Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health
trends; behavioral health; substance use; illicit drug use; prescription drug misuse; opioid misuse; pain reliever subtypes; reasons for misusing pain relievers; source of prescription pain relievers; alcohol use; tobacco use; cigarette use; substance use initiation; perceived risk of harm; substance use disorders; SUD; substance dependence or abuse; alcohol use disorder; illicit drug use disorder; opioid use disorder; need for substance use treatment; substance use treatment; specialty substance use treatment; perceived need for substance use treatment; mental illness among adults; any mental illness; AMI; serious mental illness; SMI; mental health service use; mental health service use among adults with mental illness; co-occurring mental health issues and substance use disorders among adults; mental health service use among people with co-occurring mental health issues and substance use disorders; major depressive episode; MDE; treatment for depression; co-occurring MDE and substance use disorders among adolescents; substance use and MDE among adolescents; substance use and mental health issues among adults; suicidal thoughts among adults; suicide plans among adults; suicide attempts among adults; perceived unmet need for mental health services among adults
Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health, Substance Abuse and Mental Health Reports from SAMHSA's Center for Behavioral Health Statistics and Quality
Key Substance Use and Mental Health Indicators in the United States:

Results from the 2019 National Survey on Drug Use and Health

Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), under Contract No. HHSS283201700002C with RTI International. Beth Han was the SAMHSA author. Kathryn Piscopo served as the government project officer and as the contracting officer representative.

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Recommended Citation

Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

Originating Office

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

Nondiscrimination Notice

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

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Behavioral Health Statistics and Quality

Populations Survey Branch

Publication Number PEP20-07-01-001

September 2020

Table of Contents

Summary

Introduction

Survey Background

Data Presentation and Interpretation

Substance Use in the Past Month

Tobacco Use in the Past Month

Cigarette Use

Daily Cigarette Use

Alcohol Use in the Past Month

Any Alcohol Use

Binge Alcohol Use

Heavy Alcohol Use

Underage Alcohol Use

Kratom Use in the Past Month

Illicit Drug Use in the Past Year

Any Illicit Drug Use

Marijuana Use

Cocaine Use

Heroin Use

Methamphetamine Use

Hallucinogen Use

Inhalant Use

Misuse of Psychotherapeutic Drugs

Stimulant Misuse

Tranquilizer or Sedative Misuse

Benzodiazepine Misuse

Pain Reliever Misuse

Opioid Misuse

Initiation of Substance Use

Initiation of Cigarette Smoking

Initiation of Alcohol Use

Initiation of Marijuana Use

Initiation of Cocaine Use

Initiation of Heroin Use

Initiation of Methamphetamine Use

Initiation of Hallucinogen Use

Initiation of Inhalant Use

Initiation of Prescription Stimulant Misuse

Initiation of Prescription Tranquilizer or Sedative Misuse

Initiation of Prescription Pain Reliever Misuse

Perceived Risk from Substance Use

Perceived Risk from Substance Use among Adolescents

Perceived Risk from Substance Use among Young Adults

Perceived Risk from Substance Use among Adults Aged 26 or Older

Age Comparisons for Perceived Risk from Substance Use

Substance Use Disorders in the Past Year

Alcohol Use Disorder

Illicit Drug Use Disorder

Marijuana Use Disorder

Cocaine Use Disorder

Heroin Use Disorder

Methamphetamine Use Disorder

Prescription Stimulant Use Disorder

Prescription Tranquilizer or Sedative Use Disorder

Prescription Pain Reliever Use Disorder

Opioid Use Disorder

Substance Use Disorder (Alcohol or Illicit Drugs)

