.1001/jamapsychiatry.2020.0279 exit icon

93Mojtabai, R., Olfson, M., & Han, B. (2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138(6), e20161878. https://doi.org/10.1542/peds.2016-1878 exit icon

94Examples of ACEs include abuse, neglect, and negative family interactions. ACEs can occur anytime from birth to age 17.

95Thompson, M. P., Kingree, J. B., & Lamis, D. (2019). Associations of adverse childhood experiences and suicidal behaviors in adulthood in a US nationally representative sample. Child: Care, Health and Development, 45(1), 121-128. https://doi.org/10.1111/cch.12617 exit icon

96Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences Study. JAMA, 286(24), 3089-3096. https://doi.org/10.1001/jama.286.24.3089 exit icon

97Yard, E., Radhakrishnan, L., Ballesteros, M. F., Sheppard, M., Gates, A., Stein, Z., Hartnett, K., Kite-Powell, A., Rodgers, L., Adjemian, J., Ehlman, D. C., Holland, K., Idaikkadar, N., Ivey-Stephenson, A., Martinez, P., Law, R., & Stone, D. M. (2021). Emergency department visits for suspected suicide attempts among persons aged 12-25 years before and during the COVID-19 pandemic — United States, January 2019–May 2021. Morbidity and Mortality Weekly Report, 70(24), 888-894. https://doi.org/10.15585/mmwr.mm7024e1 exit icon

98Respondents were eligible to be asked the substance use treatment questions if they reported lifetime use of alcohol, marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine, or the lifetime misuse of prescription psychotherapeutic drugs (i.e., pain relievers, tranquilizers, stimulants, or sedatives). Respondents who were lifetime users of tobacco products or other substances (e.g., kratom) but who did not report lifetime use or misuse of the substances mentioned in the previous sentence were not asked the substance use treatment questions.

99Substance Abuse and Mental Health Services Administration. (2020). Opioid treatment program (OTP) guidance. Retrieved from https://www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf

100Drug Enforcement Administration. (2020). Use of telephone evaluations to initiate buprenorphine prescribing. Retrieved on June 8, 2021, from https://www.deadiversion.usdoj.gov/

101U.S. Department of Health and Human Services. (2021). Best practice guide: Telehealth for behavioral health care: Billing for telebehavioral health. Retrieved on June 18, 2021, from https://telehealth.hhs.gov/providers/telehealth-for-behavioral-health/billing-for-telebehavioral-health/

102Lin, L., Casteel, D., Shigekawa, E., Weyrich, M. S., Roby, D. H., & McMenamin, S. B. (2019). Telemedicine-delivered treatment interventions for substance use disorders: A systematic review. Journal of Substance Abuse Treatment, 101, 38-49. https://doi.org/10.1016/j.jsat.2019.03.007 exit icon

103Fiacco, L., Pearson, B. L., & Jordan, R. (2021). Telemedicine works for treating substance use disorder: The STAR clinic experience during COVID-19. Journal of Substance Abuse Treatment, 125. https://doi.org/10.1016/j.jsat.2021.108312 exit icon

104Benavides-Vaello, S., Strode, A., & Sheeran, B. C. (2013). Using technology in the delivery of mental health and substance abuse treatment in rural communities: A review. Journal of Behavioral Health Services & Research, 40, 111-120. https://doi.org/10.1007/s11414-012-9299-6 exit icon

105Substance use treatment at a specialty facility refers to substance use treatment at a hospital (only as an inpatient), a drug or alcohol rehabilitation facility (as an inpatient or outpatient), or a mental health center. This NSDUH definition historically has not considered emergency rooms, private doctors’ offices, prisons or jails, and self-help groups to be specialty facilities for the receipt of substance use treatment.

106The NSDUH definition of the need for treatment does not explicitly indicate the need for treatment at a specialty facility. People with an SUD in the past year can be considered to need some form of assistance for their problems with substance use. For more information about the DSM-5 criteria for having an SUD, see Section 3.4.3 and the definition for SUD in Appendix A of CBHSQ (2021). See the following references:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Arlington, VA: Author.

Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

107There were 40.3 million people aged 12 or older in 2020 with an SUD in the past year. Approximately 98 percent of the people in 2020 who needed treatment for a substance use problem were classified as such because they had an SUD in the past year, regardless of whether they received substance use treatment at a specialty facility.

108As per the definition of the need for substance use treatment, people with an SUD were classified as needing substance use treatment.

109Due to rounding, estimated numbers and percentages of people in Figure 45 who made an effort or did not make an effort to get substance use treatment do not sum to the total number of people who needed substance use treatment, did not receive specialty treatment in the past year, and perceived a need for treatment.

110Respondents in Quarter 4 of 2020 who did not report receiving substance use treatment in the past year were not asked if they received telehealth services as substance use treatment. Therefore, reasons for not receiving treatment from Quarter 4 can include reasons for not receiving telehealth services.

111Reported estimates in this section may differ slightly from corresponding estimates in the 2020 detailed tables because the estimates in this section used a special break-off analysis weight for adult respondents who did not complete the interview. For more information about this break-off analysis weight, see Section 2.3.4 in the following reference: Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

112Waugh, M., Voyles, D., & Thomas, M. R. (2015). Telepsychiatry: Benefits and costs in a changing health-care environment. International Review of Psychiatry, 27, 558-568. https://doi.org/10.3109/09540261.2015.1091291 exit icon

113Reay, R. E., Looi, J. C. L., & Keightley, P. (2020). Telehealth mental health services during COVID-19: Summary of evidence and clinical practice. Australasian Psychiatry, 28, 514-516. https://doi.org/10.1177/1039856220943032 exit icon

114Health professionals include general practitioners or family doctors; other medical doctors (e.g., cardiologist, gynecologist, urologist); psychologists; psychiatrists or psychotherapists; social workers; counselors; other mental health professionals (e.g., mental health nurse or other therapist where type is not specified); and nurses, occupational therapists, or other health professionals.

115The specialty mental health setting includes services in outpatient or inpatient settings. Outpatient services include those from (a) a private therapist, psychologist, psychiatrist, social worker, or counselor; (b) a mental health clinic or center; (c) a partial day hospital or day treatment program; or (d) an in-home therapist, counselor, or family preservation worker. Inpatient or residential specialty mental health services in which adolescents stayed overnight or longer include services in a hospital or a residential treatment center.

116Due to questionnaire changes in 2009, estimates for the receipt of youth mental health services in educational settings are not comparable with estimates prior to 2009. Additionally, estimates for the receipt of youth mental health services in juvenile justice settings were not available prior to 2009.

117Compton, W. M., Thomas, Y. F., Stinson, F. S., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 64, 566-576. https://doi.org/10.1001/archpsyc.64.5.566 exit icon

118Mojtabai, R., Chen, L.-Y., Kaufmann, C. N., & Crum, R. M. (2014). Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders. Journal of Substance Abuse Treatment, 46, 268-273. https://doi.org/10.1016/j.jsat.2013.07.012 exit icon

119Hartz, S. M., Pato, C. N., Medeiros, H., Cavazos-Rehg, P., Sobell, J. L., Knowles, J. A., Bierut, L. J., & Pato, M. T. (2014). Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry, 71, 248-254. https://doi.org/10.1001/jamapsychiatry.2013.3726 exit icon

120Watkins, K. E., Hunter, S. B., Burnam, M. A., Pincus, H. A., & Nicholson, G. (2005). Review of treatment recommendations for persons with a co-occurring affective or anxiety and substance use disorder. Psychiatric Services, 56, 913-926. https://doi.org/10.1176/appi.ps.56.8.913 exit icon

121Pettinati, H. M., O’Brien, C. P., & Dundon, W. D. (2013). Current status of co-occurring mood and substance use disorders: A new therapeutic target. American Journal of Psychiatry, 170, 23-30. https://doi.org/10.1176/appi.ajp.2012.12010112 exit icon

122Han, B., Compton, W. M., Blanco, C., & Colpe, L. J. (2017). Prevalence, treatment, and unmet treatment needs of US adults with mental health and substance use disorders. Health Affairs (Millwood), 36, 1739-1747. https://doi.org/10.1377/hlthaff.2017.0584 exit icon

123Centers for Disease Control and Prevention. (n.d.). COVID Data Tracker: Trends in number of COVID-19 cases and deaths in the US reported to CDC, by state/territory. Retrieved on June 18, 2021, from https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases

124National Institute on Alcohol Abuse and Alcoholism. (2021, June 15). State alcohol-related laws during the COVID-19 emergency for on-premises and off-premises establishments as of June 15, 2021. Alcohol Policy Information System (APIS). Retrieved from https://alcoholpolicy.niaaa.nih.gov/resource/covid-19/98

125Barbosa, C., Cowell, A. J., & Dowd, W. N. (2020). Alcohol consumption in response to the COVID-19 pandemic in the United States. Journal of Addiction Medicine. https://doi.org/10.1097/ADM.0000000000000767 exit icon

126Pollard, M. S., Tucker, J. S., & Green, Jr., H. D. (2020). Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Network Open, 3(9). https://doi.org/10.1001/jamanetworkopen.2020.22942 exit icon

127European Monitoring Centre for Drugs and Drug Addiction. (2021). European Drug Report 2021: Trends and developments. Luxembourg: Publications Office of the European Union.

128Use of drugs other than alcohol included the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine in the past year or any use (i.e., not necessarily misuse) of prescription pain relievers, tranquilizers, stimulants, or sedatives in the past year. Drugs other than alcohol did not include tobacco products or nicotine vaping.

129U.S. Department of Health and Human Services. (2021, May). What is telehealth? Retrieved on July 27, 2021, from https://telehealth.hhs.gov/patients/understanding-telehealth/

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Appendix A: Special Tables of Estimates for Substance Use
and Mental Health Indicators in the United States

