Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health

Key Substance Use and

Mental Health Indicators

in the United States:

Results from the 2021 National

Survey on Drug Use and Health

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

Results from the 2021 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. Marlon Daniel served as the government project oﬃcer and as the contracting oﬃcer

representative. Douglas Richesson, Iva Magas, Samantha Brown, and Jennifer M. Hoenig were SAMHSA authors.

Additional SAMHSA reviewers included P. Mae Cooper, Shiromani Gyawali, Tenecia Smith, and Jingsheng Yan.

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. (2022). Key substance use and mental health indicators

in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No.

PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and

Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report

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 email

CBHSQrequest@

samhsa.hhs.gov.

Nondiscrimination Notice/Aviso de no discriminación

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color,

national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no

discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Behavioral Health Statistics and Quality

Populations Survey Branch

Publication Number PEP22-07-01-005

December 2022

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | iii

Table of Contents

Executive Summary ��1

Introduction ��5

Survey Background ��5

Overview of Data Collection in 2021 ��5

Data Collection in Each Quarter of 2021 ��5

Data Presentation and Interpretation ��6

Presentation of Estimates and Statistical Testing ��6

Implications of the COVID-19 Pandemic for the 2021 NSDUH ��6

General Substance Use in the Past Month ��7

Tobacco Use or Nicotine Vaping in the Past Month ��7

Tobacco Product Use ��9

Cigarette Use ��10

Daily Cigarette Use ��10

Nicotine Vaping ��10

Underage Tobacco Use or Nicotine Vaping ��11

Alcohol Use in the Past Month ��11

Any Alcohol Use ��12

Binge Alcohol Use ��12

Heavy Alcohol Use ��13

Underage Alcohol Use ��13

Marijuana Use and Marijuana Vaping in the Past Month ��14

Any Vaping in the Past Month ��14

Illicit Drug Use in the Past Year �� 15

Any Illicit Drug Use ��16

Marijuana Use ��17

Cocaine Use ��17

Heroin Use ��18

Methamphetamine Use ��18

Hallucinogen Use ��18

Inhalant Use ��18

Misuse of Psychotherapeutic Drugs ��19

Stimulant Misuse ��19

Tranquilizer or Sedative Misuse ��19

Benzodiazepine Misuse ��20

Pain Reliever Misuse ��20

Misuse of Subtypes of Pain Relievers ��20

Main Reasons for the Last Misuse of Pain Relievers ��21

Source of the Last Pain Reliever That Was Misused ��22

Opioid Misuse ��22

Central Nervous System Stimulant Misuse ��23

Other Substance Use in the Past Year ��24

GHB Use ��24

Nonprescription Cough and Cold Medicine Misuse ��24

Kratom Use ��24

Synthetic Marijuana Use ��24

Synthetic Stimulant Use ��25

Initiation of Substance Use ��25

Initiation of Cigarette Use ��26

Initiation of Alcohol Use ��26

Initiation of Marijuana Use ��26

Initiation of Cocaine Use ��26

Initiation of Heroin Use ��26

Initiation of Methamphetamine Use ��27

Initiation of Hallucinogen Use��27

Initiation of Inhalant Use ��27

Initiation of Prescription Stimulant Misuse ��27

Initiation of Prescription Tranquilizer or Sedative Misuse ��27

Initiation of Prescription Tranquilizer Misuse ��27

Initiation of Prescription Sedative Misuse ��27

Initiation of Prescription Pain Reliever Misuse ��27

Perceived Risk from Substance Use ��28

Substance Use Disorders in the Past Year ��29

Alcohol Use Disorder ��33

Drug Use Disorder ��33

Marijuana Use Disorder ��33

Cocaine Use Disorder ��34

Heroin Use Disorder ��34

Methamphetamine Use Disorder ��34

Prescription Stimulant Use Disorder ��34

Prescription Tranquilizer Use Disorder or Sedative Use Disorder ��34

Prescription Pain Reliever Use Disorder ��35

Opioid Use Disorder ��35

Central Nervous System Stimulant Use Disorder ��35

Illicit Drug or Alcohol Use Disorder ��36

Substance Use Disorder Severity ��36

Major Depressive Episode in the Past Year �� 37

MDE and MDE with Severe Impairment among Adolescents ��38

MDE and MDE with Severe Impairment among Adults ��39

Any Mental Illness among Adults in the Past Year ��39

Serious Mental Illness among Adults in the Past Year ��40

Co‑Occurring MDE and SUD among Adolescents ��40

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

Results from the 2021 National Survey on Drug Use and Healthiv | December 2022

Substance Use among Adolescents with MDE �� 41

Co‑Occurring Mental Health Issues and SUD among Adults ��41

Co-Occurring AMI and SUD ��41

Co-Occurring SMI and SUD ��42

Substance Use among Adults, byMental Illness Status ��43

Suicidal Thoughts and Behaviors among Adults ��43

Serious Thoughts of Suicide among Adults ��44

Suicide Plans among Adults ��45

Suicide Attempts among Adults ��45

Suicidal Thoughts and Behaviors among Adults Because

of COVID-19

��45

Suicidal Thoughts and Behaviors among Adolescents �� 46

Suicidal Thoughts and Behaviors among Adolescents for

Any Reason ��47

Suicidal Thoughts and Behaviors among Adolescents

Because of COVID-19

��48

Substance Use Treatment in the Past Year ��49

Need for Substance Use Treatment ��49

Receipt of Substance Use Treatment ��50

Receipt of Any Substance Use Treatment ��51

Receipt of Any Substance Use Treatment among

People with a Past Year Illicit Drug or Alcohol Use Disorder

��51

Receipt of Substance Use Treatment at a Specialty Facility ��52

Receipt of Substance Use Treatment at a Specialty

Facility among People Who Needed Substance

Use Treatment

��52

Receipt of Virtual (Telehealth) Services for Substance

Use Treatment

��53

Perceived Need for Substance Use Treatment ��53

Reasons for Not Receiving Substance Use Treatment ��53

Medication-Assisted Treatment for Alcohol Use or Opioid Misuse ��54

Medication-Assisted Treatment for Alcohol Use ��54

Medication-Assisted Treatment for Opioid Misuse ��54

Mental Health Service Use in the Past Year ��55

Treatment for Depression among Adolescents ��55

Treatment for Depression among Adults ��56

Mental Health Service Use among Adolescents ��56

Receipt of Mental Health Services in Specialty and

Nonspecialty Settings among Adolescents

��57

Receipt of Virtual (Telehealth) Mental Health Services

among Adolescents

��57

Mental Health Service Use among Adults ��57

Mental Health Service Use among Adults with AMI ��58

Mental Health Service Use among Adults with SMI ��60

Perceived Unmet Need for Mental Health Services

among Adults with Mental Illness ��60

Perceived Unmet Need for Mental Health Services

among Adults with AMI

��60

Perceived Unmet Need for Mental Health Services

among Adults with SMI

��61

Reasons for Not Receiving Mental Health Services

among Adults with Mental Illness and a Perceived

Unmet Need

��61

Receipt of Services for Co‑Occurring Mental Health

Issues and Illicit Drug or Alcohol Use Disorder ��62

Receipt of Services among Adolescents with a

Co-Occurring MDE and an Illicit Drug or Alcohol Use Disorder ��62

Receipt of Services among Adults with Co-Occurring AMI

and an Illicit Drug or Alcohol Use Disorder ��62

Receipt of Services among Adults with Co-Occurring SMI

and an Illicit Drug or Alcohol Use Disorder ��63

Perceived Recovery ��64

Substance Use, Mental Health Issues, and the COVID‑19

Pandemic ��65

Perceived Negative Effects of the COVID-19 Pandemic

on Mental Health ��66

Perceived Negative Effects of the COVID-19 Pandemic

on Mental Health among Adolescents Aged 12 to 17

��66

Perceived Negative Effects of the COVID-19 Pandemic

on Mental Health among Adults Aged 18 or Older

��67

Perceived Effects of the COVID-19 Pandemic on Substance Use ��68

Perceived Effects on Alcohol Use ��68

Perceived Effects on Drug Use ��69

Perceived Effects of the COVID-19 Pandemic on Access

to Services

��69

Access to Substance Use Treatment ��70

Access to Mental Health Services ��70

Access to Medical Services ��71

Endnotes ��72

AppendixA: Special Tables of Estimates for Substance

Use and Mental Health Indicators in the United States �� A‑1

AppendixB: Special Tables of Race/Ethnicity Estimates

for Substance Use and Mental Health Indicators in the

United States

��B‑1

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 1

Executive Summary

e Substance Abuse and Mental Health Services

Administration (SAMHSA) presents Key Substance Use and

Mental Health Indicators in the United States: Results from the

2021 National Survey on Drug Use and Health. e National

Survey on Drug Use and Health (NSDUH) is an annual

survey sponsored by SAMHSA, within the U.S. Department

of Health and Human Services. e 2021 NSDUH used

multimode data collection, in which 69,850 respondents

aged 12 or older completed the survey in person or via the

web. Estimates based on multimode data collection in 2021

are not comparable with estimates from 2020 or prior years.

erefore, this report presents NSDUH estimates from

2021 only.

SAMHSA is pleased to announce that the 2021 report

includes selected estimates by race and ethnicity, in addition

to estimates by age group. SAMHSA is committed to

using data and evidence to fulﬁll the mission and vision of

promoting mental health, preventing substance misuse, and

providing treatments and supports to foster recovery while

ensuring equitable access and positive outcomes. NSDUH is

a vital data tool that supports SAMHSA’s mission and aligns

with SAMHSA’s vision to guide stakeholders in developing

policies and programs so that people in the United States

who have, are aﬀected by, or are at risk for mental health or

substance use conditions receive care, thrive, and achieve

wellbeing.

Key ﬁndings from the 2021 NSDUH are highlighted as

follows:

Alcohol Use in the Past Month

• Among the 133.1 million current alcohol users aged

12 or older in 2021, 60.0 million people (or 45.1 percent)

were past month binge drinkers. Among past month

binge drinkers, 16.3 million people were past month

heavy drinkers.

• Among people aged 12 or older in 2021, Asian people

(10.7 percent) were less likely to be binge drinkers in

the past month compared with people in other racial or

ethnic groups.

Illicit Drug Use in the Past Year

• Among people aged 12 or older in 2021, 3.3 percent

(or 9.2 million people) misused opioids (heroin or

prescription pain relievers) in the past year.

• Opioid misuse in the past year among people aged

12 or older in 2021 did not diﬀer among racial or ethnic

groups.

Substance Use Disorders in the Past Year

• In 2021, 46.3 million people aged 12 or older (or

16.5 percent) had a substance use disorder (SUD) in the

past year, including 29.5 million who had an alcohol use

disorder, 24.0 million who had a drug use disorder, and

7.3 million people who had both an alcohol use disorder

and a drug use disorder.

• e percentage of people aged 12 or older in 2021 with

a past year SUD was higher among American Indian

or Alaska Native (27.6 percent) or Multiracial people

(25.9 percent) than among Black (17.2 percent), White

(17.0 percent), Hispanic (15.7 percent), or Asian people

(8.0 percent). e percentage was lower among Asian

people than among people in all other racial or ethnic

groups.

Substance Use Treatment

• Among the 40.7 million people aged 12 or older in 2021

with an illicit drug or alcohol use disorder in the past

year who did not receive treatment at a specialty facility,

96.8 percent (or 39.5 million people) felt they did not

need treatment, 2.1 percent (or 837,000 people) felt

that they needed treatment but did not make an eﬀort

to get treatment, and 1.1 percent (or 447,000 people)

felt that they needed treatment and made an eﬀort to get

treatment.

• Among people aged 12 or older in 2021 who had an

illicit drug or alcohol use disorder in the past year and did

not receive substance use treatment at a specialty facility,

similar percentages of people across racial or ethnic groups

felt they did not need substance use treatment.

Tobacco Product Use or Nicotine Vaping in the Past

Month

• In 2021, about 3 in 5 adolescents aged 12 to 17 who used

nicotine products in the past month (60.5 percent) vaped

nicotine but did not use tobacco products.

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

Results from the 2021 National Survey on Drug Use and Health2 | December 2022

Mental Illness among Adults

• In 2021, 5.5 percent of adults aged 18 or older (or

14.1 million people) had serious mental illness (SMI) in

the past year. e percentage of adults aged 18 or older

with SMI was highest among young adults aged 18 to 25

(11.4 percent or 3.8 million people), followed by adults

aged 26 to 49 (7.1 percent or 7.3 million people), then

by adults aged 50 or older (2.5 percent or 3.0 million

people).

• Among adults aged 18 or older in 2021, Multiracial

adults (8.2 percent) were more likely to have had SMI

in the past year compared with Hispanic (5.1 percent),

Black (4.3 percent), or Asian adults (2.8 percent). e

percentage of adults with SMI in the past year was

lower among Black adults than among White adults

(6.1 percent). e percentage was also lower among Asian

adults than among White or Hispanic adults.

Major Depressive Episode among Adolescents

• Among adolescents aged 12 to 17 in 2021, 20.1 percent

(or 5.0 million people) had a past year major depressive

episode (MDE), and 14.7 percent (or 3.7 million people)

had a past year MDE with severe impairment.

• e percentages of Asian or Black adolescents

aged 12 to 17 in 2021 who had a past year MDE

(13.8 and 14.0 percent, respectively) were lower than the

corresponding percentages of Multiracial (27.2 percent),

Hispanic (22.2 percent), or White adolescents

(20.7 percent).

Suicidal Thoughts and Behavior

• Among adolescents aged 12 to 17 in 2021, 12.7 percent

(or 3.3 million people) had serious thoughts of suicide,

5.9 percent (or 1.5 million people) made a suicide plan,

and 3.4 percent (or 892,000 people) attempted suicide

in the past year. However, these estimates are likely to be

conservative because the questions for respondents aged

12 to 17 included the response options “I’m not sure” and

“I don’t want to answer,” which were not included in the

corresponding questions for adults.

• Among adults aged 18 or older in 2021, 4.8 percent

(or 12.3 million people) had serious thoughts of suicide,

1.4 percent (or 3.5 million people) made a suicide plan,

and 0.7 percent (or 1.7 million people) attempted suicide

in the past year.

• Few racial/ethnic diﬀerences in suicidal thoughts and

behavior in 2021 were found among youth and adults.

Mental Health Services

• In 2021, 18.8 percent of adults aged 18 or older

(or 46.5 million people) received any of the following

mental health services in the past year: inpatient or

outpatient mental health services, prescription medication

for a mental health issue, or virtual (i.e., telehealth)

services. Among the 57.8 million adults with any mental

illness (AMI) in the past year, 47.2 percent (or 26.5 million

people) received any of these mental health services in the

past year. Among the 14.1 million adults with SMI in the

past year, 65.4 percent (or 9.1 million people) received any

of these mental health services in the past year.

• Among adults aged 18 or older in 2021 who had AMI in

the past year, White (52.4 percent) or Multiracial adults

(52.2 percent) were more likely than Black (39.4 percent),

Hispanic (36.1 percent), or Asian adults (25.4 percent)

to have received any of these mental health services in

the past year. Asian adults with AMI also were less likely

to have received mental health services in the past year

compared with Black or Hispanic adults with AMI.

Mental Health and Substance Use Conditions

• Nearly half of young adults aged 18 to 25 in 2021

(45.8 percent or 15.3 million people) had either an SUD

or AMI in the past year. is percentage was higher than

corresponding percentages among adults aged 26 to 49

(39.5 percent or 40.4 million people) and adults aged 50

or older (22.6 percent or 26.7 million people).

• e percentage of adults aged 18 or older in 2021 who

had either an SUD or AMI in the past year was higher

among Multiracial adults (48.0 percent) than among

White (33.6 percent), Black (32.3 percent), Hispanic

(30.3 percent), or Asian adults (21.4 percent). Asian

adults were less likely to have had either AMI or an SUD

in the past year compared with adults in most other racial

or ethnic groups. Similar patterns among racial or ethnic

groups were observed for the percentages of adults who

had both an SUD and AMI in past year.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 3

Perceived Recovery

• Among the 29.0 million adults aged 18 or older in

2021 who perceived that they ever had a substance use

problem, 72.2 percent (or 20.9 million people) considered

themselves to be in recovery or to have recovered from

their drug or alcohol use problem.

• Among adults aged 18 or older in 2021 who perceived

that they ever had a substance use problem, there were

no diﬀerences among White (73.5 percent), Black

(69.2 percent), or Hispanic adults (67.6 percent) who

considered themselves to be in recovery or to have

recovered from their drug or alcohol use problem.

• Among the 58.7 million adults aged 18 or older in 2021

who perceived that they ever had a problem with their

mental health, 66.5 percent (or 38.8 million people)

considered themselves to be in recovery or to have

recovered from their mental health issues.

• Among adults aged 18 or older in 2021 who perceived

that they ever had a problem with their mental health,

percentages of those who considered themselves to be in

recovery or to have recovered from their mental health

issues did not diﬀer among racial or ethnic groups.

NSDUH supports SAMHSA’s mission to promote mental

health, prevent substance misuse, and provide treatments

and supports to foster recovery by providing data on key

mental health and substance use outcomes that inform

policy and practice. By leveraging data to inform the public

health response, SAMHSA will better achieve its vision that

people with, aﬀected by, or at risk for mental health and

substance use conditions receive care, thrive, and achieve

wellbeing. Key Substance Use and Mental Health Indicators in

the United States: Results from the 2021 National Survey on

Drug Use and Health summarizes the most recent data on

substance use, mental health, and treatment in the United

States.

is page intentionally left blank

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 5

Introduction

Substance use and mental health issues have signiﬁcant

impacts on people, families, communities, and societies.

1,2,3,4

e National Survey on Drug Use and Health (NSDUH),

conducted annually by the Substance Abuse and Mental

Health Services Administration (SAMHSA), provides

nationally representative data on use of tobacco, alcohol,

and illicit drugs; substance use disorders (SUDs);

receipt of substance use treatment; mental health issues;

and use of mental health services among the civilian,

noninstitutionalized population aged 12 or older in the

United States. NSDUH estimates allow researchers,

clinicians, policymakers, and the general public to better

understand and improve the nation’s behavioral health.

SAMHSA is steadfast in its eﬀorts to advance the health

of the nation while also promoting equity. erefore, this

report, based on 2021 NSDUH data, contains ﬁndings on

key substance use and mental health indicators in the United

States by race/ethnicity.

Results from the 2021 National Survey on Drug Use and

Health: Detailed Tables show comprehensive substance

use and mental health-related estimates and are available

separately at https://

www.samhsa.gov/data/report/2021

-nsduh-detailed-tables.

e 2021 NSDUH used multimode data collection, in

which respondents completed the survey in person or via

the web. As discussed in the 2021 National Survey on Drug

Use and Health (NSDUH): Methodological Summary and

Deﬁnitions report, methodological investigations led to

the conclusion that estimates based on multimode data

collection in 2021 are not comparable with estimates

from 2020 or prior years.

erefore, this report presents

NSDUH estimates from 2021 only.

Survey Background

NSDUH is an annual survey sponsored by SAMHSA

within the U.S. Department of Health and Human Services

(HHS). NSDUH covers residents of households and

people in noninstitutional group settings (e.g., shelters,

boarding houses, college dormitories, migratory workers’

camps, halfway houses). 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 settings, such as jails, nursing homes,

mental health institutions, and long-term care hospitals.

Overview of Data Collection in 2021

NSDUH employs a 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 2021

NSDUH used multimode data collection throughout the

year. Eligibility of areas for in-person data collection in 2021

was determined by state- and county-level coronavirus disease

2019 (COVID-19) metrics.

In-person data collection

commenced in eligible areas after potential respondents ﬁrst

were given the opportunity to complete the survey via the

web. roughout 2021 data collection, sampled individuals

residing in areas approved for in-person data collection also

retained the option to participate via the web. erefore,

respondents could choose whether to complete screenings

or interviews via the web or in person. Respondents also

could transition between data collection modes for screening

and interviewing (e.g., completing household screening

via the web and the main interview in person) if in-person

interviewing was available where respondents lived.

Data Collection in Each Quarter of 2021

A full sample was available from all 4 quarters in 2021.

(See the next paragraph for deﬁnitions of the individual

quarters.) Screening was completed for 220,743 addresses,

and the ﬁnal sample consisted of 69,850 completed

interviews. Based on information from the household

screenings, there were 13,270 interviews from adolescents

aged 12 to 17 and 56,580 interviews from adults aged 18 or

older.

Overall, 54.6 percent of interviews were completed

via the web, and 45.4 percent were completed in person.

Weighted response rates for household screening and for

interviewing were 22.2 and 46.2 percent, respectively, for

an overall response rate of 10.3 percent for people aged

12 or older. e weighted interview response rates were

38.4 percent for adolescents aged 12 to 17 and 47.0 percent

for adults aged 18 or older.

e percentages of interviews that were completed via the

web or in person varied by quarter in 2021. e percentage

of interviews that were completed via the web decreased

by quarter as 2021 progressed. About three fourths of

interviews in Quarter 1 of 2021 (i.e., January to March)

were completed via the web (76.6 percent). In Quarter 2

of 2021 (i.e., April to June), the majority of the interviews

(56.8 percent) also were completed via the web. Fewer than

half of interviews in Quarter 3 (i.e., July to September)

and Quarter 4 of 2021 (i.e., October to December) were

completed via the web (47.9 and 41.5 percent, respectively).

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

Results from the 2021 National Survey on Drug Use and Health6 | December 2022

Further information about the 2021 NSDUH design and

methods can be found on the web at https://www.samhsa.gov/

data/report/2021-methodological-summary-and-deﬁnitions.

Data Presentation and Interpretation

Presentation of Estimates and Statistical Testing

is report focuses on substance use and mental health

indicators in the United States based on NSDUH data

from 2021. All estimates (e.g., percentages and numbers)

presented in the report are derived from survey data that

are subject to sampling errors and have met the criteria for

statistical precision.

Estimates of substance use and related treatment are

presented for people aged 12 or older, including adolescents

and adults.

However, estimates of mental health issues

and mental health service use are presented separately for

adolescents aged 12 to 17 and adults aged 18 or older

because the two groups answered diﬀerent questions

regarding mental health and mental health service utilization.

New for 2021, estimates are presented by racial or ethnic

group for selected outcomes. Estimates that are presented

for racial or ethnic groups are based on federal standards for

reporting these data.

Deﬁnitions for racial and ethnic groups

are provided in Appendix A of the 2021 Methodological

Summary and Deﬁnitions report.

e racial and ethnic

groups discussed in this report are mutually exclusive. People

who were of Hispanic or Latino ethnicity could be of any

race but are not included in the estimates for any of the racial

categories. Estimates for people who were not of Hispanic or

Latino ethnicity are reported by race. People reporting two or

more races and who were not of Hispanic or Latino ethnicity

are noted as “Two or More Races” in the 2021 Detailed

Tables and as “Multiracial” in this report; the two terms are

used interchangeably. People reporting their race as Black

or African American are subsequently referred to as Black.

People reporting their ethnicity as Hispanic or Latino are

subsequently referred to as Hispanic.

Statistical testing was performed for comparisons of

estimates across age groups and among racial or ethnic

groups according to procedures described in the 2021

Methodological Summary and Deﬁnitions report.

For

consistency with the typical criteria for statistical testing in

NSDUH, age group diﬀerences were considered statistically

signiﬁcant at the .05 level of signiﬁcance. For testing among

racial or ethnic groups, a more conservative level of .01 was

used for considering diﬀerences to be statistically signiﬁcant.

Statistically signiﬁcant diﬀerences resulting from these

testing procedures are described using terms such as “higher,”

“lower,” “more likely,” or “less likely.” Statements use terms

such as “similar” or “the same” when a diﬀerence was

not statistically signiﬁcant. When estimates are presented

without reference to diﬀerences across groups, statistical

signiﬁcance is not implied.

Implications of the COVID-19 Pandemic for the 2021

NSDUH

e COVID-19 pandemic continued to aﬀect data

collection for the 2021 NSDUH. Because multimode data

collection was used in 2021, data processing accounted for

the potential eﬀects of survey mode

on responses.

noted previously, the percentage of interviews that were

completed via the diﬀerent data collection modes varied by

quarter in 2021. In addition, the 2021 NSDUH marked

the ﬁrst year in which population projections from the 2020

decennial census were used to develop analysis weights for

making estimates.

Presentation of NSDUH estimates from prior years can be

misleading because apparent diﬀerences in estimates between

2021 and prior years may be attributable to multimode data

collection in 2021 rather than actual changes in the civilian,

noninstitutionalized population of the United States during

the COVID-19 pandemic. For this reason, this report

presents NSDUH estimates from 2021 only, as indicated in

the Introduction.

However, this report does present people’s perceptions

of how the COVID-19 pandemic in 2021 aﬀected their

substance use, mental health, and other parts of their lives

in the section on Substance Use, Mental Health Issues, and

the COVID-19 Pandemic. Sections on suicidal thoughts

and behaviors among adults and adolescents also include

estimates of whether these thoughts and behaviors were

because of COVID-19.

Moreover, this report does compare estimates among

members of diﬀerent age groups in 2021. is report also

presents estimates by racial or ethnic group for selected

outcomes. Diﬀerences in estimates by age group or by

racial or ethnic group are useful for identifying age groups

or racial or ethnic groups that appear to be at greater or

lower risk for negative substance use and mental health

outcomes or that are less likely to receive needed services.

In addition, the 2021 Detailed Tables present estimates

by gender and by racial or ethnic group that can be used

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 7

to identify other disparities in behavioral health outcomes

during the COVID-19 pandemic. Because some estimates

in supplemental tables in the appendices of this report may

not be found in the 2021 Detailed Tables, the appendices

include standard errors for the associated estimates.

Appendices A and B contain tables of estimates by age group

and by racial or ethnic group, respectively.

Although it is not appropriate for data users to compare

estimates from this report with estimates from prior years,

estimates from 2021 remain important to inform eﬀorts

across multiple behavioral health programming and policy

areas. ese eﬀorts include preventing substance use and

the onset of mental disorders, identifying substance use and

mental health issues before they progress to SUDs or mental

disorders, ensuring equitable access to appropriate substance

use treatment and mental health services, and promoting

long-term recovery from SUDs or mental disorders.

NSDUH also was not the only national survey that was

aﬀected by the COVID-19 pandemic. For example, the

2021 National Youth Tobacco Survey (NYTS) did not

compare nicotine product use estimates from 2021 with

those from prior years because of methodological changes to

the 2021 NYTS in response to the COVID-19 pandemic.

e 2021 Methodological Summary and Deﬁnitions report

discusses how the COVID-19 pandemic has aﬀected data

collection for other national surveys.

As COVID-19 infections in the United States wax and wane

over time, the proportions of web and in-person NSDUH

interviews may continue to ﬂuctuate somewhat by quarter

in the short term. However, these proportions are expected

to stabilize at some future point. SAMHSA is investigating

approaches to ensure that estimates from the 2021 NSDUH

can be compared with estimates from future years.

General Substance Use in the Past Month

is section provides an overview of estimates according to

whether respondents aged 12 or older reported using tobacco

products, alcohol, or illicit drugs, or vaping nicotine or

tobacco in the 30 days before the NSDUH interview (i.e., in

the past month, also referred to as “current use”). Additional

information on the use of tobacco products, alcohol, and

illicit drugs is provided in other sections of this report.

Past month tobacco use includes any use of these four

tobacco products: cigarettes, smokeless tobacco (such as

snuﬀ, dip, chewing tobacco, or snus), cigars, and pipe

tobacco. Past month alcohol use refers to having more than

a sip or two of any type of alcoholic drink (e.g., a can or

a bottle of beer, a glass of wine or a wine cooler, a shot of

liquor, or a mixed drink with liquor in it). Past month illicit

drug use includes any use of marijuana (including use of

marijuana with a vaping device), cocaine (including crack),

heroin, hallucinogens, inhalants, or methamphetamine, as

well as misuse of prescription stimulants, tranquilizers or

sedatives (e.g., benzodiazepines), or pain relievers. (See the

section on the Misuse of Psychotherapeutic Drugs for

the deﬁnition of “misuse.”) Past month nicotine vaping

refers to the use of an e-cigarette or other vaping device

to vaporize (i.e., vape) nicotine or tobacco. Any vaping in

the past month includes the use of a vaping device to vape

any substance, including (but not limited to) nicotine,

marijuana, or ﬂavoring.

Tables in Appendix A also include estimates of

past month use for the following other substances: gamma

hydroxybutyrate (GHB), the misuse of nonprescription

cold and cough medicine, kratom, synthetic marijuana (fake

weed, K2, or Spice), and synthetic stimulants (“bath salts”

or ﬂakka). Estimates for the use or misuse of these other

substances are discussed later in the report for the past year

(rather than the past month) because of low prevalence

estimates in the past month for many of these substances.

Among people aged 12 or older in 2021, 57.8 percent (or

161.8 million people) used tobacco, alcohol, or an illicit

drug in the past month; 47.5 percent (or 133.1 million

people) drank alcohol in the past month; 19.5 percent

(or 54.7 million people) used a tobacco product in the

past month; and 14.3 percent (or 40.0 million people) used

an illicit drug in the past month (Figure 1 and Table A.1B).

Estimates for tobacco, alcohol, or illicit drugs are not

mutually exclusive because respondents could have used

more than one type of substance (e.g., tobacco products and

alcohol) in the past month.

Tobacco Use or Nicotine Vaping in the Past

Month

Before 2020, NSDUH assessed tobacco use but did not

include questions on nicotine vaping. However, ﬁndings

from the 2019 National Youth Tobacco Survey (NYTS) and

the 2019 Monitoring the Future (MTF) study indicated

increases in nicotine vaping.

21,22,23

NYTS data indicate that

e-cigarettes have been the most commonly used nicotine

product among youths since 2014, including in 2021,

and that e-cigarette use in 2019 had reached epidemic

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

Results from the 2021 National Survey on Drug Use and Health8 | December 2022

proportions among youths.

In addition, vaping of nicotine

products among adolescents has been identiﬁed as a risk

factor for future cigarette use.

However, combined data

for 8th, 10th, and 12th graders in the 2021 MTF study

indicated a signiﬁcant decrease between 2020 and 2021

in nicotine vaping in the past month.

e prevalence of

nicotine vaping among adults aged 19 to 30 did not diﬀer

signiﬁcantly between 2019 and 2020.

e 2021 NYTS indicated that 11.3 percent of high

school students used e-cigarettes in the past month

and that e-cigarettes were the most common form of

nicotine products used among adolescents. Because of

methodological changes to the 2021 NYTS in response

to the COVID-19 pandemic, the NYTS did not compare

nicotine product use estimates from 2021 with those from

prior years. Nevertheless, NYTS researchers stressed the need

for continued eﬀorts to reduce all forms of nicotine product

use among adolescents.

erefore, the 2021 NSDUH

included questions to assess the use of nicotine vaping in

both adolescents and adults.

As noted in the section on General Substance Use in the

Past Month

, past month tobacco use in NSDUH includes

any use of these four tobacco products: cigarettes, smokeless

tobacco (such as snuﬀ, dip, chewing tobacco, or snus),

cigars, and pipe tobacco. Past month nicotine vaping refers

to the use of an e-cigarette or other vaping device to vape

nicotine or tobacco. Aggregate estimates for the past month

use of tobacco or nicotine vaping (also referred to as current

use of nicotine products) are presented for people who

used any of these tobacco products or vaped nicotine in the

past month (or both).

e following sections present the overall estimates ﬁrst,

then by age group. Estimates among racial or ethnic groups

are presented for selected measures.

Among people aged 12 or older in 2021, 22.0 percent

(or 61.6 million people) used tobacco products or vaped

nicotine in the past month (Figure 2 and Table A.1B). e

percentage of people who used tobacco products or vaped

nicotine in the past month was lowest among adolescents

aged 12 to 17 (6.7 percent or 1.7 million people). Estimates

among young adults aged 18 to 25 and adults aged 26

or older were 24.7 percent (or 8.3 million people) and

23.4 percent (or 51.6 million people), respectively.

Among current nicotine product users, the use of speciﬁc

nicotine products varied by age group. An estimated

60.5 percent of adolescents aged 12 to 17 who used nicotine

products in the past month vaped only nicotine products

Figure1. Past Month Substance Use: Among People Aged 12 or

Older; 2021

133.1M

54.7M

13.2M

36.4M

2.4M

2.2M

1.8M

1.6M

1.4M

1.1M

830,000

589,000

0 50M 100M 150M

Alcohol

Tobacco Products

Nicotine Vaping

Marijuana

Rx Pain Reliever Misuse

Hallucinogens

Cocaine

Methamphetamine

Rx Tranquilizer or Sedative Misuse

Rx Stimulants Misuse

Inhalants

Heroin

Number of Past Month Users

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.

Figure2. Past Month Tobacco Use or Nicotine Vaping: Among People Aged 12 or Older; 2021

43.6M

10.3M

7.3M

1.8M

13.2M

0 10M 20M 30M 40M 50M 60M

Cigarettes

Cigars

Smokeless Tobacco

Pipe Tobacco

Nicotine Vaping

Number of Past Month Users

Past Month

Tobacco Use or

Nicotine Vaping

61.6 Million People

(22.0%)

No Past Month

Tobacco Use or

Nicotine Vaping

218.2 Million People

(78.0%)

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

one type of tobacco product or used tobacco products and vaped nicotine in the pastmonth.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 9

compared with 32.2 percent of young adults aged 18 to

25 and only 6.2 percent of adults aged 26 or older who

used nicotine products in the past month (Figure 3 and

Table A.2B). In contrast, 86.2 percent of adults aged 26

or older who used nicotine products in the past month

used only tobacco products compared with 21.2 percent

of adolescents aged 12 to 17 and 42.8 percent of young

adults aged 18 to 25 who used nicotine products in the

past month.

By Race/Ethnicity

Among people aged 12 or older in 2021, 36.1 percent of

American Indian or Alaska Native people used tobacco

products or vaped nicotine in the past month (Figure 4

and Table B.1B). is percentage was higher than the

corresponding percentages of White (24.6 percent), Black

(23.6 percent), Hispanic (14.9 percent), or Asian people

(9.3 percent). e percentage of people who used tobacco

products or vaped nicotine in the past month was lowest

among Asian people compared with people in all other racial

or ethnic groups.