Major Depressive Episode in the Past Year

MDE and MDE with Severe Impairment among Adolescents

MDE and MDE with Severe Impairment among Adults

Any Mental Illness among Adults in the Past Year

Serious Mental Illness among Adults in the Past Year

Co-Occurring MDE and SUD among Adolescents

Substance Use among Adolescents with MDE

Co-Occurring Mental Health Issues and SUD among Adults

Co-Occurring AMI and SUD

Co-Occurring SMI and SUD

Substance Use among Adults, by Mental Illness Status

Suicidal Thoughts and Behavior among Adults

Had Serious Thoughts of Suicide

Made a Suicide Plan

Attempted Suicide

Substance Use Treatment in the Past Year

Need for Substance Use Treatment

Receipt of Substance Use Treatment

Perceived Need for Substance Use Treatment

Reasons for Not Receiving Substance Use Treatment

Medication-Assisted Treatment for Alcohol Use or Opioid Misuse

Mental Health Service Use in the Past Year

Treatment for Depression among Adolescents

Treatment for Depression among Adults

Any Mental Health Service Use among Adolescents

Any Mental Health Service Use among Adults

Any Mental Health Service Use among Adults with AMI

Any Mental Health Service Use among Adults with SMI

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

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

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

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

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

Perceived Recovery

Endnotes

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

Appendix B: Selected 2019 Detailed Tables That Support Estimates for Key Substance Use and Mental Health Indicators in the United States

Summary

This report summarizes key findings from the 2019 National Survey on Drug Use and Health (NSDUH) for national indicators of substance use and mental health among the civilian, noninstitutionalized population aged 12 or older in the United States. In this report, overall statements use terms such as "increased," "decreased," or "declined" to describe a trend from the baseline year to 2019 that was statistically significant (at the .05 level) based on results of linear or quadratic trend tests. Pairwise t tests also were conducted to compare the estimates in 2019 with corresponding estimates in prior years.

Substance Use

Among people aged 12 or older in 2019, 60.1 percent (or 165.4 million people) used a substance (i.e., tobacco, alcohol, kratom, or an illicit drug) in the past month. In particular, 50.8 percent (or 139.7 million people) drank alcohol in the past month, 21.1 percent (or 58.1 million people) used a tobacco product in the past month, and 13.0 percent (or 35.8 million people) used an illicit drug in the past month. In addition, 0.3 percent (or 825,000 people) used kratom in the past month.

Tobacco Use

Among people aged 12 or older in 2019 who used any tobacco product in the past month, 65.3 percent smoked cigarettes but did not use other tobacco products, 13.8 percent smoked cigarettes and used some other type of tobacco product, and 21.0 percent used only noncigarette tobacco products (i.e., other tobacco products but not cigarettes). Thus, most of the past month tobacco users in the United States were cigarette users.

Among past month tobacco product users in 2019, the percentage who used only cigarettes increased with age (35.4 percent of adolescents aged 12 to 17, 49.6 percent of young adults aged 18 to 25, and 68.5 percent of adults aged 26 or older), but the percentage who used only noncigarette tobacco products decreased with age (39.6 percent of adolescents, 27.9 percent of young adults, and 19.5 percent of adults aged 26 or older).

Among people aged 12 or older, the percentage who were past month cigarette users declined from 26.0 percent (or 61.1 million people) in 2002 to 16.7 percent (or 45.9 million people) in 2019.

Among past month cigarette smokers aged 12 or older, the percentage who smoked cigarettes daily declined from 63.4 percent in 2002 (or 38.7 million people) to 58.4 percent (or 26.8 million people) in 2019.

Alcohol Use

Among the 139.7 million current alcohol users aged 12 or older in 2019, 65.8 million people (47.1 percent) were past month binge drinkers. Among past month binge drinkers, 16.0 million people (24.4 percent of current binge drinkers and 11.5 percent of current alcohol users) were past month heavy drinkers.

Among adolescents aged 12 to 17, the percentage who were past month alcohol users declined from 17.6 percent (or 4.4 million people) in 2002 to 9.4 percent (or 2.3 million people) in 2019. The percentage who were past month binge alcohol users declined from 5.8 percent (or 1.4 million people) in 2015 to 4.9 percent (or 1.2 million people) in 2019.

Among young adults aged 18 to 25, the percentage who were past month alcohol users declined from 61.4 percent (or 19.5 million people) in 2003 to 54.3 percent (or 18.3 million people) in 2019. The percentage who were past month binge alcohol users declined from 39.0 percent (or 13.6 million people) in 2015 to 34.3 percent (or 11.6 million people) in 2019.

Among people aged 12 to 20, the percentage who were past month alcohol users declined from 28.8 percent (or 10.7 million people) in 2002 to 18.5 percent (or 7.0 million people) in 2019. The percentage who were past month binge alcohol users declined from 13.4 percent (or 5.1 million people) in 2015 to 11.1 percent (or 4.2 million people) in 2019, and the percentage who were past month heavy alcohol users declined from 3.3 percent (or 1.3 million people) in 2015 to 2.2 percent (or 825,000 people) in 2019.