Table A.1B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Month: Among People Aged 12 or Older; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GENERAL SUBSTANCE USE                                        
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Illicit Drugs or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tobacco Products or Alcohol 61.0 (0.40) 60.1 (0.38) 59.6 (0.40) 61.1 (0.39) 60.7 (0.39) 60.5 (0.37) 60.6 (0.38) 60.6 (0.36) 60.9 (0.39) 60.3 (0.38)
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products 30.4 (0.35) 29.8 (0.34) 29.2 (0.33) 29.4 (0.35) 29.6 (0.35) 28.7 (0.34) 28.4 (0.35) 27.7 (0.33) 27.5 (0.34) 26.5 (0.33)
Cigarettes 26.0 (0.34) 25.4 (0.33) 24.9 (0.32) 24.9 (0.32) 25.0 (0.33) 24.3 (0.33) 24.0 (0.32) 23.3 (0.32) 23.0 (0.31) 22.1 (0.32)
Daily Cigarette Smoking1 63.4 (0.66) 62.9 (0.67) 62.3 (0.63) 63.0 (0.62) 62.3 (0.59) 61.3 (0.65) 61.5 (0.70) 61.0 (0.68) 59.5 (0.71) 60.7 (0.71)
Smoked 1+ Packs of
   Cigarettes per Day2
53.1 (0.91) 53.5 (0.82) 54.0 (0.87) 51.4 (0.86) 50.6 (0.85) 50.9 (0.88) 49.2 (0.94) 45.9 (0.98) 45.1 (0.94) 43.8 (0.90)
Smokeless Tobacco   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Cigars 5.4 (0.15) 5.4 (0.14) 5.7 (0.13) 5.6 (0.15) 5.6 (0.14) 5.4 (0.14) 5.3 (0.15) 5.3 (0.14) 5.2 (0.14) 5.0 (0.14)
Pipe Tobacco 0.8 (0.07) 0.7 (0.06) 0.8 (0.06) 0.9 (0.06) 0.9 (0.07) 0.8 (0.07) 0.8 (0.06) 0.8 (0.06) 0.8 (0.06) 0.8 (0.06)
Nicotine Vaping   --   --   --   --   --   --   --   --   --   --
ALCOHOL 51.0 (0.42) 50.1 (0.39) 50.3 (0.40) 51.8 (0.40) 51.0 (0.39) 51.2 (0.41) 51.6 (0.39) 51.9 (0.38) 51.8 (0.39) 51.8 (0.39)
Binge Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Heavy Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
OTHER SUBSTANCE USE                                        
GHB   --   --   --   -- 0.0 (0.01) 0.0 (0.00) 0.0 (0.01) 0.0 (0.00) 0.0 (0.01) 0.0 (0.01)
Nonprescription Cough or Cold Medicine   --   --   --   -- 0.2 (0.02) 0.2 (0.02) 0.2 (0.02) 0.2 (0.02) 0.2 (0.03) 0.2 (0.02)
Kratom   --   --   --   --   --   --   --   --   --   --
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   --   --   --
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   --   --   --
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.1B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Month: Among People Aged 12 or Older; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
GENERAL SUBSTANCE USE                                    
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc 60.9 (0.30) 60.2 (0.30) 60.7 (0.32) 60.2 (0.35) 60.1 (0.32) 58.7 (0.51)
Illicit Drugs or Alcohol   nc   nc   nc 54.1 (0.31) 53.4 (0.32) 54.3 (0.33) 53.9 (0.36) 54.2 (0.34) 53.6 (0.52)
Tobacco Products or Alcohol 61.0 (0.37) 60.6 (0.39) 61.0 (0.31) 59.8 (0.30) 58.9 (0.30) 59.4 (0.32) 58.8 (0.35) 58.3 (0.33) 56.9 (0.51)
ILLICIT DRUGS   nc   nc   nc 10.1 (0.17) 10.6 (0.18) 11.2 (0.19) 11.7 (0.21) 13.0 (0.20) 13.5 (0.32)
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   -- 20.7 (0.41)
Tobacco Products 26.7 (0.34) 25.5 (0.32) 25.2 (0.28) 23.9 (0.26) 23.5 (0.27) 22.4 (0.26) 21.5 (0.27) 21.1 (0.25) 18.7 (0.40)
Cigarettes 22.1 (0.32) 21.3 (0.30) 20.8 (0.26) 19.4 (0.25) 19.1 (0.25) 17.9 (0.25) 17.2 (0.25) 16.7 (0.23) 15.0 (0.38)
Daily Cigarette Smoking1 60.7 (0.71) 59.6 (0.73) 58.8 (0.59) 58.1 (0.64) 57.9 (0.66) 57.1 (0.69) 58.2 (0.71) 58.4 (0.71) 60.1 (1.25)
Smoked 1+ Packs of
   Cigarettes per Day2
42.0 (0.94) 41.3 (1.00) 40.3 (0.83) 41.1 (0.87) 41.1 (0.89) 41.2 (0.92) 39.6 (0.94) 40.5 (0.95) 37.8 (1.78)
Smokeless Tobacco   nc   nc   nc 3.4 (0.11) 3.3 (0.10) 3.2 (0.09) 2.9 (0.09) 3.1 (0.10) 2.5 (0.14)
Cigars 5.2 (0.15) 4.7 (0.14) 4.5 (0.11) 4.7 (0.12) 4.6 (0.11) 4.6 (0.11) 4.5 (0.12) 4.3 (0.11) 3.8 (0.19)
Pipe Tobacco 1.0 (0.07) 0.9 (0.06) 0.8 (0.05) 0.8 (0.05) 0.8 (0.05) 0.9 (0.05) 0.8 (0.04) 0.7 (0.04) 0.7 (0.08)
Nicotine Vaping   --   --   --   --   --   --   --   -- 3.8 (0.15)
ALCOHOL 52.1 (0.39) 52.2 (0.41) 52.7 (0.33) 51.7 (0.32) 50.7 (0.31) 51.7 (0.33) 51.1 (0.37) 50.8 (0.34) 50.0 (0.52)
Binge Alcohol Use   nc   nc   nc 24.9 (0.27) 24.2 (0.26) 24.5 (0.27) 24.5 (0.26) 23.9 (0.26) 22.2 (0.41)
Heavy Alcohol Use   nc   nc   nc 6.5 (0.14) 6.0 (0.14) 6.1 (0.13) 6.1 (0.14) 5.8 (0.14) 6.4 (0.23)
OTHER SUBSTANCE USE                                    
GHB 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.00) * (*) 0.0 (0.00) 0.0 (0.01) 0.0 (0.01)
Nonprescription Cough or Cold Medicine 0.2 (0.03) 0.2 (0.03) 0.1 (0.02) 0.2 (0.02) 0.2 (0.02) 0.2 (0.03) 0.2 (0.03) 0.3 (0.04) 0.3 (0.05)
Kratom   --   --   --   --   --   --   -- 0.3 (0.03) 0.4 (0.06)
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   -- 0.2 (0.03)
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   -- 0.0 (0.01)
* = low precision; -- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 Percentages for daily cigarette smoking are among past month cigarette smokers.
2 Percentages for smoking one or more packs of cigarettes per day are among daily cigarette smokers in the past month. Respondents with missing data for the number of cigarettes smoked per day were excluded from the analysis.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.2B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Month: Among Adolescents Aged 12 to 17; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GENERAL SUBSTANCE USE                                        
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Illicit Drugs or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tobacco Products or Alcohol 24.0 (0.38) 23.6 (0.38) 23.4 (0.35) 22.0 (0.37) 21.8 (0.37) 21.1 (0.38) 19.7 (0.35) 19.7 (0.36) 18.2 (0.36) 17.5 (0.36)
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products 15.2 (0.33) 14.4 (0.32) 14.4 (0.32) 13.1 (0.31) 12.9 (0.29) 12.4 (0.30) 11.5 (0.28) 11.8 (0.29) 10.7 (0.28) 10.0 (0.27)
Cigarettes 13.0 (0.30) 12.2 (0.29) 11.9 (0.30) 10.8 (0.28) 10.4 (0.26) 9.9 (0.27) 9.2 (0.25) 9.0 (0.26) 8.4 (0.26) 7.8 (0.24)
Daily Cigarette Smoking1 31.8 (1.03) 29.7 (1.06) 27.6 (1.13) 25.8 (1.12) 26.5 (1.19) 26.4 (1.16) 22.3 (1.11) 23.0 (1.17) 22.5 (1.29) 22.7 (1.28)
Smoked 1+ Packs of
   Cigarettes per Day2
21.8 (1.61) 22.0 (1.68) 19.4 (1.80) 20.1 (1.87) 17.9 (1.94) 18.7 (2.14) 18.4 (2.08) 17.9 (2.12) 16.7 (2.24) 14.8 (1.97)
Smokeless Tobacco   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Cigars 4.5 (0.19) 4.5 (0.17) 4.8 (0.18) 4.2 (0.18) 4.1 (0.16) 4.3 (0.18) 3.8 (0.16) 4.0 (0.16) 3.2 (0.15) 3.4 (0.16)
Pipe Tobacco 0.6 (0.06) 0.6 (0.07) 0.7 (0.08) 0.6 (0.07) 0.7 (0.07) 0.7 (0.08) 0.7 (0.07) 0.9 (0.09) 0.6 (0.07) 0.7 (0.07)
Nicotine Vaping   --   --   --   --   --   --   --   --   --   --
ALCOHOL 17.6 (0.32) 17.7 (0.33) 17.6 (0.32) 16.5 (0.32) 16.7 (0.32) 16.0 (0.34) 14.7 (0.32) 14.8 (0.32) 13.6 (0.33) 13.3 (0.31)
Binge Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Heavy Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
OTHER SUBSTANCE USE                                        
GHB   --   --   --   -- 0.0 (0.01) 0.0 (0.01) 0.0 (0.00) 0.0 (0.01) * (*) 0.0 (0.00)
Nonprescription Cough or Cold Medicine   --   --   --   -- 0.5 (0.05) 0.5 (0.06) 0.4 (0.05) 0.4 (0.05) 0.4 (0.05) 0.3 (0.05)
Kratom   --   --   --   --   --   --   --   --   --   --
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   --   --   --
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   --   --   --
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.2B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Month: Among Adolescents Aged 12 to 17; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
GENERAL SUBSTANCE USE                                    
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc 15.6 (0.37) 14.7 (0.36) 15.1 (0.37) 14.2 (0.34) 15.0 (0.34) 12.2 (0.68)
Illicit Drugs or Alcohol   nc   nc   nc 14.2 (0.35) 13.2 (0.35) 13.8 (0.35) 13.2 (0.33) 14.1 (0.33) 11.5 (0.64)
Tobacco Products or Alcohol 16.5 (0.34) 15.1 (0.33) 14.6 (0.35) 12.4 (0.33) 11.8 (0.33) 12.0 (0.34) 11.0 (0.32) 11.2 (0.32) 9.4 (0.62)
ILLICIT DRUGS   nc   nc   nc 8.8 (0.27) 7.9 (0.26) 7.9 (0.26) 8.0 (0.27) 8.7 (0.28) 6.7 (0.45)
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   -- 6.5 (0.49)
Tobacco Products 8.6 (0.25) 7.8 (0.24) 7.0 (0.25) 6.0 (0.23) 5.3 (0.21) 4.9 (0.21) 4.2 (0.19) 3.8 (0.19) 2.4 (0.29)
Cigarettes 6.6 (0.22) 5.6 (0.20) 4.9 (0.21) 4.2 (0.20) 3.4 (0.18) 3.2 (0.17) 2.7 (0.16) 2.3 (0.15) 1.4 (0.22)
Daily Cigarette Smoking1 22.0 (1.33) 19.4 (1.35) 24.1 (1.89) 20.0 (1.84) 15.0 (1.64) 12.2 (1.64) 14.7 (2.04) 13.2 (2.04) * (*)
Smoked 1+ Packs of
   Cigarettes per Day2
10.8 (1.88) 11.9 (2.47) 11.9 (2.52) 7.8 (2.51) * (*) * (*) * (*) * (*) * (*)
Smokeless Tobacco   nc   nc   nc 1.5 (0.10) 1.4 (0.11) 1.3 (0.10) 1.1 (0.10) 1.0 (0.10) 0.6 (0.11)
Cigars 2.6 (0.13) 2.3 (0.13) 2.1 (0.13) 2.1 (0.14) 1.8 (0.12) 1.9 (0.13) 1.7 (0.13) 1.4 (0.12) 0.8 (0.15)
Pipe Tobacco 0.7 (0.07) 0.6 (0.07) 0.7 (0.08) 0.3 (0.06) 0.5 (0.06) 0.4 (0.07) 0.3 (0.06) 0.3 (0.06) 0.3 (0.12)
Nicotine Vaping   --   --   --   --   --   --   --   -- 5.1 (0.43)
ALCOHOL 12.9 (0.31) 11.6 (0.29) 11.5 (0.33) 9.6 (0.29) 9.2 (0.30) 9.9 (0.30) 9.0 (0.29) 9.4 (0.30) 8.2 (0.57)
Binge Alcohol Use   nc   nc   nc 5.8 (0.23) 4.9 (0.22) 5.3 (0.22) 4.7 (0.22) 4.9 (0.22) 4.1 (0.42)
Heavy Alcohol Use   nc   nc   nc 0.9 (0.10) 0.8 (0.09) 0.7 (0.08) 0.5 (0.07) 0.8 (0.10) 0.6 (0.15)
OTHER SUBSTANCE USE                                    
GHB 0.0 (0.02) * (*) 0.0 (0.01) * (*) * (*) * (*) * (*) 0.0 (0.02) * (*)
Nonprescription Cough or Cold Medicine 0.4 (0.06) 0.3 (0.05) 0.2 (0.04) 0.3 (0.06) 0.3 (0.06) 0.3 (0.05) 0.3 (0.05) 0.2 (0.04) 0.1 (0.04)
Kratom   --   --   --   --   --   --   -- 0.1 (0.03) 0.1 (0.08)
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   -- 0.5 (0.14)
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   -- 0.0 (0.03)
* = low precision; -- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 Percentages for daily cigarette smoking are among past month cigarette smokers.
2 Percentages for smoking one or more packs of cigarettes per day are among daily cigarette smokers in the past month. Respondents with missing data for the number of cigarettes smoked per day were excluded from the analysis.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.3B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Month: Among Young Adults Aged 18 to 25; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GENERAL SUBSTANCE USE                                        
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Illicit Drugs or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tobacco Products or Alcohol 70.3 (0.48) 70.7 (0.46) 70.2 (0.48) 70.1 (0.49) 71.0 (0.47) 69.9 (0.47) 69.7 (0.47) 70.4 (0.49) 70.2 (0.46) 69.6 (0.48)
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products 45.3 (0.48) 44.8 (0.48) 44.6 (0.50) 44.3 (0.48) 44.0 (0.49) 41.9 (0.50) 41.4 (0.47) 41.6 (0.50) 40.9 (0.49) 39.5 (0.49)
Cigarettes 40.8 (0.48) 40.2 (0.47) 39.5 (0.49) 39.0 (0.47) 38.5 (0.48) 36.2 (0.49) 35.7 (0.45) 35.8 (0.48) 34.3 (0.47) 33.5 (0.47)
Daily Cigarette Smoking1 51.8 (0.72) 52.7 (0.69) 51.6 (0.72) 50.1 (0.73) 48.8 (0.77) 49.2 (0.76) 47.8 (0.81) 45.3 (0.80) 45.8 (0.80) 45.3 (0.86)
Smoked 1+ Packs of
   Cigarettes per Day2
39.1 (0.93) 37.1 (0.88) 34.9 (0.86) 36.9 (0.93) 34.4 (0.93) 32.9 (0.92) 31.6 (0.91) 29.5 (0.92) 27.3 (0.94) 26.1 (0.97)
Smokeless Tobacco   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Cigars 11.0 (0.27) 11.4 (0.26) 12.7 (0.30) 12.0 (0.28) 12.1 (0.29) 11.9 (0.28) 11.4 (0.29) 11.5 (0.29) 11.3 (0.30) 10.9 (0.29)
Pipe Tobacco 1.1 (0.08) 0.9 (0.08) 1.2 (0.09) 1.5 (0.11) 1.3 (0.10) 1.2 (0.10) 1.4 (0.10) 1.8 (0.12) 1.8 (0.12) 1.9 (0.14)
Nicotine Vaping   --   --   --   --   --   --   --   --   --   --
ALCOHOL 60.5 (0.53) 61.4 (0.50) 60.5 (0.51) 60.9 (0.51) 62.0 (0.51) 61.3 (0.52) 61.1 (0.49) 61.8 (0.52) 61.4 (0.50) 60.7 (0.54)
Binge Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Heavy Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
OTHER SUBSTANCE USE                                        
GHB   --   --   --   -- 0.0 (0.01) 0.1 (0.03) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01)
Nonprescription Cough or Cold Medicine   --   --   --   -- 0.3 (0.05) 0.4 (0.06) 0.3 (0.05) 0.4 (0.05) 0.4 (0.06) 0.3 (0.04)
Kratom   --   --   --   --   --   --   --   --   --   --
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   --   --   --
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   --   --   --
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.3B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Month: Among Young Adults Aged 18 to 25; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
GENERAL SUBSTANCE USE                                    
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc 67.9 (0.49) 66.8 (0.51) 65.8 (0.56) 64.4 (0.52) 64.0 (0.54) 59.7 (1.03)
Illicit Drugs or Alcohol   nc   nc   nc 61.9 (0.52) 61.5 (0.53) 60.9 (0.59) 59.9 (0.55) 59.8 (0.56) 56.9 (1.05)
Tobacco Products or Alcohol 69.0 (0.46) 67.9 (0.49) 67.6 (0.53) 66.3 (0.49) 64.6 (0.52) 63.7 (0.56) 61.8 (0.53) 60.8 (0.56) 56.6 (1.02)
ILLICIT DRUGS   nc   nc   nc 22.3 (0.42) 23.2 (0.43) 24.2 (0.47) 23.9 (0.48) 24.9 (0.45) 23.9 (0.84)
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   -- 25.1 (0.83)
Tobacco Products 38.1 (0.47) 37.0 (0.49) 35.0 (0.54) 33.0 (0.48) 30.0 (0.48) 29.1 (0.48) 25.8 (0.43) 24.3 (0.45) 19.2 (0.74)
Cigarettes 31.8 (0.47) 30.6 (0.46) 28.4 (0.53) 26.7 (0.46) 23.5 (0.47) 22.3 (0.44) 19.1 (0.39) 17.5 (0.40) 13.9 (0.64)
Daily Cigarette Smoking1 45.1 (0.88) 43.1 (0.83) 43.0 (0.91) 42.0 (1.02) 39.9 (1.03) 38.4 (1.02) 37.4 (1.11) 35.4 (1.13) 33.1 (2.24)
Smoked 1+ Packs of
   Cigarettes per Day2
25.1 (0.90) 22.3 (0.90) 22.5 (1.16) 22.5 (1.11) 26.2 (1.42) 25.0 (1.45) 23.4 (1.49) 25.0 (1.60) 20.8 (3.03)
Smokeless Tobacco   nc   nc   nc 5.4 (0.22) 5.2 (0.22) 4.8 (0.21) 4.4 (0.19) 4.9 (0.22) 3.9 (0.38)
Cigars 10.7 (0.27) 10.0 (0.29) 9.7 (0.30) 8.9 (0.27) 8.8 (0.27) 9.1 (0.29) 8.6 (0.27) 7.7 (0.26) 5.9 (0.46)
Pipe Tobacco 1.8 (0.11) 2.2 (0.14) 1.9 (0.13) 1.8 (0.13) 1.7 (0.12) 1.6 (0.14) 1.8 (0.14) 1.2 (0.11) 1.2 (0.18)
Nicotine Vaping   --   --   --   --   --   --   --   -- 11.7 (0.57)
ALCOHOL 60.2 (0.49) 59.6 (0.53) 59.6 (0.56) 58.3 (0.53) 57.1 (0.55) 56.3 (0.60) 55.1 (0.57) 54.3 (0.58) 51.5 (1.04)
Binge Alcohol Use   nc   nc   nc 39.0 (0.51) 38.4 (0.54) 36.9 (0.57) 34.9 (0.51) 34.3 (0.54) 31.4 (0.95)
Heavy Alcohol Use   nc   nc   nc 10.9 (0.33) 10.1 (0.32) 9.6 (0.34) 9.0 (0.34) 8.4 (0.29) 8.6 (0.54)
OTHER SUBSTANCE USE                                    
GHB 0.0 (0.02) 0.0 (0.01) * (*) 0.0 (0.01) 0.0 (0.02) * (*) * (*) 0.0 (0.02) * (*)
Nonprescription Cough or Cold Medicine 0.3 (0.07) 0.3 (0.05) 0.3 (0.06) 0.4 (0.06) 0.3 (0.06) 0.2 (0.04) 0.4 (0.07) 0.4 (0.07) 0.3 (0.10)
Kratom   --   --   --   --   --   --   -- 0.5 (0.07) 0.2 (0.07)
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   -- 0.5 (0.17)
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   -- 0.0 (0.02)
* = low precision; -- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 Percentages for daily cigarette smoking are among past month cigarette smokers.
2 Percentages for smoking one or more packs of cigarettes per day are among daily cigarette smokers in the past month. Respondents with missing data for the number of cigarettes smoked per day were excluded from the analysis.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.4B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Month: Among Adults Aged 26 or Older; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GENERAL SUBSTANCE USE                                        
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Illicit Drugs or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tobacco Products or Alcohol 64.5 (0.51) 63.2 (0.47) 62.7 (0.51) 64.9 (0.49) 64.2 (0.48) 64.1 (0.47) 64.3 (0.48) 64.1 (0.45) 64.6 (0.48) 64.1 (0.48)
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products 29.9 (0.44) 29.3 (0.41) 28.5 (0.41) 29.0 (0.43) 29.4 (0.43) 28.6 (0.42) 28.4 (0.44) 27.3 (0.40) 27.2 (0.42) 26.3 (0.41)
Cigarettes 25.2 (0.42) 24.7 (0.41) 24.1 (0.39) 24.3 (0.39) 24.7 (0.40) 24.1 (0.40) 23.8 (0.41) 23.0 (0.39) 22.8 (0.38) 21.9 (0.39)
Daily Cigarette Smoking1 68.8 (0.87) 68.0 (0.86) 67.8 (0.80) 68.9 (0.79) 67.9 (0.74) 66.3 (0.83) 67.0 (0.86) 67.2 (0.84) 64.8 (0.86) 66.5 (0.88)
Smoked 1+ Packs of
   Cigarettes per Day2
57.1 (1.12) 58.0 (0.99) 59.2 (1.05) 55.1 (1.02) 54.5 (1.00) 55.1 (1.06) 53.0 (1.10) 49.4 (1.16) 48.8 (1.09) 47.4 (1.05)
Smokeless Tobacco   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Cigars 4.6 (0.18) 4.5 (0.18) 4.6 (0.17) 4.7 (0.18) 4.6 (0.18) 4.4 (0.16) 4.4 (0.18) 4.4 (0.18) 4.4 (0.17) 4.2 (0.18)
Pipe Tobacco 0.8 (0.09) 0.6 (0.07) 0.7 (0.08) 0.8 (0.08) 0.9 (0.09) 0.8 (0.09) 0.6 (0.07) 0.7 (0.07) 0.7 (0.07) 0.7 (0.07)
Nicotine Vaping   --   --   --   --   --   --   --   --   --   --
ALCOHOL 53.9 (0.53) 52.5 (0.49) 53.0 (0.51) 55.1 (0.51) 53.7 (0.49) 54.1 (0.52) 54.7 (0.50) 54.9 (0.48) 54.9 (0.48) 55.1 (0.49)
Binge Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Heavy Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
OTHER SUBSTANCE USE                                        
GHB   --   --   --   -- 0.0 (0.01) * (*) 0.0 (0.01) * (*) 0.0 (0.01) 0.0 (0.01)
Nonprescription Cough or Cold Medicine   --   --   --   -- 0.1 (0.02) 0.1 (0.02) 0.1 (0.03) 0.1 (0.03) 0.1 (0.03) 0.1 (0.03)
Kratom   --   --   --   --   --   --   --   --   --   --
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   --   --   --
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   --   --   --
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.4B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Month: Among Adults Aged 26 or Older; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
GENERAL SUBSTANCE USE                                    
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc 65.2 (0.36) 64.5 (0.36) 65.3 (0.38) 64.9 (0.40) 64.6 (0.39) 63.8 (0.60)
Illicit Drugs or Alcohol   nc   nc   nc 57.6 (0.37) 56.8 (0.39) 58.0 (0.39) 57.6 (0.43) 57.9 (0.40) 57.9 (0.61)
Tobacco Products or Alcohol 65.1 (0.45) 65.0 (0.47) 65.5 (0.36) 64.4 (0.36) 63.5 (0.36) 64.3 (0.38) 63.9 (0.40) 63.3 (0.39) 62.4 (0.60)
ILLICIT DRUGS   nc   nc   nc 8.2 (0.19) 8.9 (0.21) 9.5 (0.22) 10.1 (0.24) 11.6 (0.23) 12.6 (0.37)
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   -- 21.6 (0.50)
Tobacco Products 27.0 (0.42) 25.7 (0.40) 25.8 (0.33) 24.5 (0.32) 24.6 (0.33) 23.4 (0.31) 22.8 (0.33) 22.6 (0.30) 20.4 (0.50)
Cigarettes 22.4 (0.40) 21.6 (0.38) 21.5 (0.32) 20.0 (0.31) 20.2 (0.31) 18.9 (0.30) 18.5 (0.30) 18.2 (0.28) 16.7 (0.47)
Daily Cigarette Smoking1 66.0 (0.85) 64.9 (0.88) 63.3 (0.72) 62.7 (0.76) 62.2 (0.75) 61.5 (0.79) 62.3 (0.79) 62.5 (0.79) 64.1 (1.36)
Smoked 1+ Packs of
   Cigarettes per Day2
45.2 (1.09) 44.7 (1.15) 43.3 (0.93) 44.1 (0.98) 43.1 (1.00) 43.2 (1.02) 41.4 (1.03) 42.0 (1.01) 38.9 (1.86)
Smokeless Tobacco   nc   nc   nc 3.2 (0.13) 3.1 (0.12) 3.1 (0.11) 2.9 (0.11) 3.1 (0.11) 2.5 (0.17)
Cigars 4.5 (0.19) 4.1 (0.17) 3.9 (0.12) 4.3 (0.14) 4.2 (0.13) 4.2 (0.13) 4.1 (0.14) 4.0 (0.14) 3.9 (0.23)
Pipe Tobacco 0.9 (0.09) 0.7 (0.07) 0.7 (0.06) 0.8 (0.06) 0.7 (0.06) 0.8 (0.06) 0.7 (0.05) 0.7 (0.05) 0.6 (0.09)
Nicotine Vaping   --   --   --   --   --   --   --   -- 2.4 (0.15)
ALCOHOL 55.6 (0.48) 55.9 (0.50) 56.5 (0.39) 55.6 (0.38) 54.6 (0.38) 55.8 (0.40) 55.3 (0.43) 55.0 (0.41) 54.6 (0.62)
Binge Alcohol Use   nc   nc   nc 24.8 (0.32) 24.2 (0.32) 24.7 (0.32) 25.1 (0.31) 24.5 (0.31) 22.9 (0.49)
Heavy Alcohol Use   nc   nc   nc 6.4 (0.17) 6.0 (0.17) 6.2 (0.16) 6.2 (0.17) 6.0 (0.17) 6.7 (0.28)
OTHER SUBSTANCE USE                                    
GHB 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) * (*) 0.0 (0.00) 0.0 (0.01) 0.0 (0.01) 0.0 (0.02)
Nonprescription Cough or Cold Medicine 0.1 (0.03) 0.1 (0.04) 0.1 (0.02) 0.1 (0.02) 0.2 (0.03) 0.2 (0.04) 0.2 (0.03) 0.3 (0.04) 0.3 (0.06)
Kratom   --   --   --   --   --   --   -- 0.3 (0.04) 0.4 (0.07)
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   -- 0.1 (0.02)
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   -- 0.0 (0.01)
* = low precision; -- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 Percentages for daily cigarette smoking are among past month cigarette smokers.