Among current nicotine product users aged 12 or older in

2021, the use of speciﬁc nicotine products varied by racial

or ethnic group. Black people who used nicotine products

in the past month were less likely to vape only nicotine

(5.1 percent) compared with past month users of nicotine

products who were Multiracial (17.7 percent), White

(12.3 percent), or Hispanic (11.2 percent) (Table B.2B).

In contrast, Black people who were current nicotine product

users were more likely to use only tobacco products in

the past month (90.5 percent) compared with current

nicotine product users who were Hispanic (79.4 percent),

White (76.5 percent), Asian (76.5 percent), or Multiracial

(70.0 percent).

Tobacco Product Use

In 2021, of the 54.7 million current (i.e., past month)

tobacco users aged 12 or older (Figure 1), the majority were

current cigarette smokers (43.6 million; Figure 2). is

pattern matches historical usage patterns.

Additionally,

10.3 million people aged 12 or older were current cigar

smokers, 7.3 million people were current smokeless tobacco

users, and 1.8 million people were current pipe tobacco

smokers.

Among people aged 12 or older in 2021 who used any

tobacco product in the past month (regardless of whether or

not they vaped nicotine), 67.5 percent smoked cigarettes but

did not use other tobacco products, 12.3 percent smoked

cigarettes and used some other type of tobacco product, and

20.3 percent used only noncigarette tobacco products (i.e.,

other tobacco products but not cigarettes) (Table A.3B).

e percentage for the use of only cigarettes was highest

among adults aged 26 or older who used tobacco products

in the past month (69.6 percent). Among adolescents aged

12 to 17 and young adults aged 18 to 25 who used tobacco

products in the past month, 48.0 percent and 51.2 percent,

respectively, used only cigarettes in the past month. Overall,

57.5 percent of adolescents aged 12 to 17 and 68.4 percent

Figure3. Type of Past Month Tobacco Use and Nicotine Vaping:

Among Past Month Nicotine Product Users Aged 12 or Older; 2021

78.6

21.2

42.8

86.2

10.2

18.2

25.0

7.6

11.2

60.5

32.2

6.2

100

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

Percent Using in Past Month

Only Nicotine Vaping

Nicotine Vaping and Tobacco Product Use

Only Tobacco Product Use

Figure4. Past Month Tobacco Use or Nicotine Vaping: Among

People Aged 12 or Older; by Race/Ethnicity, 2021

22.0

36.1

29.7

28.6

24.6

23.6

14.9

9.3

Percent Using in Past Month

NH Asian

Hispanic

NH Black

NH White

NH NHOPI

NH Multiracial

NH AIAN

12 or Older

40302010

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

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

Results from the 2021 National Survey on Drug Use and Health10 | December 2022

of young adults aged 18 to 25 who were past month tobacco

users smoked cigarettes, either as the only tobacco product

they used or in addition to other tobacco products.

e remainder of this section on tobacco use focuses on

cigarette smoking because most current tobacco users aged

12 or older were cigarette smokers. Information on the

use of smokeless tobacco, cigars, and pipe tobacco in the

past month among people aged 12 or older and by age group

can be found in Table A.1B.

Cigarette Use

Among people aged 12 or older in 2021, 15.6 percent (or

43.6 million people) smoked cigarettes in the past month

(Figure 5 and Table A.1B). e percentage of people who

smoked cigarettes in the past month was highest among

adults aged 26 or older (17.9 percent or 39.4 million

people), followed by young adults aged 18 to 25

(11.5 percent or 3.8 million people), then by adolescents

aged 12 to 17 (1.5 percent or 392,000 people).

By Race/Ethnicity

Among people aged 12 or older in 2021, the percentage of

people who were past month cigarette smokers was lower

among Asian (7.4 percent) or Hispanic people (11.2 percent)

than among those who were American Indian or Alaska

Native (26.5 percent), Multiracial (20.4 percent), Black

(17.3 percent), or White (17.1 percent) (Table B.1B). Asian

people were also less likely than Hispanic people to smoke

cigarettes in the past month.

Daily Cigarette Use

Among the 43.6 million current cigarette smokers aged

12 or older in 2021 (see the section on Cigarette Use),

27.0 million people (or 61.9 percent) were daily cigarette

smokers (Figure 6). Among current cigarette smokers,

adults aged 26 or older were more likely than young adults

aged 18 to 25 to be daily smokers (65.8 vs. 27.6 percent)

(Table A.1B). Estimates for daily cigarette smoking among

adolescents aged 12 to 17 could not be calculated with

suﬃcient precision.

Among the 27.0 million daily cigarette smokers aged 12 or

older in 2021, 11.3 million people (or 41.9 percent) smoked

one or more packs of cigarettes per day (Figure 6 and

Table A.1B). Among daily cigarette smokers, adults aged 26

or older were more likely than young adults aged 18 to 25

to smoke one or more packs of cigarettes per day (42.7 vs.

24.2 percent).

Nicotine Vaping

In 2021, 13.2 million people aged 12 or older (or

4.7 percent) used an e-cigarette or other vaping device

to vape nicotine in the past month (Figures 2 and 7 and

Table A.1B). e percentage of people who vaped nicotine

Figure5. Past Month Cigarette Use: Among People Aged 12 or

Older; 2021

15.6

1.5

11.5

17.9

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

Percent Using in Past Month

Figure6. Daily Cigarette Use: Among Past Month (Current) Cigarette Smokers Aged 12 or Older;

Smoking of One or More Packs of Cigarettes per Day: Among Current Daily Smokers; 2021

15.7 Million

Smokers of

Less Than a

Pack per Day

(58.1%)

11.3 Million

Smokers of

One or More

Packs per Day

(41.9%)

16.6 Million

Current Less

Than Daily

Smokers

(38.1%)

27.0 Million

Current Daily

Smokers

(61.9%)

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

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 11

was highest among young adults aged 18 to 25 (14.1 percent

or 4.7 million people), followed by adolescents aged 12 to

17 (5.2 percent or 1.4 million people), then by adults aged

26 or older (3.2 percent or 7.1 million people).

By Race/Ethnicity

Among people aged 12 or older in 2021, Multiracial

(8.9 percent), American Indian or Alaska Native

(7.5 percent), or White people (5.8 percent) were more likely

to have used an e-cigarette or other vaping device to vape

nicotine in the past month compared with Black (2.2 percent)

or Asian people (2.2 percent) (Table B.1B). Multiracial or

White people were also more likely than Hispanic people

(3.1 percent) to have vaped nicotine in the past month.

Underage Tobacco Use or Nicotine Vaping

Legislation in December 2019 raised the federal minimum

age for sale of tobacco products (along with e-cigarettes)

from 18 to 21 years.

All 50 states and the District of

Columbia now prohibit the sale of tobacco products to

people younger than 21.

Among people aged 12 to 20 in 2021, 11.0 percent (or

4.3 million people) used tobacco products or used an

e-cigarette or other vaping device to vape nicotine in the

past month (Table A.1B). Among people in this age group,

8.1 percent (or 3.1 million people) vaped nicotine, 5.4 percent

(or 2.1 million people) used tobacco products, and 3.4 percent

(or 1.3 million people) smoked cigarettes in the past month.

By Race/Ethnicity

Among people aged 12 to 20 in 2021, White (14.5 percent)

or Multiracial people (12.2 percent) were more likely to have

used tobacco products or to have used an e-cigarette or other

vaping device to vape nicotine in the past month compared

with people in most other racial or ethnic groups (Table B.3B).

Asian people were less likely to have used tobacco products

or vaped nicotine in the past month (2.9 percent) compared

with people in most other racial or ethnic groups. White or

Multiracial people aged 12 to 20 in 2021 were more likely to

have vaped nicotine in the past month (11.1 and 9.5 percent,

respectively) compared with underage Hispanic (5.0 percent),

Black (3.9 percent), or Asian people (2.7 percent).

White people aged 12 to 20 in 2021 were more likely to

have used tobacco products or to have smoked cigarettes in

the past month compared with underage Black, Hispanic,

or Asian people (

Table B.3B). For example, 7.0 percent

of underage White people used tobacco products in the

past month compared with 4.0 percent of those who

were Black, 3.6 percent of those who were Hispanic, and

1.8 percent of those who were Asian. e percentage of

underage Multiracial people who used tobacco products

in the past month (4.9 percent) also was higher than the

corresponding percentage of underage Asian people.

Alcohol Use in the Past Month

As noted in the section on General Substance Use in the

Past Month, the 2021 NSDUH asked respondents aged

12 or older about their alcohol use in the 30 days before

the interview. In addition to asking about any alcohol

use, NSDUH collected information on past month binge

alcohol use and heavy alcohol use. In the 2021 NSDUH,

binge drinking for males was deﬁned as drinking ﬁve or

more drinks

on the same occasion on at least 1 day in

the past 30 days. Binge drinking for females was 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 was deﬁned as binge drinking on 5 or more

days in the past 30 days based on the thresholds previously

described for males and females.

e following sections present the overall estimates ﬁrst,

then by age group. Estimates among racial or ethnic groups

are presented for the measures in this section.

Among the 133.1 million current alcohol users aged 12 or

older in 2021, 60.0 million people (or 45.1 percent) were

past month binge drinkers (Figure 8). Among past month

binge drinkers, 16.3 million people were past month

heavy drinkers. e 16.3 million heavy drinkers represent

27.2 percent of current binge drinkers and 12.3 percent of

current alcohol users.

Figure7. Past Month Nicotine Vaping: Among People Aged 12 or

Older; 2021

4.7

5.2

14.1

3.2

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

Percent Using in Past Month

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

Results from the 2021 National Survey on Drug Use and Health12 | December 2022

Any Alcohol Use

Among people aged 12 or older in 2021, 47.5 percent (or

133.1 million people) drank alcohol in the past month

(Figure 9 and Table A.1B). e percentage was highest

among adults aged 26 or older (51.9 percent or 114.5 million

people), followed by young adults aged 18 to 25 (50.1 percent

or 16.8 million people). e percentage was lowest among

adolescents aged 12 to 17 (7.0 percent or 1.8 million people).

By Race/Ethnicity

Among people aged 12 or older in 2021, 52.2 percent of

White people drank alcohol in the past month (Table B.4B).

is percentage was higher than the percentages of people

in all other racial or ethnic groups. Asian people had a

lower estimate of past month alcohol use (32.0 percent)

compared with White, Multiracial (43.2 percent), Hispanic

(41.9 percent), or Black people (41.6 percent).

Binge Alcohol Use

Among people aged 12 or older in 2021, 21.5 percent (or

60.0 million people) were binge drinkers in the past month

(Figures 8 and 9 and Table A.1B). e percentage was

highest among young adults aged 18 to 25 (29.2 percent

or 9.8 million people), followed by adults aged 26 or older

(22.4 percent or 49.3 million people). e percentage was

lowest among adolescents aged 12 to 17 (3.8 percent or

995,000 people).

By Race/Ethnicity

Among people aged 12 or older in 2021, Asian people

(10.7 percent) were less likely to be binge drinkers in the

past month compared with people in other racial or ethnic

groups (Figure 10 and Table B.4B). e estimate of binge

drinking in the past month could not be calculated with

suﬃcient precision for people in the Native Hawaiian or

Figure9. Past Month Alcohol Use, Past Month Binge Alcohol Use,

and Past Month Heavy Alcohol Use: Among People Aged 12 or

Older; 2021

47.5

21.5

5.8

7.0

3.8

0.4

50.1

29.2

7.1

51.9

22.4

6.3

Past Month

Alcohol Use

Past Month

Binge Alcohol Use

Past Month

Heavy Alcohol Use

Percent Using in Past Month

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

Age Category:

Note: Binge Alcohol Use is defined as drinking five or more drinks (for males) or four or more drinks

(for females) on the same occasion on at least 1 day in the past30days. Heavy Alcohol Use is

defined as binge drinking on the same occasion on 5 or more days in the past30days; all heavy

alcohol users are also binge alcohol users.

Figure10. Past Month Binge Alcohol Use: Among People Aged 12

or Older; by Race/Ethnicity, 2021

21.5

26.2

22.9

21.9

21.6

21.2

10.7

Percent Using in Past Month

NH NHOPI

NH Asian

NH AIAN

NH Black

NH White

Hispanic

NH Multiracial

12 or Older

0 40302010

* Low precision; no estimate reported.

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

Note: Binge Alcohol Use is defined as drinking five or more drinks (for males) or four or more drinks

(for females) on the same occasion on at least 1 day in the past30days.

Figure8. Past Month Alcohol Use, Binge Alcohol Use, and Heavy

Alcohol Use: Among People Aged 12 or Older; 2021

133.1 Million

Alcohol Users

60.0 Million

Binge Alcohol Users

(45.1% of Alcohol Users)

16.3 Million

Heavy Alcohol Users

(27.2% of Binge Alcohol

Users and 12.3% of

Alcohol Users)

Note: Binge Alcohol Use is defined as drinking five or more drinks (for males) or four or more drinks

(for females) on the same occasion on at least 1 day in the past30days. Heavy Alcohol Use is

defined as binge drinking on the same occasion on 5 or more days in the past30days; all heavy

alcohol users are also binge alcohol users.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 13

Other Paciﬁc Islander group.

Estimates of binge drinking

in the past month did not diﬀer among people in the other

racial or ethnic groups.

Heavy Alcohol Use

Among people aged 12 or older in 2021, 5.8 percent

(or 16.3 million people) were heavy alcohol users in

the past month (Figures 8 and 9 and Table A.1B). e

percentage was highest among young adults aged 18 to

25 (7.1 percent or 2.4 million people), followed by adults

aged 26 or older (6.3 percent or 13.9 million people). e

percentage was lowest among adolescents aged 12 to 17

(0.4 percent or 103,000 people).

By Race/Ethnicity

Among people aged 12 or older in 2021, White people were

more likely to be heavy alcohol users in the past month

(6.7 percent) compared with Black (5.2 percent), Hispanic

(4.7 percent), or Asian people (1.9 percent) (Figure 11

and Table B.4B). Asian people were less likely to be heavy

alcohol users in the past month than American Indian or

Alaska Native (7.2 percent), Multiracial (5.7 percent), Black,

or Hispanic people.

Underage Alcohol Use

In 2021, all 50 states and the District of Columbia

prohibited the possession of alcoholic beverages by

people younger than 21 (although some states may have

had exceptions).

Most states also prohibited underage

consumption (i.e., consumption of alcoholic beverages

prior to the age of 21).

Among people aged 12 to 20 in

2021, 15.1 percent (or 5.9 million people) were past month

alcohol users (Table A.1B). Estimates of binge alcohol use

and heavy alcohol use in the past month among underage

people were 8.3 percent (or 3.2 million people) and

1.6 percent (or 613,000 people), respectively.

By Race/Ethnicity

Among people aged 12 to 20 in 2021, White people were

more likely than people in many other racial or ethnic

groups to be past month alcohol users, binge drinkers, or

heavy alcohol users. Underage Asian people tended to have

lower estimates of past month alcohol use, binge drinking,

or heavy alcohol use than underage people in many other

racial or ethnic groups.

For example, 18.1 percent of underage White people in

2021 drank alcohol in the past month compared with

14.5 percent of underage people who were Hispanic,

13.2 percent of those who were Multiracial, 9.4 percent

of those who were Black, and 6.4 percent of those who

were Asian (Table B.5B). Underage Asian people were less

likely than underage Hispanic or Multiracial people to be

past month alcohol users.

In addition, 10.1 percent of White people aged 12 to

20 in 2021 were past month binge drinkers compared

with 7.3 percent of underage people who were Hispanic,

5.5 percent of those who were Black, and 2.5 percent of

those who were Asian (Table B.5B). Underage Asian people

were less likely to be past month binge drinkers compared

with underage Multiracial (7.5 percent), Hispanic, or Black

people.

In 2021, 2.1 percent of White people aged 12 to 20

were past month heavy alcohol users (Table B.5B). is

percentage was higher than the percentages of underage

Hispanic (1.0 percent) or Asian people (0.2 percent).

Underage Asian people were less likely than underage

Hispanic people to be heavy alcohol users in the past month.

Figure11. Past Month Heavy Alcohol Use: Among People Aged 12

or Older; by Race/Ethnicity, 2021

5.8

7.2

6.7

5.7

5.6

5.2

4.7

1.9

Percent Using in Past Month

NH Asian

Hispanic

NH Black

NH NHOPI

NH Multiracial

NH White

NH AIAN

12 or Older

0 161284

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

Note: Heavy Alcohol Use is defined as drinking five or more drinks (for males) or four or more drinks

(for females) on the same occasion on 5 or more days in the past30days.

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

Results from the 2021 National Survey on Drug Use and Health14 | December 2022

Marijuana Use and Marijuana Vaping in the

Past Month

e 2021 NSDUH questionnaire included new questions to

assess the use of vaping devices to vape marijuana. Questions

about marijuana vaping appeared in a later section of the

questionnaire, after respondents had answered questions

about any marijuana use. Consequently, some respondents

reported that they last vaped marijuana more recently than

when they reported last using any marijuana. As part of

the procedures for logically editing 2021 NSDUH data,

respondents who reported that they vaped marijuana more

recently than they previously reported using marijuana were

inferred to be more recent users of any marijuana.

In 2021, 13.0 percent of people aged 12 or older (or

36.4 million people) used marijuana in the past month,

including 2.7 percent (or 7.4 million people) who vaped

marijuana in that period (Table A.1B). e percentage

of people who used marijuana in the past month was

highest among young adults aged 18 to 25 (24.1 percent

or 8.1 million people), followed by adults aged 26 or older

(12.2 percent or 26.8 million people), then by adolescents

aged 12 to 17 (5.8 percent or 1.5 million people).

e percentage of people who vaped marijuana in the

past month was also highest among young adults aged 18

to 25 (6.5 percent or 2.2 million people). Percentages of

adolescents aged 12 to 17 and adults aged 26 or older who

vaped marijuana in the past month were similar (2.3 and

2.1 percent, respectively). ese percentages correspond to

600,000 adolescents aged 12 to 17 and 4.7 million adults

aged 26 or older who vaped marijuana in the past month.

About 1 in 5 current marijuana users aged 12 or older

(20.5 percent) vaped marijuana in the past month (Figure 12

and Table A.4B). e percentage for marijuana vaping in

the past month among current marijuana users was highest

among adolescents aged 12 to 17 (40.0 percent), followed

by young adults aged 18 to 25 (27.0 percent), then by adults

aged 26 or older (17.4 percent).

By Race/Ethnicity

Among people aged 12 or older in 2021, American Indian

or Alaska Native (27.0 percent) or Multiracial people

(21.1 percent) were more likely to have used marijuana in

the past month compared with people in most other racial or

ethnic groups (Table B.6B). Asian people (5.4 percent) were

less likely to use marijuana in the past month compared with

people in all other racial or ethnic groups.

Among people aged 12 or older in 2021, similar percentages

of Multiracial or White people vaped marijuana in the

past month (4.9 and 3.1 percent, respectively) (Table B.6B).

Percentages for these two groups were higher than

the percentages among Hispanic (2.0 percent), Black

(1.5 percent), or Asian people (1.5 percent).

Among current marijuana users aged 12 or older in

2021, 9.9 percent of Black people vaped marijuana in the

past month (Table B.6B). is percentage was lower than the

corresponding percentages among current marijuana users

who were Multiracial (23.0 percent), White (23.0 percent),

or Hispanic (19.1 percent).

Any Vaping in the Past Month

e 2021 NSDUH added new questions to assess the use

of vaping devices to vape ﬂavoring. Along with questions on

nicotine vaping and marijuana vaping, these questions on

vaping of ﬂavoring allow for more in-depth examination of

the types of substances that people vaped in the past month.

is section does not present ﬁndings by race or ethnicity

because of the complexity of the associated measures for any

vaping.

Among people aged 12 or older in 2021, 6.6 percent (or

18.6 million people) used a vaporizing device to vape any

substance in the past month (Table A.1B). As indicated

previously, 4.7 percent of people aged 12 or older (or

13.2 million people) vaped nicotine, and 2.7 percent (or

7.4 million people) vaped marijuana in the past month. In

addition, 1.3 percent (or 3.6 million people) vaped ﬂavoring

in that period, including 3.3 percent of young adults aged

Figure12. Type of Marijuana Use: Among Past Month Marijuana

Users Aged 12 or Older; 2021

20.5

40.0

27.0

17.4

79.5

60.0

73.0

82.6

100

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

Percent Using in Past Month

Marijuana Use but Not Marijuana Vaping

Marijuana Vaping

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 15

18 to 25 (or 1.1 million people), 1.8 percent of adolescents

aged 12 to 17 (or 462,000 people), and 0.9 percent of adults

aged 26 or older (or 2.0 million people).

Among people in 2021 who vaped any substance in the

past month, use of a vaporizing device to vape nicotine was

the predominant form of vaping for people aged 12 or older

and in each age group, followed by marijuana vaping, then

by vaping of ﬂavoring (

Table A.5B). Among people aged

12 or older who vaped any substance, 71.1 percent vaped

nicotine, 40.1 percent vaped marijuana, and 19.2 percent

vaped ﬂavoring. Among adolescents aged 12 to 17 and

young adults aged 18 to 25 who vaped any substance in the

past month, about four ﬁfths vaped nicotine (80.6 percent

of adolescents aged 12 to 17 and 81.9 percent of young

adults aged 18 to 25), and about one third vaped marijuana

(35.5 percent of adolescents aged 12 to 17 and 37.7 percent

of young adults aged 18 to 25). Among adults aged 26 or

older who vaped any substance, 64.1 percent vaped nicotine,

42.0 percent vaped marijuana, and 18.0 percent vaped

ﬂavoring. Note that these estimates for nicotine vaping,

marijuana vaping, and vaping of ﬂavoring are not mutually

exclusive. erefore, the individual estimates for vaping these

substances sum to more than 100 percent.

Because people who vaped any substance could have vaped

more than one substance in the past month, Table A.5B

also presents estimates for the number of substances (i.e.,

nicotine, marijuana, or ﬂavoring) that people vaped in

the past month. Estimates for vaping of only one of these

substances, two of these substances, or all three substances

sum to less than 100 percent because people who vaped any

substance in the past month could have vaped substances

other than nicotine, marijuana, or ﬂavoring.

Among people aged 12 or older in 2021 who vaped any

substance in the past month, 65.0 percent vaped only one

of three substances (i.e., nicotine, marijuana, or ﬂavoring),

25.0 percent vaped two of these three substances, and

5.1 percent vaped all three substances (Figure 13 and

Table A.5B). An additional 4.8 percent of people who vaped

any substance in the past month did not vape nicotine,

marijuana, or ﬂavoring; the other substance(s) that these

people vaped in the past month is unknown.

Among people who vaped any substance in the past month,

there were age group diﬀerences in the number of substances

that people vaped. About half of adolescents aged 12 to 17

and young adults aged 18 to 25 who vaped any substance in

the past month vaped only one substance among nicotine,

marijuana, or ﬂavoring (52.5 and 57.3 percent, respectively)

(Table A.5B). In comparison, 70.9 percent of adults aged 26

or older who vaped any substance vaped only one of these

substances. About one third of adolescents aged 12 to 17 and

young adults aged 18 to 25 who vaped any substance in the

past month vaped two of these three substances (32.6 and

32.5 percent, respectively) compared with 1 in 5 adults aged

26 or older who vaped any substance (20.0 percent).

Illicit Drug Use in the Past Year

e 2021 NSDUH obtained illicit drug use information

for the use of marijuana (including use of marijuana

with a vaping device), cocaine (including crack), heroin,

hallucinogens, inhalants, and methamphetamine, as well

as for the misuse of prescription stimulants, tranquilizers,

sedatives,

and pain relievers (see the section on the Misuse

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

is report presents estimates of past year (rather than

past month) illicit drug use because of low prevalence

estimates for some illicit drugs (e.g., heroin). Moreover,

the 2021 NSDUH collected only past year (rather than

past month) data on the misuse of benzodiazepines and

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

products).

e following sections present the overall estimates ﬁrst,

then by age group. Estimates among racial or ethnic groups

are presented for selected measures.

Among people aged 12 or older in 2021, 61.2 million people

used illicit drugs in the past year (Figure 14). e most

commonly used illicit drug in the past year was marijuana,

Figure13. Type of Vaping Use: Among Past Month Users Aged 12

or Older Who Vaped Any Substance; 2021

Only One Substance

(65.0%)

Two of the

Three Substances

(25.0%)

All Three Substances

(5.1%)

Other (Substances Unknown)

(4.8%)

Note: People who vaped any substance could have used vaping devices to vape substances other than

nicotine, marijuana, or flavoring.

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

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

Results from the 2021 National Survey on Drug Use and Health16 | December 2022

which was used by 52.5 million people. e second most

common type of illicit drug use in the past year was the

misuse of prescription pain relievers, which were misused by

8.7 million people. Smaller numbers of people were past year

users of the other illicit drugs shown in Figure 14.

Any Illicit Drug Use

Among people aged 12 or older in 2021, 21.9 percent

(or 61.2 million people) used illicit drugs in the past year

(Figures 14 and 15 and Table A.6B). e percentage was

highest among young adults aged 18 to 25 (38.0 percent or

12.7 million people), followed by adults aged 26 or older

(20.3 percent or 44.8 million people), then by adolescents

aged 12 to 17 (14.1 percent or 3.7 million people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

used illicit drugs in the past year was higher among

American Indian or Alaska Native (36.1 percent)

or Multiracial people (34.6 percent) than among

Black (24.3 percent), White (22.5 percent), Hispanic

(19.4 percent), or Asian people (11.1 percent) (Figure 16

and Table B.7B). e estimate of illicit drug use in the

past year could not be calculated with suﬃcient precision

for people in the Native Hawaiian or Other Paciﬁc Islander

group.

Asian people were less likely to use illicit drugs in

the past year compared with people in all other racial or

ethnic groups. Black or White people were more likely to

use illicit drugs in the past year compared with Hispanic

Figure15. Past Year Illicit Drug Use and Past Year Marijuana Use:

Among People Aged 12 or Older; 2021

21.9

18.7

14.1

10.5

38.0

35.4

20.3

17.2

Past Year Illicit Drug Use Past Year Marijuana Use

Percent Using in Past Year

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

Age Category:

Figure16. Past Year Illicit Drug Use: Among People Aged 12 or

Older; by Race/Ethnicity, 2021

21.9

36.1

34.6

24.3

22.5

19.4

11.1

Percent Using in Past Year

NH NHOPI

NH Asian

Hispanic

NH White

NH Black

NH Multiracial

NH AIAN

12 or Older

40302010

* Low precision; no estimate reported.

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

Figure14. Past Year Illicit Drug Use: Among People Aged 12 or Older; 2021

52.5M

8.7M

7.4M

4.9M

4.8M

3.7M

2.5M

2.2M

1.1M

0 10M 20M 30M 40M 50M 60M

Marijuana

Rx Pain Reliever Misuse

Hallucinogens

Rx Tranquilizer or Sedative Misuse

Cocaine

Rx Stimulant Misuse

Methamphetamine

Inhalants

Heroin

Number of Past Year Users

Past Year

Illicit Drug Use

61.2 Million People

(21.9%)

No Past Year

Illicit Drug Use

218.6 Million People

(78.1%)

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 2021 National Survey on Drug Use and Health December 2022 | 17

people. Estimates for illicit drug use in the past year did not

diﬀer among Black or White people.

Marijuana Use

In 2021, 18.7 percent of people aged 12 or older (or

52.5 million people) used marijuana in the past year

(Figures 14 and 15 and Table A.7B). e percentage was

highest among young adults aged 18 to 25 (35.4 percent or

11.8 million people), followed by adults aged 26 or older

(17.2 percent or 37.9 million people), then by adolescents

aged 12 to 17 (10.5 percent or 2.7 million people).

By Race/Ethnicity

In 2021, the percentage of people aged 12 or older who

used marijuana in the past year was higher among American

Indian or Alaska Native (35.0 percent) or Multiracial people

(30.7 percent) than among Black (21.3 percent), White

(19.5 percent), Hispanic (15.8 percent), or Asian people

(8.6 percent) (Figure 17 and Table B.7B). e estimate of

marijuana use in the past year could not be calculated with

suﬃcient precision for people in the Native Hawaiian or Other

Paciﬁc Islander group.

Asian people were less likely to use

marijuana in the past year compared with people in all other

racial or ethnic groups. Black or White people were more likely

to use marijuana in the past year compared with Hispanic

people. Estimates for marijuana use in the past year did not

diﬀer among Black or White people.

Cocaine Use

Cocaine use includes the use of crack cocaine. Estimates of

crack use are presented separately as well. Among people

aged 12 or older in 2021, 1.7 percent (or 4.8 million

people) used cocaine in the past year (Figures 14 and

18 and Table A.7B). e percentage was highest among

young adults aged 18 to 25 (3.5 percent or 1.2 million

people), followed by adults aged 26 or older (1.6 percent

or 3.6 million people), then by adolescents aged 12 to 17

(0.2 percent or 40,000 people).

In 2021, an estimated 0.4 percent of people aged 12 or

older (or 996,000 people) used crack in the past year

(Table A.7B). e percentage was lowest among adolescents

aged 12 to 17 (less than 0.1 percent or 3,000 people). An

estimated 0.2 percent of young adults aged 18 to 25 (or

74,000 people) and 0.4 percent of adults aged 26 or older

(or 919,000 people) used crack in the past year.

By Race/Ethnicity

In 2021, cocaine use in the past year among people aged

12 or older did not diﬀer among racial or ethnic groups

(Table B.7B). Percentages ranged from 1.0 percent among

Asian people to 3.2 percent among Multiracial people.

However, Black people (0.9 percent) were more likely to

use crack in the past year compared with Hispanic or Asian

people (both 0.1 percent).

Figure17. Past Year Marijuana Use: Among People Aged 12 or

Older; by Race/Ethnicity, 2021

18.7

35.0

30.7

21.3

19.5

15.8

8.6

Percent Using in Past Year

NH NHOPI

NH Asian

Hispanic

NH White

NH Black

NH Multiracial

NH AIAN

12 or Older

40302010

* Low precision; no estimate reported.

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

Figure18. Past Year Cocaine Use and Past Year Heroin Use:

Among People Aged 12 or Older; 2021

1.7

0.4

0.2

3.5

0.2

1.6

0.5

Past Year Cocaine Use Past Year Heroin Use

Percent Using in Past Year

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

Age Category:

* Low precision; no estimate reported.

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

Results from the 2021 National Survey on Drug Use and Health18 | December 2022

Heroin Use

Among people aged 12 or older in 2021, 0.4 percent (or

1.1 million people) used heroin in the past year (Figures 14

and 18 and Table A.7B). e percentage was higher among

adults aged 26 or older (0.5 percent or 1.0 million people)

than among young adults aged 18 to 25 (0.2 percent or

66,000 people). Estimates of past year heroin use among

adolescents aged 12 to 17 could not be calculated with

suﬃcient precision.

Methamphetamine Use

Although methamphetamine is legally available by

prescription (Desoxyn

), most methamphetamine

used in the United States is produced and distributed

illicitly rather than through the pharmaceutical industry.

erefore, the 2021 NSDUH includes separate sections

for methamphetamine use and the use and misuse of

prescription stimulants.

Among people aged 12 or older in 2021, 0.9 percent (or

2.5 million people) used methamphetamine in the past year

(Figures 14 and 19 and Table A.7B). Adolescents aged 12 to

17 had the lowest estimate of past year methamphetamine

use (0.1 percent or 37,000 people). Percentages increased

with age (0.5 percent of young adults aged 18 to 25 or

166,000 people; 1.1 percent of adults aged 26 or older or

2.3 million people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

used methamphetamine in the past year was higher among

Multiracial (1.6 percent) or White people (1.1 percent) than

among Black (0.4 percent) or Asian people (0.3 percent)

(Table B.8B).

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 2021, 2.6 percent of people aged 12 or older (or

7.4 million people) used hallucinogens in the past year

(Figures 14 and 19 and Table A.7B). e percentage was

highest among young adults aged 18 to 25 (7.1 percent or

2.4 million people), followed by adults aged 26 or older

(2.1 percent or 4.7 million people), then by adolescents aged

12 to 17 (1.3 percent or 347,000 people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who used

hallucinogens in the past year was higher among Multiracial

people (5.5 percent) than among White (2.9 percent),

Hispanic (2.4 percent), Black (1.7 percent), or Asian people

(1.4 percent) (Table B.8B). White people also were more

likely to use hallucinogens in the past year compared with

Black or Asian people.

Inhalant Use

Inhalants include volatile solvents (e.g., paint thinners and

removers, dry cleaning ﬂuids, degreasers, gasoline, glues,

shoe polish, correction ﬂuids, felt-tip markers), aerosols (e.g.,

spray paints, deodorant and hair sprays, fabric protector

sprays, computer keyboard cleaner), gases (e.g., ether,

halothane, nitrous oxide, butane, propane), and nitrites (e.g.,

amyl nitrite, “poppers,” locker room deodorizers, “rush”).

NSDUH respondents were asked to report the use of

inhalants to get high but not to include accidental inhalation

of a substance.

Among people aged 12 or older in 2021, 0.8 percent

(or 2.2 million people) used inhalants in the past year

(Figures 14 and 19 and Table A.7B). Unlike other illicit drug

use estimates, the percentage was highest among adolescents

aged 12 to 17 (2.4 percent or 626,000 people). Percentages

decreased with age (1.5 percent of young adults aged 18 to

25 or 497,000 people; 0.5 percent of adults aged 26 or older

or 1.1 million people).

Figure19. Past Year Methamphetamine Use, Past Year

Hallucinogen Use, and Past Year Inhalant Use: Among People

Aged 12 or Older; 2021

0.9

2.6

0.8

0.1

1.3

2.4

0.5

7.1

1.5

1.1

2.1

0.5

Past Year

Methamphetamine Use

Past Year

Hallucinogen Use

Past Year

Inhalant Use

Percent Using in Past Year

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

Age Category:

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 19

By Race/Ethnicity

Inhalant use in the past year among people aged 12 or

older in 2021 did not diﬀer among racial or ethnic groups.