Illicit Drug Use

Among people aged 12 or older, the percentage who were past year marijuana users increased from 11.0 percent (or 25.8 million people) in 2002 to 17.5 percent (or 48.2 million people) in 2019. Over this same period, the percentage who were past year cocaine users decreased from 2.5 percent (or 5.9 million people) to 2.0 percent (or 5.5 million people).

Among people aged 12 or older, the percentage who were past year misusers of prescription pain relievers declined from 4.7 percent (or 12.5 million people) in 2015 to 3.5 percent (or 9.7 million people) in 2019.

Among people aged 12 or older, the percentage who were past year misusers of prescription benzodiazepines declined from 2.1 percent (or 5.5 million people) in 2015 to 1.8 percent (or 4.8 million people) in 2019. Among young adults aged 18 to 25, the percentage who were past year misusers of prescription benzodiazepines declined from 5.2 percent (or 1.8 million people) in 2015 to 3.8 percent (or 1.3 million people) in 2019.

Among adults aged 26 or older, the percentage who were past year marijuana users increased from 7.0 percent (or 12.6 million people) in 2002 to 15.2 percent (or 33.0 million people) in 2019. The percentage who were past year hallucinogen users increased from 0.8 percent (or 1.7 million people) in 2015 to 1.5 percent (or 3.1 million people) in 2019. The percentage who were past year methamphetamine users increased from 0.5 percent (or 1.1 million people) in 2016 to 0.8 percent (or 1.7 million people) in 2019.

Initiation of Substance Use

Among people aged 12 or older, the number of past year initiates of marijuana use increased from 2.2 million people in 2002 to 3.5 million people in 2019. The number of past year initiates of cocaine use decreased from 1.0 million in 2002 to 671,000 in 2019.

Among people aged 12 or older, the number of past year initiates of prescription pain reliever misuse declined from 2.1 million people in 2015 to 1.6 million people in 2019. Over this period, the number of past year initiates of prescription tranquilizer misuse declined from 1.4 million people to 949,000 people, and the number of past year initiates of prescription stimulant misuse declined from 1.3 million people to 901,000 people.

Among adolescents aged 12 to 17, the number of past year initiates of cigarette smoking declined from 1.2 million people in 2002 to 541,000 people in 2019. Over this same period, the number of past year initiates of alcohol use declined from 2.6 million adolescents to 2.3 million adolescents, and the number of past year initiates of cocaine use decreased from 310,000 adolescents to 59,000 adolescents. The number of adolescents who were past year initiates of prescription pain reliever misuse declined from 415,000 in 2015 to 245,000 in 2019.

Among young adults aged 18 to 25, the number of past year initiates of alcohol use increased from 1.2 million people in 2002 to 2.4 million people in 2019. Over this same period, the number of past year initiates of marijuana use increased from 733,000 young adults to 1.2 million young adults. The number of young adults who were past year initiates of prescription pain reliever misuse declined from 596,000 in 2015 to 404,000 in 2019.

Among adults aged 26 or older, the number of past year initiates of marijuana use increased from 90,000 people in 2002 to 887,000 people in 2019, but the number of past year initiates of prescription pain reliever misuse remained stable between 2015 and 2019.

Perceived Risk from Substance Use

Among adolescents aged 12 to 17, perceived great risk of harm from smoking marijuana weekly declined from 40.6 percent in 2015 to 34.6 percent in 2019, and perceived great risk of harm from smoking one or more packs of cigarettes per day declined from 68.2 percent to 65.0 percent over this same period.

Among young adults aged 18 to 25, perceived great risk of harm from smoking marijuana weekly declined from 19.1 percent in 2015 to 15.0 percent in 2019.

Among adults aged 26 or older, perceived great risk of harm from smoking marijuana weekly declined from 38.7 percent in 2015 to 30.8 percent in 2019.

Substance Use Disorders

Among people aged 12 or older, the percentage with a past year substance use disorder (SUD) (i.e., alcohol use disorder, illicit drug use disorder, or both) remained stable between 2015 and 2019. Among the 20.4 million people aged 12 or older with a past year SUD in 2019, 71.1 percent (or 14.5 million people) had a past year alcohol use disorder, 40.7 percent (or 8.3 million people) had a past year illicit drug use disorder, and 11.8 percent (or 2.4 million people) had both an alcohol use disorder and an illicit drug use disorder in the past year.