2 Percentages for smoking one or more packs of cigarettes per day are among daily cigarette smokers in the past month. Respondents with missing data for the number of cigarettes smoked per day were excluded from the analysis.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.5B – Type of Nicotine Product Use: Among Past Month Nicotine Product Users Aged 12 or Older; by Age Group, 2020
Nicotine Product Use1 Total 12 to 17 18 to 25 26 or Older
Only Nicotine Vaping2 9.7 (0.47) 63.1 (3.54) 23.6 (1.42) 5.4 (0.46)
Nicotine Vaping and Tobacco Products2,3 8.5 (0.48) 15.7 (2.24) 22.9 (1.41) 5.7 (0.49)
Nicotine Vaping and Only Cigarettes2 4.7 (0.35) 7.7 (1.84) 10.6 (1.08) 3.5 (0.36)
Nicotine Vaping, Cigarettes, and Noncigarette Tobacco
   Products2,4
2.1 (0.25) 3.5 (0.95) 6.4 (0.83) 1.3 (0.27)
Nicotine Vaping and Only Noncigarette Tobacco Products2,4 1.7 (0.22) 4.4 (1.24) 5.9 (0.83) 0.9 (0.21)
Only Tobacco Products3 81.8 (0.70) 21.2 (2.95) 53.4 (1.72) 88.9 (0.67)
NOTE: Estimates shown are percentages with standard errors included in parentheses. Percentages for only nicotine vaping, nicotine vaping and tobacco products, and only tobacco products in an age group category may not add to 100 percent due to rounding.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Nicotine product use refers to the use of tobacco or nicotine vaping.
2 Nicotine vaping refers to the use of an e-cigarette or other vaping device to vape nicotine or tobacco.
3 Tobacco products include cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or pipe tobacco. Use of any tobacco product does not include nicotine vaping because people could have used a vaping device to vape nicotine-containing products other than tobacco.
4 Noncigarette tobacco products include smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or pipe tobacco.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.6B – Type of Tobacco Product Use: Among Past Month Tobacco Users Aged 12 or Older; by Age Group, 2020
Tobacco Product Use1 Total 12 to 17 18 to 25 26 or Older
Only Cigarettes 65.3 (1.10) * (*) 49.3 (2.03) 68.0 (1.24)
Cigarettes and Noncigarette Tobacco Products2 14.8 (0.81) 22.7 (4.94) 23.2 (1.68) 13.4 (0.90)
Only Noncigarette Tobacco Products2 19.9 (0.88) * (*) 27.6 (1.96) 18.5 (0.98)
* = low precision.
NOTE: Estimates shown are percentages with standard errors included in parentheses. Percentages in an age group category may not add to 100 percent due to rounding.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Tobacco products include cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or pipe tobacco. Use of any tobacco product does not include nicotine vaping because people could have used a vaping device to vape nicotine-containing products other than tobacco.
2 Noncigarette tobacco products include smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or pipe tobacco.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.7B – Nicotine Product1 and Alcohol Use in the Past Month: Among People Aged 12 to 20; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
TOBACCO PRODUCTS OR
   NICOTINE VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products2 24.7 (0.35) 23.9 (0.36) 23.8 (0.36) 22.8 (0.34) 22.5 (0.35) 21.6 (0.34) 21.3 (0.32) 21.6 (0.36) 21.0 (0.35) 19.6 (0.35)
Cigarettes 21.6 (0.33) 20.8 (0.34) 20.3 (0.34) 19.2 (0.32) 18.9 (0.33) 17.7 (0.32) 17.6 (0.30) 17.6 (0.33) 16.9 (0.33) 16.1 (0.33)
Nicotine Vaping3   --   --   --   --   --   --   --   --   --   --
ALCOHOL 28.8 (0.39) 29.0 (0.41) 28.7 (0.39) 28.2 (0.41) 28.4 (0.42) 28.0 (0.46) 26.5 (0.40) 27.2 (0.43) 26.2 (0.41) 25.1 (0.47)
Binge Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Heavy Alcohol Use   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.7B – Nicotine Product1 and Alcohol Use in the Past Month: Among People Aged 12 to 20; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
TOBACCO PRODUCTS OR
   NICOTINE VAPING
  --   --   --   --   --   --   --   -- 11.8 (0.61)
Tobacco Products2 17.8 (0.35) 16.9 (0.33) 15.3 (0.34) 13.7 (0.33) 12.3 (0.31) 11.4 (0.30) 10.1 (0.27) 9.1 (0.27) 6.7 (0.47)
Cigarettes 14.1 (0.32) 13.0 (0.31) 11.5 (0.30) 10.2 (0.30) 8.6 (0.28) 8.0 (0.25) 6.8 (0.22) 6.0 (0.22) 4.1 (0.33)
Nicotine Vaping3   --   --   --   --   --   --   --   -- 7.7 (0.46)
ALCOHOL 24.3 (0.48) 22.7 (0.40) 22.8 (0.46) 20.3 (0.42) 19.3 (0.45) 19.7 (0.47) 18.8 (0.42) 18.5 (0.45) 16.1 (0.72)
Binge Alcohol Use   nc   nc   nc 13.4 (0.36) 12.1 (0.35) 11.9 (0.37) 11.4 (0.33) 11.1 (0.36) 9.2 (0.59)
Heavy Alcohol Use   nc   nc   nc 3.3 (0.20) 2.8 (0.17) 2.5 (0.18) 2.3 (0.16) 2.2 (0.14) 1.8 (0.25)
-- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Nicotine product use refers to the use of tobacco or nicotine vaping.
2 Tobacco products include cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or pipe tobacco.
3 Nicotine vaping refers to the use of an e-cigarette or other vaping device to vape nicotine or tobacco.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.8B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year: Among People Aged 12 or Older; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GENERAL SUBSTANCE USE                                        
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Illicit Drugs or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tobacco Products or Alcohol 72.5 (0.36) 71.5 (0.36) 71.1 (0.36) 72.8 (0.35) 72.2 (0.35) 71.8 (0.34) 72.0 (0.37) 72.3 (0.34) 72.3 (0.36) 71.8 (0.35)
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products1 36.0 (0.38) 35.1 (0.35) 34.5 (0.34) 34.9 (0.36) 35.0 (0.36) 34.3 (0.35) 33.8 (0.37) 33.2 (0.34) 32.9 (0.36) 31.8 (0.35)
Cigarettes 30.3 (0.36) 29.4 (0.34) 29.1 (0.33) 29.1 (0.34) 29.1 (0.34) 28.5 (0.34) 28.1 (0.34) 27.5 (0.33) 27.0 (0.33) 26.1 (0.33)
Smokeless Tobacco   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Cigars 11.0 (0.21) 10.7 (0.19) 10.8 (0.19) 11.1 (0.20) 10.9 (0.19) 10.8 (0.20) 10.5 (0.20) 10.6 (0.20) 10.3 (0.20) 9.7 (0.20)
Pipe Tobacco1   --   --   --   --   --   --   --   --   --   --
Nicotine Vaping   --   --   --   --   --   --   --   --   --   --
ALCOHOL 66.1 (0.39) 65.0 (0.37) 65.1 (0.37) 66.5 (0.38) 66.0 (0.37) 65.8 (0.39) 66.0 (0.38) 66.8 (0.36) 66.4 (0.38) 66.2 (0.38)
OTHER SUBSTANCE USE                                        
GHB   --   --   --   -- 0.1 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.1 (0.02) 0.0 (0.01)
Nonprescription Cough or Cold Medicine   --   --   --   -- 0.6 (0.04) 0.5 (0.03) 0.6 (0.04) 0.6 (0.04) 0.7 (0.06) 0.6 (0.04)
Kratom   --   --   --   --   --   --   --   --   --   --
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   --   --   --
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   --   --   --
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.8B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year: Among People Aged 12 or Older; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
GENERAL SUBSTANCE USE                                    
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc 72.5 (0.28) 71.5 (0.29) 72.3 (0.31) 72.1 (0.31) 71.8 (0.30) 70.3 (0.50)
Illicit Drugs or Alcohol   nc   nc   nc 68.1 (0.29) 67.2 (0.31) 68.2 (0.33) 67.9 (0.34) 68.0 (0.32) 67.1 (0.51)
Tobacco Products or Alcohol 72.2 (0.34) 71.8 (0.36) 72.1 (0.30) 71.2 (0.28) 70.2 (0.29) 70.9 (0.31) 70.7 (0.31) 70.2 (0.30) 68.6 (0.51)
ILLICIT DRUGS   nc   nc   nc 17.8 (0.23) 18.0 (0.23) 19.0 (0.24) 19.4 (0.26) 20.8 (0.27) 21.4 (0.39)
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   -- 25.6 (0.43)
Tobacco Products1 31.9 (0.36) 30.8 (0.33) 30.6 (0.29) 29.2 (0.28) 28.5 (0.28) 27.5 (0.28) 26.7 (0.29) 26.2 (0.26) 23.3 (0.43)
Cigarettes 26.1 (0.34) 25.3 (0.32) 24.8 (0.28) 23.1 (0.27) 22.7 (0.27) 21.5 (0.27) 21.0 (0.27) 20.2 (0.24) 18.4 (0.39)
Smokeless Tobacco   nc   nc   nc 4.7 (0.12) 4.4 (0.11) 4.3 (0.10) 4.0 (0.10) 4.2 (0.11) 3.3 (0.16)
Cigars 9.9 (0.20) 9.5 (0.19) 9.0 (0.15) 9.1 (0.16) 8.5 (0.14) 8.6 (0.15) 8.4 (0.16) 8.1 (0.15) 7.1 (0.23)
Pipe Tobacco1   --   --   --   --   --   --   --   --   --
Nicotine Vaping   --   --   --   --   --   --   --   -- 6.5 (0.20)
ALCOHOL 66.7 (0.37) 66.3 (0.38) 66.6 (0.31) 65.7 (0.30) 64.8 (0.30) 65.7 (0.34) 65.5 (0.35) 65.1 (0.32) 64.2 (0.52)
OTHER SUBSTANCE USE                                    
GHB 0.1 (0.02) 0.0 (0.01) 0.1 (0.01) 0.1 (0.02) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.1 (0.01) 0.1 (0.02)
Nonprescription Cough or Cold Medicine 0.5 (0.04) 0.6 (0.05) 0.5 (0.03) 0.6 (0.04) 0.6 (0.04) 0.6 (0.05) 0.6 (0.05) 0.7 (0.05) 0.9 (0.09)
Kratom   --   --   --   --   --   --   -- 0.7 (0.04) 0.8 (0.08)
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   -- 0.4 (0.05)
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   -- 0.0 (0.02)
-- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 Information about past year use of pipe tobacco was not collected. Tobacco product use in the past year excludes past year pipe tobacco use, but includes past month pipe tobacco use.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.9B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year: Among Adolescents Aged 12 to 17; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GENERAL SUBSTANCE USE                                        
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Illicit Drugs or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tobacco Products or Alcohol 39.9 (0.45) 39.2 (0.44) 38.6 (0.42) 37.9 (0.44) 37.4 (0.43) 36.2 (0.45) 35.1 (0.41) 35.0 (0.44) 33.1 (0.44) 31.8 (0.44)
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products1 23.6 (0.37) 22.5 (0.37) 22.1 (0.38) 21.2 (0.39) 20.9 (0.36) 19.8 (0.38) 19.1 (0.34) 19.5 (0.38) 18.1 (0.37) 16.8 (0.34)
Cigarettes 20.3 (0.35) 19.0 (0.36) 18.4 (0.35) 17.3 (0.36) 17.0 (0.35) 15.7 (0.34) 15.1 (0.32) 15.1 (0.34) 14.2 (0.34) 13.2 (0.31)
Smokeless Tobacco   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Cigars 10.1 (0.26) 10.0 (0.26) 10.2 (0.27) 9.8 (0.27) 9.4 (0.25) 9.4 (0.26) 8.5 (0.24) 9.0 (0.25) 7.7 (0.22) 7.8 (0.24)
Pipe Tobacco1   --   --   --   --   --   --   --   --   --   --
Nicotine Vaping   --   --   --   --   --   --   --   --   --   --
ALCOHOL 34.6 (0.42) 34.3 (0.42) 33.9 (0.41) 33.3 (0.41) 33.0 (0.42) 31.9 (0.42) 31.0 (0.41) 30.5 (0.42) 28.7 (0.43) 27.8 (0.43)
OTHER SUBSTANCE USE                                        
GHB   --   --   --   -- 0.1 (0.02) 0.0 (0.01) 0.0 (0.01) 0.1 (0.02) 0.0 (0.01) 0.0 (0.02)
Nonprescription Cough or Cold Medicine   --   --   --   -- 1.9 (0.12) 1.7 (0.12) 1.6 (0.10) 1.5 (0.10) 1.5 (0.11) 1.3 (0.10)
Kratom   --   --   --   --   --   --   --   --   --   --
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   --   --   --
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   --   --   --
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.9B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year: Among Adolescents Aged 12 to 17; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
GENERAL SUBSTANCE USE                                    
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc 29.9 (0.45) 28.7 (0.44) 29.0 (0.47) 28.2 (0.44) 28.6 (0.43) 23.6 (0.88)
Illicit Drugs or Alcohol   nc   nc   nc 28.3 (0.44) 26.8 (0.43) 27.6 (0.46) 26.9 (0.44) 27.4 (0.43) 22.9 (0.85)
Tobacco Products or Alcohol 29.7 (0.44) 28.2 (0.43) 27.2 (0.44) 25.5 (0.44) 24.5 (0.44) 24.4 (0.45) 23.2 (0.43) 23.4 (0.42) 19.8 (0.86)
ILLICIT DRUGS   nc   nc   nc 17.5 (0.37) 15.8 (0.35) 16.3 (0.37) 16.7 (0.37) 17.2 (0.36) 13.8 (0.67)
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   -- 12.0 (0.67)
Tobacco Products1 15.2 (0.32) 13.9 (0.32) 12.7 (0.34) 11.6 (0.31) 10.5 (0.31) 9.7 (0.29) 8.3 (0.27) 8.3 (0.27) 5.6 (0.43)
Cigarettes 11.8 (0.29) 10.3 (0.27) 8.9 (0.29) 8.1 (0.27) 7.2 (0.26) 6.3 (0.24) 5.5 (0.23) 5.4 (0.22) 3.9 (0.35)
Smokeless Tobacco   nc   nc   nc 3.5 (0.17) 3.0 (0.16) 3.0 (0.16) 2.5 (0.16) 2.5 (0.15) 1.4 (0.17)
Cigars 6.8 (0.22) 5.7 (0.20) 5.7 (0.23) 5.1 (0.21) 4.4 (0.19) 4.6 (0.20) 3.7 (0.18) 3.6 (0.19) 2.4 (0.27)
Pipe Tobacco1   --   --   --   --   --   --   --   --   --
Nicotine Vaping   --   --   --   --   --   --   --   -- 9.5 (0.60)
ALCOHOL 26.3 (0.42) 24.6 (0.40) 24.0 (0.42) 22.7 (0.42) 21.6 (0.42) 21.9 (0.43) 20.8 (0.42) 21.2 (0.42) 18.5 (0.83)
OTHER SUBSTANCE USE                                    
GHB 0.1 (0.03) 0.0 (0.01) 0.0 (0.02) 0.0 (0.01) 0.0 (0.02) 0.0 (0.01) 0.0 (0.03) 0.0 (0.02) * (*)
Nonprescription Cough or Cold Medicine 1.3 (0.11) 1.1 (0.08) 1.1 (0.10) 1.0 (0.10) 1.0 (0.09) 1.0 (0.09) 1.0 (0.09) 0.9 (0.10) 0.9 (0.17)
Kratom   --   --   --   --   --   --   -- 0.2 (0.05) 0.2 (0.09)
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   -- 0.8 (0.16)
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   -- 0.0 (0.03)
* = low precision; -- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 Information about past year use of pipe tobacco was not collected. Tobacco product use in the past year excludes past year pipe tobacco use, but includes past month pipe tobacco use.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.10B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year: Among Young Adults Aged 18 to 25; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GENERAL SUBSTANCE USE                                        
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Illicit Drugs or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tobacco Products or Alcohol 82.4 (0.38) 82.7 (0.36) 82.8 (0.41) 82.6 (0.40) 83.2 (0.38) 82.4 (0.41) 82.8 (0.40) 82.9 (0.39) 83.1 (0.37) 82.0 (0.39)
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products1 54.9 (0.50) 53.8 (0.48) 54.3 (0.50) 54.3 (0.48) 54.0 (0.49) 52.4 (0.49) 52.4 (0.50) 52.4 (0.50) 51.3 (0.50) 50.0 (0.50)
Cigarettes 49.0 (0.50) 47.6 (0.46) 47.5 (0.52) 47.2 (0.48) 47.0 (0.48) 45.2 (0.49) 45.1 (0.48) 45.3 (0.51) 43.2 (0.50) 42.3 (0.50)
Smokeless Tobacco   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Cigars 22.7 (0.36) 22.7 (0.36) 24.0 (0.38) 24.2 (0.38) 24.2 (0.40) 23.7 (0.38) 23.1 (0.38) 23.5 (0.41) 22.7 (0.39) 22.1 (0.41)
Pipe Tobacco1   --   --   --   --   --   --   --   --   --   --
Nicotine Vaping   --   --   --   --   --   --   --   --   --   --
ALCOHOL 77.9 (0.41) 78.1 (0.41) 78.0 (0.44) 77.9 (0.43) 78.8 (0.43) 77.9 (0.45) 78.0 (0.44) 78.7 (0.42) 78.6 (0.41) 77.0 (0.46)
OTHER SUBSTANCE USE                                        
GHB   --   --   --   -- 0.1 (0.03) 0.1 (0.03) 0.1 (0.02) 0.1 (0.03) 0.1 (0.03) 0.1 (0.02)
Nonprescription Cough or Cold Medicine   --   --   --   -- 1.6 (0.12) 1.5 (0.11) 1.4 (0.10) 1.4 (0.11) 1.4 (0.11) 1.5 (0.12)
Kratom   --   --   --   --   --   --   --   --   --   --
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   --   --   --
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   --   --   --
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.10B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year: Among Young Adults Aged 18 to 25; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
GENERAL SUBSTANCE USE                                    
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc 81.5 (0.40) 79.9 (0.42) 79.9 (0.46) 78.5 (0.43) 77.9 (0.47) 74.0 (0.90)
Illicit Drugs or Alcohol   nc   nc   nc 78.2 (0.43) 77.0 (0.44) 77.0 (0.50) 76.1 (0.45) 75.2 (0.49) 72.3 (0.92)
Tobacco Products or Alcohol 81.8 (0.39) 81.3 (0.42) 80.8 (0.44) 80.0 (0.41) 78.6 (0.43) 78.2 (0.48) 76.7 (0.45) 75.9 (0.49) 72.2 (0.92)
ILLICIT DRUGS   nc   nc   nc 37.5 (0.49) 37.7 (0.53) 39.4 (0.54) 38.7 (0.54) 39.1 (0.54) 37.0 (0.97)
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   -- 35.1 (0.92)
Tobacco Products1 48.8 (0.47) 47.7 (0.51) 46.0 (0.55) 43.8 (0.52) 40.5 (0.52) 39.8 (0.51) 36.7 (0.47) 35.2 (0.51) 28.8 (0.83)
Cigarettes 41.0 (0.48) 39.5 (0.49) 37.7 (0.56) 35.0 (0.52) 31.7 (0.51) 31.0 (0.48) 27.9 (0.44) 25.8 (0.45) 21.6 (0.78)
Smokeless Tobacco   nc   nc   nc 9.0 (0.29) 8.0 (0.27) 7.7 (0.27) 7.1 (0.26) 7.7 (0.27) 6.0 (0.45)
Cigars 21.7 (0.39) 20.7 (0.41) 20.0 (0.43) 19.5 (0.40) 18.0 (0.40) 17.9 (0.38) 17.1 (0.39) 16.3 (0.42) 12.3 (0.56)
Pipe Tobacco1   --   --   --   --   --   --   --   --   --
Nicotine Vaping   --   --   --   --   --   --   --   -- 18.1 (0.73)
ALCOHOL 77.4 (0.42) 76.8 (0.45) 76.5 (0.47) 75.5 (0.44) 74.4 (0.47) 74.0 (0.52) 73.1 (0.47) 72.0 (0.51) 69.5 (0.95)
OTHER SUBSTANCE USE                                    
GHB 0.1 (0.03) 0.1 (0.02) 0.1 (0.03) 0.1 (0.02) 0.1 (0.04) 0.1 (0.03) 0.0 (0.01) 0.1 (0.04) 0.1 (0.05)
Nonprescription Cough or Cold Medicine 1.4 (0.12) 1.4 (0.11) 1.1 (0.10) 1.2 (0.10) 1.0 (0.10) 1.0 (0.09) 1.1 (0.10) 1.0 (0.11) 1.2 (0.21)
Kratom   --   --   --   --   --   --   -- 1.3 (0.11) 0.9 (0.15)
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   -- 0.9 (0.19)
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   -- 0.1 (0.05)
-- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 Information about past year use of pipe tobacco was not collected. Tobacco product use in the past year excludes past year pipe tobacco use, but includes past month pipe tobacco use.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.11B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year: Among Adults Aged 26 or Older; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GENERAL SUBSTANCE USE                                        
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Illicit Drugs or Alcohol   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tobacco Products or Alcohol 75.3 (0.46) 74.0 (0.45) 73.6 (0.47) 75.9 (0.45) 75.0 (0.43) 74.7 (0.43) 75.0 (0.46) 75.2 (0.43) 75.3 (0.45) 75.0 (0.45)
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   --   --   --
Tobacco Products1 34.5 (0.47) 33.5 (0.43) 32.8 (0.42) 33.4 (0.45) 33.6 (0.44) 33.1 (0.44) 32.6 (0.46) 31.6 (0.42) 31.5 (0.45) 30.5 (0.43)
Cigarettes 28.5 (0.44) 27.6 (0.42) 27.3 (0.40) 27.6 (0.41) 27.7 (0.42) 27.4 (0.42) 26.8 (0.43) 26.0 (0.40) 25.8 (0.41) 24.9 (0.41)
Smokeless Tobacco   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Cigars 9.1 (0.26) 8.7 (0.24) 8.6 (0.23) 8.9 (0.24) 8.8 (0.23) 8.7 (0.24) 8.6 (0.24) 8.5 (0.24) 8.4 (0.25) 7.8 (0.23)
Pipe Tobacco1   --   --   --   --   --   --   --   --   --   --
Nicotine Vaping   --   --   --   --   --   --   --   --   --   --
ALCOHOL 68.4 (0.50) 67.0 (0.48) 67.2 (0.47) 69.0 (0.48) 68.3 (0.46) 68.2 (0.49) 68.5 (0.49) 69.3 (0.45) 69.0 (0.47) 69.1 (0.48)
OTHER SUBSTANCE USE                                        
GHB   --   --   --   -- 0.0 (0.01) 0.0 (0.01) 0.0 (0.02) 0.0 (0.01) 0.1 (0.02) 0.0 (0.02)
Nonprescription Cough or Cold Medicine   --   --   --   -- 0.3 (0.05) 0.2 (0.04) 0.3 (0.05) 0.3 (0.05) 0.5 (0.08) 0.4 (0.05)
Kratom   --   --   --   --   --   --   --   --   --   --
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   --   --   --
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   --   --   --
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.11B – Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year: Among Adults Aged 26 or Older; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
GENERAL SUBSTANCE USE                                    
Illicit Drugs, Tobacco Products, or Alcohol   nc   nc   nc 76.1 (0.33) 75.2 (0.35) 76.1 (0.36) 76.2 (0.37) 75.8 (0.36) 75.1 (0.57)
Illicit Drugs or Alcohol   nc   nc   nc 71.2 (0.35) 70.3 (0.37) 71.5 (0.39) 71.4 (0.41) 71.5 (0.38) 71.4 (0.60)
Tobacco Products or Alcohol 75.9 (0.42) 75.5 (0.44) 76.1 (0.35) 75.1 (0.34) 74.2 (0.35) 75.1 (0.37) 75.3 (0.37) 74.7 (0.36) 73.6 (0.58)
ILLICIT DRUGS   nc   nc   nc 14.6 (0.26) 15.0 (0.26) 16.1 (0.27) 16.7 (0.30) 18.3 (0.31) 19.9 (0.45)
TOBACCO PRODUCTS OR NICOTINE
   VAPING
  --   --   --   --   --   --   --   -- 25.6 (0.52)
Tobacco Products1 31.0 (0.44) 30.0 (0.42) 30.1 (0.35) 28.9 (0.34) 28.6 (0.34) 27.6 (0.33) 27.3 (0.35) 26.8 (0.32) 24.4 (0.52)
Cigarettes 25.3 (0.42) 24.6 (0.39) 24.6 (0.34) 22.9 (0.33) 23.1 (0.32) 21.7 (0.32) 21.7 (0.32) 21.0 (0.30) 19.6 (0.48)
Smokeless Tobacco   nc   nc   nc 4.1 (0.14) 4.0 (0.13) 3.9 (0.12) 3.7 (0.12) 3.8 (0.13) 3.1 (0.19)
Cigars 8.2 (0.24) 8.0 (0.23) 7.5 (0.17) 7.8 (0.19) 7.4 (0.17) 7.6 (0.17) 7.5 (0.18) 7.3 (0.18) 6.8 (0.27)
Pipe Tobacco1   --   --   --   --   --   --   --   --   --
Nicotine Vaping   --   --   --   --   --   --   --   -- 4.3 (0.21)
ALCOHOL 69.9 (0.46) 69.6 (0.47) 70.1 (0.37) 69.2 (0.36) 68.4 (0.37) 69.5 (0.40) 69.5 (0.42) 69.1 (0.38) 68.6 (0.61)
OTHER SUBSTANCE USE                                    
GHB 0.0 (0.02) 0.0 (0.02) 0.1 (0.01) 0.1 (0.02) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.1 (0.01) 0.1 (0.02)
