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The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-.
Background: Substance use disorders (SUDs), which include substance dependence or abuse, have a tremendous impact on individuals, families, communities, and governments. This report highlights the number of American adults with SUDs in the past year and trends in SUDs between 2002 and 2014. Method: This report uses data from the 2002 to 2014 National Surveys on Drug Use and Health to examine trends in SUDs and receipt of treatment for substance use between 2002 and 2014. Results: Approximately 20.2 million adults aged 18 or older had a past year SUD. Of these adults, 16.3 million had an alcohol use disorder and 6.2 million had an illicit drug use disorder. An estimated 2.3 million adults had both an alcohol use disorder and an illicit drug use disorder in the past year. Of the adults with a past year SUD, 4 out of 5 had an alcohol use disorder, nearly 3 out of 10 had an illicit drug use disorder, and 1 out of 9 had both an alcohol use disorder and an illicit drug use disorder. The percentage of adults with a past year SUD in 2014 was similar to the percentages in 2010 to 2013 but was lower than the percentages in 2002 to 2009. Conclusion: Monitoring trends in SUDs gives public health providers opportunities to assess the scope of the issue in the United States and to plan substance abuse prevention and treatment programming. Most SUDs in the United States are related to alcohol use, and the long-term trends indicate that there has been a decrease in the prevalence of past year alcohol use disorders among adults. Although illicit drug use disorders are less prevalent than alcohol use disorders among adults, the long-term trends in this report indicate that there has not been a reduction in the percentage of adults who had an illicit drug use disorder in the past year.
Substance use disorders (SUDs), which include substance dependence or abuse, have a tremendous impact on individuals, families, and communities. SUDs occur when recurrent alcohol or illicit drug use causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home. Reducing SUDs and related problems among adults is critical for mental and physical health, safety, and quality of life. In 2014, of the 21.5 million people aged 12 or older who had an SUD in the past year, 20.2 million were adults aged 18 or older, representing 94.2 percent of people who had experienced an SUD.1
SUDs contribute heavily to the burden of disease in the United States and are costly to the nation as a whole because of lost productivity, health care, and crime.2,3,4 However, SUDs are preventable and treatable. Although there are benefits to receiving substance use treatment, recent research indicates that many people do not receive the treatment they need.5 Understanding the prevalence and characteristics of adults with SUDs is information that is relevant to policymakers and service providers.
The National Survey on Drug Use and Health (NSDUH) is an annual survey of the U.S. civilian, noninstitutionalized population aged 12 years or older. One of NSDUH's strengths is the stability of the survey design, which allows for comparisons of SUD estimates across multiple years of data. The Substance Abuse and Mental Health Services Administration (SAMHSA) produces annual estimates of the percentage of Americans aged 12 or older who have had a past year SUD.6 This issue of The CBHSQ Report expands on this research by focusing on adults aged 18 or older. NSDUH asks respondents a series of questions to assess dependence on or abuse of alcohol or illicit drugs in the past year (“dependence or abuse”) if they previously reported alcohol or illicit drug use in the past 12 months. These questions are designed to measure symptoms of dependence and abuse based on criteria specified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),7 including withdrawal, tolerance, use in dangerous situations, trouble with the law and interference in major obligations at work, school, or home during the past year. NSDUH also allows for estimating of alcohol use disorder and illicit drug use disorder. In NSDUH, illicit drugs include marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutic drugs. Adults with alcohol or illicit drug dependence or abuse are defined as having an SUD. This report examines trends in SUDs and receipt of substance use treatment at a specialty facility between 2002 and 2014.8
In 2014, approximately 20.2 million adults aged 18 or older had a past year SUD. Of these adults, 16.3 million had an alcohol use disorder and 6.2 million had an illicit drug use disorder (Figure 1). An estimated 2.3 million adults had both an alcohol use disorder and an illicit drug use disorder in the past year. Of the adults with a past year SUD, 4 out of 5 had an alcohol use disorder, nearly 3 out of 10 had an illicit drug use disorder, and 1 out of 9 had both an alcohol use disorder and an illicit drug use disorder. This suggests that most adults who had an alcohol use disorder did not have an illicit drug use disorder, and a little more than 3 out of 5 adults with an illicit drug use disorder did not have an alcohol use disorder (Figure 1).
SUDs in the past year among adults aged 18 or older: 2014.