Among people aged 12 or older, the percentage with a past year alcohol use disorder declined from 7.7 percent (or 18.1 million people) in 2002 to 5.3 percent (or 14.5 million people) in 2019. Over that same period, the percentage with a past year cocaine use disorder declined from 0.6 percent (or 1.5 million people) to 0.4 percent (or 1.0 million people).

Among people aged 12 or older, the percentage with a past year prescription pain reliever use disorder decreased from 0.8 percent (or 2.0 million people) in 2015 to 0.5 percent (or 1.4 million people) in 2019. Over that same period, the percentage with a past year opioid use disorder also decreased from 0.9 percent (or 2.4 million people) to 0.6 percent (or 1.6 million people).

Among adolescents aged 12 to 17, the percentage with a past year marijuana use disorder declined from 4.3 percent (or 1.1 million people) in 2002 to 2.8 percent (or 699,000 people) in 2019. Among adults aged 26 or older, however, the percentage with a past year marijuana use disorder increased from 0.8 percent (or 1.4 million people) in 2002 to 1.0 percent (or 2.2 million people) in 2019.

Among adults aged 26 or older, the percentage with a past year methamphetamine use disorder increased from 0.3 percent (or 539,000 people) in 2016 to 0.4 percent (or 904,000 people) in 2019. The percentage with a past year prescription pain reliever use disorder decreased from 0.7 percent (or 1.5 million people) in 2015 to 0.5 percent (or 1.1 million people) in 2019.

Major Depressive Episode

Among adolescents aged 12 to 17, the percentage who had a past year major depressive episode (MDE) increased from 9.0 percent (or 2.2 million people) in 2004 to 15.7 percent (or 3.8 million people) in 2019. The percentage who had a past year MDE with severe impairment increased from 5.5 percent (or 1.4 million people) in 2006 to 11.1 percent (or 2.7 million people) in 2019.

Among young adults aged 18 to 25, the percentage who had a past year MDE increased from 8.8 percent (or 2.8 million people) in 2005 to 15.2 percent (or 5.0 million people) in 2019. The percentage who had a past year MDE with severe impairment increased from 5.2 percent (or 1.7 million people) in 2009 to 10.3 percent (or 3.4 million people) in 2019.

Among adults aged 26 to 49, the percentage who had a past year MDE increased from 7.6 percent (or 7.5 million people) in 2005 to 8.9 percent (or 8.9 million people) in 2019. The percentage who had a past year MDE with severe impairment increased from 4.8 percent (or 4.8 million people) in 2009 to 6.1 percent (or 6.1 million people) in 2019.

Mental Illness among Adults

Among adults aged 18 or older, the percentage who had any mental illness (AMI) in the past year increased from 17.7 percent (or 39.8 million people) in 2008 to 20.6 percent (or 51.5 million people) in 2019. Over that same period, the percentage who had serious mental illness (SMI) in the past year increased from 3.7 percent (or 8.3 million people) to 5.2 percent (or 13.1 million people).

Among young adults aged 18 to 25, the percentage who had AMI in the past year increased from 18.5 percent (or 6.1 million people) in 2008 to 29.4 percent (or 9.9 million people) in 2019. Over that same period, the percentage who had SMI in the past year increased from 3.8 percent (or 1.2 million people) to 8.6 percent (or 2.9 million people).

Among adults aged 26 to 49, the percentage who had AMI in the past year increased from 20.7 percent (or 20.7 million people) in 2008 to 25.0 percent (or 25.3 million people) in 2019. Over that same period, the percentage who had SMI in the past year increased from 4.8 percent (or 4.8 million people) to 6.8 percent (or 6.8 million people).

Co-Occurring Mental Health Issues and Substance Use Disorder

Among adolescents aged 12 to 17 in 2019, 18.7 percent (or 4.5 million people) had either an SUD or an MDE in the past year, 14.1 percent (or 3.4 million people) had an MDE but not an SUD, 2.7 percent (or 682,000 people) had an SUD but not an MDE, and 1.7 percent (or 397,000 people) had both an MDE and an SUD in the past year. These co-occurring MDE and SUD estimates in 2019 were similar to the estimates in each year from 2015 through 2018.