Nonprescription Cough or Cold Medicine 0.3 (0.04) 0.4 (0.06) 0.3 (0.04) 0.5 (0.05) 0.5 (0.05) 0.6 (0.06) 0.5 (0.05) 0.7 (0.06) 0.8 (0.10)
Kratom   --   --   --   --   --   --   -- 0.7 (0.05) 0.8 (0.09)
Synthetic Marijuana (Fake Weed, K2,
   Spice)
  --   --   --   --   --   --   --   -- 0.3 (0.05)
Synthetic Stimulants (“Bath Salts,” Flakka)   --   --   --   --   --   --   --   -- 0.0 (0.02)
-- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 Information about past year use of pipe tobacco was not collected. Tobacco product use in the past year excludes past year pipe tobacco use, but includes past month pipe tobacco use.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.12B – Types of Illicit Drug Use in the Past Year: Among People Aged 12 or Older; 2002-2020
Drug 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Marijuana 11.0 (0.20) 10.6 (0.19) 10.6 (0.19) 10.4 (0.19) 10.3 (0.19) 10.1 (0.20) 10.4 (0.19) 11.4 (0.21) 11.6 (0.22) 11.5 (0.20)
Cocaine 2.5 (0.09) 2.5 (0.10) 2.4 (0.09) 2.3 (0.08) 2.5 (0.09) 2.3 (0.10) 2.1 (0.08) 1.9 (0.08) 1.8 (0.08) 1.5 (0.07)
Crack 0.7 (0.05) 0.6 (0.05) 0.5 (0.05) 0.6 (0.05) 0.6 (0.05) 0.6 (0.05) 0.4 (0.04) 0.4 (0.04) 0.3 (0.04) 0.2 (0.03)
Heroin 0.2 (0.02) 0.1 (0.02) 0.2 (0.02) 0.2 (0.02) 0.2 (0.03) 0.2 (0.02) 0.2 (0.02) 0.2 (0.03) 0.2 (0.03) 0.2 (0.03)
Hallucinogens   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
LSD 0.4 (0.03) 0.2 (0.02) 0.2 (0.02) 0.2 (0.02) 0.3 (0.02) 0.3 (0.02) 0.3 (0.02) 0.3 (0.02) 0.3 (0.03) 0.3 (0.02)
PCP 0.1 (0.01) 0.1 (0.01) 0.1 (0.01) 0.1 (0.01) 0.1 (0.02) 0.1 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01)
Ecstasy   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Inhalants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Methamphetamine   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Misuse of Psychotherapeutics   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Pain Relievers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers or Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Benzodiazepines   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Opioids   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Central Nervous System Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.12B – Types of Illicit Drug Use in the Past Year: Among People Aged 12 or Older; 2002-2020 (continued)
Drug 2012 2013 2014 2015 2016 2017 2018 2019 2020
ILLICIT DRUGS   nc   nc   nc 17.8 (0.23) 18.0 (0.23) 19.0 (0.24) 19.4 (0.26) 20.8 (0.27) 21.4 (0.39)
Marijuana 12.1 (0.21) 12.6 (0.22) 13.2 (0.20) 13.5 (0.20) 13.9 (0.20) 15.0 (0.22) 15.9 (0.24) 17.5 (0.24) 17.9 (0.37)
Cocaine 1.8 (0.08) 1.6 (0.07) 1.7 (0.07) 1.8 (0.07) 1.9 (0.07) 2.2 (0.08) 2.0 (0.07) 2.0 (0.08) 1.9 (0.11)
Crack 0.4 (0.04) 0.2 (0.03) 0.3 (0.03) 0.3 (0.03) 0.3 (0.03) 0.3 (0.04) 0.3 (0.03) 0.3 (0.04) 0.2 (0.04)
Heroin 0.3 (0.03) 0.3 (0.03) 0.3 (0.03) 0.3 (0.03) 0.4 (0.03) 0.3 (0.03) 0.3 (0.04) 0.3 (0.04) 0.3 (0.06)
Hallucinogens   nc   nc   nc 1.8 (0.07) 1.8 (0.07) 1.9 (0.07) 2.0 (0.08) 2.2 (0.08) 2.6 (0.14)
LSD 0.4 (0.03) 0.4 (0.03) 0.5 (0.03) 0.6 (0.03) 0.7 (0.04) 0.8 (0.04) 0.8 (0.04) 0.9 (0.05) 1.0 (0.07)
PCP 0.1 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01)
Ecstasy   nc   nc   nc 1.0 (0.05) 0.9 (0.05) 0.9 (0.04) 0.9 (0.05) 0.9 (0.05) 0.9 (0.07)
Inhalants   nc   nc   nc 0.7 (0.03) 0.6 (0.03) 0.6 (0.03) 0.7 (0.04) 0.8 (0.04) 0.9 (0.07)
Methamphetamine   nc   nc   nc 0.6 (0.04) 0.5 (0.04) 0.6 (0.04) 0.7 (0.04) 0.7 (0.05) 0.9 (0.10)
Misuse of Psychotherapeutics   nc   nc   nc 7.1 (0.14) 6.9 (0.14) 6.6 (0.13) 6.2 (0.14) 5.9 (0.14) 5.8 (0.21)
Pain Relievers   nc   nc   nc 4.7 (0.11) 4.3 (0.11) 4.1 (0.10) 3.6 (0.10) 3.5 (0.11) 3.3 (0.17)
Stimulants   nc   nc   nc 2.0 (0.07) 2.1 (0.07) 2.1 (0.07) 1.9 (0.06) 1.8 (0.06) 1.8 (0.11)
Tranquilizers or Sedatives   nc   nc   nc 2.6 (0.08) 2.6 (0.08) 2.5 (0.08) 2.4 (0.09) 2.1 (0.09) 2.2 (0.12)
Tranquilizers   nc   nc   nc 2.3 (0.08) 2.2 (0.08) 2.2 (0.08) 2.1 (0.08) 1.9 (0.08) 2.0 (0.11)
Sedatives   nc   nc   nc 0.6 (0.04) 0.6 (0.04) 0.5 (0.04) 0.4 (0.04) 0.4 (0.04) 0.4 (0.06)
Benzodiazepines   nc   nc   nc 2.1 (0.07) 2.1 (0.07) 2.1 (0.07) 2.0 (0.08) 1.8 (0.08) 1.7 (0.10)
Opioids   nc   nc   nc 4.7 (0.12) 4.4 (0.11) 4.2 (0.10) 3.7 (0.11) 3.7 (0.11) 3.4 (0.17)
Central Nervous System Stimulants   nc   nc   nc 3.7 (0.10) 3.7 (0.09) 4.0 (0.10) 3.7 (0.10) 3.7 (0.10) 3.7 (0.17)
LSD = lysergic acid diethylamide; nc = not comparable due to methodological changes; PCP = phencyclidine.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.13B – Types of Illicit Drug Use in the Past Year: Among Adolescents Aged 12 to 17; 2002-2020
Drug 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Marijuana 15.8 (0.32) 15.0 (0.31) 14.5 (0.31) 13.3 (0.30) 13.2 (0.31) 12.5 (0.30) 13.1 (0.29) 13.7 (0.32) 14.0 (0.34) 14.2 (0.33)
Cocaine 2.1 (0.13) 1.8 (0.11) 1.6 (0.11) 1.7 (0.11) 1.6 (0.11) 1.5 (0.11) 1.2 (0.10) 1.0 (0.09) 1.0 (0.09) 0.9 (0.08)
Crack 0.4 (0.06) 0.4 (0.05) 0.3 (0.04) 0.2 (0.04) 0.3 (0.05) 0.3 (0.04) 0.1 (0.03) 0.1 (0.03) 0.1 (0.02) 0.1 (0.03)
Heroin 0.2 (0.04) 0.1 (0.03) 0.2 (0.04) 0.1 (0.03) 0.1 (0.03) 0.1 (0.02) 0.2 (0.04) 0.1 (0.03) 0.1 (0.03) 0.2 (0.05)
Hallucinogens   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
LSD 1.3 (0.10) 0.6 (0.06) 0.6 (0.07) 0.6 (0.07) 0.4 (0.05) 0.5 (0.06) 0.7 (0.07) 0.6 (0.06) 0.6 (0.07) 0.6 (0.07)
PCP 0.4 (0.05) 0.4 (0.05) 0.3 (0.05) 0.3 (0.06) 0.2 (0.04) 0.2 (0.04) 0.2 (0.04) 0.2 (0.04) 0.1 (0.03) 0.2 (0.03)
Ecstasy   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Inhalants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Methamphetamine   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Misuse of Psychotherapeutics   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Pain Relievers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers or Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Benzodiazepines   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Opioids   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Central Nervous System Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.13B – Types of Illicit Drug Use in the Past Year: Among Adolescents Aged 12 to 17; 2002-2020 (continued)
Drug 2012 2013 2014 2015 2016 2017 2018 2019 2020
ILLICIT DRUGS   nc   nc   nc 17.5 (0.37) 15.8 (0.35) 16.3 (0.37) 16.7 (0.37) 17.2 (0.36) 13.8 (0.67)
Marijuana 13.5 (0.30) 13.4 (0.31) 13.1 (0.33) 12.6 (0.32) 12.0 (0.31) 12.4 (0.33) 12.5 (0.33) 13.2 (0.34) 10.1 (0.57)
Cocaine 0.7 (0.08) 0.5 (0.06) 0.7 (0.09) 0.6 (0.08) 0.5 (0.07) 0.5 (0.06) 0.4 (0.07) 0.4 (0.07) 0.3 (0.10)
Crack 0.1 (0.03) 0.0 (0.02) 0.1 (0.03) 0.0 (0.01) 0.0 (0.02) 0.1 (0.03) 0.0 (0.01) 0.0 (0.03) 0.0 (0.01)
Heroin 0.1 (0.04) 0.1 (0.03) 0.1 (0.03) 0.1 (0.03) 0.1 (0.02) 0.1 (0.02) 0.0 (0.02) * (*) * (*)
Hallucinogens   nc   nc   nc 2.1 (0.15) 1.8 (0.13) 2.1 (0.14) 1.5 (0.13) 1.8 (0.13) 1.5 (0.21)
LSD 0.6 (0.07) 0.6 (0.06) 0.9 (0.10) 1.0 (0.10) 0.8 (0.08) 1.0 (0.09) 0.8 (0.09) 1.1 (0.11) 0.9 (0.16)
PCP 0.2 (0.04) 0.1 (0.03) 0.1 (0.03) 0.1 (0.04) 0.1 (0.02) 0.1 (0.03) 0.1 (0.02) 0.1 (0.03) * (*)
Ecstasy   nc   nc   nc 0.8 (0.09) 0.7 (0.08) 0.7 (0.08) 0.5 (0.08) 0.6 (0.08) 0.3 (0.08)
Inhalants   nc   nc   nc 2.7 (0.16) 2.2 (0.14) 2.3 (0.14) 2.7 (0.16) 3.0 (0.16) 2.7 (0.32)
Methamphetamine   nc   nc   nc 0.2 (0.04) 0.1 (0.03) 0.2 (0.04) 0.2 (0.04) 0.2 (0.04) 0.1 (0.05)
Misuse of Psychotherapeutics   nc   nc   nc 5.9 (0.23) 5.3 (0.21) 4.9 (0.21) 4.8 (0.22) 4.3 (0.21) 2.8 (0.32)
Pain Relievers   nc   nc   nc 3.9 (0.19) 3.5 (0.17) 3.1 (0.16) 2.8 (0.17) 2.3 (0.16) 1.6 (0.24)
Stimulants   nc   nc   nc 2.0 (0.14) 1.7 (0.14) 1.8 (0.14) 1.5 (0.11) 1.7 (0.15) 1.2 (0.20)
Tranquilizers or Sedatives   nc   nc   nc 1.8 (0.14) 1.9 (0.13) 2.0 (0.13) 1.8 (0.14) 1.8 (0.14) 0.9 (0.16)
Tranquilizers   nc   nc   nc 1.6 (0.13) 1.7 (0.13) 1.8 (0.13) 1.7 (0.13) 1.6 (0.14) 0.8 (0.15)
Sedatives   nc   nc   nc 0.4 (0.06) 0.4 (0.06) 0.3 (0.05) 0.3 (0.05) 0.3 (0.07) 0.1 (0.06)
Benzodiazepines   nc   nc   nc 1.5 (0.12) 1.7 (0.12) 1.8 (0.13) 1.6 (0.13) 1.5 (0.14) 0.6 (0.15)
Opioids   nc   nc   nc 3.9 (0.19) 3.6 (0.17) 3.1 (0.16) 2.8 (0.17) 2.3 (0.16) 1.6 (0.24)
Central Nervous System Stimulants   nc   nc   nc 2.4 (0.16) 2.1 (0.14) 2.2 (0.15) 1.9 (0.13) 2.0 (0.16) 1.4 (0.22)
* = low precision; LSD = lysergic acid diethylamide; nc = not comparable due to methodological changes; PCP = phencyclidine.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.14B – Types of Illicit Drug Use in the Past Year: Among Young Adults Aged 18 to 25; 2002-2020
Drug 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Marijuana 29.8 (0.43) 28.5 (0.46) 27.8 (0.47) 28.0 (0.45) 28.1 (0.46) 27.5 (0.46) 27.8 (0.46) 30.8 (0.46) 30.0 (0.49) 30.8 (0.49)
Cocaine 6.7 (0.24) 6.6 (0.23) 6.6 (0.25) 6.9 (0.23) 6.9 (0.24) 6.4 (0.24) 5.6 (0.21) 5.3 (0.20) 4.7 (0.20) 4.6 (0.21)
Crack 0.9 (0.08) 0.9 (0.07) 0.8 (0.07) 1.0 (0.09) 0.9 (0.08) 0.8 (0.07) 0.7 (0.07) 0.5 (0.06) 0.5 (0.06) 0.3 (0.05)
Heroin 0.4 (0.05) 0.3 (0.04) 0.4 (0.05) 0.5 (0.06) 0.4 (0.06) 0.4 (0.06) 0.5 (0.06) 0.5 (0.06) 0.6 (0.07) 0.7 (0.07)
Hallucinogens   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
LSD 1.8 (0.14) 1.1 (0.09) 1.0 (0.08) 1.0 (0.09) 1.2 (0.10) 1.1 (0.09) 1.5 (0.11) 1.6 (0.12) 1.6 (0.13) 1.7 (0.13)
PCP 0.3 (0.04) 0.4 (0.06) 0.3 (0.05) 0.2 (0.03) 0.2 (0.04) 0.2 (0.03) 0.1 (0.02) 0.1 (0.02) 0.1 (0.03) 0.2 (0.05)
Ecstasy   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Inhalants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Methamphetamine   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Misuse of Psychotherapeutics   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Pain Relievers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers or Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Benzodiazepines   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Opioids   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Central Nervous System Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.14B – Types of Illicit Drug Use in the Past Year: Among Young Adults Aged 18 to 25; 2002-2020 (continued)
Drug 2012 2013 2014 2015 2016 2017 2018 2019 2020
ILLICIT DRUGS   nc   nc   nc 37.5 (0.49) 37.7 (0.53) 39.4 (0.54) 38.7 (0.54) 39.1 (0.54) 37.0 (0.97)
Marijuana 31.5 (0.49) 31.6 (0.47) 31.9 (0.53) 32.2 (0.47) 33.0 (0.51) 34.9 (0.53) 34.8 (0.53) 35.4 (0.52) 34.5 (0.97)
Cocaine 4.6 (0.21) 4.4 (0.21) 4.6 (0.23) 5.4 (0.26) 5.6 (0.26) 6.2 (0.26) 5.8 (0.26) 5.3 (0.24) 4.3 (0.37)
Crack 0.4 (0.05) 0.3 (0.05) 0.4 (0.06) 0.3 (0.05) 0.3 (0.05) 0.3 (0.06) 0.3 (0.05) 0.2 (0.04) 0.1 (0.06)
Heroin 0.8 (0.08) 0.7 (0.08) 0.8 (0.09) 0.6 (0.08) 0.7 (0.08) 0.6 (0.08) 0.5 (0.07) 0.3 (0.05) 0.2 (0.06)
Hallucinogens   nc   nc   nc 7.0 (0.28) 6.9 (0.28) 7.0 (0.28) 6.9 (0.30) 7.2 (0.26) 7.3 (0.50)
LSD 1.8 (0.14) 2.0 (0.14) 2.3 (0.16) 2.8 (0.18) 3.4 (0.20) 3.8 (0.20) 3.5 (0.19) 3.6 (0.20) 3.7 (0.35)
PCP 0.2 (0.03) 0.1 (0.02) 0.1 (0.02) 0.1 (0.04) 0.0 (0.02) 0.1 (0.03) 0.0 (0.01) 0.1 (0.03) 0.2 (0.09)
Ecstasy   nc   nc   nc 4.1 (0.20) 3.5 (0.20) 3.5 (0.20) 3.1 (0.21) 3.2 (0.19) 2.5 (0.28)
Inhalants   nc   nc   nc 1.4 (0.12) 1.4 (0.14) 1.6 (0.13) 1.5 (0.13) 1.7 (0.15) 1.5 (0.18)
Methamphetamine   nc   nc   nc 0.9 (0.10) 0.8 (0.08) 1.1 (0.11) 0.8 (0.09) 0.8 (0.09) 0.5 (0.09)
Misuse of Psychotherapeutics   nc   nc   nc 15.3 (0.36) 14.5 (0.38) 14.4 (0.35) 12.3 (0.34) 11.5 (0.36) 9.5 (0.53)
Pain Relievers   nc   nc   nc 8.5 (0.26) 7.1 (0.27) 7.2 (0.26) 5.5 (0.21) 5.2 (0.22) 4.1 (0.34)
Stimulants   nc   nc   nc 7.3 (0.27) 7.5 (0.30) 7.4 (0.29) 6.5 (0.27) 5.8 (0.27) 4.8 (0.36)
Tranquilizers or Sedatives   nc   nc   nc 5.7 (0.23) 5.7 (0.24) 5.7 (0.24) 4.9 (0.21) 4.2 (0.20) 3.7 (0.34)
Tranquilizers   nc   nc   nc 5.4 (0.22) 5.3 (0.23) 5.5 (0.23) 4.6 (0.21) 3.9 (0.19) 3.3 (0.31)
Sedatives   nc   nc   nc 0.8 (0.08) 0.7 (0.09) 0.6 (0.07) 0.6 (0.07) 0.5 (0.07) 0.7 (0.17)
Benzodiazepines   nc   nc   nc 5.2 (0.22) 5.2 (0.23) 5.3 (0.23) 4.5 (0.21) 3.8 (0.19) 3.3 (0.31)
Opioids   nc   nc   nc 8.7 (0.27) 7.3 (0.27) 7.3 (0.26) 5.6 (0.21) 5.3 (0.22) 4.1 (0.34)
Central Nervous System Stimulants   nc   nc   nc 10.9 (0.36) 11.1 (0.36) 11.3 (0.33) 10.2 (0.34) 9.5 (0.34) 7.7 (0.48)
LSD = lysergic acid diethylamide; nc = not comparable due to methodological changes; PCP = phencyclidine.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.15B – Types of Illicit Drug Use in the Past Year: Among Adults Aged 26 or Older; 2002-2020
Drug 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Marijuana 7.0 (0.23) 6.9 (0.21) 7.0 (0.22) 6.9 (0.23) 6.9 (0.22) 6.8 (0.22) 7.0 (0.22) 7.7 (0.24) 8.0 (0.25) 7.9 (0.23)
Cocaine 1.8 (0.11) 1.9 (0.11) 1.7 (0.10) 1.5 (0.10) 1.8 (0.11) 1.7 (0.12) 1.6 (0.10) 1.4 (0.10) 1.4 (0.09) 1.0 (0.08)
Crack 0.7 (0.07) 0.6 (0.07) 0.5 (0.06) 0.5 (0.06) 0.6 (0.07) 0.6 (0.06) 0.4 (0.05) 0.4 (0.05) 0.4 (0.05) 0.2 (0.03)
Heroin 0.1 (0.03) 0.1 (0.02) 0.1 (0.03) 0.1 (0.02) 0.2 (0.04) 0.1 (0.03) 0.1 (0.03) 0.2 (0.04) 0.2 (0.04) 0.2 (0.03)
Hallucinogens   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
LSD 0.1 (0.02) 0.0 (0.02) 0.1 (0.02) 0.0 (0.02) 0.1 (0.02) 0.1 (0.02) 0.1 (0.01) 0.1 (0.02) 0.1 (0.02) 0.1 (0.02)
PCP 0.0 (0.01) 0.0 (0.00) 0.0 (0.01) 0.0 (0.01) 0.0 (0.02) 0.0 (0.01) * (*) 0.0 (0.01) 0.0 (0.01) 0.0 (0.00)
Ecstasy   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Inhalants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Methamphetamine   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Misuse of Psychotherapeutics   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Pain Relievers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers or Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Benzodiazepines   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Opioids   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Central Nervous System Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.15B – Types of Illicit Drug Use in the Past Year: Among Adults Aged 26 or Older; 2002-2020 (continued)
Drug 2012 2013 2014 2015 2016 2017 2018 2019 2020
ILLICIT DRUGS   nc   nc   nc 14.6 (0.26) 15.0 (0.26) 16.1 (0.27) 16.7 (0.30) 18.3 (0.31) 19.9 (0.45)
Marijuana 8.6 (0.24) 9.2 (0.26) 10.1 (0.22) 10.4 (0.22) 11.0 (0.23) 12.2 (0.24) 13.3 (0.28) 15.2 (0.28) 16.3 (0.42)
Cocaine 1.4 (0.10) 1.2 (0.08) 1.4 (0.08) 1.3 (0.08) 1.4 (0.07) 1.7 (0.09) 1.6 (0.08) 1.7 (0.09) 1.7 (0.12)
Crack 0.4 (0.05) 0.3 (0.04) 0.3 (0.04) 0.3 (0.04) 0.4 (0.04) 0.4 (0.05) 0.3 (0.04) 0.3 (0.05) 0.3 (0.05)
Heroin 0.2 (0.04) 0.2 (0.03) 0.3 (0.03) 0.3 (0.04) 0.3 (0.04) 0.3 (0.03) 0.3 (0.04) 0.3 (0.04) 0.4 (0.07)
Hallucinogens   nc   nc   nc 0.8 (0.06) 1.0 (0.07) 1.0 (0.06) 1.3 (0.08) 1.5 (0.08) 2.0 (0.15)
LSD 0.1 (0.03) 0.1 (0.03) 0.1 (0.02) 0.1 (0.02) 0.3 (0.03) 0.3 (0.04) 0.4 (0.04) 0.5 (0.04) 0.5 (0.07)
PCP 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01) 0.0 (0.01)
Ecstasy   nc   nc   nc 0.5 (0.04) 0.5 (0.05) 0.5 (0.04) 0.6 (0.05) 0.6 (0.05) 0.8 (0.08)
Inhalants   nc   nc   nc 0.3 (0.04) 0.3 (0.03) 0.3 (0.04) 0.4 (0.04) 0.4 (0.04) 0.5 (0.08)
Methamphetamine   nc   nc   nc 0.6 (0.06) 0.5 (0.05) 0.6 (0.05) 0.7 (0.05) 0.8 (0.06) 1.1 (0.12)
Misuse of Psychotherapeutics   nc   nc   nc 5.8 (0.17) 5.9 (0.16) 5.6 (0.14) 5.3 (0.16) 5.3 (0.15) 5.6 (0.25)
Pain Relievers   nc   nc   nc 4.1 (0.14) 3.9 (0.13) 3.7 (0.12) 3.4 (0.13) 3.4 (0.13) 3.4 (0.20)
Stimulants   nc   nc   nc 1.1 (0.06) 1.3 (0.07) 1.3 (0.07) 1.2 (0.06) 1.2 (0.06) 1.5 (0.12)
Tranquilizers or Sedatives   nc   nc   nc 2.2 (0.10) 2.2 (0.10) 2.0 (0.09) 2.0 (0.10) 1.9 (0.10) 2.2 (0.15)
Tranquilizers   nc   nc   nc 1.8 (0.09) 1.8 (0.09) 1.7 (0.09) 1.7 (0.10) 1.6 (0.09) 1.9 (0.13)
Sedatives   nc   nc   nc 0.5 (0.05) 0.6 (0.05) 0.5 (0.05) 0.4 (0.04) 0.4 (0.05) 0.4 (0.07)
Benzodiazepines   nc   nc   nc 1.6 (0.08) 1.7 (0.08) 1.6 (0.08) 1.6 (0.09) 1.5 (0.09) 1.6 (0.12)
Opioids   nc   nc   nc 4.2 (0.14) 4.0 (0.13) 3.8 (0.12) 3.6 (0.13) 3.6 (0.14) 3.5 (0.21)
Central Nervous System Stimulants   nc   nc   nc 2.6 (0.11) 2.7 (0.10) 3.0 (0.12) 2.8 (0.10) 3.0 (0.11) 3.4 (0.19)
* = low precision; LSD = lysergic acid diethylamide; nc = not comparable due to methodological changes; PCP = phencyclidine.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.16B – Main Reasons for the Last Episode of Misuse: Among People Aged 12 or Older Who Misused Prescription Pain Relievers in the Past Year; 2020
Main Reason for Misuse Past Year Misusers of
Prescription Pain Relievers
Relieve Physical Pain 64.6 (2.42)
Relax or Relieve Tension 8.1 (1.45)
Help with Sleep 4.5 (0.89)
Help with Feelings or Emotions 5.6 (1.35)
Experiment or See What It’s Like 1.4 (0.32)
Feel Good or Get High 11.3 (1.52)
Increase or Decrease Effect of Other Drug 0.9 (0.37)
Because I Am Hooked or Have to Have It 2.3 (0.55)
Some Other Reason1 1.4 (0.52)
NOTE: Estimates shown are percentages with standard errors included in parentheses. Percentages may not add to 100 percent due to rounding.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Respondents with unknown information for their main reason for misuse were excluded from the analysis, including respondents who reported some other reason but had unknown data in their write-in responses.
1 Responses to the Some Other Reason category for one drug type may fall into a response category that is asked only for another drug type (e.g., “to relieve physical pain” for tranquilizer misuse).
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.17B – Source Where Prescription Pain Relievers Were Obtained for Most Recent Misuse: Among People Aged 12 or Older Who Misused Prescription Pain Relievers in the Past Year; 2020
Source for Most Recent Misuse Past Year Misusers of
Prescription Pain Relievers
GOT THROUGH PRESCRIPTION(S) OR STOLE FROM A HEALTH CARE PROVIDER 43.6 (2.68)
Prescription from One Doctor 42.0 (2.67)
Prescriptions from More Than One Doctor 1.0 (0.38)
Stole from Doctor’s Office, Clinic, Hospital, or Pharmacy 0.6 (0.37)
GIVEN BY, BOUGHT FROM, OR TOOK FROM A FRIEND OR RELATIVE 47.2 (2.66)
From Friend or Relative for Free 34.4 (2.51)
Bought from Friend or Relative 9.2 (1.61)
Took from Friend or Relative without Asking 3.7 (0.85)
BOUGHT FROM DRUG DEALER OR OTHER STRANGER 6.2 (0.93)
SOME OTHER WAY1 3.1 (0.82)
NOTE: Estimates shown are percentages with standard errors included in parentheses. Estimates for specific sources may not add to the aggregate estimates for general sources shown in all capital letters due to rounding.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Respondents were asked to choose one of eight sources as their best answer. Respondents with unknown data on Source for Most Recent Misuse and respondents with unknown or invalid responses to the corresponding other-specify questions were excluded from the analysis.
1 Some Other Way includes write-in responses not already listed in this table or responses with insufficient information that could allow them to be placed in another category.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.18A – Past Year Initiation of Specific Substance Use: Among People Aged 12 or Older; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Marijuana 2,196 (70) 1,973 (70) 2,142 (81) 2,114 (121) 2,061 (79) 2,089 (77) 2,224 (89) 2,379 (79) 2,439 (93) 2,617 (97)
Cocaine 1,032 (61) 986 (56) 998 (65) 872 (50) 977 (60) 906 (57) 724 (52) 623 (47) 642 (57) 670 (48)
Crack 337 (44) 269 (36) 215 (29) 230 (30) 243 (31) 353 (72) 209 (34) 95 (15) 83 (20) 76 (14)
Heroin 117 (20) 92 (20) 118 (28) 108 (20) 90 (15) 106 (21) 116 (23) 187 (30) 142 (24) 178 (26)
Hallucinogens   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
LSD 338 (30) 200 (20) 235 (25) 243 (29) 265 (32) 271 (23) 400 (31) 341 (28) 381 (39) 358 (30)
PCP 123 (15) 105 (14) 106 (20) 77 (13) 70 (13) 58 (11) 53 (10) 45 (9) 46 (11) 48 (10)
Ecstasy   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Inhalants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Methamphetamine   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Misuse of Psychotherapeutics   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Pain Relievers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers or Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
CIGARETTES 1,940 (75) 1,983 (72) 2,122 (72) 2,282 (86) 2,456 (79) 2,231 (71) 2,453 (90) 2,545 (89) 2,403 (81) 2,394 (86)
Daily Cigarette Use 1,016 (64) 1,064 (58) 1,101 (55) 965 (58) 1,049 (54) 983 (52) 945 (57) 1,136 (66) 962 (57) 878 (55)
