Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health

Key Substance Use and

Mental Health Indicators

in the United States:

Results from the 2018 National

Survey on Drug Use and Health

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health

Acknowledgments

is 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. Rachel N. Lipari and Eunice Park-Lee were the SAMHSA authors. Peter Tice 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

is 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. (2019). Key substance use and mental health

indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication

No. PEP19-5068, NSDUH Series H-54). 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

[email protected]v.

Nondiscrimination Notice

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

August 2019

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

iii

Summary ��1

Introduction ��5

Survey Background ��5

Data Presentation and Interpretation ��5

Substance Use in the Past Month ��6

Tobacco Use in the Past Month �� 7

Cigarette Use ��8

Daily Cigarette Use ��9

Alcohol Use in the Past Month ��10

Any Alcohol Use ��10

Binge Alcohol Use ��11

Heavy Alcohol Use ��11

Illicit Drug Use in the PastYear ��12

Any Illicit Drug Use ��12

Marijuana Use ��13

Cocaine Use ��14

Heroin Use ��15

Methamphetamine Use ��15

Hallucinogen Use ��16

Inhalant Use ��17

Misuse of Psychotherapeutic Drugs ��17

Stimulant Misuse ��18

Tranquilizer or Sedative Misuse ��18

Benzodiazepine Misuse ��19

Pain Reliever Misuse ��20

Opioid Misuse ��23

Initiation of Substance Use ��24

Initiation of Cigarette Use ��24

Initiation of Alcohol Use ��25

Initiation of Marijuana Use ��25

Initiation of Cocaine Use ��26

Initiation of Heroin Use ��26

Initiation of Methamphetamine Use ��27

Initiation of Hallucinogen Use��27

Initiation of Inhalant Use ��28

Initiation of Stimulant Misuse��28

Initiation of Tranquilizer or Sedative Misuse ��28

Initiation of Pain Reliever Misuse ��29

Perceived Risk from Substance Use ��30

Perceived Risk from Substance Use among Adolescents ��30

Perceived Risk from Substance Use among Young Adults ��31

Perceived Risk from Substance Use among Adults Aged

26 or Older ��32

Substance Use Disorders in the PastYear ��32

Alcohol Use Disorder ��32

Illicit Drug Use Disorder��33

Marijuana Use Disorder ��35

Cocaine Use Disorder ��35

Heroin Use Disorder ��36

Methamphetamine Use Disorder ��37

Stimulant Use Disorder ��37

Tranquilizer Use Disorder or Sedative Use Disorder ��38

Pain Reliever Use Disorder ��38

Opioid Use Disorder ��39

Substance Use Disorder (Alcohol or Illicit Drugs) ��39

Major Depressive Episode in the PastYear �� 41

MDE and MDE with Severe Impairment among Adolescents ��41

MDE and MDE with Severe Impairment among Adults ��42

Any Mental Illness among Adults in the PastYear ��43

Serious Mental Illness among Adults in the PastYear ��43

Co‑Occurring MDE and SUD among Adolescents ��44

Substance Use among Adolescents with MDE �� 45

Co‑Occurring Mental Health Issues and SUD among Adults ��45

Co‑Occurring AMI and SUD ��45

Co‑Occurring SMI and SUD ��46

Substance Use among Adults with Mental Health Issues ��47

Suicidal Thoughts and Behavior among Adults �� 47

Serious Thoughts of Suicide ��48

Suicide Plans ��48

Suicide Attempts ��49

Substance Use Treatment in the PastYear ��50

Need for Substance Use Treatment ��50

Receipt of Substance Use Treatment ��50

Perceived Need for Substance Use Treatment ��53

Reasons for Not Receiving Specialty Substance Use Treatment ��54

Mental Health Service Use in the PastYear ��55

Treatment for Depression among Adolescents ��55

Treatment for Depression among Adults ��55

Any Mental Health Service Use among All Adolescents ��57

Any Mental Health Service Use among All Adults ��58

Any Mental Health Service Use among Adults with AMI ��59

Table of Contents

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Healthiv

August 2019

Any Mental Health Service Use among Adults with SMI ��60

Perceived Unmet Need for Mental Health Services

among Adults with Mental Illness

��61

Receipt of Services for Co‑Occurring Substance Use

Disorder and Mental Health Issues ��63

Receipt of Services among Adolescents with

Co‑Occurring MDE and a Substance Use Disorder ��63

Receipt of Services among Adults with Co‑Occurring AMI

and a Substance Use Disorder

��64

Receipt of Services among Adults with Co‑Occurring SMI

and a Substance Use Disorder

��65

Endnotes ��67

AppendixA: Supplemental Tables of Estimates for Key

Substance Use and Mental Health Indicators in the

United States �� A‑1

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Summary

is report summarizes key ﬁndings from the 2018 National

Survey on Drug Use and Health (NSDUH) for national

indicators of substance use and mental health among people

aged 12 or older in the civilian, noninstitutionalized population

of the United States. Results are provided for the overall category

of people aged 12 or older and by age subgroups.

Substance Use

In 2018, an estimated 164.8 million people aged 12 or older

in the United States (60.2 percent) were past month substance

users (i.e., tobacco, alcohol, or illicit drugs). About 2 out of 5

people aged 12 or older (108.9 million, or 39.8 percent) did not

use substances in the past month. e 164.8 million past month

substance users in 2018 include 139.8 million people who drank

alcohol, 58.8 million people who used a tobacco product, and

31.9 million people who used an illicit drug.

Tobacco Use

In 2018, an estimated 47.0 million people aged 12 or older

were past month cigarette smokers, including 27.3 million

people who were daily cigarette smokers and 10.8 million

daily smokers who smoked approximately a pack or more

of cigarettes per day. Fewer than 1 in 6 people aged 12 or

older in 2018 were past month cigarette smokers. Cigarette

use generally declined between 2002 and 2018 across all

age groups. Some of this decline may reﬂect the use of

electronic vaporizing devices (“vaping”), such as e-cigarettes,

as a substitute for delivering nicotine. NSDUH does not

currently ask separate questions about the vaping of nicotine.

Alcohol Use

In 2018, about 139.8 million Americans aged 12 or older

were past month alcohol users, 67.1 million were binge

drinkers in the past month, and 16.6 million were heavy

drinkers in the past month.

About 2.2 million adolescents

aged 12 to 17 drank alcohol in the past month, and

1.2 million of these adolescents binge drank in that period.

Although the percentage of adolescents who drank alcohol

decreased between 2002 and 2018, about 1 in 11 adolescents

in 2018 were past month alcohol users.

NSDUH collects information on past month alcohol use, binge alcohol use,

and heavy alcohol use. For men, binge alcohol use is deﬁned in NSDUH as

drinking ﬁve or more drinks on the same occasion on at least 1 day in the

past 30 days. For women, binge drinking is deﬁned as drinking four or more

drinks on the same occasion on at least 1 day in the past 30 days. Heavy

alcohol use is deﬁned as binge drinking on 5 or more days in the past 30 days.

Illicit Drug Use

In 2018, nearly 1 in 5 people aged 12 or older (19.4 percent)

used an illicit drug in the past year, which is a higher

percentage than in 2015 and 2016. e estimate of past year

illicit drug use for 2018 was driven primarily by marijuana

use, with 43.5 million past year marijuana users. e

percentage of people aged 12 or older in 2018 who used

marijuana in the past year (15.9 percent) was higher than

the percentages in 2002 to 2017. is increase in past year

marijuana use for people aged 12 or older reﬂects increases

in marijuana use among both young adults aged 18 to 25

and adults aged 26 or older. In contrast, past year marijuana

use among adolescents aged 12 to 17 did not increase

between 2014 and 2018.

Prescription pain reliever misuse was the second most

common form of illicit drug use in the United States in

2018, with 3.6 percent of the population misusing pain

relievers. For people aged 12 or older and for young adults

aged 18 to 25, the percentages who misused prescription

pain relievers in the past year were lower in 2018 than in

2015 to 2017. Similar decreases in pain reliever misuse were

observed for adolescents aged 12 to 17 and adults aged 26 or

older in 2018 compared with 2015 and 2016 but not when

compared with 2017. Among people aged 12 or older in

2018 who misused pain relievers in the past year, the most

common main reason for their last misuse of a pain reliever

was to relieve physical pain (63.6 percent). More than half

(51.3 percent) of people who misused pain relievers in the

past year obtained the last pain reliever they misused from a

friend or relative.

NSDUH also allows for estimation of opioid misuse, which

is deﬁned as the use of heroin or the misuse of prescription

pain relievers. In 2018, an estimated 10.3 million people

aged 12 or older misused opioids in the past year, including

9.9 million prescription pain reliever misusers and 808,000

heroin users. Approximately 506,000 people misused

prescription pain relievers and used heroin in the past year.

e percentage of people aged 12 or older in 2018 who were

past year opioid misusers was lower than the percentages

between 2015 and 2017, which was largely driven by

declines in pain reliever misuse rather than by changes in

heroin use.

Substance Use Initiation

In 2018, the substances with the largest number of recent

(i.e., past year) initiates of use or misuse were alcohol

(4.9 million new users), marijuana (3.1 million new users),

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health2

August 2019

1.7 million people with a prescription pain reliever use

disorder and 0.5 million people with a heroin use disorder.

Although the percentage of people with an SUD in

2018 was similar to the percentages in 2015 to 2017, the

corresponding percentages of the population with a pain

reliever use disorder, opioid use disorder, or alcohol use

disorder were lower than in 2015.

Major Depressive Episode

In 2018, about 1 in 7 adolescents aged 12 to 17

(14.4 percent) had a past year major depressive episode

(MDE), or 3.5 million adolescents. About 1 in 10

adolescents (10.0 percent) had a past year MDE with severe

impairment, or 2.4 million adolescents.

e percentage of

adolescents in 2018 who had a past year MDE was higher

than the percentages in 2004 to 2017.

In 2018, approximately 13.8 percent of young adults aged

18 to 25 (4.6 million) had an MDE during the past year, and

8.9 percent (3.0 million) had a past year MDE with severe

impairment. e percentage of young adults in 2018 who

had a past year MDE was greater than the percentages in

2005 to 2016, but it was similar to the percentage in 2017.

Mental Illness among Adults

In 2018, an estimated 47.6 million adults aged 18 or older

(19.1 percent) had any mental illness (AMI) in the past year.

An estimated 11.4 million adults in the nation had serious

mental illness (SMI) in the past year, corresponding to

4.6 percent of all U.S. adults.

e percentages of adults

aged 18 or older in 2018 with AMI or SMI were similar to

the corresponding percentages in 2017, but they were higher

than the percentages in most years from 2008 to 2016.

Percentages of young adults aged 18 to 25 in 2018 who

had AMI or SMI also were greater than the corresponding

percentages in each year from 2008 to 2016, but they were

similar to the percentages in 2017.

People who met the criteria for MDE based on criteria speciﬁed in the

Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5),

were deﬁned as having an MDE. See the following reference: American

Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (DSM-5) (5th ed.). Arlington, VA: Author.

Adults with AMI were deﬁned as having any mental, behavioral, or

emotional disorder in the past year that met DSM-IV criteria (excluding

developmental disorders and SUDs). Adults with AMI were deﬁned as

having SMI if they had any mental, behavioral, or emotional disorder that

substantially interfered with or limited one or more major life activities.

See footnote 2 for the reference for the DSM-IV criteria.

prescription pain relievers (1.9 million new misusers), and

cigarettes (1.8 million new users). Although the number

of marijuana initiates aged 12 or older in 2018 was higher

than the numbers in 2002 to 2016, it was similar to that

in 2017. e number of people aged 12 or older in 2018

who initiated the misuse of prescription pain relievers was

similar to the numbers in 2015 to 2017. In 2018, among

adolescents aged 12 to 17 and young adults aged 18 to 25,

however, the numbers of new misusers of pain relievers were

lower than the numbers in 2015 and 2016.

Perceived Risk from Substance Use

In 2018, more than 4 out of 5 people aged 12 or older

perceived great risk of harm from weekly use of cocaine or

heroin (86.5 and 94.3 percent, respectively), while less than

one third of people (30.6 percent) perceived great risk of

harm from weekly marijuana use. About 2 out of 3 people

(68.5 percent) perceived great risk from daily binge drinking,

and nearly 3 out of 4 people (71.8 percent) perceived great

risk from smoking one or more packs of cigarettes per day.

Perceptions of risk from this level of daily cigarette use or

weekly marijuana and cocaine use among people were lower

in 2018 than in 2015. However, the percentages of people

in 2018 who perceived great risk from weekly heroin use

or daily binge drinking were similar to the corresponding

percentages in 2015 to 2017. Among adolescents aged 12

to 17 in 2018, there were declines in the percentages who

perceived great risk from this level of daily cigarette use

(smoking one or more packs per day) and weekly marijuana

use, but the percentages who perceived great risk from daily

binge drinking, weekly cocaine use, or weekly heroin use

were similar to prior years.

Substance Use Disorders

In 2018, approximately 20.3 million people aged 12 or

older had a substance use disorder (SUD) related to their

use of alcohol or illicit drugs in the past year, including

14.8 million people who had an alcohol use disorder and

8.1 million people who had an illicit drug use disorder.

e most common illicit drug use disorder was marijuana

use disorder (4.4 million people). An estimated 2.0 million

people had an opioid use disorder, which includes

People who met the criteria for dependence or abuse for alcohol or illicit

drugs in the past 12 months based on criteria speciﬁed in the Diagnostic

and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), were

deﬁned as having an SUD. See the following reference: American Psychiatric

Association. (1994). Diagnostic and statistical manual of mental disorders

(DSM-IV) (4th ed.). Washington, DC: Author.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Co‑Occurring Mental Health Issues and Substance Use

Disorders

Approximately 358,000 adolescents (1.5 percent of all

adolescents) had an SUD and an MDE in the past year,

including 288,000 adolescents (1.2 percent of all

adolescents) who had an SUD and an MDE with severe

impairment. e percentages of adolescents who had an

SUD and an MDE or who had an SUD and an MDE with

severe impairment remained steady from 2015 to 2018.

In 2018, an estimated 9.2 million adults aged 18 or older

(3.7 percent of all adults) had both AMI and at least one

SUD in the past year, and 3.2 million adults (1.3 percent

of all adults) had co-occurring SMI and an SUD in the

past year. e 2018 percentages of adults with both AMI

and an SUD and adults with both SMI and an SUD were

higher than the corresponding percentages in 2015 and

2016, but they were similar to the percentages in 2017.

Substance Use among People with Mental Health

Issues

In 2018, substance use was more common among both

adolescents and adults who had a mental health issue than

among those who did not have a mental health issue. About

1 in 16 adolescents aged 12 to 17 in 2018 (6.1 percent)

with a past year MDE smoked cigarettes in the past month

compared with 2.1 percent of those without a past year

MDE. In addition, adolescents with an MDE were more

likely than those without an MDE to binge drink in the

past month (8.5 vs. 4.1 percent) and to use an illicit drug in

the past year (32.7 vs. 14.0 percent).

Among adults aged 18 or older in 2018, an estimated

28.1 percent of adults with AMI and 37.2 percent of

adults with SMI were cigarette smokers in the past month

compared with 16.3 percent of those without any mental

illness. In addition, 31.3 percent of adults with AMI and

32.3 percent of adults with SMI were binge drinkers in the

past month compared with 25.3 percent of adults with no

mental illness. e percentages of adults who used illicit

drugs in the past year were higher among those with SMI

(49.4 percent) and adults with AMI (36.7 percent) compared

with those without any mental illness (15.7 percent).

Suicidal Thoughts and Behavior among Adults

In 2018, an estimated 10.7 million adults aged 18 or

older had thought seriously about trying to kill themselves

(4.3 percent of adults), 3.3 million had made suicide plans

(1.3 percent), and 1.4 million made a nonfatal suicide

attempt (0.6 percent). e percentage of adults aged 18

or older in 2018 who had serious thoughts of suicide was

higher than the percentages in 2008 to 2014, but it was

similar to the percentages in 2015 to 2017. e percentage

of young adults aged 18 to 25 in 2018 with serious thoughts

of suicide also was higher than in 2008 to 2016. Similarly,

the percentage of adults aged 26 to 49 in 2018 who had

serious thoughts of suicide was higher than the percentages

in most years between 2008 and 2015. In contrast, the

percentage of adults aged 50 or older in 2018 with serious

thoughts of suicide was similar to the percentages in most

years from 2008 to 2017.

Substance Use Treatment

In 2018, an estimated 21.2 million people aged 12 or older

needed substance use treatment.

is number translates to

about 1 in 13 people who needed treatment (7.8 percent).

About 1 in 26 adolescents aged 12 to 17 (3.8 percent),

about 1 in 7 young adults aged 18 to 25 (15.3 percent),

and 1 in 14 adults aged 26 or older (7.0 percent) needed

treatment. e 2018 percentage of adolescents aged 12 to

17 who needed treatment was lower than in 2015 and 2016,

but it was similar to the percentage in 2017. In contrast,

percentages of adults in 2018 who needed substance use

treatment were similar to the percentages in 2015 to 2017

for young adults aged 18 to 25 and adults aged 26 or older.

In 2018, approximately 1.4 percent of people aged 12

or older (3.7 million people) received any substance use

treatment in the past year, and 0.9 percent (2.4 million)

received substance use treatment at a specialty facility. e

percentages of people aged 12 or older in 2018 who received

any substance use treatment and who received substance

use treatment at a specialty facility were similar to the

percentages in 2015 to 2017. An estimated 11.1 percent of

people aged 12 or older who needed substance use treatment

received treatment at a specialty facility in the past year. e

percentage of people aged 12 or older in 2018 who needed

substance use treatment and received treatment at a specialty

facility also was similar to the percentages in 2015 and 2017.

For NSDUH, people are deﬁned as needing substance use treatment if they

had an SUD in the past year or they received substance use treatment at

a specialty facility in the past year. Substance use treatment at a specialty

facility refers to treatment at a hospital (only as an inpatient), a drug or

alcohol rehabilitation facility (as an inpatient or outpatient), or a mental

health center.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health4

August 2019

In 2018, among the estimated 18.9 million people aged 12

or older who needed substance use treatment but did not

receive specialty treatment in the past year, about 964,000

perceived a need for substance use treatment. About 2 in

5 people who needed and perceived a need for treatment

but did not receive treatment at a specialty facility were not

ready to stop using, and about 1 in 3 had no health care

coverage and were not able to aﬀord the cost.

Treatment for Depression

Among the 3.5 million adolescents aged 12 to 17 and the

4.6 million young adults aged 18 to 25 in 2018 who had

a past year MDE, 1.4 million adolescents (41.4 percent)

and 2.3 million young adults (49.6 percent) received

treatment for depression. e percentages of adolescents and

young adults in 2018 with a past year MDE who received

treatment for their depression were similar to the percentages

in most prior years.

Mental Health Service Use among Adults

In 2018, an estimated 37.1 million adults aged 18 or older

(15.0 percent of adults) received mental health care during the

past 12 months. Among the 47.6 million adults with AMI,

20.6 million (43.3 percent) received mental health services in

the past year. e percentage of adults in 2018 with AMI who

received mental health care was higher than the percentages

in most years from 2008 to 2012, but it was similar to the

percentages in 2013 to 2017. About 7.3 million of the

11.4 million adults with past year SMI (64.1 percent) received

mental health services in the past year. e percentage of

adults in 2018 with SMI who received mental health care was

similar to the percentages in 2008 to 2012 and 2015 to 2017,

but it was lower than the percentages in 2013 and 2014.

However, about one third of adults with SMI in any given

year did not receive mental health services.

In 2018, an estimated 11.2 million adults aged 18 or older

with past year AMI and 5.1 million adults with past year

SMI had a perceived unmet need for mental health care at

any time in the past year. e percentage of adults in 2018

with AMI who perceived an unmet need for mental health

care in the past year was higher than the percentages in most

years from 2008 to 2017. e percentage of adults in 2018

with SMI who perceived an unmet need for mental health

care in the past year was higher than the percentages in 2015

and 2016, but it was similar to the percentages in 2017 and

in most years from 2008 to 2014. In 2018, about 2 out of 5

adults with AMI (45.2 percent) and slightly more than half

of those with SMI (54.7 percent) who perceived an unmet

need for mental health services did not receive services

because they could not aﬀord the cost of care.

Receipt of Services among People with Co‑Occurring

Mental Illness and Substance Use Disorder

In 2018, among adolescents aged 12 to 17 who had

a co-occurring MDE and an SUD in the past year,

65.7 percent received either substance use treatment at a

specialty facility or mental health services in the past year.

An estimated 5.4 percent of adolescents with a co-occurring

MDE and an SUD received both mental health care and

specialty substance use treatment, 59.5 percent received only

mental health care, and 0.8 percent received only specialty

substance use treatment.

In 2018, about half of the adults aged 18 or older

with co-occurring AMI and an SUD in the past year

(51.4 percent) received either mental health care or specialty

substance use treatment, and 48.6 percent received neither

type of care. An estimated 69.5 percent of adults with

co-occurring SMI and an SUD received either type of care,

and about 1 in 3 (30.5 percent) received neither type of care.

e percentage of adults in 2018 with co-occurring AMI

and an SUD who received mental health care or specialty

substance use treatment was similar to the percentages in all

years from 2015 to 2017. For adults with SMI and an SUD,

the percentage of those who received either type of care was

higher than the percentage in 2015, but it was similar to the

percentages in 2016 and 2017.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Introduction

Substance use and mental health issues aﬀect millions of

adolescents and adults in the United States and contribute

heavily to the burden of disease in the nation.

1,2,3,4

e

National Survey on Drug Use and Health (NSDUH) is the

primary source for statistical information on illicit drug use,

alcohol use, substance use disorders (SUDs), and mental

health issues for the civilian, noninstitutionalized population

of the United States. Information on mental health and

substance use allows the Substance Abuse and Mental Health

Services Administration (SAMHSA) and other policymakers

to gauge progress toward improving the health of the nation.

is report summarizes ﬁndings for key substance use

and mental health indicators from the 2018 National

Survey on Drug Use and Health (NSDUH).

is report contains ﬁndings from the 2018 NSDUH for

key substance use and mental health indicators in the United

States. Comprehensive 2018 NSDUH detailed tables showing

additional substance use and mental health-related outcomes,

including data for various subpopulations covered in NSDUH,

are available separately at https://www.samhsa.gov/data/

Survey Background

NSDUH is an annual survey of the civilian, noninstitution-

alized population of the United States aged 12 or older.

e survey is sponsored by SAMHSA within the U.S.

Department of Health and Human Services (HHS). e

survey covers residents of households and individuals in

noninstitutional group quarters (e.g., shelters, boarding

houses, college dormitories, migratory workers’ camps,

halfway houses). e 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 quarters, such as jails, nursing homes,

mental institutions, and long-term care hospitals.

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. e 2018 NSDUH annual target sample size of

67,500 interviews was distributed 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.

NSDUH is a face-to-face household interview survey

conducted in two phases: the screening phase and the

interview phase. e interviewer conducts a screening

of the sampled household with an adult resident (aged

18 or older) in order to determine whether zero, one, or

two residents aged 12 or older should be selected for the

interview. NSDUH collects data using audio computer-

assisted self-interviewing (ACASI) in which respondents read

or listen to the questions on headphones, then enter their

answers directly into a NSDUH laptop computer. ACASI is

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,

and other sensitive behaviors. NSDUH also uses computer-

assisted personal interviewing (CAPI) in which interviewers

read less sensitive questions to respondents and enter the

respondents’ answers into a NSDUH laptop computer.

is report is based on data from

67,791 completed interviews from 2018 NSDUH

respondents aged 12 or older.

In 2018, screening was completed at 141,879 addresses,

and 67,791 completed interviews were obtained, including

16,852 interviews from adolescents aged 12 to 17 and

50,939 interviews from adults aged 18 or older. Weighted

response rates for household screening and for interviewing

were 73.3 and 66.6 percent, respectively, for an overall

response rate of 48.8 percent for people aged 12 or older.

e weighted interview response rates were 73.9 percent

for adolescents and 65.8 percent for adults.

Further details

about the 2018 NSDUH design and methods can be found

on the web at https://www.samhsa.gov/data/

Data Presentation and Interpretation

is report focuses on substance use and mental health in

the United States based on NSDUH data from 2018 and

earlier years.

Estimates of substance use and substance

use treatment are presented for people aged 12 or older,

adolescents, and adults.

However, estimates of mental

health issues and mental health service use are not presented

jointly for people aged 12 or older. Rather, these estimates

are presented separately for adolescents aged 12 to 17 and

adults aged 18 or older because adolescents and adults

completed diﬀerent sets of questions regarding mental

health and mental health service utilization. All estimates

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health6

August 2019

(e.g., percentages and numbers) presented in the report are

derived from survey data that are subject to sampling errors.

e estimates have met the criteria for statistical precision.

Estimates not meeting these criteria have been suppressed

and are not shown.

One of NSDUH’s strengths is the stability in the sample

and survey design. is stability allows for the examination

of trends across time. However, the beneﬁt of using

NSDUH data to assess trends has to be balanced with the

periodic need to revise or add content to address changes in

society and emerging issues.

Consequently, the number

of years for which comparisons can be made varies across

measures depending on when content was revised or added

for NSDUH. For example, the perceived recovery items

were added in 2018; as a result, these items will establish a

baseline that starts in 2018 (

Table A.4 in Appendix A). e

prescription drug misuse items revised in 2015 have 4 years of

trend data for 2015 to 2018 (Table A.1B), and the marijuana

use items have 17 years of trend data for 2002 to 2018

(Table A.1B). All trends in the report present 2018 estimates

and comparable estimates from 3 or more prior years.

Most trend analyses are presented for percentages because

the percentages take into account any change in the size

of the total population and facilitate the comparison of

estimates across years.

However, trend analyses for the

initiation of substance use present the number of people

who initiated substance use in the past year rather than

percentages. erefore, care should be taken in interpreting

increases over time in the estimated number of past year

initiates because some of these increases could reﬂect growth

in the size of the population. Percentages of the population

who initiated substance use in the past year are available in

the 2018 NSDUH detailed tables, such as Detailed Table

(DT) 4.4 at https://www.samhsa.gov/data/.

Analyses of trends in this report focus on long‑term trends

in substance use and mental health issues. Trends for

2015 to 2018 also are presented for selected measures.

Statistical tests have been conducted for comparisons

appearing in the text of the report. Statistically signiﬁcant

diﬀerences are described using terms such as “higher,” “lower,”

“increased,” or “decreased.” Statements use terms such as

“similar,” “remained steady,” or “stable” when a diﬀerence is

not statistically signiﬁcant. Analyses of long-term trends in

this report involving more than 4 years of data summarize

whether the 2018 estimates diﬀer from or are similar to

estimates in most or all previous years,

while minimizing

discussion of anomalous diﬀerences between any 2 years that

can occur due to these estimates being based on samples.

Substance Use in the Past Month

Tobacco products, alcohol, and illicit drugs are the three

categories of substances measured in NSDUH. is section

provides an overview of whether respondents aged 12 or

older have used any of these substances in the 30 days

before the interview (i.e., in the past month, also referred to

as “current use”). Additional details on the use of tobacco

products, alcohol, and illicit drugs are provided in other

sections of this report.

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.

Alcohol use in the past month refers to

having more than a sip or two from any type of alcoholic

drink (e.g., 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).

In NSDUH, illicit drug use in the past month includes

any use of marijuana, cocaine (including crack), heroin,

hallucinogens, inhalants, or methamphetamine, as well as

misuse of prescription stimulants, tranquilizers or sedatives

(including benzodiazepines), or pain relievers. (See the

section on the Misuse of Psychotherapeutic Drugs for the

deﬁnition of “misuse.”)

In 2018, an estimated 164.8 million people aged 12 or older

used a substance (i.e., tobacco, alcohol, or an illicit drug) in

the past month (Figure 1). is number of current substance

users corresponds to 60.2 percent of the population. About

2 out of 5 people aged 12 or older (108.9 million, or

39.8 percent) did not use substances in the past month.

e 164.8 million current substance users in 2018 include

139.8 million people who drank alcohol, 58.8 million

people who used a tobacco product, and 31.9 million people

who used an illicit drug (2018 DT 7.3). ese numbers 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.

Although about half of the people aged 12 or older

(51.1 percent) drank alcohol in the past month and 1

in 5 (21.5 percent) used a tobacco product, use of illicit

drugs was less common (Table A.1B). About 1 in 9 people

aged 12 or older (11.7 percent) used an illicit drug in the

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

past month. Given that illicit drug use was less prevalent

than the use of either tobacco or alcohol, the remainder of

this report presents past year estimates of illicit drug use to

allow presentation of estimates for low prevalence drugs,

such as heroin. In contrast, the higher prevalence of tobacco

and alcohol use makes it possible to present estimates not

only for any past month use of these substances, but also

for the intensity of their use in the past month (e.g., daily

cigarette use, binge alcohol use).

Tobacco Use in the Past Month

NSDUH data can be used to estimate the percentage of

people who currently use tobacco products and to monitor

changes in tobacco use over time. As noted in the section on

Substance Use in the Past Month, NSDUH asks respondents

aged 12 or older about their tobacco use in the 30 days

before the interview. Tobacco products include cigarettes,

smokeless tobacco (such as snuﬀ, dip, chewing tobacco, or

snus), cigars, and pipe tobacco.

Cigarette use is deﬁned

as smoking “part or all of a cigarette.” A discussion of the

estimates for daily cigarette smoking follows a presentation

of the estimates for any cigarette smoking in the past month.

e majority of the 58.8 million current (i.e., past month)

tobacco users in 2018 were current cigarette smokers (Figure 2),

as has been the case historically.

Speciﬁcally, 47.0 million

people aged 12 or older in 2018 were current cigarette smokers,

12.2 million people were current cigar smokers, 8.0 million

people were current users of smokeless tobacco, and 2.1 million

people currently smoked pipe tobacco.

Among current users of any tobacco product who were aged

12 or older, 65.5 percent smoked cigarettes but did not use

other tobacco products, 14.4 percent smoked cigarettes and

used some other type of tobacco product, and 20.1 percent

used other tobacco products but not cigarettes (Table A.2B).

is same pattern was observed in 2018 among young adults

aged 18 to 25 and adults aged 26 or older, with most current

tobacco users smoking only cigarettes. Speciﬁcally, more than

half of young adults (50.3 percent) and more than two thirds

of adults aged 26 or older (68.9 percent) who were current

tobacco users smoked only cigarettes in the past month.

Among adults who were current users of tobacco products,

25.9 percent of those aged 18 to 25 and 18.7 percent of those

aged 26 or older did not smoke cigarettes. In contrast, among

adolescents who were current tobacco users, 36.1 percent

used tobacco products other than cigarettes but did not

smoke cigarettes. In addition, 26.5 percent of adolescents and

23.8 percent of young adults aged 18 to 25 who were current

tobacco users smoked cigarettes and used other tobacco

products. Among adults aged 26 or older who were current

tobacco users, about 1 in 8 (12.4 percent) were current

cigarette smokers and current users of other tobacco products.

e remainder of this section on tobacco use focuses on

cigarette smoking because most current tobacco users were

cigarette smokers. More information on the use of cigars,

pipe tobacco, and smokeless tobacco in the past month by

people aged 12 or older can be found in Table A.1B and

in the 2018 detailed tables by age groups (i.e., DT 7.6,

DT 7.12, and DT 7.15, respectively).

Figure 1. Past Month Substance Use among People Aged 12 or Older: 2018

139.8M

58.8M

27.7M

2.9M

1.9M

1.8M

1.7M

1.6M

1.0M

612,000

354,000

0 50 100 150

Alcohol

Tobacco

Marijuana

Rx Pain Reliever Misuse

Cocaine

Rx Tranquilizer or Sedative Misuse

Rx Stimulant Misuse

Hallucinogens

Methamphetamine

Inhalants

Heroin

Number of Past Month Users

Past Month

Substance Use

164.8 Million People

(60.2%)

No Past Month

Substance Use

108.9 Million People

(39.8%)

Rx = prescription.

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.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health8

August 2019

Cigarette Use

As noted previously, an estimated 47.0 million people

aged 12 or older in 2018 were current cigarette smokers

(Figure 2). is number of current cigarette smokers

correspond to 17.2 percent of the population (Figure 3). e

percentage of the population who smoked cigarettes in the

past month was lower in 2018 than in 2002 to 2017. Stated

another way, fewer than 1 in 6 people aged 12 or older in

2018 were current cigarette smokers. In comparison, about 1

in 4 people were current cigarette smokers in 2002 to 2008

(ranging from 24.0 to 26.0 percent).

Although cigarette smoking declined, some of this decline

may reﬂect a rise in the use of electronic vaporizing devices

(“vaping”), such as e-cigarettes, as a substitute for delivering

nicotine. NSDUH does not currently ask separate questions

about the vaping of nicotine. e measurement of both

cigarette use and the vaping of nicotine may be needed to

understand tobacco use trends.

Aged 12 to 17

In 2018, an estimated 672,000 adolescents aged 12 to

17 smoked cigarettes in the past month. is number of

adolescents who were current cigarette smokers corresponds

to 2.7 percent of adolescents (Figure 3). e percentage of

adolescents who were past month cigarette smokers declined

from 13.0 percent in 2002 (or about 1 in 8 adolescents) to

2.7 percent in 2018 (or about 1 in 37). e percentage of

adolescents who were current cigarette smokers in 2018 was

lower than the percentages in each year from 2002 to 2017.