Percentages ranged from 0.3 percent among Native

Hawaiian or Other Paciﬁc Islander people to 1.1 percent

among Multiracial people (Table B.8B).

Misuse of Psychotherapeutic Drugs

e 2021 NSDUH assessed the use and misuse of

psychotherapeutic drugs currently or recently available by

prescription in the United States, including prescription

stimulants, tranquilizers or sedatives (e.g., benzodiazepines),

and pain relievers. In NSDUH, misuse of prescription drugs

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

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

greater amounts, more often, or longer than told to take

a drug; or use in any other way not directed by a doctor.

Misuse of over-the-counter (OTC) drugs was not included.

Among people aged 12 or older in 2021, 5.1 percent (or

14.3 million people) misused prescription psychotherapeutic

drugs in the past year (Table A.7B). e percentage was

highest among young adults aged 18 to 25 (7.4 percent or

2.5 million people), followed by adults aged 26 or older

(5.0 percent or 10.9 million people), then by adolescents

aged 12 to 17 (3.3 percent or 851,000 people).

Of the prescription drugs presented in this report, prescription

pain relievers were the most commonly misused prescription

drug by people aged 12 or older. e 14.3 million people

in 2021 who misused prescription psychotherapeutic drugs

in the past year included 8.7 million people who misused

prescription pain relievers, 4.9 million people who misused

prescription tranquilizers or sedatives (including 3.9 million

past year misusers of benzodiazepines), and 3.7 million people

who misused prescription stimulants (Figure 14).

Stimulant Misuse

e 2021 NSDUH assessed the misuse of prescription

stimulants in the following categories: amphetamine

products, methylphenidate products, anorectic (weight-loss)

stimulants, Provigil

, or any other prescription stimulant.

e amphetamine and methylphenidate products included

in the NSDUH questionnaire are primarily prescribed

for the treatment of attention-deﬁcit/hyperactivity

disorder (ADHD). Methamphetamine is not 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.

Among people aged 12 or older in 2021, 1.3 percent (or

3.7 million people) misused prescription stimulants in

the past year (Figures 14 and 20 and Table A.7B). e

percentage was higher among young adults aged 18 to 25

(3.7 percent or 1.2 million people) than among adolescents

aged 12 to 17 (1.2 percent or 304,000 people) or adults aged

26 or older (1.0 percent or 2.2 million people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

misused prescription stimulants in the past year was

higher among Multiracial (3.1 percent) or White people

(1.6 percent) than among Hispanic (1.0 percent), Black

(0.6 percent), or Asian people (0.6 percent) (Table B.9B).

Tranquilizer or Sedative Misuse

Estimates of the misuse of prescription tranquilizers or

sedatives are presented together because prescription drugs in

both categories have a common eﬀect on speciﬁc activity in

the brain. Prescription tranquilizers include benzodiazepine

tranquilizers (e.g., as alprazolam, lorazepam, clonazepam,

or diazepam products), muscle relaxants, or any other

prescription tranquilizer. Prescription sedatives include

zolpidem products, eszopiclone products, zaleplon products,

benzodiazepine sedatives (e.g., as ﬂurazepam and temazepam

products or triazolam products), barbiturates, or any other

prescription sedative.

Figure20. Past Year Prescription Stimulant Misuse, Past Year

Prescription Tranquilizer or Sedative Misuse, and Past Year

Prescription Pain Reliever Misuse: Among People Aged 12 or

Older; 2021

1.3

1.7

3.1

1.2

0.9

1.9

3.7

2.6

3.0

1.0

1.7

3.3

Past Year Prescription

Stimulant Misuse

Past Year Prescription

Tranquilizer or Sedative

Misuse

Past Year Prescription

Pain Reliever Misuse

Percent Using in Past Year

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

Age Category:

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

Results from the 2021 National Survey on Drug Use and Health20 | December 2022

Among people aged 12 or older in 2021, 1.7 percent (or

4.9 million people) misused tranquilizers or sedatives in

the past year (Figures 14 and 20 and Table A.7B). e

percentage was highest among young adults aged 18 to 25

(2.6 percent or 874,000 people), followed by adults aged

26 or older (1.7 percent or 3.8 million people), then by

adolescents aged 12 to 17 (0.9 percent or 225,000 people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

misused prescription tranquilizers or sedatives in the

past year was higher among White people (2.1 percent)

than among Hispanic (1.3 percent), Black (1.3 percent), or

Asian people (0.5 percent) (Table B.9B). e percentage of

people who misused prescription tranquilizers or sedatives

in the past year was lower among Asian people than among

Multiracial (2.5 percent), Hispanic, or Black people.

Benzodiazepine Misuse

Prescription benzodiazepines are a subcategory of drugs

that may be prescribed either as tranquilizers for the

relief of anxiety or as sedatives for the relief of insomnia.

Benzodiazepines prescribed as tranquilizers are typically

metabolized more slowly than benzodiazepines prescribed

as sedatives.

Nevertheless, benzodiazepines are chemically

similar, regardless of whether they are prescribed as

tranquilizers or sedatives.

Among people aged 12 or older in 2021, 1.4 percent (or

3.9 million people) misused prescription benzodiazepines

in the past year (Table A.7B). e percentage was highest

among young adults aged 18 to 25 (2.4 percent or 787,000

people), followed by adults aged 26 or older (1.3 percent

or 3.0 million people), then by adolescents aged 12 to 17

(0.7 percent or 181,000 people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

misused prescription benzodiazepines in the past year was

higher among White people (1.7 percent) than among

Hispanic (1.0 percent), Black (0.9 percent), or Asian

people (0.4 percent) (Table B.9B). e percentage also was

higher among Multiracial people (2.3 percent) than among

Asian people.

Pain Reliever Misuse

e 2021 NSDUH assessed the misuse of prescription pain

relievers in the following categories: 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 the misuse of any prescription pain reliever

and speciﬁc subtypes of prescription pain relievers, the

main reason for the most recent misuse of prescription pain

relievers, and where people obtained the prescription pain

relievers that they most recently misused in the past year.

Among people aged 12 or older in 2021, 3.1 percent (or

8.7 million people) misused prescription pain relievers

in the past year (Figures 14 and 20 and Table A.7B). e

percentage was lower among adolescents aged 12 to 17

(1.9 percent or 497,000 people) than among young adults

aged 18 to 25 (3.0 percent or 1.0 million people) or adults

aged 26 or older (3.3 percent or 7.2 million people).

By Race/Ethnicity

Prescription pain reliever misuse in the past year among

people aged 12 or older in 2021 did not diﬀer among racial

or ethnic groups. Percentages ranged from 2.2 percent

among Asian people to 6.3 percent among Multiracial

people (Table B.10B).

Misuse of Subtypes of Pain Relievers

e 2021 NSDUH asked respondents to identify speciﬁc

prescription pain relievers they used in the past year,

then asked whether they misused those pain relievers in

the past year. e speciﬁc pain relievers people misused

in the past year were categorized into subtypes, such

as hydrocodone products. For example, respondents

who reported misusing the pain relievers Vicodin

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 people aged 12 or older

who misused any pain reliever in the past year. en it

presents estimates of the misuse of subtypes of pain relievers

among people who used that subtype for any reason in the

past year (i.e., not necessarily misuse). See the Misuse of

Psychotherapeutic Drugs section for the deﬁnition of misuse.

Among the 8.7 million people aged 12 or older in 2021

who misused prescription pain relievers in the past year,

46.9 percent (or 4.0 million people) misused hydrocodone

products in the past year (Figure 21 and Table A.8B).

Hydrocodone products were the most commonly misused

subtype of prescription pain relievers for 2021, including

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 21

Vicodin

, Lortab

, Norco

, Zohydro

ER, and generic

hydrocodone. In addition, 30.4 percent of past year misusers

of pain relievers (or 2.6 million people) misused oxycodone

products in the past year, including OxyContin

, Percocet

Percodan

, Roxicodone

, and generic oxycodone. About 1 in

4 people aged 12 or older who misused pain relievers in the

past year were misusers of codeine products in the past year

(26.4 percent or 2.3 million people).

An estimated 6.2 percent of people aged 12 or older who

misused prescription pain relievers in the past year (or

539,000 people) were misusers of prescription fentanyl

products. Because NSDUH respondents were asked only

about the misuse of prescription forms of fentanyl, estimates

of fentanyl misuse for 2021 may underrepresent people who

used illicitly manufactured fentanyl (IMF) from clandestine

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

prescription fentanyl produced by the pharmaceutical

industry) and may not include those who used IMF mixed

with heroin or sold as heroin (but contained only IMF).

However, most people aged 12 or older in 2021 who used

prescription pain relievers for any reason in the past year did

not misuse them in that period (Figure 22 and Table A.8B).

Although hydrocodone products were the most commonly

misused prescription pain reliever subtype in the past year,

only 11.4 percent of people who used hydrocodone products

for any reason in the past year misused them in that period.

Among people who used buprenorphine products for any

reason in the past year, 22.2 percent misused them, and

77.8 percent did not. Among people who used prescription

fentanyl products for any reason in the past year,

20.9 percent misused them, and 79.1 percent did not. Stated

another way, more than three fourths of past year users of

buprenorphine products and about four ﬁfths of past year

users of prescription fentanyl products did not misuse them

in that period.

Main Reasons for the Last Misuse of Pain Relievers

Respondents in the 2021 NSDUH who reported

prescription pain reliever misuse in the past year were asked

to report the reasons for misusing the last prescription pain

reliever they misused. Respondents who reported more than

one reason for misusing the last prescription pain reliever

were asked to report their main reason for misusing it.

Among people aged 12 or older in 2021 who misused

prescription pain relievers in the past year, the most common

main reason for their last misuse of a pain reliever was to

relieve physical pain (64.3 percent) (Table A.9B). Based

on the NSDUH deﬁnition, use without a prescription of

one’s own or overuse of prescribed medication (e.g., use at

a higher dosage or more often than prescribed) are both

classiﬁed as misuse even if the use was for the purpose of

pain relief.

In addition, 10.7 percent of people aged 12 or older who

misused prescription pain relievers in the past year misused

a pain reliever the last time to feel good or get high, and

7.3 percent misused a pain reliever the last time to relax

or relieve tension. Other main reasons for the last misuse

were to help with sleep (4.8 percent), because people were

Figure21. Past Year Prescription Pain Reliever Misuse: Among

People Aged 12 or Older Who Misused Any Prescription Pain

Reliever; 2021

46.9

30.4

26.4

16.1

8.9

6.2

4.9

3.7

2.2

1.8

0.7

0 10 20 30 40 50

Hydrocodone

Oxycodone

Codeine

Tramadol

Buprenorphine

Fentanyl

Morphine

Methadone

Hydromorphone

Oxymorphone

Demerol

Percent among Past Year Misusers of Any Pain Reliever

Figure22. Past Year Prescription Pain Reliever Misuse: Among

People Aged 12 or Older Who Used the Speciﬁc Prescription Pain

Reliever Subtype for Any Reason in the Past Year; 2021

12.2

22.2

20.9

15.9

12.8

11.8

11.5

11.4

9.7

8.7

87.8

77.8

79.1

84.1

87.2

88.2

88.5

88.6

90.3

91.3

0 20 40 60 80 100

ANY PAIN RELIEVER

Buprenorphine

Fentanyl

Oxymorphone

Oxycodone

Hydromorphone

Codeine

Hydrocodone

Tramadol

Morphine

Percent Among Past Year Users of the Speciﬁc Pain Reliever Subtype

Past Year Misuse Past Year Use but Not Misuse

Note: Estimates for methadone and Demerol

are not shown due to low precision.

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

Results from the 2021 National Survey on Drug Use and Health22 | December 2022

“hooked” or needed to have the drug (4.7 percent), to

experiment or see what the drug was like (2.8 percent), to

help with feelings or emotions (2.6 percent), and to increase

or decrease the eﬀects of other drugs (1.2 percent).

Source of the Last Pain Reliever That Was Misused

Among people aged 12 or older in 2021 who misused

prescription pain relievers in the past year, 44.9 percent

obtained the pain relievers the last time from a friend or

relative in some way (i.e., being given them, buying them,

or taking them without asking), and 43.2 percent obtained

pain relievers the last time through prescription(s) or stole

pain relievers from a health care provider, typically getting

the pain relievers through a prescription from one doctor

(39.3 percent) (Figure 23 and Table A.10B). An estimated

33.9 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, 7.3 percent bought their

last pain reliever from a friend or relative, and 3.7 percent

took their last pain reliever from a friend or relative without

asking. About 1 in 13 people who misused pain relievers in

the past year (7.9 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 opioids, such as hydrocodone (e.g.,

Vicodin

), oxycodone (e.g., OxyContin

), and morphine.

In this report, opioid misuse includes the misuse of

prescription pain relievers or the use of heroin. Prescription

pain relievers could include some nonopioids because

respondents could occasionally specify the misuse of other

prescription pain relievers that are not opioids.

Among people aged 12 or older in 2021, 3.3 percent

(or 9.2 million people) misused opioids in the past year

(Figure 24 and Table A.7B). Similar to the misuse of

prescription pain relievers in the past year, the percentage

of people who misused opioids in the past year was lowest

among adolescents aged 12 to 17 (1.9 percent or 497,000

people). Percentages were similar among young adults aged

18 to 25 (3.1 percent or 1.0 million people) and adults aged

26 or older (3.5 percent or 7.7 million people).

e vast majority of people who misused opioids in the

past year misused prescription pain relievers (Figure 24).

Speciﬁcally, 8.7 million people aged 12 or older misused

prescription pain relievers in the past year compared with

1.1 million people who used heroin. In 2021, the majority of

the 8.7 million misusers of prescription pain relievers misused

only prescription pain relievers in the past year (8.1 million

people), but they had not used heroin. An estimated 574,000

people misused prescription pain relievers and used heroin in

the past year, and 525,000 people used heroin in the past year

but had not misused prescription pain relievers.

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; 2021

8.7 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

44.9%

Bought from Drug Dealer or Other Stranger

7.9%

Some Other Way

4.0%

Got through Prescription(s) or Stole

from a Health Care Provider

43.2%

Prescription from One Doctor (39.3%)

Prescriptions from More Than One Doctor (3.2%)

Stole from Doctor's Ofﬁce, Clinic, Hospital, or Pharmacy (0.7%)

From Friend or Relative for Free (33.9%)

Took from Friend or Relative without Asking (3.7%)

Bought from Friend or Relative (7.3%)

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 2021 National Survey on Drug Use and Health December 2022 | 23

By Race/Ethnicity

Opioid misuse in the past year among people aged 12 or

older in 2021 did not diﬀer among racial or ethnic groups.

Percentages ranged from 2.3 percent among Asian people to

6.3 percent among Multiracial people (Table B.10B).

Central Nervous System Stimulant Misuse

Central nervous system (CNS) stimulants are a group

of drugs that include cocaine, methamphetamine, and

prescription stimulants. ese drugs act in similar ways to

stimulate the brain. ey produce stimulant eﬀects, such

as increased alertness, wakefulness, or energy. ey also can

produce physical side eﬀects of rapid or irregular heartbeat

or increased blood pressure and body temperature.

40,41,42

In this report, CNS stimulant misuse includes the use of

cocaine or methamphetamine or the misuse of prescription

stimulants.

Among people aged 12 or older in 2021, 3.3 percent

(or 9.2 million people) misused CNS stimulants in the

past year (Figure 25 and Table A.7B). e percentage was

highest among young adults aged 18 to 25 (6.3 percent or

2.1 million people), followed by adults aged 26 or older

(3.1 percent or 6.7 million people), then by adolescents aged

12 to 17 (1.3 percent or 339,000 people).

Of the 9.2 million people in 2021 who misused CNS

stimulants in the past year, 230,000 used or misused all

three CNS stimulants in the past year (2.5 percent of people

who misused CNS stimulants) (Figure 25). About one third

of people who misused CNS stimulants in the past year

used only cocaine (36.9 percent of CNS stimulant misusers

or 3.4 million people), about one fourth misused only

prescription stimulants (27.7 percent of CNS stimulant

misusers or 2.5 million people), and about 1 in 6 used only

methamphetamine (17.5 percent of CNS stimulant misusers

or 1.6 million people). In addition to the 230,000 people

who used or misused all three CNS stimulants in the

past year, 701,000 people used cocaine and misused

prescription stimulants but did not use methamphetamine

(7.6 percent of CNS stimulant misusers), 452,000 used

cocaine and methamphetamine but did not misuse

prescription stimulants (4.9 percent of CNS stimulant

misusers), and 257,000 used methamphetamine and misused

prescription stimulants but did not use cocaine (2.8 percent

of CNS stimulant misusers).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

misused CNS stimulants in the past year was higher

among Multiracial people (6.4 percent) than among White

(3.5 percent), Hispanic (3.1 percent), Black (2.5 percent),

Native Hawaiian or Other Paciﬁc Islander (2.3 percent),

or Asian people (1.5 percent) (Table B.10B). White people

also were more likely than Black people to misuse CNS

stimulants in the past year. In addition to the diﬀerence

between Asian and Multiracial people, Asian people were less

likely to misuse CNS stimulants in the past year compared

with American Indian or Alaska Native (5.8 percent), White,

or Hispanic people.

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

Older; 2021

8.1 Million People with Pain

Reliever Misuse Only

(88.1% of Opioid Misusers)

8.7 Million People

with Pain Reliever Misuse

(94.3% of Opioid Misusers)

574,000 People with

Pain Reliever Misuse and

Heroin Use

(6.2% of Opioid Misusers)

1.1 Million People

with Heroin Use

(11.9% of Opioid Misusers)

525,000 People with

Heroin Use Only

(5.7% of Opioid Misusers)

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

Figure25. Past Year Central Nervous System (CNS) Stimulant

Misuse: Among People Aged 12 or Older; 2021

9.2 Million People Aged 12 or Older with Past Year CNS Stimulant Misuse

452K

230K

257K

701K

3.4

Million

2.5

Million

1.6

Million

4.8 Million People

Used Cocaine

2.5 Million People Used

Methamphetamine

Cocaine Use and Prescription Stimulant Misuse,

but Not Methamphetamine Use

Cocaine

Use Only

Prescription

Stimulant

Misuse Only

Cocaine and

Methamphetamine Use,

but Not Prescription

Stimulant Misuse

Prescription

Stimulant Misuse and

Methamphetamine Use,

but Not Cocaine Use

3.7 Million People

Misused Prescription

Stimulants

Methamphetamine

Use Only

Cocaine and

Methamphetamine Use and

Prescription Stimulant Misuse

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

Results from the 2021 National Survey on Drug Use and Health24 | December 2022

Other Substance Use in the Past Year

e 2021 NSDUH obtained information for the use and

misuse of additional substances that can produce mind-

altering eﬀects. ese substances include GHB, the misuse

of nonprescription cold and cough medicine, kratom,

synthetic marijuana (fake weed, K2, or Spice), and synthetic

stimulants (“bath salts” or ﬂakka).

GHB Use

Gamma hydroxybutyrate (GHB, also called “G,” “Georgia

Home Boy,” “Grievous Bodily Harm,” or “Liquid G”)

is a CNS depressant. GHB can produce hallucinations,

euphoria, drowsiness, decreased anxiety, and excited and

aggressive behavior. It also is addictive. GHB that is not

produced as a pharmaceutical product with U.S. Food

and Drug Administration (FDA) approval is classiﬁed as a

Schedule I controlled substance in the United States.

43,44

Among people aged 12 or older in 2021, 0.1 percent (or

311,000 people) used GHB in the past year (Table A.6B).

Less than 0.1 percent each of adolescents aged 12 to 17

and young adults aged 18 to 25 and 0.1 percent of adults

aged 26 or older used GHB in the past year. Corresponding

estimated numbers of people who used GHB in the past year

were 5,000 adolescents aged 12 to 17, 14,000 young adults

aged 18 to 25, and 292,000 adults aged 26 or older.

Nonprescription Cough and Cold Medicine Misuse

e cough suppressant dextromethorphan (DXM) is

found in many cough and cold medicines. ese medicines

are available without a prescription (i.e., OTC) in the

United States and are generally considered safe when used

appropriately. When taken in large amounts, however,

DXM can produce hallucinations or dissociative, “out-

of-body” experiences. ese eﬀects are similar to those

caused by the hallucinogens PCP and ketamine. Other

drugs found in OTC cough and cold medicines also

can have psychoactive eﬀects. For example, the OTC

antihistamine diphenhydramine (found in the brand-name

drug Benadryl

) can produce sedative side eﬀects, such as

drowsiness.

e OTC decongestant phenylephrine (found

in the brand-name drug Sudafed PE

) can produce stimulant

side eﬀects, such as nervousness and sleeplessness.

e

2021 NSDUH questionnaire asked respondents aged 12

or older about their use of nonprescription cough or cold

medicines in the past 12 months for the purpose of getting

high (i.e., “misuse”).

Among people aged 12 or older in 2021, 0.6 percent (or

1.6 million people) misused nonprescription cough and

cold medicines in the past year (Table A.6B). Similar

percentages of people in each age group misused cough

and cold medicines in the past year (0.7 percent each of

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

and 0.5 percent of adults aged 26 or older). Corresponding

estimated numbers of people who misused cough and cold

medicines in the past year were 173,000 adolescents aged 12

to 17, 243,000 young adults aged 18 to 25, and 1.2 million

adults aged 26 or older.

Kratom Use

Kratom is an herbal extract from the leaves of the Mitragyna

speciosa tree that is native to Southeast Asia. e leaves

contain chemicals with mind-altering eﬀects. Kratom can

come in forms such as powders, pills, or leaves.

47,48

e

2021 NSDUH asked respondents aged 12 or older about

their use of kratom in the 12 months before the interview.

Among people aged 12 or older in 2021, 0.6 percent

(or 1.7 million people) used kratom in the past year

(Table A.6B). e percentage was lower among adolescents

aged 12 to 17 (0.2 percent or 45,000 people) than among

young adults aged 18 to 25 (0.8 percent or 284,000 people)

or adults aged 26 or older (0.6 percent or 1.4 million

people).

Synthetic Marijuana Use

Synthetic cannabinoids are human-made chemicals that

are similar to chemicals found in the marijuana plant. For

this reason, these drugs are sometimes called “synthetic

marijuana” or “fake weed.” ey can be contained in plant

material that is later smoked. ey are also sold as liquids

to be vaporized (i.e., vaped) and inhaled in e-cigarettes and

other devices.

43,49

Several synthetic cannabinoids have been

categorized as Schedule I controlled substances.

For simplicity, the 2021 NSDUH questionnaire asked

respondents about their use of “synthetic marijuana” and

included the slang terms “fake weed,” “K2,” and “Spice.”

e 2021 NSDUH asked respondents aged 12 or older

about their use of synthetic marijuana or fake weed in the

12 months before the interview.

Among people aged 12 or older in 2021, 0.2 percent (or

483,000 people) used synthetic marijuana in the past year

(Table A.6B). e percentage was lower among adults aged

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 25

26 or older (0.1 percent or 212,000 people) than among

adolescents aged 12 to 17 (0.4 percent or 112,000 people) or

young adults aged 18 to 25 (0.5 percent or 159,000 people).

Synthetic Stimulant Use

Synthetic cathinones are human-made CNS stimulants that

are chemically related to cathinone, a substance found in

the khat plant. ese substances can be marketed as “bath

salts” or “ﬂakka.”

43,50

Several synthetic cathinones have been

categorized as Schedule I controlled substances.

For simplicity, the 2021 NSDUH questionnaire asked

respondents about their use of “synthetic stimulants” and

included the slang terms “bath salts” and “ﬂakka.” e 2021

NSDUH asked respondents aged 12 or older about their use

of synthetic stimulants, also called “bath salts” or ﬂakka, in

the 12 months before the interview.

Among people aged 12 or older in 2021, less than

0.1 percent (or 107,000 people) used synthetic stimulants

in the past year (Table A.6B). Similar percentages of people

in each age group used synthetic stimulants: 0.1 percent

each of adolescents aged 12 to 17 and young adults aged 18

to 25 and less than 0.1 percent of adults aged 26 or older.

In each age group, fewer than 50,000 people used synthetic

stimulants.

Initiation of Substance Use

e 2021 NSDUH included questions to measure the

initiation of substance use, that is, the ﬁrst use of particular

substances during a person’s lifetime.

is report presents

the estimated number of recent substance use initiates or

prescription drug misuse initiates.

Recent initiates were

substance users or prescription drug misusers who reported

ﬁrst using or misusing, respectively, a particular substance in

the 12 months before the NSDUH interview.

18,53,54

See the

section on the Misuse of Psychotherapeutic Drugs for the

deﬁnition of “misuse” of prescription drugs.

In particular, this report presents estimates for past year

initiation of heroin use, prescription pain reliever misuse,

prescription tranquilizer misuse, and prescription sedative

misuse, separately. e report does not present estimates

for past year initiation of any opioid misuse (heroin or

prescription pain reliever), any illicit drug use (including

prescription drug misuse), and any prescription tranquilizer

or sedative misuse because respondents who underreported

lifetime (but not past year) misuse of prescription drugs

might not truly be past year initiates of the use or misuse

of any drug in these aggregate categories.

Estimates for

the past year initiation of benzodiazepine misuse are not

presented because some benzodiazepines in NSDUH were

included as tranquilizers, and others were included as

sedatives.

In addition, NSDUH respondents are asked how old

they were when they ﬁrst used or misused a substance.

Respondents who ﬁrst used a substance in the past year

would need to recall only whether they ﬁrst used the

substance at their current age or at the age that was

1 year less than their current age. Information on the age

when past year initiates ﬁrst used a substance is useful for

estimating whether past year initiates of the use of cigarettes,

alcohol, or marijuana ﬁrst used these substances before age

21 or after age 21.

Figure 26 and Table A.11A provide an overview of the

numbers of people aged 12 or older in 2021 who were

past year initiates of the use or misuse of the substances

discussed in this section. In the past 12 months, 4.1 million

people initiated alcohol use, and 1.2 million people tried a

cigarette for the ﬁrst time in their lifetime.

ere were also

2.6 million new marijuana users, 1.8 million new misusers

of prescription pain relievers, 1.3 million new hallucinogen

users, 881,000 new misusers of prescription tranquilizers,

and 773,000 new misusers of prescription stimulants. Other

substances had smaller numbers of past year initiates.

Figure26. Past Year Initiates of Substances: Among People Aged

12 or Older; 2021

4.1M

1.2M

2.6M

1.8M

1.3M

881,000

773,000

478,000

385,000

188,000

101,000

26,000

0 1M 2M 3M 4M 5M

Alcohol

Cigarettes

Marijuana

Rx Pain Reliever Misuse

Hallucinogens

Rx Tranquilizer Misuse

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 2021 National Survey on Drug Use and Health26 | December 2022

Initiation of Cigarette Use

Among people aged 12 or older in 2021, 1.2 million people

initiated cigarette smoking in the past year, meaning they

had never smoked cigarettes before the past 12 months

(Figures 26 and 27 and Table A.11A). Relatively few

people (approximately 10 percent of past year initiates)

tried cigarettes for the ﬁrst time after age 25. In 2021,

362,000 adolescents aged 12 to 17, 705,000 young adults

aged 18 to 25, and 120,000 adults aged 26 or older initiated

cigarette smoking in the past year. Nearly three fourths

of the 1.2 million people in 2021 who initiated cigarette

smoking in the past year did so before age 21 (73.7 percent

or 875,000 people) (Figure 28 and Table A.12AB).

Initiation of Alcohol Use

Among people aged 12 or older in 2021, 4.1 million people

initiated alcohol use in the past year, not counting a sip or

two from a drink (Figures 26 and 27 and Table A.11A).

Among young adults aged 18 to 25 in 2021, 2.1 million

people initiated alcohol use in the past year. In addition,

1.8 million adolescents aged 12 to 17 and 228,000 adults

aged 26 or older initiated alcohol use in the past year.

Consistent with the pattern of cigarette smoking initiation,

relatively few people in 2021 started to use alcohol after age

25. Also, nearly three fourths of the 4.1 million people in

2021 who initiated alcohol use in the past year did so before

age 21 (72.8 percent or 3.0 million people) (Figure 28 and

Table A.12AB).

Initiation of Marijuana Use

Among people aged 12 or older in 2021, 2.6 million people

initiated marijuana use in the past year (Figures 26 and

27 and Table A.11A). Among young adults aged 18 to 25

in 2021, 1.1 million people initiated marijuana use in the

past year. In addition, 869,000 adolescents aged 12 to 17

and 620,000 adults aged 26 or older initiated marijuana

use in the past year. Unlike people who initiated cigarette

or alcohol use, almost 25 percent of people in 2021 who

initiated marijuana use in the past year were aged 26 or

older. About three ﬁfths of the 2.6 million people in 2021

who initiated marijuana use in the past year did so before

age 21 (60.3 percent or 1.6 million people) (Figure 28 and

Table A.12AB).

Initiation of Cocaine Use

Among people aged 12 or older in 2021, 478,000 people

initiated cocaine use in the past year (Figure 26 and

Table A.11A).

Nearly 60 percent of people who used

cocaine for the ﬁrst time in the past year were between

ages 18 and 25. Among young adults aged 18 to 25,

277,000 people initiated cocaine use in the past year.

In addition, 20,000 adolescents aged 12 to 17 and

181,000 adults aged 26 or older initiated cocaine use in the

past year.

Initiation of Heroin Use

Among people aged 12 or older in 2021, 26,000 people

initiated heroin use in the past year (Figure 26 and

Table A.11A). e number of adolescents aged 12 to 17 who

initiated heroin use in the past year was not reported due to

low statistical precision. Among young adults aged 18 to 25,

Figure27. Past Year Cigarette, Alcohol, and Marijuana Initiates:

Among People Aged 12 or Older; 2021

362,000

1.8M

869,000

705,000

2.1M

1.1M

120,000

228,000

620,000

Cigarettes Alcohol Marijuana

Past Year Initiates

26 or Older

18 to 25

12 to 17

(4.1M)

(1.2M)

(2.6M)

Age Category:

Note: The number in parentheses above each bar shows the total number of pastyear initiates aged

12 or older for that category.

Figure28. Initiation of Use before Age 21 and at Age 21 or Older:

Among People Aged 12 or Older Who Were Past Year Cigarette,

Alcohol, and Marijuana Initiates; 2021

73.7

72.8

60.3

26.3

27.2

39.7

100

Cigarettes Alcohol Marijuana

Percent of Past Year Initiates

First Use at Age 21 or Older

First Use before Age 21

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 27

11,000 people initiated heroin use in the past year. Among

adults aged 26 or older, 16,000 people initiated heroin use in

the past year.

Initiation of Methamphetamine Use

Among people aged 12 or older in 2021, 101,000 people

initiated methamphetamine use in the past year (Figure 26

and Table A.11A). Approximately 50 percent of people who

used methamphetamine for the ﬁrst time in the past year

were older than age 25. Numbers of past year initiates of

methamphetamine use by age group were 24,000 adolescents

aged 12 to 17, 25,000 young adults aged 18 to 25, and

52,000 adults aged 26 or older.

Initiation of Hallucinogen Use

Among people aged 12 or older in 2021, 1.3 million people

initiated hallucinogen use in the past year (Figure 26 and

Table A.11A).

is number includes 176,000 adolescents

aged 12 to 17, 687,000 young adults aged 18 to 25, and

427,000 adults aged 26 or older.

Initiation of Inhalant Use

Among people aged 12 or older in 2021, 385,000 people

initiated inhalant use in the past year (Figure 26 and

Table A.11A). Initiation of inhalant use was less common

for adults older than age 25. Numbers of past year initiates

of inhalant use by age group were 160,000 adolescents aged

12 to 17, 157,000 young adults aged 18 to 25, and 68,000

adults aged 26 or older.

Initiation of Prescription Stimulant Misuse

Among people aged 12 or older in 2021, 773,000 initiated

prescription stimulant misuse in the past year (Figure 26

and Table A.11A). Among adults aged 26 or older, 309,000

people initiated prescription stimulant misuse in the

past year. Corresponding numbers for young adults aged 18

to 25 and adolescents aged 12 to 17 were 310,000 people

and 154,000 people, respectively.

Initiation of Prescription Tranquilizer or Sedative

Misuse

Although this report includes combined estimates for the

past year misuse of prescription tranquilizers or sedatives,

estimates for the initiation of misuse of these substances are

presented separately in this section. As noted previously, it

cannot be determined unambiguously whether respondents

were past year initiates for the aggregate category of any

tranquilizer or sedative misuse because of the potential for

respondents to underreport the misuse of prescription drugs

that occurred more than 12 months ago.

Initiation of Prescription Tranquilizer Misuse

Among people aged 12 or older in 2021, 881,000 people

initiated prescription tranquilizer misuse in the past year

(Figure 26 and Table A.11A). Approximately two thirds of

people who misused prescription tranquilizers for the ﬁrst

time in the past year were older than age 25. Among adults

aged 26 or older, 595,000 people initiated prescription

tranquilizer misuse in the past year. Among young adults

aged 18 to 25 and adolescents aged 12 to 17, 225,000

people and 61,000 people initiated prescription tranquilizer

misuse in the past year, respectively.

Initiation of Prescription Sedative Misuse

Among people aged 12 or older in 2021, 188,000 people

initiated prescription sedative misuse (Figure 26 and

Table A.11A). Nearly 70 percent of people who misused

prescription sedatives for the ﬁrst time in the past year

were older than age 25. e numbers of past year initiates

of prescription sedative misuse by age group were 14,000

adolescents aged 12 to 17, 46,000 young adults aged 18 to

25, and 128,000 adults aged 26 or older.