NSDUH can be used to estimate SUDs associated with the use of specific illicit drugs. In 2014, approximately 3.5 million adults had a past year disorder related to their use of marijuana, and 1.8 million adults had a disorder related to their nonmedical use of prescription pain relievers (Figure 2). About 900,000 adults had a disorder related to their use of cocaine, and 600,000 had a disorder related to their use of heroin. Smaller numbers of adults had disorders related to nonmedical use of tranquilizers (420,000), nonmedical use of stimulants (416,000), use of hallucinogens (191,000), nonmedical use of sedatives (114,000), and use of inhalants (57,000) (data not shown). The SUD categories associated with the use of specific drugs are not mutually exclusive because a person can have multiple SUDs from using more than one substance (e.g., having SUDs related to both marijuana and cocaine use).
SUD in the past year among adults aged 18 or older, by selected types of substances: 2014.
The 20.2 million adults aged 18 or older with a past year SUD represent about 8.4 percent of the total population of adults. The percentage of adults with a past year SUD in 2014 was similar to the percentages in 2010 to 2013 but was lower than the percentages in 2002 to 2009 (Figure 3). This same pattern was seen in trends of adults with both an alcohol use disorder and an illicit drug use disorder. The percentage of adults with an alcohol use disorder remained steady between 2011 and 2014; however, the percentage in 2014 (6.8 percent) was lower than the percentages in 2002 to 2010. The percentage of adults with an illicit drug use disorder in 2014 was similar to previous years, with the exception of 2011.
Trends in substance use disorder in the past year among adults aged 18 or older: 2002 to 2014.
In 2014, 3.5 million adults aged 18 or older had a past year SUD related to their use of marijuana. This represents 1.5 percent of adults. The percentage of adults with a marijuana use disorder remained steady between 2002 and 2014 (Figure 4). In 2014, 1.8 million adults had a past year SUD related to their nonmedical use of prescription pain relievers. This represents 0.7 percent of adults. The percentage of adults with SUDs related to their nonmedical use of prescription pain relievers has remained steady since 2006. In 2014, smaller numbers of adults had past year SUDs related to their use of cocaine (about 900,000; 0.4 percent) or heroin (about 600,000; 0.2 percent). The percentage of adults with a cocaine use disorder remained steady from 2009 to 2014; however, the 2014 percentage was lower than the percentages in 2002 to 2008. Although the percentage of adults with a heroin use disorder has ranged from 0.1 percent to 0.2 percent of adults since 2002, the 2014 percentage was statistically higher than the percentages in 2002 to 2010. The population estimates and percentages of adults with SUDs related to other substances are shown in Tables S1 and S2.
Trends in substance use disorder in the past year among adults aged 18 or older, by selected types of substances: 2002 to 2014.
In 2014, 2.5 million adults aged 18 or older received treatment for alcohol or illicit drug use at a specialty facility in the past year. This translates to 1.0 percent of the total adult population (Figure 5) or 7.6 percent of adults with a past year SUD (data not shown) receiving substance use treatment in the past year. The percentage of adults receiving treatment for alcohol or illicit drug use at a specialty facility was relatively stable over the 13-year period between 2002 and 2014 (Figure 5). About 1.5 million adults received alcohol use treatment at a specialty facility in the past year. This translates to 0.6 percent of the total adult population and 5.4 percent of adults with an alcohol use disorder receiving alcohol use treatment at a specialty facility in the past year. The percentage of adults receiving treatment for alcohol use at a specialty facility was stable between 2002 and 2014. About 1.5 million adults received illicit drug use treatment at a specialty facility in the past year. This translates to 0.6 percent of the total adult population and 12.1 percent of adults with an illicit drug use disorder receiving illicit drug use treatment at a specialty facility in the past year. The percentage of adults receiving treatment for illicit drug use at a specialty facility was relatively stable over the 13-year period.
Trends in receipt of substance use treatment at a specialty facility in the past year among adults aged 18 or older: 2002 to 2014.
SUDs have a lasting impact on the lives of many Americans and can have social, economic, health, and/or legal consequences. Substance use treatment can be a critical resource that reduces costs to society and improves public health.9 Despite the benefits of treatment, research suggests that few Americans receive any or adequate substance use treatment.5 This report shows that the percentage of adults aged 18 or older who received substance use treatment at a specialty facility in the past year was 1.0 percent of the total adult population (Figure 5) or 7.6 percent of adults with a past year SUD (data not shown). In addition, the percentage of adults in the total population who received substance use treatment at a specialty facility has remained stable for the past 13 years.