Aged 18 to 25

In 2018, an estimated 6.5 million young adults aged 18 to 25

smoked cigarettes in the past month. is number of young

adults who were current cigarette smokers corresponds to

about one ﬁfth of young adults (19.1 percent) (Figure 3). e

percentage of young adults who were current cigarette smokers

in 2018 was lower than the percentages in 2002 to 2017.

Aged 26 or Older

In 2018, an estimated 39.8 million adults aged 26 or older

smoked cigarettes in the past month. Stated another way,

about 1 in 5 adults aged 26 or older (18.5 percent) were

Figure 3. Past Month Cigarette Use among People Aged 12 or

Older: 2002-2018

Percent Using in Past Month

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 3 Table. Past Month Cigarette Use among People Aged 12 or Older:

2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

26.0

25.4

24.9

25.0

24.3

24.0

23.3

23.0

22.1

21.3

20.8

19.4

19.1

17.9

17.2

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

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

≥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

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 2. Past Month Tobacco Use among People Aged 12 or Older: 2018

47.0M

12.2M

8.0M

2.1M

0 20 40 60

Cigarettes

Cigars

Smokeless Tobacco

Pipe Tobacco

Number of Past Month Users

Past Month

Tobacco Use

58.8 Million People

(21.5%)

No Past Month

Tobacco Use

215.0 Million People

(78.5%)

Note: The estimated numbers of current users of different tobacco products are not mutually exclusive because people could have used more than one type of tobacco

product in the past month.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

current cigarette smokers in 2018 (Figure 3). e 2018

estimate for current cigarette smoking among adults aged 26

or older was lower than the estimates from 2002 to 2016,

but it was similar to the 2017 estimate.

Daily Cigarette Use

Among the 47.0 million current cigarette smokers aged 12

or older in 2018, 27.3 million were daily cigarette smokers.

e 27.3 million daily smokers correspond to 58.2 percent

of current cigarette smokers (Figure 4). us, nearly three

ﬁfths of current cigarette smokers in 2018 smoked cigarettes

daily. e percentage of current smokers in 2018 who

smoked cigarettes daily was lower than the percentages in

most years from 2002 to 2012, but it was similar to the

percentages in 2013 to 2017 (2018 DT 7.26).

Among the 27.3 million daily smokers aged 12 or older

in 2018, 10.8 million smoked 16 or more cigarettes per

day (i.e., approximately one pack or more per day). Stated

another way, about 2 out of 5 daily smokers (39.6 percent)

smoked a pack or more of cigarettes per day (Figures 4 and

5). e percentage of daily smokers who smoked one or more

packs of cigarettes per day was lower in 2018 than in 2002 to

2011, but it was similar to the percentages in 2012 to 2017.

Aged 12 to 17

In 2018, about 99,000 adolescents aged 12 to 17 smoked

cigarettes every day in the past month. is number corresponds

to about 1 in 7 adolescent current smokers (14.7 percent) (2018

DT 7.27). e 2018 percentage was lower than the percentages

in most years from 2002 to 2014, but it was similar to the

percentages in 2015 to 2017. e percentage of adolescent

daily smokers who smoked one or more packs of cigarettes per

day was not reported for 2018 due to low precision.

Aged 18 to 25

About 2.4 million young adults aged 18 to 25 in 2018 were

daily cigarette smokers in the past month, or 37.4 percent

of young adults who were current cigarette smokers (2018

DT 7.29). us, nearly 2 in 5 young adults in 2018 who were

current cigarette users smoked cigarettes daily. e percentage

of young adult current smokers in 2018 who smoked

Figure 5. Smokers of One or More Packs of Cigarettes per Day

among Past Month Daily Cigarette Smokers Aged 12 or Older:

2002-2018

Percent Using in Past Month

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 5 Table. Smokers of One or More Packs of Cigarettes per Day among

Past Month Daily Cigarette Smokers Aged 12 or Older: 2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

53.1

53.5

54.0

51.4

50.6

50.9

49.2

45.9

45.1

43.8

42.0 41.3 40.3 41.1 41.1 41.2 39.6

12-17

21.8 22.0 19.4 20.1 17.9 18.7 18.4 17.9 16.7 14.8 10.8 11.9 11.9 7.8 * * *

18-25

39.1

37.1

34.9

36.9

34.4

32.9

31.6

29.5

27.3

26.1 25.1 22.3 22.5 22.5 26.2 25.0 23.4

≥26

57.1

58.0

59.2

55.1

54.5

55.1

53.0

49.4

48.8

47.4

45.2

44.7

43.3 44.1 43.1 43.2 41.4

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

* Low precision; no estimate reported.

Figure 4. Daily Cigarette Use among Past Month Cigarette Smokers Aged 12 or Older and

Smoking of One or More Packs of Cigarettes per Day among Current Daily Smokers: 2018

16.4 Million

Smokers of

Less Than a

Pack per Day

(60.4%)

10.8 Million

Smokers of

One or More

Packs per Day

(39.6%)

19.6 Million

Less Than

Daily Smokers

(41.8%)

27.3 Million

Daily Smokers

(58.2%)

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

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health10

August 2019

cigarettes daily was lower than the percentages in 2002 to

2015, but it was similar to the percentages in 2016 and 2017.

e percentage of young adult daily smokers in 2018 who

smoked one or more packs of cigarettes per day (23.4 percent)

was lower than the percentages in 2002 to 2010, but it was

similar to the percentages in 2011 to 2017 (Figure 5).

Aged 26 or Older

In 2018, about 24.8 million adults aged 26 or older smoked

cigarettes every day in the past month, which corresponds to

62.3 percent of the current smokers in this age group (2018

DT 7.30). e percentage of current smokers in this age

group in 2018 who smoked cigarettes every day was lower

than the percentages in 2002 to 2013, but it was similar to

the percentages in 2014 to 2017. Despite the decline since

2002, when nearly 70 percent of current smokers aged 26 or

older were daily smokers, about three ﬁfths of current smokers

in this age group in 2018 were daily smokers. Among daily

smokers aged 26 or older, the percentage in 2018 who smoked

one or more packs of cigarettes per day (41.4 percent) was

lower than in 2002 to 2013. However, the percentage was

stable from 2014 to 2018 (Figure 5).

Alcohol Use in the Past Month

As noted in the section on Substance Use in the Past Month,

NSDUH asks respondents aged 12 or older about their

alcohol use in the 30 days before the interview. Current

alcohol use is deﬁned as any use of alcohol in the

past 30 days. In addition to asking about any alcohol use,

NSDUH collects information on binge alcohol use and

heavy alcohol use. Binge drinking for males is deﬁned as

drinking ﬁve or more drinks

on the same occasion on at

least 1 day in the past 30 days, which is 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.

is deﬁnition of binge alcohol use is consistent with

federal deﬁnitions.

Heavy alcohol use is deﬁned as binge

drinking on 5 or more days in the past 30 days based on

the thresholds described previously for males and females.

Any alcohol use, binge drinking, and heavy drinking are not

mutually exclusive categories of use; heavy use is included in

estimates of binge and current use, and binge use is included

in estimates of current use (

Figure 6).

In 2018, an estimated 139.8 million Americans aged 12 or older

were current alcohol users, 67.1 million were binge drinkers

in the past month, and 16.6 million were heavy drinkers in

the past month (Figure 6). us, nearly half of current alcohol

users were binge drinkers (48.0 percent), and 1 in 8 current

alcohol users were heavy drinkers (11.8 percent). Among binge

drinkers, about 1 in 4 (24.7 percent) were heavy drinkers.

Any Alcohol Use

e estimate of 139.8 million current alcohol users aged 12

or older in 2018 (Figure 6) corresponds to past month use

by slightly more than half of the people in the population

(51.1 percent) (Figure 7). e 2018 estimate of past month

alcohol use was similar to the estimates in most years from

2002 to 2017.

Aged 12 to 17

An estimated 9.0 percent of adolescents aged 12 to 17

in 2018 were current alcohol users (Figure 7), which

corresponds to 2.2 million adolescents who drank alcohol

in the past month. e percentage of adolescents who were

current alcohol users in 2018 was lower than the percentages

in most years from 2002 through 2017. Although the

estimate of current alcohol use among adolescents decreased

between 2002 and 2018, about 1 in 11 adolescents were

current alcohol users in 2018.

Aged 18 to 25

In 2018, an estimated 55.1 percent of young adults aged 18

to 25 were current alcohol users (Figure 7), which corresponds

to about 18.8 million young adults. e percentage of young

adults in 2018 who drank alcohol in the past month was

lower than the percentages in 2002 through 2016, but it was

similar to the percentage in 2017. In addition, more than half

of young adults were current alcohol users in each year from

2002 to 2018 (ranging from 55.1 to 62.0 percent).

Figure 6. Current, Binge, and Heavy Alcohol Use among People

Aged 12 or Older: 2018

139.8 Million

Alcohol Users

67.1 Million

Binge Alcohol Users

(48.0% of Alcohol Users)

16.6 Million

Heavy Alcohol Users

(24.7% of Binge Alcohol

Users and 11.8% of

Alcohol Users)

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Aged 26 or Older

More than half of adults aged 26 or older in 2018 (55.3 percent)

were current alcohol users (Figure 7). is percentage

corresponds to about 118.8 million adults in this age group who

drank alcohol in the past month. In each year between 2002 and

2018, slightly more than half of adults aged 26 or older were

current alcohol users (ranging from 52.5 to 56.5 percent).

Binge Alcohol Use

In 2018, about 1 in 4 people aged 12 or older (24.5 percent)

were current binge alcohol users (Figure 8). is percentage

corresponds to about 67.1 million binge drinkers who were

aged 12 or older (Figure 6). e percentage of the population

who were past month binge alcohol users was stable from

2015 to 2018 (ranging from 24.2 to 24.9 percent).

Aged 12 to 17

About 1.2 million adolescents aged 12 to 17 in 2018 were

past month binge drinkers, which corresponds to 4.7 percent

of adolescents (Figure 8). us, about 1 in 21 adolescents

were current binge drinkers. e percentage of adolescents

who were current binge drinkers in 2018 was similar to the

percentages in 2016 and 2017, but it was lower than the

percentage in 2015 (5.8 percent).

Aged 18 to 25

An estimated 34.9 percent of young adults aged 18 to 25

in 2018 were binge drinkers in the past month (Figure 8),

which corresponds to about 11.9 million young adults. Stated

another way, more than a third of young adults in 2018

were current binge drinkers. Nevertheless, the percentage of

young adults who were current binge drinkers in 2018 was

lower than the percentages in 2015 to 2017 (ranging from

39.0 percent in 2015 to 36.9 percent in 2017).

Aged 26 or Older

In 2018, about a quarter (25.1 percent) of adults aged 26 or

older were current binge drinkers (Figure 8). is percentage

corresponds to about 54.0 million adults in this age group

who were binge drinkers. e percentage of adults aged

26 or older who were current binge drinkers in 2018 was

higher than the percentage in 2016, but it was similar to the

percentages in 2015 and 2017.

Heavy Alcohol Use

e estimate of 16.6 million people aged 12 or older in 2018

who were heavy alcohol users in the past month (Figure 6)

corresponds to 6.1 percent of the population (Figure 9). e

percentage of people who were current heavy alcohol users in

Figure 7. Past Month Alcohol Use among People Aged 12 or Older:

2002-2018

Percent Using in Past Month

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 7 Table. Past Month Alcohol Use among People Aged 12 or Older:

2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

51.0 50.1 50.3 51.8 51.0 51.2 51.6 51.9 51.8 51.8 52.1 52.2

52.7

51.7 50.7 51.7 51.1

12-17

17.6

17.7

17.6

16.5

16.7

16.0

14.7

14.8

13.6

13.3

12.9

11.6

11.5

9.6 9.2 9.9

9.0

18-25

60.5

61.4

60.5

60.9

62.0

61.3

61.1

61.8

61.4

60.7

60.2

59.6

58.3

57.1

56.3 55.1

≥26

53.9

52.5

53.0

55.1 53.7

54.1 54.7 54.9 54.9 55.1 55.6 55.9 56.5 55.6 54.6 55.8 55.3

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 8. Past Month Binge Alcohol Use among People Aged 12 or

Older: 2015-2018

Percent Using in Past Month

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 8 Table. Past Month Binge Alcohol Use among People Aged 12 or

Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

24.9 24.2 24.5 24.5

12 to 17

5.8

4.9 5.3 4.7

18 to 25

39.0

38.4

36.9

34.9

26 or Older

24.8 24.2

24.7 25.1

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health12

August 2019

2018 was similar to the percentages in 2016 and 2017, but it

was lower than the percentage in 2015 (6.5 percent).

Aged 12 to 17

In 2018, an estimated 131,000 adolescents aged 12 to 17

were current heavy drinkers. Stated another way, about 1 out

of 200 adolescents (0.5 percent) engaged in binge drinking

on 5 or more days in the past 30 days (Figure 9). e

percentage of adolescents who were current heavy drinkers in

2018 was lower than the percentages in 2015 and 2016 but

was similar to the percentage in 2017 (0.7 percent).

Aged 18 to 25

About 1 out of every 11 young adults aged 18 to 25

(9.0 percent) in 2018 was a current heavy alcohol drinker

(Figure 9). is percentage corresponds to 3.1 million young

adults who engaged in heavy drinking in the past month. e

percentage of young adults who were current heavy drinkers

in 2018 was lower than the percentages in 2015 and 2016

but was similar to the percentage in 2017 (9.6 percent).

Aged 26 or Older

An estimated 6.2 percent of adults aged 26 or older in 2018

were current heavy drinkers (Figure 9). is percentage

corresponds to about 13.4 million adults in this age group who

engaged in heavy drinking in the past month. e percentage

of adults aged 26 or older who were current heavy alcohol

users in 2018 was similar to the percentages in 2015 to 2017.

Illicit Drug Use in the PastYear

As noted previously, NSDUH obtains 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, the misuse of tranquilizers or sedatives,

and

the misuse of pain relievers (see the section on the Misuse

of Psychotherapeutic Drugs for the deﬁnition of “misuse”).

Estimates of “illicit drug use” reported from NSDUH

reﬂect the data from these drug categories. is report also

describes in later sections the misuse of benzodiazepines and

opioids in the past year (e.g., the misuse of prescription pain

relievers or the use of heroin).

Unlike estimates of tobacco and alcohol use, estimates of

illicit drug use are presented for use in the past year rather

than the past month. e presentation of past year estimates

improves the precision of estimates for detecting changes

over time in substances with a low prevalence, such as

heroin. In addition, details on the misuse of benzodiazepines

and speciﬁc subtypes of prescription pain relievers (e.g.,

fentanyl products) were collected only for the past year.

Among people aged 12 or older in 2018, an estimated

53.2 million people used illicit drugs in the past year

(Figure 10). e most commonly used illicit drug in the

past year was marijuana, which was used by 43.5 million

people. e second most common type of illicit drug use

in the United States was the misuse of prescription pain

relievers by an estimated 9.9 million people in the past year.

Smaller numbers of people were past year users of the other

illicit drugs, as shown in Figure 10.

Any Illicit Drug Use

e estimated 53.2 million people aged 12 or older in

2018 who were past year illicit drug users correspond to

19.4 percent of the population (Figures 10 and 11). Stated

another way, nearly 1 in 5 people aged 12 or older in the

United States used illicit drugs in the past year. e percentage

of the population in 2018 who used illicit drugs in the

past year was higher than the percentages in 2015 and 2016

but was similar to the percentage in 2017 (19.0 percent).

Figure 9. Past Month Heavy Alcohol Use among People Aged 12 or

Older: 2015-2018

Percent Using in Past Month

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 9 Table. Past Month Heavy Alcohol Use among People Aged 12 or

Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

6.5

6.0 6.1 6.1

12 to 17

0.9

0.8

0.7 0.5

18 to 25

10.9

10.1

9.6 9.0

26 or Older

6.4 6.0 6.2 6.2

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Aged 12 to 17

Approximately 4.2 million adolescents aged 12 to 17 in

2018 were past year illicit drug users, which corresponds

to about 1 in 6 adolescents (16.7 percent) (Figure 11). e

percentage of adolescents in 2015 to 2018 who used illicit

drugs in the past year ranged from 15.8 to 17.5 percent.

Aged 18 to 25

Approximately 2 in 5 young adults aged 18 to 25 in 2018

(38.7 percent) were past year users of illicit drugs (Figure 11).

is percentage corresponds to about 13.2 million young

adults who used illicit drugs in the past year. e percentage

of young adults in 2018 who used illicit drugs in the

past year was similar to the percentages in 2015 to 2017.

Aged 26 or Older

In 2018, about 1 in 6 adults aged 26 or older (16.7 percent)

were past year users of illicit drugs (Figure 11), or about

35.9 million adults in this age group. e percentage of

adults aged 26 or older in 2018 who were past year illicit

drug users was higher than the percentages in 2015 and 2016

but was similar to the percentage in 2017 (16.1 percent).

Marijuana Use

As noted in the section on Illicit Drug Use in the Past Year, an

estimated 43.5 million Americans aged 12 or older in 2018

used marijuana in the past year (Figure 10). is number of

past year marijuana users corresponds to 15.9 percent of the

population (Figure 12). e percentage of the population in

2018 who used marijuana was higher than the percentages from

2002 to 2017. is increase in marijuana use among people

aged 12 or older reﬂects increases in marijuana use among

both young adults aged 18 to 25 and adults aged 26 or older.

Aged 12 to 17

In 2018, about 1 in 8 adolescents aged 12 to 17 (12.5 percent)

were past year users of marijuana (Figure 12). is represents

approximately 3.1 million adolescents who used marijuana in

Figure 11. PastYear Illicit Drug Use among People Aged 12 or

Older: 2015-2018

Percent Using in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 11 Table. PastYear Illicit Drug Use among People Aged 12 or Older:

2015-2018

Age 2015 2016 2017 2018

12 or Older

17.8

18.0

19.0 19.4

12 to 17

17.5 15.8 16.3 16.7

18 to 25

37.5 37.7 39.4 38.7

26 or Older

14.6

15.0

16.1 16.7

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 10. PastYear Illicit Drug Use among People Aged 12 or Older: 2018

43.5M

9.9M

6.4M

5.6M

5.5M

5.1M

2.0M

1.9M

808,000

0 10 20 30 40 50

Marijuana

Rx Pain Reliever Misuse

Rx Tranquilizer or Sedative Misuse

Hallucinogens

Cocaine

Rx Stimulant Misuse

Inhalants

Methamphetamine

Heroin

Number of Past Year Users

Past Year

Illicit Drug Use

53.2 Million People

(19.4%)

No Past Year

Illicit Drug Use

220.6 Million People

(80.6%)

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.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health14

August 2019

the past year. e percentage of adolescents in 2018 who used

marijuana in the past year was lower than the percentages in

2002 to 2004 and in 2009 to 2013, but it was similar to the

percentages in 2005 to 2008 and in 2014 to 2017.

Aged 18 to 25

In 2018, more than a third of young adults aged 18 to 25

(34.8 percent) were past year users of marijuana (Figure 12),

or about 11.8 million young adults. e percentage of young

adults in 2018 who were past year marijuana users was

higher than the percentages between 2002 and 2016, but it

was similar to the percentage in 2017.

Aged 26 or Older

In 2018, an estimated 13.3 percent of adults aged 26 or older

were past year users of marijuana (Figure 12), which represents

about 28.5 million adults in this age group. e percentage

of adults aged 26 or older in 2018 who used marijuana in the

past year was higher than the percentages in 2002 to 2017.

Cocaine Use

In this report, estimates of the use of cocaine include use

of crack cocaine. Estimates also are presented separately for

crack use.

In 2018, an estimated 5.5 million people aged 12 or older

were past year users of cocaine (Figure 10), including

about 757,000 users of crack. Stated another way, about

2.0 percent of the population in 2018 used cocaine

(Figure 13), and 0.3 percent used crack (2018 DT 7.2).

e estimate of past year cocaine use in 2018 diﬀered from

the estimates in most years from 2002 to 2015, but it

was similar to the estimates in 2016 and 2017. e 2018

estimate of past year crack use among people aged 12 or

older was lower than the estimates in 2002 to 2009, but it

was similar to the estimates in 2010 to 2017.

Aged 12 to 17

ere were 112,000 adolescents aged 12 to 17 in 2018

who were past year users of cocaine, including about 4,000

users of crack. ese numbers correspond to 0.4 percent of

adolescents who used cocaine in the past year and less than

0.1 percent who used crack (Figure 13 and 2018 DT 7.5).

e 2018 estimate for cocaine use among adolescents was

similar to the estimates in 2013 to 2017, but it was lower

than the estimates in 2002 to 2012. e estimate of crack

use in 2018 among adolescents was lower than the estimates

in 2002 to 2011, but it was similar to the estimates in most

years from 2012 to 2017.

Figure 12. PastYear Marijuana Use among People Aged 12 or

Older: 2002-2018

Percent Using in Past Year

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 12 Table. PastYear Marijuana Use among People Aged 12 or Older:

2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

11.0

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

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

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

≥26

7.0

6.9

7.0

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

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 13. PastYear Cocaine Use among People Aged 12 or Older:

2002-2018

Percent Using in Past Year

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 13 Table. PastYear Cocaine Use among People Aged 12 or Older:

2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

2.5

2.4

2.3

2.5

2.3

2.1 1.9 1.8

1.5

1.8

1.6

1.7

1.8

1.9 2.2 2.0

12-17

2.1

1.8

1.6

1.7

1.6

1.5

1.2

1.0

0.9

0.7

0.5 0.7 0.6 0.5 0.5 0.4

18-25

6.7

6.6

6.9

6.4 5.6 5.3 4.7

4.6

4.4

4.6

5.4 5.6 6.2 5.8

≥26

1.8 1.9 1.7 1.5 1.8 1.7 1.6 1.4 1.4 1.0

1.4 1.2

1.4

1.3

1.4 1.7 1.6

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Aged 18 to 25

An estimated 5.8 percent of young adults aged 18 to 25

in 2018 used cocaine in the past year (Figure 13), and

0.3 percent used crack (2018 DT 7.11). ese percentages

correspond to 2.0 million young adults who used cocaine

in the past year, including 87,000 who used crack. e

percentage of young adults in 2018 who used cocaine was

higher than the percentages in 2010 to 2014, but it was

similar to the percentages in 2015 to 2017. e estimate of

past year crack use among young adults in 2018 was lower

than estimates in most years between 2002 and 2012, but it

was similar to the estimates in 2013 to 2017.

Aged 26 or Older

In 2018, an estimated 1.6 percent of adults aged 26 or older

used cocaine (Figure 13), and 0.3 percent used crack in

the past year (2018 DT 7.14). ese percentages represent

3.5 million adults aged 26 or older who used cocaine in the

past year, including 666,000 who used crack. e percentage

of adults in this age group in 2018 who used cocaine in the

past year was higher than the percentages in most years from

2011 to 2015, but it was similar to the percentages in 2016

and 2017. e estimate of past year crack use in 2018 among

adults aged 26 or older was lower than estimates in 2002 to

2008, but it was similar to the estimates in 2009 to 2017.

Heroin Use

An estimated 808,000 people aged 12 or older in 2018

used heroin in the past year (Figure 10), which corresponds

to about 0.3 percent of the population (Figure 14). e

estimate of past year heroin use in 2018 was higher than the

estimates for most years between 2002 and 2008, but it was

similar to the estimates in 2009 to 2017.

Aged 12 to 17

In 2018, less than 0.1 percent of adolescents aged 12 to

17 were past year heroin users (Figure 14). is percentage

represents about 10,000 adolescents who used heroin in

the past year. e estimate of past year heroin use among

adolescents in 2018 was lower than the estimates for most

years in 2002 to 2014, but it was similar to the estimates in

2015 to 2017. About 0.1 to 0.2 percent of adolescents used

heroin in any year from 2002 to 2017.

Aged 18 to 25

Among young adults aged 18 to 25 in 2018, 0.5 percent

were past year heroin users (Figure 14). is percentage

represents 157,000 young adults who used heroin in the

past year. e percentage of young adults in 2018 who were

past year heroin users was similar to the percentages in 2002

to 2010 and from 2015 to 2017, but it was lower than the

percentages in 2011 through 2014 (ranging from 0.7 to

0.8 percent).

Aged 26 or Older

In 2018, an estimated 0.3 percent of adults aged 26 or older

were past year heroin users (Figure 14). is percentage

represents 641,000 adults in this age group who used heroin

in the past year. e percentage of adults aged 26 or older

in 2018 who were past year heroin users was similar to the

percentages in 2013 to 2017, but it was slightly higher than

the percentages in most years from 2002 through 2012

(ranging from 0.1 to 0.2 percent).

Methamphetamine Use

Prior to 2015, questions about methamphetamine use

were asked in the context of questions about the misuse

of prescription stimulants because methamphetamine is

legally available by prescription (Desoxyn®). However, most

methamphetamine used in the United States is produced and

distributed illicitly rather than through the pharmaceutical

Figure 14. PastYear Heroin Use among People Aged 12 or Older:

2002-2018

Percent Using in Past Year

0.0

0.5

1.0

1.5

2.0

2.5

3.0

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 14 Table. PastYear Heroin Use among People Aged 12 or Older:

2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

0.2

0.1

0.2

0.2 0.2

0.2

0.2 0.2 0.2 0.3 0.3 0.3 0.3 0.4 0.3 0.3

12-17

0.2

0.1

0.2

0.1

0.1 0.2

0.1

0.2

0.1

0.1 0.1 0.1 0.0

18-25

0.4 0.3 0.4 0.5 0.4 0.4 0.5 0.5 0.6 0.7

0.8

0.7

0.8

0.6 0.7 0.6 0.5

≥26

0.1

0.2 0.1

0.1

0.2 0.2 0.2

0.2

0.2 0.3 0.3 0.3 0.3 0.3

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Note: Estimates of less than 0.05 percent round to 0.0 percent when shown to the nearest tenth of a percent.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health16

August 2019

industry. Beginning in 2015, therefore, questions speciﬁc to

methamphetamine use have been administered separately

from questions about the misuse of prescription stimulants.

In 2018, approximately 1.9 million people aged 12 or

older used methamphetamine in the past year (Figure 10).

is number of past year methamphetamine users

corresponds to 0.7 percent of the population (Figure 15).

e percentage of people aged 12 or older in 2018 who

used methamphetamine in the past year was similar to the

percentages in 2015 and 2017, but it was slightly higher

than the percentage in 2016 (0.5 percent).

Aged 12 to 17

In 2018, an estimated 0.2 percent of adolescents aged 12 to

17 used methamphetamine in the past year (Figure 15). is

percentage represents about 43,000 adolescents who used

methamphetamine in the past year. e estimate of past year

methamphetamine use among adolescents in 2018 was

similar to the estimates in 2015 to 2017.

Aged 18 to 25

In 2018, an estimated 0.8 percent of young adults aged 18

to 25 were past year methamphetamine users (Figure 15).

is percentage represents 273,000 young adults who used

methamphetamine in the past year. e percentage of young

adults in 2018 who were past year methamphetamine users

was similar to the percentages in 2015 to 2017.

Aged 26 or Older

Among adults aged 26 or older in 2018, 0.7 percent

were past year methamphetamine users (Figure 15). is

percentage represents 1.6 million adults in this age group

who used methamphetamine in the past year. e percentage

of adults aged 26 or older in 2018 who were past year

methamphetamine users was higher than the percentages in

2016 and 2017, but it was similar to the percentage in 2015.

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.

In 2018,

an estimated 5.6 million people aged 12 or older were

past year users of hallucinogens (Figure 10), corresponding

to 2.0 percent of the population (Figure 16). e percentage

of people aged 12 or older in 2018 who were past year

hallucinogen users was higher than the percentages in 2015

and 2016, but it was similar to the percentage in 2017.

Figure 15. PastYear Methamphetamine Use among People Aged

12 or Older: 2015-2018

Percent Using in Past Year

0.0

0.5

1.0

1.5

2.0

2.5

3.0

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 15 Table. PastYear Methamphetamine Use among People Aged 12 or

Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

0.6 0.5

0.6 0.7

12 to 17

0.2 0.1 0.2 0.2

18 to 25

0.9 0.8 1.1 0.8

26 or Older

0.6 0.5

0.6

0.7

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 16. PastYear Hallucinogen Use among People Aged 12 or

Older: 2015-2018

Percent Using in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 16 Table. PastYear Hallucinogen Use among People Aged 12 or Older:

2015-2018

Age 2015 2016 2017 2018

12 or Older

1.8

1.9 2.0

12 to 17

2.1

1.8 2.1

1.5

18 to 25

7.0 6.9 7.0 6.9

26 or Older

0.8

1.0

1.3

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Aged 12 to 17

In 2018, an estimated 376,000 adolescents aged 12 to 17

were past year users of hallucinogens, which corresponds to

1.5 percent of adolescents (Figure 16). e percentage of

adolescents in 2018 who were past year hallucinogen users

was lower than the percentages in 2015 and 2017, but it was

similar to the percentage in 2016.

Aged 18 to 25

An estimated 6.9 percent of young adults aged 18 to 25 in

2018 were past year users of hallucinogens (Figure 16). is

percentage represents 2.3 million young adults who used

hallucinogens in the past year. e percentage of young

adults in 2018 who were past year hallucinogen users was

similar to the percentages between 2015 and 2017.

Aged 26 or Older

In 2018, an estimated 1.3 percent of adults aged 26 or

older were past year users of hallucinogens (Figure 16),

which represents 2.9 million adults in this age group. e

percentage of adults aged 26 or older in 2018 who were

past year hallucinogen users was higher than the percentages

in 2015 through 2017 (ranging from 0.8 to 1.0 percent).

Inhalant Use

Inhalants include a variety of substances and products, such

as nitrous oxide, amyl nitrite, cleaning ﬂuids, gasoline, spray

paint, computer keyboard cleaner, other aerosol sprays,

felt-tip pens, and glue. Respondents are asked to report the

use of inhalants to get high but not to include accidental

inhalation of a substance.

In 2018, approximately 2.0 million people aged 12 or older

were past year users of inhalants (Figure 10). is number

of past year inhalant users corresponds to 0.7 percent of

the population (Figure 17). In 2015 to 2018, about 0.6 to

0.7 percent of people aged 12 or older used inhalants in the

past year. e estimate in 2018 (0.7 percent) was higher than

the estimate in 2016 (0.6 percent).

Aged 12 to 17

In 2018, an estimated 662,000 adolescents aged 12 to 17

were past year users of inhalants. is number of past year

inhalant users corresponds to 2.7 percent of adolescents

(Figure 17). e percentage of adolescents in 2018 who were

past year inhalant users was similar to the percentages in 2015

and 2017, but it was higher than the percentage in 2016.

Aged 18 to 25

An estimated 1.5 percent of young adults aged 18 to 25

in 2018 were past year users of inhalants (Figure 17). is

percentage represents 495,000 young adults who used

inhalants in the past year. e percentage of young adults in

2018 who were past year inhalant users was similar to the

percentages between 2015 and 2017.

Aged 26 or Older

An estimated 0.4 percent of adults aged 26 or older in 2018

were past year users of inhalants (Figure 17), which represents

846,000 adults in this age group. e percentage of adults

aged 26 or older in 2018 who used inhalants in the past year

was similar to the percentages between 2015 and 2017.

Misuse of Psychotherapeutic Drugs

NSDUH collects data on the use and misuse of

psychotherapeutic drugs currently or recently available

by prescription in the United States. Prescription

psychotherapeutic drugs consist of prescription stimulants,

tranquilizers or sedatives (including benzodiazepines), and

pain relievers. In NSDUH, misuse of prescription drugs is

deﬁned as use in any way not directed by a doctor, including

use without a prescription of one’s own; use in greater

Figure 17. PastYear Inhalant Use among People Aged 12 or Older:

2015-2018

Percent Using in Past Year

0.0

0.5

1.0

1.5

2.0

2.5

3.0

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 17 Table. PastYear Inhalant Use among People Aged 12 or Older:

2015-2018

Age 2015 2016 2017 2018

12 or Older

0.7 0.6

0.6 0.7

12 to 17

2.7 2.2

2.3 2.7

18 to 25

1.4 1.4 1.6 1.5

26 or Older

0.3 0.3 0.3 0.4

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health18

August 2019

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 drugs is not included. Discussion of

the estimates for prescription stimulants, tranquilizers or

sedatives (including benzodiazepines), and pain relievers

follows a presentation of the estimates for the misuse of any

psychotherapeutic drug in the past year.

In 2018, an estimated 16.9 million Americans aged 12 or

older misused prescription psychotherapeutic drugs at least

once in the past year. is number of past year prescription

psychotherapeutic drug misusers corresponds to 6.2 percent

of the population (2018 DT 7.2).