Initiation of Prescription Pain Reliever Misuse

Among people aged 12 or older in 2021, 1.8 million people

initiated prescription pain reliever misuse in the past year

(Figures 26 and 29 and Table A.11A). Nearly 80 percent of

people who misused prescription pain relievers for the ﬁrst

time in the past year were older than age 25. Among adults

aged 26 or older, 1.4 million people initiated prescription

pain reliever misuse in the past year. e numbers of

people who initiated prescription pain reliever misuse in

Figure29. Past Year Prescription Pain Reliever Misuse Initiates:

Among People Aged 12 or Older; 2021

1.8M

130,000

269,000

1.4M

0.5M

1.0M

1.5M

2.0M

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

Past Year Initiates

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

Results from the 2021 National Survey on Drug Use and Health28 | December 2022

the past year were 269,000 among young adults aged 18 to

25 and 130,000 among adolescents aged 12 to 17. Among

young adults aged 18 to 25 and adolescents aged 12 to

17, the numbers of people who initiated prescription pain

reliever misuse in the past year were 269,000 people and

130,000 people, respectively.

Perceived Risk from Substance Use

One factor that can inﬂuence whether people will use

tobacco, alcohol, or illicit drugs is the extent to which

they believe that using these substances might cause harm.

In 2021, 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 30 and Table A.13B present the percentages of people

aged 12 or older in 2021 who perceived great risk of harm

from the use of various substances. Risk perceptions across

substances are not compared because of variations in the

quantity and frequency of use across these substances.

e

2021 Detailed Tables include additional measures of risk

perceptions from substance use.

Among people aged 12 or older in 2021, 69.2 percent of

people perceived great risk of harm from smoking one or

more packs of cigarettes a day, and 68.4 percent perceived

great risk from having four or ﬁve alcoholic drinks nearly

every day. Percentages of people who perceived great risk

from cocaine or heroin use once or twice a week were

83.7 and 92.3 percent, respectively. In contrast, about

one fourth of people (26.5 percent) perceived great risk from

smoking marijuana once or twice a week.

In 2021, perceptions of great risk of harm from substance

use varied by substance and age. For example, young adults

aged 18 to 25 in 2021 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. In addition, adults

aged 26 or older were more likely than adolescents aged 12

to 17 or young adults aged 18 to 25 to perceive great risk of

harm from smoking one or more packs of cigarettes per day

or to perceive great risk of harm from having four or ﬁve

alcoholic drinks nearly every day (

Table A.13B).

Finally, adolescents aged 12 to 17 in 2021 were less likely

than young adults aged 18 to 25 or adults aged 26 or older

to perceive great risk from using heroin or cocaine weekly.

Additional data on ﬁner age group categories that can be

found in the 2021 Detailed Tables

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. us, age-

speciﬁc communications are imperative from a public health

perspective to help people fully understand important harms

associated with the use of speciﬁc substances.

By Race/Ethnicity

Perceptions of great risk of harm from substance use among

people aged 12 or older in 2021 varied by racial or ethnic

group. e percentage of people who perceived great risk of

harm from smoking one or more packs of cigarettes per day

was higher among Asian (73.6 percent) or Hispanic people

(71.9 percent) than among White people (68.1 percent)

(Table B.11B). e percentage of people who perceived great

risk of harm from having four or ﬁve alcoholic drinks nearly

every day was higher among Asian people (77.8 percent)

than among people in most other racial or ethnic groups.

is percentage was also higher among Black (71.1 percent)

or Hispanic people (70.0 percent) than among White people

(66.6 percent).

e percentage of people aged 12 or older in 2021 who

perceived great risk from smoking marijuana once or twice

a week was higher among Asian people (46.1 percent)

than among Hispanic (36.2 percent), American Indian

or Alaska Native (26.8 percent), Black (25.8 percent),

White (22.3 percent), or Multiracial people (18.0 percent)

Figure30. Perceived Great Risk from Substance Use: Among

People Aged 12 or Older; 2021

26.5

83.7

92.3

68.4

69.2

0 20 40 60 80 100

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

Percent Perceived Great Risk

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

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 29

(Table B.11B). e percentage was also higher among Hispanic

people than among Black, White, or Multiracial people.

White people aged 12 or older in 2021 were more likely

than Hispanic, Black, or Asian people to perceive great risk

of harm from heroin use once or twice a week. However,

percentages in all racial or ethnic groups were high, ranging

from 88.7 percent of Asian people to 93.7 percent of White

people (Table B.11B). Perceptions of great risk of harm from

cocaine use once or twice a week did not diﬀer among racial

or ethnic groups.

Among adolescents aged 12 to 17 in 2021, perceptions

of great risk of harm did not diﬀer among racial or ethnic

groups for smoking one or more packs of cigarettes per day

or for using cocaine once or twice a week. e percentage of

adolescents aged 12 to 17 who perceived great risk of harm

from having four or ﬁve alcoholic drinks nearly every day

was higher among Asian adolescents (81.8 percent) than

among adolescents in most other racial or ethnic groups

(Table B.12B). is percentage was also higher among Black

(67.6 percent) or White adolescents (66.5 percent) than

among Hispanic adolescents (61.9 percent).

In 2021, fewer than half of adolescents aged 12 to 17 in

each racial or ethnic group perceived great risk of harm from

smoking marijuana once or twice a week. e percentage of

adolescents who perceived great risk of harm from smoking

marijuana once or twice a week was higher among Asian

adolescents (44.4 percent) than among adolescents in most

other racial or ethnic groups (Table B.12B).

White adolescents aged 12 to 17 in 2021 were more likely

than Hispanic, Black, or Asian adolescents to perceive great

risk of harm from heroin use once or twice a week. However,

percentages in all racial or ethnic groups were high, ranging

from 73.7 percent of Asian adolescents to 81.7 percent of

White adolescents (Table B.12B).

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. e 2021 NSDUH included a series of questions

to estimate the percentage of the population aged 12 or

older who had at least one SUD in the past 12 months

(subsequently referred to as “an SUD” or “a past year SUD”).

e SUD questions assess the presence of an SUD in the

past 12 months based on criteria speciﬁed in the Diagnostic

and Statistical Manual of Mental Disorders, 5th

edition

(DSM-5).

61,62

Respondents were asked SUD questions for

any alcohol or drugs they used in the 12 months prior to the

survey. Drugs include marijuana, cocaine (including crack),

heroin, hallucinogens, inhalants, methamphetamine, and

any use of prescription stimulants, tranquilizers or sedatives

(e.g., benzodiazepines), and pain relievers.

Unlike in the

section on Illicit Drug Use in the Past Year, the DSM-5 SUD

criteria for prescription drugs apply to people who used but

did not misuse

prescription drugs in the past year, in addition

to people who misused them.

A Clinical Validation Study (CVS) was conducted in early

2020 to assess NSDUH SUD questions that were revised to

be consistent with the DSM-5 criteria discussed as follows.

For the 2021 NSDUH, the SUD questions from the CVS

replaced the SUD questions in the 2020 questionnaire. Also

beginning in 2021, NSDUH respondents who reported

any use of prescription psychotherapeutic drugs (i.e., pain

relievers, tranquilizers, stimulants, or sedatives) in the

past year (i.e., not just misuse of prescription drugs) were

asked the respective SUD questions for that category of

prescription drugs.

DSM-5 includes the following SUD criteria (as measured in

the 2021 NSDUH):

1. e substance is often taken in larger amounts or over

a longer period than intended.

2. ere is a persistent desire or unsuccessful eﬀorts to

cut down or control substance use.

3. A great deal of time is spent in activities necessary to

obtain the substance, use the substance, or recover

from its eﬀects.

4. ere is a craving, or a strong desire or urge, to use the

substance.

5. ere is recurrent substance use resulting in a failure

to fulﬁll major role obligations at work, school, or

home.

6. ere is continued substance use despite having

persistent or recurrent social or interpersonal problems

caused by or exacerbated by the eﬀects of the substance.

7. Important social, occupational, or recreational activities

are given up or reduced because of substance use.

8. ere is recurrent substance use in situations in which

it is physically hazardous.

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

Results from the 2021 National Survey on Drug Use and Health30 | December 2022

9. Substance use is continued despite knowledge

of having a persistent or recurrent physical or

psychological problem that is likely to have been

caused or exacerbated by the substance.

10. ere is a need for markedly increased amounts of the

substance to achieve intoxication or the desired eﬀect,

or markedly diminished eﬀect with continued use of

the same amount of the substance (i.e., tolerance).

11. ere are two components of withdrawal symptoms,

either of which meet the overall criterion for

withdrawal symptoms:

a. ere is a required number of withdrawal symptoms

that occur when substance use is cut back or

stopped following a period of prolonged use.

b. e substance or a related substance is used to get

over or avoid withdrawal symptoms.

Table 1 shows how these 11 DSM-5 SUD criteria apply

to substances in NSDUH. For prescription pain relievers,

tranquilizers, stimulants, and sedatives,

Table 1 also shows

how these criteria apply if respondents misused prescription

drugs or if they simply used but did not misuse prescription

drugs in the past year. For consistency with the DSM-5

criteria, NSDUH respondents were classiﬁed as having an

SUD if they met two or more of the applicable criteria in a

12-month period.

For alcohol, marijuana, cocaine, heroin, and

methamphetamine in

Table 1, respondents were classiﬁed

as having an SUD if they met 2 or more of the 11 criteria

in a 12-month period. However, respondents were classiﬁed

as having a hallucinogen use disorder or an inhalant use

disorder if they met 2 or more of the ﬁrst 10 criteria in the

past 12 months; the withdrawal criterion does not apply to

hallucinogens and inhalants.

Table1. DSM-5 SUD Criteria for Substances and Types of Use in the 2021 NSDUH

Criterion

Alcohol

Marijuana

Cocaine

Heroin

Hallucinogens

Inhalants

Methamphetamine

Pain Relievers,

Use But Not Misuse

Pain Relievers,

Misuse

Tranquilizers,

Use But Not Misuse

Tranquilizers,

Misuse

Stimulants,

Use But Not Misuse

Stimulants,

Misuse

Sedatives,

Use But Not Misuse

Sedatives,

Misuse

1: Substance is often taken in larger amounts,

longer than intended

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

2: Unsuccessful efforts to cut down/control use

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

3: A great deal of time is spent obtaining, using,

recovering

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

4: Craving/strong urge to use

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

5: Recurrent use resulting in failure to fulﬁll major

role obligations at work/school/home

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

6: Continued use despite social problems

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

7: Important social/occupational/recreational

activities given up or reduced because of use

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

8: Recurrent use in physically hazardous situations

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

9: Continued use despite physical, psychological

problems

● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

10: Increased amount of substance is needed to

achieve same effect

● ● ● ● ● ● ●

–

●

–

●

–

●

–

●

11a: Withdrawal symptoms

● ● ● ●

– –

●

–

●

–

●

–

●

–

●

11b: The same or related substance is taken to

avoid withdrawal symptoms

● ● ● ●

– –

●

–

●

–

●

–

●

–

●

● = criterion applies;

–

= criterion does not apply.

DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th edition; SUD = substance use disorder.

The criterion wording is based on the 2021 NSDUH questions.

Withdrawal symptoms and requirements differ by substance.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 31

For the use or misuse of prescription drugs in Table 1,

the number of applicable DSM-5 criteria for classifying

respondents as having a prescription drug use disorder

depends on whether respondents misused prescription drugs,

or they used prescription drugs in the past year, but they

did not misuse them. If respondents misused prescription

drugs in the past year, they were classiﬁed as having a

prescription drug use disorder if they met 2 or more of the

11 criteria shown in Table 1. However, if respondents used

prescription drugs in the past year but did not misuse them,

they were classiﬁed as having a prescription drug use disorder

if they met two or more of the ﬁrst nine criteria shown in

Table 1. Criteria 10 (tolerance) and 11 (withdrawal) do not

apply to respondents who used but did not misuse these

prescription drugs in the past year; tolerance and withdrawal

can occur as normal physiological adaptations when people

use these prescription drugs appropriately under medical

supervision.

Table 2 shows the substances and types of use or misuse

that are included in selected SUD measures in the 2021

NSDUH.

• Any SUD in the past year includes data from past year

users of alcohol, marijuana,

cocaine (including crack),

heroin, hallucinogens, inhalants, and methamphetamine,

and any

past year users of prescription psychotherapeutic

drugs.

• Alcohol use disorder includes only data from past year

users of alcohol.

• Drug use disorder includes data from past year users of

marijuana, cocaine, heroin, hallucinogens, inhalants, and

methamphetamine, and any past year users of prescription

psychotherapeutic drugs. It does not include people who

had an alcohol use disorder in the past year.

• Illicit drug or alcohol use disorder includes data from

past year users of alcohol, marijuana, cocaine, heroin,

hallucinogens, inhalants, and methamphetamine, and

past year misusers of prescription psychotherapeutic drugs.

is illicit drug or alcohol use disorder measure is relevant

to the Substance Use Treatment in the Past Year section.

In addition,

Table A.14B presents estimates for drug use

disorder, illicit drug use disorder, and prescription drug use

disorders based on all past year users of prescription drugs or

only past year misusers. us, Table A.14B shows the eﬀect

on SUD estimates for 2021 when information is included

from all past year users of prescription drugs.

e following sections present the overall estimates ﬁrst,

then by age group. Estimates among racial or ethnic groups

are presented for selected measures.

In 2021, 46.3 million people aged 12 or older (or

16.5 percent of the population) had an SUD in the past year,

including 29.5 million who had an alcohol use disorder and

24.0 million who had a drug use disorder (Figures 31, 32,

and 33 and Table A.15B). Among the 29.5 million people

with a past year alcohol use disorder, 22.2 million had an

Table2. Substances Included in SUD Measures in the 2021 NSDUH

Substance, Past Year Use or Misuse

Substance

Use Disorder

Alcohol Use

Disorder

Drug Use

Disorder

Illicit Drug

Use Disorder

Alcohol

● ●

– –

Marijuana

●

–

● ●

Cocaine

●

–

● ●

Heroin

●

–

● ●

Hallucinogens

●

–

● ●

Inhalants

●

–

● ●

Methamphetamine

●

–

● ●

Prescription Pain Relievers, Any Use

●

–

●

–

Use But Not Misuse

●

–

●

–

Misuse

●

–

● ●

Prescription Tranquilizers, Any Use

●

–

●

–

Use But Not Misuse

●

–

●

–

Misuse

●

–

● ●

Prescription Stimulants, Any Use

●

–

●

–

Use But Not Misuse

●

–

●

–

Misuse

●

–

● ●

Prescription Sedatives, Any Use

●

–

●

–

Use But Not Misuse

●

–

●

–

Misuse

●

–

● ●

Opioids, Any Use

●

–

●

–

Misuse

●

–

● ●

Central Nervous System Stimulants, Any Use

●

–

●

–

Misuse

●

–

● ●

●

= included;

–

= not included.

SUD = substance use disorder.

Use but not misuse of prescription drugs is not considered to be illicit drug use.

Any use includes people who used but did not misuse prescription drugs or people who misused

prescription drugs in the past year. If an SUD definition applies to any use of prescription drugs, it also

applies to people who used but did not misuse prescription drugs or who misused prescription drugs.

Any use of heroin or prescription pain relievers in the past year. A “use but not misuse” category is

not shown because use but not misuse does not apply to heroin.

Any use of heroin or misuse of prescription pain relievers in the past year.

Any use of cocaine, methamphetamine, or prescription stimulants in the past year. A “use but

not misuse” category is not shown because use but not misuse does not apply to cocaine or

methamphetamine.

Any use of cocaine or methamphetamine or misuse of prescription stimulants in the past year.

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

Results from the 2021 National Survey on Drug Use and Health32 | December 2022

alcohol use disorder but not a drug use disorder. Among

the 24.0 million people with a past year drug use disorder,

16.7 million had a drug use disorder but not an alcohol use

disorder. Among people with a past year SUD, 15.8 percent

(or 7.3 million people) had both an alcohol use disorder and

a drug use disorder in the past year.

e percentage of people in 2021 with a past year SUD

diﬀered by age group. e percentage was highest among

young adults aged 18 to 25 (25.6 percent or 8.6 million

people), followed by adults aged 26 or older (16.1 percent

or 35.5 million people), then by adolescents aged 12 to 17

(8.5 percent or 2.2 million people) (Figure 33).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 with a

past year SUD was higher among American Indian or Alaska

Native (27.6 percent) or Multiracial people (25.9 percent) than

among Black (17.2 percent), White (17.0 percent), Hispanic

(15.7 percent), or Asian people (8.0 percent) (Figure 34 and

Table B.13B). e percentage was lower among Asian people

than among people in all other racial or ethnic groups.

Figure32. Alcohol Use Disorder and Drug Use Disorder in the Past

Year: Among People Aged 12 or Older with a Past Year Substance

Use Disorder (SUD); 2021

People with

Alcohol Use

Disorder Only

(48.1% of People

with SUD)

29.5 Million People with

Alcohol Use Disorder

(63.9% of People

with SUD)

People with Alcohol Use Disorder

and Drug Use Disorder

(15.8% of People with SUD)

24.0 Million People

with Drug Use Disorder

(51.9% of People

with SUD)

People with

Drug Use

Disorder Only

(36.1% of People

with SUD)

46.3 Million People Aged 12 or Older with Past Year SUD

22.2

Million

7.3

Million

16.7

Million

Note: Drug Use Disorder includes data from all pastyear users of marijuana, cocaine, heroin,

hallucinogens, inhalants, methamphetamine, and prescription psychotherapeutic drugs (i.e., pain

relievers, tranquilizers, stimulants, or sedatives).

Figure33. Substance Use Disorder, Alcohol Use Disorder, and

Drug Use Disorder in the Past Year: Among People Aged 12 or

Older; 2021

16.5

10.6

8.6

8.5

3.4

6.8

25.6

15.0

16.3

16.1

10.7

7.6

Substance Use Disorder Alcohol Use Disorder Drug Use Disorder

Percent with Disorder in Past Year

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

Age Category:

Includes data from all pastyear users of marijuana, cocaine, heroin, hallucinogens, inhalants,

methamphetamine, and prescription psychotherapeutic drugs (i.e., pain relievers, tranquilizers,

stimulants, or sedatives).

Figure31. Past Year Substance Use Disorder (SUD): Among People Aged 12 or Older; 2021

29.5M

24.0M

16.3M

5.0M

1.6M

1.5M

1.4M

1.0M

0 10M 20M 30M 40M

Alcohol Use Disorder

Drug Use Disorder

Marijuana Use Disorder

Pain Reliever Use Disorder

Methamphetamine Use Disorder

Stimulant Use Disorder

Cocaine Use Disorder

Heroin Use Disorder

Number of People with Speciﬁc Past Year SUD

Past Year SUD

46.3 Million People

(16.5%)

No Past Year SUD

233.6 Million People

(83.5%)

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.

Includes data from all pastyear users of marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, and prescription psychotherapeutic drugs (i.e., pain relievers,

tranquilizers, stimulants, or sedatives).

Includes data from all pastyear users of the specific prescription drug.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 33

Alcohol Use Disorder

Respondents who used alcohol on 6 or more days in the

past 12 months were classiﬁed as having alcohol use disorder

if they met two or more of the DSM-5 criteria for alcohol

use disorder. Relevant criteria for alcohol use disorder

can be found in the 2021 Methodological Summary and

Deﬁnitions report.

Among people aged 12 or older in 2021, 10.6 percent

(29.5 million people) had a past year alcohol use disorder

(Figures 31 and 33 and Table A.15B). e percentage

of people who had a past year alcohol use disorder was

highest among young adults aged 18 to 25 (15.0 percent

or 5.0 million people), followed by adults aged 26 or older

(10.7 percent or 23.6 million people), then by adolescents

aged 12 to 17 (3.4 percent or 894,000 people). Age group

diﬀerences in the percentage of people with an alcohol use

disorder in the past year were consistent with the age group

diﬀerences described previously for binge and heavy alcohol

use in the past month.

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

had a past year alcohol use disorder was lower among Asian

people (6.0 percent) than among people in most other

racial or ethnic groups (Table B.13B). Among other racial

or ethnic groups, the percentage of people aged 12 or older

who had an alcohol use disorder in the past year ranged from

10.1 percent among Black people to 15.6 percent among

American Indian or Alaska Native people. No other racial or

ethnic diﬀerences were found.

Drug Use Disorder

is section presents overall estimates for drug use

disorder, then provides estimates for selected speciﬁc

drugs. As discussed previously, drug use disorder was

deﬁned as meeting DSM-5 SUD criteria for one or more

of the following drugs that were used in the past year:

marijuana, cocaine, heroin, hallucinogens, inhalants,

methamphetamine, or prescription psychotherapeutic

drugs (i.e., stimulants, tranquilizers or sedatives, and pain

relievers). Measures for prescription drug use disorders

for 2021 were based on data from all

past year users of

prescription drugs, not just misusers. Relevant SUD

deﬁnitions for speciﬁc drugs can be found in the 2021

Methodological Summary and Deﬁnitions report.

Among people aged 12 or older in 2021, 8.6 percent (or

24.0 million people) had at least one drug use disorder in

the past year (Figures 31 and 33 and Table A.15B). e

percentage of young adults aged 18 to 25 with a drug

use disorder (16.3 percent or 5.5 million people) was

higher than the percentages of adolescents aged 12 to 17

(6.8 percent or 1.8 million people) or adults aged 26 or older

(7.6 percent or 16.8 million people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who had

a past year drug use disorder was higher among American

Indian or Alaska Native (18.3 percent) or Multiracial people

(15.8 percent) than among Black (10.1 percent), White

(8.5 percent), Hispanic (8.4 percent), or Asian people

(3.4 percent) (Table B.13B). e percentage was also higher

among Black people than among White people. Asian people

were less likely to have a drug use disorder compared with

people in most other racial or ethnic groups.

Marijuana Use Disorder

Among people aged 12 or older in 2021, 5.8 percent

(or 16.3 million people) had a marijuana use disorder in

the past year (Figures 31 and 35 and Table A.15B). e

percentage of young adults aged 18 to 25 with a marijuana

use disorder (14.4 percent or 4.8 million people) was

higher than the percentages of adolescents aged 12 to 17

(4.8 percent or 1.3 million people) or adults aged 26 or older

(4.6 percent or 10.2 million people). e higher percentage

of young adults aged 18 to 25 with a marijuana use disorder

Figure34. Past Year Substance Use Disorder: Among People Aged

12 or Older; by Race/Ethnicity, 2021

16.5

27.6

25.9

20.7

17.2

17.0

15.7

8.0

Percent with Disorder in Past Year

NH Asian

Hispanic

NH White

NH Black

NH NHOPI

NH Multiracial

NH AIAN

12 or Older

0 40302010

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

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

Results from the 2021 National Survey on Drug Use and Health34 | December 2022

was consistent with the higher percentage among this age

group for marijuana use in the past year.

By Race/Ethnicity

In 2021, the percentage of people aged 12 or older

who had a past year marijuana use disorder was higher

among American Indian or Alaska Native (15.5 percent)

or Multiracial people (12.6 percent) than among Black

(7.4 percent), Hispanic (5.6 percent), White (5.5 percent),

or Asian people (2.4 percent) (Table B.13B). Black people

also were more likely than Hispanic, White, or Asian people

to have had a past year marijuana use disorder.

Cocaine Use Disorder

Among people aged 12 or older in 2021, 0.5 percent

(or 1.4 million people) had a cocaine use disorder in the

past year (Figure 31 and Table A.15B). e percentage

of adolescents aged 12 to 17 (less than 0.1 percent or

7,000 people) with a cocaine use disorder was lower than the

percentages of young adults aged 18 to 25 (0.8 percent or

252,000 people) or adults aged 26 or older (0.5 percent or

1.1 million people).

Heroin Use Disorder

Among people aged 12 or older in 2021, 0.4 percent (or

1.0 million people) had a heroin use disorder in the past year

(Figure 31 and Table A.15B). e percentage of people with

a heroin use disorder in the past year was highest among

adults aged 26 or older (0.4 percent or 942,000 people),

followed by young adults aged 18 to 25 (0.2 percent or

63,000 people), then by adolescents aged 12 to 17 (less than

0.1 percent or 2,000 people).

Methamphetamine Use Disorder

Among people aged 12 or older in 2021, 0.6 percent (or

1.6 million people) had a methamphetamine use disorder

in the past year (Figures 31 and 35 and Table A.15B). e

percentage of people with a methamphetamine use disorder

in the past year was highest among adults aged 26 or older

(0.7 percent or 1.5 million people), followed by young

adults aged 18 to 25 (0.3 percent or 111,000 people), then

by adolescents aged 12 to 17 (0.1 percent or 20,000 people).

Prescription Stimulant Use Disorder

Prescription stimulant use disorder estimates for 2021

included data from all past year users of prescription

stimulants. For this reason and because of other

methodological changes for 2021, readers should not

compare prescription stimulant use disorder estimates from

2021 with previously published prescription stimulant use

disorder estimates. However,

Table A.14B presents estimates

of prescription stimulant use disorder for 2021 based on data

from all past year users of prescription stimulants or from

past year misusers.

Among people aged 12 or older in 2021, 0.5 percent (or

1.5 million people) had a prescription stimulant use disorder

in the past year (Figure 31 and Table A.15B). e percentage

of adults aged 26 or older (0.4 percent or 881,000 people)

with a prescription stimulant use disorder was lower than

the percentages of adolescents aged 12 to 17 (0.9 percent or

245,000 people) or young adults aged 18 to 25 (1.1 percent

or 379,000 people).

Prescription Tranquilizer Use Disorder

or Sedative Use Disorder

Estimates for prescription tranquilizer use disorder or

sedative use disorder for 2021 included data from all

past year users of prescription tranquilizers or sedatives. For

this reason and because of other methodological changes for

2021, readers should not compare prescription tranquilizer

use disorder or sedative use disorder estimates from 2021

with previously published estimates for these disorders.

However,

Table A.14B presents estimates of prescription

tranquilizer use disorder or sedative use disorder for 2021

based on data from all past year users of prescription

tranquilizers or sedatives or from past year misusers.

Figure35. Marijuana Use Disorder, Pain Reliever Use Disorder,

and Methamphetamine Use Disorder in the Past Year: Among

People Aged 12 or Older; 2021

5.8

1.8

0.6

4.8

1.0

0.1

14.4

1.2

0.3

4.6

2.0

0.7

Marijuana Use Disorder Pain Reliever Use

Disorder

Methamphetamine Use

Disorder

Percent with Disorder in Past Year

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

Age Category:

Includes data from all pastyear users of prescription pain relievers.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 35

Among people aged 12 or older in 2021, 0.8 percent

(or 2.2 million people) had a prescription tranquilizer

use disorder or sedative use disorder in the past year

(Table A.15B). e percentage of adolescents aged 12 to

17 (0.5 percent or 127,000 people) with either of these

disorders was lower than the percentages of young adults

aged 18 to 25 (0.9 percent or 303,000 people) or adults aged

26 or older (0.8 percent or 1.8 million people).

Prescription Pain Reliever Use Disorder

Prescription pain reliever use disorder estimates for 2021

included data from all past year users of prescription

pain relievers. For this reason and because of other

methodological changes for 2021, readers should not

compare prescription pain reliever use disorder estimates

from 2021 with previously published prescription pain

reliever use disorder estimates. However,

Table A.14B

presents estimates of prescription pain reliever use

disorder for 2021 based on data from all past year users of

prescription pain relievers or from past year misusers.

Among people aged 12 or older in 2021, 1.8 percent

(or 5.0 million people) had a prescription pain reliever

use disorder in the past year (Figures 31 and 35 and

Table A.15B). e percentage of adults aged 26 or older

(2.0 percent or 4.3 million people) with a prescription pain

reliever use disorder was higher than the percentages of

adolescents aged 12 to 17 (1.0 percent or 259,000 people) or

young adults aged 18 to 25 (1.2 percent or 414,000 people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who had

a past year prescription pain reliever use disorder was lower

among Asian people (0.7 percent) than among people in

most other racial or ethnic groups (Table B.14B). Among

other racial or ethnic groups, the percentage of people aged

12 or older who had a past year prescription pain reliever use

disorder ranged from 1.5 percent among Native Hawaiian

or Other Paciﬁc Islander people to 3.9 percent among

American Indian or Alaska Native people. No other racial or

ethnic diﬀerences were found.

Opioid Use Disorder

Respondents were classiﬁed as having an opioid use disorder

if they met DSM-5 criteria for heroin use disorder or

prescription pain reliever use disorder (or both). For 2021,

opioid use disorder included prescription pain reliever

use disorder among all past year users of prescription pain

relievers (Table A.15B). Opioid use disorder estimates for

2021 included data from both past year heroin users and

past year prescription pain reliever users. For this reason

and because of other methodological changes for 2021,

readers should not compare opioid use disorder estimates

from 2021 with previously published opioid use disorder

estimates. However,

Table A.14B presents estimates of opioid

use disorder for 2021 based on data from past year users of

heroin and all past year users of prescription pain relievers.

Table A.14B also presents estimates of opioid use disorder

from past year users of heroin and past year misusers of

prescription pain relievers.

Among people aged 12 or older in 2021, 2.0 percent (or

5.6 million people) had an opioid use disorder in the

past year (Table A.15B). Consistent with the estimates for

prescription pain reliever use disorder, the percentage of

adults aged 26 or older (2.2 percent or 4.9 million people)

with an opioid use disorder was higher than the percentages

of adolescents aged 12 to 17 (1.0 percent or 259,000 people)

or young adults aged 18 to 25 (1.3 percent or 438,000

people).

By Race/Ethnicity

Following a pattern similar to that for prescription pain

reliever use disorder, the percentage of people aged 12 or

older in 2021 who had a past year opioid use disorder was

lower among Asian people (0.7 percent) than among people

in most other racial or ethnic groups (Table B.14B). Among

other racial or ethnic groups, the percentage of people aged

12 or older who had a past year opioid use disorder ranged

from 1.5 percent among Native Hawaiian or Other Paciﬁc

Islander people to 4.4 percent among American Indian or

Alaska Native people. No other racial or ethnic diﬀerences

were found.

Central Nervous System Stimulant Use Disorder

Respondents were classiﬁed as having a central nervous system

(CNS) stimulant use disorder if they met DSM-5 criteria

for cocaine use disorder, methamphetamine use disorder,

or prescription stimulant use disorder (or more than one

of these disorders). CNS stimulant use disorder included

prescription stimulant use disorder among all past year users

of prescription stimulants. CNS stimulant use disorder

estimates for 2021 included data from past year users of

cocaine or methamphetamine and from all past year users of

prescription stimulants. For this reason and because of other

methodological changes for 2021, readers should not compare

CNS stimulant use disorder estimates from 2021 with

previously published CNS stimulant use disorder estimates.

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

Results from the 2021 National Survey on Drug Use and Health36 | December 2022

However, Table A.14B presents estimates of CNS stimulant

use disorder from 2021 based on data from past year users

of cocaine and methamphetamine and all past year users of

prescription stimulants. Table A.14B also presents estimates of

CNS stimulant use disorder among past year users of cocaine

and methamphetamine and past year misusers of prescription

stimulants.

Among people aged 12 or older in 2021, 1.5 percent (or

4.1 million people) had a CNS stimulant use disorder in

the past year (Table A.15B). e percentage of adolescents

aged 12 to 17 (1.0 percent or 255,000 people) with a CNS

stimulant use disorder was lower than the percentages of

young adults aged 18 to 25 (1.9 percent or 625,000 people)

or adults aged 26 or older (1.5 percent or 3.3 million people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

had a past year CNS stimulant use disorder was higher

among Multiracial people (2.9 percent) than among Black

(1.1 percent) or Asian people (0.5 percent) (Table B.14B).

Asian people were less likely to have had a past year CNS

stimulant use disorder compared with Hispanic (1.6 percent)

or White people (1.5 percent).

Illicit Drug or Alcohol Use Disorder

As noted previously, this section is new for the 2021

report because the overall 2021 SUD measure for drugs

or alcohol counts prescription drug use disorders from all

past year users of prescription psychotherapeutic drugs.

However, NSDUH does not deﬁne the use but not misuse

of prescription psychotherapeutic drugs to be “illicit” drug

use. In addition, the substance use treatment section of the

2021 NSDUH questionnaire asked respondents about their

receipt of substance use treatment if they reported lifetime

use of alcohol or illicit drugs (i.e., including respondents who

misused prescription psychotherapeutic drugs). erefore,

estimates for illicit drug or alcohol use disorder are relevant for

classifying certain subpopulations discussed in the Substance

Use Treatment in the Past Year section. e deﬁnition of

illicit drug or alcohol use disorder can be found in the 2021

Methodological Summary and Deﬁnitions report.

In 2021, 42.9 million people aged 12 or older (or

15.3 percent of this population) had an illicit drug or

alcohol use disorder in the past year (Table A.14B). e

percentage of people in 2021 with a past year illicit drug or

alcohol use disorder diﬀered by age group. e percentage

was highest among young adults aged 18 to 25 (24.9 percent

or 8.3 million people), followed by adults aged 26 or older

(14.8 percent or 32.6 million people), then by adolescents

aged 12 to 17 (7.5 percent or 2.0 million people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021

who had a past year illicit drug or alcohol use disorder

was higher among American Indian or Alaska Native

(27.3 percent) or Multiracial people (24.9 percent) than

among Black (16.1 percent), White (15.6 percent), Hispanic

(14.9 percent), or Asian people (7.6 percent) (Table B.14B).

Asian people were less likely to have had a past year illicit

drug or alcohol use disorder compared with people in all

other racial or ethnic groups including Native Hawaiian or

Other Paciﬁc Islander people (20.6 percent).

Substance Use Disorder Severity

e DSM-5 SUD criteria include a severity level

classiﬁcation. People who meet two or three criteria are

considered to have a “mild” disorder, those who meet four

or ﬁve criteria are considered to have a “moderate” disorder,

and those who meet six or more criteria are considered to

have a “severe” disorder.

Table A.16B presents estimates

for SUD severity among people aged 12 or older who had

speciﬁc SUDs in the past year. Because estimates are among

people who had SUDs in the past year, some SUD severity

estimates could not be calculated with suﬃcient precision.

Nevertheless, these ﬁndings could have implications for

people entering substance use treatment for their use of

speciﬁc substances.

Highlights from

Figure 36 and Table A.16B for severity

levels among people aged 12 or older in 2021 with a

past year alcohol use disorder, marijuana use disorder,

cocaine use disorder, or methamphetamine use disorder

include the following:

• Among the 29.5 million people with a past year alcohol

use disorder (Figure 31), most (59.6 percent) had a mild

disorder compared with about 1 in 5 (19.5 percent) who

had a severe disorder.

