Tracking Americans' Use of Drugs and Behavioral Health Services

by Charles E. Lewis Jr.

The National Survey of Drug Use and Health (NSDUH) has taken on new significance during the current opioid epidemic sweeping the United States. The annual survey of households tracks the use of tobacco, alcohol, and illicit drugs among Americans 12 years and older, providing researchers and policymakers with extensive national data on drug use and mental health. The survey is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services. The project is supervised by SAMHSA's Center for Behavioral Health Statistics and Quality.

Authorized by Section 505 of the Public Health Service Act), SAMHSA in 1988 selected RTI International, located in Research Triangle Park in North Carolina, to administer the survey through 2017. RTI randomly selects about 70,000 individuals in households throughout the country and administers a battery of questions regarding substance use and mental health. The data are used by a wide range of researchers, policymakers, and services providers in government, academia, and the private and public sectors. National and state-level estimates inform prevention and treatment efforts and policies for substance use and mental health.

Among the more noteworthy findings in the 2016 survey:

• Cigarette smoking declined across all age groups between 2002 and 2016. An estimated 51.3 million Americans ages 12 and older were cigarette smokers in 2016—approximately one in five in that age group. About 26 percent of Americans were smokers in 2002.


• About 136.7 million Americans ages 12 and older reported using alcohol in 2016, slightly more than half of people in this age group and relatively the same percentage as 2002. Use of alcohol declined significantly among younger Americans—from 17.6 percent in 2002 to 9.2 percent in 2016 for 12- to 17-year-olds, and from 60.5 percent in 2002 to 57.1 percent in 2016 for 18- to 25-year-olds.


• An estimated 28.6 million Americans 12 and older (10.6 percent) reported using illicit substances in 2016. Marijuana was the most used substance, with 24 million in that age group reporting use. Pain relievers were the second-most misused substance, with 3.3 million Americans 12 years and older reporting misusing these drugs. Because of changes in measurement in the NSDUH in 2015, estimates from earlier years were not comparable.


• In 2016, an estimated 11.8 million Americans 12 years and older reported misusing opioids in the past year—that is, using pain relievers and prescription medication for use other than what was prescribed. Among opioid misusers, a small number, 948,000, reported using heroin in the past year. However, this is about double the reported usage in 2011.

Substance Use Treatment
The NSDUH tracks both the need for and the receipt of substance use treatment during the past year. Substance use treatment refers to services provided for problems stemming from misuse of alcohol or illicit drugs. In 2016, an estimated 21 million Americans 12 years and older (7.8 percent) needed treatment for substance use in the past year, including about 1.1 million adolescents ages 12 to 17 (4.4 percent), and about 5.3 million young adults (15.5 percent). About 14.5 million adults 26 and older needed treatment (6.9 percent) in the past year.

Those needing treatment may have received services in a variety of settings, including hospitals, mental health centers, private doctors' offices, or a self-help group such as Alcoholics Anonymous or Narcotics Anonymous. Some may have received treatment at a specialty facility designed specifically for treatment of substance use such as inpatient treatment at a hospital, or inpatient or outpatient treatment at a substance use facility or mental health center. Some respondents reported getting treatment at more than one location.

All told, fewer than one fifth (18.1 percent) of Americans ages 12 and older needing treatment for substance use received treatment—about 3.8 million people. A smaller percentage of adolescents (16.4 percent) who needed substance use intervention received treatment, and about 1 in 10 young adults (11.7 percent) who needed substance use treatment received treatment. Some 2.2 million people 12 and older needing substance use treatment (10.5 percent) received services at a specialty facility.

Treatment for Mental Illness
The NSDUH collects data on any mental illness (AMI) and serious mental illness (SMI) for adults 18 and older. It tracks only major depressive episodes (MDEs) for adolescents. Because the survey asks different questions of adolescents and adults, they are collected separately. In 2016, about 12.8 percent of adolescents (3.1 million) had an MDE in the past year. Of these, about 70.5 percent (2.2 million) experienced an MDE with severe impairment. About 6.7 percent of adults 18 and older (16.2 million) suffered an MDE in 2016; of these, about two thirds (64 percent) had an MDE with a severe impairment. Nearly one in five Americans (18.3 percent; 44.7 million) in the 2016 NSDUH reported having AMI during the past year. About 10.4 million (4.2 percent) reported having SMI during the past year.

Of the 16.2 million adults 18 and older who reported experiencing a past-year MDE in 2016, 10.6 million (65.3 percent) received treatment for depression. Of the 3.1 million adolescents who reported a past-year MDE in 2016, just 1.2 million (40.9 percent) received treatment for depression. In 2016, 19.2 million (43.1) percent of the 44.7 million adults who reported past-year AMI received mental health services that year. Some 6.7 million (64.8) percent of adults who reported an SMI received mental health services in the past year.

Notable Research Studies
Most published research studies rely on data from the 2015 NSDUH measuring drug use and mental illness during 2014. Researchers at the Center for Behavioral Health Statistics and Quality, a subdivision of SAMHSA, found that substance use is on the rise among older Americans. Using data from the NSDUH, the Treatment Episode Data Set, and the Drug Abuse Warning Network, they found that more than one million Americans age 65 and older had a substance use disorder in 2014; 978,000 had an alcohol use disorder and 161,000 had an illicit drug use disorder, signaling an emerging public health issue as the number of older American is expected to rise significantly as Baby Boomers age (Mattson, Lipari, Hays, & Van Horn, 2017).

A 2017 study by researchers at the University of Washington School of Medicine using data from the 2014 NSDUH found that significant declines in alcohol and illicit drug use among adolescents had led to significant declines in antisocial behaviors and delinquency. Researchers found that substance misuse among teenagers had decline by 49 percent over a 12-year period from 2003 through 2014. This was accompanied by a simultaneous 34 percent drop in delinquent behaviors, such as fighting, assault, stealing, selling drugs, and carrying a handgun.

A study presented at the recent American Society of Anesthesiologists annual meeting in Boston, Mass., found more than 13 percent of Americans 12 years and older—nearly 1 in 7—have abused opioids at some point in their lives. In 2000, about 8.6 of NSDUH respondents reported using opioids. By 2003, that number had jumped to 13.2 percent and has remained relatively steady since. More than half of those abusing opioids reported getting them from a friend or relative. Researchers found in 2014 (the most recent data available) that 13.6 percent of Americans 12 years and older had misused prescribed opioid painkillers.

These studies underscore the importance of the National Survey of Drug Use and Health in helping policymakers understand how drug use and mental health are affecting individuals, families, and communities. The evidence provided by research using these data helps shape and deliver effective and efficient policies.

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