Of the prescription drugs presented in this report, prescription

pain relievers were the most commonly misused by people

aged 12 or older. e 16.9 million in 2018 who misused

prescription psychotherapeutic drugs in the past year included

9.9 million who misused prescription pain relievers in that

period (Figure 10), 5.1 million who misused prescription

stimulants, and about 6.4 million who misused prescription

tranquilizers or sedatives. e estimate for the misuse of

tranquilizers or sedatives includes 5.4 million who misused

prescription benzodiazepines in the past year (2018 DT 7.2).

Stimulant Misuse

Several prescription drugs are grouped under the category

of prescription stimulants in NSDUH. ese include

amphetamine products, methylphenidate products, anorectic

(weight-loss) stimulants, Provigil®, or any other prescription

stimulant. e 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.

e estimate of 5.1 million people aged 12 or older in

2018 who misused prescription stimulants in the past year

corresponds to 1.9 percent of the population (Figures 10 and

18). e percentage of past year misusers of stimulants in

2018 was lower than the percentages in 2016 and 2017, but

it was similar to the percentage in 2015.

Aged 12 to 17

In 2018, about 369,000 adolescents aged 12 to 17 were

past year misusers of prescription stimulants, corresponding

to about 1.5 percent of adolescents (Figure 18). e

percentage of adolescents in 2018 who misused stimulants

in the past year was similar to the percentages in 2016 and

2017, but it was lower than the percentage in 2015.

Aged 18 to 25

ere were about 2.2 million young adults aged 18 to 25 in

2018 who misused prescription stimulants in the past year,

which corresponds to about 6.5 percent of young adults

(Figure 18). e percentage of young adults in 2018 who

misused stimulants in the past year was lower than the

percentages in 2016 and 2017, but it was similar to the

percentage in 2015.

Aged 26 or Older

In 2018, an estimated 2.5 million adults aged 26 or older

misused prescription stimulants in the past year, which

corresponds to 1.2 percent of adults in this age group

(Figure 18). e percentage of adults aged 26 or older in

2018 who misused stimulants in the past year was similar to

the percentages in 2015 to 2017.

Tranquilizer or Sedative Misuse

NSDUH collects information on prescription tranquilizers

and sedatives. Because prescription drugs in both categories

have a common eﬀect on speciﬁc activity in the brain,

Figure 18. PastYear Prescription Stimulant Misuse among People

Aged 12 or Older: 2015-2018

Percent Using in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 18 Table. PastYear Prescription Stimulant Misuse among People

Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

2.0 2.1

2.1

1.9

12 to 17

2.0

1.7 1.8 1.5

18 to 25

7.3 7.5

7.4

6.5

26 or Older

1.1 1.3 1.3 1.2

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

estimates of the misuse of prescription sedatives or

tranquilizers are presented together. 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.

In this report, respondents were classiﬁed as having misused

prescription tranquilizers or sedatives in the past 12 months

if they reported the misuse of prescription tranquilizers,

prescription sedatives, or both in that period. Because

prescription drugs categorized as benzodiazepines can be

prescribed as either tranquilizers or sedatives, estimates for

any benzodiazepine misuse are presented separately.

e estimate of 6.4 million people aged 12 or older in

2018 who misused prescription tranquilizers or sedatives in

the past year corresponds to 2.4 percent of the population

(Figures 10 and 19). e percentage of people aged 12 or

older in 2018 who misused tranquilizers or sedatives in the

past year was lower than the percentages in 2015 and 2016,

but it was similar to the percentage in 2017.

Aged 12 to 17

In 2018, about 460,000 adolescents aged 12 to 17 misused

prescription tranquilizers or sedatives in the past year, which

corresponds to about 1.8 percent of adolescents (Figure 19).

e percentage of adolescents in 2018 who misused

tranquilizers or sedatives in the past year was similar to the

percentages in 2015 to 2017.

Aged 18 to 25

In 2018, about 1.7 million young adults aged 18 to 25

misused prescription tranquilizers or sedatives in the

past year. is number of past year misusers of tranquilizers

or sedatives corresponds to 4.9 percent of young adults

(Figure 19). e percentage of young adults in 2018 who

misused tranquilizers or sedatives in the past year was lower

than the percentages in 2015 to 2017.

Aged 26 or Older

An estimated 4.3 million adults aged 26 or older in 2018

were past year misusers of prescription tranquilizers or

sedatives, which corresponds to 2.0 percent of adults in this

age group (Figure 19). e percentage of adults aged 26 or

older in 2018 who misused tranquilizers or sedatives in the

past year was similar to the percentages in 2015 to 2017.

Benzodiazepine Misuse

Prescription benzodiazepines are a subcategory of drugs that

may be prescribed as either 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.

Nevertheless, benzodiazepines are chemically similar, regardless

of whether they are prescribed as tranquilizers or sedatives.

ese drugs cause drowsiness and may impair motor skills

important for tasks such as operating a motor vehicle or

machinery. is section presents estimates of the misuse of

benzodiazepines, regardless of whether respondents reported

they misused benzodiazepines in the separate sections of the

NSDUH interview for tranquilizers or sedatives.

e estimated 5.4 million people aged 12 or older in 2018

who were past year misusers of prescription benzodiazepines

corresponds to 2.0 percent of the population (2018 DT 7.2

and Figure 20). e percentage of people aged 12 or older

in 2018 who were past year benzodiazepine misusers was

similar to the percentages in 2015 through 2017.

Aged 12 to 17

In 2018, about 399,000 adolescents aged 12 to 17 misused

prescription benzodiazepines in the past year. is number

Figure 19. PastYear Prescription Tranquilizer or Sedative Misuse

among People Aged 12 or Older: 2015-2018

Percent Using in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 19 Table. PastYear Prescription Tranquilizer or Sedative Misuse

among People Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

2.6

2.5 2.4

12 to 17

1.8 1.9 2.0 1.8

18 to 25

5.7

4.9

26 or Older

2.2 2.2 2.0 2.0

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health20

August 2019

of past year misusers of benzodiazepines corresponds to

1.6 percent of adolescents (Figure 20). e percentage of

adolescents in 2018 who misused benzodiazepines in the

past year was similar to the percentages in 2015 to 2017.

Aged 18 to 25

An estimated 4.5 percent of young adults aged 18 to 25 in

2018 misused prescription benzodiazepines in the past year

(Figure 20). is percentage represents 1.5 million young

adults who misused benzodiazepines in the past year. e

percentage of young adults in 2018 who were past year

benzodiazepine misusers was lower than the percentages in

2015 to 2017.

Aged 26 or Older

In 2018, about 3.5 million adults aged 26 or older misused

prescription benzodiazepines in the past year. is number

of past year misusers of benzodiazepines corresponds

to 1.6 percent of adults in this age group (Figure 20).

e percentage of adults aged 26 or older in 2018 who

misused benzodiazepines in the past year was similar to the

percentages in 2015 to 2017.

Pain Reliever Misuse

Several prescription drugs are grouped under the category

of prescription pain relievers in NSDUH. ese include

products containing hydrocodone, oxycodone, tramadol,

codeine, morphine, prescription fentanyl,

buprenorphine,

oxymorphone, and hydromorphone, as well as Demerol®,

methadone, or any other prescription pain reliever.

is

section provides estimates of any prescription pain reliever

misuse and further details on the misuse of pain relievers.

Speciﬁcally, estimates for 2018 are presented for the subtypes

of prescription pain relievers people misused, the main

reason for the most recent misuse of prescription pain

relievers, and where people obtained the prescription pain

relievers they most recently misused in the past year.

As noted previously, approximately 9.9 million people aged

12 or older in 2018 misused prescription pain relievers in the

past year (Figure 10), which corresponds to 3.6 percent of the

population (Figure 21). e percentage of people in 2018 who

were past year prescription pain reliever misusers was lower

than the percentages in 2015 to 2017. Continued monitoring

of trends in past year pain reliever misuse will be important

for assessing whether the annual estimates of misuse in future

years continue to decrease or begin increasing again.

Figure 20. PastYear Prescription Benzodiazepine Misuse among

People Aged 12 or Older: 2015-2018

Percent Using in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 20 Table. PastYear Prescription Benzodiazepine Misuse among

People Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

2.1 2.1 2.1 2.0

12 to 17

1.5 1.7 1.8 1.6

18 to 25

5.2

5.3

4.5

26 or Older

1.6 1.7 1.6 1.6

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 21. PastYear Prescription Pain Reliever Misuse among

People Aged 12 or Older: 2015-2018

Percent Using in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 21 Table. PastYear Prescription Pain Reliever Misuse among People

Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

4.7

4.3

4.1

3.6

12 to 17

3.9

3.5

3.1 2.8

18 to 25

8.5

7.1

7.2

5.5

26 or Older

4.1

3.9

3.7 3.4

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Vicodin®, Lortab®, Norco®, Zohydro® ER, and generic

hydrocodone. An estimated 5.5 million people aged 12 or

older misused these products in the past year, corresponding

to 2.0 percent of the population (Figure 22). An estimated

3.4 million people misused oxycodone products in the

past year. is number of past year misusers of oxycodone

corresponds to 1.2 percent of the population. Oxycodone

products include OxyContin®, Percocet®, Percodan®,

Roxicodone®, and generic oxycodone. An estimated

0.3 percent of the population misused buprenorphine products

in the past year, which corresponds to 718,000 people. About

256,000 (0.1 percent) misused methadone.

ere were 269,000 people aged 12 or older in 2018 who

misused prescription fentanyl products, which corresponds

to about 0.1 percent of the population (Figure 22). Because

NSDUH respondents were asked about the misuse of only

prescription forms of fentanyl, however, this estimate for

fentanyl misuse may underrepresent people who misused

fentanyl that was illicitly manufactured in clandestine

laboratories (i.e., as opposed to the misuse of diverted

fentanyl produced by the pharmaceutical industry). is

estimate of fentanyl misuse also may not include people who

misused illicitly manufactured fentanyl (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 in 2018, most people

who used prescription pain relievers in the past year did

not misuse them. Among people aged 12 or older in 2018

Aged 12 to 17

Among adolescents aged 12 to 17 in 2018, 2.8 percent

misused prescription pain relievers (Figure 21),

corresponding to 695,000 adolescents. e percentage of

adolescents in 2018 who misused prescription pain relievers

in the past year was lower than the percentages in 2015 and

2016, but it was similar to the percentage in 2017.

Aged 18 to 25

In 2018, about 1.9 million young adults aged 18 to 25 misused

pain relievers in the past year, which corresponds to about

5.5 percent of young adults (Figure 21). e percentage of

young adults in 2018 who misused prescription pain relievers in

the past year was lower than the percentages in 2015 to 2017.

Aged 26 or Older

In 2018, an estimated 7.4 million adults aged 26 or older

misused pain relievers in the past year, which corresponds

to 3.4 percent of adults in this age group (Figure 21). e

percentage of adults aged 26 or older in 2018 who misused

prescription pain relievers in the past year was lower than

the percentages in 2015 and 2016, but it was similar to the

percentage in 2017.

Misuse of Subtypes of Pain Relievers

NSDUH asked respondents in 2018 to identify the speciﬁc

prescription pain relievers they used in the past year. For

each speciﬁc pain reliever respondents reported using in

the past 12 months, respondents were asked whether they

misused that pain reliever in that period. e speciﬁc

pain relievers individuals misused in the past year were

categorized into subtypes, such as hydrocodone products.

For example, respondents who reported the misuse of the

pain relievers Vicodin® or hydrocodone were classiﬁed as

misusers of hydrocodone products.

is 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. en it presents estimates of the misuse of subtypes

of pain relievers among people who used the subtype in

the past year. Stated another way, this second presentation

provides estimates of misuse among a subpopulation

of users, such as the percentage of people who misused

hydrocodone products among those who had used

hydrocodone products in the past year.

In 2018, the most commonly misused subtype of prescription

pain relievers was hydrocodone products, which include

Figure 22. PastYear Prescription Pain Reliever Misuse among

People Aged 12 or Older, by Selected Pain Reliever Subtype: 2018

2.0

1.2

0.9

0.5

0.3

0.2

0.1

0.0

0.00.51.01.52.02.5

Hydrocodone

Oxycodone

Codeine

Tramadol

Buprenorphine

Morphine

Oxymorphone

Methadone

Hydromorphone

Fentanyl

Demerol

Percent among Total Population

11.5

12.8

9.4

8.1

28.3

7.9

28.4

23.5

13.0

12.7

4.5

0 10 20 30

Hydrocodone

Oxycodone

Codeine

Tramadol

Buprenorphine

Morphine

Oxymorphone

Methadone

Hydromorphone

Fentanyl

Demerol

Percent among Past Year Any Users

Hydrocodone

Oxycodone

Codeine

Tramadol

Buprenorphine

Morphine

Oxymorphone

Methadone

Hydromorphone

Fentanyl

Demerol

Note: Estimates of less than 0.05 percent round to 0.0 percent when shown to the nearest tenth of a

percent.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health22

August 2019

who used speciﬁc prescription pain reliever subtypes in

the past 12 months, about 28.3 percent of past year users

of buprenorphine products misused these products, and

28.4 percent of past year users of oxymorphone products

(e.g., Opana®) misused oxymorphone products in that period

(Figure 22). An estimated 23.5 percent of past year users

of methadone misused it. About 1 in 8 past year users of

oxycodone products or prescription fentanyl products misused

these pain relievers in the past year (12.8 and 12.7 percent).

Main Reasons for the Last Misuse of Pain Relievers

Respondents in the 2018 NSDUH who reported

prescription pain reliever misuse in the past year were asked

to recall the last prescription pain reliever they misused in

the past year. Respondents were then asked to report their

reasons for misusing this prescription pain reliever that last

time. Respondents who reported more than one reason

for misusing the last prescription pain reliever were asked

to report the main reason for their pain reliever misuse. If

respondents reported only one reason for misusing their last

prescription pain reliever, then that reason was their main

reason for pain reliever misuse.

Among people aged 12 or older in 2018 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 (63.6 percent) (2018 DT 6.13). According to the

NSDUH deﬁnition, use without a prescription of one’s own

or use at a higher dosage or more often than prescribed are

both classiﬁed as misuse even if it was for the purpose of pain

relief. Other common reasons were to feel good or get high

(10.6 percent) and to relax or relieve tension (9.2 percent). Less

common reasons among past year misusers of pain relievers

included to help with sleep (4.5 percent), to help with feelings

or emotions (4.0 percent), to experiment or see what the drug

was like (2.5 percent), because they were “hooked” or needed

to have the drug (3.2 percent), and to increase or decrease the

eﬀects of other drugs (0.9 percent). Some other reason was the

main reason for misuse among 1.5 percent of past year misusers

of pain relievers.

Source of the Last Pain Reliever That Was Misused

Among people aged 12 or older in 2018 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 (Figure 23). More than half

(51.3 percent) of people who misused pain relievers in

the past year obtained the pain relievers the last time from

a friend or relative. Speciﬁcally, 38.6 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, 9.5 percent bought their last pain reliever

from a friend or relative, and 3.2 percent took their last

pain reliever from a friend or relative without asking. More

than one third of people who misused pain relievers in the

past year (37.6 percent) obtained pain relievers the last time

through prescription(s) or stole pain relievers from a health

Figure 23. Source Where Pain Relievers Were Obtained for Most Recent Misuse among People Aged

12 or Older Who Misused Pain Relievers in the PastYear: 2018

9.9 Million People Aged 12 or Older Who Misused Pain Relievers in the Past Year

Given by, Bought from, or Took from

a Friend or Relative

51.3%

Bought from Drug Dealer or Other Stranger

6.5%

Some Other Way

4.6%

Got through Prescription(s) or

Stole from a Health Care Provider

37.6%

Prescription from One Doctor (34.7%)

Prescriptions from More Than One Doctor (2.0%) Stole from Doctor's Ofﬁce, Clinic, Hospital, or Pharmacy (0.9%)

From Friend or Relative for Free (38.6%)

Took from Friend or Relative without Asking (3.2%)

Bought from Friend or Relative (9.5%)

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.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

care provider, typically getting the pain relievers through

a prescription from one doctor (34.7 percent). About 1

in 15 people who misused pain relievers in the past year

(6.5 percent) bought the last pain reliever they misused from

a drug dealer or other stranger.

Opioid Misuse

Opioids are a group of chemically similar drugs that include

heroin and prescription pain relievers, 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 specify they misused other pain

relievers that are not opioids.

Approximately 10.3 million people aged 12 or older in 2018

misused opioids in the past year (Figure 24). is number of

past year opioid misusers corresponds to 3.7 percent of the

population (Figure 25).

e vast majority of past year opioid users in 2018

misused prescription pain relievers (Figure 24). Speciﬁcally,

9.9 million people aged 12 or older in 2018 misused

prescription pain relievers in the past year compared

with 808,000 people who used heroin. e majority

of prescription pain reliever misusers had misused only

prescription pain relievers in the past year but had not used

heroin (9.4 million). Approximately 506,000 people had

misused prescription pain relievers and used heroin in the

past year. About 302,000 people used heroin in the past year

but had not misused prescription pain relievers. Although

5.1 percent of prescription pain reliever misusers also used

heroin in the past year, 62.6 percent of heroin users also

misused pain relievers in the past year.

e percentage of people aged 12 or older in 2018 who were

past year opioid misusers was lower than the percentages

between 2015 and 2017 (Figure 25). is decrease in

past year opioid misuse indicates a need to monitor trends to

assess whether the annual estimates of opioid misuse in future

years will stabilize at the level in 2018, show further decreases,

or increase to levels similar to those in 2015 to 2017.

Aged 12 to 17

Among adolescents aged 12 to 17 in 2018, 2.8 percent misused

opioids, corresponding to 699,000 adolescents (Figure 25). e

percentage of adolescents in 2018 who misused opioids in the

past year was lower than the percentages in 2015 and 2016, but

it was similar to the percentage in 2017.

Aged 18 to 25

In 2018, about 1.9 million young adults aged 18 to 25

misused opioids in the past year, which corresponds to about

5.6 percent of young adults (Figure 25). e percentage of

young adults in 2018 who were past year opioid misusers

was lower than the percentages in 2015 to 2017.

Figure 24. PastYear Opioid Misuse among People Aged 12 or

Older: 2018

9.4 Million People with Pain

Reliever Misuse Only

(92.1% of Opioid Misusers)

9.9 Million People

with Pain Reliever Misuse

(97.1% of Opioid Misusers)

506,000 People with

Pain Reliever Misuse and

Heroin Use

(4.9% of Opioid Misusers)

808,000 People

with Heroin Use

(7.9% of Opioid Misusers)

302,000 People with

Heroin Use Only

(2.9% of Opioid Misusers)

10.3 Million People Aged 12 or Older with Past Year Opioid Misuse

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

Figure 25. PastYear Opioid Misuse among People Aged 12 or

Older: 2015-2018

Percent Using in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 25 Table. PastYear Opioid Misuse among People Aged 12 or Older:

2015-2018

Age 2015 2016 2017 2018

12 or Older

4.7

4.4

4.2

3.7

12 to 17

3.9

3.6

3.1 2.8

18 to 25

8.7

7.3

5.6

26 or Older

4.2

4.0

3.8 3.6

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health24

August 2019

Aged 26 or Older

An estimated 7.7 million adults aged 26 or older in 2018

misused opioids in the past year, which corresponds to

3.6 percent of adults in this age group (Figure 25). e

percentage of adults aged 26 or older in 2018 who misused

opioids in the past year was lower than the percentages in

2015 and 2016, but it was similar to the percentage in 2017.

Initiation of Substance Use

NSDUH includes questions to measure the initiation of

substance use, that is, the ﬁrst use of particular substances.

is report presents estimates of the number of recent

substance use initiates or prescription drug misuse initiates.

Recent initiates were deﬁned as substance users or prescription

drug misusers who reported ﬁrst using or misusing,

respectively, a particular substance in the prior 12 months.

34,35

e presentation of estimates of initiation of the misuse of

prescription drugs is limited because of the way prescription

drug misuse information is collected in NSDUH. As a

result, respondents could underreport the misuse of the

prescription drugs that occurred more than 12 months

before the interview. For example, past year initiates of

heroin use who last misused prescription pain relievers

more than 12 months ago might not have reported this

misuse of pain relievers; these individuals would therefore

be misclassiﬁed as past year initiates of opioid misuse

because of their recent heroin initiation. Similar issues

apply for determining whether respondents initiated any

illicit drug use or initiated the misuse of any tranquilizer or

sedative in the past year. Estimates for past year initiation

of benzodiazepine misuse are not presented because

NSDUH did not capture information on lifetime misuse of

benzodiazepines.

Unlike previous sections, this section focuses on the numbers

of people who were recent initiates (e.g., the number of people

aged 12 or older who were recent initiates of marijuana use)

rather than on percentages. However, care should be taken in

interpreting increases over time in the estimated number of

past year initiates because some of these increases could reﬂect

growth in the size of the population over time.

Figure 26 provides an overview of the numbers of people

aged 12 or older in 2018 who were past year initiates for the

substances that are discussed in this section. e illicit drugs

in 2018 with the largest number of recent initiates were

marijuana (3.1 million new users), prescription pain relievers

(1.9 million new misusers), prescription tranquilizers

(1.2 million new misusers), hallucinogens (1.1 million new

users), prescription stimulants (1.0 million new misusers),

and cocaine (874,000 new users). In addition, there were

4.9 million new users of alcohol and 1.8 million people who

tried a cigarette for the ﬁrst time in the past year.

Initiation of Cigarette Use

e estimated 1.8 million people aged 12 or older in 2018

who smoked part or all of a cigarette for the ﬁrst time in the

past 12 months (Figure 26) averages to about 5,000 people

each day who initiated cigarette smoking (Table A.3A). e

total number of initiates of cigarette smoking who were aged

12 or older in 2018 was lower than the numbers in 2004

to 2014, but it was similar to the numbers in 2015 to 2017

(2018 DT 7.40).

In 2018, an estimated 571,000 adolescents aged 12 to 17

smoked part or all of a cigarette for the ﬁrst time in the

past year (2018 DT 7.41). is number of recent initiates

among adolescents averages to approximately 1,600 adolescents

each day who initiated cigarette smoking (Table A.3A). Also,

1.1 million young adults aged 18 to 25 in 2018 initiated

cigarette use in the past year (2018 DT 7.43), which translates

to about 3,100 young adults who initiated cigarette use each

day. An estimated 113,000 adults aged 26 or older in 2018

initiated cigarette use in the past year (2018 DT 7.44).

Among adolescents aged 12 to 17 in 2018, the number of

recent initiates of any cigarette smoking was lower than

the numbers in each year between 2002 and 2016, but

it was similar to the number in 2017 (2018 DT 7.41).

Figure 26. PastYear Initiates of Substances among People Aged

12 or Older: 2018

4.9M

1.8M

3.1M

1.9M

1.2M

1.1M

1.0M

874,000

576,000

251,000

205,000

117,000

0 1 2 3 4 5

Alcohol

Cigarettes

Marijuana

Rx Pain Reliever Misuse

Rx Tranquilizer Misuse

Hallucinogens

Rx Stimulant Misuse

Cocaine

Inhalants

Rx Sedative Misuse

Methamphetamine

Heroin

Past Year Initiates

Rx = prescription.

Note: Estimates for prescription pain relievers, prescription tranquilizers, prescription stimulants, and

prescription sedatives are for the initiation of misuse.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

About 1.2 million to 1.3 million adolescents each year from

2002 to 2011 initiated cigarette smoking in the past year.

e number of initiates among adolescents decreased

to 1.0 million in 2012 and to fewer than 1.0 million in

subsequent years.

Among young adults aged 18 to 25 in 2018, the number

of recent initiates of any cigarette smoking was higher

than the numbers in 2002 to 2005, but it was similar

to the numbers in 2006 to 2017 (2018 DT 7.43). e

number of recent cigarette initiates who were aged 26 or

older in 2018 was similar to the numbers in most years

from 2002 to 2017 (2018 DT 7.44). ese data for

cigarette initiation show a consistent pattern over time

that relatively few people try cigarettes for the ﬁrst time

after age 25.

Initiation of Alcohol Use

As noted previously, about 4.9 million people aged 12

or older in 2018 used alcohol for the ﬁrst time in the

past year, not counting sips from another person’s drink

(Figure 26). is number averages to approximately

13,400 initiates per day (Table A.3A). e total number

of past year initiates aged 12 or older in 2018 for alcohol

use was higher than the numbers in 2002 to 2006, but it

was similar to the numbers in most years from 2007 to

2017 (2018 DT 7.40).

In 2018, an estimated 2.4 million adolescents aged 12

to 17 used alcohol for the ﬁrst time in the past year

(2018 DT 7.41), which averages to approximately

6,500 adolescents each day who initiated alcohol use

(Table A.3A). Also, 2.4 million young adults aged 18 to

25 (2018 DT 7.43) and 63,000 adults aged 26 or older

(2018 DT 7.44) in 2018 initiated alcohol use in the

past year.

e number of adolescents aged 12 to 17 in 2018 who

recently initiated alcohol use was lower than the numbers

in most years from 2002 to 2011, but it was similar to

the numbers in 2012 to 2017 (2018 DT 7.41). Among

young adults aged 18 to 25, the number of recent initiates

in 2018 was higher than the numbers in most years

from 2002 to 2017 (2018 DT 7.43). For adults aged

26 or older, the number of initiates in 2018 was similar

to the numbers in most years from 2002 to 2017 (2018

DT 7.44). As was the case with cigarette initiation, these

data show a consistent pattern that relatively few people

start to use alcohol after age 25.

Initiation of Marijuana Use

In 2018, about 3.1 million people aged 12 or older

used marijuana for the ﬁrst time in the past 12 months

(Figures 26 and 27). is number averages to about 8,400

new marijuana users each day (Table A.3A). e 2018

estimate for the number of past year initiates of marijuana

use was higher than the estimates in 2002 to 2016, but it

was similar to the estimate in 2017.

In 2018, an estimated 1.3 million adolescents aged 12 to 17

used marijuana for the ﬁrst time in the past year (Figure 27),

which translates to approximately 3,700 adolescents each day

who initiated marijuana use (

Table A.3A). About 1.1 million

to 1.4 million adolescents per year in 2002 to 2018 were

recent marijuana initiates. e 2018 estimate was higher

than the estimates in 2005 to 2007, but it was similar to the

estimates in most years from 2008 to 2017.

In 2018, 1.2 million young adults aged 18 to 25 initiated

marijuana use in the past year (Figure 27), or an average

of about 3,300 recent initiates per day in this age group

(

Table A.3A). e 2018 estimate for the number of young

adults who initiated marijuana use in the past year was

higher than the estimates in most years from 2002 to 2016,

but it was similar to the estimate in 2017.

Figure 27. PastYear Marijuana Initiates among People Aged 12 or

Older: 2002-2018

Past Year Initiates (in Millions)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 27 Table. PastYear Marijuana Initiates among People Aged 12 or

Older: 2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

2.2

2.0

2.1

2.2

2.4

2.6

2.4

2.6

3.0 3.1

12-17

1.4 1.2 1.3 1.1

1.2

1.2 1.3 1.3 1.4 1.3 1.2 1.2 1.2

1.2 1.2 1.3

18-25

0.7

0.8

1.0

0.9

1.1 1.0

1.0

1.1 1.0 1.0

1.3 1.2

≥26

0.1

0.2

0.3

0.1

0.2

0.0

0.2

0.3

0.4 0.4 0.5 0.5

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Note: Estimates of less than 0.05 million round to 0.0 million when shown to the nearest tenth of a million.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health26

August 2019

An estimated 525,000 adults aged 26 or older in 2018

initiated marijuana use in the past year, which rounds to

the estimate of 0.5 million initiates in this age group in

Figure 27. is number averages to about 1,400 recent

initiates per day in this age group (Table A.3A). e number

of recent marijuana initiates aged 26 or older in 2018 was

higher than the numbers of initiates in all years from 2002

to 2014, but it was similar to the numbers in 2015 to 2017.

Consistent with the pattern for cigarette and alcohol use, the

majority of people in 2018 who initiated marijuana use in

the past year were aged 12 to 25.

Initiation of Cocaine Use

In 2018, an estimated 874,000 people aged 12 or older used

cocaine for the ﬁrst time in the past year (Figures 26 and

28). is number averages to approximately 2,400 cocaine

initiates per day (

Table A.3A). e number of past year

initiates in 2018 for cocaine use was higher than the

numbers in 2009 to 2013, but it was similar to the numbers

in most recent years from 2014 to 2017.

In 2018, an estimated 74,000 adolescents aged 12 to 17 used

cocaine for the ﬁrst time in the past year (Figure 28). Among

adolescents in 2018, the number of cocaine initiates was

lower than the numbers in all years from 2002 to 2012, but

it was similar to the numbers in 2013 to 2017.

Also, 616,000 young adults aged 18 to 25 and 184,000

adults aged 26 or older in 2018 initiated cocaine use in

the past year (Figure 28). e number of young adults

who initiated cocaine use each day averages to about 1,700

young adult initiates per day (

Table A.3A). e number of

young adult cocaine initiates in 2018 was higher than the

numbers in 2008 to 2013, but it was similar to the numbers

in 2014 to 2017. Among adults aged 26 or older in 2018,

the number of cocaine initiates was similar to the numbers

in most years from 2002 to 2008 and in all years from 2014

to 2017. However, the number in 2018 was higher than the

numbers in 2011 to 2013.

Initiation of Heroin Use

In 2018, 117,000 people aged 12 or older used heroin

for the ﬁrst time in the past year (Figures 26 and 29). On

average, this represents about 320 people each day who

initiated heroin use (

Table A.3A). Among people aged 12

or older in 2018, the number of past year heroin initiates

was similar to the numbers of recent heroin initiates in most

years from 2002 to 2017.

Figure 28. PastYear Cocaine Initiates among People Aged 12 or

Older: 2002-2018

Past Year Initiates (in Thousands)

200

400

600

800

1,000

1,200

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 28 Table. PastYear Cocaine Initiates among People Aged 12 or Older:

2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

1,032 986 998 872 977 906 724 623

642

670

639

601

766 968 1,085

1,037 874

12-17

310

282

274

286

260

254

196

145

156

146

120

94 117 112 107 98 74

18-25

594 576 592 498 570 541 426

397

372

467

443

432

501 663 766 729 616

≥26

127 128 133 87

147 112 102 81

114 56

148 193 213 210 184

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 29. PastYear Heroin Initiates among People Aged 12 or

Older: 2002-2018

Past Year Initiates (in Thousands)

100

150

200

250

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 29 Table. PastYear Heroin Initiates among People Aged 12 or Older:

2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

117 92 118 108 90 106 116 187 142 178 156 169 212

135 170 81 117

12-17

18 24

16 29

19 23

21 21 13 11 8 9 7

18-25

66 42 46 57 56 70

58 83

100

66 75

57 82

46 35

≥26

25 40 33 9

28 85 37 40 40 82 124 68 80 26

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

However, caution is advised in interpreting ﬂuctuations in

the numbers of heroin initiates in single years. e relatively

small numbers of recent initiates per year can contribute to

these ﬂuctuations, especially when the estimated numbers

are presented for speciﬁc age groups, as described below.

In 2018, an estimated 7,000 adolescents aged 12 to 17,

35,000 young adults aged 18 to 25, and 75,000 adults aged

26 or older used heroin for the ﬁrst time in the past year

(Figure 29). e number of adolescents in 2018 who were

recent heroin initiates was similar to the numbers in most

years between 2012 and 2017, but it was lower than the

numbers in most years from 2002 to 2011.

e number of young adults aged 18 to 25 in 2018 who

were past year heroin initiates was similar to the numbers

in most years from 2002 to 2008 and in 2017 (Figure 29).

However, the number in 2018 was lower than the numbers

in 2009 to 2012. Among adults aged 26 or older in 2018,

the number of past year heroin initiates was similar to the

numbers in most years from 2002 to 2016, but it was higher

than the estimate in 2017.

Initiation of Methamphetamine Use

In 2018, 205,000 people aged 12 or older initiated

methamphetamine use in the past year (Figures 26 and 30),

which averages to about 560 people per day who initiated

methamphetamine use (Table A.3A). e number of

past year initiates in 2018 for methamphetamine use was

similar to the numbers in 2015 to 2017.

In 2018, an estimated 31,000 adolescents aged 12 to 17

used methamphetamine for the ﬁrst time in the past year

(Figure 30). e number of adolescents in 2018 who were

methamphetamine initiates was similar to the numbers in

2015 to 2017.

Also in 2018, an estimated 68,000 young adults aged

18 to 25 and 106,000 adults aged 26 or older initiated

methamphetamine use in the past year (Figure 30). e

number of young adults who initiated methamphetamine

use averages to about 190 young adult initiates per day

(

Table A.3A). Among young adults and adults aged 26 or

older, the numbers of methamphetamine initiates in 2018

were similar to the corresponding numbers in 2015 to 2017.

Initiation of Hallucinogen Use

In 2018, an estimated 1.1 million people aged 12 or

older used hallucinogens for the ﬁrst time in the past year

(Figure 26).

is number averages to about 3,100 new

hallucinogen users each day (Table A.3A). e number of

past year hallucinogen initiates aged 12 or older in 2018 was

similar to the numbers in 2015 to 2017 (2018 DT 7.40).