• Among the 16.3 million people with a past year marijuana

use disorder, most (57.6 percent) had a mild disorder

compared with only 16.1 percent who had a severe disorder.

• Among the 1.4 million people with a past year cocaine

use disorder, percentages of people were more evenly

distributed between the mild and severe disorder

categories (42.2 and 40.0 percent, respectively).

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 37

• Among the 1.6 million people with a past year

methamphetamine use disorder, most (58.4 percent)

had a severe disorder, and only 17.4 percent had a mild

disorder.

Table A.16B also presents prescription drug use disorder

estimates according to whether people aged 12 or older had

a disorder due to their use (but not misuse) of prescription

drugs, or they had a disorder due to their misuse of

prescription drugs. Estimates for the severity of stimulant use

disorder, tranquilizer use disorder, and sedative use disorder

among people who had a disorder due to their use of these

prescription drugs (but they did not misuse them) could not

be calculated with suﬃcient precision.

Highlights from

Figure 37 and Table A.16B for severity

levels among people aged 12 or older in 2021 with a

prescription pain reliever use disorder include the following:

• Among the 5.0 million people with a prescription pain

reliever use disorder in the past year (i.e., based on any

past year use of prescription pain relievers) (

Figure 31),

about two thirds (65.0 percent) had a mild disorder

compared with 16.0 percent who had a severe disorder.

• Among people who used but did not misuse prescription

pain relievers and had a prescription pain reliever use

disorder, about four ﬁfths (81.0 percent) had a mild

disorder compared with only 2.9 percent who had a severe

disorder.

• Among people aged 12 older who misused prescription

pain relievers and had a prescription pain reliever

use disorder, 39.1 percent had a mild disorder and

37.2 percent had a severe disorder.

Major Depressive Episode in the Past Year

In the 2021 NSDUH, respondents were classiﬁed as

having had a major depressive episode (MDE) in the

past 12 months if (1) they had at least one period of 2 weeks

or longer in the past year when for most of the day nearly

every day, they felt depressed or lost interest or pleasure in

daily activities; and (2) they also had problems with sleeping,

eating, energy, concentration, self-worth, or having recurrent

thoughts of death or recurrent suicidal ideation. e MDE

questions are based on diagnostic criteria from DSM-5,

Figure36. Substance Use Disorder Severity Level for Speciﬁc

Substances in the Past Year: Among People Aged 12 or Older with

a Speciﬁc Substance Use Disorder; 2021

59.6

57.6

42.2

17.4

20.9

26.3

17.9

24.1

19.5

16.1

40.0

58.4

100

Alcohol Marijuana Cocaine Methamphetamine

Percent with Speciﬁc Disorder in Past Year

Severe Substance Use Disorder

Moderate Substance Use Disorder

Mild Substance Use Disorder

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

Note: There are 11 criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition,

that apply to these substances. People who meet two or three criteria are considered to have a

“mild” disorder, those who meet four or five criteria are considered to have a “moderate” disorder,

and those who meet six or more criteria are considered to have a “severe” disorder.

Figure37. Pain Reliever Use Disorder Severity Level in the Past

Year: Among People Aged 12 or Older with a Pain Reliever Use

Disorder; 2021

65.0

81.0

39.1

19.0

16.1

23.7

16.0

2.9

37.2

100

Any Past Year

Prescription Pain

Reliever Use Pain Relievers

Past Year Use but Not

Misuse of Prescription

Past Year Misuse of

Prescription Pain

Relievers

Percent with Speciﬁc Disorder in Past Year

Severe Substance Use Disorder

Moderate Substance Use Disorder

Mild Substance Use Disorder

Note: There are 11 criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition,

that apply to the pain reliever use disorder estimates for pastyear prescription pain reliever misuse

and 9 criteria that apply to the pain reliever use disorder estimates for the pastyear use but not

misuse of prescription pain relievers. For the pain reliever use disorder estimates for any pastyear

user of prescription pain relievers, the number of criteria depends on whether people misused

prescription pain relievers (11 criteria) or used but did not misuse them (9 criteria). Regardless of

the total number of criteria used for classifying people as having a pain reliever use disorder, people

who meet two or three criteria are considered to have a “mild” disorder, those who meet four or five

criteria are considered to have a “moderate” disorder, and those who meet six or more criteria are

considered to have a “severe” disorder.

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

Results from the 2021 National Survey on Drug Use and Health38 | December 2022

which require the presence of ﬁve or more symptoms during

the same 2-week period.

e wording for some depression

questions asked of adolescent respondents aged 12 to 17

diﬀered from the wording for similar questions asked of

adult respondents aged 18 or older. erefore, the MDE

estimates for adults aged 18 or older and adolescents aged

12 to 17 are not directly comparable and are presented

separately.

18,68,69

e 2021 NSDUH also collected data on whether an MDE

in the past year caused respondents to experience severe

impairment in four major life activities or role domains.

ese domains were deﬁned separately for adolescents aged

12 to 17 and adults aged 18 or older to reﬂect the diﬀerent

roles associated with the two age groups. Adolescents aged

12 to 17 were classiﬁed as having an MDE with severe

impairment if their depression caused severe problems with

their ability to do chores at home, do well at work or school,

get along with their family, or have a social life. Adults aged

18 or older were classiﬁed as having an MDE with severe

impairment if their depression caused severe problems with

their ability to manage at home or work, have relationships

with others, or have a social life.

Web-based interviewing aﬀected the number of adult

respondents aged 18 or older in 2021 who provided usable

information on their substance use

but did not complete

the mental health or later questions (i.e., “break-oﬀs”). To

reduce the potential for bias, missing data for measures of

MDE and MDE with severe impairment among adults aged

18 or older were statistically imputed for 2021.

In sections that present estimates for MDE in the past year

among adolescents aged 12 to 17, estimates are ﬁrst

presented for all adolescents, followed by estimates among

racial or ethnic groups. In sections that present estimates

for MDE in the past year among adults aged 18 or older,

estimates are ﬁrst presented for all adults, followed by

estimates by age group, then by racial or ethnic groups.

Estimates among racial or ethnic groups of adolescents or

adults are presented for selected measures.

MDE and MDE with Severe Impairment among

Adolescents

Among adolescents aged 12 to 17 in 2021, 20.1 percent (or

5.0 million people) had a past year MDE (Figure 38 and

Table A.17B). An estimated 14.7 percent of adolescents aged

12 to 17 (or 3.7 million people) in 2021 had a past year

MDE with severe impairment.

By Race/Ethnicity

Among adolescents aged 12 to 17 in 2021, 13.8 percent

of Asian adolescents and 14.0 percent of Black adolescents

had a past year MDE (Figure 39 and Table B.15B). ese

percentages were lower than the corresponding percentages

of Multiracial (27.2 percent), Hispanic (22.2 percent),

or White adolescents (20.7 percent). A similar pattern of

diﬀerences among racial or ethnic groups was observed for

past year MDE with severe impairment among adolescents.

Figure38. Major Depressive Episode (MDE) and MDE with Severe

Impairment in the Past Year: Among Youths Aged 12 to 17; 2021

21.0 Million

Youths with No MDE

(79.9% of All Youths)

5.0 Million

Youths with an MDE

(with or without

Severe Impairment)

(20.1% of All Youths)

3.7 Million

Youths with an MDE

with Severe Impairment

(14.7% of All Youths and

74.2% of Youths with an MDE)

26.0 Million Youths Aged 12 to 17

Note: Youth respondents with unknown MDE data were excluded.

Figure39. Major Depressive Episode (MDE) in the Past Year:

Among Youths Aged 12 to 17; by Race/Ethnicity, 2021

20.1

27.2

22.2

20.7

14.0

13.8

* *

Percent with MDE in Past Year

NH NHOPI

NH AIAN

NH Asian

NH Black

NH White

Hispanic

NH Multiracial

12 to 17

0 40302010

* Low precision; no estimate reported.

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

Note: Youth respondents with unknown MDE data were excluded.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 39

MDE and MDE with Severe Impairment among Adults

Among adults aged 18 or older in 2021, 8.3 percent (or

21.0 million people) had a past year MDE (Figure 40 and

Table A.18B). e percentage was highest among young

adults aged 18 to 25 (18.6 percent or 6.2 million people),

followed by adults aged 26 to 49 (9.3 percent or 9.5 million

people), then by adults aged 50 or older (4.5 percent or

5.3 million people).

An estimated 5.7 percent of adults aged 18 or older (or

14.5 million people) in 2021 had a past year MDE with

severe impairment. e percentage was highest among young

adults aged 18 to 25 (13.3 percent or 4.4 million people),

followed by adults aged 26 to 49 (6.5 percent or 6.6 million

people), then by adults aged 50 or older (2.9 percent or

3.4 million people).

By Race/Ethnicity

Among adults aged 18 or older in 2021, Multiracial adults

(13.9 percent) were more likely to have had an MDE in

the past year compared with White (8.9 percent), Hispanic

(7.9 percent), Black (6.7 percent), Native Hawaiian or

Other Paciﬁc Islander (5.1 percent), or Asian adults

(4.8 percent) (Table B.16B). Black adults were less likely to

have had a past year MDE compared with White adults, and

Asian adults were less likely to have had a past year MDE

compared with White or Hispanic adults. A similar pattern

of diﬀerences among racial or ethnic groups was observed for

past year MDE with severe impairment among adults.

Any Mental Illness among Adults in the

Past Year

e 2021 NSDUH provided estimates of any mental illness

(AMI) and serious mental illness (SMI) for adults aged 18 or

older. Adults aged 18 or older were classiﬁed as having AMI

if they had any mental, behavioral, or emotional disorder

in the past year of suﬃcient duration to meet criteria from

the Diagnostic and Statistical Manual of Mental Disorders,

4th edition (DSM-IV), excluding developmental disorders

and SUDs.

72,73

Adults aged 18 or older who were classiﬁed

as having AMI were classiﬁed as having SMI if they had any

mental, behavioral, or emotional disorder that substantially

interfered with or limited one or more major life activities.

Statistical prediction models that were developed using

clinical interview data from a subset of NSDUH adult

respondents aged 18 or older between 2008 and 2012 were

used to classify whether respondents in the 2021 adult

sample had AMI or SMI in the past year. For 2021, source

variables were statistically imputed for the prediction models

used to estimate AMI or SMI.

In sections that present estimates for AMI or SMI in the

past year among adults aged 18 or older, estimates are ﬁrst

presented for all adults, followed by estimates among age

groups, then by racial or ethnic groups. Estimates among

racial or ethnic groups are presented for selected measures.

Among adults aged 18 or older in 2021, 22.8 percent (or

57.8 million people) had AMI in the past year (Figure 41

Figure40. Major Depressive Episode (MDE) and MDE with Severe

Impairment: Among Adults Aged 18 or Older; 2021

8.3

5.7

18.6

13.3

9.3

6.5

4.5

2.9

MDE (with or without

Severe Impairment)

MDE with Severe Impairment

Percent with MDE or MDE with

Severe Impairment in Past Year

18 or Older 18 to 25 26 to 49 50 or Older

Age Category:

Figure41. Any Mental Illness and Serious Mental Illness: Among

Adults Aged 18 or Older; 2021

22.8

5.5

33.7

11.4

28.1

7.1

15.0

2.5

Any Mental Illness (with or without

Serious Mental Illness)

Serious Mental Illness

Percent with Any Mental Illness

or Serious Mental Illness in Past Year

18 or Older 18 to 25 26 to 49 50 or Older

Age Category:

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

Results from the 2021 National Survey on Drug Use and Health40 | December 2022

and Table A.19B). e percentage was highest among

young adults aged 18 to 25 (33.7 percent or 11.3 million

people), followed by adults aged 26 to 49 (28.1 percent

or 28.8 million people), then by adults aged 50 or older

(15.0 percent or 17.7 million people).

By Race/Ethnicity

Among adults aged 18 or older in 2021, Multiracial adults

(34.9 percent) were more likely to have had AMI in the

past year compared with White (23.9 percent), Black

(21.4 percent), Hispanic (20.7 percent), Native Hawaiian

or Other Paciﬁc Islander (18.1 percent), or Asian adults

(16.4 percent) (Figure 42 and Table B.17B). e percentage

of adults with AMI in the past year was lower among

Hispanic adults than among White adults. e percentage

was lower among Asian adults than among White, Black, or

Hispanic adults.

Serious Mental Illness among Adults in the

Past Year

Among adults aged 18 or older in 2021, 5.5 percent (or

14.1 million people) had SMI in the past year (Figure 41

and Table A.19B). Consistent with the age group pattern for

AMI, the percentage of adults aged 18 or older with SMI

was highest among young adults aged 18 to 25 (11.4 percent

or 3.8 million people), followed by adults aged 26 to 49

(7.1 percent or 7.3 million people), then by adults aged 50

or older (2.5 percent or 3.0 million people).

By Race/Ethnicity

Among adults aged 18 or older in 2021, Multiracial adults

(8.2 percent) were more likely to have had SMI in the

past year compared with Hispanic (5.1 percent), Black

(4.3 percent), or Asian adults (2.8 percent) (Table B.17B).

e percentage of adults with SMI in the past year was lower

among Black adults than among White adults (6.1 percent).

e percentage was also lower among Asian adults than

among White or Hispanic adults.

Co-Occurring MDE and SUD among

Adolescents

Adolescents aged 12 to 17 who had both a past year MDE

and a past year SUD (i.e., drug use disorder, alcohol use

disorder, or both) were classiﬁed as having co-occurring MDE

and SUD. e order of the onset of an SUD relative to the

onset of an MDE among adolescents aged 12 to 17 cannot be

established based on the NSDUH data (i.e., whether the onset

of an SUD preceded the onset of an MDE, or vice versa).

As noted previously, SUD estimates for 2021 included data

from all past year users of prescription psychotherapeutic

drugs (i.e., pain relievers, tranquilizers, stimulants, or

sedatives). e Substance Use Treatment in the Past Year

section discusses these changes in the measurement and

estimation of SUDs in more detail.

Among adolescents aged 12 to 17 in 2021, 25.2 percent (or

6.3 million people) had either an SUD or an MDE in the

past year, 16.4 percent (or 4.1 million people) had an MDE

but not an SUD, 4.8 percent (or 1.2 million people) had an

SUD but not an MDE, and 3.7 percent (or 935,000 people)

had both an MDE and an SUD in the past year (Figure 43

and Table A.20AB).

Among adolescents aged 12 to 17 in 2021, 2.9 percent (or

724,000 people) had both an MDE with severe impairment

and an SUD in the past year.

By Race/Ethnicity

Among adolescents aged 12 to 17 in 2021, Asian

(15.4 percent) or Black adolescents (19.6 percent) were less

likely to have either an SUD or an MDE in the past year

compared with Multiracial (31.2 percent), Hispanic

(27.7 percent), or White adolescents (25.8 percent)

(Table B.18B). Black adolescents (1.6 percent) also were

less likely to have a co-occurring MDE and an SUD in the

past year compared with White (4.2 percent) or Hispanic

adolescents (3.7 percent).

Figure42. Any Mental Illness (AMI): Among Adults Aged 18 or

Older; by Race/Ethnicity, 2021

22.8

34.9

26.6

23.9

21.4

20.7

18.1

16.4

Percent with AMI in Past Year

NH Asian

NH NHOPI

Hispanic

NH Black

NH White

NH AIAN

NH Multiracial

18 or Older

40302010

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 41

Substance Use among Adolescents with MDE

Adolescents aged 12 to 17 who had a past year MDE

were more likely to use some substances in the past year

or past month compared with their counterparts who did

not have an MDE in the past year. In 2021, adolescents

aged 12 to 17 with a past year MDE were more likely

than adolescents aged 12 to 17 without a past year MDE

to be past year illicit drug users (27.7 vs. 10.7 percent),

including past year marijuana users (20.3 vs. 8.0 percent)

(Figure 44 and Table A.21B). Adolescents aged 12 to 17

with a past year MDE also were more likely than those

without a past year MDE to be past month binge alcohol

users (6.7 vs. 3.1 percent). In addition, adolescents aged 12

to 17 with a past year MDE were more likely than those

without a past year MDE to use tobacco products or to vape

nicotine in the past month (14.3 vs. 4.7 percent). Except

for cocaine and methamphetamine use in the past year and

heavy alcohol use in the past month, adolescents aged 12 to

17 with a past year MDE also were more likely than those

without a past year MDE to be past year or past month users

of the other substances shown in Table A.21B.

Co-Occurring Mental Health Issues and SUD

among Adults

Among adults aged 18 or older, having AMI and an SUD in

the past year is referred to as having co-occurring AMI and

SUD. Adults aged 18 or older having SMI and an SUD in

the past year are referred to as having co-occurring SMI and

SUD. However, the order of the onset of SUDs relative to

the onset of mental disorders cannot be established based on

the NSDUH data for adults aged 18 or older (i.e., whether

the onset of SUDs preceded the onset of mental disorders, or

vice versa).

As noted previously, SUD estimates for 2021 included data

from all past year users of prescription psychotherapeutic

drugs (i.e., pain relievers, tranquilizers, stimulants, or

sedatives). e Substance Use Treatment in the Past Year

section discusses the measurement and estimation of SUDs

in more detail.

e following sections for adults aged 18 or older present the

overall estimates ﬁrst, then by age group. Estimates among

racial or ethnic groups are presented for selected measures.

Co-Occurring AMI and SUD

Among adults aged 18 or older in 2021, 32.5 percent (or

82.5 million people) had either AMI or an SUD in the

past year, 15.1 percent (or 38.4 million people) had AMI but

not an SUD, 9.7 percent (or 24.7 million people) had an

SUD but not AMI, and 7.6 percent (or 19.4 million people)

had both AMI and an SUD (Figure 45 and Tables A.22A

and A.22B).

Nearly half of young adults aged 18 to 25 in 2021 had

either AMI or an SUD in the past year (45.8 percent or

15.3 million people) (Tables A.22A and A.22B). is

percentage was higher than the percentages for AMI or

an SUD in the past year among adults aged 26 to 49

(39.5 percent or 40.4 million people) and adults aged 50 or

older (22.6 percent or 26.7 million people). Adults aged 26

to 49 also were more likely than adults aged 50 or older to

have AMI or an SUD in the past year.

Figure43. Past Year Substance Use Disorder (SUD) and Major

Depressive Episode (MDE): Among Youths Aged 12 to 17; 2021

2.2 Million Youths

Had SUD

Youths Had

SUD but

Not MDE

Youths Had SUD and MDE

Youths Had

MDE but

Not SUD

5.0 Million Youths

Had MDE

1.2

Million

935,000

4.1

Million

6.3 Million Youths Had Either SUD or MDE

Note: Youth respondents with unknown MDE data were excluded.

Figure44. Substance Use: Among Youths Aged 12 to 17; by Past

Year Major Depressive Episode (MDE) Status, 2021

27.7

20.3

4.2

6.7

14.3

10.7

8.0

1.3

3.1

4.7

0 5 10 15 20 25 30

Percent Using

Had MDE

Did Not Have MDE

Illicit Drugs, Past Year

Marijuana, Past Year

Opioid Misuse, Past Year

Binge Alcohol,

Past Month

Tobacco Products or

Nicotine Vaping, Past Month

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 2021 National Survey on Drug Use and Health42 | December 2022

e percentage of adults aged 18 or older in 2021 who

had both AMI and an SUD in the past year was lowest

among adults aged 50 or older (3.7 percent or 4.4 million

people) (Tables A.22A and A.22B). e percentage of adults

aged 26 to 49 with both AMI and an SUD (10.2 percent

or 10.5 million people) also was slightly lower than the

percentage among young adults aged 18 to 25 (13.5 percent

or 4.5 million people).

By Race/Ethnicity

e percentage of adults aged 18 or older in 2021 who

had either AMI or an SUD in the past year was higher

among Multiracial adults (48.0 percent) than among

White (33.6 percent), Black (32.3 percent), Hispanic

(30.3 percent), or Asian adults (21.4 percent) (Table B.19B).

Asian adults were less likely to have had either AMI or an

SUD in the past year compared with adults in most other

racial or ethnic groups.

Similar patterns among racial or ethnic groups were observed

for the percentages of adults aged 18 or older who had both

AMI and an SUD in the past year. e percentage of adults

aged 18 or older who had both AMI and an SUD in the

past year was higher among Multiracial adults (16.3 percent)

than among White (7.9 percent), Black (7.4 percent),

Hispanic (7.2 percent), or Asian adults (3.5 percent)

(Table B.19B). Asian adults were less likely to have had both

AMI and an SUD in the past year compared with adults in

most other racial or ethnic groups.

Co-Occurring SMI and SUD

Among adults aged 18 or older in 2021, 20.4 percent (or

51.7 million people) had either SMI or an SUD in the

past year, 3.0 percent (or 7.7 million people) had SMI but

not an SUD, 14.8 percent (or 37.7 million people) had an

SUD but not SMI, and 2.5 percent (or 6.4 million people)

had both SMI and an SUD (Figure 45 and Tables A.22A

and A.22B).

Nearly one third of young adults aged 18 to 25 in 2021

had either SMI or an SUD in the past year (31.6 percent

or 10.6 million people) (Tables A.22A and A.22B). is

percentage was higher than the percentages for SMI or

an SUD in the past year among adults aged 26 to 49

(25.4 percent or 26.0 million people) and adults aged 50 or

older (12.8 percent or 15.2 million people). Adults aged 26

to 49 also were more likely than adults aged 50 or older to

have SMI or an SUD in the past year.

By Race/Ethnicity

e percentage of adults aged 18 or older in 2021 who

had either SMI or an SUD in the past year was higher

among American Indian or Alaska Native (34.2 percent)

or Multiracial adults (33.6 percent) than among

White (21.1 percent), Black (20.4 percent), Hispanic

(19.2 percent), or Asian adults (10.8 percent) (Table B.20B).

Asian adults were less likely to have had either SMI or an

SUD in the past year compared with adults in most other

racial or ethnic groups.

Asian adults (0.5 percent) aged 18 or older in 2021 were

also less likely to have had both SMI and an SUD in the

Figure45. Past Year Substance Use Disorder (SUD), Any Mental Illness (AMI), and Serious Mental Illness (SMI):

Among Adults Aged 18 or Older; 2021

44.0 Million

Adults Had SUD

but Not AMI (with

or without SMI)

Adults Had SUD

and AMI (with or

without SMI)

Adults Had AMI

(with or without

SMI) but Not SUD

57.8 Million Adults

Had AMI (with or

without SMI)

24.7

Million

19.4

Million

38.4

Million

82.5 Million Adults Had Either SUD or AMI (with or without SMI)

37.7

Million

6.4

Million

7.7

Million

44.0 Million

Adults Had SUD

but Not SMI

Adults Had SUD

and SMI

Adults Had SMI

but Not SUD

14.1 Million

Adults Had SMI

51.7 Million Adults Had Either SUD or SMI

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 43

past year compared with adults in most other racial or ethnic

groups (Table B.20B). Estimates for having had both SMI

and an SUD in the past year did not diﬀer among other

racial or ethnic groups of adults.

Substance Use among Adults, byMental

Illness Status

is section discusses how the prevalence of substance use

among adults aged 18 or older diﬀered based on past year

mental illness status. Among adults aged 18 or older in

2021, those with SMI or AMI in the past year were more

likely than those without mental illness in the past year

to be past year users of illicit drugs (50.2 percent for SMI

and 39.7 percent for AMI vs. 17.7 percent for adults

aged 18 or older with no mental illness), past year users

of marijuana (41.6 and 33.8 percent vs. 15.4 percent), or

past year misusers of opioids (i.e., heroin users or misusers

of prescription pain relievers) (10.3 and 7.7 percent vs.

2.2 percent) (Figure 46 and Table A.23B). In addition,

adults aged 18 or older with SMI or AMI were more likely

than adults aged 18 or older with no mental illness in

the past year to be past month binge alcohol users (30.3

and 27.9 percent vs. 21.9 percent). Adults aged 18 or

older with SMI or AMI were more likely to use tobacco

products or to vape nicotine in the past month than adults

aged 18 or older with no mental illness in the past year

(37.3 and 32.6 percent vs. 20.9 percent). Except for alcohol

use in the past month among adults aged 18 or older with

SMI, adults aged 18 or older with AMI or SMI in the

past year also were more likely than those without mental

illness to be past year or past month users of the other

substances shown in Table A.23B.

Suicidal Thoughts and Behaviors among

Adults

Suicide is a leading cause of death and an important public

health problem in the United States.

It is a tragedy for

all involved—those who die by suicide and their families,

friends, neighbors, colleagues, and communities. Provisional

data from the National Vital Statistics System (NVSS)

indicated that in 2020, 45,855 people in the United States

died by suicide; this number was 3 percent less than the

47,511 deaths by suicide in 2019.

75,76

In 2020, suicide was

the 12th leading cause of death among people of all ages in

the United States. e age-adjusted rate of deaths by suicide

declined between 2018 and 2020. Nevertheless, suicide was

the second leading cause of death among people aged 10 to

34 and the ﬁfth leading cause among people aged 35 to 54.

However, people who die by suicide represent a fraction

of those who consider or attempt suicide.

Out of every

31 adults aged 18 or older in 2008 to 2011 in the United

States who attempted suicide in the past 12 months, there

was 1 death by suicide.

In 2021, 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 (serious thoughts

of suicide). Adults aged 18 or older also were asked whether

they made a plan to kill themselves (suicide plan) or tried

to kill themselves (suicide attempt) in the past 12 months,

regardless of whether they had serious thoughts of suicide in

that period. is information helps guide suicide prevention

programs and clinical intervention eﬀorts.

e following sections for adults aged 18 or older present the

overall estimates ﬁrst, then by age group. Estimates among

racial or ethnic groups are presented for selected measures.

In 2021, 12.3 million adults aged 18 or older (4.8 percent)

had serious thoughts of suicide in the past year,

3.5 million (1.4 percent) made suicide plans, and

1.7 million (0.7 percent) attempted suicide (Figure 47 and

Table A.24B). An estimated 1.3 million adults aged 18 or

older (0.5 percent) had serious thoughts of suicide, made

Figure46. Substance Use: Among Adults Aged 18 or Older; by

Mental Illness Status, 2021

39.7

33.8

7.7

27.9

32.6

50.2

41.6

10.3

30.3

37.3

17.7

15.4

2.2

21.9

20.9

0 10 20 30 40 50 60

Percent Using

Any Mental Illness (with or without Serious Mental Illness)

Serious Mental Illness

No Mental Illness

Illicit Drugs, Past Year

Marijuana, Past Year

Opioid Misuse, Past Year

Binge Alcohol,

Past Month

Tobacco Products or

Nicotine Vaping, Past Month

Difference between this estimate and the estimate for adults aged 18 or older without mental illness

is statistically significant at the .05 level.

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

Results from the 2021 National Survey on Drug Use and Health44 | December 2022

suicide plans, and also attempted suicide in the past year.

Additional highlights from Figure 47 include the following:

• Among the 12.3 million adults aged 18 or older who

had serious thoughts of suicide in the past year, most

(8.8 million) had serious thoughts of suicide only. An

additional 1.9 million adults aged 18 or older had serious

thoughts of suicide and made suicide plans, but they did

not attempt suicide in the past year.

• Among the 3.5 million adults aged 18 or older who made

suicide plans in the past year, 1.9 million adults aged

18 or older had serious thoughts of suicide but did not

attempt suicide and 1.3 million adults aged 18 or older

had serious thoughts of suicide and attempted suicide.

• Among the 1.7 million adults aged 18 or older who

attempted suicide in the past year, most had serious

thoughts of suicide, including 263,000 who had serious

thoughts of suicide but did not make suicide plans and

1.3 million who had serious thoughts of suicide and

made suicide plans. Only 67,000 adults aged 18 or older

attempted suicide in the past year without having serious

thoughts of suicide or making suicide plans.

Serious Thoughts of Suicide among Adults

Among adults aged 18 or older in 2021, 4.8 percent (or

12.3 million people) had serious thoughts of suicide in

the past year (Figures 47 and 48 and Table A.24B). e

percentage was highest among young adults aged 18 to 25

(13.0 percent or 4.4 million people), followed by adults aged

26 to 49 (5.4 percent or 5.5 million people), then by adults

aged 50 or older (2.0 percent or 2.4 million people).

By Race/Ethnicity

e percentage of adults aged 18 or older in 2021 who had

serious thoughts of suicide in the past year was higher among

American Indian or Alaska Native adults (8.5 percent)

than among Asian adults (2.6 percent) (Figure 49 and

Table B.21B). Multiracial adults (8.2 percent) also were

more likely to have had serious thoughts of suicide in the

past year compared with Black (4.6 percent) or Asian adults.

Figure48. Had Serious Thoughts of Suicide, Made a Suicide Plan,

or Attempted Suicide in the Past Year: Among Adults Aged 18 or

Older; 2021

4.8

1.4

0.7

13.0

4.9

2.7

5.4

1.5

0.7

2.0

0.3

0.1

Had Serious Thoughts

of Suicide

Made a Suicide Plan Attempted Suicide

Percent with Thought or Behavior in the Past Year

18 or Older 18 to 25 26 to 49 50 or Older

Age Category:

Figure47. Adults Aged 18 or Older with Serious Thoughts of Suicide, Suicide Plans, or Suicide

Attempts in the Past Year; 2021

12.3 Million Adults Had Serious

Thoughts of Suicide

Had Serious Thoughts

of Suicide Only

Made Suicide Plans Only (178K)

3.5 Million Adults

Made Suicide Plans

8.8

Million

12.7 Million Adults Aged 18 or Older Had Serious Thoughts of Suicide, Made Suicide Plans, or Attempted Suicide in the Past Year

Attempted Suicide Only (67K)

1.7 Million Adults

Attempted Suicide

1.3 Million

1.9 Million

Had Serious Thoughts of Suicide and

Attempted Suicide, but Did Not Make

Suicide Plans (263K)

Made Suicide Plans and Attempted Suicide, but

Did Not Have Serious Thoughts of Suicide (111K)

Had Serious Thoughts of Suicide

and Made Suicide Plans, but Did

Not Attempt Suicide

Had Serious Thoughts of Suicide, Made

Suicide Plans, and Attempted Suicide

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 45

Asian adults were less likely to have had serious thoughts of

suicide in the past year compared with adults in most other

racial or ethnic groups.

Suicide Plans among Adults

Among adults aged 18 or older in 2021, 1.4 percent (or

3.5 million people) made a suicide plan in the past year

(Figures 47 and 48 and Table A.24B). e percentage was

highest among young adults aged 18 to 25 (4.9 percent

or 1.6 million people), followed by adults aged 26 to 49

(1.5 percent or 1.5 million people), then by adults aged 50

or older (0.3 percent or 400,000 people).

By Race/Ethnicity

Percentages of adults aged 18 or older in 2021 who made a

suicide plan in the past year did not diﬀer among racial or

ethnic groups. Percentages of adults who made a suicide plan

in the past year ranged from 0.5 percent of Native Hawaiian

or Other Paciﬁc Islander adults to 2.4 percent of Multiracial

adults (Table B.21B).

Suicide Attempts among Adults

Among adults aged 18 or older in 2021, 0.7 percent (or

1.7 million people) attempted suicide in the past year

(Figures 47 and 48 and Table A.24B). e percentage was

highest among young adults aged 18 to 25 (2.7 percent

or 902,000 people), followed by adults aged 26 to 49

(0.7 percent or 672,000 people), then by adults aged 50 or

older (0.1 percent or 173,000 people).

By Race/Ethnicity

e percentage of adults aged 18 or older in 2021 who

attempted suicide in the past year was higher among

Hispanic adults (1.1 percent) than among White

(0.5 percent) or Asian adults (0.3 percent) (Table B.21B).

Black adults (0.9 percent) also were more likely to have

attempted suicide in the past year compared with Asian

adults.

Suicidal Thoughts and Behaviors among Adults

Because of COVID-19

During the COVID-19 pandemic, people with mental

illness may experience worsening mental health problems

and associated symptoms, such as thoughts of suicide. Other

people may develop new mental health problems, such as

depression, anxiety, or posttraumatic stress disorder, all of

which are associated with increased suicide risk.

Indeed,

levels of psychological distress among adults aged 18 or

older have been elevated from April 2020 at the start of

the COVID-19 pandemic into August 2021.

Elevated

symptoms of depression and anxiety have also persisted

into later stages of the COVID-19 pandemic in the United

States.

82,83,84

Questions were included in the 2021 NSDUH to better

understand the potential impact of the COVID-19

pandemic on suicidal thoughts and behaviors among adults

in the United States. If adult respondents aged 18 or older

reported that they thought seriously about trying to kill

themselves in the past 12 months, they were asked if they

had these suicidal thoughts because of the COVID-19

pandemic. Adult respondents aged 18 or older who reported

plans to kill themselves or who tried to kill themselves were

also asked if they made these plans or tried to kill themselves

because of the COVID-19 pandemic.

For the large majority of adults aged 18 or older in 2021

who had serious thoughts of suicide, made suicide plans, or

attempted suicide in the past year, there was no evidence that

they experienced these thoughts or behaviors because of the

COVID-19 pandemic. Among adults aged 18 or older in

2021 who had serious thoughts of suicide in the past year,

15.8 percent (or 1.9 million people) were estimated to have

had serious thoughts of suicide because of the COVID-19

pandemic (Figure 50 and Table A.25B). Among adults

aged 18 or older who made a suicide plan in the past year,

13.7 percent (or 483,000 people) were estimated to have

made a suicide plan because of the COVID-19 pandemic.

Among adults aged 18 or older who attempted suicide in the

Figure49. Had Serious Thoughts of Suicide in the Past Year:

Among Adults Aged 18 or Older; by Race/Ethnicity, 2021

4.8

8.5

8.2

7.4

4.9

4.6

2.6

Percent with Serious Thoughts of Suicide in Past Year

NH Asian

NH Black

Hispanic

NH White

NH NHOPI

NH Multiracial

NH AIAN

18 or Older

0 2015105

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

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

Results from the 2021 National Survey on Drug Use and Health46 | December 2022

past year, 16.0 percent (or 279,000 people) were estimated

to have attempted suicide because of the COVID-19

pandemic. However, these estimates could be conservative if

the COVID-19 pandemic indirectly contributed to suicidal

thoughts or behavior among adult respondents aged 18 or

older, but they did not attribute these thoughts or behaviors

directly to the COVID-19 pandemic.