Prevention and treatment specialists may be able to target their efforts to increase access to substance use treatment if they understand the number of adults with SUDs. This report highlights the number of American adults with SUDs in the past year. Monitoring trends in SUDs and receipt of substance use treatment gives public health providers opportunities to assess the scope of the issue in the United States and to plan substance use prevention and treatment programming. Although understanding the number of adults who receive substance use treatment enhances understanding of the scope of the issue, it does not inform why adults who may need substance use treatment are not receiving treatment. Research indicates that the two most common reasons for not receiving substance use treatment among the total population aged 12 or older and among adults aged 18 or older who needed but did not receive treatment at a specialty facility, despite perceiving a need for treatment, were that they were not ready to stop using alcohol or illicit drugs or that they had no health care coverage and could not afford the cost of treatment.10,11,12 Given that not being ready to stop using alcohol or illicit drugs has been one of the most common reasons for not receiving treatment for several years, this highlights the importance of reducing the prevalence of SUD.
Most SUDs in the United States are related to alcohol use, and the long-term trends indicate that the nation has made progress in reducing the prevalence of past year alcohol use disorders among adults. The percentage of adults with an alcohol use disorder in 2014 (6.8 percent) has remained steady since 2011; however, the percentage was lower than percentages in 2002 to 2010. Although illicit drug use disorders are less prevalent than alcohol use disorders among adults, the long-term trends in this report indicate that there has been little progress in reducing the percentage of adults who had a past year illicit drug use disorder. The most common types of SUDs were related to past year marijuana use and nonmedical use of prescription pain relievers, which are the most commonly used substances among U.S. adults.
For more information and resources on substance use prevention and treatment, call SAMHSA's National Helpline at 1–800-662-HELP (1-800-662-4357) or visit SAMHSA's online Behavioral Health Treatment Services Locator at https://findtreatment.samhsa.gov.
Lipari, R.N. and Van Horn, S.L. Trends in substance use disorders among adults aged 18 or older. The CBHSQ Report: June 29, 2017. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.
| Past year dependence or abuse | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 |
| Illicit drugs 1 | 5,740 | 5,548a | 5,951 | 5,647 | 5,849 | 5,774 | 5,857 | 6,056 | 5,990 | 5,374b | 6,316 | 5,976 | 6,210 |
| Marijuana and hashish | 3,239 | 3,243 | 3,491 | 3,182 | 3,315 | 3,156 | 3,382 | 3,487 | 3,637 | 3,286 | 3,498 | 3,491 | 3,510 |
| Cocaine | 1,383b | 1,429b | 1,480b | 1,456b | 1,571b | 1,508b | 1,329b | 1,063 | 979 | 778 | 1,080 | 833 | 886 |
| Heroin | 201b | 177b | 249b | 218b | 311b | 206b | 267b | 351a | 354a | 396 | 447 | 507 | 568 |
| Hallucinogens | 288a | 215 | 329b | 243 | 259 | 252 | 265 | 264 | 263 | 257 | 244 | 213 | 191 |
| Inhalants | 79 | 66 | 99 | 113 | 68 | 64 | 79 | 71 | 81 | 62 | 106 | 91 | 57 |
| Nonmedical use of psychotherapeutics2,3 | 1,684b | 1,562b | 1,660b | 1,630b | 1,686b | 1,851 | 1,840a | 2,033 | 2,085 | 1,838a | 2,394 | 2,103 | 2,176 |
| Pain relievers | 1,273b | 1,143b | 1,078b | 1,272b | 1,371a | 1,478 | 1,462 | 1,660 | 1,684 | 1,518 | 1,907 | 1,745 | 1,750 |
| Tranquilizers | 422 | 339 | 498 | 348 | 341 | 382 | 380 | 424 | 455 | 337 | 575 | 383 | 420 |
| Stimulants2 | 339 | 280a | 384 | 336 | 293 | 331 | 283a | 323 | 306 | 262a | 485 | 427 | 416 |
| Sedatives | 126 | 119 | 106 | 63 | 98 | 130 | 104 | 128 | 146 | 66 | 116 | 88 | 114 |
| Alcohol | 16,647 | 16,334 | 17,137 | 17,251 | 17,490a | 17,319 | 17,258 | 17,626a | 16,858 | 15,724 | 16,859 | 16,602 | 16,316 |
| Both illicit drugs and alcohol 1 | 2,590 | 2,509 | 2,810b | 2,718a | 2,723a | 2,666 | 2,635 | 2,787a | 2,413 | 2,212 | 2,506 | 2,319 | 2,296 |
| Illicit drugs or alcohol 1 | 19,797 | 19,372 | 20,278 | 20,180 | 20,616 | 20,427 | 20,480 | 20,895 | 20,435 | 18,887a | 20,669 | 20,259 | 20,230 |
Difference between this estimate and the 2014 estimate is statistically significant at the .05 level.