In 2018, an estimated 234,000 adolescents aged 12 to 17

used hallucinogens for the ﬁrst time in the past year (2018

DT 7.41), which translates to approximately 640 adolescents

each day who initiated hallucinogen use (Table A.3A). e

2018 estimate of adolescent hallucinogen initiation was

lower than the estimates in 2015 to 2017. is decrease

in the hallucinogen initiation among adolescents indicates

a need to monitor trends to assess whether the number

of initiates continues to decrease or if it returns to a level

consistent with the numbers prior to 2018.

In 2018, an estimated 632,000 young adults aged 18 to 25

initiated hallucinogen use in the past year (2018 DT 7.43),

or an average of about 1,700 recent initiates per day in this

age group (Table A.3A). e 2018 estimate for the number

of young adults who initiated hallucinogen use in the

past year was similar to the estimates in 2015 to 2017.

An estimated 250,000 adults aged 26 or older in 2018

initiated hallucinogen use in the past year (2018 DT 7.44).

is number averages to about 690 recent initiates per

day in this age group (Table A.3A). e number of recent

hallucinogen initiates aged 26 or older in 2018 was higher

Figure 30. PastYear Methamphetamine Initiates among People

Aged 12 or Older: 2015-2018

Past Year Initiates (in Thousands)

100

150

200

250

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Figure 30 Table. PastYear Methamphetamine Initiates among People Aged

12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

225 192 195 205

12 to 17

24 16 27 31

18 to 25

91 79 95 68

26 or Older

110 97 73 106

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health28

August 2019

than the number of initiates in 2016, but it was similar to

the numbers in 2015 and 2017.

Initiation of Inhalant Use

In 2018, an estimated 576,000 people aged 12 or older

had used inhalants for the ﬁrst time in the past 12 months

(Figure 26), which averages to about 1,600 people per day

who initiated inhalant use (Table A.3A). e number of

past year inhalant initiates aged 12 or older in 2018 was

similar to the numbers in 2015 to 2017 (2018 DT 7.40).

In 2018, an estimated 308,000 adolescents aged 12 to 17

used inhalants for the ﬁrst time in the past year (2018

DT 7.41). is number averages to approximately

840 adolescents each day who initiated inhalant use

(Table A.3A). ere were 210,000 young adults aged 18

to 25 who initiated inhalant use in the past year (2018

DT 7.43), or an average of 580 young adults each day who

initiated inhalant use. An estimated 58,000 adults aged 26

or older used inhalants for the ﬁrst time in the past year

(2018 DT 7.44), or an average of about 160 initiates per

day in this age group. e 2018 estimates for the numbers

of adolescents, young adults, and adults aged 26 or older

who initiated inhalant use in the past year were similar to the

estimates for the respective age groups in 2015 to 2017.

Initiation of Stimulant Misuse

In 2018, approximately 1.0 million people aged 12 or older

misused prescription stimulants for the ﬁrst time in the

past year (Figure 26). is estimated number of initiates

averages to about 2,700 initiates per day for prescription

stimulant misuse (

Table A.3A). e number of initiates of

stimulant misuse aged 12 or older in 2018 was lower than

the numbers in 2015 and 2016, but it was similar to the

number in 2017 (2018 DT 7.40).

Approximately 181,000 adolescents aged 12 to 17 in

2018 misused prescription stimulants for the ﬁrst time

in the past year (2018 DT 7.41). is number averages

to approximately 500 adolescents each day who initiated

stimulant misuse (Table A.3A). e number of adolescents

in 2018 who initiated stimulant misuse was lower than the

number in 2015, but it was similar to the numbers in 2016

and 2017.

ere were 517,000 young adults aged 18 to 25 in 2018

who initiated prescription stimulant misuse in the past year

(2018 DT 7.43), or an average of 1,400 young adults each

day who initiated stimulant misuse (Table A.3A). e

number of young adults in 2018 who initiated stimulant

misuse was similar to the numbers in 2015 to 2017.

In 2018, about 302,000 adults aged 26 or older misused

prescription stimulants for the ﬁrst time in the past year

(2018 DT 7.44), which averages to about 830 new misusers

in this age group each day (Table A.3A). e number of

adults aged 26 or older in 2018 who initiated stimulant

misuse was lower than the number in 2016, but it was

similar to the numbers in 2015 and 2017.

Initiation of 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 Tranquilizer Misuse

About 1.2 million people aged 12 or older in 2018 misused

prescription tranquilizers for the ﬁrst time in the past year

(Figure 26). is number averages to about 3,300 initiates

per day (Table A.3A). e number of tranquilizer misuse

initiates aged 12 or older in 2018 was similar to the numbers

in 2015 to 2017 (2018 DT 7.40).

Approximately 215,000 adolescents aged 12 to 17 in

2018 misused prescription tranquilizers for the ﬁrst time

in the past year (2018 DT 7.41). is number averages

to approximately 590 adolescents each day who initiated

tranquilizer misuse (Table A.3A). e number of adolescents

in 2018 who initiated tranquilizer misuse was similar to the

numbers in 2015 to 2017.

ere were 434,000 young adults aged 18 to 25 in

2018 who initiated prescription tranquilizer misuse in

the past year (2018 DT 7.43), or an average of 1,200

young adults each day who initiated tranquilizer misuse

(Table A.3A). e number of young adults who initiated

tranquilizer misuse in 2018 was similar to the numbers in

2015 and 2017, but it was lower than the number in 2016.

In 2018, about 560,000 adults aged 26 or older misused

prescription tranquilizers for the ﬁrst time in the past year

(2018 DT 7.44), which averages to about 1,500 new misusers

in this age group each day (Table A.3A). e number of

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

adults aged 26 or older in 2018 who initiated tranquilizer

misuse was similar to the numbers in 2015 to 2017.

Initiation of Sedative Misuse

In 2018, approximately 251,000 people aged 12 or older

misused prescription sedatives for the ﬁrst time in the past year

(Figure 26). is estimated number of initiates averages to

about 690 initiates per day for prescription sedative misuse

(

Table A.3A). e number of sedative misuse initiates aged

12 or older in 2018 was similar to the numbers in 2016 and

2017, but it was lower than in 2015 (2018 DT 7.40).

In 2018, an estimated 36,000 adolescents aged 12 to 17

misused prescription sedatives for the ﬁrst time in the

past year (2018 DT 7.41). is number averages to

approximately 100 adolescents each day who initiated

sedative misuse (Table A.3A). e number of adolescents

in 2018 who initiated sedative misuse was similar to the

numbers in 2015 to 2017.

ere were 73,000 young adults aged 18 to 25 in 2018

who initiated prescription sedative misuse in the past year

(2018 DT 7.43), or an average of 200 young adults each

day (Table A.3A). e number of young adults in 2018 who

initiated sedative misuse was similar to the numbers in 2015

to 2017.

In 2018, about 143,000 adults aged 26 or older misused

prescription sedatives for the ﬁrst time in the past year

(2018 DT 7.44), which averages to about 390 new sedative

misusers in this age group each day (Table A.3A). e

number of adults aged 26 or older in 2018 who initiated

sedative misuse was similar to the numbers in 2016 and

2017, but it was lower than the number in 2015.

Initiation of Pain Reliever Misuse

In 2018, the number of recent initiates of prescription

pain reliever misuse (1.9 million) in the past year was the

second highest among the illicit drugs, after the number

of marijuana initiates (Figures 26 and 31). e number

of people aged 12 or older who misused prescription pain

relievers for the ﬁrst time in the past year averages to about

5,200 initiates per day (Table A.3A). e number of pain

reliever misuse initiates aged 12 or older in 2018 was similar

to the numbers in 2015 to 2017.

In 2018, approximately 310,000 adolescents aged 12 to 17

misused prescription pain relievers for the ﬁrst time in the

past year (Figure 31). is number averages to approximately

850 adolescents each day who initiated prescription pain

reliever misuse (Table A.3A). e number of adolescents in

2018 who initiated pain reliever misuse was lower than the

numbers in 2015 and 2016, but it was similar to the number

in 2017.

An estimated 464,000 young adults aged 18 to 25 in 2018

initiated prescription pain reliever misuse in the past year

(Figure 31), or an average of about 1,300 young adults each

day who initiated pain reliever misuse (Table A.3A). e

number of young adults in 2018 who initiated pain reliever

misuse was lower than the numbers in 2015 and 2016, but it

was similar to the number in 2017.

In 2018, about 1.1 million adults aged 26 or older initiated

prescription pain reliever misuse in the past year (Figure 31).

is number averages to about 3,100 adults in this age group

each day who initiated pain reliever misuse (

Table A.3A).

Unlike the patterns for cigarette, alcohol, and marijuana

use, the majority of the people in 2018 who initiated pain

reliever misuse were aged 26 or older. e number of adults

in this age group in 2018 who were pain reliever misuse

initiates was similar to the numbers in 2015 to 2017.

Figure 31. PastYear Prescription Pain Reliever Misuse Initiates

among People Aged 12 or Older: 2015-2018

Past Year Initiates (in Thousands)

500

1,000

1,500

2,000

2,500

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 31 Table. PastYear Prescription Pain Reliever Misuse Initiates among

People Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

2,126 2,139 2,010 1,908

12 to 17

415

423

316 310

18 to 25

596

585

465 464

26 or Older

1,114 1,130 1,229 1,134

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health30

August 2019

About 2 out of 3 people aged 12 or older in 2018

(68.5 percent) perceived great risk of harm from having four

or ﬁve drinks of alcohol nearly every day (Figure 32). For

brevity, this level of alcohol consumption on a single day

is subsequently referred to as “daily binge drinking.”

e

percentage of the population in 2018 who perceived great

risk of harm from daily binge drinking was similar to the

percentages in 2015 to 2017 (2018 DT 7.33).

About one third of people aged 12 or older in 2018

(30.6 percent) perceived great risk of harm from smoking

marijuana once or twice a week (Figure 32). For brevity, this

level of consumption in a week is referred to as “weekly use.”

e percentage of the population in 2018 who perceived

great risk of harm from weekly marijuana use was lower than

the percentages in 2015 to 2017 (2018 DT 7.33).

In 2018, an estimated 86.5 percent of people aged 12 or

older perceived great risk of harm from weekly cocaine use

(Figure 32). e 2018 percentage of the population who

perceived great risk of harm from weekly cocaine use was

similar to that in 2017, but it was lower than the percentages

in 2015 and 2016 (2018 DT 7.33). Although the percentage

of the population in 2018 who perceived great risk from

weekly cocaine use was lower than the percentage in 2015

and 2016, more than 85 percent in each year thought this

behavior was harmful.

In 2018, an estimated 94.3 percent of people aged 12 or

older perceived great risk of harm from weekly heroin use

(Figure 32). e percentage of the population in 2018 who

perceived great risk of harm from weekly heroin use was

similar to the percentages in 2015 to 2017 (2018 DT 7.33).

More than 90 percent in each year from 2015 to 2018

perceived great risk from weekly heroin use.

Perceived Risk from Substance Use among

Adolescents

In 2018, about 2 out of 3 adolescents aged 12 to 17

perceived great risk of harm from smoking one or more

packs of cigarettes per day (65.3 percent) and from having

four or ﬁve drinks of alcohol nearly every day (64.4 percent)

(Figure 33). e percentage of adolescents in 2018 who

perceived great risk from daily binge drinking was similar to

the percentages in 2015 to 2017. Although the percentage of

adolescents in 2018 who perceived great risk of harm from

smoking one or more packs of cigarettes per day was lower

than the percentages in 2015 to 2017, about two thirds of

adolescents in each year thought this behavior was harmful.

Perceived Risk from Substance Use

One factor that can inﬂuence whether individuals will use

tobacco, alcohol, or illicit drugs is the extent to which they

believe that using these substances might cause them harm.

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 32 presents the percentages of people aged 12 or older

in 2018 who perceived great risk of harm from the use of

various substances. In this report, the various risk measures

are presented for each age group. Risk perceptions across

substances are not compared because of variations in the

quantity and frequency of use across these substances.

e

2018 NSDUH detailed tables include additional measures of

risk perceptions from substance use.

In 2018, an estimated 71.8 percent of people aged 12 or

older perceived great risk of harm from smoking one or more

packs of cigarettes per day (Figure 32). e percentage of the

population in 2018 who perceived great risk from smoking

one or more packs of cigarettes per day was similar to the

percentage in 2017, but it was lower than the percentages in

2015 and 2016 (2018 DT 7.33). Although the percentage of

the population who perceived great risk from smoking one

or more packs of cigarettes a day was lower in 2018 than in

2015 and 2016, more than 70 percent of the population in

each year thought this behavior was harmful.

Figure 32. Perceived Great Risk from Substance Use among

People Aged 12 or Older: 2018

30.6

86.5

94.3

68.5

71.8

100

Smoking

Marijuana

Once or Twice

a Week

Using Cocaine

Once or Twice

a Week a Week

Using Heroin

Once or Twice

Having 4 or 5

Drinks of Alcohol

Nearly Every Day

Smoking One

or More Packs

of Cigarettes

per Day

Percent Perceived Great Risk

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

About 1 in 3 adolescents aged 12 to 17 in 2018 perceived

great risk of harm from smoking marijuana weekly

(34.9 percent). About 4 out of 5 adolescents (79.6 percent)

perceived great risk of harm from weekly cocaine use, and

5 out of 6 (83.0 percent) perceived great risk from weekly

heroin use (Figure 33). e percentage of adolescents in

2018 who perceived great risk from weekly marijuana use

was lower than the percentages in 2015 to 2017. In contrast,

the percentages of adolescents in 2018 who perceived great

risk from weekly cocaine use or weekly heroin use were

similar to the corresponding percentages in 2015 to 2017.

In 2018, adolescents aged 12 to 17 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. For example,

83.0 percent of adolescents perceived great risk of harm from

weekly heroin use (Figure 33) compared with 93.3 percent

of young adults (Figure 34) and 95.7 percent of adults aged

26 or older (2018 DT 7.37). An estimated 79.6 percent

of adolescents perceived great risk from weekly cocaine use

compared with 82.6 percent of young adults and 87.9 percent

of adults aged 26 or older. Additional data on ﬁner age group

categories that can be found in the 2018 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.

Perceived Risk from Substance Use among Young

Adults

In 2018, about 2 out of 3 young adults aged 18 to 25

(67.5 percent) perceived great risk of harm from smoking one

or more packs of cigarettes per day, and more than 2 out of 5

(63.4 percent) perceived great risk from daily binge drinking

(Figure 34). e percentages of young adults in 2018 who

perceived great risk from smoking one or more packs of

cigarettes per day and from daily binge drinking were similar

to the corresponding percentages in 2015 to 2017.

Figure 33. Perceived Great Risk from Substance Use among

Youths Aged 12 to 17: 2015-2018

Percent Perceived Great Risk

100

2018201720162015

Smoking Marijuana Weekly

Using Cocaine Weekly

Using Heroin Weekly

Having 4 or 5 Drinks of Alcohol Daily

Smoking One or More Packs of

Cigarettes per Day

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure33 Table. Perceived Great Risk from Substance Use among Youths

Aged 12 to 17: 2015-2018

Substance Use 2015 2016 2017 2018

Smoking Marijuana Once or Twice a Week

40.6

40.0

37.7

34.9

Using Cocaine Once or Twice a Week

80.2 80.6 80.1 79.6

Using Heroin Once or Twice a Week

82.9 83.4 84.0 83.0

Having 4 or 5 Drinks of Alcohol Nearly Every Day

64.1 65.5 65.2 64.4

Smoking One or More Packs of Cigarettes per Day

68.2

69.3

67.2

65.3

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 34. Perceived Great Risk from Substance Use among

Young Adults Aged 18 to 25: 2015-2018

Percent Perceived Great Risk

100

2018201720162015

Smoking Marijuana Weekly

Using Cocaine Weekly

Using Heroin Weekly

Having 4 or 5 Drinks of Alcohol Daily

Smoking One or More Packs of

Cigarettes per Day

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure34 Table. Perceived Great Risk from Substance Use among Young

Adults Aged 18 to 25: 2015-2018

Substance Use 2015 2016 2017 2018

Smoking Marijuana Once or Twice a Week

19.1

17.2

15.4 15.4

Using Cocaine Once or Twice a Week

84.3

83.6 83.3 82.6

Using Heroin Once or Twice a Week

94.0

93.5 93.9 93.3

Having 4 or 5 Drinks of Alcohol Nearly Every Day

62.1 62.3 63.2 63.4

Smoking One or More Packs of Cigarettes per Day

68.0 68.6 66.6 67.5

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health32

August 2019

An estimated 15.4 percent of young adults aged 18 to 25 in

2018 perceived great risk of harm from smoking marijuana

weekly (Figure 34). More than 4 out of 5 young adults

perceived great risk from weekly cocaine use (82.6 percent),

and more than 9 out of 10 (93.3 percent) perceived great

risk from weekly heroin use. e percentages of young adults

in 2018 who perceived great risk from weekly cocaine use or

weekly heroin use were similar to the percentages in 2016

and 2017 but were lower than the percentages in 2015.

For weekly marijuana use, the percentage of young adults

in 2018 who perceived great risk of harm was lower than

the percentages in 2015 and 2016 but was similar to the

percentage in 2017.

In 2018, young adults aged 18 to 25 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.

Compared with the estimated 15.4 percent of young adults

who perceived great risk from smoking marijuana weekly

(Figure 34), 34.9 percent of adolescents (Figure 33) and

32.5 percent of adults aged 26 or older (2018 DT 7.37)

perceived great risk from smoking marijuana weekly.

Perceived Risk from Substance Use among Adults

Aged 26 or Older

In 2018, about 3 out of 4 adults aged 26 or older perceived

great risk of harm from smoking one or more packs of

cigarettes per day (73.2 percent), and about 7 out of 10

(69.7 percent) perceived great risk from having four or ﬁve

drinks of alcohol nearly every day (2018 DT 7.37). Similar

percentages of adults in this age group in 2015 to 2018

perceived great risk from daily binge drinking. Although the

percentage of adults in this age group who perceived great risk

from smoking one or more packs of cigarettes a day was lower

in 2018 than in 2015, nearly three fourths of adults in this

age group in each year thought this behavior was harmful.

Among adults aged 26 or older in 2018, 32.5 percent

perceived great risk of harm from smoking marijuana weekly,

87.9 percent perceived great risk from weekly cocaine use,

and 95.7 percent perceived great risk from weekly heroin use

(2018 DT 7.37). More than 95 percent of adults in this age

group in each year from 2015 to 2018 perceived great risk

from weekly heroin use. Although the percentage of adults in

this age group in 2018 who perceived great risk from weekly

cocaine use was lower than the percentage in 2015, nearly

90 percent of adults in this age group in each year thought

this behavior was harmful. Unlike risk perceptions for these

other substances, the percentage of adults in this age group

in 2018 who perceived great risk from weekly marijuana use

was lower than the percentages in 2015 to 2017.

In 2018, adults aged 26 or older were more likely than

adolescents aged 12 to 17 and young adults aged 18 to 25

to perceive great risk from smoking one or more packs of

cigarettes per day (73.2 percent for adults aged 26 or older vs.

65.3 percent for adolescents and 67.5 percent for young adults)

(2018 DT 7.37; Figures 33 and 34). Nevertheless, about two

thirds or more of people in each age group perceived great risk

from smoking a pack or more of cigarettes per day.

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. NSDUH includes 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). Respondents

were asked SUD questions if they previously reported use

of alcohol or illicit drugs in the past 12 months. Illicit drugs

include the use of marijuana, cocaine (including crack),

heroin, hallucinogens, inhalants, and methamphetamine, as

well as the misuse of prescription stimulants, tranquilizers

or sedatives (including benzodiazepines), and pain relievers.

e SUD questions classify people as having an SUD in the

past 12 months based on criteria speciﬁed in the Diagnostic

and Statistical Manual of Mental Disorders, 4th edition

(DSM-IV).

42,43

is section presents SUD estimates for the most common

disorders among the population aged 12 or older. Less

common SUD estimates are not discussed in this report

(e.g., inhalant use disorder). However, trend data for these

SUD measures are available in Tables 7.45 to 7.49 in the

2018 NSDUH detailed tables for the population aged 12 or

older and by age group.

Alcohol Use Disorder

Alcohol use disorder was deﬁned as meeting DSM-IV criteria

for either dependence or abuse for alcohol. Respondents who

used alcohol on 6 or more days in the past 12 months were

deﬁned as having dependence if they met three or more of

the following seven dependence criteria:

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

1. spent a lot of time engaging in activities related to

alcohol use,

2. used alcohol in greater quantities or for a longer time

than intended,

3. developed tolerance,

4. made unsuccessful attempts to cut down on use,

5. continued use despite physical health or emotional

problems associated with alcohol use,

6. reduced or eliminated participation in other activities

because of alcohol use, and

7. experienced withdrawal symptoms when cutting back

or stopping use.

Respondents who used alcohol on 6 or more days in the

past 12 months and did not meet criteria for alcohol

dependence were deﬁned as having abuse if they reported

one or more of the following:

1. problems at work, home, or school because of alcohol

use;

2. regularly using alcohol and then doing something

physically dangerous;

3. repeated trouble with the law because of alcohol use; and

4. continued use of alcohol despite problems with family

or friends.

An estimated 14.8 million people aged 12 or older in

2018 had an alcohol use disorder, which corresponds to

5.4 percent of the population (Figure 35), or about 1 in 19

people. e percentage of people aged 12 or older in 2018

with an alcohol use disorder was lower than the percentages

in 2002 to 2015, but it was similar to the percentages in

2016 and 2017.

Aged 12 to 17

An estimated 401,000 adolescents aged 12 to 17 in 2018

had a past year alcohol use disorder, or 1.6 percent of

adolescents (Figure 35). e percentage of adolescents

in 2018 with an alcohol use disorder was lower than the

percentages in 2002 to 2015, but it was similar to the

percentages in 2016 and 2017.

Aged 18 to 25

Approximately 3.4 million young adults aged 18 to 25 in

2018 had an alcohol use disorder in the past year. is number

of young adults with an alcohol use disorder corresponds to

10.1 percent of young adults (Figure 35). e percentage of

young adults in 2018 with an alcohol use disorder was lower

than the percentages in 2002 to 2015, but it was similar to the

percentages in 2016 and 2017. Nevertheless, 1 in 10 young

adults in 2018 had an alcohol use disorder.

Aged 26 or Older

In 2018, approximately 11.0 million adults aged 26 or

older had an alcohol use disorder in the past year, which

corresponds to 5.1 percent of the adults in this age group

(Figure 35). e percentage of adults aged 26 or older

in 2018 with an alcohol use disorder was lower than the

percentages in most years from 2002 to 2014, but it was

similar to the percentages in 2015 to 2017.

Illicit Drug Use Disorder

is section presents overall estimates for illicit drug use

disorder, then provides SUD estimates for selected speciﬁc

illicit drugs. Illicit drug use disorder is deﬁned as meeting

DSM-IV criteria for either dependence or abuse 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).

ere are seven

possible dependence criteria for speciﬁc illicit drugs:

Figure 35. Alcohol Use Disorder in the PastYear among People

Aged 12 or Older: 2002-2018

Percent with Alcohol Use Disorder

in Past Year

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 35 Table. Alcohol Use Disorder in the PastYear among People Aged

12 or Older: 2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

7.7

7.5

7.8

7.7

7.5

7.4

7.5

7.1

6.5

6.8

6.6

6.4

5.9

5.6 5.3 5.4

12-17

5.9

6.0

5.5

5.4

4.9

4.6

3.8

3.4

2.8

2.7

2.5

2.0 1.8 1.6

18-25

17.7

17.2

17.4

17.5

17.6

16.9

17.4

16.1

15.7

14.4

14.3

13.0

12.3

10.9

10.7 10.0 10.1

≥26

6.2

6.0

6.3

6.2

6.0

6.3

5.9

5.4 5.9

6.0

5.9

5.4 5.2 5.0 5.1

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health34

August 2019

1. spent a lot of time engaging in activities related to use

of the drug,

2. used the drug in greater quantities or for a longer time

than intended,

3. developed tolerance to the drug,

4. made unsuccessful attempts to cut down on use of the

drug,

5. continued to use the drug despite physical health or

emotional problems associated with use,

6. reduced or eliminated participation in other activities

because of use of the drug, and

7. experienced withdrawal symptoms when respondents

cut back or stopped using the drug.

For most illicit drugs, dependence is deﬁned as meeting three or

more of these seven criteria. However, experiencing withdrawal

symptoms is not included as a criterion for some illicit drugs

based on DSM-IV criteria. For these substances, dependence is

deﬁned as meeting three or more of the ﬁrst six criteria.

Respondents who used (or misused) a speciﬁc illicit drug in

the past 12 months and did not meet the dependence criteria

for that drug were deﬁned as having abuse for that drug if

they reported one or more of the following:

1. problems at work, home, or school because of use of

the drug;

2. regularly using the drug and then doing something

physically dangerous;

3. repeated trouble with the law because of use of the

drug; and

4. continued use of the drug despite problems with family

or friends.

Application of these criteria is discussed brieﬂy in the

respective SUD sections for speciﬁc illicit drugs. Detailed

deﬁnitions for SUDs for speciﬁc illicit drugs also can

be found in a glossary of key deﬁnitions for the 2018

NSDUH.

In 2018, an estimated 8.1 million people aged 12 or older

had at least one illicit drug use disorder. is number of

people with an illicit drug use disorder corresponds to

3.0 percent of the population (Figure 36). e percentage

of people aged 12 or older in 2018 with an illicit drug use

disorder was similar to the percentages in 2015 to 2017.

Aged 12 to 17

An estimated 681,000 adolescents aged 12 to 17 in 2018

had a past year illicit drug use disorder, or 2.7 percent of

adolescents (Figure 36). e percentage of adolescents in

2018 with an illicit drug use disorder was lower than the

percentage in 2015, but it was similar to the percentages in

2016 and 2017.

Aged 18 to 25

Approximately 2.6 million young adults aged 18 to 25 in

2018 had an illicit drug use disorder in the past year. is

number of young adults with an illicit drug use disorder

corresponds to 7.6 percent of young adults (Figure 36). e

percentage of young adults in 2018 with an illicit drug use

disorder was similar to the percentages in 2015 to 2017.

Aged 26 or Older

In 2018, approximately 4.8 million adults aged 26 or

older had an illicit drug use disorder in the past year,

corresponding to 2.2 percent of the adults in this age group

(Figure 36). e percentage of adults aged 26 or older in

2018 with an illicit drug use disorder was similar to the

percentages in 2015 to 2017.

Figure 36. Illicit Drug Use Disorder in the PastYear among People

Aged 12 or Older: 2015-2018

Percent with Illicit Drug Use Disorder

in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 36 Table. Illicit Drug Use Disorder in the PastYear among People

Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

2.9 2.7 2.8 3.0

12 to 17

3.4

3.2 3.0 2.7

18 to 25

7.2 7.0 7.3 7.6

26 or Older

2.1 2.0 2.0 2.2

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Marijuana Use Disorder

Marijuana use disorder occurs when someone experiences

clinically signiﬁcant impairment caused by the recurrent

use of marijuana, including health problems, persistent or

increasing use, and failure to meet major responsibilities

at work, school, or home. NSDUH respondents who used

marijuana on 6 or more days in the past 12 months were

categorized as having a marijuana use disorder if they met

the DSM-IV criteria for either dependence or abuse for

marijuana. Dependence and abuse criteria for illicit drugs

(including marijuana) were described previously.

Approximately 4.4 million people aged 12 or older in

2018 had a marijuana use disorder in the past year, which

corresponds to 1.6 percent of the population (Figure 37).

e percentage of the population aged 12 or older in 2018

with a marijuana use disorder was similar to the percentages

in most years between 2002 and 2017.

Aged 12 to 17

In 2018, an estimated 2.1 percent of adolescents aged 12 to

17 had a marijuana use disorder in the past year (Figure 37),

or about 512,000 adolescents. e percentage of adolescents

in 2018 with a marijuana use disorder was lower than

the percentages in 2002 to 2015, but it was similar to the

percentages in 2016 and 2017.

Aged 18 to 25

Approximately 2.0 million young adults aged 18 to 25

in 2018 had a marijuana use disorder in the past year, or

5.9 percent of young adults (Figure 37). e percentage of

young adults in 2018 with a marijuana use disorder was

similar to the corresponding percentages in 2002 through

2013 and 2017, but it was higher than the percentages

between 2014 and 2016.

Aged 26 or Older

In 2018, approximately 1.9 million adults aged 26 or older had

a marijuana use disorder in the past year, or 0.9 percent of adults

in this age group (Figure 37). e 2018 percentage of adults

aged 26 or older with a marijuana use disorder was similar to

the percentages in most years between 2002 and 2017.

Cocaine Use Disorder

Cocaine use disorder occurs when someone experiences

clinically signiﬁcant impairment caused by the recurrent

use of cocaine, including health problems, physical

withdrawal, persistent or increasing use, and failure to meet

major responsibilities at work, school, or home. NSDUH

respondents who used cocaine or crack in the past 12 months

were categorized as having a cocaine use disorder if they

met the DSM-IV criteria for either dependence or abuse

for cocaine. Dependence and abuse criteria for illicit drugs

(including cocaine) were described previously.

About 977,000 people aged 12 or older in 2018 had a

cocaine use disorder in the past year. is number of people

with a cocaine use disorder corresponds to 0.4 percent of the

population (Figure 38). e percentage of the population

aged 12 or older in 2018 with a cocaine use disorder was

similar to the percentages in 2009 to 2017, but it was lower

than the percentages from 2002 to 2008.

Aged 12 to 17

Less than 0.1 percent of adolescents aged 12 to 17 in 2018

had a cocaine use disorder in the past year (Figure 38), or

about 5,000 adolescents. e percentage of adolescents

in 2018 with a cocaine use disorder was lower than the

percentages in all years from 2002 to 2017.

Aged 18 to 25

Approximately 212,000 young adults aged 18 to 25 in 2018

had a cocaine use disorder in the past year. is number

Figure 37. Marijuana Use Disorder in the PastYear among People

Aged 12 or Older: 2002-2018

Percent with Marijuana Use Disorder

in Past Year

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 37 Table. Marijuana Use Disorder in the PastYear among People Aged

12 or Older: 2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

1.8

1.8 1.9

1.7 1.7 1.6 1.7 1.7 1.8 1.6 1.7 1.6 1.6 1.5 1.5 1.5 1.6

12-17

4.3

3.8

3.9

3.6

3.4

3.1

3.4

3.6

3.5

3.2

2.9

2.7

2.6

2.3 2.2 2.1

18-25

6.0 5.9 6.0 5.9 5.7 5.6 5.6 5.6 5.7 5.7 5.5 5.4 4.9

5.1

5.0

5.2 5.9

≥26

0.8 0.7 0.8 0.7

0.8 0.7

0.8 0.8 0.9 0.7

0.8 0.8 0.9 0.8 0.8 0.8 0.9

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health36

August 2019

of young adults with a cocaine use disorder corresponds to

0.6 percent of young adults (Figure 38). e percentage of

young adults in 2018 with a cocaine use disorder was lower

than the percentages in 2002 to 2009, but it was similar to

the percentages from 2010 to 2017.

Aged 26 or Older

In 2018, approximately 760,000 adults aged 26 or older had

a cocaine use disorder in the past year, which corresponds

to 0.4 percent of adults in this age group (Figure 38). e

percentage of adults aged 26 or older in 2018 with a cocaine

use disorder was lower than the percentages from 2002 to

2008, but it was similar to the percentages between 2009

and 2017.

Heroin Use Disorder

Heroin use disorder occurs when someone experiences

clinically signiﬁcant impairment caused by the recurrent

use of heroin, including health problems, physical

withdrawal, persistent or increasing use, and failure to meet

major responsibilities at work, school, or home. NSDUH

respondents who used heroin in the past 12 months were

categorized as having a heroin use disorder if they met the

DSM-IV criteria for either dependence or abuse for heroin.

Dependence and abuse criteria for illicit drugs (including

heroin) were described previously.

About 526,000 people aged 12 or older in 2018 had a

heroin use disorder. is number of people with a heroin

use disorder corresponds to 0.2 percent of the population

(Figure 39). e percentage of people in 2018 with a heroin

use disorder was higher than the percentages in most years

from 2002 to 2008, but it was similar to the percentages

from 2009 to 2017. Although the percentages in some

earlier years were lower than in 2018, all percentages from

2002 to 2018 were 0.2 percent or less.

Aged 12 to 17

Less than 0.1 percent of adolescents aged 12 to 17 in 2018

had a heroin use disorder in the past year (Figure 39), which

corresponds to about 4,000 adolescents. e percentage of

adolescents in 2018 with a heroin use disorder was similar to

the percentages in most years from 2002 to 2017.

Aged 18 to 25

Approximately 101,000 young adults aged 18 to 25 in 2018

had a heroin use disorder in the past year, which corresponds

to 0.3 percent of young adults (Figure 39). e percentage of

young adults in 2018 with a heroin use disorder was lower than

Figure 38. Cocaine Use Disorder in the PastYear among People

Aged 12 or Older: 2002-2018

Percent with Cocaine Use Disorder

in Past Year

0.0

0.5

1.0

1.5

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 38 Table. Cocaine Use Disorder in the PastYear among People Aged

12 or Older: 2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

0.6

0.7

0.6

0.7

0.6

0.4 0.4 0.3 0.4 0.3 0.3 0.3 0.3 0.4 0.4

12-17

0.4

0.3

0.4

0.3

0.2

0.1

0.2

0.1

0.0

18-25

1.2

1.4

1.5

1.3

1.4

1.2

0.9

0.7 0.6 0.6 0.7 0.5 0.7 0.6 0.7 0.6

≥26

0.6

0.5

0.6

0.5

0.4 0.4 0.3 0.4 0.3 0.3 0.3 0.3 0.3 0.4

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Note: Estimates of less than 0.05 percent round to 0.0 percent when shown to the nearest tenth of a percent.