Among adults aged 18 or older in 2021 who had serious

thoughts of suicide in the past year, the percentage whose

thoughts of suicide were because of the COVID-19

pandemic was lowest among adults aged 50 or older

(10.1 percent or 243,000 people) (Figure 50 and

Table A.25B). Percentages for serious thoughts of suicide

because of the COVID-19 pandemic were similar among

young adults aged 18 to 25 and adults aged 26 to 49 who

had serious thoughts of suicide in the past year (15.3 percent

or 667,000 young adults aged 18 to 25; 18.6 percent or

1.0 million adults aged 26 to 49).

Among adults aged 18 or older in 2021 who made a suicide

plan in the past year, similar percentages of young adults

aged 18 to 25 and adults aged 26 to 49 made a suicide

plan because of the COVID-19 pandemic (12.7 percent

or 209,000 young adults aged 18 to 25; 16.5 percent or

245,000 adults aged 26 to 49) (Figure 50 and Table A.25B).

Corresponding estimates for adults aged 50 or older who

made a suicide plan because of the COVID-19 pandemic

could not be calculated with suﬃcient precision.

Among young adults aged 18 to 25 in 2021 who made a

suicide attempt in the past year, about 1 in 10 (9.6 percent

or 87,000 people) attempted suicide because of the

COVID-19 pandemic (Figure 50 and Table A.25B).

Corresponding estimates for adults in other age groups who

attempted suicide because of the COVID-19 pandemic

could not be calculated with suﬃcient precision.

Suicidal Thoughts and Behaviors among

Adolescents

Trends in suicide attempts and deaths by suicide have

been increasing among adolescents.

85,86,87

ese trends in

suicidal behaviors among adolescents are major public health

concerns in the United States.

88,89

Vulnerable adolescent

populations exposed to adverse childhood experiences

(ACEs) are at particular risk of suicide and related

behaviors.

90,91,92

In the midst of the COVID-19 pandemic,

preliminary data suggest a rise in suicide-related emergency

department (ED) visits, particularly among adolescents.

During March to October 2020, the proportion of all

ED visits that were for mental health conditions increased

among adolescents aged 12 to 17 compared with the

proportion in 2019. Among adolescent females aged 12

to 17, the weekly average number of ED visits for mental

health conditions increased between corresponding weeks in

2019 and 2021 for depression, eating disorders, tic disorders,

and obsessive-compulsive disorder. In contrast, among

adolescent males aged 12 to 17, the weekly average number

of ED visits for mental health conditions decreased in 2020

and 2021. ese gender diﬀerences could reﬂect diﬀerences

in need, recognition, and help-seeking behavior.

Questions were included in the 2021 NSDUH to better

understand suicidal thoughts and behaviors among

adolescents aged 12 to 17. Adolescent respondents aged 12

to 17 were asked if they seriously thought about trying to

kill themselves, if they made plans to kill themselves, and

if they had tried to kill themselves in the past 12 months.

Unlike the questions for adults, the questions for adolescent

respondents aged 12 to 17 included the response options

“I’m not sure” and “I don’t want to answer.”

If adolescent respondents aged 12 to 17 reported that they

thought seriously about trying to kill themselves in the

past 12 months, they were asked if they had these suicidal

Figure50. Had Serious Thoughts of Suicide Because of the

COVID-19 Pandemic, Made a Suicide Plan Because of the COVID-19

Pandemic, or Attempted Suicide Because of the COVID-19

Pandemic in the Past Year: Among Adults Aged 18 or Older with

Respective Suicidal Thoughts and Behaviors in the Past Year; 2021

15.8

13.7

16.0

15.3

12.7

9.6

18.6

16.5

10.1

Had Serious Thoughts of

Suicide Because of the

COVID-19 Pandemic

Made a Suicide Plan

Because of the

COVID-19 Pandemic

Attempted Suicide

Because of the

COVID-19 Pandemic

Percent with Thought or Behavior Because of COVID-19

among Those with Thought or Behavior in the Past Year

18 or Older 18 to 25 26 to 49 50 or Older

Age Category:

* Low precision; no estimate reported.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 47

thoughts because of the COVID-19 pandemic. Adolescent

respondents aged 12 to 17 who reported plans to kill

themselves or who tried to kill themselves were also asked if

they had these plans or tried to kill themselves because of the

COVID-19 pandemic.

e following sections present the overall estimates for

adolescents aged 12 to 17. Estimates among racial or ethnic

groups are presented for selected measures.

In 2021, 3.3 million adolescents aged 12 to 17

(12.7 percent) had serious thoughts of suicide in the

past year, 1.5 million (5.9 percent) made suicide plans, and

892,000 (3.4 percent) attempted suicide (Figure 51 and

Table A.26B). An estimated 711,000 adolescents aged 12

to 17 (2.7 percent) had serious thoughts of suicide, made

suicide plans, and also attempted suicide in the past year.

Additional highlights from Figure 51 include the following:

• A slight majority of the 3.3 million adolescents aged 12 to

17 who had serious thoughts of suicide in the past year had

serious thoughts of suicide only (1.8 million adolescents

aged 12 to 17). An estimated 714,000 adolescents aged

12 to 17 had serious thoughts of suicide and made suicide

plans, but they did not attempt suicide in the past year.

• e majority of the 1.5 million adolescents aged 12 to 17

who made suicide plans in the past year either had serious

thoughts of suicide but did not attempt suicide (714,000

adolescents aged 12 to 17) or had serious thoughts of

suicide and attempted suicide (711,000 adolescents aged

12 to 17).

• Among the 892,000 adolescents aged 12 to 17 who

attempted suicide in the past year, most had serious

thoughts of suicide, including 89,000 who had serious

thoughts of suicide but did not make suicide plans and

711,000 who had serious thoughts of suicide and made

suicide plans. An estimated 58,000 adolescents aged 12

to 17 attempted suicide in the past year without having

serious thoughts of suicide or making suicide plans.

Suicidal Thoughts and Behaviors among Adolescents

for Any Reason

Among adolescents aged 12 to 17 in 2021, 12.7 percent (or

3.3 million people) had serious thoughts of suicide in the

past year (Figures 51 and 52 and Table A.26B). In addition,

adolescent respondents aged 12 to 17 who reported that

they were not sure or did not know if they had serious

thoughts of suicide correspond to a population estimate of

7.9 percent (or 2.0 million people). Adolescent respondents

aged 12 to 17 who did not want to report whether they

had serious thoughts of suicide correspond to a population

estimate of 9.0 percent (or 2.3 million people). erefore,

the estimate of 12.7 percent of adolescents aged 12 to 17

who had serious thoughts of suicide in the past year is likely

to be conservative. ere were adolescents aged 12 to 17

who were unsure about whether they had serious thoughts

of suicide or were unwilling to report whether they had these

thoughts. is information suggests that some adolescents

aged 12 to 17 could have had these thoughts but did not feel

comfortable disclosing that information.

Figure51. Youths Aged 12 to 17 with Serious Thoughts of Suicide, Suicide Plans, or Suicide Attempts

in the Past Year; 2021

3.3 Million Youths Had Serious

Thoughts of Suicide

Had Serious Thoughts

of Suicide Only

Made Suicide Plans Only (59K)

1.5 Million Youths

Made Suicide Plans

1.8

Million

3.4 Million Youths Aged 12 to 17 Had Serious Thoughts of Suicide, Made Suicide Plans, or Attempted Suicide in the Past Year

Attempted Suicide Only (58K)

892,000 Youths

Attempted Suicide

711K

714K

Made Suicide Plans and Attempted Suicide, but

Did Not Have Serious Thoughts of Suicide (34K)

Had Serious Thoughts of Suicide, Made

Suicide Plans, and Attempted Suicide

Had Serious Thoughts of Suicide and

Attempted Suicide, but Did Not Make

Suicide Plans (89K)

Had Serious Thoughts of Suicide

and Made Suicide Plans, but Did

Not Attempt Suicide

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

Results from the 2021 National Survey on Drug Use and Health48 | December 2022

An estimated 5.9 percent of adolescents aged 12 to 17 in

2021 (or 1.5 million people) made a suicide plan in the

past year (Figures 51 and 52 and Table A.26B). Adolescent

respondents aged 12 to 17 who reported that they were

not sure or did not know whether they made a suicide plan

correspond to a population estimate of 3.6 percent (or

941,000 people). Adolescent respondents aged 12 to 17

who did not want to report whether they made a suicide

plan correspond to a population estimate of 7.4 percent (or

1.9 million people). erefore, the estimate of 5.9 percent

of adolescents aged 12 to 17 who had made a suicide plan in

the past year is likely to be conservative.

An estimated 3.4 percent of adolescents aged 12 to 17

in 2021 (or 892,000 people) attempted suicide in the

past year (Figures 51 and 52 and Table A.26B). Adolescent

respondents aged 12 to 17 who reported that they were

not sure or did not know whether they attempted suicide

correspond to a population estimate of 1.9 percent (or

492,000 people). Adolescent respondents aged 12 to 17

who did not want to report whether they attempted suicide

correspond to a population estimate of 6.0 percent (or

1.6 million people). erefore, the estimate of 3.4 percent

of adolescents aged 12 to 17 who attempted suicide in the

past year is likely to be conservative.

By Race/Ethnicity

Percentages of adolescents aged 12 to 17 in 2021 who

had serious thoughts of suicide, made suicide plans, or

attempted suicide in the past year did not diﬀer among racial

or ethnic groups of adolescents. Percentages of adolescents

who had serious thoughts of suicide in the past year ranged

from 11.2 percent of Asian adolescents to 16.8 percent

of Multiracial adolescents (Table B.22B). Percentages of

adolescents who made a suicide plan in the past year ranged

from 4.2 percent of Multiracial adolescents to 7.0 percent

of Hispanic adolescents. Percentages of adolescents who

attempted suicide in the past year ranged from 2.7 percent

of Multiracial adolescents to 4.2 percent of Hispanic

adolescents.

Suicidal Thoughts and Behaviors among Adolescents

Because of COVID-19

As for adolescents aged 12 to 17 in 2021, the large majority

who had serious thoughts of suicide, made suicide plans,

or attempted suicide in the past year did not connect these

thoughts or behaviors to the COVID-19 pandemic. Among

adolescents aged 12 to 17 in 2021 who had serious thoughts

of suicide in the past year, 15.1 percent (or 484,000 people)

had serious thoughts of suicide because of the COVID-19

pandemic (Figure 53 and Table A.27B). Among adolescents

aged 12 to 17 who made a suicide plan in the past year,

12.0 percent (or 178,000 people) made a suicide plan

because of the COVID-19 pandemic. Among adolescents

aged 12 to 17 who attempted suicide in the past year,

8.4 percent (or 73,000 people) attempted suicide because of

the COVID-19 pandemic.

Figure53. Had Serious Thoughts of Suicide Because of the

COVID-19 Pandemic, Made a Suicide Plan Because of the COVID-19

Pandemic, or Attempted Suicide Because of the COVID-19

Pandemic in the Past Year: Among Youths Aged 12 to 17 with

Respective Suicidal Thoughts and Behaviors in the Past Year; 2021

15.1

12.0

8.4

Had Serious Thoughts of

Suicide Because of the

COVID-19 Pandemic

Made a Suicide Plan

Because of the

COVID-19 Pandemic

Attempted Suicide

Because of the

COVID-19 Pandemic

Percent with Thought or Behavior Because of COVID-19

among Those with Thought or Behavior in the Past Year

Figure52. Had Serious Thoughts of Suicide, Made a Suicide Plan,

or Attempted Suicide in the Past Year: Among Youths Aged 12 to

17; 2021

12.7

5.9

3.4

7.9

3.6

1.9

9.0

7.4

6.0

Had Serious Thoughts of

Suicide

Made a Suicide Plan Attempted Suicide

Percent with Thought or Behavior in the Past Year

Yes Not Sure/Don't Know Don't Want to Answer/Refuse

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 49

Substance Use Treatment in the Past Year

Substance use treatment is intended to help people address

problems associated with their use of alcohol or drugs not

counting tobacco use, including medical problems associated

with the use of alcohol or drugs.

e 2021 NSDUH

provided two principal measures related to substance use

treatment in the past year: (a) the need for substance use

treatment and (b) the receipt of substance use treatment.

e survey also collected information on the types of settings

where people received treatment and barriers associated with

people needing substance use treatment but not receiving it.

As noted in the Substance Use Disorders in the Past Year

section, respondents in 2021 who reported any past year

use of prescription pain relievers, tranquilizers, stimulants,

or sedatives in the past year (i.e., not just misuse) were

asked SUD questions about the respective prescription

drug category. However, respondents in 2021 who reported

lifetime use (but not misuse) of prescription drugs were

not asked questions about their receipt of substance use

treatment unless they also reported lifetime use of alcohol,

marijuana, cocaine, heroin, hallucinogens, inhalants, or

methamphetamine.

In addition, SAMHSA historically has classiﬁed people as

having a need for substance use treatment if they had an

illicit drug or alcohol use disorder in the past year or if they

received substance use treatment at a specialty facility

the past year (regardless of whether they had either of these

disorders).

97,98

Although respondents in 2021 who reported

the past year use but not misuse of prescription drugs were

asked the respective prescription drug use disorder questions,

respondents who reported only the use but not misuse of

prescription drugs (i.e., they did not report the lifetime use

of alcohol or illicit drugs) did not have the opportunity

to report whether they received substance use treatment

at a specialty facility in the past year. erefore, a measure

of the need for substance use treatment was created for

2021 according to the deﬁnition mentioned previously.

Speciﬁcally, respondents in 2021 were classiﬁed as needing

substance use treatment in the past year if they had an

illicit drug or alcohol use disorder in the past year or if they

received substance use treatment at a specialty facility in the

past year.

Before the COVID-19 pandemic, substance use treatment

was typically delivered in person. e COVID-19 pandemic

required changes in substance use treatment delivery to

include expansion of virtual treatments. To support this

need, regulations for opioid treatment have been relaxed

for take-home medications

and requirements for in-person

treatment as long as the COVID-19 public health emergency

(PHE) remains in eﬀect.

99,100,101

Although reimbursement

for some virtual behavioral health services was allowed

before 2020, reimbursement for additional virtual services

(including substance use treatment) was expanded during the

COVID-19 pandemic, including reimbursement for services

delivered over the phone (i.e., using only audio).

102

However,

the Centers for Medicare & Medicaid Services (CMS), which

pays opioid treatment programs for opioid use disorder

treatment services to people with Medicare Part B (medical

insurance), announced that after the end of the COVID-19

PHE, CMS will allow audio-only interaction (e.g., telephone

calls) in situations where audio/video communication is not

available to opioid treatment patients.

103

Virtual substance use treatment has been shown to be

eﬀective

104,105,106

and has been proposed as an alternative

to in-person services for some time, particularly in

instances where access to such services is limited.

107

Data

from SAMHSA’s Behavioral Health Treatment Services

Locator indicated that the availability of virtual substance

use treatment services increased by 143 percent between

January 2020 and January 2021. By January 2021, more

than half of substance use treatment facilities were oﬀering

virtual services.

108

In light of these changes to substance use treatment delivery

and reimbursement, the 2021 NSDUH questionnaire

included questions on the receipt of virtual substance use

treatment services. e Receipt of Virtual (Telehealth) Services

for Substance Use Treatment section presents estimates on the

receipt of virtual services for substance use treatment.

e following sections present the overall estimates ﬁrst,

then by age group. Estimates among racial or ethnic groups

are presented for selected measures.

Need for Substance Use Treatment

As noted previously, NSDUH respondents in 2021 were

classiﬁed as needing substance use treatment in the past year

if they had an illicit drug or alcohol use disorder or if they

received substance use treatment at a specialty facility in the

past year. Based on this deﬁnition, 15.6 percent of people

aged 12 or older in 2021 (or 43.7 million people) needed

substance use treatment in the past year (Figure 54 and

Table A.28AB). Consistent with data on the presence of

an illicit drug or alcohol use disorder in the past year, the

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

Results from the 2021 National Survey on Drug Use and Health50 | December 2022

percentage of people needing substance use treatment was

highest among young adults aged 18 to 25 (25.1 percent

or 8.4 million people), followed by adults aged 26 or older

(15.1 percent or 33.3 million people), then by adolescents

aged 12 to 17 (7.6 percent or 2.0 million people).

However, respondents who reported only the lifetime

use (but not misuse) of prescription psychotherapeutic

drugs were not asked questions to measure the receipt of

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

Although some of these lifetime users (but not misusers) of

only prescription psychotherapeutic drugs could have had

prescription drug use disorders in the past year (so that they

needed treatment for their use of prescription drugs), they

did not have an opportunity to report whether they received

services in response to their need. Consequently, respondents

whose only SUDs were for the use (but not misuse) of

prescription psychotherapeutic drugs were not counted in

the 2021 estimates of the need for substance use treatment.

erefore, these 2021 estimates for the need for substance

use treatment may be conservative.

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 needing

substance use treatment in the past year was higher

among American Indian or Alaska Native (28.7 percent)

or Multiracial people (25.5 percent) than among

Black (16.4 percent), White (15.9 percent), Hispanic

(15.0 percent), or Asian people (7.7 percent) (Figure 55 and

Table B.23B). Asian people were less likely to need substance

use treatment in the past year compared with people in all

other racial or ethnic groups including Native Hawaiian and

Other Paciﬁc Islander people (20.6 percent).

Receipt of Substance Use Treatment

NSDUH respondents who used alcohol or illicit drugs in

their lifetime were asked whether they ever received substance

use treatment, and those who received substance use

treatment in their lifetime were asked whether they received

treatment in the 12 months prior to the survey interview (i.e.,

in the past year). Of the respondents in 2021 who reported

lifetime use of alcohol or drugs, 7.6 percent (unweighted)

reported lifetime use of only prescription drugs but not

misuse (and they did not report lifetime use of alcohol,

marijuana, cocaine, heroin, hallucinogens, inhalants, or

methamphetamine). us, 92.4 percent of respondents who

were lifetime users of alcohol or drugs were also lifetime users

of alcohol or illicit drugs.

For this reason, not including

respondents who reported only the lifetime use (but not

misuse) of prescription psychotherapeutic drugs in the group

of respondents who were asked the substance use treatment

questions is assumed to have a minimal eﬀect on estimates for

the receipt of substance use treatment in the past year.

Receipt of any substance use treatment includes substance

use treatment received in the past year at any location, such

as a hospital (inpatient), rehabilitation facility (outpatient

or inpatient), mental health center, emergency room,

private doctor’s oﬃce, prison or jail, or self-help group

(e.g., Alcoholics Anonymous or Narcotics Anonymous).

In addition, respondents in 2021 who reported receiving

substance use treatment in the past year were asked if they

received professional counseling, medication, or treatment

in the past 12 months for their alcohol or drug use over the

Figure55. Need for Substance Use Treatment in the Past Year:

Among People Aged 12 or Older; by Race/Ethnicity, 2021

15.6

28.7

25.5

20.6

16.4

15.9

15.0

7.7

Percent Needing Substance Use Treatment in Past Year

NH Asian

Hispanic

NH White

NH Black

NH NHOPI

NH Multiracial

NH AIAN

12 or Older

0 40302010

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

Figure54. Need for Substance Use Treatment in the Past Year:

Among People Aged 12 or Older; 2021

15.6

7.6

25.1

15.1

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

Percent Needing Substance Use

Treatment in Past Year

Note: Need for Substance Use Treatment is defined as having an illicit drug or alcohol use disorder in

the pastyear or receiving substance use treatment at a specialty facility.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 51

phone, by email, or through video calling (i.e., virtual or

telehealth services).

e 2021 NSDUH also collected information on the receipt

of substance use treatment at a specialty facility. Substance

use treatment at a specialty facility is included in the

estimates of any substance use treatment because a subset of

the treatment locations was categorized as specialty facilities.

Receipt of substance use treatment at a specialty facility was

deﬁned as substance use treatment received by a respondent

at a hospital (only as an inpatient), a drug or alcohol

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

mental health center. Substance use treatment at a specialty

facility did not include virtual services or self-help groups.

Receipt of Any Substance Use Treatment

Among people aged 12 or older in 2021, 1.5 percent (or

4.1 million people) received any substance use treatment

in the past year (Table A.28AB). An estimated 2.0 million

people aged 12 or older received substance use treatment in

the past year at a self-help group, 1.9 million received virtual

services, 1.8 million received treatment at a rehabilitation

facility as an outpatient, 1.5 million received treatment

at a mental health center as an outpatient, 1.3 million

received treatment at a rehabilitation facility as an inpatient,

1.1 million received treatment at a private doctor’s oﬃce,

and 1.1 million received treatment at a hospital as an

inpatient (Figure 56 and Table A.29AB). Smaller numbers

of people received treatment in an emergency room or in a

prison or jail.

In 2021, 1.6 percent of adults aged 26 or older (or

3.6 million people) and 1.3 percent of young adults aged

18 to 25 (or 438,000 people) received any substance use

treatment in the past year (Table A.28AB). ese percentages

were higher than the corresponding percentage among

adolescents aged 12 to 17 (0.3 percent or 82,000 people).

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

received any substance use treatment in the past year

was lower among Hispanic (1.0 percent) or Asian people

(0.7 percent) than among American Indian or Alaska Native

people (5.3 percent) (Table B.23B). Hispanic people also

were less likely than White people (1.6 percent) to receive

any substance use treatment in the past year.

Receipt of Any Substance Use Treatment among People

with a Past Year Illicit Drug or Alcohol Use Disorder

Among people aged 12 or older in 2021 with a past year

illicit drug or alcohol use disorder, 6.3 percent (or

2.7 million people) received any substance use treatment

in the past year (Figure 57 and Table A.28AB). e

percentage of people with a past year illicit drug or alcohol

use disorder who received any substance use treatment

in the past year was highest for adults aged 26 or older

(7.1 percent or 2.3 million people). Percentages for the

receipt of any substance use treatment in the past year

were similar for adolescents aged 12 to 17 (3.5 percent)

and for young adults aged 18 to 25 (4.1 percent).

Corresponding numbers of adolescents aged 12 to 17 and

young adults aged 18 to 25 with a past year illicit drug

or alcohol use disorder who received any substance use

treatment in the past year were 68,000 adolescents and

339,000 young adults.

Figure57. Received Any Substance Use Treatment in the Past

Year: Among People Aged 12 or Older Who Had an Illicit Drug or

Alcohol Use Disorder in the Past Year; 2021

6.3

3.5

4.1

7.1

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

Percent Receiving Any Substance

Use Treatment in Past Year

Figure56. Locations Where Substance Use Treatment in the Past

Year Was Received: Among People Aged 12 or Older; 2021

2.0M

1.9M

1.8M

1.5M

1.3M

1.1M

571,000

354,000

0 0.5M 1.0M 1.5M 2.0M 2.5M

Self-Help Group

Virtual Services

Outpatient Rehabilitation

Outpatient Mental Health Center

Inpatient Rehabilitation

Hospital Inpatient

Private Doctor’s Ofﬁce

Emergency Room

Prison or Jail

Number of People

Note: Locations where people received substance use treatment are not mutually exclusive because

respondents could report that they received treatment in more than one location in the pastyear.

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

Results from the 2021 National Survey on Drug Use and Health52 | December 2022

By Race/Ethnicity

In 2021, there were no diﬀerences by racial or ethnic

group in the percentage of people aged 12 or older with a

past year illicit drug or alcohol use disorder who received any

substance use treatment in the past year.

Receipt of Substance Use Treatment at a Specialty Facility

Among people aged 12 or older in 2021, 1.1 percent (or

3.0 million people) received substance use treatment at a

specialty facility in the past year (Table A.28AB). Among

people aged 12 or older in 2021 who received any substance

use treatment in the past year, 71.8 percent received

substance use treatment at a specialty facility. Among adults

who received substance use treatment in the past year,

percentages for the receipt of substance use treatment at a

specialty facility did not diﬀer by age group (71.5 percent

of young adults aged 18 to 25 and 71.9 percent of adults

aged 26 or older). Estimates for the receipt of substance use

treatment at a specialty facility among adolescents aged 12

to 17 who received substance use treatment in the past year

could not be calculated with suﬃcient precision.

By Race/Ethnicity

e percentage of people aged 12 or older in 2021 who

received substance use treatment at a specialty facility in

the past year was lower among Asian people (0.3 percent)

than among Multiracial (2.1 percent), White (1.2 percent),

or Black people (1.2 percent) (Figure 58 and Table B.23B).

Hispanic people (0.6 percent) also were less likely than

White people to receive substance use treatment at a

specialty facility. Estimates for receipt of substance use

treatment at a specialty facility in the past year among

people aged 12 or older who received any substance use

treatment are not presented by racial or ethnic group. is is

because estimates for groups other than White could not be

calculated with suﬃcient precision.

Receipt of Substance Use Treatment at a Specialty Facility

among People Who Needed Substance Use Treatment

Among the 43.7 million people aged 12 or older in 2021

who needed substance use treatment in the past year,

6.8 percent (or 3.0 million people) received substance use

treatment at a specialty facility in the past year (Figure 59

and Table A.28AB).

109

Adults aged 26 or older who needed

substance use treatment in the past year were more likely

than adolescents aged 12 to 17 or young adults aged 18 to

25 to have received substance use treatment at a specialty

facility in the past year. Among the 33.3 million adults aged

26 or older in 2021 who needed substance use treatment in

the past year, 7.8 percent (or 2.6 million people) received

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

In comparison, among the 2.0 million adolescents aged 12

to 17 in 2021 who needed substance use treatment in the

past year, 2.8 percent (or 56,000 people) received substance

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

the 8.4 million young adults aged 18 to 25 in 2021 who

needed substance use treatment in the past year, 3.7 percent

(or 314,000 people) received substance use treatment at a

specialty facility in the past year.

Figure58. Received Substance Use Treatment at a Specialty

Facility in the Past Year: Among People Aged 12 or Older; by

Race/Ethnicity, 2021

1.1

3.7

2.1

1.2

0.6

0.3

Percent Receiving Substance Use Treatment at a Specialty Facility in Past Year

NH NHOPI

NH Asian

Hispanic

NH Black

NH White

NH Multiracial

NH AIAN

12 or Older

8642

* Low precision; no estimate reported.

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

Figure59. Received Substance Use Treatment at a Specialty

Facility in the Past Year: Among People Aged 12 or Older Who

Needed Substance Use Treatment in the Past Year; 2021

6.8

2.8

3.7

7.8

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

Percent Receiving Substance Use Treatment

at a Specialty Facility in Past Year

Note: Need for Substance Use Treatment is defined as having an illicit drug or alcohol use disorder in

the pastyear or receiving substance use treatment at a specialty facility.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 53

By Race/Ethnicity

In 2021, there were no diﬀerences among racial or ethnic

groups in the percentage of people aged 12 or older who

received substance use treatment at a specialty facility among

those who needed substance use treatment in the past year.

Percentages for the receipt of substance use treatment at a

specialty facility ranged from 3.9 percent of Asian people

who needed substance use treatment in the past year to

8.3 percent of Multiracial people who needed substance use

treatment in the past year (Table B.23B).

Receipt of Virtual (Telehealth) Services

for Substance Use Treatment

Among people aged 12 or older in 2021 who received any

substance use treatment in the past year, 46.2 percent (or

1.9 million people) received virtual (i.e., telehealth) services

for substance use treatment (Table A.30AB). Among adults

who received substance use treatment in the past year,

46.8 percent of those aged 26 or older (or 1.7 million people)

and 44.3 percent of young adults aged 18 to 25 (or 194,000

people) received virtual substance use services. Estimates for

the receipt of virtual services among adolescents aged 12 to

17 who received substance use treatment in the past year

could not be calculated with suﬃcient precision.

By Race/Ethnicity

Estimates by racial or ethnic group among people aged 12

or older in 2021 are not presented for the receipt of virtual

services among people who received substance use treatment

in the past year because estimates for groups other than

White could not be calculated with suﬃcient precision.

Perceived Need for Substance Use Treatment

NSDUH respondents were classiﬁed as having a perceived

need for substance use treatment (i.e., treatment for

problems related to their use of alcohol or illicit drugs)

if they indicated that they felt they needed substance

use treatment in the past year. Respondents may have a

perceived need for substance use treatment, regardless of

whether they had an illicit drug or alcohol use disorder in

the past year. In this report, estimates for the perceived need

for substance use treatment are discussed only among people

aged 12 or older who were classiﬁed as having an illicit drug

or alcohol use disorder in the past year

110

but did not receive

substance use treatment at a specialty facility.

97,98

Among the 40.7 million people aged 12 or older in 2021

who had an illicit drug or alcohol use disorder in the

past year and did not receive substance use treatment at

a specialty facility, 96.8 percent (or 39.5 million people)

did not feel they needed treatment, and 3.2 percent

(or 1.3 million people) felt that they needed treatment

(Figure 60 and Table A.31AB). An estimated 2.1 percent

of people with an illicit drug or alcohol use disorder

who did not receive treatment at a specialty facility (or

837,000 people) felt they needed treatment but did not

make an eﬀort to get treatment, and 1.1 percent (or 447,000

people) felt they needed treatment and made an eﬀort to get

treatment.

111

Among people in diﬀerent age groups in 2021

with a past year illicit drug or alcohol use disorder who did

not receive substance use treatment at a specialty facility,

98.6 percent of adolescents aged 12 to 17 (or 1.9 million

people), 97.9 percent of young adults aged 18 to 25 (or

7.9 million people), and 96.5 percent of adults aged 26

or older (or 29.7 million people) did not feel they needed

treatment.

By Race/Ethnicity

Among people aged 12 or older in 2021 who had an illicit

drug or alcohol use disorder in the past year and did not

receive substance use treatment at a specialty facility, similar

percentages of people across racial or ethnic groups did not

feel they needed substance use treatment. ese percentages

ranged from 96.7 percent of Black people to 99.4 percent of

American Indian or Alaska Native people (Table B.24B).

Figure60. Perceived Need for Substance Use Treatment: Among

People Aged 12 or Older with a Past Year Illicit Drug or Alcohol

Use Disorder Who Did Not Receive Substance Use Treatment at a

Specialty Facility in the Past Year; 2021

40.7 Million People with an Illicit Drug or Alcohol Use Disorder Who Did

Not Receive Substance Use Treatment at a Specialty Facility

39.5 Million

Did Not Feel They

Needed Treatment

(96.8%)

447,000 Felt They Needed

Treatment and Made an Effort

to Get Treatment

(1.1%)

837,000 Felt They Needed

Treatment and Did Not Make

an Effort to Get Treatment

(2.1%)

Note: People who had an illicit drug or alcohol use disorder were classified as needing substance use

treatment.

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

Results from the 2021 National Survey on Drug Use and Health54 | December 2022

Reasons for Not Receiving Substance Use Treatment

NSDUH respondents who did not receive substance use

treatment in the past 12 months but felt they needed

treatment were asked to report the reasons for not receiving

treatment.

112

As noted in the previous section, among

people aged 12 or older in 2021 who were classiﬁed as

having an illicit drug or alcohol use disorder and did not

receive substance use treatment at a specialty facility, only

3.2 percent perceived that they needed treatment.

111

For

people who perceived a need for treatment, information on

common reasons for not receiving substance use treatment

is important for identifying and addressing barriers to

treatment receipt.

Among people aged 12 or older in 2021 with a past year

illicit drug or alcohol use disorder who did not receive

treatment at a specialty facility and perceived a need for

treatment, the following were common reasons for not

receiving substance use treatment:

• not being ready to stop using (36.7 percent),

• having no health care coverage and not being able to

aﬀord the cost of treatment (24.9 percent),

• not knowing where to go for treatment (17.9 percent),

• not ﬁnding a program that oﬀered the type of treatment

they wanted (15.8 percent),

• thinking they could handle the problem without

treatment (15.0 percent), and

• being concerned that getting treatment might have a

negative eﬀect on their job (14.7 percent) (Table A.32B).

Medication-Assisted Treatment for Alcohol Use or

Opioid Misuse

e use of medications prescribed by a doctor to help people

reduce or stop their use of alcohol or opioids is known as

medication-assisted treatment (MAT). Speciﬁc drugs are

approved for use as MAT. MAT does not include the use

of medications that are prescribed to manage withdrawal

symptoms or administered to stop a drug overdose.

In 2021, NSDUH respondents aged 12 or older who

reported lifetime alcohol use and the receipt of substance use

treatment at any location in the past year were asked to report

whether a doctor or other health professional prescribed them

medication in the past year to help reduce or stop their use of

alcohol. Examples of medications shown to respondents that

are prescribed as MAT for alcohol use included acamprosate

(also known as Campral

), disulﬁram (also known as

Antabuse

), naltrexone pills (also known as ReVia

Trexan

), and injectable naltrexone (also known as Vivitrol

Questions on MAT for opioid misuse were asked of

respondents aged 12 or older who reported ever using heroin

or ever misusing prescription pain relievers and reported

receiving substance use treatment at any location in the

past year. ese respondents were asked whether a doctor or

other health professional prescribed them medication in the

past year to help reduce or stop their use of heroin, misuse

of prescription pain relievers, or both. Respondents also

were informed that MAT for opioid misuse was diﬀerent

from medications given to stop a drug overdose. Examples

of medications shown to respondents that are prescribed

as MAT for opioid misuse included buprenorphine or

buprenorphine-naloxone pills (also known as Suboxone

Zubsolv

, Bunavail

, or Subutex

), injectable buprenorphine

(also known as Sublocade

), buprenorphine implants (also

known as Probuphine

), methadone, naltrexone pills (also

known as ReVia

or Trexan

), and injectable naltrexone (also

known as Vivitrol

Medication-Assisted Treatment for Alcohol Use

In 2021, 2.6 million people aged 12 or older received

treatment at any location in the past year for their alcohol

use (regardless of whether they had a past year alcohol use

disorder). Among these people who received treatment in

the past year for their alcohol use, 15.1 percent (or 381,000

people) received MAT in the past year for their use of

alcohol (Table A.33AB). Among the 29.5 million people

aged 12 or older with a past year alcohol use disorder,

0.9 percent (or 265,000 people) received MAT in the

past year for their alcohol use.