Among adults aged 18 or older in 2019, 24.5 percent (or 61.2 million people) had either AMI or an SUD in the past year, 16.8 percent (or 42.0 million people) had AMI but not an SUD, 3.9 percent (or 9.7 million people) had an SUD but not AMI, and 3.8 percent (or 9.5 million people) had both AMI and an SUD. The percentage who had both AMI and an SUD increased from 3.3 percent (or 8.1 million people) in 2015 to 3.8 percent (or 9.5 million people) in 2019.

Among adults aged 18 or older in 2019, 11.5 percent (or 28.8 million people) had either SMI or an SUD in the past year, 3.8 percent (or 9.6 million people) had SMI but not an SUD, 6.3 percent (or 15.7 million people) had an SUD but not SMI, and 1.4 percent (or 3.6 million people) had both SMI and an SUD. The percentage who had both SMI and an SUD increased from 1.0 percent (or 2.3 million people) in 2015 to 1.4 percent (or 3.6 million people) in 2019.

Substance Use among People with Mental Health Issues

In 2019, adolescents with a past year MDE were more likely than adolescents without a past year MDE to be past year illicit drug users (31.9 vs. 14.4 percent), past year marijuana users (24.6 vs. 11.1 percent), past year opioid misusers (i.e., heroin users or misusers of prescription pain relievers) (4.2 vs. 1.8 percent), past month binge alcohol users (8.9 vs. 4.1 percent), or past month cigarette smokers (4.4 vs. 1.8 percent).

Among adults aged 18 or older in 2019, those with past year SMI or AMI were more likely than those without mental illness in the past year to be past year users of illicit drugs (49.4 percent for SMI and 38.8 percent for AMI vs. 16.6 percent for adults with no mental illness), past year users of marijuana (39.8 and 32.5 percent vs. 14.2 percent), past year misusers of opioids (13.8 and 8.8 percent vs. 2.5 percent), past month binge alcohol users (32.7 and 30.9 percent vs. 24.5 percent), or past month cigarette smokers (33.0 and 27.2 percent vs. 15.8 percent).

Suicidal Thoughts and Behavior among Adults

Among adults aged 18 or older, the percentage who had serious thoughts of suicide in the past year increased from 3.7 percent (or 8.3 million people) in 2008 to 4.8 percent (or 12.0 million people) in 2019. Over that same period, the percentage who made a suicide plan in the past year increased from 1.0 percent (or 2.3 million people) to 1.4 percent (or 3.5 million people). The percentage of adults in 2019 who attempted suicide in the past year did not differ from the percentages in 2008 through 2018.

Substance Use Treatment

Among people aged 12 or older in 2019, 1.5 percent (or 4.2 million people) received any substance use treatment in the past year, and 1.0 percent (or 2.6 million people) received substance use treatment at a specialty facility in the past year.

Among people aged 12 or older in 2019, 2.1 million received substance use treatment at a self-help group, 1.7 million received treatment at a rehabilitation facility as an outpatient, 1.3 million received treatment at a mental health center as an outpatient, 1.0 million received treatment at a rehabilitation facility as an inpatient, and 948,000 received treatment at a private doctor's office. The number of people who received substance use treatment at a private doctor's office increased from 2015 (686,000 people) to 2019.

Among the 21.6 million people aged 12 or older in 2019 who needed substance use treatment in the past year, 12.2 percent (or 2.6 million people) received substance use treatment at a specialty facility in the past year. This percentage in 2019 was similar to the percentages in 2015 to 2018.

Among the 18.9 million people aged 12 or older in 2019 with an SUD in the past year who did not receive treatment at a specialty facility, 95.7 percent (or 18.1 million people) did not feel that they needed treatment, 3.0 percent (or 577,000 people) felt that they needed treatment but did not make an effort to get treatment, and 1.2 percent (or 236,000 people) felt that they needed treatment and made an effort to get treatment.

Treatment for Depression

Among adolescents aged 12 to 17 with a past year MDE, receipt of treatment for depression in the past year increased from 37.8 percent (or 822,000 people) in 2005 to 43.3 percent (or 1.6 million people) in 2019.

Among the 19.4 million adults aged 18 or older in 2019 who had a past year MDE, 66.3 percent (or 12.8 million people) received treatment for depression in the past year. This percentage in 2019 was similar to the percentage in each year from 2009 through 2018.