Figure 39. Heroin Use Disorder in the PastYear among People

Aged 12 or Older: 2002-2018

Percent with Heroin Use Disorder

in Past Year

0.0

0.5

1.0

1.5

1817161514131211100908070605040302

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 39 Table. Heroin Use Disorder in the PastYear among People Aged 12

or Older: 2002-2018

Age 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

≥12

0.1

0.1 0.1

0.1

0.1 0.1 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2

12-17

0.1 0.0 0.1

0.0 0.0 0.0 0.1

0.1

0.0 0.1

0.1 0.0 0.1 0.0 0.0 0.0 0.0

18-25

0.2

0.1

0.2 0.3 0.2 0.2 0.3 0.3 0.3 0.4 0.5

0.5

0.4 0.4 0.5

0.3

≥26

0.1

0.1 0.1

0.1

0.1 0.1 0.1 0.1 0.2 0.2 0.2 0.2 0.2 0.2

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Note: Estimates of less than 0.05 percent round to 0.0 percent when shown to the nearest tenth of a percent.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

the percentages in most years from 2011 to 2017 (ranging from

0.4 to 0.5 percent), but it was similar to the percentages from

2004 to 2010 (ranging from 0.2 to 0.3 percent). Compared

with 2002 and 2003, there was a higher percentage of young

adults in 2018 with a heroin use disorder.

Aged 26 or Older

In 2018, approximately 421,000 adults aged 26 or older had

a heroin use disorder in the past year, which corresponds to

0.2 percent of adults in this age group (Figure 39). Between

2002 and 2018, 0.1 to 0.2 percent of adults aged 26 or older

had a heroin use disorder in the past year. e 2018 estimate

was higher than the estimates in most years from 2002 to

2008, but it was similar to the estimates between 2009 and

2017.

Methamphetamine Use Disorder

Respondents were asked questions about SUD symptoms

that they attributed speciﬁcally to their use of methamphet-

amine. Methamphetamine use disorder does not include

disorders based on the misuse of prescription stimulants

because, starting in 2015, these concepts were measured

and reported separately.

Methamphetamine use disorder occurs when someone

experiences clinically signiﬁcant impairment caused by

the recurrent use of methamphetamine, including health

problems, physical withdrawal, persistent or increasing

use, and failure to meet major responsibilities at work,

school, or home. NSDUH respondents who used

methamphetamine in the past 12 months were categorized

as having a methamphetamine use disorder if they met

the DSM-IV criteria for either dependence or abuse for

methamphetamine. Dependence and abuse criteria for

illicit drugs (including methamphetamine) were described

previously.

In 2018, an estimated 1.1 million people aged 12 or older

had a methamphetamine use disorder. is number of

people with a methamphetamine use disorder corresponds

to about 0.4 percent of the population (2018 DT 7.45).

e percentage of people aged 12 or older in 2018 with

a methamphetamine use disorder was higher than the

percentage in 2016, but it was similar to the percentages in

2015 and 2017.

Aged 12 to 17

An estimated 0.1 percent of adolescents aged 12 to 17 had

a methamphetamine use disorder in the past year (2018

DT 7.46), which represents about 18,000 adolescents. e

percentage of adolescents in 2018 with a methamphetamine

use disorder was similar to the percentages in 2015 to 2017.

Aged 18 to 25

Approximately 134,000 young adults aged 18 to 25 in

2018 had a methamphetamine use disorder in the past year,

which corresponds to 0.4 percent of young adults (2018

DT 7.48). e percentage of young adults in 2018 with

a methamphetamine use disorder was similar to the

percentages in 2015 to 2017.

Aged 26 or Older

In 2018, 0.4 percent of adults aged 26 or older had a

methamphetamine use disorder (2018 DT 7.49). is

percentage represents approximately 899,000 adults in this

age group. e 2018 methamphetamine use disorder estimate

among adults aged 26 or older was higher than the estimate in

2016, but it was similar to the estimates in 2015 and 2017.

Stimulant Use Disorder

Stimulant use disorder occurs when someone experiences

clinically signiﬁcant impairment caused by the recurrent

use of prescription stimulants, including health problems,

persistent or increasing use, and failure to meet major

responsibilities at work, school, or home. NSDUH

respondents who misused stimulants in the past 12 months

were categorized as having a stimulant use disorder if they

met the DSM-IV criteria for either dependence or abuse for

stimulants. Dependence and abuse criteria for illicit drugs

(including misused stimulants) were described previously.

Respondents who met criteria for methamphetamine use

disorder but did not meet the criteria for having a stimulant

use disorder were not classiﬁed as having a stimulant use

disorder.

In 2018, an estimated 561,000 people aged 12 or older

had a stimulant use disorder in the past year. is number

of people with a stimulant use disorder corresponds to

0.2 percent of the population (2018 DT 7.45). In each year

from 2015 to 2018, 0.2 percent of people aged 12 or older

had a stimulant use disorder.

Aged 12 to 17

An estimated 53,000 adolescents aged 12 to 17 in 2018

had a past year stimulant use disorder, or 0.2 percent of

adolescents (2018 DT 7.46). In each year from 2015 to

2018, 0.2 percent had a stimulant use disorder.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health38

August 2019

Aged 18 to 25

Approximately 185,000 young adults aged 18 to 25 in 2018

had a stimulant use disorder in the past year, or 0.5 percent

of young adults (2018 DT 7.48). In each year from 2015 to

2018, 0.5 percent of young adults had a stimulant use disorder.

Aged 26 or Older

In 2018, approximately 323,000 adults aged 26 or older had

a stimulant use disorder in the past year, which corresponds to

0.2 percent of adults in this age group (2018 DT 7.49). e

2018 estimate of stimulant use disorder among adults aged 26

or older was similar to the estimates in 2015 to 2017.

Tranquilizer Use Disorder or Sedative Use Disorder

Tranquilizer use disorder or sedative use disorder occur

when someone experiences clinically signiﬁcant impairment

caused by the recurrent use of tranquilizers, sedatives, or

both. Impairment includes health problems, persistent or

increasing use, and failure to meet major responsibilities at

work, school, or home. NSDUH collects dependence and

abuse information for these two categories of prescription

drugs. Respondents were classiﬁed as having a tranquilizer

or sedative use disorder if they met DSM-IV criteria

for tranquilizer use disorder or sedative use disorder.

Dependence and abuse criteria for illicit drugs (including

misused tranquilizers or sedatives) were described previously.

In 2018, an estimated 751,000 people aged 12 or older had

a tranquilizer or sedative use disorder. is number of people

with a tranquilizer or sedative use disorder corresponds to

0.3 percent of the population (2018 DT 7.45). In each year

from 2015 to 2017, 0.3 percent of people aged 12 or older

had a tranquilizer or sedative use disorder.

Aged 12 to 17

An estimated 0.3 percent of adolescents aged 12 to 17 had

a tranquilizer or sedative use disorder in the past year (2018

DT 7.46), which corresponds to about 68,000 adolescents. e

percentage of adolescents in 2018 with a tranquilizer or sedative

use disorder was similar to the percentages in 2015 to 2017.

Aged 18 to 25

Approximately 224,000 young adults aged 18 to 25 in 2018

had a tranquilizer or sedative use disorder in the past year, or

0.7 percent of young adults (2018 DT 7.48). e percentage

of young adults in 2018 with a tranquilizer or sedative use

disorder was similar to the corresponding percentages in

2015 through 2017.

Aged 26 or Older

In 2018, approximately 458,000 adults aged 26 or older had

a tranquilizer or sedative use disorder in the past year, which

corresponds to 0.2 percent of adults in this age group (2018

DT 7.49). In each year from 2015 to 2018, 0.2 percent of

adults aged 26 or older had a tranquilizer or sedative use

disorder.

Pain Reliever Use Disorder

Pain reliever use disorder occurs when someone experiences

clinically signiﬁcant impairment caused by the recurrent

use of pain relievers, including health problems, physical

withdrawal, persistent or increasing use, and failure to

meet major responsibilities at work, school, or home.

NSDUH respondents who misused pain relievers in the

past 12 months were categorized as having a pain reliever

use disorder if they met the DSM-IV criteria for either

dependence or abuse for pain relievers. Dependence and

abuse criteria for illicit drugs (including misused pain

relievers) were described previously.

In 2018, an estimated 1.7 million people aged 12 or older

had a pain reliever use disorder, which corresponds to

0.6 percent of the population (Figure 40). e percentage

Figure 40. Pain Reliever Use Disorder in the PastYear among

People Aged 12 or Older: 2015-2018

Percent with Pain Reliever Use Disorder

in Past Year

0.0

0.5

1.0

1.5

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 40 Table. Pain Reliever Use Disorder in the PastYear among People

Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

0.8

0.7 0.6 0.6

12 to 17

0.5 0.6 0.4 0.4

18 to 25

1.2

0.8 1.0

0.7

26 or Older

0.7 0.6 0.6 0.6

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

of people aged 12 or older in 2018 with a pain reliever use

disorder was similar to the percentages in 2016 and 2017,

but it was lower than the percentage in 2015.

Aged 12 to 17

An estimated 0.4 percent of adolescents aged 12 to 17 had a

pain reliever use disorder in the past year (Figure 40), which

represents about 104,000 adolescents. e percentage of

adolescents in 2018 with a pain reliever use disorder was

similar to the percentages in 2015 to 2017.

Aged 18 to 25

Approximately 248,000 young adults aged 18 to 25 in

2018 had a pain reliever use disorder in the past year, or

0.7 percent of young adults (Figure 40). e percentage of

young adults in 2018 with a pain reliever use disorder was

lower than the percentages in 2015 and 2017, but it was

similar to the percentage in 2016.

Aged 26 or Older

In 2018, approximately 1.3 million adults aged 26 or older had

a pain reliever use disorder in the past year, which corresponds

to 0.6 percent of adults in this age group (Figure 40). e 2018

estimate of pain reliever use disorder among adults aged 26 or

older was similar to the estimates in 2015 to 2017.

Opioid Use Disorder

Misuse of opioids includes two categories of drugs: the

use of heroin and the misuse of prescription pain relievers.

NSDUH collects dependence and abuse information for

these two categories of drugs. Respondents were classiﬁed as

having an opioid use disorder if they met DSM-IV criteria

for heroin use disorder or pain reliever use disorder (or

both), as described previously.

In 2018, an estimated 2.0 million people aged 12 or

older had an opioid use disorder, which corresponds to

0.7 percent of the population (Figure 41). e percentage

of people aged 12 or older in 2018 with an opioid use

disorder was similar to the percentages in 2016 and 2017,

but it was lower than the percentage in 2015.

Aged 12 to 17

An estimated 0.4 percent of adolescents aged 12 to 17 had

an opioid use disorder in the past year (Figure 41), which

represents about 108,000 adolescents. e percentage

of adolescents in 2018 with an opioid use disorder was

similar to the percentages in 2015 to 2017.

Aged 18 to 25

Approximately 312,000 young adults aged 18 to 25

in 2018 had an opioid use disorder in the past year, or

0.9 percent of young adults (Figure 41). e percentage

of young adults in 2018 with an opioid use disorder was

similar to the percentage in 2016, but it was lower than

the percentages in 2015 and 2017.

Aged 26 or Older

In 2018, approximately 1.6 million adults aged 26 or

older had an opioid use disorder in the past year, which

corresponds to 0.7 percent of adults in this age group

(Figure 41). e 2018 estimate of opioid use disorder

among adults aged 26 or older was similar to the estimates

in 2015 to 2017.

Substance Use Disorder (Alcohol or Illicit Drugs)

NSDUH’s overall estimates of SUD include people who met

the DSM-IV criteria for either dependence or abuse for alcohol

or illicit drugs. In 2018, approximately 20.3 million people

aged 12 or older had an SUD in the past year, including

14.8 million who had an alcohol use disorder and 8.1 million

who had an illicit drug use disorder (Figure 42). Among the

Figure 41. Opioid Use Disorder in the PastYear among People

Aged 12 or Older: 2015-2018

Percent with Opioid Use Disorder

in Past Year

0.0

0.5

1.0

1.5

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 41 Table. Opioid Use Disorder in the PastYear among People Aged 12

or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

0.9

0.8 0.8 0.7

12 to 17

0.5 0.6 0.4 0.4

18 to 25

1.5

1.1 1.3

0.9

26 or Older

0.8 0.8 0.7 0.7

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health40

August 2019

8.1 million people who had an illicit drug use disorder, the

most common disorders were for marijuana (4.4 million) and

misuse of prescription pain relievers (1.7 million).

e estimated 14.8 million people aged 12 or older in 2018

who had an alcohol use disorder in the past year correspond

to nearly 3 out of 4 people who had an SUD (73.1 percent)

(Figure 43).

e 8.1 million people who had an illicit drug

use disorder correspond to about 2 out of 5 people who had

an SUD (40.0 percent). An estimated 2.7 million people had

both an alcohol use disorder and an illicit drug use disorder

in the past year, or about 1 in 8 people who had a past year

SUD (13.1 percent).

In 2018, the 20.3 million people with a past year SUD

correspond to 7.4 percent of people aged 12 or older

(Figure 44). is percentage of people who had an SUD

corresponds to about 1 in 14 people aged 12 or older. e

percentage of the population in 2018 with an SUD was

similar to the percentages in 2015 to 2017.

Aged 12 to 17

An estimated 916,000 adolescents aged 12 to 17 in

2018 had a past year SUD, or 3.7 percent of adolescents

Figure 43. Alcohol Use Disorder (AUD) and Illicit Drug Use

Disorder (IDUD) in the PastYear among People Aged 12 or Older

with PastYear Substance Use Disorder (SUD): 2018

People with

AUD Only

(60.0% of People

with SUD)

14.8 Million People

with AUD

(73.1% of People

with SUD)

People with AUD and IDUD

(13.1% of People with SUD)

8.1 Million People

with IDUD

(40.0% of People

with SUD)

People with

IDUD Only

(26.9% of People

with SUD)

20.3 Million People Aged 12 or Older with Past Year SUD

12.2

Million

2.7

Million

5.4

Million

Figure 44. Substance Use Disorder in the PastYear among People

Aged 12 or Older: 2015-2018

Percent with Substance Use Disorder

in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 44 Table. Substance Use Disorder in the PastYear among People

Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

7.8 7.5 7.2 7.4

12 to 17

5.0

4.3

4.0 3.7

18 to 25

15.3 15.1 14.8 15.0

26 or Older

6.9 6.6 6.4 6.6

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 42. People Aged 12 or Older with a PastYear Substance Use Disorder (SUD): 2018

14.8M

8.1M

4.4M

1.7M

1.1M

977,000

561,000

526,000

0 4 8 12 16

Alcohol

Illicit Drugs

Marijuana

Rx Pain Reliever Misuse

Methamphetamine

Cocaine

Rx Stimulant Misuse

Heroin

Number of People with Past Year SUD

Past Year SUD

20.3 Million People

(7.4%)

No Past Year SUD

253.5 Million People

(92.6%)

Rx = prescription.

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.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

(Figure 44). Stated another way, about 1 in 27 adolescents

had an SUD in the past year. e percentage of adolescents

in 2018 with an SUD was lower than the percentages in

2015 and 2016, but it was similar to the percentage in 2017.

Aged 18 to 25

About 1 in 7 young adults aged 18 to 25 had an SUD in the

past year, or about 15.0 percent of young adults (Figure 44).

Approximately 5.1 million young adults aged 18 to 25 in

2018 had an SUD in the past year. e percentage of young

adults in 2018 with an SUD was similar to the percentages

in 2015 to 2017.

Aged 26 or Older

In 2018, approximately 14.2 million adults aged 26 or older

had an SUD in the past year. is number corresponds to

about 1 in 15 adults in this age group (6.6 percent) with an

SUD in the past year (Figure 44). e percentage of adults

aged 26 or older in 2018 with an SUD was similar to the

percentages in 2015 to 2017.

Major Depressive Episode in the PastYear

Mental disorders are characterized by negative changes in

mood, thought, or behavior and are accompanied by distress

or impairment. ese disorders can make carrying out daily

activities diﬃcult and can impair an individual’s ability to

work or function in school, interact with family, or fulﬁll

other major life functions.

One such mental disorder is major depressive episode

(MDE). Respondents were deﬁned as having had an MDE in

the past 12 months if they had at least one period of 2 weeks

or longer in the past year when they experienced a depressed

mood or loss of interest or pleasure in daily activities,

accompanied by problems with sleeping, eating, energy,

concentration, or self-worth. e MDE questions are based

on diagnostic criteria from DSM-5.

Some of the wordings

of the depression questions for adolescents aged 12 to 17

and adults aged 18 or older diﬀered slightly to make the

questions more developmentally appropriate for adolescents.

erefore, the adult and youth estimates for MDE are not

directly comparable and are presented separately.

46,47

NSDUH also collects data on whether an MDE in

the past year caused respondents to experience severe

impairment in four major life activities or role domains.

ese domains are deﬁned separately for adults aged 18 or

older and youths aged 12 to 17 to reﬂect the diﬀerent roles

associated with the two age groups. Adults were deﬁned 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.

Adolescents were deﬁned 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.

MDE and MDE with Severe Impairment among

Adolescents

In 2018, about 1 in 7 adolescents aged 12 to 17 had a

past year MDE (14.4 percent) and 1 in 10 had a past year

MDE with severe impairment (10.0 percent) (Figure 45).

ese percentages correspond to 3.5 million adolescents

having had an MDE in the past year and 2.4 million

adolescents having had a past year MDE with severe

impairment. us, more than two thirds of adolescents in

2018 who had a past year MDE (70.0 percent) had an MDE

with severe impairment.

e percentage of adolescents aged 12 to 17 in 2018 who had

a past year MDE was higher than the percentages in 2004 to

2017 (Figure 45). e percentage of adolescents in 2018 who

Figure 45. Major Depressive Episode (MDE) and MDE with Severe

Impairment in the PastYear among Youths Aged 12 to 17:

2004-2018

Percent with MDE or MDE with

Severe Impairment in Past Year

181716151413121110090807060504

MDE MDE with Severe Impairment

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure45 Table. Major Depressive Episode (MDE) and MDE with Severe

Impairment in the PastYear among Youths Aged 12 to 17: 2004-2018

MDE Status 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

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

MDE with

Severe

Impairment

N/A N/A 5.5

5.5

6.0

5.8

5.7

6.3

7.7

8.2

8.8

9.0

9.4 10.0

N/A = not available.

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health42

August 2019

had a past year MDE with severe impairment also was higher

than the percentages in 2006 to 2016 (ranging from 5.5 to

9.0 percent), but it was similar to the percentage in 2017.

MDE and MDE with Severe Impairment among Adults

In 2018, an estimated 7.2 percent of adults aged 18 or older

(17.7 million adults) had at least one MDE in the past year

(Figure 46), and 4.7 percent of adults (11.5 million adults)

had an MDE with severe impairment in the past year

(Figure 47). Adults in 2018 who had an MDE with severe

impairment correspond to nearly two thirds (65.1 percent)

of adults who had a past year MDE.

e percentage of adults aged 18 or older in 2018 who had

a past year MDE was higher than the percentages in most

years from 2005 to 2016, but it was similar to the percentage

in 2017 (Figure 46). e percentage of adults in 2018 with a

past year MDE with severe impairment also was higher than

the percentages in most years between 2009 and 2016, but it

was similar to the percentage in 2017 (Figure 47).

Aged 18 to 25

In 2018, an estimated 4.6 million young adults aged 18 to

25 had a past year MDE, or 13.8 percent of young adults

(Figure 46). e percentage of young adults with a past year

MDE was greater in 2018 than in the years from 2005 to

2016, but it was similar to the percentage in 2017.

Approximately 3.0 million young adults aged 18 to 25 in

2018 had a past year MDE with severe impairment, or

8.9 percent of young adults (Figure 47). e percentage of

young adults with a past year MDE with severe impairment

was greater in 2018 than in 2009 to 2016, but it was similar

to the percentage in 2017.

Aged 26 to 49

In 2018, about 8.0 million adults aged 26 to 49 had a

past year MDE, or 8.0 percent of adults in this age group

(Figure 46). e percentage of adults in this age group

in 2018 who had a past year MDE was similar to the

corresponding percentages in most years from 2005 to 2017.

An estimated 5.3 million adults aged 26 to 49 in 2018 had

a past year MDE with severe impairment, or 5.3 percent

of adults in this age group (Figure 47). Between 2009 and

2017, the percentages of adults aged 26 to 49 who had a

past year MDE with severe impairment ranged from 4.6 to

5.2 percent; the 2018 percentage was either similar to or

higher than the earlier percentages. Percentages of adults

in this age group who had a past year MDE with severe

impairment were similar between 2017 and 2018.

Figure 46. Major Depressive Episode in the PastYear among

Adults Aged 18 or Older: 2005-2018

Percent with Major Depressive Episode

in Past Year

1817161514131211100908070605

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure46 Table. Major Depressive Episode in the PastYear among Adults

Aged 18 or Older: 2005-2018

Age 05 06 07 08 09 10 11 12 13 14 15 16 17 18

18 or Older

6.6

6.5

6.7

6.5

6.6

6.8 6.6

6.9 6.7

6.6

6.7

7.1 7.2

18 to 25

8.8

8.1

8.0

8.4

8.0

8.3

8.9

8.7

9.3

10.3

10.9

13.1 13.8

26 to 49

7.6 7.7 7.6 7.4 7.6 7.5 7.7 7.6 7.6 7.2

7.5 7.4

7.7 8.0

50 or Older

4.5 4.5 5.2 4.8 4.9 5.6

4.8 5.5

5.1 5.2 4.8 4.8 4.7 4.5

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 47. Major Depressive Episode with Severe Impairment in

the PastYear among Adults Aged 18 or Older: 2009-2018

Percent with Major Depressive Episode

with Severe Impairment in Past Year

2018201720162015201420132012201120102009

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure47 Table. Major Depressive Episode with Severe Impairment in the

PastYear among Adults Aged 18 or Older: 2009-2018

Age 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

18 or Older

4.0

4.2

4.5 4.3 4.3

4.3

4.5 4.7

18 to 25

5.2

5.8

5.7

6.0

6.5

7.0

8.5 8.9

26 to 49

4.8 4.7

5.2 5.1 4.9 4.6

4.9 4.7

5.0 5.3

50 or Older

2.6 3.5 2.9 3.4 3.2 3.5

3.0 3.0 2.8 2.9

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Aged 50 or Older

In 2018, about 5.1 million adults aged 50 or older had a

past year MDE, or 4.5 percent of adults in this age group

(Figure 46). e percentage of adults aged 50 or older

in 2018 who had a past year MDE was similar to the

corresponding percentages in most years from 2005 to

2017.

An estimated 3.2 million adults aged 50 or older in

2018 had a past year MDE with severe impairment, or

2.9 percent of adults in this age group (Figure 47). e

percentage of adults aged 50 or older in 2018 who had a

past year MDE with severe impairment was similar to the

percentages in most years from 2009 to 2017.

Any Mental Illness among Adults in the PastYear

NSDUH provides estimates of any mental illness (AMI)

and serious mental illness (SMI) for adults aged 18 or older.

Except for MDE, NSDUH does not include questions or

methods for estimating the occurrence of mental illness

among adolescents. erefore, NSDUH does not include

any measure for adolescents that is equivalent to AMI or

SMI for adults.

Adults aged 18 or older with AMI were deﬁned as having

any mental, behavioral, or emotional disorder in the past year

that met DSM-IV criteria (excluding developmental

disorders and SUDs).

Adults with AMI were deﬁned as

having SMI if they had any mental, behavioral, or emotional

disorder that substantially interfered with or limited one or

more major life activities. AMI and SMI are not mutually

exclusive categories; adults with SMI are included in

estimates of adults with AMI. Adults with AMI who do not

meet the criteria for having SMI are categorized as having

AMI excluding SMI.

In 2018, approximately 47.6 million adults aged 18 or older

had AMI in the past year (2018 DT 10.1), including an

estimated 11.4 million (2018 DT 10.3) adults who had SMI

and about 36.3 million adults who had AMI excluding SMI

in the past year (2018 DT 10.5).

e 36.3 million adults

who had AMI excluding SMI correspond to 14.6 percent of

all adults and 76.1 percent of adults with AMI.

e 47.6 million adults aged 18 or older in 2018 who had

AMI in the past year correspond to 19.1 percent of all adults

(Figure 48). e percentage of adults in 2018 who had AMI

was similar to the percentage in 2017, but it was higher than

percentages in most years from 2008 to 2016.

Aged 18 to 25

In 2018, approximately 8.9 million young adults aged 18

to 25 (26.3 percent) had AMI in the past year (Figure 48).

e percentage of young adults in 2018 who had AMI was

greater than the percentages in 2008 to 2016, but it was

similar to the percentage in 2017.

Aged 26 to 49

In 2018, about 22.7 million adults aged 26 to 49

(22.5 percent) had AMI in the past year (Figure 48). e

2018 estimate of AMI among adults in this age group was

higher than the estimates in most years from 2008 to 2016,

but it was similar to the estimate in 2017.

Aged 50 or Older

In 2018, an estimated 16.0 million adults aged 50 or older

(14.0 percent) had AMI in the past year (Figure 48). e

2018 estimate of AMI among adults in this age group was

similar to estimates in most years from 2008 to 2017.

Serious Mental Illness among Adults in the

PastYear

Adults aged 18 or older with AMI were deﬁned as having SMI

if they had any diagnosable mental, behavioral, or emotional

Figure 48. Any Mental Illness in the PastYear among Adults Aged

18 or Older: 2008-2018

Percent with Any Mental Illness

in Past Year

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure48 Table. Any Mental Illness in the PastYear among Adults Aged 18

or Older: 2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

18 or Older

17.7

18.1

17.8

18.6 18.5 18.1

17.9

18.3

18.9 19.1

18 to 25

18.5

18.0

18.1

18.5

19.6

19.4

20.1

21.7

22.1

25.8 26.3

26 to 49

20.7

21.6 20.9

20.3

21.2

21.5 20.4

20.9

21.1

22.2 22.5

50 or Older

14.1 14.5 15.1 15.0 15.8

15.3 15.4

14.0 14.5 13.8 14.0

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health44

August 2019

disorder, other than a developmental or substance use disorder,

that substantially interfered with or limited one or more major

life activities.

In 2018, an estimated 11.4 million adults had

SMI in the past year, which corresponds to 4.6 percent of

adults (Figure 49). e percentage of adults in 2018 with SMI

was higher than percentages in most years from 2008 to 2016,

but it was similar to the percentage in 2017.

Aged 18 to 25

In 2018, about 2.6 million young adults aged 18 to 25

(7.7 percent) had SMI in the past year (Figure 49). e

percentage of young adults in 2018 who had SMI was

greater than the percentages in 2008 to 2016, but it was

similar to the percentage in 2017.

Aged 26 to 49

An estimated 5.9 million adults aged 26 to 49 (5.9 percent)

in 2018 had SMI in the past year (Figure 49). e estimate

of SMI among adults in this age group in 2018 was higher

than the estimates in most years from 2008 to 2016, but it

was similar to the estimate in 2017.

Aged 50 or Older

In 2018, approximately 2.8 million adults aged 50 or older

(2.5 percent) had SMI in the past year (Figure 49). e

percentage of adults in this age group in 2018 with past year

SMI was similar to the percentages in most years from 2008

to 2017.

Co‑Occurring MDE and SUD among

Adolescents

Adolescents aged 12 to 17 with a past year MDE and an

SUD (i.e., illicit drug use disorder or alcohol use disorder) are

deﬁned as having co-occurring MDE and an SUD. e order

of onset of SUDs and MDE symptoms for adolescents cannot

be established in the NSDUH data (e.g., whether the onset of

SUDs preceded the onset of MDE symptoms, or vice versa).

In 2018, about 3.5 million adolescents aged 12 to 17 had

an MDE in the past year, and 2.4 million adolescents had

a past year MDE with severe impairment. As also discussed

previously, an estimated 916,000 adolescents in 2018 had a

past year SUD. An estimated 1.5 percent of adolescents in

2018 had an SUD and an MDE in the past year (Figure 50),

corresponding to 358,000 adolescents (Figure 51). About

288,000 adolescents in 2018 (1.2 percent of adolescents) had

an SUD and an MDE with severe impairment in the past year.

e percentages of adolescents aged 12 to 17 who had an

SUD and an MDE in the past year remained steady from

Figure 49. Serious Mental Illness in the PastYear among Adults

Aged 18 or Older: 2008-2018

Percent with Serious Mental Illness

in Past Year

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure49 Table. Serious Mental Illness in the PastYear among Adults Aged

18 or Older: 2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

18 or Older

3.7

4.1

3.9

4.1

4.2 4.1

4.0

4.2

4.5 4.6

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

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

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

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 50. PastYear Substance Use Disorder (SUD) and Major

Depressive Episode (MDE) Status among Youths Aged 12 to 17:

2015-2018

Percent with SUD and MDE in Past Year

0.0

0.5

1.0

1.5

2.0

2018201720162015

Co-Occurring SUD and MDE

Co-Occurring SUD and MDE with Severe Impairment

Figure 50 Table. PastYear Substance Use Disorder (SUD) and Major

Depressive Episode (MDE) Status among Youths Aged 12 to 17: 2015-2018

SUD/MDE Status 2015 2016 2017 2018

Co-Occurring SUD and MDE

1.4 1.4 1.4 1.5

Co-Occurring SUD and MDE with Severe

Impairment

1.2 1.1 1.1 1.2

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

2015 to 2018 at 1.4 to 1.5 percent (Figure 50). Similarly, the

percentages of adolescents who had an SUD and an MDE

with severe impairment in the past year also remained steady

from 2015 to 2018 at 1.1 to 1.2 percent.

Substance Use among Adolescents with MDE

is section compares the prevalence of substance use among

adolescents aged 12 to 17 who had a past year MDE with the

prevalence among adolescents who did not have a past year

MDE. In 2018, the percentage of adolescents who used

illicit drugs in the past year was higher among those with a

past year MDE than it was among those without a past year

MDE (32.7 vs. 14.0 percent) (Figure 52). Adolescents who

had a past year MDE also were more likely than adolescents

without an MDE to be past year users of marijuana (25.2

vs. 10.5 percent) or misusers of opioids (i.e., heroin users or

misusers of prescription pain relievers) (6.1 vs. 2.2 percent).

Unlike the illicit drug use estimates described previously,

estimates of cigarette smoking and binge alcohol use

refer to substance use behaviors that occurred in the

past month. In 2018, about 1 in 16 adolescents aged 12

to 17 (6.1 percent) with a past year MDE were cigarette

smokers in the past month compared with 2.1 percent of

those without a past year MDE (Figure 52). In addition,

adolescents who had a past year MDE were more likely than

adolescents without an MDE to be past month binge alcohol

drinkers (8.5 vs. 4.1 percent).

Co‑Occurring Mental Health Issues and SUD

among Adults

Adults aged 18 or older who had both a mental disorder

and an SUD in the past year are referred to as having

co-occurring disorders. In NSDUH, the presence of mental

disorders is deﬁned as having either AMI or SMI, and

SUDs refer to the presence of either alcohol use disorder or

illicit drug use disorder. is section presents ﬁndings on

co-occurring disorders among adults in the United States. As

described previously for adolescents aged 12 to 17, however,

the order of onset of SUDs and symptoms of mental

disorders cannot be established in the NSDUH data for

adults (e.g., whether the onset of SUDs preceded the onset

of symptoms of mental disorders, or vice versa).

Co‑Occurring AMI and SUD

As noted previously, 47.6 million adults aged 18 or older in

2018 had AMI in the past year. In addition, 19.3 million adults

had a past year SUD. About 9.2 million adults had both AMI

and an SUD (Figure 53), which corresponds to 3.7 percent of

adults (Figure 54). e 2018 percentage of adults with both

AMI and an SUD was higher than the percentages in 2015

and 2016, but it was similar to the percentage in 2017.

In 2018, approximately 8.9 million young adults aged 18 to

25 had AMI in the past year, and 5.1 million had a past year

SUD, as also had been discussed previously. Among young

adults, 2.4 million had both AMI and an SUD in the past year

(2018 DT 10.6). is corresponds to 7.2 percent of young

adults (Figure 54). e 2018 percentage of young adults with

both AMI and an SUD was higher than the percentages in

2015 and 2016, but it was similar to the percentage in 2017.

Figure 51. PastYear Substance Use Disorder (SUD) and Major

Depressive Episode (MDE) among Youths Aged 12 to 17: 2018

0.9 Million Youths

Had SUD

Youths Had

SUD but

Not MDE

Youths Had SUD and MDE

Youths Had

MDE but

Not SUD

3.5 Million Youths

Had MDE

0.5

Million

0.4

Million

3.1

Million

4.0 Million Youths Had Either SUD or MDE

Note: Youth respondents with unknown MDE data were excluded.