Medication-Assisted Treatment for Opioid Misuse

In 2021, 1.2 million people aged 12 or older received

treatment at any location in the past year for their misuse of

opioids (regardless of whether they had a past year opioid

use disorder). Among these people who received treatment

in the past year for their opioid misuse, 72.9 percent (or

887,000 people) received MAT in the past year for opioid

misuse (Table A.34AB).

Estimates of opioid use disorder for 2021 were among people

who used heroin in the past year or used prescription pain

relievers for any reason in that period. A second estimate for

opioid use disorder among people who used heroin or misused

prescription pain relievers is shown in

Table A.14B. is

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 55

second estimate indicated that 0.9 percent of people aged 12

or older in 2021 had an opioid use disorder due to their use of

heroin or misuse of prescription pain relievers in the past year.

is second measure for opioid use disorder for heroin use

or prescription pain reliever misuse in the past year was used

for estimates of the receipt of MAT in the past year among

people with an opioid use disorder because the corresponding

MAT estimates were among people who received substance

use treatment in the past year and used heroin or misused

prescription pain relievers in their lifetime. Among the

2.5 million people aged 12 or older with a past year opioid use

disorder due to their use of heroin or misuse of prescription

pain relievers, 22.1 percent (or 533,000 people) received MAT

in the past year for opioid misuse (Table A.34AB).

Mental Health Service Use in the Past Year

e 2021 NSDUH included questions to estimate the use

of mental health services in the United States among the

adolescent and adult populations. In addition to estimating

the use of mental health services among the overall

adolescent and adult populations, these questions allowed

for the estimation of mental health service utilization among

adolescents aged 12 to 17 and adults aged 18 or older with

mental health issues (i.e., MDE, AMI, and SMI).

Similar to its eﬀect on substance use treatment, the

COVID-19 pandemic aﬀected the availability of services

as well as the modes of mental health service delivery. Even

before the COVID-19 pandemic, virtual (i.e., telehealth)

mental health care was proposed as an alternative to

in-person mental health services as a means to increase

availability and access, particularly in areas where services

are limited or there are barriers to treatment (e.g., issues in

transportation).

113,114

Mental health care delivered virtually

has been shown to be eﬀective.

115,116

Data from SAMHSA’s

Behavioral Health Treatment Services Locator indicated that

the availability of virtual mental health services increased

by 77 percent between January 2020 and January 2021. By

January 2021, more than two thirds of outpatient mental

health facilities were oﬀering virtual services.

108

In light of these changes to the delivery of mental health

services, questions were included in the 2021 NSDUH

questionnaire to assess the use of virtual mental health

services. e Receipt of Virtual (Telehealth) Mental Health

Services among Adolescents and Mental Health Service Use

among Adults subsections present estimates of the receipt of

virtual mental health services.

In sections that present estimates for adolescents aged 12 to

17, estimates are presented for all adolescents. Estimates are

not presented among racial or ethnic groups of adolescents

because the relatively smaller sample of adolescents aﬀects

the conclusions that can be reached for the receipt of mental

health services by racial or ethnic group. In sections that

present estimates for adults aged 18 or older, estimates are

ﬁrst presented by age group, followed where applicable

by estimates among racial or ethnic groups. For adults,

estimates among racial or ethnic groups are presented for

selected measures.

Treatment for Depression among Adolescents

Adolescents aged 12 to 17 who met the criteria for having

a past year MDE were asked whether they had received

treatment for their depression in the past year. Adolescents

aged 12 to 17 were classiﬁed as having received treatment

for their depression in the past year if they reported seeing

or talking to a health professional or taking prescription

medication for their depression in that period.

117

Among the 5.0 million adolescents aged 12 to 17 in 2021 who

had a past year MDE, 40.6 percent (or 2.0 million people)

received treatment for depression in the past year (Figure 61

and Table A.35B). Among the 3.7 million adolescents aged

12 to 17 in 2021 who had a past year MDE with severe

impairment, 44.2 percent (or 1.6 million people) received

treatment for depression in the past year. Stated another way,

however, most adolescents aged 12 to 17 in 2021 who had a

past year MDE or a past year MDE with severe impairment

did not receive treatment for depression in the past year.

Figure61. 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; 2021

40.6

44.2

59.4

55.8

100

MDE (with or without

Severe Impairment)

MDE with Severe Impairment

Percent Receiving

Depression Treatment in Past Year

Did Not Receive Treatment

Received Treatment

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

Results from the 2021 National Survey on Drug Use and Health56 | December 2022

Treatment for Depression among Adults

Adults aged 18 or older who met the criteria for having

a past year MDE were asked whether they had received

treatment for their depression in the past year. Recall that

adults aged 18 or older who had a past year MDE include

those who had an MDE with severe impairment and those

who did not have an MDE with severe impairment in the

past year. Adults aged 18 or older were classiﬁed as having

received treatment for their depression in the past year if

they reported seeing or talking to a health professional or

taking prescription medication for their depression in that

period.

117

As previously noted, missing data for measures of MDE and

MDE with severe impairment among adults aged 18 or older

were statistically imputed for 2021. However, missing data

were not statistically imputed for treatment for depression

among adults aged 18 or older. erefore, to reduce the

potential for bias, a break-oﬀ analysis weight was used for

estimates of treatment for depression among adults aged 18

or older.

Among the 21.0 million adults aged 18 or older in 2021

who had a past year MDE, 61.0 percent (or 12.6 million

people) received treatment for depression in the past year

(Figure 62 and Table A.36B). Among the 14.5 million adults

aged 18 or older in 2021 who had a past year MDE with

severe impairment, 64.8 percent (or 9.2 million people)

received treatment for depression in the past year.

e percentage of adults in 2021 with a past year MDE

(regardless of their level of impairment) who received

treatment for depression in the past year was lower among

young adults aged 18 to 25 (51.1 percent or 3.1 million

people out of 6.2 million people with an MDE) than among

adults aged 26 to 49 (63.5 percent or 6.0 million people out

of 9.5 million people with an MDE) or adults aged 50 or

older (68.2 percent or 3.5 million people out of 5.3 million

people with an MDE). Similarly, the percentage of adults

in 2021 with a past year MDE with severe impairment

who received treatment for depression in the past year was

lower among young adults aged 18 to 25 (56.7 percent or

2.5 million people out of 4.4 million people with an MDE

with severe impairment) than among adults aged 26 to 49

(66.6 percent or 4.3 million people out of 6.6 million people

with an MDE with severe impairment) or adults aged 50 or

older (71.8 percent or 2.4 million people out of 3.4 million

people with an MDE with severe impairment).

By Race/Ethnicity

Among adults aged 18 or older in 2021 with a past year

MDE (regardless of their level of impairment), Black adults

were less likely than White adults to receive treatment

for depression (51.0 vs. 64.0 percent) (Table B.25B). e

percentage of adults with a past year MDE who received

treatment for depression in the past year could not be

calculated with suﬃcient precision for American Indian

or Alaska Native, Asian, or Native Hawaiian or Other

Paciﬁc Islander adults.

Similarly, among adults who had

a past year MDE with severe impairment, Black adults

were less likely than White adults to receive treatment

for depression (52.5 vs. 68.6 percent). e percentage of

adults with a past year MDE with severe impairment who

received treatment for depression in the past year could not

be calculated with suﬃcient precision for American Indian

or Alaska Native, Asian, Multiracial, or Native Hawaiian or

Other Paciﬁc Islander adults.

Mental Health Service Use among Adolescents

In addition to asking adolescents aged 12 to 17 about

treatment for depression, the 2021 NSDUH included

questions that asked about their receipt of any service for

emotional or behavioral problems (i.e., not just depression)

not caused by substance use. e youth mental health

service utilization section of the interview asked adolescent

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,

118

(b) education settings (talked with a school social worker,

Figure62. Received Treatment in the Past Year for Depression:

Among Adults Aged 18 or Older with a Past Year Major

Depressive Episode (MDE) or MDE with Severe Impairment; 2021

61.0

64.8

51.1

56.7

63.5

66.6

68.2

71.8

MDE (with or without

Severe Impairment)

MDE with Severe Impairment

Percent Receiving

Depression Treatment in Past Year

18 or Older 18 to 25 26 to 49 50 or Older

Age Category:

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 57

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).

Also, adolescents aged 12 to 17 in 2021 were asked if

they had received professional counseling, medication, or

treatment in the past 12 months for their mental health,

emotions, or behavior over the phone, by email, or through

video calling (i.e., virtual or telehealth services). Virtual

mental health services were categorized separately from the

mental health settings described in the preceding paragraph.

Receipt of Mental Health Services in Specialty and

Nonspecialty Settings among Adolescents

In 2021, 18.3 percent of adolescents aged 12 to 17 (or

4.7 million people) received mental health services in a

specialty setting, including 17.5 percent (or 4.5 million

people) who received mental health treatment in an

outpatient setting and 2.5 percent (or 629,000 people) who

received mental health treatment in an inpatient setting

(Figure 63 and Table A.37B).

An estimated 14.7 percent of adolescents aged 12 to 17

(or 3.7 million people) received mental health services in a

nonspecialty setting, including the following percentages:

• 11.9 percent (or 3.0 million people) who received mental

health services in an educational setting (such as from

a school social worker, school psychologist, or school

counselor, or as part of a special school or program),

• 3.8 percent (or 977,000 people) who received mental

health services in a general medicine setting,

• 0.4 percent (or 96,000 people) who received mental

health services in a child welfare setting, and

• 0.1 percent (or 30,000 people) who received mental

health services in a juvenile justice setting.

An estimated 7.9 percent of adolescents aged 12 to 17

received mental health services in a combination of specialty

and nonspecialty settings. ese adolescents who received

services in specialty and nonspecialty settings are included

in the 18.3 percent of adolescents aged 12 to 17 who

received services in specialty settings and in the 14.7 percent

of adolescents aged 12 to 17 who received services in

nonspecialty settings.

Receipt of Virtual (Telehealth) Mental Health

Services among Adolescents

In 2021, 10.6 percent of adolescents aged 12 to 17 received

mental health services as virtual (i.e., telehealth) services

(Table A.37B). is percentage corresponds to 2.7 million

adolescents aged 12 to 17.

Mental Health Service Use among Adults

Adult respondents aged 18 or older were asked whether

they received treatment or counseling for any problem with

emotions, nerves, or mental health in the past year in any

inpatient or outpatient setting or if they used prescription

medication in the past year for a mental or emotional

condition. Adults aged 18 or older in 2021 also were asked

if they received professional counseling, medication, or

treatment for their mental health, emotions, or behavior over

the phone, by email, or through video calling (i.e., virtual or

telehealth services) in the past 12 months.

All adult respondents aged 18 or older (i.e., not just those

with mental illness) were asked these questions about their

use of mental health services. Respondents were asked

not to include treatment for their use of alcohol or illicit

drugs. Unlike the previously discussed questions about

treatment for depression, general questions about the

receipt of treatment or counseling for mental health issues

among adults did not ask about treatment for a particular

mental disorder. Consequently, references in this section to

treatment or counseling for any problem with emotions,

Figure63. Sources of Mental Health Services in the Past Year:

Among Youths Aged 12 to 17; 2021

17.5

2.5

11.9

3.8

0.4

0.1

10.6

0 5 10 15 20

Outpatient Setting

Inpatient or Residential Setting

Education Setting

General Medical Setting

Child Welfare Setting

Juvenile Justice Setting

Virtual Services

Percent Receiving Mental Health Services in Past Year

Note: Sources of Mental Health Services are not mutually exclusive because respondents could report

that they received mental health services in more than one setting in the pastyear.

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

Results from the 2021 National Survey on Drug Use and Health58 | December 2022

nerves, or mental health are described broadly as “mental

health services” or “mental health care.”

In 2021, 18.8 percent of adults aged 18 or older (or

46.5 million people) received any of the following mental

health services in the past year: inpatient or outpatient

mental health services, prescription medication for a mental

health issue, or virtual (i.e., telehealth) services (Figure 64

and Table A.38B). An estimated 13.9 percent of adults

aged 18 or older (or 34.4 million people) took prescription

medication, 11.3 percent (or 28.1 million people) received

virtual services, 8.1 percent (or 20.1 million people) received

outpatient services, and 1.0 percent (or 2.5 million people)

received inpatient services. Adults aged 50 or older were less

likely than young adults aged 18 to 25 or adults aged 26 to

49 to have received any of these mental health services in the

past year. Speciﬁcally, 15.3 percent of adults aged 50 or older

(or 17.7 million people) received any of these mental health

services compared with 22.5 percent of young adults aged 18

to 25 (or 7.3 million people) and 21.6 percent of adults aged

26 to 49 (or 21.5 million people).

Adults aged 50 or older in 2021 were less likely than young

adults aged 18 to 25 or adults aged 26 to 49 to have taken

prescription medication for a mental health issue or to

have received virtual mental health services in the past year

(Table A.38B). An estimated 12.4 percent of adults aged

50 or older (or 14.3 million people) took prescription

medication in the past year compared with 14.5 percent

of young adults aged 18 to 25 (or 4.8 million people)

and 15.4 percent of adults aged 26 to 49 (or 15.4 million

people). Among adults aged 50 or older, 7.5 percent (or

8.7 million people) received virtual mental health services in

the past year compared with 15.5 percent of young adults

aged 18 to 25 (or 5.1 million people) and 14.4 percent of

adults aged 26 to 49 (or 14.3 million people).

e percentage of adults aged 18 or older in 2021 who

received outpatient mental health services in the past year

was highest among young adults aged 18 to 25 (11.3 percent

or 3.7 million people), followed by adults aged 26 to 49

(9.5 percent or 9.4 million people), then by adults aged 50

or older (6.1 percent or 7.0 million people) (Table A.38B).

e percentage of adults who received inpatient mental

health services in the past year also was highest among

young adults aged 18 to 25 (1.6 percent or 539,000 people),

followed by adults aged 26 to 49 (1.1 percent or 1.1 million

people), then by adults aged 50 or older (0.7 percent or

857,000 people).

By Race/Ethnicity

Among adults aged 18 or older in 2021, Multiracial

(25.8 percent) or White adults (22.2 percent) were more

likely than Black (13.5 percent), Hispanic (12.9 percent), or

Asian adults (8.3 percent) to receive any of these four types

of mental health services in the past year (Table B.26B).

Asian adults were less likely to have received any of these

mental health services in the past year compared with adults

in most other racial or ethnic groups.

Adults who were Multiracial or White also were more likely

than adults who were Black, Hispanic, or Asian to receive

speciﬁc types of mental health services in the past year,

except for inpatient mental health services (Table B.26B).

For the receipt of virtual mental health services in the

past year, Multiracial (17.3 percent) or White adults

(12.8 percent) also were more likely than American Indian

or Alaska Native adults (7.7 percent) to receive this type of

service. However, Black adults were more likely than White

adults to receive inpatient mental health services in the

past year (1.7 vs. 0.8 percent). In addition, Asian adults were

less likely than adults in most other racial or ethnic groups

to receive speciﬁc mental health services in the past year,

including inpatient mental health services.

Mental Health Service Use among Adults with AMI

Among the 57.8 million adults aged 18 or older in 2021

with AMI in the past year, 47.2 percent (or 26.5 million

people) received mental health services in the past year (i.e.,

inpatient or outpatient services, prescription medication

for a mental health issue, or virtual services) (Figure 65

and Table A.39B). An estimated 3.1 percent of adults aged

Figure64. Type of Mental Health Services Received in the Past

Year: Among Adults Aged 18 or Older; 2021

18.8

1.0

8.1

13.9

11.3

0 5 10 15 20

Mental Health Services

Inpatient

Outpatient

Prescription Medication

Virtual Services

Percent Receiving Mental Health Services in Past Year

Note: Mental Health Service Types are not mutually exclusive because respondents could report that

they received more than one type of mental health service in the pastyear.

Note: Mental Health Services include any combination of inpatient or outpatient services, receipt of

prescription medication, or virtual services.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 59

18 or older with AMI (or 1.8 million people) received

inpatient services, 24.2 percent (or 13.4 million people)

received outpatient services, 36.1 percent (or 20.3 million

people) took prescription medication, and 31.6 percent

(or 17.8 million people) received virtual (i.e., telehealth)

services. e percentages of adults aged 18 or older with

AMI who received any of these services in the past year

were similar across age groups (44.6 percent of young adults

aged 18 to 25, 48.1 percent of adults aged 26 to 49, and

47.4 percent of adults aged 50 or older). ese percentages

correspond to 4.9 million young adults aged 18 to 25,

13.4 million adults aged 26 to 49, and 8.2 million adults

aged 50 or older with AMI who received any of these

services in the past year.

Consistent with the pattern for the receipt of any of these

four types of mental health services, percentages of adults

aged 18 or older in 2021 with AMI who received inpatient

or outpatient mental health services in the past year did not

diﬀer signiﬁcantly by age group (Table A.39B). However,

adults aged 50 or older with AMI were less likely than

young adults aged 18 to 25 or adults aged 26 to 49 with

AMI to have received virtual mental health services in the

past year. Speciﬁcally, 27.1 percent of adults aged 50 or older

with AMI (or 4.7 million people) received virtual mental

health services in the past year compared with 32.2 percent

of young adults aged 18 to 25 (or 3.6 million people)

and 34.2 percent of adults aged 26 to 49 with AMI (or

9.5 million people).

In addition, young adults aged 18 to 25 with AMI were less

likely than adults aged 26 to 49 or adults aged 50 or older

with AMI to have taken prescription medication to treat

a mental health condition in the past year (Table A.39B).

Speciﬁcally, 30.6 percent of young adults aged 18 to 25 with

AMI (or 3.4 million people) took prescription medication

to treat a mental health condition in the past year compared

with 36.3 percent of adults aged 26 to 49 (or 10.1 million

people) and 39.1 percent of adults aged 50 or older with

AMI (or 6.8 million people).

By Race/Ethnicity

Among adults aged 18 or older in 2021 who had AMI in

the past year, White (52.4 percent) or Multiracial adults

(52.2 percent) were more likely than Black (39.4 percent),

Hispanic (36.1 percent), or Asian adults (25.4 percent)

to have received any of these mental health services in the

past year (Figure 66 and Table B.27B). Asian adults with

AMI were less likely to receive mental health services in the

past year compared with Black or Hispanic adults with AMI.

When compared with adults with AMI in many other

racial or ethnic groups, White adults were more likely

to have received speciﬁc mental health services in the

past year. White adults with AMI were more likely than

Black, Hispanic, or Asian adults with AMI to have taken

prescription medication in the past year for a mental health

Figure66. Mental Health Services Received in the Past Year:

Among Adults Aged 18 or Older with Any Mental Illness in the

Past Year; by Race/Ethnicity, 2021

47.2

52.4

52.2

39.4

36.1

25.4

* *

Percent Receiving Mental Health Services in Past Year

NH NHOPI

NH AIAN

NH Asian

Hispanic

NH Black

NH Multiracial

NH White

18 or Older

60453015

* Low precision; no estimate reported.

AIAN = American Indian or Alaska Native; Black = Black or African American; Hispanic = Hispanic or

Latino; NH = Not Hispanic or Latino; NHOPI = Native Hawaiian or Other Pacific Islander.

Note: Error bars were calculated as 99percent confidence intervals. Wider error bars indicate less

precise estimates. Large apparent differences between groups may not be statistically significant.

Note: Mental Health Services include any combination of inpatient or outpatient services, receipt of

prescription medication, or virtual services.

Figure65. Mental Health Services Received in the Past Year:

Among Adults Aged 18 or Older with Any Mental Illness or

Serious Mental Illness in the Past Year; 2021

47.2

65.4

44.6

57.9

48.1

67.0

47.4

71.0

Any Mental Illness (with or without

Serious Mental Illness)

Serious Mental Illness

Percent Receiving

Mental Health Services in Past Year

18 or Older 18 to 25 26 to 49 50 or Older

Age Category:

Note: Mental Health Services include any combination of inpatient or outpatient services, receipt of

prescription medication, or virtual services.

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

Results from the 2021 National Survey on Drug Use and Health60 | December 2022

issue or to have received virtual mental health services in the

past year (Table B.27B). In addition, White adults with AMI

were more likely than Hispanic or Asian adults with AMI

to have received outpatient mental health services in the

past year. However, the percentages of adults with AMI who

received inpatient mental health services in the past year did

not diﬀer signiﬁcantly among racial or ethnic groups.

Mental Health Service Use among Adults with SMI

Among the 14.1 million adults aged 18 or older in 2021

with SMI in the past year, 65.4 percent (or 9.1 million

people) received mental health services in the past year (i.e.,

inpatient or outpatient services, prescription medication

for a mental health issue, or virtual services) (Figure 65 and

Table A.40B). An estimated 6.9 percent of adults aged 18

or older with SMI (or 966,000 people) received inpatient

services, 40.5 percent (or 5.5 million people) received

outpatient services, 53.2 percent (or 7.4 million people) took

prescription medication, and 49.7 percent (or 6.9 million

people) received virtual (i.e., telehealth) services.

At least half of adults with SMI in each age group in 2021

received mental health services in the past year. However,

young adults aged 18 to 25 with SMI in the past year were

less likely than adults aged 26 to 49 or adults aged 50

or older with SMI to receive any of these services in the

past year. Speciﬁcally, 57.9 percent of young adults aged

18 to 25 with SMI (or 2.2 million people) received any

of these mental health services in the past year compared

with 67.0 percent of adults aged 26 to 49 with SMI (or

4.8 million people) and 71.0 percent of adults aged 50 or

older with SMI (or 2.1 million people).

Except for taking prescription medication, diﬀerences by

age group in 2021 for the receipt of speciﬁc mental health

services in the past year were not statistically signiﬁcant

for adults with SMI. However, young adults aged 18 to 25

with SMI were less likely than adults aged 26 to 49 with

SMI or adults aged 50 or older with SMI to have taken

prescription medication to treat a mental health condition

in the past year. Speciﬁcally, 43.8 percent of young adults

aged 18 to 25 with SMI (or 1.7 million people) took

prescription medication to treat a mental health condition in

the past year compared with 54.8 percent of adults aged 26

to 49 with SMI (or 3.9 million people) and 61.1 percent of

adults aged 50 or older with SMI (or 1.8 million people).

By Race/Ethnicity

Among adults aged 18 or older in 2021 with SMI in the

past year, there were no racial or ethnic diﬀerences in

the receipt of any of these mental health services in the

past year or for the receipt of inpatient, outpatient, or

virtual mental health services in the past year. However,

Hispanic adults with SMI were less likely to have taken

prescription medication for a mental health issue in the

past year compared with White adults with SMI (41.8 vs.

58.3 percent) (Table B.28B).

Perceived Unmet Need for Mental Health Services

among Adults with Mental Illness

is section discusses estimates of perceived unmet need for

mental health services among adults aged 18 or older with

AMI or SMI in the past year. e section also discusses the

reasons adults aged 18 or older with AMI or SMI did not

receive these services in the past year if they had a perceived

unmet need.

Perceived unmet need for mental health services among

adults is estimated from a question that asked all adults

aged 18 or older whether there was any time in the

past 12 months when they thought they needed treatment

or counseling for mental health issues but did not receive

services. However, this section presents estimates of

perceived unmet need for mental health services among

adults aged 18 or older with AMI or SMI, regardless

of whether they received mental health services in the

past 12 months. If adult NSDUH respondents—including

those with AMI or SMI—perceived an unmet need for

mental health services but also reported that they received

mental health services in the past year, the timing of the

unmet need cannot be determined from respondents’

answers. For some respondents, the unmet need could refer

to a need they felt before they received services. For other

respondents, the unmet need could refer to the need for

additional services they did not receive.

Perceived Unmet Need for Mental Health

Services among Adults with AMI

Among the 57.8 million adults aged 18 or older in 2021

with AMI in the past year, 27.6 percent (or 15.5 million

people) perceived an unmet need for mental health services

in the past year (Figure 67 and Tables A.41A and A.41B).

e percentage of adults in 2021 with AMI in the past year

who had a perceived unmet need for mental health services

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 61

was highest among young adults aged 18 to 25 (43.9 percent

or 4.8 million people), followed by adults aged 26 to 49

(29.5 percent or 8.2 million people), then by adults aged 50

or older (14.2 percent or 2.5 million people) (Figure 67 and

Tables A.41A and A.41B).

Among the 15.5 million adults with AMI and a perceived

unmet need for mental health services, 46.1 percent (or

7.1 million people) did not receive any mental health

services in the past year (Table A.42B). Young adults aged

18 to 25 and adults aged 26 to 49 with AMI and a perceived

unmet need for mental health services in the past year were

more likely than their counterparts aged 50 or older not

to have received any of these mental health services in the

past year. Speciﬁcally, 49.6 percent of young adults aged 18

to 25 (or 2.4 million people) and 47.0 percent of adults aged

26 to 49 (or 3.9 million people) with AMI and a perceived

unmet need did not receive mental health services in the

past year. In comparison, 36.4 percent of adults aged 50

or older with AMI and a perceived unmet need for mental

health services (or 894,000 people) did not receive any of

these mental health services in the past year.

Perceived Unmet Need for Mental Health

Services among Adults with SMI

Among the 14.1 million adults aged 18 or older in 2021

with SMI in the past year, 51.5 percent (or 7.2 million

people) perceived an unmet need for mental health services

in the past year (Figure 67 and Tables A.41A and A.41B).

e percentage of adults in 2021 with SMI in the past year

who had a perceived unmet need for mental health services

was highest among young adults aged 18 to 25 (65.1 percent

or 2.5 million people) compared with percentages among

adults aged 26 to 49 (49.1 percent or 3.5 million people)

and adults aged 50 or older (40.0 percent or 1.2 million

people) (Figure 67 and Tables A.41A and A.41B). us,

nearly two thirds of young adults aged 18 to 25 and nearly

half of adults aged 26 to 49 with SMI had a perceived unmet

need for mental health services.

Among the 7.2 million adults with SMI and a perceived

unmet need for mental health services, 39.7 percent (or

2.8 million people) did not receive any mental health

services in the past year (Table A.42B). Similar percentages

of young adults aged 18 to 25 and adults aged 26 to 49 with

SMI and a perceived unmet need for mental health services

in the past year did not receive any mental health services

in the past year (44.8 percent of young adults aged 18 to 25

and 38.5 percent of adults aged 26 to 49). ese percentages

of adults with SMI and a perceived unmet need for mental

health services correspond to 1.1 million young adults aged

18 to 25 and 1.4 million adults aged 26 to 49 who did not

receive services. Estimates for adults aged 50 or older with

SMI and a perceived unmet need for mental health services

in the past year who did not receive any mental health

services could not be calculated with suﬃcient precision.

Reasons for Not Receiving Mental Health Services among

Adults with Mental Illness and a Perceived Unmet Need

Among adults aged 18 or older in 2021 who had mental

illness in the past year and 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 they could not aﬀord the cost of care (47.8 percent for

these adults aged 18 or older with AMI and 54.5 percent

for these adults aged 18 or older with SMI) (Table A.43B).

Estimates are not compared between adults aged 18 or older

with AMI and those with SMI because all adults aged 18 or

older with SMI also have AMI. Other common reasons for

not receiving services included not knowing where to go for

services (38.3 percent for these adults aged 18 or older with

AMI and 38.9 percent for these adults aged 18 or older with

SMI) and believing they could handle the problem without

treatment (31.4 percent for these adults aged 18 or older

with AMI and 36.1 percent for these adults aged 18 or older

with SMI).

Figure67. Perceived Unmet Need for Mental Health Services in

the Past Year: Among Adults Aged 18 or Older with Any Mental

Illness or Serious Mental Illness in the Past Year; 2021

27.6

51.5

43.9

65.1

29.5

49.1

14.2

40.0

Any Mental Illness (with or without

Serious Mental Illness)

Serious Mental Illness

Percent with Perceived Unmet Need

for Mental Health Services in Past Year

18 or Older 18 to 25 26 to 49 50 or Older

Age Category:

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

Results from the 2021 National Survey on Drug Use and Health62 | December 2022

Receipt of Services for Co-Occurring Mental

Health Issues and Illicit Drug or Alcohol Use

Disorder

e relationship between SUDs and mental disorders is

known to be bidirectional. e presence of a mental disorder

may contribute to the development or exacerbation of an

SUD. Likewise, the presence of an SUD may contribute to

the development or exacerbation of a mental disorder. e

combined presence of SUDs and mental disorders (hereafter

referred to as co-occurring disorders) results in more

profound functional impairment; worse treatment outcomes;

higher morbidity and mortality; increased treatment costs;

and higher risk for homelessness, incarceration, and suicide

than if people had only one of these disorders.

119,120,121

Current treatment guidelines recommend that people

with co-occurring disorders receive treatment for both

disorders.

122,123,124

is section presents estimates of the receipt of services

among adolescents aged 12 to 17 and adults aged 18 or

older with co-occurring mental health issues and illicit drug

or alcohol use disorder. Estimates are presented for the

receipt of services among people with co-occurring mental

health issues and illicit drug or alcohol use disorder because

respondents in 2021 who reported lifetime use of alcohol

or illicit drugs (i.e., marijuana, cocaine [including crack],

heroin, hallucinogens, inhalants, or methamphetamine

or the lifetime misuse of prescription psychotherapeutic

drugs) were asked questions about their receipt of

substance use treatment. Estimates for the receipt of virtual

(i.e., telehealth) services among adolescents aged 12 to 17

and adults aged 18 or older with co-occurring mental health

issues and illicit drug or alcohol use disorder are presented

separately from estimates for the receipt of other services

because virtual services were considered to be distinct from

substance use treatment at a specialty facility and the receipt

of other mental health services described in this report.

Estimates are presented overall and by age group.

Receipt of Services among Adolescents with a

Co-Occurring MDE and an Illicit Drug or Alcohol Use

Disorder

Among the 842,000 adolescents aged 12 to 17 in 2021

with a co-occurring MDE and an illicit drug or alcohol use

disorder in the past year, 56.1 percent (or 471,000 people)

received either substance use treatment at a specialty facility

or mental health services in the past year; 52.4 percent (or

440,000 people) received only mental health services, and

3.6 percent (or 31,000 people) received both substance use

treatment at a specialty facility and mental health services

(Figure 68 and Table A.44B).

Most of the 471,000 adolescents aged 12 to 17 with a

co-occurring MDE and an illicit drug or alcohol use disorder

who received either substance use treatment at a specialty

facility or mental health services in the past year received

only mental health services (93.5 percent) (Figure 68). An

estimated 6.5 percent of these adolescents aged 12 to 17

received both services.

Receipt of Services among Adults with Co-Occurring

AMI and an Illicit Drug or Alcohol Use Disorder

Among the 17.9 million adults aged 18 or older in 2021

with co-occurring AMI and an illicit drug or alcohol use

Figure68. Receipt of Substance Use Treatment at a Specialty Facility and Mental Health

Services in the Past Year: Among Youths Aged 12 to 17 with Past Year Illicit Drug or Alcohol

Use Disorder and Major Depressive Episode; 2021

Both SU Tx and

MH Services

31,000 People

(6.5%)

MH Services,

but No SU Tx

440,000 People

(93.5%)

SU Tx, but No MH

Services*

SU Tx or

MH Services

471,000 People

(56.1%)

No Treatment

368,000 People

(43.9%)

* Low precision; no estimate reported.

MH = mental health; SU Tx = substance use treatment.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 63

disorder in the past year, 52.5 percent (or 9.0 million

people) received either substance use treatment at a specialty

facility or mental health services in the past year, and

47.5 percent (or 8.2 million people) received neither service

(Figure 69 and Table A.45B). Stated another way, nearly

half of adults aged 18 or older with co-occurring AMI and

an illicit drug or alcohol use disorder in the past year did

not receive substance use treatment at a specialty facility or

mental health services for either condition. An estimated

44.1 percent of adults aged 18 or older with co-occurring

AMI and an illicit drug or alcohol use disorder in the

past year (or 7.6 million people) received only mental

health services, 1.4 percent (or 251,000 people) received

only substance use treatment at a specialty facility, and

6.6 percent (or 1.2 million people) received both substance

use treatment at a specialty facility and mental health

services.

Among adults aged 18 or older with co-occurring AMI and

an illicit drug or alcohol use disorder who received either

substance use treatment at a specialty facility or mental

health services in the past year, most received only mental

health services. Speciﬁcally, among the 9.0 million adults

aged 18 or older with co-occurring AMI and an illicit drug

or alcohol use disorder who received either substance use

treatment at a specialty facility or mental health services

in the past year, 84.0 percent received only mental health

services, 2.8 percent received only substance use treatment

at a specialty facility, and 13.0 percent received both services

(Figure 69).

Among adults aged 18 or older in 2021 with co-occurring

AMI and an illicit drug or alcohol use disorder in the

past year, young adults aged 18 to 25 were less likely than

adults aged 26 to 49 or adults aged 50 or older to have

received either substance use treatment at a specialty facility

or mental health services in the past year (Table A.45B).

Speciﬁcally, 46.1 percent of young adults aged 18 to 25

with co-occurring AMI and an illicit drug or alcohol use

disorder in the past year (or 2.0 million people) received

either substance use treatment at a specialty facility or

mental health services in the past year compared with

52.6 percent of adults aged 26 to 49 (or 5.0 million people)

and 60.0 percent of adults aged 50 or older (or 2.1 million

people) with co-occurring AMI and an illicit drug or alcohol

use disorder in the past year.