SMOKELESS TOBACCO   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
CIGARS 2,858 (103) 2,736 (99) 3,058 (112) 3,349 (113) 3,061 (104) 3,078 (107) 2,918 (105) 3,146 (121) 2,950 (120) 2,800 (143)
ALCOHOL 3,942 (101) 4,082 (104) 4,396 (127) 4,274 (108) 4,378 (107) 4,551 (111) 4,466 (116) 4,561 (112) 4,675 (131) 4,699 (124)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.18A – Past Year Initiation of Specific Substance Use: Among People Aged 12 or Older; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
ILLICIT DRUGS   nc   nc   nc   nr   nr   nr   nr   nr   nr
Marijuana 2,398 (96) 2,427 (86) 2,568 (95) 2,600 (95) 2,582 (99) 3,033 (117) 3,061 (103) 3,478 (130) 2,839 (178)
Cocaine 639 (48) 601 (47) 766 (57) 968 (68) 1,085 (73) 1,037 (69) 874 (67) 671 (56) 489 (59)
Crack 84 (16) 58 (13) 109 (24) 37 (9) 88 (19) 83 (21) 101 (26) 92 (27) 53 (23)
Heroin 156 (23) 169 (36) 212 (35) 135 (24) 170 (29) 81 (17) 117 (24) 50 (18) 103 (58)
Hallucinogens   nc   nc   nc 1,160 (69) 1,178 (70) 1,194 (68) 1,116 (72) 1,221 (82) 1,413 (133)
LSD 421 (41) 482 (40) 586 (48) 664 (45) 844 (62) 794 (51) 778 (60) 883 (70) 859 (104)
PCP 90 (21) 32 (7) 41 (10) 42 (11) 43 (20) 23 (8) 14 (6) 30 (9) 52 (27)
Ecstasy   nc   nc   nc 839 (62) 757 (55) 787 (56) 722 (58) 744 (56) 632 (84)
Inhalants   nc   nc   nc 600 (44) 526 (43) 575 (42) 576 (45) 730 (54) 678 (79)
Methamphetamine   nc   nc   nc 225 (37) 192 (32) 195 (31) 205 (31) 184 (33) 153 (41)
Misuse of Psychotherapeutics   nc   nc   nc   nr   nr   nr   nr   nr   nr
Pain Relievers   nc   nc   nc 2,126 (115) 2,139 (119) 2,010 (119) 1,908 (121) 1,607 (113) 1,223 (136)
Stimulants   nc   nc   nc 1,260 (80) 1,374 (89) 1,192 (76) 1,001 (64) 901 (63) 734 (112)
Tranquilizers or Sedatives   nc   nc   nc   nr   nr   nr   nr   nr   nr
Tranquilizers   nc   nc   nc 1,437 (94) 1,374 (77) 1,446 (102) 1,210 (88) 949 (78) 950 (149)
Sedatives   nc   nc   nc 425 (63) 294 (42) 271 (42) 251 (38) 239 (49) 343 (108)
CIGARETTES 2,336 (89) 2,071 (81) 2,164 (90) 1,956 (77) 1,782 (77) 1,898 (80) 1,825 (89) 1,595 (79) 1,264 (110)
Daily Cigarette Use 778 (53) 813 (52) 756 (51) 622 (45) 620 (54) 608 (47) 495 (43) 488 (51) 458 (78)
SMOKELESS TOBACCO   nc   nc   nc 1,335 (75) 1,157 (86) 1,013 (61) 918 (66) 1,041 (68) 653 (95)
CIGARS 2,664 (108) 2,770 (144) 2,597 (104) 2,569 (110) 2,359 (103) 2,338 (107) 2,274 (101) 2,114 (100) 1,502 (132)
ALCOHOL 4,589 (130) 4,559 (113) 4,655 (127) 4,761 (126) 4,639 (126) 4,914 (136) 4,878 (129) 4,879 (136) 4,076 (202)
LSD = lysergic acid diethylamide; nc = not comparable due to methodological changes; nr = not reported due to measurement issues; PCP = phencyclidine.
NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.19A – Past Year Initiation of Specific Substance Use: Among Adolescents Aged 12 to 17; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Marijuana 1,373 (50) 1,219 (45) 1,252 (45) 1,139 (44) 1,194 (48) 1,168 (45) 1,248 (49) 1,343 (49) 1,274 (51) 1,375 (53)
Cocaine 310 (24) 282 (22) 274 (23) 286 (23) 260 (22) 254 (22) 196 (20) 145 (17) 156 (18) 146 (16)
Crack 86 (13) 76 (11) 42 (9) 32 (7) 41 (8) 52 (10) 17 (5) 18 (5) 14 (4) 19 (5)
Heroin 39 (10) 25 (7) 31 (8) 18 (5) 24 (7) 16 (5) 29 (10) 19 (5) 23 (7) 38 (10)
Hallucinogens   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
LSD 180 (18) 96 (13) 99 (13) 105 (14) 76 (11) 97 (13) 147 (16) 106 (12) 100 (15) 123 (16)
PCP 77 (11) 59 (10) 43 (9) 55 (11) 43 (10) 38 (8) 37 (7) 26 (7) 22 (6) 29 (7)
Ecstasy   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Inhalants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Methamphetamine   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Misuse of Psychotherapeutics   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Pain Relievers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers or Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
CIGARETTES 1,187 (44) 1,226 (47) 1,294 (50) 1,303 (50) 1,333 (48) 1,198 (48) 1,288 (50) 1,273 (50) 1,205 (47) 1,165 (46)
Daily Cigarette Use 403 (27) 439 (27) 417 (32) 334 (24) 386 (27) 333 (23) 277 (23) 313 (24) 286 (24) 268 (22)
SMOKELESS TOBACCO   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
CIGARS 1,113 (40) 1,163 (46) 1,246 (48) 1,270 (47) 1,217 (42) 1,145 (44) 1,120 (43) 1,085 (43) 940 (40) 969 (41)
ALCOHOL 2,588 (64) 2,593 (65) 2,743 (73) 2,749 (69) 2,706 (68) 2,698 (69) 2,568 (64) 2,662 (69) 2,476 (62) 2,622 (69)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.19A – Past Year Initiation of Specific Substance Use: Among Adolescents Aged 12 to 17; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
ILLICIT DRUGS   nc   nc   nc   nr   nr   nr   nr   nr   nr
Marijuana 1,255 (49) 1,200 (46) 1,203 (52) 1,169 (50) 1,197 (50) 1,204 (52) 1,339 (56) 1,351 (58) 1,029 (89)
Cocaine 120 (16) 94 (13) 117 (20) 112 (16) 107 (16) 98 (14) 74 (15) 59 (14) 82 (26)
Crack 18 (8) 10 (4) 11 (5) * (*) 6 (3) 9 (4) 4 (3) 11 (7) 2 (2)
Heroin 21 (7) 21 (6) 13 (7) 11 (4) 8 (3) 9 (4) 7 (4) * (*) * (*)
Hallucinogens   nc   nc   nc 340 (31) 319 (26) 344 (28) 234 (23) 281 (26) 251 (41)
LSD 125 (15) 122 (14) 165 (22) 206 (24) 160 (18) 188 (20) 142 (18) 205 (23) 167 (34)
PCP 45 (11) 19 (6) 17 (6) 34 (11) 12 (4) 13 (5) 5 (3) 16 (7) * (*)
Ecstasy   nc   nc   nc 168 (22) 143 (19) 146 (20) 105 (18) 116 (19) 78 (19)
Inhalants   nc   nc   nc 349 (27) 262 (23) 289 (25) 308 (29) 381 (28) 360 (57)
Methamphetamine   nc   nc   nc 24 (8) 16 (5) 27 (7) 31 (8) 25 (7) 6 (4)
Misuse of Psychotherapeutics   nc   nc   nc   nr   nr   nr   nr   nr   nr
Pain Relievers   nc   nc   nc 415 (32) 423 (30) 316 (29) 310 (28) 245 (26) 158 (33)
Stimulants   nc   nc   nc 276 (27) 244 (28) 217 (25) 181 (19) 238 (26) 116 (26)
Tranquilizers or Sedatives   nc   nc   nc   nr   nr   nr   nr   nr   nr
Tranquilizers   nc   nc   nc 210 (23) 228 (22) 223 (23) 215 (23) 185 (22) 103 (33)
Sedatives   nc   nc   nc 46 (11) 55 (11) 34 (9) 36 (10) 23 (7) 18 (8)
CIGARETTES 1,032 (43) 932 (41) 838 (44) 823 (43) 723 (42) 604 (37) 571 (38) 541 (38) 385 (54)
Daily Cigarette Use 197 (22) 209 (19) 165 (19) 119 (15) 105 (14) 86 (13) 63 (11) 74 (12) 42 (14)
SMOKELESS TOBACCO   nc   nc   nc 460 (29) 353 (28) 397 (29) 307 (25) 337 (29) 167 (29)
CIGARS 849 (38) 730 (36) 797 (41) 671 (37) 575 (34) 599 (35) 493 (31) 442 (34) 373 (58)
ALCOHOL 2,448 (72) 2,417 (67) 2,335 (67) 2,358 (75) 2,293 (71) 2,332 (66) 2,380 (76) 2,259 (73) 1,817 (117)
* = low precision; LSD = lysergic acid diethylamide; nc = not comparable due to methodological changes; nr = not reported due to measurement issues; PCP = phencyclidine.
NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.20A – Past Year Initiation of Specific Substance Use: Among Young Adults Aged 18 to 25; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Marijuana 733 (37) 666 (37) 714 (45) 723 (45) 742 (46) 787 (45) 817 (49) 988 (55) 918 (51) 1,060 (61)
Cocaine 594 (42) 576 (36) 592 (41) 498 (35) 570 (40) 541 (38) 426 (33) 397 (32) 372 (32) 467 (38)
Crack 100 (15) 109 (15) 120 (17) 142 (21) 132 (18) 88 (15) 91 (15) 62 (11) 39 (8) 40 (9)
Heroin 66 (13) 42 (9) 46 (10) 57 (13) 56 (12) 70 (14) 58 (11) 83 (13) 83 (15) 100 (17)
Hallucinogens   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
LSD 142 (18) 98 (14) 112 (16) 114 (16) 162 (22) 171 (18) 235 (23) 228 (25) 261 (33) 222 (23)
PCP 46 (11) 41 (9) 49 (14) 22 (6) 27 (8) 19 (7) 16 (6) 17 (6) 24 (9) 18 (8)
Ecstasy   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Inhalants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Methamphetamine   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Misuse of Psychotherapeutics   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Pain Relievers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers or Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
CIGARETTES 641 (40) 659 (45) 765 (46) 848 (46) 1,041 (52) 989 (48) 1,076 (58) 1,147 (60) 1,120 (54) 1,156 (59)
Daily Cigarette Use 447 (31) 474 (35) 566 (36) 493 (33) 554 (36) 566 (38) 549 (35) 618 (39) 599 (44) 525 (37)
SMOKELESS TOBACCO   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
CIGARS 1,031 (46) 1,055 (48) 1,199 (54) 1,332 (58) 1,275 (54) 1,379 (58) 1,277 (54) 1,417 (61) 1,388 (66) 1,238 (58)
ALCOHOL 1,230 (51) 1,430 (64) 1,484 (62) 1,421 (61) 1,612 (68) 1,741 (70) 1,706 (68) 1,775 (66) 2,008 (79) 1,971 (80)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.20A – Past Year Initiation of Specific Substance Use: Among Young Adults Aged 18 to 25; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
ILLICIT DRUGS   nc   nc   nc   nr   nr   nr   nr   nr   nr
Marijuana 966 (57) 1,017 (54) 1,094 (62) 1,048 (57) 1,013 (58) 1,304 (73) 1,197 (64) 1,240 (65) 1,146 (104)
Cocaine 443 (37) 432 (37) 501 (40) 663 (52) 766 (57) 729 (52) 616 (50) 476 (42) 341 (47)
Crack 49 (11) 25 (6) 54 (14) 37 (9) 48 (14) 21 (7) 36 (10) 17 (6) 29 (14)
Heroin 95 (16) 66 (13) 75 (15) 57 (12) 82 (19) 46 (13) 35 (10) 19 (8) 12 (8)
Hallucinogens   nc   nc   nc 670 (54) 725 (53) 683 (47) 632 (51) 681 (54) 785 (103)
LSD 264 (33) 312 (31) 371 (37) 387 (35) 567 (48) 487 (39) 468 (42) 460 (46) 521 (81)
PCP 28 (8) 13 (5) 24 (8) 8 (4) 9 (6) 9 (5) 8 (5) 15 (6) 45 (27)
Ecstasy   nc   nc   nc 531 (45) 460 (42) 507 (44) 460 (45) 448 (41) 309 (54)
Inhalants   nc   nc   nc 188 (25) 184 (26) 212 (25) 210 (27) 250 (30) 201 (38)
Methamphetamine   nc   nc   nc 91 (21) 79 (15) 95 (18) 68 (14) 63 (14) 51 (17)
Misuse of Psychotherapeutics   nc   nc   nc   nr   nr   nr   nr   nr   nr
Pain Relievers   nc   nc   nc 596 (43) 585 (50) 465 (40) 464 (36) 404 (34) 290 (50)
Stimulants   nc   nc   nc 600 (48) 617 (49) 581 (47) 517 (40) 364 (37) 294 (50)
Tranquilizers or Sedatives   nc   nc   nc   nr   nr   nr   nr   nr   nr
Tranquilizers   nc   nc   nc 489 (40) 617 (45) 473 (40) 434 (38) 329 (38) 290 (55)
Sedatives   nc   nc   nc 86 (16) 75 (18) 51 (12) 73 (16) 39 (11) 77 (23)
CIGARETTES 1,204 (65) 1,031 (57) 1,181 (72) 1,050 (58) 978 (61) 1,151 (61) 1,141 (65) 964 (56) 752 (84)
Daily Cigarette Use 488 (39) 505 (36) 479 (40) 403 (34) 363 (37) 393 (36) 353 (35) 235 (25) 248 (48)
SMOKELESS TOBACCO   nc   nc   nc 517 (43) 452 (39) 398 (34) 414 (38) 424 (37) 375 (84)
CIGARS 1,291 (61) 1,334 (61) 1,311 (67) 1,281 (67) 1,226 (68) 1,118 (64) 1,246 (64) 1,154 (64) 678 (72)
ALCOHOL 1,945 (77) 2,056 (76) 2,225 (86) 2,203 (78) 2,191 (86) 2,440 (95) 2,436 (86) 2,415 (88) 2,084 (136)
LSD = lysergic acid diethylamide; nc = not comparable due to methodological changes; nr = not reported due to measurement issues; PCP = phencyclidine.
NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.21A – Past Year Initiation of Specific Substance Use: Among Adults Aged 26 or Older; 2002-2020
Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
ILLICIT DRUGS   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Marijuana 90 (25) 88 (30) 176 (47) 252 (97) 126 (33) 134 (37) 159 (45) 49 (15) 247 (60) 182 (49)
Cocaine 127 (33) 128 (36) 133 (39) 87 (23) 147 (38) 112 (32) 102 (34) 81 (28) 114 (41) 56 (22)
Crack 151 (38) 83 (31) 53 (21) 55 (19) 70 (24) 212 (69) 101 (30) 15 (10) 30 (18) 17 (9)
Heroin 12 (11) 25 (16) 40 (25) 33 (15) 9 (6) 20 (14) 28 (17) 85 (27) 37 (17) 40 (17)
Hallucinogens   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
LSD 16 (13) * (*) 24 (15) 24 (19) 28 (19) * (*) 18 (12) * (*) 20 (15) 13 (8)
PCP * (*) * (*) 14 (10) * (*) * (*) * (*) * (*) * (*) * (*) * (*)
Ecstasy   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Inhalants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Methamphetamine   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Misuse of Psychotherapeutics   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Pain Relievers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Stimulants   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers or Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Tranquilizers   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
Sedatives   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
CIGARETTES 111 (36) 98 (31) 63 (20) 131 (40) 83 (30) 45 (15) 89 (31) 124 (35) 78 (24) 73 (25)
Daily Cigarette Use 166 (48) 150 (39) 118 (29) 137 (42) 109 (33) 84 (23) 119 (37) 204 (49) 77 (23) 85 (32)
SMOKELESS TOBACCO   nc   nc   nc   nc   nc   nc   nc   nc   nc   nc
CIGARS 714 (82) 518 (74) 614 (79) 747 (86) 570 (77) 555 (73) 521 (77) 644 (90) 622 (87) 593 (119)
ALCOHOL 124 (40) 60 (21) 169 (74) 105 (31) 60 (22) 112 (32) 193 (50) 124 (34) 191 (76) 106 (32)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.21A – Past Year Initiation of Specific Substance Use: Among Adults Aged 26 or Older; 2002-2020 (continued)
Substance 2012 2013 2014 2015 2016 2017 2018 2019 2020
ILLICIT DRUGS   nc   nc   nc   nr   nr   nr   nr   nr   nr
Marijuana 177 (53) 210 (44) 271 (45) 383 (55) 372 (53) 525 (68) 525 (61) 887 (94) 664 (111)
Cocaine 76 (26) 75 (29) 148 (35) 193 (39) 213 (39) 210 (37) 184 (34) 135 (32) 66 (23)
Crack 17 (8) 23 (11) 44 (18) * (*) 34 (13) 52 (19) 61 (23) 63 (26) 23 (18)
Heroin 40 (15) 82 (32) 124 (31) 68 (20) 80 (21) 26 (11) 75 (22) 31 (16) 91 (57)
Hallucinogens   nc   nc   nc 150 (29) 134 (30) 167 (35) 250 (43) 259 (47) 376 (74)
LSD 33 (16) 48 (25) 50 (19) 71 (20) 117 (32) 120 (28) 169 (35) 219 (44) 171 (45)
PCP 17 (16) * (*) * (*) * (*) 22 (19) * (*) * (*) * (*) * (*)
Ecstasy   nc   nc   nc 141 (31) 154 (27) 134 (31) 157 (33) 180 (36) 245 (60)
Inhalants   nc   nc   nc 62 (20) 80 (25) 75 (27) 58 (19) 99 (30) 117 (42)
Methamphetamine   nc   nc   nc 110 (29) 97 (28) 73 (24) 106 (25) 96 (29) 97 (37)
Misuse of Psychotherapeutics   nc   nc   nc   nr   nr   nr   nr   nr   nr
Pain Relievers   nc   nc   nc 1,114 (101) 1,130 (102) 1,229 (111) 1,134 (109) 958 (105) 774 (117)
Stimulants   nc   nc   nc 384 (57) 513 (65) 394 (54) 302 (46) 299 (45) 324 (94)
Tranquilizers or Sedatives   nc   nc   nc   nr   nr   nr   nr   nr   nr
Tranquilizers   nc   nc   nc 738 (82) 530 (59) 749 (89) 560 (76) 435 (64) 557 (136)
Sedatives   nc   nc   nc 293 (61) 164 (37) 186 (39) 143 (33) 176 (47) 249 (106)
CIGARETTES 101 (28) 108 (32) 144 (29) 84 (20) 81 (20) 142 (29) 113 (29) 90 (25) 127 (45)
Daily Cigarette Use 92 (27) 99 (31) 113 (25) 100 (24) 152 (35) 130 (26) 80 (24) 180 (43) 168 (64)
SMOKELESS TOBACCO   nc   nc   nc 358 (53) 352 (72) 218 (41) 197 (46) 280 (50) 110 (35)
CIGARS 524 (72) 706 (126) 489 (62) 617 (75) 558 (72) 622 (75) 535 (62) 518 (69) 450 (94)
ALCOHOL 196 (56) 85 (26) 95 (37) 200 (48) 156 (44) 143 (38) 63 (16) 205 (40) 176 (56)
* = low precision; LSD = lysergic acid diethylamide; nc = not comparable due to methodological changes; nr = not reported due to measurement issues; PCP = phencyclidine.
NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.22B – Perceived Great Risk of Harm Associated with Selected Substance Use: Among People Aged 12 or Older; 2015-2020
Substance/Perceptions of Great Risk1 2015 2016 2017 2018 2019 2020
Cigarettes                        
Smoke One or More Packs per Day 72.8 (0.27) 72.8 (0.27) 71.6 (0.27) 71.8 (0.27) 71.2 (0.29) 70.7 (0.45)
Marijuana                        
Smoke Once a Month 29.1 (0.32) 27.7 (0.29) 26.1 (0.31) 25.0 (0.31) 23.8 (0.31) 21.6 (0.45)
Smoke Once or Twice a Week 36.3 (0.33) 34.0 (0.31) 31.9 (0.32) 30.6 (0.31) 29.2 (0.32) 27.4 (0.49)
Cocaine                        
Use Once a Month 72.0 (0.27) 71.8 (0.27) 71.3 (0.29) 71.2 (0.29) 70.0 (0.29) 67.2 (0.45)
Use Once or Twice a Week 87.4 (0.19) 87.1 (0.19) 86.8 (0.21) 86.5 (0.21) 85.7 (0.22) 84.7 (0.35)
Heroin                        
Try Once or Twice 85.2 (0.20) 85.6 (0.21) 86.4 (0.20) 86.2 (0.20) 85.2 (0.20) 83.1 (0.35)
Use Once or Twice a Week 94.2 (0.13) 94.1 (0.14) 94.5 (0.13) 94.3 (0.13) 93.8 (0.14) 93.2 (0.26)
Alcohol                        
Have Four or Five Drinks Nearly Every Day 68.7 (0.27) 68.3 (0.29) 68.9 (0.28) 68.5 (0.28) 67.9 (0.28) 68.7 (0.46)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents with unknown Perception of Great Risk data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015-2019 and Quarters 1 and 4, 2020.
Table A.23B – Perceived Great Risk of Harm Associated with Selected Substance Use: Among Adolescents Aged 12 to 17; 2015-2020
Substance/Perceptions of Great Risk1 2015 2016 2017 2018 2019 2020
Cigarettes                        
Smoke One or More Packs per Day 68.2 (0.46) 69.3 (0.47) 67.2 (0.49) 65.3 (0.50) 65.0 (0.53) 67.3 (0.98)
Marijuana                        
Smoke Once a Month 27.3 (0.44) 27.1 (0.47) 24.4 (0.43) 22.8 (0.41) 22.6 (0.43) 23.1 (0.94)
Smoke Once or Twice a Week 40.6 (0.52) 40.0 (0.53) 37.7 (0.53) 34.9 (0.49) 34.6 (0.50) 37.4 (1.02)
Cocaine                        
Use Once a Month 56.7 (0.50) 56.4 (0.51) 55.6 (0.49) 54.2 (0.53) 53.9 (0.50) 52.7 (1.07)
Use Once or Twice a Week 80.2 (0.40) 80.6 (0.39) 80.1 (0.42) 79.6 (0.44) 78.7 (0.44) 81.2 (0.83)
Heroin                        
Try Once or Twice 65.3 (0.51) 65.6 (0.47) 66.3 (0.47) 64.5 (0.52) 62.9 (0.50) 61.2 (1.07)
Use Once or Twice a Week 82.9 (0.38) 83.4 (0.38) 84.0 (0.39) 83.0 (0.39) 82.1 (0.41) 83.1 (0.83)
Alcohol                        
Have Four or Five Drinks Nearly Every Day 64.1 (0.50) 65.5 (0.47) 65.2 (0.47) 64.4 (0.51) 63.5 (0.52) 66.7 (1.01)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents with unknown Perception of Great Risk data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015-2019 and Quarters 1 and 4, 2020.
Table A.24B – Perceived Great Risk of Harm Associated with Selected Substance Use: Among Young Adults Aged 18 to 25; 2015-2020
Substance/Perceptions of Great Risk1 2015 2016 2017 2018 2019 2020
Cigarettes                        
Smoke One or More Packs per Day 68.0 (0.43) 68.6 (0.46) 66.6 (0.50) 67.5 (0.46) 66.2 (0.48) 66.5 (0.85)
Marijuana                        
Smoke Once a Month 15.2 (0.35) 13.5 (0.35) 12.3 (0.36) 12.0 (0.34) 11.8 (0.36) 11.8 (0.60)
Smoke Once or Twice a Week 19.1 (0.40) 17.2 (0.39) 15.4 (0.40) 15.4 (0.38) 15.0 (0.40) 14.8 (0.66)
Cocaine                        
Use Once a Month 65.3 (0.51) 64.8 (0.51) 63.0 (0.53) 62.7 (0.56) 62.6 (0.52) 59.3 (0.88)
Use Once or Twice a Week 84.3 (0.36) 83.6 (0.38) 83.3 (0.37) 82.6 (0.39) 82.6 (0.40) 82.2 (0.70)
Heroin                        
Try Once or Twice 82.6 (0.38) 83.0 (0.39) 82.6 (0.39) 82.5 (0.36) 82.4 (0.39) 80.1 (0.76)
Use Once or Twice a Week 94.0 (0.24) 93.5 (0.25) 93.9 (0.25) 93.3 (0.26) 93.3 (0.25) 93.3 (0.52)
Alcohol                        
Have Four or Five Drinks Nearly Every Day 62.1 (0.47) 62.3 (0.46) 63.2 (0.50) 63.4 (0.49) 62.4 (0.51) 64.6 (0.87)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents with unknown Perception of Great Risk data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015-2019 and Quarters 1 and 4, 2020.
Table A.25B – Perceived Great Risk of Harm Associated with Selected Substance Use: Among Adults Aged 26 or Older; 2015-2020
Substance/Perceptions of Great Risk1 2015 2016 2017 2018 2019 2020
Cigarettes                        
Smoke One or More Packs per Day 74.2 (0.32) 73.9 (0.33) 73.0 (0.33) 73.2 (0.33) 72.7 (0.35) 71.8 (0.54)
Marijuana                        
Smoke Once a Month 31.7 (0.40) 30.2 (0.36) 28.5 (0.38) 27.3 (0.38) 25.8 (0.37) 22.9 (0.55)
Smoke Once or Twice a Week 38.7 (0.40) 36.1 (0.38) 34.0 (0.39) 32.5 (0.38) 30.8 (0.39) 28.2 (0.60)
Cocaine                        
Use Once a Month 75.0 (0.33) 74.7 (0.32) 74.5 (0.35) 74.5 (0.35) 73.0 (0.35) 70.0 (0.53)
Use Once or Twice a Week 88.8 (0.23) 88.4 (0.24) 88.2 (0.25) 87.9 (0.25) 86.9 (0.26) 85.5 (0.42)
Heroin                        
Try Once or Twice 88.0 (0.24) 88.4 (0.24) 89.3 (0.24) 89.3 (0.23) 88.2 (0.23) 86.0 (0.38)
Use Once or Twice a Week 95.5 (0.16) 95.4 (0.16) 95.8 (0.16) 95.7 (0.15) 95.2 (0.17) 94.3 (0.29)
Alcohol                        
Have Four or Five Drinks Nearly Every Day 70.4 (0.34) 69.6 (0.35) 70.2 (0.35) 69.7 (0.34) 69.3 (0.33) 69.5 (0.55)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents with unknown Perception of Great Risk data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015-2019 and Quarters 1 and 4, 2020.
Table A.26B – Substance Use Disorder for Specific Substances in the Past Year: Among People Aged 12 or Older; by Age Group, 2020
Substance Use Disorder Aged 12 or Older Aged 12 to 17 Aged 18 to 25 Aged 26 or Older
ALCOHOL OR ILLICIT DRUGS1 14.5 (0.33) 6.3 (0.49) 24.4 (0.83) 14.0 (0.39)
ALCOHOL 10.2 (0.29) 2.8 (0.34) 15.6 (0.72) 10.3 (0.34)
ILLICIT DRUGS 6.6 (0.21) 4.9 (0.42) 14.6 (0.63) 5.6 (0.24)
Marijuana 5.1 (0.18) 4.1 (0.38) 13.5 (0.61) 4.0 (0.19)
Cocaine 0.5 (0.06) 0.1 (0.06) 0.7 (0.13) 0.5 (0.07)