Figure 52. Substance Use among Youths Aged 12 to 17, by

PastYear Major Depressive Episode (MDE) Status: 2018

32.7

25.2

6.1

8.5

6.1

14.0

10.5

2.2

4.1

2.1

Illicit Drugs,

Past Year

Marijuana,

Past Year

Opioids,

Past Year

Binge Alcohol,

Past Month

Cigarettes,

Past Month

Percent Using

Had MDE

Did Not Have MDE

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.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health46

August 2019

As noted previously, 22.7 million adults aged 26 to 49

in 2018 had AMI in the past year, and 9.7 million had a

past year SUD. Among adults in this age group, 5.0 million

had both AMI and an SUD (2018 DT 10.6). is

corresponds to 5.0 percent of adults in this age group. e

percentage of adults aged 26 to 49 in 2018 who had both

AMI and an SUD was higher than the percentages in 2015

and 2017, but it was similar to the percentage in 2016.

In 2018, approximately 16.0 million adults aged 50 or older

had AMI in the past year, and 4.5 million had a past year

SUD. Among adults in this age group, 1.7 million had

both AMI and an SUD (2018 DT 10.6). is corresponds

to 1.5 percent of adults in this age group. e percentages

of adults aged 50 or older with both AMI and an SUD

remained steady from 2015 to 2018 at 1.5 to 1.6 percent.

Co‑Occurring SMI and SUD

As noted previously, 11.4 million adults aged 18 or older

in 2018 had SMI in the past year, and 19.3 million adults

had a past year SUD. Approximately 3.2 million adults had

co-occurring SMI and an SUD in the past year (Figure 55),

which corresponds to 1.3 percent of adults (Figure 54). e

2018 percentage of adults with both SMI and an SUD was

higher than the percentages in 2015 and 2016, but it was

similar to the percentage in 2017.

In 2018, approximately 2.6 million young adults aged 18 to

25 had SMI in the past year, and 5.1 million had a past year

SUD, as noted previously. About 879,000 young adults

had co-occurring SMI and an SUD in the past year, which

corresponds to 2.6 percent of young adults (2018 DT 10.6

and Figure 54). e 2018 percentage of young adults with

both SMI and an SUD was higher than the percentages in

2015 and 2016, but it was similar to the percentage in 2017.

As noted previously, 5.9 million adults aged 26 to 49 in

2018 had SMI in the past year, and 9.7 million had a

Figure 54. Co-Occurring PastYear Substance Use Disorder (SUD),

Any Mental Illness (AMI), and Serious Mental Illness (SMI) among

Adults Aged 18 or Older: 2015-2018

Percent with SUD and Mental Illness

in Past Year

2018201720162015

SUD and AMI—18 or Older

SUD and SMI

—18 or Older

SUD and SMI

—18 to 25

SUD and AMI—18 to 25

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 54 Table. Co-Occurring PastYear Substance Use Disorder (SUD), Any

Mental Illness (AMI), and Serious Mental Illness (SMI) among Adults Aged

18 or Older: 2015-2018

SUD/Mental Illness Status and Age 2015 2016 2017 2018

SUD and AMI

18 or Older

3.3

3.4

3.4 3.7

18 to 25

5.9

6.1

6.9 7.2

SUD and SMI

18 or Older

1.0

1.1

1.3 1.3

18 to 25

1.7

2.1

2.8 2.6

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 53. PastYear Substance Use Disorder (SUD) and Mental

Illness among Adults Aged 18 or Older: 2018

19.3 Million

Adults Had SUD

but Not Mental

Illness

Adults Had SUD and

Mental Illness

Adults Had

Mental Illness

but Not SUD

47.6 Million Adults

Had Mental Illness

10.2

Million

9.2

Million

38.4

Million

57.8 Million Adults Had Either SUD or Mental Illness

Figure 55. PastYear Substance Use Disorder (SUD) and Serious

Mental Illness (SMI) among Adults Aged 18 or Older: 2018

19.3 Million

Adults Had SUD

Adults Had

SUD but

Not SMI

Adults Had SUD and SMI

Adults Had

SMI but

Not SUD

11.4 Million

Adults Had SMI

16.2

Million

3.2

Million

8.2

Million

27.6 Million Adults Had Either SUD or SMI

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

past year SUD. Approximately 1.7 million adults in this age

group had co-occurring SMI and an SUD in the past year

(2018 DT 10.6), which corresponds to 1.7 percent of adults

in this age group. e 2018 percentage of adults aged 26

to 49 who had both SMI and an SUD in the past year was

higher than the percentages in 2015 and 2016, but it was

similar to the percentage in 2017.

In 2018, about 2.8 million adults aged 50 or older had

past year SMI, and 4.5 million had a past year SUD, as noted

previously. Approximately 560,000 adults in this age group

had co-occurring SMI and an SUD (2018 DT 10.6), which

corresponds to 0.5 percent of adults in this age group. e

percentages of adults aged 50 or older with both SMI and an

SUD remained steady from 2015 to 2018 at 0.4 to 0.5 percent.

Substance Use among Adults with Mental

Health Issues

is section compares the prevalence of substance use among

adults aged 18 or older who had a mental health issue in the

past year with the prevalence among adults who did not have

a past year mental health issue. In NSDUH, the presence of a

mental health issue among adults refers to them having AMI

or SMI. In 2018, the percentages of adults who used illicit

drugs in the past year were higher among those with SMI

(49.4 percent) and adults with AMI (36.7 percent) compared

with those without any mental illness (15.7 percent)

(Figure 56). Adults in 2018 who had AMI or SMI were

more likely than those without any mental illness to be

past year users of marijuana (29.2 or 38.9 vs. 13.2 percent)

or past year misusers of opioids (9.2 or 14.6 vs. 2.6 percent).

Unlike the illicit drug use estimates described previously,

estimates of cigarette smoking and binge alcohol use refer

to substance use behaviors that occurred in the past month.

Among adults aged 18 or older in 2018, 28.1 percent of

adults with AMI and 37.2 percent of adults with SMI

were cigarette smokers in the past month compared with

16.3 percent of those without any mental illness (Figure 56).

In addition, 31.3 percent of adults with AMI and

32.3 percent of adults with SMI were binge alcohol drinkers

in the past month compared with 25.3 percent of adults

with no mental illness.

Suicidal Thoughts and Behavior among Adults

Suicide is an important public health problem in the

United States and a tragedy for all involved—the individuals

and their families, friends, neighbors, colleagues, and

communities. In 2017, more than 47,000 people in the

United States died by suicide.

In addition, suicide rates

increased in most states between 1999 and 2016, including

increases by more than 30 percent in 25 states over this

period.

However, individuals who died by suicide represent

a fraction of those who consider or attempt suicide.

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.

Individuals are likely to have thought about

suicide before attempting it.

NSDUH has collected information on past year suicidal

thoughts and behavior among adults aged 18 or older in

the United States since 2008. Information from NSDUH

on adults who have seriously thought about suicide or have

made suicide plans or attempts can be useful to policymakers

and service providers in gauging the size of the adult

population at a high level of risk for suicide and in tracking

changes in the size of this population over time.

NSDUH respondents aged 18 or older were asked if at

any time during the past 12 months they had thought

seriously about trying to kill themselves. Adults who had

serious thoughts of suicide in the past 12 months were asked

whether they made a plan to kill themselves or tried to kill

themselves in that period.

In 2018, approximately 10.7 million adults aged 18 or

older (4.3 percent) had thought seriously about trying to

kill themselves (Figures 57 and 58). Of the 10.7 million

Figure 56. Substance Use among Adults Aged 18 or Older, by

Mental Illness Status: 2018

36.7

29.2

9.2

31.3

28.1

49.4

38.9

14.6

32.3

37.2

15.7

13.2

2.6

25.3

16.3

Illicit Drugs,

Past Year

Marijuana,

Past Year

Opioids,

Past Year

Binge Alcohol,

Past Month

Cigarettes,

Past Month

Percent Using

Any Mental Illness

Serious Mental Illness

No Mental Illness

Difference between this estimate and the estimate for adults without mental illness is statistically

significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health48

August 2019

adults who had serious thoughts of suicide, 3.3 million had

made suicide plans, and 1.4 million made a nonfatal suicide

attempt. Among the 1.4 million adults who attempted

suicide in the past year, 1.2 million made suicide plans, and

0.2 million did not make suicide plans. Stated another way,

about 1 in 3 adults who had serious thoughts of suicide

made suicide plans, and about 1 in 8 adults who had serious

thoughts of suicide made a suicide attempt.

Serious Thoughts of Suicide

e estimated 10.7 million adults aged 18 or older in

2018 who had serious thoughts of suicide in the past year

(Figure 57) correspond to 4.3 percent of adults (Figure 58).

e percentage of adults in 2018 who had serious thoughts

of suicide was higher than the percentages in 2008 to 2014,

but it was similar to the percentages in 2015 to 2017.

Aged 18 to 25

In 2018, approximately 3.7 million young adults aged 18

to 25 (11.0 percent) had serious thoughts of suicide in the

past year (Figure 58). is number corresponds to about 1

in 9 young adults (11.0 percent) who had serious thoughts

of suicide. e percentage of young adults who had serious

thoughts of suicide was higher in 2018 than in 2008 to

2016, but it was similar to the percentage in 2017.

Aged 26 to 49

In 2018, about 4.7 million adults aged 26 to 49 had serious

thoughts of suicide in the past year, or 4.7 percent of adults in

this age group (Figure 58). e percentage of adults in this age

group in 2018 who had serious thoughts of suicide was higher

than the percentages in most years between 2008 and 2015,

but it was similar to the percentages in 2016 and 2017.

Aged 50 or Older

In 2018, approximately 2.4 million adults aged 50 or older

had serious thoughts of suicide in the past year, which

corresponds to 2.1 percent of adults in this age group

(Figure 58). e percentage of adults aged 50 or older in

2018 who had serious thoughts of suicide was similar in

most years from 2008 to 2017.

Suicide Plans

e estimated 3.3 million adults aged 18 or older in

2018 who made suicide plans in the past year (Figure 57)

correspond to 1.3 percent of adults (Figure 59). e

percentage of adults aged 18 or older in 2018 who made

suicide plans was higher than in 2008 to 2016, but it was

similar to the percentage in 2017.

Aged 18 to 25

In 2018, approximately 1.2 million young adults aged 18 to

25 made suicide plans in the past year, which corresponds

to 3.4 percent of young adults (Figure 59). e percentage

of young adults in 2018 who made suicide plans was higher

than the percentages in 2008 to 2016, but it was similar to

the percentage in 2017.

Figure 57. Suicidal Thoughts, Plans, and Attempts in the

PastYear among Adults Aged 18 or Older: 2018

3.3 Million

Made

Suicide Plans

10.7 Million Adults Had Serious Thoughts of Committing Suicide

1.4 Million

Attempted

Suicide

1.2 Million Made

Plans and

Attempted

Suicide

0.2 Million

Made No Plans

and Attempted

Suicide

Figure 58. Suicidal Thoughts in the PastYear among Adults Aged

18 or Older: 2008-2018

Percent with Suicidal Thoughts

in Past Year

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure58 Table. Suicidal Thoughts in the PastYear among Adults Aged 18 or

Older: 2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

18 or Older

3.7

3.8

3.7

3.9

4.0 4.0 4.3 4.3

18 to 25

6.8

6.1

6.7

6.8

7.2

7.4

7.5

8.3

8.8

10.5 11.0

26 to 49

4.0

4.3 4.1

3.7

4.2 4.0

4.0

4.1

4.2 4.3 4.7

50 or Older

2.3 2.3 2.6 2.6 2.4 2.7

2.7

2.6 2.4 2.5 2.1

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Aged 26 to 49

In 2018, about 1.5 million adults aged 26 to 49 made

suicide plans in the past year, which corresponds to

1.4 percent of adults in this age group (Figure 59). e

percentage of adults aged 26 to 49 in 2018 who made

suicide plans in the past year was higher than the percentages

in most years from 2008 to 2015, but it was similar to the

percentages in 2016 and 2017.

Aged 50 or Older

In 2018, approximately 702,000 adults aged 50 or older made

suicide plans in the past year, which corresponds to 0.6 percent

of adults in this age group (Figure 59). e percentage of

adults aged 50 or older in 2018 who made suicide plans in the

past year was similar to the percentages in 2008 to 2017.

Suicide Attempts

e estimated 1.4 million adults aged 18 or older in 2018

who attempted suicide in the past year (with or without ﬁrst

making suicide plans) (Figure 57) correspond to 0.6 percent

of all adults (Figure 60). e percentage of adults in 2018

who attempted suicide was similar to the percentages in

most years between 2008 and 2017.

Aged 18 to 25

In 2018, approximately 647,000 young adults aged 18 to 25

attempted suicide in the past year. is number corresponds

to 1.9 percent of young adults (Figure 60). e percentage

of young adults who attempted suicide was higher in 2018

than in 2008 to 2014, but it was similar to the percentages

in 2015 to 2017.

Aged 26 to 49

In 2018, about 521,000 adults aged 26 to 49 attempted

suicide in the past year, which corresponds to 0.5 percent

of adults in this age group (Figure 60). e percentage of

adults aged 26 to 49 in 2018 who attempted suicide in the

past year was similar to the percentages from 2008 to 2017.

Aged 50 or Older

In 2018, about 274,000 adults aged 50 or older attempted

suicide in the past year, which corresponds to 0.2 percent

of adults in that age group (Figure 60). e percentage of

adults aged 50 or older in 2018 who attempted suicide in the

past year was similar to the percentages from 2008 to 2017.

Figure 59. Suicide Plans in the PastYear among Adults Aged 18

or Older: 2008-2018

Percent with Suicide Plans

in Past Year

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure59 Table. Suicide Plans in the PastYear among Adults Aged 18 or

Older: 2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

18 or Older

1.0

1.1

1.0

1.1

1.3 1.3

18 to 25

2.0

1.9

2.4

2.5

2.3

2.7

2.9

3.7 3.4

26 to 49

1.1

1.0

1.1

1.3 1.3 1.1

1.1

1.3 1.2 1.4

50 or Older

0.7 0.6 0.9 0.7 0.6 0.6 0.7 0.7 0.5 0.6 0.6

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 60. Suicide Attempts in the PastYear among Adults Aged

18 or Older: 2008-2018

Percent with Suicide Attempts

in Past Year

0.0

0.5

1.0

1.5

2.0

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure60 Table. Suicide Attempts in the PastYear among Adults Aged 18 or

Older: 2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

18 or Older

0.5 0.5

0.5 0.5 0.6 0.6 0.5

0.6 0.5 0.6 0.6

18 to 25

1.2

1.1

1.2

1.5

1.3

1.2

1.6 1.8 1.9 1.9

26 to 49

0.4 0.5 0.4 0.5 0.5 0.6 0.5 0.5 0.5 0.4 0.5

50 or Older

0.3 0.2 0.3 0.3 0.3 0.3 0.2 0.3 0.2 0.3 0.2

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health50

Substance Use Treatment in the PastYear

Substance use treatment (i.e., treatment for problems related

to the use of alcohol or illicit drugs) is intended to help

people address problems associated with their substance use.

NSDUH provides two principal measures related to substance

use treatment: (a) the need for substance use treatment and

(b) the receipt of substance use treatment. NSDUH also

collects information on the types of settings where people

received treatment and whether people needed substance use

treatment but did not receive it. In addition, NSDUH collects

information about people who did not receive treatment but

felt they needed it and why they did not get treatment.

Need for Substance Use Treatment

NSDUH includes questions used to identify people who

needed substance use treatment in the past year. For this report,

people are classiﬁed as needing substance use treatment if they

had an SUD in the past year or if they received substance use

treatment at a specialty facility

in the past year.

57,58

In 2018, an estimated 21.2 million people aged 12 or older

needed substance use treatment in the past year. Stated another

way, about 1 in 13 people aged 12 or older (7.8 percent)

needed substance use treatment (Figure 61). e percentage of

the population in 2018 who needed substance use treatment

was similar to the percentages from 2015 to 2017.

Aged 12 to 17

In 2018, about 946,000 adolescents aged 12 to 17 needed

substance use treatment in the past year. is number

corresponds to 3.8 percent of adolescents, or about 1 in 26

adolescents (Figure 61). e percentage of adolescents in

2018 who needed substance use treatment was lower than

the corresponding percentages in 2015 and 2016, but it was

similar to the percentage in 2017.

Aged 18 to 25

About 5.2 million young adults aged 18 to 25 in 2018

needed treatment for a substance use problem in the

past year, corresponding to 15.3 percent of young adults

(Figure 61). Stated another way, about 1 in 7 young adults

needed substance use treatment. e percentages of young

adults who needed substance use treatment were similar

from 2015 to 2018. In each year from 2015 to 2018, at least

15 percent of young adults needed substance use treatment.

Aged 26 or Older

About 15.1 million adults aged 26 or older in 2018 needed

substance use treatment in the past year. is number

corresponds to 7.0 percent of adults in this age group, or

about 1 in 14 adults aged 26 or older (Figure 61). e 2018

estimate of adults in this age group who needed treatment

for a substance use problem was similar to the estimates

between 2015 and 2017.

Receipt of Substance Use Treatment

NSDUH respondents who used alcohol or illicit drugs in their

lifetime are asked whether they ever received substance use

treatment, and those who received substance use treatment in

their lifetime are asked whether they received treatment in the

12 months prior to the survey interview (i.e., the past year).

Substance use treatment refers to treatment or counseling

received for alcohol or illicit drug use or for medical problems

associated with the use of alcohol or illicit drugs.

NSDUH collects information on the receipt of any substance

use treatment and the receipt of substance use treatment at a

specialty facility. e categories of any substance use treatment

and treatment at a specialty facility are not mutually exclusive.

People could report receiving treatment at more than one

location. 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

Figure 61. Need for Substance Use Treatment in the PastYear

among People Aged 12 or Older: 2015-2018

Percent Needing Substance Use Treatment

in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 61 Table. Need for Substance Use Treatment in the PastYear among

People Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

8.1 7.8 7.6 7.8

12 to 17

5.1

4.4

4.1 3.8

18 to 25

15.5 15.5 15.1 15.3

26 or Older

7.2 6.9 6.8 7.0

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

August 2019

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

(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).

Substance use treatment at a specialty facility is included in

estimates of any substance use treatment because a subset of the

treatment locations is categorized as specialty facilities. Receipt

of substance use treatment at a specialty facility is deﬁned as

substance use treatment a respondent received at a hospital

(only as an inpatient), a drug or alcohol rehabilitation facility

(as an inpatient or outpatient), or a mental health center.

Receipt of substance use treatment at a specialty facility is also

referred to as receipt of specialty substance use treatment.

is section presents the following past year estimates for

the population aged 12 or older: receipt of any substance use

treatment and receipt of specialty substance use treatment

among all people in this age group and receipt of specialty

substance use treatment among people who needed

substance use treatment. To provide a better understanding

of why people may have received substance use treatment,

this section also presents treatment estimates among people

with speciﬁc types of SUDs, such as receipt of specialty

alcohol use treatment among people with alcohol use

disorder, and receipt of specialty illicit drug use treatment

among people with speciﬁc illicit drug use disorders.

Receipt of Any Substance Use Treatment

In 2018, approximately 3.7 million people aged 12 or older

received any substance use treatment in the past year, or

1.4 percent of the population (Figure 62). e 2018 percentage

of people aged 12 or older who received any substance use

treatment was similar to the percentages in 2015 to 2017.

By Age Group

Among adolescents aged 12 to 17 in 2018, 159,000 received

any substance use treatment in the past year, or 0.6 percent

of adolescents (Figure 62). e 2018 percentage was similar

to the percentages in 2015 to 2017.

An estimated 547,000 young adults aged 18 to 25 in 2018

received any substance use treatment in the past year. is

number of young adults who received any substance use

treatment corresponds to 1.6 percent of young adults

(Figure 62). e percentage of young adults who received

any substance use treatment in 2018 was similar to the

percentages in 2015 to 2017.

About 3.0 million adults aged 26 or older in 2018 received

any substance use treatment in the past year, or 1.4 percent

of adults in this age group (Figure 62). e 2018 percentage

of adults aged 26 or older who received any substance use

treatment was similar to the percentages in 2015 to 2017.

Receipt of Specialty Substance Use Treatment

Approximately 2.4 million people aged 12 or older in 2018

received substance use treatment at a specialty facility in the

past year, or 0.9 percent of the population (Figure 63). e

percentage of people who received substance use treatment

at a specialty facility in 2018 was similar to the percentages

in 2015 to 2017.

By Age Group

In 2018, about 83,000 adolescents aged 12 to 17 received

substance use treatment at a specialty facility in the

past year, which corresponds to 0.3 percent of adolescents

(Figure 63). e percentage of adolescents in 2018 who

received substance use treatment at a specialty facility was

similar to the percentages from 2015 to 2017.

An estimated 331,000 young adults aged 18 to 25 in 2018

received substance use treatment at a specialty facility in the

past year, or 1.0 percent of young adults (Figure 63). e

2018 percentage of young adults who received substance use

treatment at a specialty facility was similar to the percentages

in 2015 and 2016, but it was lower than the percentage in

2017. Nevertheless, in each year from 2015 to 2018, about

Figure 62. Received Any Substance Use Treatment in the

PastYear among People Aged 12 or Older: 2015-2018

Percent Receiving Any Substance Use

Treatment in Past Year

0.0

0.5

1.0

1.5

2.0

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Figure 62 Table. Received Any Substance Use Treatment in the PastYear

among People Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

1.4 1.4 1.5 1.4

12 to 17

0.8 0.7 0.7 0.6

18 to 25

1.9 1.8 1.9 1.6

26 or Older

1.4 1.4 1.5 1.4

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health52

August 2019

1.0 to 1.3 percent of young adults received substance use

treatment at a specialty facility in the past year.

In 2018, about 1.9 million adults aged 26 or older received

substance use treatment at a specialty facility in the

past year. is number corresponds to 0.9 percent of adults

in this age group (Figure 63). e percentage of adults aged

26 or older in 2018 who received substance use treatment

at a specialty facility was similar to the corresponding

percentages in 2015 to 2017.

Receipt of Specialty Substance Use Treatment among

People Who Needed Substance Use Treatment

e estimated 2.4 million people aged 12 or older in 2018

who received substance use treatment at a specialty facility

in the past year also correspond to 11.1 percent of the

people who needed treatment (Figure 64). Among people

aged 12 or older who needed substance use treatment, the

percentage in 2018 who received specialty substance use

treatment was similar to the percentages in 2015 to 2017.

By Age Group

e 83,000 adolescents aged 12 to 17 in 2018 who received

substance use treatment at a specialty facility in the past year

correspond to 8.8 percent of the adolescents who needed

substance use treatment (Figure 64). Among adolescents

who needed substance use treatment, the percentage in 2018

who received substance use treatment at a specialty facility

was similar to the percentages in 2015 to 2017.

In 2018, the 331,000 young adults aged 18 to 25 who

received substance use treatment at a specialty facility

in the past year correspond to 6.3 percent of the young

adults who needed substance use treatment (Figure 64).

Among young adults who needed substance use treatment,

the 2018 percentage who received specialty substance use

treatment was similar to the percentages in 2015 and 2016,

but it was lower than the percentage in 2017.

e estimated 1.9 million adults aged 26 or older in 2018

who received substance use treatment at a specialty facility

in the past year correspond to 12.9 percent of the adults

in this age group who needed substance use treatment

(Figure 64). Among adults aged 26 or older who needed

substance use treatment, the percentage who received

substance use treatment at a specialty facility in 2018 was

similar to the percentages in 2015 to 2017.

Figure 64. Received Specialty Substance Use Treatment in the

PastYear among People Aged 12 or Older Who Needed Substance

Use Treatment in the PastYear: 2015-2018

Percent Receiving Specialty Substance Use

Treatment in Past Year

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 64 Table. Received Specialty Substance Use Treatment in the

PastYear among People Aged 12 or Older Who Needed Substance Use

Treatment in the PastYear: 2015-2018

Age 2015 2016 2017 2018

12 or Older

10.8 10.6 12.2 11.1

12 to 17

6.3 8.2 8.8 8.8

18 to 25

7.7 7.2 8.5

6.3

26 or Older

12.3 12.1 13.8 12.9

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 63. Received Specialty Substance Use Treatment in the

PastYear among People Aged 12 or Older: 2015-2018

Percent Receiving Specialty Substance Use

Treatment in Past Year

0.0

0.5

1.0

1.5

2.0

2018201720162015

12 or Older 12 to 17 18 to 25 26 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 63 Table. Received Specialty Substance Use Treatment in the

PastYear among People Aged 12 or Older: 2015-2018

Age 2015 2016 2017 2018

12 or Older

0.9 0.8 0.9 0.9

12 to 17

0.3 0.4 0.4 0.3

18 to 25

1.2 1.1 1.3

1.0

26 or Older

0.9 0.8 0.9 0.9

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Receipt of Alcohol Use Treatment at a Specialty

Facility among People with Alcohol Use Disorder

In 2018, about 686,000 people aged 12 or older with an

alcohol use disorder received alcohol use treatment at a

specialty facility in the past year, or 4.6 percent of people

with an alcohol use disorder (2018 DT 7.58). Among people

aged 12 or older with an alcohol use disorder, the percentage

in 2018 who received alcohol use treatment at a specialty

facility was similar to the percentages in 2015 to 2017.

Receipt of Illicit Drug Use Treatment at a Specialty Facility

among People with Speciﬁc Illicit Drug Use Disorders

In 2018, approximately 743,000 people aged 12 or older

with an illicit drug use disorder received illicit drug use

treatment at a specialty facility in the past year (2018

DT 7.57). is number corresponds to 9.2 percent of people

aged 12 or older with an illicit drug use disorder (Figure 65).

Among people aged 12 or older with an illicit drug use

disorder, the percentage in 2018 who received illicit drug use

treatment at a specialty facility was similar to the percentages

in 2015 and 2016 (11.0 and 9.2 percent, respectively), but it

was lower than the percentage in 2017 (13.0 percent).

About 400,000 people aged 12 or older in 2018 with an

opioid use disorder received illicit drug use treatment at a

specialty facility in the past year, or 19.7 percent of those

with an opioid use disorder (Figure 65). In addition, the

following percentages of people received illicit drug use

treatment at a specialty facility: 19.0 percent of people

with a cocaine use disorder, 18.1 percent of people with

a methamphetamine use disorder, 17.6 percent of people

with a tranquilizer or sedative use disorder, and 9.3 percent

of people with a stimulant use disorder. Estimates for the

receipt of illicit drug use treatment at a specialty facility

among people aged 12 or older with a heroin use disorder,

hallucinogen use disorder, or inhalant use disorder were not

reported for 2018 due to low precision.

Similar to the trend described previously for the receipt

of illicit drug use treatment at a specialty facility in the

past year among people with an illicit drug use disorder, the

percentage of people in 2018 with an opioid use disorder

who received illicit drug use treatment at a specialty

facility (19.7 percent) was similar to the percentages in

2015 and 2016 (20.7 and 21.1 percent, respectively), but

it was lower than the percentage in 2017 (28.6 percent)

(Figure 65). In contrast, among people aged 12 or older in

2018 with a marijuana use disorder, cocaine use disorder,

methamphetamine use disorder, pain reliever use disorder,

stimulant use disorder, or tranquilizer use disorder,

the respective percentages who received illicit drug use

treatment at a specialty facility in the past year were similar

to the corresponding percentages from 2015 to 2017 (2018

DT 7.57). For example, 5.0 to 6.7 percent of people in

2015 to 2018 who had a marijuana use disorder received

illicit drug use treatment at a specialty facility.

Perceived Need for Substance Use Treatment

NSDUH respondents are deﬁned 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 for people aged 12 or older

Figure 65. Received Specialty Illicit Drug Use Treatment in the

PastYear among People Aged 12 or Older, by Speciﬁc Illicit Drug

Use Disorders: 2015-2018

Percent Receiving Specialty Illicit Drug Use

Treatment in Past Year

2018201720162015

Illicit Drug Use Disorder

Marijuana Use Disorder

Pain Reliever Use Disorder

Cocaine Use Disorder

Opioid Use Disorder

Methamphetamine Use Disorder

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 65 Table. Received Specialty Illicit Drug Use Treatment in the

PastYear among People Aged 12 or Older, by Speciﬁc Illicit Drug Use

Disorders: 2015-2018

Drug Use Disorder 2015 2016 2017 2018

Illicit Drug Use Disorder

11.0 9.2 13.0

9.2

Marijuana Use Disorder

5.0 5.1 6.7 5.1

Pain Reliever Use Disorder

18.2 17.5 20.6 15.6

Cocaine Use Disorder

17.7 16.7 26.9 19.0

Opioid Use Disorder

20.7 21.1 28.6

19.7

Methamphetamine Use Disorder

25.4 17.8 23.5 18.1

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health54

August 2019

who were classiﬁed as needing treatment but who did not

receive specialty treatment for their use of alcohol or illicit

drugs. As described previously, people are deﬁned as

needing substance use treatment if they had an SUD in the

past year or if they received substance use treatment at a

specialty facility

in the past year.

57,58

In 2018, among the estimated 18.9 million people aged 12

or older who needed substance use treatment but did not

receive specialty treatment in the past year, about 964,000

perceived a need for treatment for their use of illicit drugs

or alcohol. ese individuals who perceived a need for

substance use treatment include 392,000 who made an

eﬀort to get treatment and 573,000 who did not make an

eﬀort to get treatment (

Figure 66).

e estimated 964,000 people who perceived a need for

substance use treatment correspond to about 5.1 percent of

people aged 12 or older who needed treatment but did not

receive specialty substance use treatment in the past year

(2018 DT 7.64). us, the large majority (94.9 percent) of

people aged 12 or older who needed substance use treatment

but did not receive specialty treatment did not think they

needed treatment in the past 12 months for their substance

use. Among people aged 12 or older who needed treatment

but did not receive specialty substance use treatment, the

percentage in 2018 who perceived they needed treatment

was similar to the percentages in 2015 to 2017.

Aged 12 to 17

Most adolescents aged 12 to 17 in 2018 who needed

treatment for their substance use but did not receive specialty

treatment did not perceive a need for substance use treatment.

Among the estimated 863,000 adolescents in 2018 who

needed substance use treatment but did not receive treatment

at a specialty facility in the past year, about 15,000 perceived

a need for treatment for their substance use. is number of

adolescents who perceived a need for substance use treatment

corresponds to 1.8 percent of adolescents who needed but

did not receive specialty treatment (2018 DT 7.64). Among

adolescents who needed treatment but did not receive

specialty substance use treatment, the percentage in 2018 who

perceived a need for substance use treatment was similar to

the percentages in 2015 to 2017.

Aged 18 to 25

Most young adults aged 18 to 25 in 2018 who needed

treatment for their substance use but did not receive specialty

treatment did not perceive a need for treatment. Among

the estimated 4.9 million young adults in 2018 who needed

substance use treatment but did not receive treatment at a

specialty facility in the past year, about 169,000 perceived

a need for treatment for their substance use. is number

of young adults who perceived a need for substance use

treatment corresponds to 3.5 percent of young adults who

needed treatment but did not receive specialty treatment

(2018 DT 7.64). Among young adults who needed treatment

but did not receive specialty substance use treatment, the

percentage in 2018 who perceived a need for substance use

treatment was similar to the percentages in 2015 to 2017.

Aged 26 or Older

In 2018, the estimated 13.1 million adults aged 26 or older

who needed substance use treatment but did not receive

specialty treatment in the past year include approximately

780,000 adults in this age group who perceived a need for

treatment for their substance use. is number of adults

aged 26 or older who perceived a need for substance use

treatment corresponds to 5.9 percent of adults in this age

group who needed treatment but did not receive specialty

treatment (2018 DT 7.64). Among adults aged 26 or

older who needed treatment but did not receive specialty

substance use treatment, the percentage in 2018 who

perceived a need for substance use treatment was similar to

the percentages in 2015 to 2017.

Reasons for Not Receiving Specialty Substance Use

Treatment

NSDUH respondents who did not receive substance use

treatment in the past 12 months but felt they needed

Figure 66. Perceived Need for Substance Use Treatment among

People Aged 12 or Older Who Needed but Did Not Receive

Specialty Substance Use Treatment in the PastYear: 2018

18.9 Million People Needed but Did Not Receive Specialty Substance Use Treatment

17.9 Million

Did Not Feel They

Needed Treatment

(94.9%)

392,000 Felt They Needed

Treatment and Made an Effort

to Get Treatment

(2.1%)

573,000 Felt They Needed

Treatment and Did Not Make

an Effort to Get Treatment

(3.0%)

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

treatment were asked to report the reasons for not receiving

treatment. As noted in the previous section, 94.9 percent

of people aged 12 or older in 2018 who were classiﬁed as

needing substance use treatment (i.e., either had an SUD

or received specialty substance use treatment) but who did

not receive specialty substance use treatment did not think

they needed treatment (

Figure 66). Information on common

reasons for not receiving substance use treatment despite

individuals perceiving a need for treatment is important for

identifying and addressing barriers to treatment receipt.