Any Mental Health Services

Among adolescents aged 12 to 17, the percentage who received mental health services in a specialty mental health setting (inpatient or outpatient care) in the past year increased from 11.8 percent (or 2.9 million people) in 2002 to 16.7 percent (or 4.1 million people) in 2019. Over that same period, the percentage who received mental health services in a general medical setting in the past year increased from 2.7 percent (or 657,000 people) to 3.7 percent (or 902,000 people). The percentage who received mental health services in an education setting in the past year increased from 12.1 percent (or 2.9 million people) in 2009 to 15.4 percent (or 3.7 million people) in 2019.

Among adults aged 18 or older, the percentage who received any mental health services in the past year increased from 13.0 percent (or 27.2 million people) in 2002 to 16.1 percent (or 40.2 million people) in 2019. Over that same period, the percentage who received prescription medication for a mental health issue increased from 10.5 percent (or 22.0 million people) to 13.1 percent (or 32.6 million people), the percentage who received outpatient mental health services in the past year increased from 7.4 percent (or 15.5 million people) to 8.3 percent (or 20.6 million people), and the percentage who received inpatient mental health services in the past year increased from 0.7 percent (or 1.5 million people) to 1.0 percent (or 2.4 million people).

Among adults aged 18 or older with past year AMI, receipt of mental health services in the past year increased from 40.9 percent (or 16.2 million people) in 2008 to 44.8 percent (or 23.0 million people) in 2019. Among the 13.1 million adults aged 18 or older in 2019 with past year SMI, 65.5 percent (or 8.6 million people) received mental health services in the past year, which was similar to the percentage in each year from 2008 through 2018.

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

Among the 51.5 million adults aged 18 or older in 2019 with past year AMI, 26.0 percent (or 13.3 million people) perceived an unmet need for mental health services in the past year, which was higher than the percentage in each year from 2008 through 2018.

Among the 13.1 million adults aged 18 or older in 2019 with past year SMI, 47.7 percent (or 6.2 million people) perceived an unmet need for mental health services in the past year, which was higher than the percentages in most years from 2008 through 2018.

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

Among the 397,000 adolescents aged 12 to 17 in 2019 who had a co-occurring SUD and an MDE in the past year, 66.3 percent (or 263,000 people) received either substance use treatment at a specialty facility or mental health services in the past year, 62.5 percent (or 249,000 people) received only mental health services, and 2.4 percent (or 10,000 people) received only substance use treatment at a specialty facility. These percentages in 2019 were similar to the percentages in 2015 to 2018 when data were available. Moreover, 1.3 percent of adolescents in 2019 (or 5,000 people) who had a co-occurring SUD and an MDE in the past year received both substance use treatment at a specialty facility and mental health services, which was lower than the percentages in 2016 to 2018.

Among the 9.5 million adults aged 18 or older in 2019 who had a co-occurring SUD and AMI in the past year, 48.6 percent (or 4.6 million people) received either substance use treatment at a specialty facility or mental health services in the past year, 38.7 percent (or 3.7 million people) received only mental health services, and 7.8 percent (or 742,000 people) received both substance use treatment at a specialty facility and mental health services. These percentages in 2019 were similar to the percentages in 2015 to 2018. Moreover, 1.9 percent of adults in 2019 (or 182,000 people) who had a co-occurring SUD and AMI in the past year received only substance use treatment at a specialty facility. This percentage in 2019 was lower than the percentages in 2015 and 2017 but was similar to the percentages in 2016 and 2018.

Among the 3.6 million adults aged 18 or older in 2019 who had a co-occurring SUD and SMI in the past year, 66.6 percent (or 2.4 million people) received either substance use treatment at a specialty facility or mental health services in the past year, 52.0 percent (or 1.9 million people) received only mental health services, 12.7 percent (or 452,000 people) received both substance use treatment at a specialty facility and mental health services, and 1.9 percent (or 68,000 people) received only substance use treatment at specialty facility. These percentages in 2019 were similar to the percentages in 2015 to 2018.

Figure 1. Past Month Substance Use among People Aged 12 or Older: 2019

D

Rx = prescription.

Note: Substance Use includes any illicit drug, kratom, alcohol, and tobacco use.

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.

Figure 33. Perceived Great Risk from Substance Use among People Aged 12 or Older: 2015-2019

D

+ Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.