Heroin 0.2 (0.05) *     (*) 0.1 (0.05) 0.3 (0.06)
Hallucinogens 0.1 (0.02) 0.3 (0.08) 0.4 (0.09) 0.1 (0.02)
Inhalants 0.1 (0.02) 0.3 (0.14) 0.1 (0.06) 0.0 (0.02)
Methamphetamine 0.6 (0.07) 0.1 (0.05) 0.3 (0.07) 0.6 (0.09)
Misuse of Psychotherapeutics 1.3 (0.11) 0.6 (0.12) 1.6 (0.21) 1.3 (0.14)
Pain Relievers 0.8 (0.09) 0.3 (0.10) 0.8 (0.14) 0.9 (0.11)
Stimulants 0.3 (0.04) 0.2 (0.05) 0.4 (0.10) 0.3 (0.05)
Tranquilizers or Sedatives 0.4 (0.06) 0.3 (0.09) 0.7 (0.13) 0.4 (0.07)
Tranquilizers 0.3 (0.05) 0.3 (0.09) 0.6 (0.12) 0.3 (0.06)
Sedatives 0.1 (0.04) 0.0 (0.02) 0.1 (0.06) 0.1 (0.05)
Opioids 1.0 (0.10) 0.3 (0.10) 0.9 (0.14) 1.1 (0.12)
Central Nervous System Stimulants 1.1 (0.10) 0.4 (0.09) 1.3 (0.18) 1.2 (0.12)
BOTH ALCOHOL AND ILLICIT DRUGS 2.3 (0.12) 1.4 (0.22) 5.7 (0.42) 1.9 (0.14)
* = low precision.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Substance use disorder (SUD) estimates in 2020 are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. SUD and related estimates are not comparable between 2020 and prior years of NSDUH because prior years’ estimates were based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The 2020 estimates reflect additional methodological changes for the 2020 NSDUH. Due to these changes, estimates are shown for 2020 only. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details on these changes.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.
1 The term “alcohol or illicit drugs” in this table corresponds to the term “substance use disorder” in the main body of the report.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.27B – Major Depressive Episode (MDE) and MDE with Severe Impairment in the Past Year: Among Adolescents Aged 12 to 17; 2004-2020
MDE 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MDE 9.0 (0.25) 8.8 (0.25) 7.9 (0.24) 8.2 (0.25) 8.3 (0.25) 8.1 (0.24) 8.0 (0.24) 8.2 (0.24) 9.1 (0.26) 10.7 (0.30) 11.4 (0.32)
MDE with Severe Impairment1   --   -- 5.5 (0.20) 5.5 (0.20) 6.0 (0.22) 5.8 (0.20) 5.7 (0.20) 5.7 (0.19) 6.3 (0.22) 7.7 (0.26) 8.2 (0.27)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.27B – Major Depressive Episode (MDE) and MDE with Severe Impairment in the Past Year: Among Adolescents Aged 12 to 17; 2004-2020 (continued)
MDE 2015 2016 2017 2018 2019 2020
MDE 12.5 (0.33) 12.8 (0.32) 13.3 (0.35) 14.4 (0.36) 15.7 (0.37) 17.0 (0.82)
MDE with Severe Impairment1 8.8 (0.28) 9.0 (0.27) 9.4 (0.31) 10.0 (0.29) 11.1 (0.32) 12.0 (0.66)
-- = not available.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown past year MDE data were excluded.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Impairment is based on the Sheehan Disability Scale role domains, which measure the impact of a disorder on an adolescent’s life. Impairment is defined as the highest severity level of role impairment across four domains: (1) chores at home, (2) school or work, (3) close relationships with family, and (4) social life. Ratings ≥ 7 on a 0 to 10 scale were considered Severe Impairment. Respondents with unknown impairment data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2004-2019 and Quarters 1 and 4, 2020.
Table A.28B – Major Depressive Episode (MDE) and MDE with Severe Impairment in the Past Year: Among Adults Aged 18 or Older; by Age Group, 2005-2020
MDE/Age Group 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
MDE 6.6 (0.19) 6.5 (0.18) 6.7 (0.18) 6.5 (0.18) 6.6 (0.18) 6.8 (0.19) 6.6 (0.18) 6.9 (0.19) 6.7 (0.19) 6.6 (0.15) 6.7 (0.15)
18-25 8.8 (0.26) 8.1 (0.23) 8.0 (0.24) 8.4 (0.25) 8.0 (0.24) 8.3 (0.25) 8.3 (0.25) 8.9 (0.27) 8.7 (0.26) 9.3 (0.29) 10.3 (0.28)
26-49 7.6 (0.27) 7.7 (0.29) 7.6 (0.26) 7.4 (0.27) 7.6 (0.26) 7.5 (0.27) 7.7 (0.28) 7.6 (0.27) 7.6 (0.29) 7.2 (0.21) 7.5 (0.21)
50 or Older 4.5 (0.32) 4.5 (0.29) 5.2 (0.34) 4.8 (0.35) 4.9 (0.32) 5.6 (0.35) 4.8 (0.30) 5.5 (0.34) 5.1 (0.31) 5.2 (0.24) 4.8 (0.26)
MDE with Severe
   Impairment1
  --   --   --   -- 4.0 (0.14) 4.2 (0.15) 4.2 (0.15) 4.5 (0.15) 4.3 (0.15) 4.3 (0.12) 4.3 (0.12)
18-25   --   --   --   -- 5.2 (0.20) 5.2 (0.21) 5.2 (0.20) 5.8 (0.21) 5.7 (0.22) 6.0 (0.24) 6.5 (0.23)
26-49   --   --   --   -- 4.8 (0.21) 4.7 (0.21) 5.2 (0.23) 5.1 (0.23) 4.9 (0.24) 4.6 (0.17) 4.9 (0.17)
50 or Older   --   --   --   -- 2.6 (0.23) 3.5 (0.28) 2.9 (0.24) 3.4 (0.28) 3.2 (0.25) 3.5 (0.21) 3.0 (0.21)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.28B – Major Depressive Episode (MDE) and MDE with Severe Impairment in the Past Year: Among Adults Aged 18 or Older; by Age Group, 2005-2020 (continued)
MDE/Age Group 2016 2017 2018 2019 2020
MDE 6.7 (0.15) 7.1 (0.16) 7.2 (0.15) 7.8 (0.16) 8.4 (0.27)
18-25 10.9 (0.31) 13.1 (0.34) 13.8 (0.34) 15.2 (0.37) 17.0 (0.69)
26-49 7.4 (0.21) 7.7 (0.23) 8.0 (0.23) 8.9 (0.22) 9.1 (0.36)
50 or Older 4.8 (0.25) 4.7 (0.24) 4.5 (0.24) 4.7 (0.24) 5.4 (0.41)
MDE with Severe
   Impairment1
4.3 (0.12) 4.5 (0.12) 4.7 (0.13) 5.3 (0.13) 6.0 (0.23)
18-25 7.0 (0.27) 8.5 (0.29) 8.9 (0.28) 10.3 (0.30) 12.1 (0.57)
26-49 4.7 (0.16) 5.0 (0.18) 5.3 (0.19) 6.1 (0.18) 6.5 (0.32)
50 or Older 3.0 (0.22) 2.8 (0.18) 2.9 (0.20) 3.2 (0.21) 3.8 (0.35)
-- = not available.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown past year MDE data were excluded.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Estimates in this table for 2020 exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Impairment is based on the Sheehan Disability Scale role domains, which measure the impact of a disorder on an adult’s life. Impairment is defined as the highest severity level of role impairment across four domains: (1) home management, (2) work, (3) close relationships with others, and (4) social life. Ratings ≥ 7 on a 0 to 10 scale were considered Severe Impairment. Respondents with unknown impairment data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2005-2019 and Quarters 1 and 4, 2020.
Table A.29B – Level of Mental Illness in the Past Year: Among Adults Aged 18 or Older; by Age Group, 2008-2020
Mental Illness/Age Group 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
AMI 17.7 (0.30) 18.1 (0.31) 18.1 (0.30) 17.8 (0.30) 18.6 (0.31) 18.5 (0.31) 18.1 (0.23) 17.9 (0.25) 18.3 (0.24) 18.9 (0.27)
18-25 18.5 (0.34) 18.0 (0.32) 18.1 (0.35) 18.5 (0.37) 19.6 (0.35) 19.4 (0.36) 20.1 (0.39) 21.7 (0.38) 22.1 (0.43) 25.8 (0.49)
26-49 20.7 (0.42) 21.6 (0.43) 20.9 (0.42) 20.3 (0.43) 21.2 (0.44) 21.5 (0.45) 20.4 (0.34) 20.9 (0.34) 21.1 (0.33) 22.2 (0.36)
50 or Older 14.1 (0.59) 14.5 (0.54) 15.1 (0.55) 15.0 (0.53) 15.8 (0.55) 15.3 (0.52) 15.4 (0.40) 14.0 (0.42) 14.5 (0.40) 13.8 (0.42)
SMI 3.7 (0.14) 3.7 (0.14) 4.1 (0.16) 3.9 (0.14) 4.1 (0.14) 4.2 (0.16) 4.1 (0.12) 4.0 (0.12) 4.2 (0.12) 4.5 (0.12)
18-25 3.8 (0.16) 3.3 (0.15) 3.9 (0.17) 3.8 (0.17) 4.1 (0.17) 4.2 (0.18) 4.8 (0.21) 5.0 (0.21) 5.9 (0.24) 7.5 (0.26)
26-49 4.8 (0.21) 4.9 (0.22) 5.2 (0.23) 5.0 (0.22) 5.2 (0.23) 5.3 (0.25) 4.9 (0.18) 5.0 (0.18) 5.3 (0.18) 5.6 (0.19)
50 or Older 2.5 (0.24) 2.5 (0.23) 3.0 (0.27) 2.8 (0.22) 3.0 (0.25) 3.2 (0.26) 3.1 (0.19) 2.8 (0.20) 2.7 (0.20) 2.7 (0.19)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.29B – Level of Mental Illness in the Past Year: Among Adults Aged 18 or Older; by Age Group, 2008-2020 (continued)
Mental Illness/Age Group 2018 2019 2020
AMI 19.1 (0.26) 20.6 (0.25) 21.0 (0.39)
18-25 26.3 (0.44) 29.4 (0.48) 30.6 (0.84)
26-49 22.5 (0.35) 25.0 (0.36) 25.3 (0.54)
50 or Older 14.0 (0.42) 14.1 (0.40) 14.5 (0.63)
SMI 4.6 (0.12) 5.2 (0.13) 5.6 (0.23)
18-25 7.7 (0.25) 8.6 (0.27) 9.7 (0.53)
26-49 5.9 (0.18) 6.8 (0.19) 6.9 (0.31)
50 or Older 2.5 (0.19) 2.9 (0.20) 3.4 (0.35)
AMI = any mental illness; SMI = serious mental illness.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Estimates in this table for 2020 exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008-2019 and Quarters 1 and 4, 2020.
Table A.30AB – Substance Use Disorder (SUD) and Major Depressive Episode (MDE) in the Past Year: Among Adolescents Aged 12 to 17; 2020
SUD or MDE Status Number in Thousands1 Percentage2
SUD or MDE 5,072 (218) 20.9 (0.89)
SUD but no MDE 900   (96) 3.7 (0.40)
MDE but no SUD 3,488 (186) 14.4 (0.77)
Co-Occurring SUD and MDE 644   (79) 2.7 (0.33)
Co-Occurring SUD and MDE with Severe Impairment3 447   (60) 1.8 (0.25)
NOTE: Respondents with unknown past year MDE data were excluded.
NOTE: SUD estimates in 2020 are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. SUD and related estimates are not comparable between 2020 and prior years of NSDUH because prior years’ estimates were based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The 2020 estimates reflect additional methodological changes for the 2020 NSDUH. Due to these changes, estimates are shown for 2020 only. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details on these changes.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Estimates shown are numbers in thousands with standard errors included in parentheses.
2 Estimates shown are percentages with standard errors included in parentheses.
3 Impairment is based on the Sheehan Disability Scale role domains, which measure the impact of a disorder on an adolescent’s life. Impairment is defined as the highest severity level of role impairment across four domains: (1) chores at home, (2) school or work, (3) close relationships with family, and (4) social life. Ratings ≥ 7 on a 0 to 10 scale were considered Severe Impairment. Respondents with unknown impairment data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.31B – Substance Use in the Past Year and Past Month: Among Adolescents Aged 12 to 17; by Past Year Major Depressive Episode (MDE), 2020
Period/Substance Total1 MDE No MDE
PAST YEAR USE            
Illicit Drugs 13.8 (0.67) 28.6 (2.27) 10.7 (0.64)
Marijuana 10.1 (0.57) 22.0 (2.11) 7.9 (0.57)
Cocaine 0.3 (0.10) 0.9 (0.42) 0.2 (0.10)
Heroin *     (*) *     (*) *     (*)
Hallucinogens 1.5 (0.21) 3.7 (0.87) 1.1 (0.18)
Inhalants 2.7 (0.32) 7.0 (1.29) 1.8 (0.27)
Methamphetamine 0.1 (0.05) *     (*) 0.1 (0.03)
Misuse of Psychotherapeutics 2.8 (0.32) 5.5 (0.92) 2.1 (0.33)
Pain Relievers 1.6 (0.24) 2.3 (0.49) 1.4 (0.28)
Stimulants 1.2 (0.20) 2.8 (0.73) 0.8 (0.19)
Tranquilizers or Sedatives 0.9 (0.16) 2.6 (0.70) 0.5 (0.14)
Opioids 1.6 (0.24) 2.3 (0.49) 1.4 (0.28)
Central Nervous System Stimulants 1.4 (0.22) 3.4 (0.80) 0.9 (0.21)
PAST MONTH USE            
Cigarettes 1.4 (0.22) 2.7 (1.00) 1.1 (0.20)
Nicotine Vaping 5.1 (0.43) 11.2 (1.43) 3.9 (0.45)
Binge Alcohol Use 4.1 (0.42) 6.2 (0.96) 3.8 (0.48)
Heavy Alcohol Use 0.6 (0.15) 1.2 (0.59) 0.4 (0.15)
* = low precision.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Estimates in the Total column represent all adolescents aged 12 to 17, including those with unknown past year MDE data.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.32A – Level of Mental Illness in the Past Year: Among Adults Aged 18 or Older; by Past Year Substance Use Disorder Status and Age Group, 2020
Level of Mental Illness/SUD Status 18 or Older 18 to 25 26 to 49 50 or Older
SUD or AMI 73,797 (1,120) 14,205 (320) 35,848 (627) 23,744 (854)
SUD but no AMI 20,938 (679) 3,967 (204) 10,172 (396) 6,799 (513)
AMI but no SUD 35,874 (836) 6,167 (237) 16,378 (479) 13,329 (653)
SUD and AMI 16,985 (597) 4,071 (200) 9,298 (381) 3,616 (398)
SUD or SMI 46,462 (977) 9,756 (295) 23,250 (566) 13,456 (709)
SUD but no SMI 32,262 (852) 6,498 (261) 16,269 (502) 9,495 (612)
SMI but no SUD 8,540 (455) 1,719 (132) 3,780 (228) 3,041 (361)
SUD and SMI 5,661 (317) 1,539 (113) 3,201 (225) 920 (185)
AMI = any mental illness; SMI = serious mental illness; SUD = substance use disorder.
NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses.
NOTE: SUD estimates in 2020 are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. SUD and related estimates are not comparable between 2020 and prior years of NSDUH because prior years’ estimates were based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The 2020 estimates reflect additional methodological changes for the 2020 NSDUH. Due to these changes, estimates are shown for 2020 only. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details on these changes.
NOTE: Estimates in this table exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.32B – Level of Mental Illness in the Past Year: Among Adults Aged 18 or Older; by Past Year Substance Use Disorder Status and Age Group, 2020
Level of Mental Illness/SUD Status 18 or Older 18 to 25 26 to 49 50 or Older
SUD or AMI 29.3 (0.44) 42.4 (0.96) 35.3 (0.62) 20.3 (0.73)
SUD but no AMI 8.3 (0.27) 11.8 (0.61) 10.0 (0.39) 5.8 (0.44)
AMI but no SUD 14.2 (0.33) 18.4 (0.71) 16.1 (0.47) 11.4 (0.56)
SUD and AMI 6.7 (0.24) 12.2 (0.60) 9.2 (0.38) 3.1 (0.34)
SUD or SMI 18.4 (0.39) 29.1 (0.88) 22.9 (0.56) 11.5 (0.61)
SUD but no SMI 12.8 (0.34) 19.4 (0.78) 16.0 (0.49) 8.1 (0.52)
SMI but no SUD 3.4 (0.18) 5.1 (0.39) 3.7 (0.22) 2.6 (0.31)
SUD and SMI 2.2 (0.13) 4.6 (0.34) 3.2 (0.22) 0.8 (0.16)
AMI = any mental illness; SMI = serious mental illness; SUD = substance use disorder.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: SUD estimates in 2020 are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. SUD and related estimates are not comparable between 2020 and prior years of NSDUH because prior years’ estimates were based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The 2020 estimates reflect additional methodological changes for the 2020 NSDUH. Due to these changes, estimates are shown for 2020 only. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details on these changes.
NOTE: Estimates in this table exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.33B – Substance Use in the Past Year and Past Month: Among Adults Aged 18 or Older; by Past Year Mental Illness Status, 2020
Period/Substance Total Any Mental Illness Serious Mental Illness No Mental Illness
PAST YEAR USE                
Illicit Drugs 21.8 (0.43) 39.8 (0.99) 47.8 (2.07) 17.0 (0.45)
Marijuana 18.4 (0.41) 32.8 (0.96) 39.2 (2.01) 14.6 (0.43)
Cocaine 2.0 (0.13) 4.4 (0.39) 7.2 (0.92) 1.3 (0.11)
Heroin 0.3 (0.06) 1.1 (0.26) 1.8 (0.47) 0.1 (0.02)
Hallucinogens 2.6 (0.15) 6.2 (0.42) 9.7 (0.95) 1.7 (0.14)
Inhalants 0.7 (0.07) 1.6 (0.21) 3.2 (0.58) 0.4 (0.07)
Methamphetamine 0.9 (0.11) 3.0 (0.42) 5.2 (1.09) 0.4 (0.07)
Misuse of Psychotherapeutics 6.0 (0.23) 13.9 (0.69) 18.6 (1.45) 3.9 (0.21)
Pain Relievers 3.4 (0.19) 7.8 (0.56) 11.1 (1.17) 2.2 (0.18)
Stimulants 1.9 (0.12) 4.2 (0.35) 6.1 (0.82) 1.3 (0.11)
Tranquilizers or Sedatives 2.4 (0.13) 7.1 (0.53) 10.6 (1.13) 1.1 (0.09)
Opioids 3.5 (0.19) 8.1 (0.56) 11.6 (1.19) 2.3 (0.18)
Central Nervous System Stimulants 3.9 (0.19) 8.8 (0.58) 13.9 (1.39) 2.6 (0.17)
PAST MONTH USE                
Cigarettes 16.3 (0.42) 23.1 (0.89) 27.5 (1.66) 14.5 (0.47)
Nicotine Vaping 3.7 (0.16) 7.7 (0.46) 12.7 (1.10) 2.7 (0.15)
Binge Alcohol Use 24.0 (0.45) 28.5 (0.96) 30.9 (1.82) 22.8 (0.50)
Heavy Alcohol Use 6.9 (0.25) 8.8 (0.59) 10.2 (1.05) 6.4 (0.28)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in this table exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. Therefore, some estimates in this table could differ from corresponding estimates in other tables that did not undergo sample size adjustments. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.34B – Had Serious Thoughts of Suicide, Made Any Suicide Plans, and Attempted Suicide in the Past Year: Among Adults Aged 18 or Older; by Demographic Characteristics, 2020
Demographic Characteristic Had Serious Thoughts of Suicide
in the Past Year
Made Any Suicide Plans
in the Past Year
Attempted Suicide
in the Past Year
TOTAL 4.9 (0.20) 1.3 (0.09) 0.5 (0.05)
AGE GROUP            
18-25 11.3 (0.56) 4.0 (0.32) 1.9 (0.23)
26 or Older 3.9 (0.21) 0.9 (0.09) 0.3 (0.05)
26-49 5.3 (0.28) 1.3 (0.16) 0.4 (0.09)
50 or Older 2.7 (0.28) 0.4 (0.10) 0.1 (0.04)
GENDER            
Male 4.5 (0.26) 1.2 (0.13) 0.4 (0.06)
Female 5.2 (0.27) 1.4 (0.13) 0.6 (0.08)
HISPANIC ORIGIN AND RACE            
Not Hispanic or Latino 5.0 (0.22) 1.3 (0.10) 0.5 (0.05)
White 5.3 (0.27) 1.4 (0.12) 0.5 (0.06)
Black or African American 3.4 (0.49) 1.1 (0.27) 0.3 (0.10)
American Indian or Alaska Native 5.6 (2.47) 1.8 (0.86) *     (*)
Native Hawaiian or Other Pacific Islander 2.3 (1.15) 0.7 (0.54) 0.9 (0.62)
Asian 2.8 (0.49) 0.3 (0.12) 0.1 (0.08)
Two or More Races 11.0 (1.89) 3.3 (1.01) 1.2 (0.57)
Hispanic or Latino 4.2 (0.47) 1.2 (0.23) 0.6 (0.16)
EMPLOYMENT STATUS            
Full-Time 4.1 (0.24) 0.9 (0.10) 0.3 (0.06)
Part-Time 6.8 (0.59) 1.9 (0.28) 0.7 (0.16)
Unemployed 9.2 (1.13) 3.5 (0.73) 1.9 (0.44)
Other1 4.6 (0.37) 1.3 (0.16) 0.5 (0.08)
* = low precision.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in this table exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Other Employment includes students, adults keeping house or caring for children full time, retired or disabled adults, or other adults not in the labor force.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.35B – Had Serious Thoughts of Suicide, Made Any Suicide Plans, and Attempted Suicide Because of the COVID-19 Pandemic: Among Adults Aged 18 or Older with Respective Suicidal Thoughts and Behaviors in the Past Year; by Demographic Characteristics, Quarter 4, 2020
Demographic Characteristic Had Serious Thoughts of Suicide
Because of the COVID-19 Pandemic among All
Adults Who Had Serious Thoughts of Suicide
Made Suicide Plans
Because of the COVID-19 Pandemic among All
Adults Who Made Any Suicide Plans
Attempted Suicide
Because of the COVID-19 Pandemic among All
Adults Who Attempted Suicide
TOTAL 21.1 (2.31) 8.5 (2.98) * (*)
AGE GROUP            
18-25 22.6 (3.05) 8.2 (2.95) * (*)
26 or Older 20.5 (3.04) *     (*) * (*)
26-49 19.1 (3.03) *     (*) * (*)
50 or Older *     (*) *     (*) * (*)
GENDER            
Male 20.0 (3.22) *     (*) * (*)
Female 21.9 (3.35) *     (*) * (*)
HISPANIC ORIGIN AND RACE            
Not Hispanic or Latino 21.1 (2.49) 8.9 (3.34) * (*)
White 20.1 (2.78) *     (*) * (*)
Black or African American *     (*) *     (*) * (*)
American Indian or Alaska Native *     (*) *     (*) * (*)
Native Hawaiian or Other Pacific Islander *     (*) *     (*) * (*)
Asian *     (*) *     (*) * (*)
Two or More Races *     (*) *     (*) * (*)
Hispanic or Latino *     (*) *     (*) * (*)
EMPLOYMENT STATUS            
Full-Time 17.6 (2.90) *     (*) * (*)
Part-Time *     (*) *     (*) * (*)
Unemployed *     (*) *     (*) * (*)
Other1 18.4 (4.47) *     (*) * (*)
* = low precision; COVID-19 = coronavirus disease 2019.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown information on their suicide behaviors because of the COVID-19 pandemic were excluded.
NOTE: Estimates in this table exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Other Employment includes students, adults keeping house or caring for children full time, retired or disabled adults, or other adults not in the labor force.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarter 4, 2020.
Table A.36B – Had Serious Thoughts of Suicide, Made Any Suicide Plans, and Attempted Suicide in the Past Year: Among Adolescents Aged 12 to 17; Quarter 4, 2020
Suicidal Thoughts/Behavior Total
HAD SERIOUS THOUGHTS OF SUICIDE    
Yes 12.0 (1.20)
No 74.8 (1.59)
Not Sure/Don’t Know 7.1 (0.92)
Don’t Want to Answer/Refuse 6.1 (0.94)
MADE SUICIDE PLANS    
Yes 5.3 (0.89)
No 87.9 (1.18)
Not Sure/Don’t Know 2.9 (0.65)
Don’t Want to Answer/Refuse 4.0 (0.66)
ATTEMPTED SUICIDE    
Yes 2.5 (0.63)
No 92.6 (1.03)
Not Sure/Don’t Know 1.1 (0.48)
Don’t Want to Answer/Refuse 3.8 (0.70)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown suicide data other than the categories shown in this table were excluded.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarter 4, 2020.
Table A.37B – Had Serious Thoughts of Suicide Because of the COVID-19 Pandemic: Among Adolescents Aged 12 to 17 Who Had Serious Thoughts of Suicide in the Past Year; Quarter 4, 2020
Characteristic Total
Had Serious Thoughts of Suicide Because of the COVID-19 Pandemic
  among Adolescents Who Had Serious Thoughts of Suicide
* (*)
* = low precision; COVID-19 = coronavirus disease 2019.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown suicide data other than the categories shown in this table were excluded.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarter 4, 2020.
Table A.38AB – Need for Substance Use Treatment, Receipt of Substance Use Treatment, and Receipt of Substance Use Treatment at a Specialty Facility in the Past Year: Among People Aged 12 or Older; by Age Group, Quarters 1 and 4, 2020