In 2018, common reasons for not receiving substance use

treatment among people aged 12 or older who needed

treatment and perceived a need for treatment but did not

receive treatment at a specialty facility were not being

ready to stop using (38.4 percent) or having no health care

coverage and not being able to aﬀord the cost of treatment

(32.5 percent) (2018 DT 7.65). Stated another way, about 2

in 5 people who needed and perceived a need for treatment

but did not receive substance use treatment at a specialty

facility were not ready to stop using, and about 1 in 3 had

no health care coverage and were not able to aﬀord the cost.

Among people aged 12 or older who needed and perceived

a need for treatment but did not receive treatment at a

specialty facility, the percentages in 2015 to 2018 who

were not ready to stop using were similar across the years

and ranged from 37.7 to 40.3 percent. Corresponding

percentages in 2015 to 2018 for people not receiving

substance use treatment because they had no health care

coverage and could not aﬀord the cost were also similar

across the years and ranged from 26.4 to 32.5 percent.

About 1 in 5 people aged 12 or older in 2018 who needed

and perceived a need for treatment but did not receive

treatment at a specialty facility did not know where to

go to get treatment (21.1 percent) (2018 DT 7.65). is

percentage in 2018 was higher than the percentage in 2017

(10.9 percent), but it was similar to the percentages in 2015

and 2016 (12.5 and 18.6 percent, respectively).

In 2018, about 1 in 6 people aged 12 or older who needed and

perceived a need for treatment but did not receive treatment

at a specialty facility (16.0 percent) felt that getting treatment

would have a negative eﬀect on their job (2018 DT 7.65).

An estimated 14.9 percent of these people felt that getting

treatment would cause their neighbors or community to

have a negative opinion of them. ese percentages in 2018

were similar to the percentages in 2015 to 2017 (ranging

from 11.5 to 20.5 percent for eﬀects on jobs and from 8.3 to

17.2 percent for opinions of neighbors or the community).

Mental Health Service Use in the PastYear

NSDUH includes 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 allow the estimation of

the use of mental health services among adolescents and

adults with mental health issues (i.e., MDE, AMI, and 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 who reported seeing or talking to a health

professional or taking prescribed medication for their

depression were deﬁned as having received treatment for

their depression in the past year.

Of the 3.5 million adolescents in 2018 with a past year

MDE, an estimated 1.4 million adolescents received

treatment for depression. Stated another way, 41.4 percent of

adolescents who had a past year MDE received treatment for

depression (Figure 67). e 2018 percentage was similar to

the percentages in most years from 2004 to 2017.

In 2018, about 1.1 million adolescents aged 12 to 17 who

had a past year MDE with severe impairment received

treatment for depression, or 46.9 percent of adolescents who

had a past year MDE with severe impairment (Figure 67).

e percentage of adolescents in 2018 with an MDE with

severe impairment who received treatment for depression was

similar to the percentages in most years from 2006 to 2017.

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. Treatment for

depression in adults is deﬁned as seeing or talking to a health

professional or other professional or using prescription

medication for depression in the past year.

Of the 17.7 million adults aged 18 or older in 2018 who had a

past year MDE, 11.5 million received treatment for depression,

or nearly two thirds (64.8 percent) of adults who had a

past year MDE (Figure 68). e percentage of adults in 2018

with a past year MDE who received treatment for depression

was similar to the percentages in 2009 and in 2015 to 2017,

but it was lower than the percentages in 2010 to 2014.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health56

August 2019

Among the 11.5 million adults aged 18 or older in 2018

who had a past year MDE with severe impairment,

7.9 million received treatment for depression, or more than

two thirds (68.6 percent) of adults with a past year MDE

with severe impairment (2018 DT 10.35). e percentage

of adults in 2018 with an MDE with severe impairment

who received treatment for depression was lower than the

percentages in 2010 to 2017.

Aged 18 to 25

Of the 4.6 million young adults aged 18 to 25 in 2018 with

a past year MDE, about 2.3 million received treatment for

depression in the past year, or about half (49.6 percent)

of young adults with a past year MDE (Figure 68). e

percentage of young adults in 2018 with a past year MDE

who received treatment for depression was similar to

percentages in most years from 2009 to 2017.

In 2018, approximately 1.6 million of the young adults aged

18 to 25 with a past year MDE with severe impairment

received treatment for depression in the past year, or slightly

more than half of these young adults (53.7 percent) (2018

DT 10.35). e percentage of young adults in 2018 with an

MDE with severe impairment who received treatment for

depression was similar to the percentages in 2009 to 2017

(ranging from 51.2 to 57.1 percent).

Aged 26 to 49

In 2018, about 5.1 million of the 8.0 million adults aged 26

to 49 with a past year MDE received treatment for depression

in the past year, or close to two thirds of the adults in this age

group who had a past year MDE (64.4 percent) (Figure 68).

e percentage of adults in this age group in 2018 with a

past year MDE who received treatment for depression was

similar to the percentages in most years from 2009 to 2017.

In 2018, approximately 3.6 million adults aged 26 to 49

with a past year MDE with severe impairment received

treatment for depression in the past year, or 68.0 percent of

adults in this age group who had a past year MDE with severe

impairment (2018 DT 10.35). e percentage of adults in

this age group in 2018 with an MDE with severe impairment

who received treatment for depression was lower than the

percentages in 2010 to 2013 and in 2016 (ranging from 73.7

to 74.4 percent), but it was similar to the percentages in 2009,

2014 to 2015, and 2017 (ranging from 71.8 to 72.4 percent).

Figure 67. 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: 2004-2018

Percent Who Received Treatment

for Depression in Past Year

100

181716151413121110090807060504

MDE MDE with Severe Impairment

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure67 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: 2004-2018

MDE Status

04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

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

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

N/A = not available.

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 68. Received Treatment in the PastYear for Depression

among Adults Aged 18 or Older with a PastYear Major

Depressive Episode: 2009-2018

Percent Who Received Treatment

for Depression in Past Year

100

2018201720162015201420132012201120102009

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 68 Table. Received Treatment in the PastYear for Depression

among Adults Aged 18 or Older with a PastYear Major Depressive Episode:

2009-2018

Age 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

18 or Older

64.3 68.2

68.1

68.0

68.6

67.2 65.3 66.8 64.8

18 to 25

47.0 48.7 47.8 49.8 50.8 49.5 46.8 44.1

50.7 49.6

26 to 49

64.8 68.1 68.1 68.8

66.7 67.9 67.4 67.4 67.3 64.4

50 or Older

73.8 78.4 80.0 76.8 81.3 80.8 80.9 77.3 79.7 78.9

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Aged 50 or Older

Of the 5.1 million adults aged 50 or older in 2018 who had

a past year MDE, about 4.0 million received treatment for

depression in the past year, or 78.9 percent of adults in

this age group who had a past year MDE (Figure 68). e

percentage of adults aged 50 or older in 2018 with an MDE

who received treatment for depression was similar to the

percentages from 2009 to 2017.

In 2018, 2.7 million of the 3.2 million adults aged 50 or

older with a past year MDE with severe impairment received

treatment for depression in the past year, or 83.1 percent of

adults in this age group with a past year MDE with severe

impairment (2018 DT 10.35). e percentage of adults aged

50 or older in 2018 with an MDE with severe impairment

who received treatment for depression was similar to the

percentages in most years from 2009 to 2017.

Any Mental Health Service Use among All Adolescents

In addition to asking youths aged 12 to 17 about treatment

for depression, NSDUH includes questions for adolescents

that ask about any receipt of services for emotional and

behavioral problems (i.e., not just depression) not caused by

substance use. e youth mental health service utilization

section of the interview asks 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;

(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).

As noted previously, the NSDUH interview does not

include questions or methods for estimating the occurrence

of mental disorders among adolescents aged 12 to 17 other

than whether they had an MDE. erefore, NSDUH does

not include measures for adolescents equivalent to AMI or

SMI for adults. Consequently, this section focuses on mental

health care among all adolescents.

In 2018, the following numbers and percentages of

adolescents aged 12 to 17 received mental health services

in the past 12 months in speciﬁc settings for problems with

emotions or behaviors (2018 DT 11.1 and Figure 69):

• 3.9 million adolescents (16.0 percent) received mental

health services in a specialty mental health setting

(inpatient or outpatient care),

• 3.4 million adolescents (14.2 percent) received mental

health services in an education setting,

• 767,000 adolescents (3.1 percent) received mental

health services in a general medical setting,

• 94,000 adolescents (0.4 percent) received mental health

services in a child welfare setting, and

• 48,000 adolescents (0.2 percent) received mental health

services in a juvenile justice setting.

e percentage of adolescents aged 12 to 17 in 2018 who

received mental health services in a specialty mental health

setting in the past 12 months (16.0 percent) was higher than

the percentages in 2009 to 2017, which ranged from 12.0

to 14.8 percent (Figure 69). e percentage of adolescents

in 2018 who received mental health services in an education

Figure 69. Sources of Mental Health Services in the PastYear

among Youths Aged 12 to 17: 2009-2018

Percent Receiving Mental Health

Services in Past Year

2018201720162015201420132012201120102009

Specialty Mental Health Setting

Education Setting

General Medical Setting

Child Welfare Setting

Juvenile Justice Setting

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure69 Table. Sources of Mental Health Services in the PastYear among

Youths Aged 12 to 17: 2009-2018

Source

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Specialty Mental Health

Setting

12.0

12.1

12.6

12.7

13.6

13.7

13.3

14.7

14.8

16.0

Education Setting 12.1

12.4

11.9

12.9

13.0

13.2 13.2

13.1

13.3 14.2

General Medical Setting 2.5

2.5

2.8 2.9 2.7 2.9 3.3 3.1

Child Welfare Setting 0.4 0.4 0.6

0.4 0.4 0.4 0.3 0.4 0.4 0.4

Juvenile Justice Setting 0.4

0.3

0.4

0.3

0.2 0.3 0.2 0.2 0.2 0.2

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health58

August 2019

setting (14.2 percent) also was higher than the percentages

in most years from 2009 to 2017, ranging from 11.9 to

13.3 percent. In contrast, the percentages of adolescents in

2018 who received mental health services in a child welfare

setting (0.4 percent), a juvenile justice setting (0.2 percent),

and a general medical setting (3.1 percent) were similar to

the corresponding percentages between 2013 and 2017.

Any Mental Health Service Use among All Adults

Adults aged 18 or older are 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 adults

are asked these questions about their use of mental health

services (i.e., not just those with mental illness). Respondents

are asked not to include treatment for their use of alcohol

or illicit drugs. Unlike the previously discussed questions

about treatment for depression, general questions for the

receipt of treatment or counseling for mental health issues

among adults do 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 service use” or “mental health care.” is section

presents estimates of mental health service use for the entire

adult population, regardless of whether they were deﬁned as

having AMI or SMI in the past 12 months.

In 2018, an estimated 37.1 million adults aged 18 or older

received any mental health services during the past

12 months. is number corresponds to 15.0 percent of

adults, or about 1 in 7 adults (Figure 70). An estimated

12.2 percent of adults received prescription medication for a

mental health issue, 7.9 percent received outpatient mental

health services, and 1.0 percent received inpatient mental

health services.

e estimate of adults aged 18 or older in 2018 who received

any mental health services in the past 12 months was greater

than the estimates in all years between 2002 and 2011, but it

was similar to the estimates in most years from 2012 to 2017

(

Figure 70). e percentage of adults in 2018 who received

prescription medication was greater than the percentages

in 2002 to 2009, but it was similar to the percentages

in 2010 to 2017. e percentage of adults in 2018 who

received outpatient mental health services was greater than

the percentages in 2003 to 2016, but it was similar to the

percentage in 2017. e estimate of adults in 2018 who

received inpatient mental health services was similar to the

estimates in most years from 2002 to 2017.

Aged 18 to 25

In 2018, approximately 5.1 million young adults aged 18

to 25 used mental health services in the past year (2018

DT 10.7). is number of young adults who received

mental health services corresponds to 15.2 percent of young

adults. An estimated 11.1 percent of young adults received

prescription medication for a mental health issue, 9.3 percent

received outpatient mental health services, and 1.6 percent

received inpatient mental health services (2018 DT 10.16).

e percentage of young adults aged 18 to 25 in 2018

who received mental health services in the past year was

higher than the percentages in 2002 to 2016, but it was

similar to the percentage in 2017 (14.9 percent) (2018

DT 10.7). e percentages of young adults in 2018 who

received prescription medication or outpatient services were

higher than the percentages in 2002 to 2016, but they were

similar to the corresponding percentages in 2017 (2018

DT 10.16). e percentage of young adults in 2018 who

Figure 70. Type of Mental Health Services Received in the

PastYear among Adults Aged 18 or Older: 2002-2018

Percent Receiving Mental Health

Services in Past Year

1817161514131211100908070605040302

Any Mental Health Services

Inpatient

Outpatient

Prescription Medication

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 70 Table. Type of Mental Health Services Received in the PastYear

among Adults Aged 18 or Older: 2002-2018

Service

Type

02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18

Any 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

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

Outpatient

7.4 7.1

7.1

6.8

6.7

7.0

6.8

6.4

6.6

6.7

6.6

6.7

7.1

6.9

7.5 7.9

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

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

received inpatient services was higher than the percentages

in most years from 2002 to 2014, but it was similar to the

percentages in 2015 to 2017.

Aged 26 to 49

In 2018, about 16.1 million adults aged 26 to 49 used mental

health services in the past year (2018 DT 10.7). is number

corresponds to 16.1 percent of adults in this age group. An

estimated 12.9 percent of adults aged 26 to 49 received

prescription medication for a mental health issue, 8.8 percent

received outpatient mental health services, and 1.0 percent

received inpatient mental health services (2018 DT 10.16).

e 2018 estimate of the receipt of mental health services

in the past year among adults aged 26 to 49 was higher

than the estimates from 2002 to 2011, but it was similar

to the estimates in most years from 2012 to 2017 (2018

DT 10.7). e percentage of adults in this age group in

2018 who received prescription medication was higher

than the percentages in 2002 to 2008, but it was similar

to the percentages in 2009 to 2017 (2018 DT 10.16). e

percentage of adults aged 26 to 49 in 2018 who received

outpatient services was higher than the percentages in 2005

to 2016, but it was similar to the percentages in 2002 to

2004 and 2017. e percentage of adults in this age group

in 2018 who received inpatient services was similar to the

percentages in most years from 2002 to 2017.

Aged 50 or Older

In 2018, approximately 15.9 million adults aged 50 or older

used mental health services in the past year (2018 DT 10.7).

is number corresponds to 14.0 percent of adults in this

age group. An estimated 11.8 percent of adults aged 50 or

older received prescription medication for a mental health

issue, 6.6 percent received outpatient mental health services,

and 0.7 percent received inpatient mental health services

(2018 DT 10.16).

e 2018 estimate of the receipt of mental health services

in the past year among adults aged 50 or older was higher

than the estimates in 2002 to 2006, but it was similar to the

estimates in 2007 to 2017, except for 2014 (15.4 percent)

(2018 DT 10.7). Percentages of adults in this age group

in 2018 who received prescription medication or inpatient

services were similar to corresponding estimates in most

years (for prescription medication) or all years (for inpatient

services) from 2002 to 2017 (2018 DT 10.16). e percentage

of adults aged 50 or older in 2018 who received outpatient

services was higher than percentages in 2009 to 2012, but it

was similar to percentages in most years from 2013 to 2017.

Any Mental Health Service Use among Adults with AMI

NSDUH data may also be used to assess mental health

service use among adults aged 18 or older with AMI.

Among the 47.6 million adults in 2018 with AMI, fewer

than half (20.6 million, or 43.3 percent) received mental

health services in the past year (Figure 71). is percentage

of adults in 2018 with AMI who received mental health care

was higher than the percentages in most years from 2008 to

2012, but it was similar to the percentages in 2013 to 2017.

Aged 18 to 25

In 2018, approximately 3.3 million young adults aged 18

to 25 with AMI used mental health services in the past year.

is number of young adults who used mental health

services corresponds to 37.3 percent of young adults with

AMI (Figure 71). e percentage of young adults in 2018

with AMI who received mental health care was similar to the

percentages in 2016 and 2017, and it was higher than the

percentages between 2008 and 2015, when nearly one third

Figure 71. Any Mental Health Services Received in the PastYear

among Adults Aged 18 or Older with Any Mental Illness in the

PastYear: 2008-2018

Percent Receiving Any Mental Health

Services in Past Year

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 71 Table. Any Mental Health Services Received in the PastYear among

Adults Aged 18 or Older with Any Mental Illness in the PastYear: 2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

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

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

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

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

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health60

August 2019

of young adults with AMI received services. Nevertheless,

more than 60 percent of young adults in 2018 who had AMI

did not receive mental health services in the past year.

Aged 26 to 49

In 2018, an estimated 10.0 million adults aged 26 to 49

with AMI used mental health services in the past year. is

number of adults in this age group who received mental

health services corresponds to 43.9 percent of those with

AMI (Figure 71). e percentage of adults aged 26 to 49 in

2018 with AMI who received mental health care was similar

to the percentages in most years from 2008 to 2017.

Aged 50 or Older

In 2018, approximately 7.3 million adults aged 50 or older

with AMI used mental health services in the past year. is

number of adults in this age group who used mental health

services corresponds to 45.8 percent of those with AMI

(Figure 71). e percentage of adults aged 50 or older in

2018 with AMI who received mental health care was similar

to the percentages in all years from 2008 to 2017.

Any Mental Health Service Use among Adults with SMI

NSDUH data may also be used to assess mental health

service use among adults aged 18 or older with SMI.

In 2018, about 7.3 million of the 11.4 million adults with

past year SMI (64.1 percent) received mental health services

in the past year (Figure 72). is percentage of adults in

2018 with SMI who received mental health services in the

past year was similar to the percentages in 2008 to 2012

and in 2015 to 2017, but it was lower than the percentages

in 2013 and 2014. In any given year, about two thirds of

adults with past year SMI received mental health services in

the past year. Stated another way, however, about one third

of adults with SMI in any given year did not receive mental

health services.

Aged 18 to 25

In 2018, approximately 1.4 million young adults aged 18

to 25 with SMI used mental health services in the past year.

is number of young adults who used mental health

services corresponds to 53.8 percent of those with SMI

(Figure 72). e percentage of young adults in 2018 with

SMI who received mental health services was similar to the

percentages in 2009 to 2017, but it was higher than the

percentage in 2008.

Aged 26 to 49

In 2018, about 3.8 million adults aged 26 to 49 with SMI

used mental health services in the past year. is number of

adults in this age group who received mental health services

in the past year corresponds to 63.7 percent of those with

SMI (Figure 72). e percentage of adults aged 26 to 49

with SMI who received mental health services remained

steady from 2008 to 2018.

Aged 50 or Older

In 2018, an estimated 2.1 million adults aged 50 or older

with SMI used mental health services in the past year. is

number of adults in this age group who used mental health

services corresponds to about three fourths of those with

SMI (74.4 percent) (Figure 72). e percentage of adults

aged 50 or older with SMI who received mental health

services remained steady from 2008 to 2018.

Figure 72. Any Mental Health Services Received in the PastYear

among Adults Aged 18 or Older with Serious Mental Illness in the

PastYear: 2008-2018

Percent Receiving Any Mental Health

Services in Past Year

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 72 Table. Any Mental Health Services Received in the PastYear

among Adults Aged 18 or Older with Serious Mental Illness in the PastYear:

2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

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

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

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

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

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Perceived Unmet Need for Mental Health Services

among Adults with Mental Illness

is section discusses estimates of the perceived unmet need

for mental health services among adults aged 18 or older

with AMI or SMI and the reasons for not receiving these

services among adults with a perceived unmet need.

In contrast to how the perceived unmet need for substance

use treatment is estimated (see the earlier section on the

Perceived Need for Substance Use Treatment), the perceived

unmet need for mental health services is estimated from a

question that asks 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 focuses on

discussing 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. erefore, 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 care in the past 12 months. Adults with AMI or SMI

who received mental health services in the past 12 months

could have felt an unmet need for services before or after

they received services.

Perceived Unmet Need for Mental Health

Services among Adults with AMI

In 2018, approximately 11.2 million adults aged 18 or

older with past year AMI perceived an unmet need for

mental health care in the past year (2018 DT 10.23),

including 5.0 million adults with AMI who did not

receive any mental health services in the past year (2018

DT 10.25). About 1 in 4 adults with past year AMI

(23.6 percent) perceived an unmet need for mental health

care (Figure 73). Among adults with a perceived unmet

need and past year AMI, 44.4 percent did not receive any

mental health services.

e estimate of 23.6 percent of adults aged 18 or older in

2018 with past year AMI who perceived an unmet need

for mental health care in that period was higher than the

estimates in most years from 2008 to 2017 (Figure 73). e

2018 percentage of adults with a perceived unmet need and

past year AMI who did not receive mental health services

was similar to the percentages in most years from 2008 to

2017 (2018 DT 10.25).

Aged 18 to 25

About 3.4 million young adults aged 18 to 25 in 2018 with

past year AMI perceived an unmet need for mental health

care in the past year, which corresponds to 37.9 percent

of young adults with past year AMI (Figure 73). is

percentage in 2018 of young adults with AMI who perceived

an unmet need for mental health services was higher than

the percentages in all years from 2008 to 2017 (ranging from

27.8 to 35.3 percent).

In 2018, slightly more than half of the 3.4 million young

adults aged 18 to 25 with AMI who perceived an unmet

need for mental health care did not receive any mental

health services in the past year (1.8 million young adults

with AMI, or 54.3 percent) (2018 DT 10.25).

e

percentage of young adults in 2018 with a perceived unmet

need and past year AMI who did not receive mental health

services in the past year was similar to the percentages in all

years from 2008 to 2017, ranging from 50.1 to 56.7 percent.

Figure 73. 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: 2008-2018

Percent with Perceived Unmet Need for

Mental Health Services in Past Year

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 73 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: 2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

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

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

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

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

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health62

August 2019

Aged 26 to 49

An estimated 5.7 million adults aged 26 to 49 in 2018

with past year AMI perceived an unmet need for mental

health care in the past year. is number corresponds to

25.3 percent of adults in this age group with past year AMI

(Figure 73). is percentage was similar to the percentages

in 2008, 2009, 2011, 2012, and 2017, but it was higher

than the percentages in 2010 and in 2013 to 2016.

Among the estimated 5.7 million adults aged 26 to 49 with

AMI who had a perceived unmet need for mental health

care, 44.2 percent (2.5 million adults) did not receive any

mental health services in the past year (2018 DT 10.25).

is percentage in 2018 was similar to the percentages in

most years from 2008 to 2017.

Aged 50 or Older

About 2.1 million or 13.2 percent of adults aged 50 or

older in 2018 with past year AMI perceived an unmet

need for mental health care in the past year (Figure 73).

e percentages of adults in this age group with AMI

who perceived an unmet need for mental health services

remained steady between 2008 and 2018 (ranging from

11.8 to 16.1 percent) (Figure 73). Among adults aged 50

or older with AMI who had a perceived unmet need for

mental health care, 29.2 percent (614,000 adults) did not

receive any mental health services in the past year (2018

DT 10.25). e 2018 percentage of adults in this age

group with AMI and a perceived unmet need for mental

health care who did not receive any mental health services

was similar to the percentages in all years from 2008

to 2017.

Perceived Unmet Need for Mental Health

Services among Adults with SMI

In 2018, about 5.1 million adults aged 18 or older with

past year SMI perceived an unmet need for mental health

care in the past year (2018 DT 10.23), including 1.8 million

adults with SMI who did not receive any mental health

services in the past year (2018 DT 10.26). More than 2 out

of 5 adults with SMI (45.1 percent) perceived an unmet

need for mental health services (Figure 74). About one third

of adults with a perceived unmet need and past year SMI

(36.1 percent) did not receive any mental health services in

the past year.

e percentage of adults aged 18 or older in 2018 with

SMI who perceived an unmet need for mental health

services (45.1 percent) was higher than the percentages in

2015 and 2016, but it was similar to the percentages in

2017 and most years between 2008 and 2014 (Figure 74).

e 2018 percentage of adults with SMI and a perceived

unmet need for mental health services who did not receive

any mental health services in the past year was higher than

the percentages in 2008 to 2010 (ranging from 27.9 to

30.1 percent), but it was similar to the percentages in all

years from 2011 to 2017 except for 2015 (30.7 percent)

(2018 DT 10.26).

Aged 18 to 25

In 2018, an estimated 1.5 million young adults aged 18 to

25 with SMI perceived an unmet need for mental health care

in the past year, or 59.5 percent of young adults with SMI

(Figure 74). For young adults with SMI, the 2018 estimate

of the perceived unmet need for mental health services was

higher than the estimates in most years from 2008 to 2016,

but it was similar to the estimate in 2017.

About 726,000 of the 1.5 million young adults aged 18 to 25

in 2018 with SMI who perceived an unmet need for mental

Figure 74. 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: 2008-2018

Percent with Perceived Unmet Need for

Mental Health Services in Past Year

20182017201620152014201320122011201020092008

18 or Older 18 to 25 26 to 49 50 or Older

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 74 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: 2008-2018

Age 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

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

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

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

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

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

health services did not receive any mental health services in

the past year, or 47.0 percent of these young adults (2018

DT 10.26). e 2018 percentage of young adults with SMI

and a perceived unmet need for mental health services who

did not receive any mental health services was similar to the

percentages in all years from 2008 to 2017, ranging from

40.6 to 49.1 percent.

Aged 26 to 49

In 2018, approximately 2.7 million adults aged 26 to 49

with SMI perceived an unmet need for mental health care in

the past year, or 45.2 percent of adults in this age group with

SMI (Figure 74). Among adults with SMI who were aged

26 to 49, the 2018 estimate of the perceived unmet need for

mental health services was similar to the estimates in most

years from 2008 to 2017.

About 905,000 of the 2.7 million adults aged 26 to 49 in

2018 with SMI who perceived an unmet need for mental

health services in the past year did not receive any mental

health services (2018 DT 10.23), or 34.0 percent of these

adults who perceived an unmet need for mental health

services (2018 DT 10.26). For adults aged 26 to 49 with

SMI who perceived an unmet need for mental health

services, the percentages who did not receive any mental

health services remained steady between 2008 and 2018

(ranging from 26.8 to 36.3 percent).

Aged 50 or Older

In 2018, about 907,000 adults aged 50 or older with SMI

perceived an unmet need for mental health care in the

past year, corresponding to 31.9 percent of adults in this age

group with SMI (Figure 74). Among adults aged 50 or older

with SMI, the 2018 estimate of the perceived unmet need

for mental health services was similar to the estimates in

most years from 2008 to 2017.

e percentage of adults aged 50 or older with SMI and a

perceived unmet need for mental health care who did not

receive any mental health services in the past year did not

meet the criteria for statistical precision (2018 DT 10.26).

erefore, trends are not discussed for these estimates among

adults in this age group.

Reasons for Not Receiving Mental Health Services among

Adults with Mental Illness and a Perceived Unmet Need

Among adults aged 18 or older in 2018 with AMI in the

past year and among adults with SMI in the past year who

had a perceived unmet need for mental health services

but who did not receive services in the past year, the most

common reason for not receiving services was that these

adults could not aﬀord the cost of care. About 2 out of 5

adults with AMI (45.2 percent) (2018 DT 8.34) and slightly

more than half of adults with SMI (54.7 percent) (2018

DT 8.35) who perceived an unmet need for mental health

services did not receive services because they could not aﬀord

the cost of care.

Other reasons in 2018 for not receiving mental health care

among adults aged 18 or older with mental illness included

not knowing where to go for services and believing that they

could handle the problem without treatment. Among adults

with AMI who had a perceived unmet need for mental health

care and did not receive services in the past year, 29.6 percent

believed at the time that they could handle the problem

without treatment, and 29.3 percent did not know where to

go for services (2018 DT 8.34). In addition, 21.3 percent of

these adults with AMI did not have the time to go for care.

Among corresponding adults aged 18 or older in 2018 with

SMI, 25.4 percent did not receive services because they

believed at the time they could handle the problem without

treatment (2018 DT 8.35), and 31.6 percent did not know

where to go for services. An estimated 22.5 percent of these

adults with SMI were concerned about being committed to a

psychiatric hospital or having to take medication.

Receipt of Services for Co‑Occurring Substance

Use Disorder and Mental Health Issues

People with co-occurring SUD and mental health issues may

receive services to help with either or both of these issues.

is section presents estimates of the receipt of services

among adolescents and adults with co-occurring SUD and

mental health issues.

Receipt of Services among Adolescents with

Co‑Occurring MDE and a Substance Use Disorder

Among the 358,000 adolescents aged 12 to 17 in 2018

who had a co-occurring MDE and an SUD in the past year,

234,000 received either substance use treatment at a

specialty facility or mental health services in the past year

(2018 DT 11.14). is number of adolescents who received

mental health care or specialty substance use treatment

corresponds to 65.7 percent of adolescents who had a

co-occurring MDE and an SUD (Figure 75). Stated another

way, more than a third of adolescents with both an MDE

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health64

and an SUD in the past year did not receive either type of

service. Among adolescents in 2018 with a co-occurring

MDE and an SUD, 5.4 percent received both mental health

care and specialty substance use treatment, 59.5 percent

received only mental health care, and 0.8 percent received

only specialty substance use treatment.

Receipt of Services among Adults with Co‑Occurring

AMI and a Substance Use Disorder

Among the 9.2 million adults aged 18 or older in 2018

with co-occurring AMI and an SUD in the past year, about

4.7 million received either substance use treatment at a

specialty facility

or mental health care in the past year, or

about half of these adults (51.4 percent) (Figure 76). us,

48.6 percent of adults with co-occurring AMI and an SUD

did not receive either type of care. e percentages of adults

in 2018 with co-occurring AMI and an SUD who received

either type of service was similar to the percentages in all

years from 2015 to 2017, ranging from 48.0 to 51.0 percent.

Stated another way, however, about half of the adults in

each year who had co-occurring AMI and an SUD in the

past year did not receive either type of service.

An estimated 7.0 percent of adults aged 18 or older in 2018

with these co-occurring disorders received both mental

health services and specialty substance use treatment in the

past year (Figure 76), 41.0 percent received only mental

health services, and 3.3 percent received only specialty

substance use treatment (2018 DT 10.27). e percentage

of adults with co-occurring AMI and an SUD who received

both mental health care and specialty substance use

treatment remained steady between 2015 and 2018.

Aged 18 to 25

Among young adults aged 18 to 25 in 2018 who had

co-occurring AMI and an SUD in the past year, 43.8 percent

received substance use treatment at a specialty facility or

mental health care in the past year (2018 DT 10.28). e

2018 percentage of young adults with these co-occurring

disorders who received either type of service was higher

than the percentage in 2015 (35.2 percent), but it was

Figure 76. Receipt of Mental Health Services and Specialty

Substance Use Treatment in the PastYear among Adults Aged

18 or Older with PastYear Mental Illness and Substance Use

Disorder: 2015-2018

Percent Receiving Mental Health Services and

Specialty Substance Use Treatment in Past Year

2018201720162015

No Treatment

MH Services or SU Tx

Both MH Services and SU Tx

Figure 76 Table. Receipt of Mental Health Services and Specialty Substance

Use Treatment in the PastYear among Adults Aged 18 or Older with

PastYear Mental Illness and Substance Use Disorder: 2015-2018

Service Type 2015 2016 2017 2018

No Treatment

52.0 51.9 49.0 48.6

Mental Health Services or Specialty

Substance Use Treatment

48.0 48.1 51.0 51.4

Both Mental Health Services and Specialty

Substance Use Treatment

6.8 6.9 8.3 7.0

Figure 75. Receipt of Mental Health Services and Specialty

Substance Use Treatment in the PastYear among Youths Aged

12 to 17 with PastYear Major Depressive Episode and Substance

Use Disorder: 2015-2018

Percent Receiving Mental Health Services and

Specialty Substance Use Treatment in Past Year

2018201720162015

No Treatment

MH Services or SU Tx

Both MH Services and SU Tx

Figure 75 Table. Receipt of Mental Health Services and Specialty Substance

Use Treatment in the PastYear among Youths Aged 12 to 17 with PastYear

Major Depressive Episode and Substance Use Disorder: 2015-2018

Service Type 2015 2016 2017 2018

No Treatment

36.9 28.1 37.3 34.3

Mental Health Services or Specialty

Substance Use Treatment

63.1 71.9 62.7 65.7

Both Mental Health Services and Specialty

Substance Use Treatment

3.8 4.6 5.9 5.4

August 2019

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

similar to the percentages in 2016 and 2017 (42.0 and

46.7 percent, respectively). In each year from 2015 to 2018,

therefore, more than half of young adults with co-occurring

AMI and an SUD in the past year did not receive either

service, including nearly two thirds of young adults in 2015

(64.8 percent).

Among young adults aged 18 to 25 in 2018 who had

co-occurring AMI and an SUD, 37.9 percent received

only mental health care, 3.7 percent received both mental

health care and specialty substance use treatment, and

2.0 percent received only specialty substance use treatment

in the past year (2018 DT 10.28). e 2018 percentage

of young adults with co-occurring AMI and an SUD who

received both mental health services and specialty substance

use treatment was lower than the percentage in 2017

(6.3 percent), but it was similar to the percentages in 2015

(5.4 percent) and 2016 (3.8 percent).