Difference between this estimate and the 2014 estimate is statistically significant at the .01 level.
Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically, including data from original methamphetamine questions but not including new methamphetamine items added in 2005 and 2006.
Estimates in these designated rows do not include data from new methamphetamine items added in 2005 and 2006.
Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs.
Note: Some 2006 to 2010 estimates may differ from previously published estimates because of updates (see Section B.3 in Appendix B of Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings).
Note: Dependence or abuse is based on definitions found in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002 to 2005, 2006 to 2010 (revised March 2012), and 2011 to 2014.
| Past year dependence or abuse | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 |
| Illicit drugs 1 | 2.7 | 2.6 | 2.8 | 2.6 | 2.7 | 2.6 | 2.6 | 2.7 | 2.6 | 2.3a | 2.7 | 2.5 | 2.6 |
| Marijuana and hashish | 1.5 | 1.5 | 1.6 | 1.5 | 1.5 | 1.4 | 1.5 | 1.5 | 1.6 | 1.4 | 1.5 | 1.5 | 1.5 |
| Cocaine | 0.7b | 0.7b | 0.7b | 0.7b | 0.7b | 0.7b | 0.6b | 0.5 | 0.4 | 0.3 | 0.5 | 0.4 | 0.4 |
| Heroin | 0.1b | 0.1b | 0.1b | 0.1b | 0.1a | 0.1b | 0.1b | 0.2a | 0.2a | 0.2 | 0.2 | 0.2 | 0.2 |
| Hallucinogens | 0.1b | 0.1 | 0.2b | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 |
| Inhalants | < 0.1 | < 0.1 | < 0.1 | 0.1 | < 0.1 | < 0.1 | < 0.1 | < 0.1 | < 0.1 | < 0.1 | < 0.1 | < 0.1 | < 0.1 |
| Nonmedical use of psychotherapeutics2,3 | 0.8 | 0.7a | 0.8 | 0.7a | 0.8a | 0.8 | 0.8 | 0.9 | 0.9 | 0.8 | 1.0 | 0.9 | 0.9 |
| Pain relievers | 0.6 | 0.5b | 0.5b | 0.6a | 0.6 | 0.7 | 0.6 | 0.7 | 0.7 | 0.7 | 0.8 | 0.7 | 0.7 |
| Tranquilizers | 0.2 | 0.2 | 0.2 | 0.2 | 0.2 | 0.2 | 0.2 | 0.2 | 0.2 | 0.1 | 0.2 | 0.2 | 0.2 |
| Stimulants2 | 0.2 | 0.1 | 0.2 | 0.2 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1a | 0.2 | 0.2 | 0.2 |
| Sedatives | 0.1 | 0.1 | < 0.1 | < 0.1 | < 0.1 | 0.1 | < 0.1 | 0.1 | 0.1 | < 0.1 | < 0.1 | < 0.1 | < 0.1 |
| Alcohol | 7.9b | 7.7b | 8.0b | 7.9b | 7.9b | 7.8b | 7.7b | 7.8b | 7.4a | 6.8 | 7.2 | 7.0 | 6.8 |
| Both illicit drugs and alcohol 1 | 1.2b | 1.2b | 1.3b | 1.2b | 1.2b | 1.2b | 1.2b | 1.2b | 1.1 | 1.0 | 1.1 | 1.0 | 1.0 |
| Illicit drugs or alcohol 1 | 9.4b | 9.1b | 9.4b | 9.3b | 9.3b | 9.2b | 9.1b | 9.2b | 8.9 | 8.1 | 8.8 | 8.5 | 8.4 |
Difference between this estimate and the 2014 estimate is statistically significant at the .05 level.
Difference between this estimate and the 2014 estimate is statistically significant at the .01 level.
Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically, including data from original methamphetamine questions but not including new methamphetamine items added in 2005 and 2006.
Estimates in these designated rows do not include data from new methamphetamine items added in 2005 and 2006.
Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs.
Note: Some 2006 to 2010 estimates may differ from previously published estimates because of updates (see Section B.3 in Appendix B of Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings).
Note: Dependence or abuse is based on definitions found in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002 to 2005, 2006 to 2010 (revised March 2012), and 2011 to 2014.
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.
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