Needed/Received Substance Use
Treatment
Aged 12 or
Older,
Number1
Percentage
among People
Aged 12 or
Older2
Aged 12-17,
Number1
Percentage
among
Adolescents
Aged
12-172
Aged 18-25,
Number1
Percentage
among Young
Adults
Aged 18-252
Aged 26 or
Older,
Number1
Percentage
among Adults
Aged 26 or
Older2
Needed Substance Use Treatment3 41,135 (926) 14.9 (0.33) 1,600 (123) 6.4 (0.49) 8,227 (280) 24.6 (0.83) 31,308 (859) 14.3 (0.39)
Received Any Substance Use Treatment4,5 4,009 (313) 1.4 (0.11) 169 (36) 0.7 (0.14) 445 (76) 1.3 (0.23) 3,395 (300) 1.6 (0.14)
Received Any Substance Use Treatment among People
  with a Past Year SUD5,6
2,630 (250) 6.5 (0.59) 120 (33) 7.6 (2.02) 363 (71) 4.4 (0.85) 2,147 (232) 7.0 (0.72)
Received Substance Use Treatment at a Specialty Facility5 2,685 (259) 1.0 (0.09) 55 (21) 0.2 (0.08) 301 (67) 0.9 (0.20) 2,329 (245) 1.1 (0.11)
Received Substance Use Treatment at a Specialty Facility
  among People Who Needed Substance Use Treatment3,4,5
2,685 (259) 6.5 (0.60) 55 (21) 3.5 (1.28) 301 (68) 3.7 (0.81) 2,329 (245) 7.4 (0.74)
SUD = substance use disorder.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Estimates shown are numbers in thousands with standard errors included in parentheses.
2 Estimates shown are percentages with standard errors included in parentheses.
3 Respondents were classified as needing substance use treatment if they met the criteria for an SUD as defined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or received treatment for illicit drug or alcohol use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient only], or mental health center).
4 Received Substance Use Treatment includes treatment received at any location, such as a hospital (inpatient), rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor’s office, self-help group, or prison/jail.
5 Estimates include people who received treatment specifically for illicit drugs or alcohol, as well as people who received treatment for unspecified substance(s).
6 Substance use disorder is defined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.39AB – Receipt of Virtual Treatment for Substance Use: Among People Who Received Any Substance Use Treatment in the Past Year; by Age Group, Quarter 4, 2020
Received Virtual Treatment for
Substance Use
Aged 12 or
Older,
Number1
Percentage
among People
Aged 12 or
Older2
Aged 12-17,
Number1
Percentage
among
Adolescents
Aged 12-172
Aged 18-25,
Number1
Percentage
among Young
Adults
Aged 18-252
Aged 26 or
Older,
Number1
Percentage
among Adults
Aged 26 or
Older2
Received Virtual Treatment for Substance Use 2,190 (276) 0.8 (0.10) 74 (43) 0.3 (0.17) 207 (65) 0.6 (0.19) 1,909 (267) 0.9 (0.12)
Received Virtual Treatment for Substance Use among
  People Who Received Any Substance Use Treatment
2,190 (279) 58.0 (4.58) * (*) * (*) * (*) * (*) 1,909 (268) 58.4 (5.07)
* = low precision.
NOTE: Estimates include people who received treatment specifically for illicit drugs or alcohol, as well as people who received treatment for unspecified substance(s).
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Estimates shown are numbers in thousands with standard errors included in parentheses.
2 Estimates shown are percentages with standard errors included in parentheses.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarter 4, 2020.
Table A.40AB – Perceived Need for Substance Use Treatment and Whether Made an Effort to Get Treatment in the Past Year: Among People Aged 12 or Older with a Past Year Substance Use Disorder Who Did Not Receive Substance Use Treatment at a Specialty Facility; by Age Group, Quarters 1 and 4, 2020
Perceived Need/Effort Aged 12 or
Older,
Number1
Percentage
among People
Aged 12 or
Older2
Aged 12-17,
Number1
Percentage
among
Adolescents
Aged 12-172
Aged 18-25,
Number1
Percentage
among Young
Adults
Aged 18-252
Aged 26 or
Older,
Number1
Percentage
among Adults
Aged 26 or
Older2
Past Year Substance Use Disorder and Did Not Receive
  Substance Use Treatment at a Specialty Facility
38,449 (953) 100.0 (0.00) 1,544 (127) 100.0 (0.00) 7,926 (340) 100.0 (0.00) 28,979 (883) 100.0 (0.00)
Felt Need for Treatment 948 (139) 2.5 (0.36) 24 (13) 1.6 (0.85) 151 (32) 1.9 (0.40) 773 (132) 2.7 (0.45)
Felt Need and Made Effort to Get Treatment 211 (55) 0.5 (0.14) 4 (2) 0.2 (0.15) 46 (19) 0.6 (0.24) 161 (51) 0.6 (0.18)
Felt Need and Made No Effort to Get Treatment 737 (128) 1.9 (0.33) 21 (13) 1.3 (0.84) 105 (26) 1.3 (0.32) 611 (124) 2.1 (0.43)
Did Not Feel Need for Treatment 37,501 (944) 97.5 (0.36) 1,520 (127) 98.4 (0.85) 7,775 (338) 98.1 (0.40) 28,207 (879) 97.3 (0.45)
NOTE: Respondents were classified as needing substance use treatment if they met the criteria for a substance use disorder as defined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or received treatment for illicit drug or alcohol use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient only], or mental health center).
NOTE: Substance use disorder is defined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Estimates shown are numbers in thousands with standard errors included in parentheses.
2 Estimates shown are percentages with standard errors included in parentheses.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.41B – Locations of Illicit Drug Use Treatment in the Past Year: Among People Aged 12 or Older Who Received Illicit Drug Use Treatment in the Past Year; by Quarter, 2020
Location of Treatment1 Quarter 1 Quarter 4 Quarters 1 and 4
RECEIVED ILLICIT DRUG USE TREATMENT 0.9 (0.14) 0.9 (0.11) 0.9 (0.09)
Hospital - Inpatient *     (*) 13.2 (3.87) 16.8 (4.03)
Rehabilitation Facility - Inpatient *     (*) 22.8 (4.95) 28.7 (4.79)
Rehabilitation Facility - Outpatient *     (*) 60.2 (5.77) 52.1 (4.98)
Mental Health Center - Outpatient *     (*) 45.0 (5.94) 40.2 (4.81)
Emergency Room *     (*) 11.8 (3.84) *     (*)
Private Doctor’s Office 22.9 (4.87) *     (*) 24.7 (3.82)
Self-Help Group *     (*) 45.4 (5.94) 43.0 (4.65)
Prison/Jail 1.8 (0.80) *     (*) 4.7 (1.92)
Virtual       na 56.2 (5.83)       na
* = low precision; na = not applicable.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Received Illicit Drug Use Treatment includes treatment received at any location, such as a hospital (inpatient), rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor’s office, self-help group, prison/jail, or virtual. Questions on virtual substance use treatment were added in Quarter 4 of 2020.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents could indicate multiple locations for receiving illicit drug use treatment; thus, these response categories are not mutually exclusive.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.42B – Locations of Alcohol Use Treatment in the Past Year: Among People Aged 12 or Older Who Received Alcohol Use Treatment in the Past Year; by Quarter, 2020
Location of Treatment1 Quarter 1 Quarter 4 Quarters 1 and 4
RECEIVED ALCOHOL USE TREATMENT 0.7 (0.09) 0.8 (0.09) 0.7 (0.07)
Hospital - Inpatient *     (*) *     (*) 23.1 (4.09)
Rehabilitation Facility - Inpatient *     (*) *     (*) 29.9 (4.67)
Rehabilitation Facility - Outpatient *     (*) *     (*) 35.3 (4.68)
Mental Health Center - Outpatient *     (*) 29.6 (5.27) 29.2 (3.99)
Emergency Room *     (*) *     (*) 17.4 (4.38)
Private Doctor’s Office *     (*) *     (*) 22.8 (4.43)
Self-Help Group *     (*) *     (*) 55.7 (4.83)
Prison/Jail *     (*) 3.0 (1.80) 3.7 (1.67)
Virtual       na *     (*)       na
* = low precision; na = not applicable.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Received Alcohol Use Treatment includes treatment received at any location, such as a hospital (inpatient), rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor’s office, self-help group, prison/jail, or virtual. Questions on virtual substance use treatment were added in Quarter 4 of 2020.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents could indicate multiple locations for receiving alcohol use treatment; thus, these response categories are not mutually exclusive.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.43B – Locations of Substance Use Treatment in the Past Year: Among People Aged 12 or Older Who Received Substance Use Treatment in the Past Year; by Quarter, 2020
Location of Treatment1 Quarter 1 Quarter 4 Quarters 1 and 4
RECEIVED SUBSTANCE USE TREATMENT 1.5 (0.19) 1.4 (0.13) 1.4 (0.11)
Hospital - Inpatient *     (*) 19.2 (3.77) 20.0 (3.19)
Rehabilitation Facility - Inpatient *     (*) 27.6 (4.27) 27.5 (3.55)
Rehabilitation Facility - Outpatient 35.1 (5.43) 55.3 (4.88) 44.6 (3.84)
Mental Health Center - Outpatient 30.3 (5.37) 41.3 (4.54) 35.5 (3.52)
Emergency Room *     (*) 16.7 (4.11) 18.3 (3.45)
Private Doctor’s Office 20.6 (3.73) 32.6 (5.10) 26.3 (3.28)
Self-Help Group 40.4 (5.57) 52.2 (5.05) 46.0 (3.77)
Prison/Jail 3.6 (1.57) 5.5 (2.44) 4.5 (1.44)
Virtual       na 58.0 (4.58)       na
* = low precision; na = not applicable.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Received Substance Use Treatment includes treatment received at any location, such as a hospital (inpatient), rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor’s office, self-help group, prison/jail, or virtual. Questions on virtual substance use treatment were added in Quarter 4 of 2020.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents could indicate multiple locations for receiving substance use treatment; thus, these response categories are not mutually exclusive.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.44B – Detailed Reasons for Not Receiving Substance Use Treatment in the Past Year: Among People Aged 12 or Older Classified as Needing but Not Receiving Substance Use Treatment at a Specialty Facility and Who Felt a Need for Treatment in the Past Year; Quarters 1 and 4, 2020
Reason for Not Receiving Substance Use Treatment1 Aged 12 or Older
No Health Care Coverage and Could Not Afford Cost 19.1 (4.60)
Had Health Care Coverage but Did Not Cover Treatment or Did Not Cover Full Cost *     (*)
No Transportation/Programs Too Far Away/Hours Inconvenient *     (*)
Did Not Find a Program That Offered the Type of Treatment Wanted 14.4 (3.82)
Not Ready to Stop Using *     (*)
No Openings in a Program 1.7 (0.93)
Did Not Know where to Go for Treatment *     (*)
Might Cause Neighbors/Community to Have Negative Opinion 11.9 (3.46)
Might Have Negative Effect on Job *     (*)
Did Not Feel Need for Treatment at the Time 5.6 (1.83)
Could Handle the Problem without Treatment 9.0 (2.75)
Treatment Would Not Help 4.3 (1.96)
Did Not Have Time 5.2 (2.36)
Did Not Want Others to Find Out 6.5 (2.59)
Some Other Reason *     (*)
* = low precision.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents were classified as needing substance use treatment if they met the criteria for a substance use disorder as defined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or received treatment for illicit drug or alcohol use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient only], or mental health center).
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents could indicate multiple reasons for not receiving treatment; thus, these response categories are not mutually exclusive.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.45AB – Received Medication-Assisted Treatment for Alcohol Use in the Past Year: Among People Aged 12 or Older and among People with an Alcohol Use Disorder; by Receipt of Alcohol Use Treatment, Quarters 1 and 4, 2020
Characteristic Number Who Received
Medication-Assisted
Treatment for Alcohol Use1
Percentage Who Received
Medication-Assisted
Treatment for Alcohol Use2
Number Who Received
Medication-Assisted
Treatment for Alcohol Use
among People with an
Alcohol Use Disorder1
Percentage Who Received
Medication-Assisted
Treatment for Alcohol Use
among People with an
Alcohol Use Disorder2
TOTAL 362 (105) 0.1 (0.04) 292 (98) 1.0 (0.35)
Received Alcohol Use Treatment
  in the Past Year at Any Location
362 (105) 17.2 (4.49) *   (*) *     (*)
* = low precision.
NOTE: Medication-assisted treatment for alcohol use refers to medication prescribed by a doctor or other health professional to help reduce or stop the use of alcohol.
NOTE: Estimates in this table exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Estimates shown are numbers in thousands with standard errors included in parentheses.
2 Estimates shown are percentages with standard errors included in parentheses.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.46AB – Received Medication-Assisted Treatment for Opioid Misuse in the Past Year: Among People Aged 12 or Older and among People with an Opioid Use Disorder; by Receipt of Opioid Use Treatment, Quarters 1 and 4, 2020
Characteristic Number Who Received
Medication-Assisted
Treatment for Opioid
Misuse1
Percentage Who Received
Medication-Assisted
Treatment for Opioid
Misuse2
Number Who Received
Medication-Assisted
Treatment for Opioid Misuse
among People with an
Opioid Use Disorder1
Percentage Who Received
Medication-Assisted
Treatment for Opioid Misuse
among People with an
Opioid Use Disorder2
TOTAL 798 (130) 0.3 (0.05) 278 (54) 11.2 (2.14)
Received Illicit Drug Use Treatment
  in the Past Year at Any Location
798 (130) 30.5 (4.27) *   (*) *     (*)
* = low precision.
NOTE: Medication-assisted treatment for opioid misuse refers to medication prescribed by a doctor or other health professional to help reduce or stop the use of opioids.
NOTE: People who received illicit drug use treatment in the past year may not necessarily have received treatment for opioid misuse.
NOTE: Estimates in this table exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Estimates shown are numbers in thousands with standard errors included in parentheses.
2 Estimates shown are percentages with standard errors included in parentheses.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.47B – Receipt of Treatment for Depression in the Past Year: Among Adolescents Aged 12 to 17 with Major Depressive Episode (MDE) or MDE with Severe Impairment in the Past Year; 2004-2020
MDE 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
MDE 40.3 (1.38) 37.8 (1.42) 38.8 (1.60) 39.0 (1.52) 37.7 (1.48) 34.6 (1.52) 37.8 (1.51) 38.4 (1.47) 37.0 (1.34) 38.1 (1.35) 41.2 (1.42)
MDE with Severe Impairment1        --        -- 46.5 (1.95) 43.9 (1.90) 42.6 (1.73) 38.8 (1.83) 41.1 (1.80) 43.5 (1.79) 41.0 (1.66) 45.0 (1.61) 44.7 (1.67)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.47B – Receipt of Treatment for Depression in the Past Year: Among Adolescents Aged 12 to 17 with Major Depressive Episode (MDE) or MDE with Severe Impairment in the Past Year; 2004-2020 (continued)
MDE 2015 2016 2017 2018 2019 2020
MDE 39.3 (1.40) 40.9 (1.30) 41.5 (1.29) 41.4 (1.36) 43.3 (1.34) 41.6 (2.45)
MDE with Severe Impairment1 44.6 (1.63) 46.7 (1.58) 47.5 (1.57) 46.9 (1.65) 49.7 (1.63) 46.9 (2.69)
-- = not available.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown past year depression treatment data and/or unknown past year MDE data were excluded.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Impairment is based on the Sheehan Disability Scale role domains, which measure the impact of a disorder on an adolescent’s life. Impairment is defined as the highest severity level of role impairment across four domains: (1) chores at home, (2) school or work, (3) close relationships with family, and (4) social life. Ratings ≥ 7 on a 0 to 10 scale were considered Severe Impairment. Respondents with unknown impairment data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2004-2019 and Quarters 1 and 4, 2020.
Table A.48B – Receipt of Treatment for Depression in the Past Year: Among Adults Aged 18 or Older with Major Depressive Episode (MDE) or MDE with Severe Impairment in the Past Year; 2009-2020
MDE/Age Group 2009 2010 2011 2012 2013 2014 2015 2016 2017
MDE 64.3 (1.31) 68.2 (1.25) 68.1 (1.24) 68.0 (1.24) 68.6 (1.22) 68.6 (1.03) 67.2 (1.08) 65.3 (1.09) 66.8 (1.01)
18-25 47.0 (1.57) 48.7 (1.57) 47.8 (1.64) 49.8 (1.52) 50.8 (1.50) 49.5 (1.64) 46.8 (1.58) 44.1 (1.45) 50.7 (1.40)
26-49 64.8 (1.72) 68.1 (1.69) 68.1 (1.74) 68.8 (1.75) 66.7 (1.80) 67.9 (1.36) 67.4 (1.36) 67.4 (1.35) 67.3 (1.36)
50 or Older 73.8 (2.83) 78.4 (2.55) 80.0 (2.50) 76.8 (2.52) 81.3 (2.64) 80.8 (2.04) 80.9 (2.32) 77.3 (2.23) 79.7 (2.15)
MDE with Severe
   Impairment1
71.5 (1.49) 72.9 (1.47) 73.7 (1.44) 73.1 (1.47) 76.4 (1.36) 73.7 (1.19) 72.7 (1.22) 72.2 (1.23) 72.1 (1.13)
18-25 51.2 (1.95) 53.9 (1.94) 54.2 (2.08) 55.5 (1.89) 56.8 (1.80) 55.3 (2.02) 52.0 (1.98) 51.3 (1.75) 57.1 (1.82)
26-49 72.4 (1.97) 74.2 (1.89) 74.1 (1.96) 73.7 (2.14) 74.4 (2.12) 72.3 (1.68) 72.0 (1.63) 74.3 (1.52) 71.8 (1.62)
50 or Older 84.4 (3.20) 81.4 (3.01) 85.0 (3.00) 82.4 (2.91) 90.8 (2.48) 85.9 (2.17) 87.9 (2.26) 84.1 (2.57) 86.4 (2.18)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.48B – Receipt of Treatment for Depression in the Past Year: Among Adults Aged 18 or Older with Major Depressive Episode (MDE) or MDE with Severe Impairment in the Past Year; 2009-2020 (continued)
MDE/Age Group 2018 2019 2020
MDE 64.8 (0.96) 66.3 (0.94) 66.0 (1.58)
18-25 49.6 (1.36) 50.9 (1.35) 57.6 (2.05)
26-49 64.4 (1.37) 68.9 (1.25) 64.8 (2.25)
50 or Older 78.9 (2.18) 76.5 (2.34) 75.3 (3.64)
MDE with Severe Impairment1 68.6 (1.18) 72.2 (1.07) 71.0 (1.75)
18-25 53.7 (1.65) 56.4 (1.61) 63.8 (2.38)
26-49 68.0 (1.67) 74.4 (1.43) 68.7 (2.58)
50 or Older 83.1 (2.43) 83.6 (2.55) 80.9 (3.95)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown past year depression treatment data and/or unknown past year MDE data were excluded.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Estimates in this table for 2020 exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Impairment is based on the Sheehan Disability Scale role domains, which measure the impact of a disorder on an adult’s life. Impairment is defined as the highest severity level of role impairment across four domains: (1) home management, (2) work, (3) close relationships with others, and (4) social life. Ratings ≥ 7 on a 0 to 10 scale were considered Severe Impairment. Respondents with unknown impairment data were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2009-2019 and Quarters 1 and 4, 2020.
Table A.49B – Sources of Mental Health Services in the Past Year: Among Adolescents Aged 12 to 17; 2002-2020
Source of Mental Health
Service
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Specialty Mental Health
Service
11.8 (0.28) 12.4 (0.28) 13.4 (0.31) 13.4 (0.30) 13.0 (0.29) 12.4 (0.31) 12.7 (0.29) 12.0 (0.30) 12.1 (0.30) 12.6 (0.31) 12.7 (0.28)
Outpatient 10.8 (0.27) 11.3 (0.27) 12.1 (0.30) 12.1 (0.29) 11.7 (0.29) 11.2 (0.29) 11.5 (0.29) 10.9 (0.29) 10.9 (0.28) 11.5 (0.30) 11.5 (0.27)
Inpatient or Residential (Overnight
   or Longer Stay)
2.1 (0.12) 2.2 (0.13) 2.5 (0.14) 2.5 (0.14) 2.4 (0.14) 2.3 (0.13) 2.2 (0.13) 2.1 (0.13) 2.2 (0.13) 2.1 (0.13) 2.2 (0.13)
Education1   nc   nc   nc   nc   nc   nc   nc 12.1 (0.30) 12.4 (0.29) 11.9 (0.28) 12.9 (0.29)
General Medicine                                            
Pediatrician or Other Family Doctor 2.7 (0.13) 2.9 (0.15) 3.4 (0.15) 3.2 (0.17) 2.8 (0.14) 2.8 (0.14) 2.9 (0.14) 2.5 (0.14) 2.5 (0.14) 2.5 (0.14) 2.5 (0.13)
Juvenile Justice                                            
Juvenile Detention Center, Prison,
   or Jail
  --   --   --   --   --   --   -- 0.4 (0.06) 0.3 (0.05) 0.4 (0.06) 0.3 (0.05)
Child Welfare                                            
Foster Care or Therapeutic Foster
   Care
0.6 (0.06) 0.7 (0.08) 0.6 (0.07) 0.6 (0.07) 0.5 (0.07) 0.5 (0.05) 0.5 (0.06) 0.4 (0.05) 0.4 (0.06) 0.6 (0.07) 0.4 (0.05)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.49B – Sources of Mental Health Services in the Past Year: Among Adolescents Aged 12 to 17; 2002-2020 (continued)
Source of Mental Health
Service
2013 2014 2015 2016 2017 2018 2019 2020
Specialty Mental Health
Service
13.6 (0.32) 13.7 (0.34) 13.3 (0.32) 14.7 (0.33) 14.8 (0.36) 16.0 (0.38) 16.7 (0.38) 17.3 (0.76)
Outpatient 12.5 (0.31) 12.7 (0.33) 12.0 (0.31) 13.2 (0.32) 13.6 (0.35) 14.5 (0.36) 15.3 (0.38) 16.6 (0.76)
Inpatient or Residential (Overnight
   or Longer Stay)
2.3 (0.14) 2.5 (0.15) 2.6 (0.15) 3.0 (0.16) 2.9 (0.16) 2.8 (0.16) 2.9 (0.15) 2.1 (0.28)
Education1 13.0 (0.32) 13.2 (0.33) 13.2 (0.34) 13.1 (0.33) 13.3 (0.34) 14.2 (0.35) 15.4 (0.37) 12.8 (0.61)