Aged 26 to 49

Among adults aged 26 to 49 in 2018 who had co-occurring

AMI and an SUD in the past year, 49.5 percent received

mental health care or substance use treatment at a specialty

facility in the past year (2018 DT 10.30). e percentages

of adults in this age group with co-occurring AMI and an

SUD who received either type of service remained steady

between 2015 and 2018, ranging from 47.9 to 52.6 percent.

However, about half of adults in this age group in 2015

to 2018 who had co-occurring AMI and an SUD did not

receive either service.

Among adults aged 26 to 49 in 2018 who had co-occurring

AMI and an SUD, 38.7 percent received only mental health

care, 8.2 percent received both mental health care and

specialty substance use treatment, and 2.5 percent received

only specialty substance use treatment in the past year (2018

DT 10.30). e percentage of adults in this age group with

co-occurring AMI and an SUD who received both mental

health care and specialty substance use treatment remained

steady between 2015 and 2018.

Aged 50 or Older

Among adults aged 50 or older in 2018 who had

co-occurring AMI and an SUD in the past year, 67.6 percent

received mental health care or substance use treatment at

a specialty facility in the past year (2018 DT 10.31). e

2018 percentage of adults in this age group with these

co-occurring disorders who received either type of service

was similar to the percentages in 2015 and 2016 (57.1

and 56.3 percent, respectively), but it was higher than

the percentage in 2017 (52.6 percent). In 2015 to 2017,

more than 40 percent of adults aged 50 or older with these

co-occurring disorders did not receive either service.

Among adults in this age group in 2018 who had

co-occurring AMI and an SUD, 51.9 percent received only

mental health care, and 8.3 percent received both mental

health care and specialty substance use treatment (2018

DT 10.31). e percentage of adults aged 50 or older with

co-occurring AMI and an SUD who received both types of

services remained steady between 2015 and 2018.

Receipt of Services among Adults with Co‑Occurring

SMI and a Substance Use Disorder

Among the 3.2 million adults aged 18 or older in 2018

who had co-occurring SMI and an SUD in the past year,

69.5 percent received either substance use treatment at a

specialty facility or mental health care in the past year, and

30.5 percent did not receive either type of care (Figure 77).

e 2018 percentage of adults with these co-occurring

disorders who received either type of care was higher than

the percentage in 2015, but it was similar to the percentages

in 2016 and 2017. Stated another way, however, about 1

in 3 adults in 2015 to 2018 with co-occurring SMI and an

SUD did not receive either type of care.

Among adults aged 18 or older in 2018 with co-occurring

SMI and an SUD, 10.9 percent received both mental health

care and specialty substance use treatment, 55.9 percent

received only mental health care, and 2.7 percent received

only specialty substance use treatment (2018 DT 10.27).

e percentage of adults with co-occurring SMI and an

SUD who received both mental health care and specialty

substance use treatment remained steady between 2015 and

2018 (

Figure 77).

Aged 18 to 25

Among young adults aged 18 to 25 in 2018 with

co-occurring SMI and an SUD, 60.1 percent received either

mental health care or specialty substance use treatment in the

past year (2018 DT 10.28). e 2018 percentage of young

adults with these co-occurring disorders who received either

type of care was similar to the percentages in 2015 to 2017

(ranging from 53.1 to 59.2 percent). In each year from 2015

to 2018, however, at least 40 percent of young adults with

co-occurring SMI and an SUD did not receive either service.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health66

August 2019

In 2018, about 5.8 percent of young adults aged 18 to 25

with SMI and an SUD received both mental health care and

specialty substance use treatment, 52.8 percent received only

mental health care, and 1.5 percent received only specialty

substance use treatment in the past year (2018 DT 10.28). e

percentage of young adults with co-occurring SMI and an SUD

who received both mental health care and specialty substance

use treatment remained steady between 2015 and 2018.

Aged 26 to 49

Among adults aged 26 to 49 in 2018 with co-occurring

SMI and an SUD, 67.2 percent received either mental

health care or specialty substance use treatment, including

13.7 percent who received both mental health care and

specialty substance use treatment, 51.6 percent who received

only mental health care, and 1.9 percent who received only

specialty substance use treatment in the past year (2018

DT 10.30). e percentages of adults in this age group with

co-occurring SMI and an SUD who received either type

of service or received both types of service remained steady

between 2015 and 2018. Among adults aged 26 to 49 in

2015 to 2018 who had co-occurring SMI and an SUD, 31.0

to 34.6 percent did not receive either service.

Aged 50 or Older

In 2015 to 2018, estimates for the receipt of services among

adults aged 50 or older with co-occurring SMI and an

SUD were not reported because of low precision (2018

DT 10.31).

Figure 77. Receipt of Mental Health Services and Specialty

Substance Use Treatment in the PastYear among Adults Aged 18

or Older with PastYear Serious Mental Illness and Substance Use

Disorder: 2015-2018

Percent Receiving Mental Health Services and

Specialty Substance Use Treatment in Past Year

2018201720162015

No Treatment

MH Services or SU Tx

Both MH Services and SU Tx

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Figure 77 Table. Receipt of Mental Health Services and Specialty Substance

Use Treatment in the PastYear among Adults Aged 18 or Older with

PastYear Serious Mental Illness and Substance Use Disorder: 2015-2018

Service Type 2015 2016 2017 2018

No Treatment

37.4

34.4 36.0 30.5

Mental Health Services or Specialty

Substance Use Treatment

62.6

65.6 64.0 69.5

Both Mental Health Services and Specialty

Substance Use Treatment

11.0 12.0 11.8 10.9

Difference between this estimate and the 2018 estimate is statistically significant at the .05 level.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

Endnotes

1. Hasin, D. S., & Grant, B. F. (2015). e 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

2. World Health Organization. (2013). Mental health action plan

2013 ‒ 2020. Retrieved from http://www.who.int/mental_health/

publications/action_plan/en/

3. Reeves, W. C., Strine, T. W., Pratt, L. A., ompson, 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

4. Murray, 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

5. is 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 2018 NSDUH

available at https://www.samhsa.gov/data/.

6. In this report, terms such as “Americans,” “people in this country,”

“general population,” or similar terms are used broadly to refer to the

civilian, noninstitutionalized population covered by NSDUH. Although

some people in the general population of the United States are outside of

the civilian, noninstitutionalized population, information from the 2010

census suggests the civilian, noninstitutionalized population includes at

least 97 percent of the total U.S. population. See the following reference:

Lofquist, D., Lugaila, T., O’Connell, M., & Feliz, S. (2012, April).

Households and families: 2010 (C2010BR-14, 2010 Census Briefs).

Retrieved from https://www.census.gov/prod/cen2010/briefs/c2010br-14.

pdf

Details about the sample design, weighting, and interviewing results

for the 2018 NSDUH are provided in Sections 2.1, 2.3.4, and 3.3.1 of

CBHSQ (2019). In particular, Tables 2.1 and 2.2 in CBHSQ (2019)

provide sample design information on the targeted numbers of completed

interviews by state and by age group, respectively. e report also

discusses diﬀerences in the current sample allocation compared with the

allocation used from 2002 to 2013. See the following reference: Center

for Behavioral Health Statistics and Quality. (2019). 2018 National

Survey on Drug Use and Health: Methodological summary and deﬁnitions.

Retrieved from

https://www.samhsa.gov/data/

8. Overall response rates are not calculated for adolescents or adults because

the screening response rate is not speciﬁc to age groups.

Center for Behavioral Health Statistics and Quality. (2019).

National Survey on Drug Use and Health: Methodological summary and

deﬁnitions. Retrieved from

https://www.samhsa.gov/data/

10. For methodological reasons, the 2018 NSDUH estimates 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.

11. Estimates presented in this report have been weighted to reﬂect

characteristics of the civilian, noninstitutionalized population aged 12

or older in the United States. e 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.

12.

For 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. (2019). 2018 National

Survey on Drug Use and Health: Methodological summary and deﬁnitions.

Retrieved from https://www.samhsa.gov/data/

13. Changes in survey content and methodology make current NSDUH

estimates not comparable with NSDUH data collected prior to 2002. For

selected measures since 2015, comparability with estimates prior to 2015

also has been aﬀected. Details about recent questionnaire changes and

their eﬀects on the comparability of estimates are provided in Section C

of CBHSQ (2016). See the following reference: Center for Behavioral

Health Statistics and Quality. (2016). 2015 National Survey on Drug

Use and Health: Methodological summary and deﬁnitions. Retrieved from

https://www.samhsa.gov/data/

14. If the number of people in the population with a characteristic of interest

has increased (e.g., the number of substance users) simply because the size

of the overall population has increased, then the percentages will control

for the increases both in the number of people with the characteristic of

interest and the total number of people in the population.

15. Where trends in this report involve more than 4 years of data, the

term “most years” is used when the 2018 estimate is either similar to

or signiﬁcantly diﬀerent from the estimates in the majority of years

referenced in the sentence.

16. Anomalous diﬀerences between 2 years of data usually “correct”

themselves with 1 or 2 additional years of data. For estimates that started

a new baseline in 2015, additional years of data also will be useful for

monitoring whether the trends observed for 2015 to 2018 continue to

hold or to change as part of longer-term trends.

17. NSDUH does not currently ask separate questions about the vaping of

nicotine.

18. See 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/

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health68

August 2019

19. Recent increases in vaping nicotine have resulted in changes in adolescent

tobacco use. Findings from the 2018 National Youth Tobacco Survey

(NYTS) and Monitoring the Future Study indicate increases in vaping

nicotine (Cullen et al., 2018; Johnston et al., 2019; U.S. Food and Drug

Administration [FDA], 2019). e NYTS data suggest vaping nicotine is

reversing declines in overall tobacco use among adolescents. In addition,

vaping of nicotine products among adolescents has been identiﬁed as

a risk factor for future cigarette use (FDA, 2019), which may aﬀect

long-term cigarette use trends. See the following three references:

Cullen, K. A., Ambrose, B. M., Gentzke, A. S., Apelberg, B. J., Jamal, A.,

& King, B. A. (2018). Notes from the ﬁeld: Use of electronic cigarettes

and any tobacco product among middle and high school students—

United States, 2011–2018. Morbidity and Mortality Weekly Report,

67(45), 1276-1277. https://doi.org/10.15585/mmwr.mm6745a5

Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G.,

Schulenberg, J. E., & Patrick, M. E. (2019). Monitoring the Future

national survey results on drug use 1975‑2018: 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-overview2018.pdf

U.S. Food and Drug Administration. (2019). 2018 NYTS data: A

startling rise in youth e‑cigarette use. Retrieved from https://www.fda.gov

20. In NSDUH, a “drink” is 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 only had a sip or two from a drink are not

considered to be alcohol consumption.

21. e 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. e 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

2018 for binge and heavy alcohol use among males are available in the

2018 NSDUH detailed tables at https://www.samhsa.gov/data/.

22. e 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). is

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

23. ese estimates were calculated from special analyses but are not included

in the appendix tables or in the 2018 detailed tables.

24. e NSDUH questionnaire includes 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.

25.

All questions for speciﬁc pain relievers in the NSDUH questionnaire ask

about opioid pain relievers, but respondents could specify they misused

other pain relievers that are not opioids. Nevertheless, in 2015 to 2018,

about 97 percent or more of individuals in each year who misused

prescription pain relievers in the past year misused a prescription opioid

pain reliever. For more information on this topic, see Chapter 4 of the

following reference: Center for Behavioral Health Statistics and Quality.

(2019). 2018 National Survey on Drug Use and Health: Methodological

summary and deﬁnitions. Retrieved from https://www.samhsa.gov/data/

26. e 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.

27.

LSD = 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. (2019). 2018 National Survey on

Drug Use and Health: Methodological summary and deﬁnitions. Retrieved

from https://www.samhsa.gov/data/

28. Desoxyn® was not mentioned in 2018 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.

29. For 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 FDA’s Center for Drug

Evaluation and Research website at https://www.fda.gov/Drugs/.

30. Respondents who reported use of benzodiazepines in sections other than

for tranquilizers or sedatives (e.g., pain relievers) were not included in the

measures of benzodiazepine use or misuse.

31. Examples 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.

32. To 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.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

41. Survey 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.

42. American Psychiatric Association. (1994). Diagnostic and statistical

manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: Author.

43.

e DSM-IV criteria for SUDs include separate criteria for dependence

or abuse. Individuals 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. (2019). 2018 National Survey on

Drug Use and Health: Methodological summary and deﬁnitions. Retrieved

from https://www.samhsa.gov/data/

44. Respondents 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.

45. American Psychiatric Association. (2013). Diagnostic and statistical

manual of mental disorders (DSM-5) (5th ed.). Arlington, VA: Author.

46. Adolescents 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

enjoy. Adolescents who reported any of these problems were asked further

questions about having an MDE in their lifetime, including whether they

had at least ﬁve of 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 daily activities. Unlike questions

for adults, adolescents who reported gaining weight without trying were

asked if this occurred because they were growing. ose who had lifetime

MDE were asked if they had a period of time in the past 12 months

when they felt depressed or lost interest or pleasure in daily activities for

2 weeks or longer, and they reported they had some of their other lifetime

MDE symptoms in the past 12 months. ese adolescents were deﬁned as

having past year MDE.

47. Adults 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 having an MDE in their lifetime,

including whether they had at least ﬁve of 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 daily activities.

ose who had lifetime MDE were asked if they had a period of time in

the past 12 months when they felt depressed or lost interest or pleasure in

daily activities for 2 weeks or longer, and they reported they had some of

their other lifetime MDE symptoms in the past 12 months. ese adults

were deﬁned as having past year MDE. Data on MDE in the past year for

adults are available in NSDUH since 2005.

48. Data on MDE with severe impairment for adults are available since 2009.

49. Questions measuring adolescents’ impairment in carrying out life

activities because of MDE were added to the survey in 2006.

33. Estimates 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.

34. For 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. us, past year initiates of

the use of substances other than prescription psychotherapeutic drugs

reported their ﬁrst use within 12 months of the interview date.

35. Assessing whether respondents in the 2018 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 2018 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 deﬁned

as being past year initiates of the misuse of any prescription drug in the

overall category. is answer meant respondents had never misused any

prescription drug in that category more than 12 months prior to the

interview date.

36.

More 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. (2019). 2018 National Survey on

Drug Use and Health: Methodological summary and deﬁnitions. Retrieved

from https://www.samhsa.gov/data/

37. Numbers in Figure 26 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.

38. Past year initiates of crack cocaine use were counted as past year initiates

of cocaine use only if they had not previously used cocaine in any form.

39. For more information, see Section B.2.3 in the following reference:

Center for Behavioral Health Statistics and Quality. (2017). 2016

National Survey on Drug Use and Health: Methodological summary and

deﬁnitions. Retrieved from https://www.samhsa.gov/data/

40. 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.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health70

August 2019

50.

In order to generate estimates of AMI and SMI in the United States,

SAMHSA designed and implemented the Mental Health Surveillance

Study (MHSS). From 2008 to 2012, a subsample of adults was selected

from the main NSDUH study to participate in a follow-up telephone

interview that obtained a detailed mental health assessment administered

by trained mental health clinicians. e MHSS interview used the

Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research

Version, Non-patient Edition (SCID-I/NP). A prediction model created

from clinical interview data was applied to data from the 2008 to 2015

NSDUHs to produce estimates of AMI for the entire NSDUH adult

sample in these years. e SCID instrument is available in First, Spitzer,

Gibbon, and Williams (2002), and information on the deﬁnitions and

estimation methods for the mental illness estimates are provided in

Section 3.4.7 and Appendix A of CBHSQ (2019). See the following

references:

Center for Behavioral Health Statistics and Quality. (2019). 2018

National Survey on Drug Use and Health: Methodological summary and

deﬁnitions. Retrieved from https://www.samhsa.gov/data/

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.

51. Estimated numbers of adults aged 18 or older with SMI or AMI

excluding SMI do not sum to the estimated number of adults with AMI

due to rounding.

52. Centers for Disease Control and Prevention, National Center for Injury

Prevention and Control. (2018). National Violent Death Reporting System

(NVDRS): About NVDRS, NVDRS overview fact sheet. Retrieved from

https://www.cdc.gov/violenceprevention/datasources/nvdrs/

53. Stone, 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 suicide rates — United States, 1999-2016 and

circumstances contributing to suicide — 27 states, 2015. Morbidity and

Mortality Weekly Report, 67(22), 617-624. Retrieved from https://www.

cdc.gov/mmwr/volumes/67/wr/pdfs/mm6722a1-H.pdf

54. Crosby, 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

55. Han, 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

56. Specialty treatment 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. is NSDUH deﬁnition

historically has not considered emergency rooms, private doctors’

oﬃces, prisons or jails, and self-help groups to be specialty substance use

treatment facilities.

57.

e NSDUH deﬁnition of the need for treatment does not explicitly

indicate the need for treatment at a specialty facility. People who had an

SUD in the past year can be considered to need some form of assistance

for their problems with substance use. However, individuals who met

DSM-IV criteria for abuse but not dependence may not necessarily need

treatment at a specialty facility. For more information about the DSM-IV

criteria for having an SUD, see Section 3.4.3 and the deﬁnitions for abuse

and dependence in Appendix A of CBHSQ (2019). See the following

references:

American Psychiatric Association. (1994). Diagnostic and statistical

manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: Author.

Center for Behavioral Health Statistics and Quality. (2019). 2018

National Survey on Drug Use and Health: Methodological summary and

deﬁnitions. Retrieved from https://www.samhsa.gov/data/

58. Because there were 20.3 million people aged 12 or older in 2018 with an

SUD in the past year, about 95 percent of the people in 2018 who needed

treatment for a substance use problem were deﬁned as such because

they had an SUD in the past year, regardless of whether they received

substance use treatment at a specialty facility.

59. Estimated numbers of people in Figure 66 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

due to rounding.

60. Health 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.

61. e 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.

62. Percentages that readers calculate from estimated numbers of adults with

a perceived unmet need for mental health services may not agree with

reported percentages because the estimated numbers are rounded to the

nearest 0.1 million adults.

63. Percentages for the receipt of speciﬁc types of services do not sum to the

total percentage who received any type of service due to rounding.

Key Substance Use and Mental Health Indicators in the United States:

Results from the 2018 National Survey on Drug Use and Health August 2019

A-1

AppendixA: Supplemental Tables of Estimates for Key Substance Use and Mental Health

Indicators in the United States

A-2

Table A.1B Types of Illicit Drug, Tobacco Product, and Alcohol Use in the Past Month among Individuals Aged 12 or Older: 2002-2018

Substance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

ILLICIT DRUGS nc nc nc nc nc nc nc nc nc nc nc

Marijuana 6.2

(0.14) 6.2* (0.14) 6.1

(0.15) 6.0

(0.15) 5.8

(0.14) 6.1

(0.15) 6.7

(0.16) 6.9

(0.16) 7.0

(0.16) 7.3

(0.17)

Cocaine

0.9

(0.05) 1.0* (0.06) 0.8 (0.05) 1.0

(0.06) 1.0

(0.06) 0.8 (0.06) 0.7 (0.05) 0.7 (0.05) 0.6

(0.04) 0.5

(0.04) 0.6 (0.05)

Crack 0.2

(0.03) 0.3* (0.04) 0.2 (0.03) 0.3

(0.04) 0.3

(0.04) 0.2

(0.03) 0.1 (0.02) 0.2 (0.03) 0.1 (0.02) 0.1

(0.02) 0.2 (0.04)

Heroin 0.1

(0.02) 0.1* (0.01) 0.1

(0.02) 0.1

(0.01) 0.1 (0.03) 0.1

(0.02) 0.1 (0.02) 0.1

(0.01) 0.1 (0.02) 0.1 (0.02) 0.1 (0.02)

Hallucinogens nc nc nc nc nc nc nc nc nc nc nc

LSD 0.0* (0.01) 0.1* (0.01) 0.1* (0.01) 0.0* (0.01) 0.1* (0.01) 0.1* (0.01) 0.1* (0.01) 0.1* (0.01) 0.1* (0.01) 0.1* (0.01) 0.1* (0.01)

PCP 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 (0.00) 0.0 (0.01) 0.0 (0.01) 0.0 (0.00) 0.0 (0.00)

Ecstasy nc nc nc nc nc nc nc nc nc nc nc

Inhalants nc nc nc nc nc nc nc nc nc nc nc

Methamphetamine nc nc nc nc nc nc nc nc nc nc nc

Misuse of Psychotherapeutics nc nc nc nc nc nc nc nc nc nc nc

Pain Relievers nc nc nc nc nc nc nc nc nc nc nc

Stimulants nc nc nc nc nc nc nc nc nc nc nc

Tranquilizers or Sedatives nc nc nc nc nc nc nc nc nc nc nc

Tranquilizers nc nc nc nc nc nc nc nc nc nc nc

Sedatives nc nc nc nc nc nc nc nc nc nc nc

Benzodiazepines -- -- -- -- -- -- -- -- -- -- --

Opioids nc nc nc nc nc nc nc nc nc nc nc

Illicit Drugs Other Than Marijuana nc nc nc nc nc nc nc nc nc nc nc

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) 26.7* (0.34)

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) 22.1* (0.32)

Smokeless Tobacco nc 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) 5.2* (0.15)

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) 1.0* (0.07)

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) 52.1 (0.39)

Binge Alcohol Use nc nc nc nc nc nc nc nc nc nc nc

Heavy Alcohol Use nc nc nc nc nc nc nc nc nc nc nc

SUBSTANCE USE

Illicit Drugs, Tobacco Products, or

Alcohol nc nc nc nc nc nc nc nc nc nc nc

Illicit Drugs or Alcohol nc 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) 61.0

(0.37)

NOTE: Footnotes and source information are shown at the end of the second half of this table.

A-3

Table A.1B Types of Illicit Drug, Tobacco Product, and Alcohol Use in the Past Month among Individuals Aged 12 or Older: 2002-2018 (continued)

Substance 2013 2014 2015 2016 2017 2018

ILLICIT DRUGS nc nc 10.1

(0.17) 10.6

(0.18) 11.2 (0.19) 11.7 (0.21)

Marijuana 7.5

(0.17) 8.4

(0.16) 8.3

(0.15) 8.9

(0.16) 9.6

(0.18) 10.1 (0.20)

Cocaine

0.6 (0.05) 0.6

(0.04) 0.7 (0.05) 0.7 (0.04) 0.8 (0.05) 0.7 (0.05)

Crack 0.1 (0.02) 0.1 (0.02) 0.1 (0.02) 0.2 (0.02) 0.2 (0.03) 0.2 (0.03)

Heroin 0.1 (0.02) 0.2 (0.02) 0.1 (0.02) 0.2 (0.02) 0.2 (0.02) 0.1 (0.02)

Hallucinogens nc nc 0.5

(0.03) 0.5 (0.03) 0.5 (0.03) 0.6 (0.04)

LSD 0.1* (0.01) 0.1

(0.02) 0.1 (0.01) 0.1 (0.02) 0.2 (0.02) 0.2 (0.02)

PCP 0.0 (0.01) ** (**) 0.0 (0.00) 0.0 (0.00) 0.0 (0.01) 0.0 (0.00)

Ecstasy nc nc 0.2 (0.02) 0.2 (0.02) 0.2 (0.02) 0.3 (0.02)

Inhalants nc nc 0.2 (0.02) 0.2 (0.02) 0.2 (0.02) 0.2 (0.02)

Methamphetamine nc nc 0.3 (0.03) 0.2

(0.03) 0.3 (0.03) 0.4 (0.04)

Misuse of Psychotherapeutics nc nc 2.4

(0.08) 2.3

(0.08) 2.2 (0.08) 2.0 (0.08)

Pain Relievers nc nc 1.4

(0.06) 1.2

(0.06) 1.2 (0.06) 1.0 (0.06)

Stimulants nc nc 0.6 (0.04) 0.6 (0.04) 0.7 (0.04) 0.6 (0.04)

Tranquilizers or Sedatives nc nc 0.8

(0.05) 0.9

(0.05) 0.7 (0.04) 0.7 (0.05)

Tranquilizers nc nc 0.7 (0.04) 0.7

(0.04) 0.6 (0.04) 0.6 (0.04)

Sedatives nc nc 0.2

(0.02) 0.2

(0.03) 0.1 (0.02) 0.1 (0.02)

Benzodiazepines -- -- -- -- -- --

Opioids nc nc 1.5* (0.06) 1.4* (0.06) 1.3* (0.06) 1.1 (0.06)

Illicit Drugs Other Than Marijuana nc nc 3.5 (0.10) 3.4 (0.10) 3.4 (0.10) 3.2 (0.10)

TOBACCO PRODUCTS 25.5* (0.32) 25.2* (0.28) 23.9* (0.26) 23.5* (0.27) 22.4* (0.26) 21.5 (0.27)

Cigarettes 21.3* (0.30) 20.8* (0.26) 19.4* (0.25) 19.1* (0.25) 17.9* (0.25) 17.2 (0.25)

Smokeless Tobacco nc nc 3.4* (0.11) 3.3* (0.10) 3.2* (0.09) 2.9 (0.09)

Cigars 4.7 (0.14) 4.5 (0.11) 4.7 (0.12) 4.6 (0.11) 4.6 (0.11) 4.5 (0.12)

Pipe Tobacco 0.9 (0.06) 0.8 (0.05) 0.8 (0.05) 0.8 (0.05) 0.9 (0.05) 0.8 (0.04)

ALCOHOL 52.2* (0.41) 52.7* (0.33) 51.7 (0.32) 50.7 (0.31) 51.7 (0.33) 51.1 (0.37)

Binge Alcohol Use nc nc 24.9 (0.27) 24.2 (0.26) 24.5 (0.27) 24.5 (0.26)

Heavy Alcohol Use nc nc 6.5* (0.14) 6.0 (0.14) 6.1 (0.13) 6.1 (0.14)

SUBSTANCE USE

Illicit Drugs, Tobacco Products, or

Alcohol nc nc 60.9 (0.30) 60.2 (0.30) 60.7 (0.32) 60.2 (0.35)

Illicit Drugs or Alcohol nc nc 54.1 (0.31) 53.4 (0.32) 54.3 (0.33) 53.9 (0.36)

Tobacco Products or Alcohol 60.6

(0.39) 61.0

(0.31) 59.8* (0.30) 58.9 (0.30) 59.4 (0.32) 58.8 (0.35)

** = Low precision; no estimate reported; -- = not available; nc = not comparable due to methodological changes.

NOTE: Estimates shown are percentages with standard errors included in parentheses.

NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.

NOTE: Additional estimates may be found in the detailed tables for the 2018 NSDUH at https://www.samhsa.gov/data/

. Measures and terms are defined in Appendix A of the 2018 NSDUH detailed tables.

* The difference between this estimate and the 2018 estimate is statistically significant at the .05 level. Rounding may make the estimates appear identical.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2018.

A-4

Table A.2B Type of Tobacco Product Use among Past Month Tobacco Users Aged 12 or Older, by Age Group: 2018

Tobacco Product Use Total 12 to 17 18 to 25 26 or Older

Only Cigarettes 65.5 (0.58) 37.3 (2.20) 50.3 (0.97) 68.9 (0.65)

Cigarettes and Some Other Type of Tobacco Product 14.4 (0.40) 26.5 (2.17) 23.8 (0.83) 12.4 (0.46)

Only Noncigarette Tobacco Products 20.1 (0.51) 36.1 (2.17) 25.9 (0.81) 18.7 (0.58)

NOTE: Estimates shown are percentages with standard errors included in parentheses.

NOTE: Additional estimates may be found in the detailed tables for the 2018 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2018 NSDUH detailed tables.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2018.

Table A.3A Average Number of Initiates per Day among Individuals Aged 12 or Older, by Age Group: 2018

Substance Aged 12 or Older Aged 12 to 17 Aged 18 or Older Aged 18 to 25 Aged 26 or Older

TOBACCO PRODUCTS

Cigarettes 5,000 (243) 1,564 (104) 3,436 (210) 3,126 (179) 310 (79)

Daily Cigarette Use 1,357 (117) 171 (30) 1,186 (115) 967 (95) 220 (65)

Smokeless Tobacco 2,515 (182) 841 (68) 1,674 (165) 1,134 (105) 540 (126)

Cigars 6,229 (276) 1,350 (84) 4,879 (259) 3,414 (175) 1,465 (171)

ALCOHOL 13,365 (355) 6,521 (207) 6,845 (258) 6,673 (234) 171 (43)

ILLICIT DRUGS

Marijuana 8,387 (282) 3,668 (153) 4,719 (246) 3,281 (175) 1,438 (167)

Cocaine 2,394 (183) 204 (41) 2,190 (180) 1,686 (137) 504 (92)

Crack 276 (72) ** (**) 266 (72) 98 (28) 168 (64)

Heroin 321 (66) ** (**) 302 (65) 97 (27) 205 (59)

Hallucinogens 3,057 (197) 640 (64) 2,417 (186) 1,732 (139) 685 (118)

LSD 2,131 (166) 388 (49) 1,743 (160) 1,281 (116) 462 (97)

PCP 39 (16) ** (**) ** (**) ** (**) ** (**)

Ecstasy 1,979 (159) 289 (48) 1,690 (152) 1,260 (123) 430 (90)

Inhalants 1,579 (124) 843 (78) 737 (92) 577 (75) 160 (52)

Methamphetamine 561 (84) 85 (22) 477 (80) 186 (39) 291 (70)

Misuse of Psychotherapeutics

Pain Relievers 5,228 (330) 849 (77) 4,378 (316) 1,271 (98) 3,108 (298)

Tranquilizers 3,315 (242) 590 (64) 2,725 (234) 1,190 (103) 1,535 (209)

Stimulants 2,743 (175) 497 (53) 2,246 (166) 1,418 (110) 828 (127)

Sedatives 689 (104) 98 (27) 591 (99) 199 (43) 391 (90)

** = Low precision; no estimate reported.

NOTE: Estimates shown are unrounded averages with standard errors included in parentheses.

NOTE: Additional estimates may be found in the detailed tables for the 2018 NSDUH at https://www.samhsa.gov/data/. Measures and terms are defined in Appendix A of the 2018 NSDUH detailed tables.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2018.

A-5

Table A.4 Perceived Recovery from Substance Use Problems or Mental Health Issues among Adults Aged 18 or Older, by Age Group: Numbers in Thousands and

Percentages: 2018

Measure

Aged 18 or Older Aged 18 to 25 Aged 26 to 49 Aged 50 or Older

Number

Percent

Number

Percent

Number

Percent

Number

Percent

Ever Had a Drug/Alcohol Use

Problem

27,207 (540) 11.0 (0.22) 2,367 (86) 7.0 (0.25) 12,662 (279) 12.7 (0.28) 12,178 (454) 10.8 (0.40)

In Recovery from a Drug/

Alcohol Use Problem

20,221 (468) 8.2 (0.19) 1,627 (74) 4.8 (0.22) 8,961 (236) 9.0 (0.24) 9,633 (397) 8.5 (0.35)

Adults with a Drug/Alcohol Use

Problem

20,221 (501) 74.5 (0.87) 1,627 (78) 68.9 (1.77) 8,961 (255) 70.9 (1.03) 9,633 (422) 79.4 (1.55)

Ever Had a Mental Health Issue

43,649 (628) 17.7 (0.25) 8,898 (156) 26.4 (0.46) 20,239 (344) 20.2 (0.34) 14,512 (451) 12.8 (0.40)

In Recovery from a Mental

Health Issue

30,833 (549) 12.5 (0.22) 5,859 (130) 17.4 (0.39) 13,643 (290) 13.6 (0.29) 11,331 (418) 10.0 (0.37)

Adults with a Mental Health

Issue

30,833 (597) 71.1 (0.64) 5,859 (156) 66.4 (0.87) 13,643 (325) 67.8 (0.85) 11,331 (440) 78.6 (1.38)

NOTE: Respondents were excluded from the analysis if they had unknown information about (a) ever having a drug or alcohol use problem or a mental health issue or (b) perceived recovery from a problem or issue.

Estimates shown are numbers in thousands with standard errors in parentheses.

Estimates shown are percentages with standard errors in parentheses.

The question in the survey asks all adults aged 18 or older, "Do you think you ever had a problem with your own drug or alcohol use?"

The question in the survey asks all adults aged 18 or older, "At this time do you consider yourself to be in recovery or recovered from your own problem with drugs or alcohol use?"

Estimates shown are respondents who answered "yes" to being in "recovery or recovered" among those who answered "yes" to ever having a problem with their own drug or alcohol use.

The question in the survey asks all adults aged 18 or older, "Do you think you ever had a problem with your own mental health?"

The question in the survey asks all adults aged 18 or older, "At this time do you consider yourself to be in recovery or recovered from your own mental health problem?"

Estimates shown are respondents who answered "yes" to being in "recovery or recovered" from a mental health problem among those who answered "yes" to ever having a mental health problem.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2018.

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[back cover]

HHS Publication No. PEP19-5068

2019

U.S. Department of Health and

Human Services

Substance Abuse and Mental Health

Services Administration

Center for Behavioral Health

Statistics and Quality