Among people aged 12 or older, the percentage who perceived great risk of harm from smoking marijuana once or twice a week declined from 36.3 percent in 2015 to 29.2 percent in 2019 (Figure 33 and 2019 DT 7.33). This percentage in 2019 was lower than the percentage in each year from 2015 through 2018.

Among people aged 12 or older from 2015 to 2019, percentages who perceived great risk of harm from substance use also declined slightly for weekly cocaine use (from 87.4 to 85.7 percent) and for smoking one or more packs of cigarettes per day (from 72.8 to 71.2 percent) (Figure 33 and 2019 DT 7.33). The percentage who perceived great risk of harm from weekly heroin use ranged from 93.8 percent in 2019 to 94.5 percent in 2017.

Among people aged 12 or older, the percentages who perceived great risk of harm from having four or five drinks of alcohol nearly every day ranged from 67.9 percent in 2019 to 68.9 percent in 2017 (Figure 33 and 2019 DT 7.33). For brevity, this level of alcohol consumption on a single day is subsequently referred to as "daily binge drinking."19

Perceived Risk from Substance Use among Adolescents

Among adolescents aged 12 to 17, perceived great risk of harm from smoking marijuana weekly declined from 40.6 percent in 2015 to 34.6 percent in 2019 (Figure 34 and 2019 DT 7.34). Adolescents' perceptions of great risk of harm from substance use also declined slightly from 2015 to 2019 for smoking one or more packs of cigarettes per day (from 68.2 to 65.0 percent) and weekly cocaine use (from 80.2 to 78.7 percent). In addition, the perceived great risk of harm declined slightly from 2016 to 2019 for daily binge drinking (from 65.5 to 63.5 percent) and weekly heroin use (from 83.4 to 82.1 percent).

Figure 34. Perceived Great Risk from Substance Use among Youths Aged 12 to 17: 2015-2019

D

+ Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.

Perceived Risk from Substance Use among Young Adults

Among young adults aged 18 to 25, perceived great risk of harm from smoking marijuana weekly declined from 19.1 percent in 2015 to 15.0 percent in 2019 (Figure 35 and 2019 DT 7.36). Perceptions of great risk of harm from substance use among young adults declined slightly from 2015 to 2019 for smoking one or more packs of cigarettes per day (from 68.0 to 66.2 percent), weekly cocaine use (from 84.3 to 82.6 percent), and weekly heroin use (from 94.0 to 93.3 percent). However, the perceived great risk of harm from daily binge drinking remained stable between 2015 (62.1 percent) and 2019 (62.4 percent).

Figure 35. Perceived Great Risk from Substance Use among Young Adults Aged 18 to 25: 2015-2019

D

+ Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.

Perceived Risk from Substance Use among Adults Aged 26 or Older

Among adults aged 26 or older between 2015 and 2019, perceived great risk of harm from smoking marijuana weekly declined from 38.7 percent in 2015 to 30.8 percent in 2019 (Figure 36 and 2019 DT 7.37). Perceptions of great risk of harm among adults aged 26 or older declined slightly from 2015 to 2019 for daily binge drinking (from 70.4 to 69.3 percent), smoking one or more packs of cigarettes per day (from 74.2 to 72.7 percent), and weekly cocaine use (from 88.8 to 86.9 percent). In addition, the perceived great risk of harm from weekly heroin use among this population declined slightly from 2017 (95.8 percent) to 2019 (95.2 percent).

Figure 36. Perceived Great Risk from Substance Use among Adults Aged 26 or Older: 2015-2019

D

+ Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.

Age Comparisons for Perceived Risk from Substance Use

In 2019, perceptions of great risk of harm from substance use varied by substance and age. For example, adults aged 26 or older were more likely than adolescents aged 12 to 17 or young adults aged 18 to 25 to perceive great risk of harm from smoking one or more packs of cigarettes per day (Figures 34, 35, and 36 and 2019 DT 7.34, 7.36, and 7.37).

Moreover, 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 (Figures 34, 35, and 36 and 2019 DT 7.34, 7.36, and 7.37). Recent research has identified associations among adults between decreases in perceptions of great risk of harm from smoking marijuana weekly and increases in marijuana use.42,43 Nevertheless, people can experience adverse effects from marijuana use, such as marijuana use disorder or injury resulting from operating a motor vehicle while impaired by marijuana.44,45 Therefore, it is necessary to educate young adults about adverse effects of marijuana use.