General Medicine                                
Pediatrician or Other Family Doctor 2.8 (0.15) 2.9 (0.15) 2.7 (0.16) 2.9 (0.15) 3.3 (0.17) 3.1 (0.17) 3.7 (0.18) 3.1 (0.29)
Juvenile Justice                                
Juvenile Detention Center, Prison,
   or Jail
0.2 (0.04) 0.3 (0.05) 0.2 (0.04) 0.2 (0.05) 0.2 (0.04) 0.2 (0.04) 0.2 (0.04) 0.1 (0.04)
Child Welfare                                
Foster Care or Therapeutic Foster
   Care
0.4 (0.05) 0.4 (0.06) 0.3 (0.05) 0.4 (0.07) 0.4 (0.06) 0.4 (0.06) 0.4 (0.07) 0.3 (0.09)
-- = not available; nc = not comparable due to methodological changes.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown receipt of mental health service information were excluded.
NOTE: Respondents could indicate multiple service sources; thus, these response categories are not mutually exclusive.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents who did not report their school enrollment status, who reported not being enrolled in school in the past 12 months, or who reported being home-schooled were not asked about receipt of mental health services from this source; however, respondents who reported not being enrolled in school in the past 12 months were classified as not having received mental health services from this source.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.50B – Sources of Mental Health Services in the Past Year: Among Adolescents Aged 12 to 17; by Quarter, 2020
Source of Mental Health Service Quarter 1 Quarter 4
Specialty Mental Health Service 16.9 (0.79) 17.6 (1.33)
Outpatient 15.9 (0.79) 17.3 (1.31)
Inpatient or Residential (Overnight or Longer Stay) 2.9 (0.43) 1.3 (0.34)
Education1 15.7 (0.84) 9.9 (0.88)
General Medicine        
Pediatrician or Other Family Doctor 3.4 (0.37) 2.8 (0.45)
Juvenile Justice        
Juvenile Detention Center, Prison, or Jail 0.2 (0.08) *     (*)
Child Welfare        
Foster Care or Therapeutic Foster Care 0.4 (0.16) 0.1 (0.07)
Virtual2       na 10.1 (1.11)
* = low precision; na = not applicable.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown receipt of mental health service information were excluded.
NOTE: Respondents could indicate multiple service sources; thus, these response categories are not mutually exclusive.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents who did not report their school enrollment status, who reported not being enrolled in school in the past 12 months, or who reported being home-schooled were not asked about receipt of mental health services from this source; however, respondents who reported not being enrolled in school in the past 12 months were classified as not having received mental health services from this source.
2 Virtual mental health services for adolescents aged 12 to 17 include treatment/counseling for emotional or behavioral problems not caused by drug or alcohol use. Respondents with unknown virtual mental health service information were excluded.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.51B – Type of Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older; by Age Group, 2002-2020
Mental Health
Services1/Age Group
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
MENTAL HEALTH
SERVICES
13.0 (0.27) 13.2 (0.26) 12.8 (0.26) 13.0 (0.26) 12.9 (0.26) 13.3 (0.27) 13.5 (0.29) 13.4 (0.27) 13.8 (0.27) 13.6 (0.26) 14.5 (0.28)
18-25 10.5 (0.25) 11.1 (0.28) 10.8 (0.26) 11.2 (0.27) 10.8 (0.28) 10.4 (0.28) 11.0 (0.28) 11.2 (0.27) 11.0 (0.27) 11.4 (0.30) 12.0 (0.29)
26-49 14.5 (0.36) 14.5 (0.35) 14.4 (0.34) 13.9 (0.34) 14.0 (0.37) 14.3 (0.35) 14.1 (0.34) 14.6 (0.36) 14.9 (0.37) 14.9 (0.36) 15.2 (0.38)
50 or Older 12.0 (0.54) 12.3 (0.53) 11.7 (0.51) 12.5 (0.53) 12.4 (0.48) 13.2 (0.53) 13.7 (0.57) 12.9 (0.52) 13.6 (0.52) 13.2 (0.47) 14.8 (0.51)
INPATIENT 0.7 (0.06) 0.8 (0.07) 0.9 (0.07) 1.0 (0.08) 0.7 (0.06) 1.0 (0.08) 0.9 (0.10) 0.8 (0.07) 0.8 (0.07) 0.8 (0.06) 0.8 (0.06)
18-25 0.9 (0.08) 1.0 (0.09) 1.2 (0.10) 1.1 (0.09) 1.1 (0.08) 1.1 (0.09) 1.1 (0.10) 1.1 (0.10) 1.0 (0.09) 1.1 (0.09) 1.1 (0.10)
26-49 0.8 (0.09) 0.9 (0.10) 0.8 (0.09) 0.9 (0.10) 0.8 (0.09) 1.1 (0.11) 0.8 (0.09) 1.0 (0.11) 0.8 (0.09) 0.8 (0.09) 0.7 (0.08)
50 or Older 0.5 (0.10) 0.7 (0.14) 0.9 (0.14) 1.0 (0.17) 0.5 (0.10) 0.7 (0.15) 0.9 (0.22) 0.6 (0.11) 0.7 (0.13) 0.7 (0.11) 0.8 (0.12)
OUTPATIENT2,3 7.4 (0.21) 7.1 (0.19) 7.1 (0.19) 6.8 (0.20) 6.7 (0.20) 7.0 (0.19) 6.8 (0.20) 6.4 (0.19) 6.6 (0.20) 6.7 (0.19) 6.6 (0.19)
18-25 6.7 (0.21) 6.6 (0.21) 6.2 (0.21) 6.4 (0.22) 5.9 (0.23) 5.6 (0.21) 5.9 (0.21) 6.1 (0.20) 5.7 (0.21) 6.2 (0.22) 6.5 (0.22)
26-49 8.9 (0.29) 8.7 (0.28) 8.6 (0.27) 7.8 (0.27) 7.6 (0.27) 8.0 (0.28) 7.9 (0.26) 7.5 (0.27) 7.8 (0.28) 7.8 (0.28) 7.6 (0.26)
50 or Older 5.7 (0.39) 5.3 (0.35) 5.6 (0.36) 5.9 (0.39) 6.0 (0.37) 6.3 (0.37) 6.0 (0.39) 5.3 (0.34) 5.7 (0.35) 5.7 (0.34) 5.7 (0.33)
PRESCRIPTION
MEDICATION
10.5 (0.25) 10.9 (0.25) 10.5 (0.23) 10.7 (0.24) 10.9 (0.24) 11.2 (0.25) 11.4 (0.27) 11.3 (0.25) 11.7 (0.24) 11.5 (0.25) 12.4 (0.26)
18-25 7.5 (0.22) 8.3 (0.25) 8.1 (0.23) 8.3 (0.23) 8.0 (0.24) 8.0 (0.24) 8.1 (0.24) 8.5 (0.23) 8.4 (0.24) 8.8 (0.25) 9.0 (0.25)
26-49 11.4 (0.32) 11.9 (0.32) 11.7 (0.31) 11.4 (0.31) 11.7 (0.34) 11.8 (0.32) 11.7 (0.32) 12.3 (0.33) 12.5 (0.33) 12.3 (0.33) 13.0 (0.36)
50 or Older 10.5 (0.51) 10.9 (0.51) 10.1 (0.48) 10.8 (0.49) 11.0 (0.45) 11.7 (0.50) 12.2 (0.53) 11.3 (0.49) 12.0 (0.49) 11.8 (0.45) 12.9 (0.49)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.51B – Type of Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older; by Age Group, 2002-2020 (continued)
Mental Health
Services1/Age Group
2013 2014 2015 2016 2017 2018 2019 2020
MENTAL HEALTH
SERVICES
14.6 (0.28) 14.8 (0.23) 14.2 (0.23) 14.4 (0.23) 14.8 (0.25) 15.0 (0.24) 16.1 (0.24) 16.9 (0.36)
18-25 12.2 (0.32) 11.9 (0.34) 11.7 (0.31) 12.9 (0.34) 14.9 (0.39) 15.2 (0.36) 17.2 (0.39) 19.5 (0.68)
26-49 15.5 (0.40) 15.3 (0.28) 15.3 (0.29) 15.4 (0.29) 15.7 (0.30) 16.1 (0.29) 17.8 (0.32) 18.3 (0.49)
50 or Older 14.6 (0.52) 15.4 (0.42) 13.9 (0.40) 14.0 (0.42) 14.0 (0.42) 14.0 (0.42) 14.4 (0.41) 15.0 (0.62)
INPATIENT 0.9 (0.07) 1.0 (0.06) 0.9 (0.06) 0.9 (0.06) 1.0 (0.06) 1.0 (0.06) 1.0 (0.07) 0.9 (0.10)
18-25 1.3 (0.11) 1.2 (0.11) 1.4 (0.12) 1.5 (0.11) 1.5 (0.12) 1.6 (0.12) 1.7 (0.13) 1.4 (0.19)
26-49 1.0 (0.10) 1.0 (0.08) 0.9 (0.07) 1.0 (0.08) 0.9 (0.07) 1.0 (0.08) 0.9 (0.08) 1.0 (0.14)
50 or Older 0.7 (0.11) 1.0 (0.12) 0.8 (0.11) 0.7 (0.10) 0.8 (0.10) 0.7 (0.10) 0.7 (0.11) 0.7 (0.16)
OUTPATIENT2,3 6.6 (0.21) 6.7 (0.16) 7.1 (0.17) 6.9 (0.16) 7.5 (0.18) 7.9 (0.18) 8.3 (0.19) 8.8 (0.27)
18-25 6.3 (0.22) 6.4 (0.25) 6.6 (0.24) 7.3 (0.26) 9.0 (0.29) 9.3 (0.30) 10.3 (0.33) 11.9 (0.54)
26-49 7.4 (0.29) 7.5 (0.20) 7.9 (0.22) 8.1 (0.22) 8.5 (0.22) 8.8 (0.23) 9.8 (0.25) 10.6 (0.40)
50 or Older 6.0 (0.37) 6.1 (0.29) 6.4 (0.29) 5.8 (0.27) 6.3 (0.30) 6.6 (0.30) 6.3 (0.30) 6.4 (0.43)
PRESCRIPTION
MEDICATION
12.5 (0.27) 12.6 (0.21) 11.8 (0.21) 12.0 (0.21) 12.1 (0.22) 12.2 (0.22) 13.1 (0.22) 13.8 (0.33)
18-25 9.4 (0.27) 8.8 (0.30) 8.6 (0.27) 9.7 (0.30) 11.1 (0.33) 11.1 (0.30) 12.4 (0.34) 14.5 (0.62)
26-49 13.1 (0.37) 12.8 (0.26) 12.6 (0.26) 12.6 (0.26) 12.7 (0.27) 12.9 (0.27) 14.3 (0.27) 14.4 (0.45)
50 or Older 12.9 (0.49) 13.5 (0.39) 12.0 (0.38) 12.3 (0.39) 11.8 (0.39) 11.8 (0.39) 12.3 (0.38) 13.1 (0.57)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Some 2006 to 2010 estimates may differ from previously published estimates due to updates (see Chapter 3 of the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions).
NOTE: Mental Health Services for adults includes inpatient treatment/counseling, outpatient treatment/counseling, or use of prescription medication for problems with emotions, nerves, or mental health. Respondents with unknown mental health service information were excluded. Questions on virtual services were added in Quarter 4 of 2020. Estimates in this table do not include data from these questions. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents could indicate multiple service sources; thus, these response categories are not mutually exclusive.
2 Because of revisions in 2004 to the logical editing of the outpatient mental health services data, these 2002 and 2003 estimates may differ from estimates published prior to the 2004 NSDUH.
3 Because of revisions in 2017 to the outpatient mental health service estimates, these 2010 to 2016 estimates may differ from estimates published prior to the 2017 NSDUH.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2019 and Quarters 1 and 4, 2020.
Table A.52B – Received Mental Health Services Including Virtual Services in the Past Year: Among Adults Aged 18 or Older; by Age Group and Quarter, 2020
Type of Mental
Health Service
18 or Older 18-25 26-49 50 or Older
Quarter 1 Quarter 4 Quarter 1 Quarter 4 Quarter 1 Quarter 4 Quarter 1 Quarter 4
Mental Health Service
or Virtual Service1
16.6 (0.53) 18.7 (0.52) 18.5 (0.96) 22.5 (0.97) 17.6 (0.68) 21.1 (0.73) 15.1 (0.93) 15.6 (0.90)
Inpatient 1.1 (0.17) 0.7 (0.10) 1.4 (0.28) 1.4 (0.27) 1.1 (0.20) 1.0 (0.19) 1.0 (0.30) 0.3 (0.11)
Outpatient 8.3 (0.40) 9.4 (0.38) 11.0 (0.80) 12.8 (0.77) 9.8 (0.56) 11.4 (0.56) 6.1 (0.63) 6.7 (0.62)
Prescription Medication 13.3 (0.47) 14.3 (0.47) 12.9 (0.86) 16.1 (0.85) 13.8 (0.61) 15.1 (0.63) 13.0 (0.83) 13.1 (0.84)
Virtual   na 11.0 (0.40)   na 14.9 (0.83)   na 13.4 (0.59)   na 7.8 (0.69)
na = not applicable.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Mental Health Services including Virtual Services for adults includes treatment/counseling for problems with emotions, nerves, or mental health. Respondents with unknown mental health service including virtual service information were excluded.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Questions on virtual services were added in Quarter 4 of 2020; therefore, the estimates for Quarter 1 do not include data from these questions.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.53B – Type of Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older with Any Mental Illness in the Past Year; by Age Group, 2008-2020
Mental Health Services1/
Age Group
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
MENTAL HEALTH SERVICES 40.9 (0.93) 40.2 (0.86) 42.4 (0.89) 40.8 (0.82) 41.0 (0.82) 44.7 (0.91) 44.7 (0.72) 43.1 (0.72) 43.1 (0.75) 42.6 (0.71)
18-25 30.3 (0.94) 32.0 (0.97) 32.6 (0.93) 32.9 (0.98) 34.5 (0.96) 34.7 (0.98) 33.6 (1.05) 32.0 (0.91) 35.1 (0.94) 38.4 (0.98)
26-49 41.4 (1.09) 40.8 (1.10) 43.3 (1.07) 41.1 (1.09) 42.0 (1.10) 43.5 (1.15) 44.2 (0.83) 43.3 (0.89) 43.1 (0.87) 43.3 (0.88)
50 or Older 45.2 (2.26) 42.8 (1.92) 45.1 (1.93) 43.6 (1.75) 42.4 (1.67) 50.5 (1.95) 49.9 (1.48) 48.3 (1.54) 46.8 (1.57) 44.2 (1.63)
INPATIENT 3.7 (0.51) 3.2 (0.29) 2.7 (0.25) 3.3 (0.31) 3.0 (0.28) 3.3 (0.29) 3.8 (0.26) 3.4 (0.26) 3.3 (0.24) 3.3 (0.24)
18-25 3.5 (0.39) 4.1 (0.45) 3.3 (0.35) 3.9 (0.40) 3.8 (0.39) 4.2 (0.40) 3.7 (0.37) 4.3 (0.42) 4.6 (0.41) 4.2 (0.42)
26-49 2.9 (0.38) 3.7 (0.43) 2.8 (0.38) 2.9 (0.38) 2.3 (0.30) 3.3 (0.37) 3.7 (0.34) 3.1 (0.31) 3.4 (0.32) 3.3 (0.28)
50 or Older 5.2 (1.42) 2.1 (0.50) 2.1 (0.44) 3.5 (0.63) 3.6 (0.65) 2.9 (0.60) 3.9 (0.56) 3.5 (0.59) 2.7 (0.48) 3.0 (0.53)
OUTPATIENT2 24.1 (0.78) 22.5 (0.74) 23.4 (0.78) 24.0 (0.74) 22.4 (0.68) 24.4 (0.84) 24.3 (0.61) 25.4 (0.63) 24.5 (0.60) 25.7 (0.59)
18-25 18.9 (0.80) 20.3 (0.80) 19.9 (0.82) 20.9 (0.84) 21.9 (0.84) 21.0 (0.82) 21.3 (0.92) 20.6 (0.82) 22.8 (0.84) 24.9 (0.86)
26-49 26.0 (0.89) 23.6 (0.90) 24.9 (0.92) 25.1 (0.98) 23.6 (0.89) 24.3 (0.99) 25.8 (0.71) 26.1 (0.77) 26.0 (0.74) 26.9 (0.75)
50 or Older 23.5 (1.85) 21.9 (1.63) 22.8 (1.63) 23.8 (1.60) 21.0 (1.40) 26.1 (1.83) 23.9 (1.26) 27.0 (1.41) 23.4 (1.28) 24.4 (1.37)
PRESCRIPTION MEDICATION 35.5 (0.91) 34.8 (0.82) 36.9 (0.90) 35.6 (0.82) 35.3 (0.79) 38.9 (0.91) 38.7 (0.71) 36.7 (0.71) 37.1 (0.72) 35.7 (0.69)
18-25 23.3 (0.84) 25.3 (0.88) 25.5 (0.89) 25.3 (0.92) 26.8 (0.88) 27.2 (0.90) 25.5 (1.00) 24.3 (0.85) 27.2 (0.87) 29.1 (0.90)
26-49 35.9 (1.07) 35.3 (1.08) 37.7 (1.07) 35.6 (1.05) 37.1 (1.10) 37.7 (1.11) 38.0 (0.81) 36.4 (0.86) 36.7 (0.83) 36.1 (0.82)
50 or Older 40.8 (2.25) 38.1 (1.84) 40.7 (1.94) 39.8 (1.77) 36.7 (1.65) 45.5 (1.92) 45.3 (1.46) 43.2 (1.49) 42.2 (1.54) 38.8 (1.61)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.53B – Type of Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older with Any Mental Illness in the Past Year; by Age Group, 2008-2020 (continued)
Mental Health Services1/
Age Group
2018 2019 2020
MENTAL HEALTH SERVICES 43.3 (0.68) 44.8 (0.65) 46.2 (1.04)
18-25 37.3 (0.87) 38.9 (0.90) 42.1 (1.51)
26-49 43.9 (0.82) 45.4 (0.78) 46.6 (1.34)
50 or Older 45.8 (1.61) 47.2 (1.58) 48.0 (2.38)
INPATIENT 3.3 (0.23) 3.3 (0.25) 2.9 (0.33)
18-25 4.6 (0.36) 4.4 (0.38) 3.3 (0.55)
26-49 3.3 (0.30) 2.9 (0.28) 3.4 (0.52)
50 or Older 2.6 (0.48) 3.1 (0.59) 2.1 (0.55)
OUTPATIENT2 26.1 (0.59) 27.1 (0.59) 28.5 (0.91)
18-25 24.5 (0.80) 26.0 (0.82) 28.4 (1.33)
26-49 26.7 (0.73) 28.2 (0.70) 29.6 (1.12)
50 or Older 26.2 (1.33) 25.9 (1.42) 27.0 (2.12)
PRESCRIPTION MEDICATION 36.2 (0.65) 36.7 (0.62) 38.8 (1.01)
18-25 28.6 (0.84) 28.8 (0.84) 32.4 (1.44)
26-49 36.6 (0.79) 37.3 (0.74) 38.2 (1.27)
50 or Older 40.0 (1.55) 40.4 (1.52) 43.4 (2.36)
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Respondents with unknown mental health service information were excluded.
NOTE: Estimates in the 2020 column are italicized to indicate caution should be used when comparing estimates between 2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing between 2020 and prior years was not performed. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Estimates in this table for 2020 exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Some 2008 to 2010 estimates may differ from previously published estimates due to updates (see Chapter 3 of the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions).
NOTE: Mental Health Services for adults includes inpatient treatment/counseling, outpatient treatment/counseling, or use of prescription medication for problems with emotions, nerves, or mental health. Respondents with unknown mental health service information were excluded. Questions on virtual services were added in Quarter 4 of 2020. Estimates in this table do not include data from these questions. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Any Mental Illness (AMI) aligns with criteria from the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder. AMI estimates from 2008 to 2011 may differ from previously published estimates due to revised estimation procedures. These mental illness estimates are based on a predictive model and are not direct measures of diagnostic status.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Respondents could indicate multiple service sources; thus, these response categories are not mutually exclusive.
2 Because of revisions in 2017 to the outpatient mental health service estimates, these 2010 to 2016 estimates may differ from estimates published prior to the 2017 NSDUH.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008-2019 and Quarters 1 and 4, 2020.
Table A.54B – Received Mental Health Services Including Virtual Services in the Past Year: Among Adults Aged 18 or Older with Any Mental Illness in the Past Year; by Age Group and Quarter, 2020
Type of Mental
Health Service
18 or Older 18-25 26-49 50 or Older
Quarter 1 Quarter 4 Quarter 1 Quarter 4 Quarter 1 Quarter 4 Quarter 1 Quarter 4
Mental Health Service
or Virtual Service1
44.9 (1.53) 49.8 (1.43) 38.0 (2.06) 50.5 (2.35) 46.1 (2.04) 49.8 (1.76) 48.1 (3.37) 49.4 (3.42)
Inpatient 3.0 (0.47) 2.9 (0.46) 2.7 (0.67) 3.9 (0.92) 3.5 (0.76) 3.2 (0.70) 2.4 (0.84) 1.8 (0.72)
Outpatient 27.0 (1.31) 30.0 (1.34) 24.9 (1.90) 32.6 (2.08) 28.4 (1.62) 30.7 (1.57) 26.3 (3.11) 27.6 (3.06)
Prescription Medication 37.4 (1.42) 40.0 (1.40) 28.4 (1.96) 37.1 (2.15) 37.6 (1.89) 38.8 (1.69) 43.5 (3.26) 43.2 (3.33)
Virtual   na 33.7 (1.37)   na 35.9 (2.10)   na 34.9 (1.65)   na 30.9 (3.10)
na = not applicable.
NOTE: Estimates shown are percentages with standard errors included in parentheses.
NOTE: Estimates in this table exclude a subset of respondents who did not complete the questionnaire. The analysis weights and estimates were adjusted for the reduced sample size. Therefore, some estimates in this table could differ from corresponding estimates in other tables that did not undergo sample size adjustments. See the 2020 National Survey on Drug Use and Health: Methodological Summary and Definitions for details.
NOTE: Mental Health Services including Virtual Services for adults includes treatment/counseling for problems with emotions, nerves, or mental health. Respondents with unknown mental health service including virtual service information were excluded.
NOTE: Mental Illness aligns with criteria from the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder. Estimates of serious mental illness (SMI) are a subset of estimates of any mental illness (AMI) because SMI is limited to people with AMI that resulted in serious functional impairment. These mental illness estimates are based on a predictive model and are not direct measures of diagnostic status.
NOTE: Additional estimates may be found in the detailed tables for the 2020 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2020 detailed tables.
1 Questions on virtual services were added in Quarter 4 of 2020; therefore, the estimates for Quarter 1 do not include data from these questions.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Quarters 1 and 4, 2020.
Table A.55B – Type of Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older with Serious Mental Illness in the Past Year; by Age Group, 2008-2020
Mental Health Services1/
Age Group
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
MENTAL HEALTH SERVICES 65.7 (1.76) 66.5 (1.68) 67.5 (1.67) 64.9 (1.70) 62.9 (1.65) 68.5 (1.78) 68.5 (1.33) 65.3 (1.33) 64.8 (1.34) 66.7 (1.27)
18-25 45.9 (2.28) 55.0 (2.20) 53.7 (2.32) 52.1 (2.27) 53.1 (2.14) 54.0 (2.30) 53.9 (2.13) 50.7 (2.14) 51.5 (2.05) 57.4 (1.94)
26-49 67.2 (2.08) 64.5 (2.06) 67.4 (2.05) 63.6 (2.20) 63.5 (2.27) 68.4 (2.29) 66.2 (1.72) 66.1 (1.68) 66.1 (1.57) 66.2 (1.60)
50 or Older 73.2 (4.33) 76.1 (3.74) 74.0 (3.74) 73.2 (3.60) 66.3 (3.62) 74.9 (3.51) 79.2 (2.59) 72.2 (3.09) 71.5 (3.16) 75.6 (3.08)
INPATIENT 8.6 (1.29) 8.6 (0.98) 6.7 (0.77) 8.8 (1.11) 6.2 (0.77) 8.3 (0.93) 8.8 (0.85) 7.0 (0.71) 7.6 (0.73) 7.6 (0.65)
18-25 7.9 (1.18) 11.4 (1.81) 8.1 (1.06) 8.0 (1.19) 8.5 (1.18) 10.3 (1.27) 8.2 (1.05) 8.9 (1.17) 8.8 (1.06) 8.6 (1.10)
26-49 6.9 (1.19) 9.7 (1.44) 7.0 (1.04) 8.0 (1.17) 4.8 (0.82) 8.4 (1.22) 8.0 (0.93) 7.3 (0.95) 8.1 (0.93) 8.3 (0.89)
50 or Older 12.4 (3.65) 4.9 (1.47) 5.5 (1.50) 10.8 (2.61) 7.3 (1.90) 7.3 (1.93) 10.2 (2.07) 5.5 (1.51) 6.0 (1.67) 5.6 (1.50)
OUTPATIENT2 46.2 (1.86) 44.6 (1.97) 42.5 (1.89) 44.1 (1.78) 39.0 (1.68) 46.9 (1.97) 44.2 (1.39) 43.6 (1.44) 42.6 (1.40) 45.3 (1.27)
18-25 33.0 (2.05) 38.6 (2.27) 36.2 (2.30) 37.2 (2.20) 35.8 (2.08) 37.3 (2.13) 39.2 (2.12) 36.0 (2.10) 36.8 (1.88) 39.3 (1.82)
26-49 48.2 (2.23) 43.8 (2.21) 42.9 (2.13) 42.8 (2.17) 40.3 (2.23) 47.1 (2.33) 43.8 (1.74) 44.8 (1.78) 44.8 (1.70) 46.7 (1.64)
50 or Older 49.0 (4.66) 49.0 (4.74) 44.6 (4.48) 49.6 (4.14) 38.2 (3.62) 50.7 (4.21) 47.3 (3.15) 46.0 (3.25) 42.6 (3.56) 47.8 (3.33)
PRESCRIPTION MEDICATION 59.7 (1.81) 61.1 (1.77) 61.0 (1.80) 58.2 (1.80) 57.8 (1.65) 62.1 (1.91) 61.4 (1.42) 57.3 (1.43) 58.0 (1.42) 58.9 (1.34)
18-25 35.9 (2.12) 43.4 (2.22) 44.0 (2.31) 41.0 (2.22) 45.5 (2.09) 46.2 (2.21) 42.4 (2.02) 40.0 (2.03) 41.1 (2.00) 45.7 (1.91)
26-49 60.1 (2.22) 59.5 (2.17) 61.2 (2.15) 57.2 (2.26) 58.7 (2.25) 60.7 (2.42) 60.1 (1.79) 58.2 (1.78) 59.1 (1.68) 58.5 (1.68)
50 or Older 71.5 (4.32) 72.6 (4.00) 68.4 (4.10) 68.1 (3.76) 61.9 (3.66) 71.3 (3.74) 72.9 (2.89) 65.6 (3.27) 67.4 (3.29) 70.7 (3.26)
NOTE: Footnotes and source information are shown at the end of the second half of this table.
Table A.55B – Type of Mental Health Services Received in the Past Year: Among Adults Aged 18 or Older with Serious Mental Illness in the Past Year; by Age Group, 2008-2020 (continued)
Mental Health Services1/
Age Group
2018 2019 2020
MENTAL HEALTH SERVICES 64.1 (1.24) 65.5 (1.18) 64.5 (1.96)
18-25 53.8 (1.72) 56.4 (1.76) 57.6 (2.63)
26-49 63.7 (1.55) 65.1 (1.42) 63.0 (2.39)
50 or Older 74.4 (3.30) 74.3 (3.17) 72.9 (5.17)
INPATIENT 7.3 (0.66) 7.4 (0.70) 6.5 (0.93)
18-25 9.4