Receipt of Services among Adults with Co-Occurring

SMI and an Illicit Drug or Alcohol Use Disorder

Among the 5.8 million adults aged 18 or older in 2021 with

co-occurring SMI and an illicit drug or alcohol use disorder

in the past year, 66.9 percent (or 3.9 million people) received

either substance use treatment at a specialty facility or

mental health services in the past year, and 33.1 percent (or

1.9 million people) received neither service (Figure 70 and

Table A.45B). Stated another way, about one third of adults

aged 18 or older with co-occurring SMI and an illicit drug

or alcohol use disorder in the past year (representing nearly

2.0 million people) did not receive substance use treatment

at a specialty facility or mental health services for either

condition. An estimated 54.6 percent of adults aged 18 or

older with co-occurring SMI and an illicit drug or alcohol

use disorder in the past year (or 3.1 million people) received

only mental health services, 1.4 percent (or 84,000 people)

received only substance use treatment at a specialty facility,

Figure69. Receipt of Substance Use Treatment at a Specialty Facility and Mental Health

Services in the Past Year: Among Adults Aged 18 or Older with Past Year Illicit Drug or Alcohol

Use Disorder and Any Mental Illness; 2021

SU Tx or

MH Services

9.0 Million Adults

(52.5%)

No Treatment

8.2 Million Adults

(47.5%)

Both SU Tx and

MH Services

1.2 Million Adults

(13.0%)

MH Services,

but No SU Tx

7.6 Million

Adults

(84.0%)

SU Tx, but No

MH Services

251,000 Adults

(2.8%)

MH = mental health; SU Tx = substance use treatment.

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

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

Results from the 2021 National Survey on Drug Use and Health64 | December 2022

and 10.7 percent (or 620,000 people) received both

substance use treatment at a specialty facility and mental

health services.

Among adults aged 18 or older with co-occurring SMI and

an illicit drug or alcohol use disorder who received either

substance use treatment at a specialty facility or mental

health services in the past year, most received only mental

health services. Speciﬁcally, among the 3.9 million adults

aged 18 or older with co-occurring SMI and an illicit drug

or alcohol use disorder who received either substance use

treatment at a specialty facility or mental health services

in the past year, 81.5 percent received only mental health

services, 2.2 percent received only substance use treatment at

a specialty facility, and 16.1 percent received both services.

Among adults aged 18 or older in 2021 with co-occurring

SMI and an illicit drug or alcohol use disorder in the

past year, young adults aged 18 to 25 were less likely than

adults aged 26 to 49 to have received either substance use

treatment at a specialty facility or mental health services

in the past year. Speciﬁcally, 57.9 percent of young adults

aged 18 to 25 with co-occurring SMI and an illicit drug or

alcohol use disorder in the past year (or 1.0 million people)

received either substance use treatment at a specialty facility

or mental health services in the past year compared with

70.4 percent of adults aged 26 to 49 (or 2.2 million people)

with co-occurring SMI and an illicit drug or alcohol use

disorder in the past year (Table A.45B).

Perceived Recovery

Respondents aged 18 or older were asked whether they

thought they ever had a problem with their use of drugs

or alcohol or whether they ever had a problem with their

mental health. Respondents who reported that they ever

had a problem with their drug or alcohol use were asked

whether they considered themselves (at the time they were

interviewed) to be in recovery or to have recovered from

their drug or alcohol use problem. Similarly, respondents

aged 18 or older who reported that they had a problem with

their mental health were asked whether they considered

themselves (at the time they were interviewed) to be in

recovery or to have recovered from their mental health issue.

Among adults aged 18 or older in 2021, 11.5 percent (or

29.0 million people) perceived that they ever had a problem

with their use of drugs or alcohol (Table A.46B). Young

adults aged 18 to 25 were less likely than adults aged 26 or

older to perceive that they ever had a problem with their use

of drugs or alcohol (7.1 vs. 12.2 percent). ese percentages

correspond to 2.4 million young adults aged 18 to 25 and

26.6 million adults aged 26 or older who perceived that they

ever had a problem with their use of drugs or alcohol. ese

ﬁndings contrast with the ﬁndings noted in prior sections of

this report that young adults aged 18 to 25 in 2021 tended

to be more likely than adults aged 26 or older to be binge

alcohol users in the past month, to have used illicit drugs in

the past year, or to have had an SUD in the past year.

Among the 29.0 million adults in 2021 who perceived that

they ever had a substance use problem, 72.2 percent (or

20.9 million people) considered themselves to be in recovery

Figure70. Receipt of Substance Use Treatment at a Specialty Facility and Mental Health

Services in the Past Year: Among Adults Aged 18 or Older with Past Year Illicit Drug or Alcohol

Use Disorder and Serious Mental Illness; 2021

SU Tx or

MH Services

3.9 Million Adults

(66.9%)

No Treatment

1.9 Million Adults

(33.1%)

Both SU Tx and

MH Services

620,000 Adults

(16.1%)

MH Services,

but No SU Tx

3.1 Million

Adults

(81.5%)

SU Tx, but No

MH Services

84,000 Adults

(2.2%)

MH = mental health; SU Tx = substance use treatment.

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

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 65

or to have recovered from their drug or alcohol use problem

(Table A.47B). Adults aged 26 or older who perceived that

they ever had a substance use problem were more likely

than corresponding young adults aged 18 to 25 to consider

themselves to be in recovery or to have recovered from their

substance use problem. About three fourths of adults aged

26 or older who perceived that they ever had a substance

use problem considered themselves to be in recovery or

to have recovered (72.7 percent or 19.4 million people)

compared with about two thirds of young adults aged 18 to

25 who perceived that they ever had a substance use problem

(67.0 percent or 1.6 million people).

In 2021, 23.3 percent of adults aged 18 or older (or

58.7 million people) perceived that they ever had a problem

with their mental health (Table A.46B). Young adults aged

18 to 25 were more likely than adults aged 26 or older to

perceive that they ever had a problem with their mental

health (37.6 percent of young adults aged 18 to 25 or

12.5 million people vs. 21.1 percent of adults aged 26 or

older or 46.2 million people).

Among the 58.7 million adults in 2021 who perceived

that they ever had a problem with their mental health,

66.5 percent (or 38.8 million people) considered themselves

to be in recovery or to have recovered from their mental

health issue (Table A.47B). Young adults aged 18 to 25 who

perceived that they ever had a problem with their mental

health were less likely than corresponding adults aged 26

or older to consider themselves to be in recovery or to have

recovered from their mental health issue (63.0 percent

of young adults aged 18 to 25 or 7.8 million people vs.

67.4 percent of adults aged 26 or older or 31.0 million

people).

By Race/Ethnicity

e percentage of adults aged 18 or older in 2021

who perceived that they ever had a problem with their

use of drugs or alcohol was higher among Multiracial

(18.0 percent), American Indian or Alaska Native

(16.6 percent), or White adults (13.7 percent) than among

adults in most other racial or ethnic groups (Table B.29B).

Asian adults (3.7 percent) were least likely to perceive

that they ever had a problem with their use of drugs or

alcohol compared with adults in most other racial or ethnic

groups. However, among adults aged 18 or older who

perceived that they ever had a substance use problem, there

were no diﬀerences among White (73.5 percent), Black

(69.2 percent), or Hispanic adults (67.6 percent) who

considered themselves to be in recovery or to have recovered

from their drug or alcohol use problem (Table B.30B).

e percentage of adults aged 18 or older in 2021 who

perceived that they ever had a problem with their mental

health was higher among Multiracial adults (38.8 percent)

than among White (26.7 percent), American Indian or

Alaska Native (21.7 percent), Black (17.5 percent), Hispanic

(17.3 percent), or Asian adults (12.7 percent) (Table B.29B).

Asian adults were least likely to have perceived they ever had

a problem with their mental health compared with adults in

other racial or ethnic groups. However, among adults who

perceived that they ever had a problem with their mental

health, percentages of those who considered themselves

to be in recovery or to have recovered from their mental

health issue did not diﬀer among racial or ethnic groups

(

Table B.30B).

Substance Use, Mental Health Issues, and the

COVID-19 Pandemic

e COVID-19 pandemic, and the requisite measures taken

to combat it, created challenges in the lives of Americans.

To describe ongoing eﬀects of the COVID-19 pandemic

on people’s substance use, mental health, and other parts

of their lives, the 2021 NSDUH included questions about

people’s perceptions of how the COVID-19 pandemic

aﬀected their lives. ese questions asked respondents to

describe how the COVID-19 pandemic aﬀected their mental

health; substance use; ﬁnancial security; housing; and access

to substance use treatment, mental health services, and

medical care. is section provides estimates of the eﬀect

of the COVID-19 pandemic on substance use and mental

health issues.

Data from most of these questions reﬂect respondents’

subjective perceptions of how their lives changed during the

COVID-19 pandemic. e questions concerning mental

health and substance use asked respondents to rate the eﬀects

of the COVID-19 pandemic on their mental or emotional

health using a scale of responses (“not at all,” “a little,”

“some,” “quite a bit,” or “a lot”). Similarly, respondents were

asked how much the COVID-19 pandemic aﬀected their

substance use, with responses for using a substance “much

less,” “a little less,” “about the same,” “a little more,” or “a lot

more” than they did before the COVID-19 pandemic began.

However, there are no objective indicators to deﬁne the

categories on these subjective measures. For example, one

respondent could deﬁne negative eﬀects on mental health

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

Results from the 2021 National Survey on Drug Use and Health66 | December 2022

as having “some” negative eﬀect, and another respondent

could deﬁne the same eﬀects as negatively aﬀecting their

mental health “quite a bit.” Similarly, one respondent could

deﬁne a change in substance use as “much less,” and another

respondent could deﬁne the same change as “a little less.”

Also, these are sensitive questions, and some respondents

may have given responses they felt were more socially

desirable. Some respondents may have been reluctant to

accurately report negative changes in their mental health

during the COVID-19 pandemic. Some respondents whose

substance use increased during the COVID-19 pandemic

may have been reluctant to report that they were using

substances more than they did before the COVID-19

pandemic began.

Also, the accuracy of respondents’ recall of how their mental

health and substance use have changed since the COVID-19

pandemic began in the United States in early 2020 could

depend on when respondents were interviewed in 2021.

Respondents who were interviewed earlier in 2021 (and

potentially within a year of the start of the COVID-19

pandemic) could recall changes in their mental health and

substance use more accurately than respondents who were

interviewed later in 2021.

An additional consideration is that the COVID-19

pandemic has not been a single event. Data from the Centers

for Disease Control and Prevention showed three peaks in

the number of daily COVID-19 cases in the United States

in 2021: (1) in January as part of an increase that began in

October 2020, (2) in late August to early September for the

Delta variant, and (3) at the end of the year for the Omicron

variant.

125

In addition, the number of daily cases started to

decline in January 2021 and reached a low point in June

2021 before the emergence of the Delta and Omicron

variants. Also, public health responses in many states were

more stringent in spring to early summer 2020 and were

progressively relaxed over time. erefore, responses to these

questions about impacts of the COVID-19 pandemic on

mental health, substance use, and access to services could

depend on the period(s) of the COVID-19 pandemic that

respondents recalled when answering the questions.

Perceived Negative Effects of the COVID-19 Pandemic

on Mental Health

Respondents were asked to rate the COVID-19 pandemic’s

negative eﬀect on their mental health on a ﬁve-category scale

ranging from “not at all” to “a lot.” To facilitate analysis,

responses were collapsed into three categories: “not at all,”

“a little or some,” and “quite a bit or a lot.” As previously

noted, the resulting data reﬂect respondents’ subjective

perceptions and are not objective indicators of mental health

issues. In addition, asking respondents how much (if at all)

the COVID-19 pandemic negatively aﬀected their mental

health presupposes that the COVID-19 pandemic had a

negative eﬀect. Respondents were not oﬀered a choice to

indicate improvement in mental health since the COVID-19

pandemic began.

Perceived Negative Effects of the COVID-19 Pandemic

on Mental Health among Adolescents Aged 12 to 17

In 2021, most adolescents aged 12 to 17 perceived a negative

eﬀect of the COVID-19 pandemic on their mental health.

About 1 in 5 adolescents aged 12 to 17 (19.2 percent

or 4.9 million people) perceived that the COVID-19

pandemic negatively aﬀected their mental health “quite a bit

or a lot,” and an additional 47.0 percent (or 12.0 million

people) perceived “a little or some” negative eﬀect on their

mental health (Figure 71 and Table A.48B). About 1 in

3 adolescents aged 12 to 17 (33.8 percent or 8.6 million

people) perceived no negative eﬀect on their mental health

because of the COVID-19 pandemic.

Adolescents aged 12 to 17 who had a past year MDE or a

past year MDE with severe impairment were more likely

than those without a past year MDE to perceive that the

COVID-19 pandemic negatively aﬀected their mental health

Figure71. Perceived COVID-19 Pandemic Negative Effect on

Emotional or Mental Health: Among Youths Aged 12 to 17; by Past

Year Major Depressive Episode (MDE) Status; 2021

33.8

11.5

10.7

39.8

47.0

43.4

38.3

47.8

19.2

45.1

50.9

12.4

Total Had MDE

(with or without

Severe Impairment)

Had MDE with

Severe Impairment

Did Not Have MDE

Percent Perceiving Effect

Not at all A little or some Quite a bit or a lot

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

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 67

“quite a bit or a lot.” Among adolescents aged 12 to 17 with

a past year MDE, nearly half (45.1 percent or 2.2 million

people) perceived that the COVID-19 pandemic negatively

aﬀected their mental health “quite a bit or a lot,” as did

about half of adolescents aged 12 to 17 who had a past year

MDE with severe impairment (50.9 percent or 1.9 million

people). In comparison, 12.4 percent of adolescents aged

12 to 17 without a past year MDE (or 2.4 million people)

perceived this level of a negative eﬀect on their mental health

because of the COVID-19 pandemic. Among adolescents

aged 12 to 17 who had a past year MDE or a past year MDE

with severe impairment, an unknown number may have had

an MDE that started before the COVID-19 pandemic and

became worse during the COVID-19 pandemic as opposed

to those who experienced an MDE that started during the

COVID-19 pandemic.

In addition, almost half of adolescents aged 12 to 17 who

did not have a past year MDE (47.8 percent or 9.4 million

people), 43.4 percent (or 2.2 million people) of adolescents

aged 12 to 17 with a past year MDE, and 38.3 percent (or

1.4 million people) of adolescents aged 12 to 17 with a

past year MDE with severe impairment perceived that the

COVID-19 pandemic negatively aﬀected their mental health

“a little or some.” It is unclear whether these negative eﬀects

were temporary or longer lasting. Even if adolescents aged 12

to 17 did not have a past year MDE, they could have needed

mental health services during the COVID-19 pandemic.

Perceived Negative Effects of the COVID-19 Pandemic

on Mental Health among Adults Aged 18 or Older

Most adults aged 18 or older in 2021 perceived a negative

eﬀect of the COVID-19 pandemic on their mental

health. About 1 in 7 adults aged 18 or older (14.4 percent

or 36.1 million people) perceived that the COVID-19

pandemic negatively aﬀected their mental health “quite a

bit or a lot,” and about half (49.7 percent or 124.4 million

people) perceived “a little or some” negative eﬀect on their

mental health (Figure 72 and Table A.49B). However, slightly

more than 1 in 3 adults aged 18 or older (35.8 percent or

89.7 million people) perceived no negative eﬀect on their

mental health because of the COVID-19 pandemic. e

percentage of adults who perceived that the COVID-19

pandemic negatively aﬀected their mental health “quite a

bit or a lot” was highest among young adults aged 18 to

25 (21.5 percent or 7.1 million people), followed by adults

aged 26 to 49 (17.3 percent or 17.5 million people), then by

adults aged 50 or older (10.0 percent or 11.6 million people).

In 2021, adults aged 18 or older with AMI or SMI in

the past year were more likely than those who did not

have mental illness in the past year to perceive that the

COVID-19 pandemic negatively aﬀected their mental

health “quite a bit or a lot.” Among adults aged 18 or older

with AMI in the past year, 36.2 percent (or 20.4 million

people) perceived the COVID-19 pandemic to have

negatively aﬀected their mental health “quite a bit or a

lot,” as did nearly half of adults aged 18 or older with SMI

in the past year (48.9 percent or 6.8 million people). In

comparison, about 1 in 12 adults aged 18 or older with no

mental illness in the past year (8.1 percent or 15.7 million

people) perceived the COVID-19 pandemic to have

negatively aﬀected their mental health “quite a bit or a lot.”

e percentage of adults with AMI who perceived that

the COVID-19 pandemic negatively aﬀected their mental

health “quite a bit or a lot” was highest among adults aged

18 to 25 (41.9 percent or 4.6 million people), followed by

adults aged 26 to 49 (38.5 percent or 10.8 million people),

then by adults aged 50 or older (28.9 percent or 5.0 million

people). However, it is not known from these data whether

adults aged 18 or older had preexisting AMI or SMI that

they perceived to have worsened or whether they had AMI

or SMI for the ﬁrst time during the COVID-19 pandemic.

Nevertheless, these data indicate the need for adults aged 18

or older with AMI and SMI to receive mental health services

during the COVID-19 pandemic.

Figure72. Perceived COVID-19 Pandemic Negative Effect on

Emotional or Mental Health: Among Adults Aged 18 or Older; by

Past Year Mental Illness Status; 2021

35.8

16.3

11.4

41.5

49.7

47.5

39.6

50.4

14.4

36.2

48.9

8.1

Total Any Mental Illness

(with or without

Serious Mental

Illness)

Serious Mental

Illness

No Mental Illness

Percent Perceiving Effect

Not at all A little or some Quite a bit or a lot

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

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

Results from the 2021 National Survey on Drug Use and Health68 | December 2022

Perceived Effects of the COVID-19 Pandemic on

Substance Use

Stressors and feelings of social isolation during the

COVID-19 pandemic could have negatively aﬀected

Americans’ substance use. In many states, establishments

that sold alcohol for oﬀ-premises consumption (e.g., liquor

stores, grocery stores) remained open during periods when

stay-at-home orders were in eﬀect in 2020. Some states

also changed laws to allow “to-go” drinks from bars and

restaurants or loosened restrictions on home delivery of

alcohol.

126

By mid-February 2021, however, all restaurants

were allowed to be open in the large majority of states,

and all bars were allowed to be open in a majority of states

(although many states that allowed bars and restaurants

to be open continued to have restrictions in place). In all

states except Hawaii, any remaining restrictions on bars and

restaurants were lifted by September 15, 2021.

Questions in the 2021 NSDUH asked respondents to rate

how the COVID-19 pandemic aﬀected their use of alcohol

and other drugs. Respondents who used alcohol or other

drugs in the past 12 months could report substance use in

ﬁve categories ranging from “much less” to “a lot more”

than use before the COVID-19 pandemic. Respondents

answered separate questions about eﬀects of the COVID-19

pandemic on their alcohol and other drug use. To facilitate

analysis, responses were collapsed into three categories: “a

little less or much less,” “about the same,” and “a little more

or much more.”

127

However, these questions were not asked

of respondents who abstained from using alcohol or drugs

throughout the past 12 months.

Some people could have increased their substance use in

the early phases of the COVID-19 pandemic, then later

returned to their previous level of use, but this pattern would

not be captured by the 2021 survey data. It is also unknown

whether people might return to their earlier patterns of

substance use in the future.

In addition, adolescents aged 12 to 17 and young adults

aged 18 to 25 could have increased their substance use as

they got older, even if there had not been a COVID-19

pandemic. As discussed in the Initiation of Substance Use

section, for example, more than 2 million people in 2021

did not initiate alcohol use until they were aged 18 or older.

Also, nearly 40 percent of past year initiates of marijuana use

in 2021 did not use marijuana until they were aged 21 or

older.

Perceived Effects on Alcohol Use

Among people aged 12 or older in 2021 who drank alcohol

in the past year, more than half (56.9 percent or 95.6 million

people) perceived that they drank “about the same”

amount as they did before the COVID-19 pandemic began

(

Figure 73 and Table A.50B). In addition, 29.6 percent of

past year alcohol users (or 49.8 million people) perceived

that they drank “a little less or much less” alcohol than

they did before the COVID-19 pandemic began, and

13.5 percent (or 22.7 million people) perceived that they

drank “a little more or much more” than they did before.

About 1 in 6 adolescents aged 12 to 17 in 2021 who drank

alcohol in the past year (16.6 percent or 638,000 people)

perceived that they drank “a little more or much more”

than they did before the COVID-19 pandemic began. e

percentage of adolescent alcohol users aged 12 to 17 who

perceived that they drank “a little more or much more” than

they did before the COVID-19 pandemic was higher than

the corresponding percentage among past year alcohol users

aged 26 or older (13.2 percent or 18.9 million people).

In addition, 14.6 percent of young adults aged 18 to 25

who drank alcohol in the past year (or 3.1 million people)

perceived that they drank “a little more or much more” than

they did before the COVID-19 pandemic began. Some

increases in alcohol use among young adults aged 18 to 25

since the beginning of the COVID-19 pandemic may be

because they reached the legal drinking age of 21 after the

COVID-19 pandemic began; as noted previously, these

increases could have occurred even in the absence of the

COVID-19 pandemic.

Figure73. Perceived COVID-19 Pandemic Effect on Alcohol Use:

Among Past Year Alcohol Users Aged 12 or Older; 2021

29.6

40.9

33.2

28.8

56.9

42.5

52.2

58.0

13.5

16.6

14.6

13.2

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

Percent Perceiving Effect

A little less or much less About the same A little more or much more

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 69

In 2021, the percentage of people who drank alcohol in the

past year and perceived that they were drinking “a little less

or much less” was highest among adolescents aged 12 to

17 (40.9 percent or 1.6 million people), followed by young

adults aged 18 to 25 (33.2 percent or 7.1 million people),

then by adults aged 26 or older (28.8 percent or 41.1 million

people). It is unknown whether people who were drinking

less than they did before the COVID-19 pandemic began

will return to their earlier patterns of alcohol consumption.

For example, college-age young adults who were living with

their parents during the height of the COVID-19 pandemic

could resume their earlier patterns of alcohol consumption

once they return to a campus environment. Adolescents may

increase their drinking as the continued lifting of restrictions

on social gatherings creates more opportunities for social

activities without parental supervision.

Perceived Effects on Drug Use

Among people aged 12 or older in 2021 who used drugs

other than alcohol in the past year (subsequently referred to

as “drugs”),

127

about 3 in 8 (37.1 percent or 39.7 million

people) perceived that they used these drugs “a little less or

much less” than they did before the COVID-19 pandemic

began, and more than half (53.3 percent or 57.0 million

people) perceived that they used these drugs “about the

same” as they did before the COVID-19 pandemic began

(

Figure 74 and Table A.51B). An estimated 9.6 percent of

past year users of drugs other than alcohol (or 10.2 million

people) perceived that they used these drugs “a little more or

much more” during the COVID-19 pandemic than they did

before.

In 2021, more than half of adolescents aged 12 to 17 who

used drugs in the past year (52.0 percent or 2.7 million

people) perceived that they used these drugs “a little less or

much less” than they did before the COVID-19 pandemic

began. is percentage among adolescents was higher than

the corresponding percentages among young adults aged 18

to 25 (36.4 percent or 5.5 million people) and those aged

26 or older (36.4 percent or 31.6 million people) who used

these drugs. As previously noted in relation to perceived

reductions in alcohol use, these adolescents could increase

their use of drugs as they have more opportunities to engage

in social activities with peers over time.

e percentage of people in 2021 who used drugs in the

past year and perceived that they used these drugs “a little

more or much more” than they did before the COVID-19

pandemic was highest among young adults aged 18 to 25

(17.0 percent or 2.5 million people), followed by adolescents

aged 12 to 17 (12.8 percent or 654,000 people), then by

adults aged 26 or older (8.1 percent or 7.0 million people).

It is unknown, however, whether these will be short- or

long-term increases in drug use that persist beyond the

COVID-19 pandemic.

Perceived Effects of the COVID-19 Pandemic on

Access to Services

e COVID-19 pandemic may have aﬀected access to

substance use treatment, mental health services, and medical

care in diﬀerent ways. In response to the COVID-19

pandemic, for example, health care providers (including

behavioral health care providers) turned to virtual (i.e.,

telehealth) services as a means of delivering services

while also limiting in-person contact that could spread

COVID-19.

128

As discussed in the Substance Use Treatment

in the Past Year section, telehealth services for substance use

treatment refer to the delivery of services over the phone or

Internet. Reimbursement for virtual services was expanded

during the COVID-19 pandemic, including reimbursement

for services delivered over the phone (i.e., using only audio).

To assess the various eﬀects of the COVID-19 pandemic on

access to behavioral health and medical services, respondents

were asked if they experienced the following circumstances

because of the COVID-19 pandemic: (1) appointments

moved from in-person to telehealth format, (2) delays

Figure74. Perceived COVID-19 Pandemic Effect on Drug Use:

Among Past Year Drug Users Aged 12 or Older; 2021

37.1

52.0

36.4 36.4

53.3

35.2

46.7

55.5

9.6

12.8

17.0

8.1

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

Percent Perceiving Effect

A little less or much less About the same A little more or much more

Note: Use of drugs included the use of marijuana, cocaine (including crack), heroin, hallucinogens,

inhalants, or methamphetamine in the pastyear or any use (i.e., not necessarily misuse) of

prescription pain relievers, tranquilizers, stimulants, or sedatives in the pastyear. Drugs did not

include tobacco products or nicotine vaping.

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

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

Results from the 2021 National Survey on Drug Use and Health70 | December 2022

or cancellations in appointments, (3) delays in getting

prescriptions, and (4) inability to access needed care resulting

in moderate to severe impact on health. Respondents were

asked separately about each of these situations in relation

to their access to substance use treatment, mental health

treatment, and medical care.

Changes during the COVID-19 pandemic supported

increased use of virtual services for medical care of all

types, including substance use treatment and mental health

services. However, it is unknown whether people considered

this shift in the delivery of care to be a positive or negative

eﬀect of the COVID-19 pandemic.

Access to Substance Use Treatment

Among people aged 12 or older in 2021 who used illicit

drugs or alcohol in the past year, 8.2 percent (or 14.8 million

people) had substance use treatment appointments moved

from in person to telehealth, and 7.1 percent (or 12.9 million

people) experienced delays or cancellations in appointments

(Table A.52B). An estimated 3.3 percent of people who used

illicit drugs or alcohol in the past year (or 6.0 million people)

experienced delays in getting prescriptions, and 2.4 percent

(or 4.3 million people) were unable to access needed care

resulting in a perceived moderate to severe impact on health.

e COVID-19 pandemic’s eﬀect on access to substance use

treatment would not be relevant to people who did not use

alcohol or illicit drugs.

Among people aged 12 or older in 2021 who had an illicit

drug or alcohol use disorder in the past year (and would be

classiﬁed as needing substance use treatment), 11.9 percent

(or 5.0 million people) had substance use treatment

appointments moved from in person to telehealth, and

10.5 percent (or 4.4 million people) experienced delays or

cancellations in appointments (Table A.52B). In addition,

6.1 percent of people with a past year illicit drug or alcohol

use disorder (or 2.5 million people) experienced delays in

getting prescriptions, and 5.2 percent (or 2.2 million people)

were unable to access needed care resulting in a perceived

moderate to severe impact on health.

Among the 4.1 million people aged 12 or older in 2021

who received any substance use treatment in the past year,

44.5 percent (or 1.8 million people) had substance use

treatment appointments moved from in person to telehealth,

and 30.9 percent (or 1.2 million people) experienced

delays or cancellations in appointments (Figure 75 and

Tables A.53A and A.53B). In addition, 17.6 percent of

people who received substance use treatment in the past year

(or 705,000 people) experienced delays or cancellations in

getting prescriptions, and 14.8 percent (or 586,000 people)

were unable to access needed care resulting in a perceived

moderate to severe impact on health.

Access to Mental Health Services

Among adolescents aged 12 to 17 in 2021 who received

mental health services in the past year, nearly 4 in 10

(38.9 percent or 2.5 million people) had appointments

moved from in person to telehealth, and 3 in 8 (37.5 percent

or 2.4 million people) experienced delays or cancellations

in appointments (Table A.54B). In addition, about 1 in

9 (11.6 percent or 745,000 people) experienced delays in

getting prescriptions, and 1 in 12 (8.3 percent or 534,000

people) were unable to access needed mental health services

resulting in a perceived moderate to severe impact on health.

Among adults aged 18 or older in 2021 who received mental

health services in the past year, more than half (56.5 percent or

26.5 million people) had appointments moved from in person

to telehealth, and about 3 in 8 (37.1 percent or 17.4 million

people) experienced delays or cancellations in appointments

(Figure 76 and Table A.55B). e ﬁnding that more than half

of adults aged 18 or older who received mental health services

in the past year had appointments moved from in person

to telehealth likely reﬂects the use of virtual (i.e., telehealth)

services to continue delivering mental health services and the

expansion of reimbursement for virtual services.

Figure75. Perceived COVID-19 Pandemic Effect on Access to

Substance Use Treatment: Among People Aged 12 or Older Who

Received Substance Use Treatment in the Past Year; 2021

44.5

22.4

47.2

30.9

21.8

32.0

17.6

16.1

17.9

14.8

15.6

14.8

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

Percent Perceiving Effect

Appointments moved from in person to telehealth

Delays or cancellations in appointments

Delays in getting prescriptions

Unable to access needed care resulting in moderate to severe impact on health

* Low precision; no estimate reported.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 71

In addition, about 1 in 6 adults aged 18 or older in 2021

who received mental health services in the past year

(16.8 percent or 7.9 million people) experienced delays

in getting prescriptions, and 1 in 10 (10.3 percent or

4.8 million people) were unable to access needed care

resulting in a perceived moderate to severe impact on

health. at 4.8 million adults aged 18 or older perceived

their health to have been negatively aﬀected because they

were unable to access needed mental health services is an

important indicator of adverse impacts of changes in access

to these services during the COVID-19 pandemic.

Among adults aged 18 or older in 2021 who received mental

health services in the past year, adults aged 18 to 25 or 26 to

49 were more likely than adults aged 50 or older to perceive

that the COVID-19 pandemic aﬀected their access to that

care. Speciﬁcally, 60.7 percent of young adults aged 18 to

25 (or 4.4 million people) and 63.3 percent of adults aged

26 to 49 who received mental health services in the past year

(or 13.8 million people) had appointments moved from in

person to telehealth compared with 46.5 percent of their

counterparts who were aged 50 or older (or 8.3 million

people). In addition, 39.1 percent of young adults aged 18

to 25 (or 2.9 million people) and 40.6 percent of adults aged

26 to 49 (or 8.8 million people) who received mental health

services in the past year experienced delays or cancellations

in appointments compared with 32.1 percent of adults aged

50 or older who received services (or 5.7 million people).

Young adults aged 18 to 25 and adults aged 26 to 49

who received mental health services in the past year were

more likely to be unable to access needed care resulting

in a perceived moderate to severe impact on health

(12.9 percent of young adults aged 18 to 25 or 947,000

people; 11.7 percent of adults aged 26 to 49 or 2.6 million

people). In comparison, 7.5 percent of adults aged 50 or

older who received mental health services in the past year (or

1.3 million people) were unable to access mental health care

that resulted in a moderate to severe impact on their health.

Access to Medical Services

Among people aged 12 or older in 2021, 30.0 percent (or

82.4 million people) had medical appointments moved from

in person to telehealth (Figure 77 and Table A.56B).

In addition, 24.5 percent of people aged 12 or older

in 2021 (or 67.3 million people) experienced delays or

cancellations in medical appointments or preventive services.

An estimated 8.5 percent of people (or 23.2 million people)

experienced delays in getting prescriptions, and 5.2 percent

(or 14.2 million people) were unable to access needed

medical care resulting in a perceived moderate to severe

impact on health. at 14.2 million people whose health was

negatively aﬀected because they were unable to access needed

medical care is particularly concerning.

Adults aged 26 or older in 2021 were more likely than

adolescents aged 12 to 17 and young adults aged 18 to

25 to have had two or more outpatient medical visits in

Figure76. Perceived COVID-19 Pandemic Effect on Mental Health

Services: Among Adults Aged 18 or Older Who Received Services;

2021

56.5

60.7

63.3

46.5

37.1

39.1

40.6

32.1

16.8

19.6

18.1

14.0

10.3

12.9

11.7

7.5

18 or Older 18 to 25 26 to 49 50 or Older

Percent Perceiving Effect

Appointments moved from in person to telehealth

Delays or cancellations in appointments

Delays in getting prescriptions

Unable to access needed care resulting in moderate to severe impact on health

Figure77. Perceived COVID-19 Pandemic Effect on Access to

Medical Care: Among People Aged 12 or Older; 2021

30.0

14.5

21.8

33.0

24.5

17.4

18.0

26.3

8.5

6.2

7.3

8.9

5.2

2.9

4.4

5.5

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

Percent Perceiving Effect

Appointments moved from in person to telehealth

Delays or cancellations in appointments

Delays in getting prescriptions

Unable to access needed care resulting in moderate to severe impact on health

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

Results from the 2021 National Survey on Drug Use and Health72 | December 2022

the past year.

erefore, perceptions of whether the

COVID-19 pandemic aﬀected people’s access to medical

care would be especially relevant to adults aged 26 or

older. In general, adults aged 26 or older were more likely

than adolescents aged 12 to 17 and young adults aged

18 to 25 to perceive COVID-19 pandemic eﬀects on

their access to medical care. Among adults aged 26 or

older in 2021, 33.0 percent (or 71.6 million people) had

medical appointments moved from in person to telehealth,

26.3 percent (or 57.1 million people) experienced delays or

cancellations in medical appointments or preventive services,

8.9 percent (or 19.3 million people) experienced delays

in getting prescriptions, and 5.5 percent (or 12.0 million

people) were unable to access needed medical care resulting

in a perceived moderate to severe impact on health.

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. https://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. 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 2021 Detailed Tables available at

https://

www.samhsa.gov/data/report/2021-nsduh-detailed-tables.

6. Chapter 6 of CBHSQ (2022) discusses these investigations for the

2021 NSDUH in greater detail. See the following reference: Center for

Behavioral Health Statistics and Quality. (2022). 2021 National Survey

on Drug Use and Health: Methodological summary and deﬁnitions. https://

www.samhsa.gov/data/report/2021-methodological-summary-and

-deﬁnitions

7. Details about the sample design, weighting, and interviewing results

for the 2021 NSDUH are provided in Sections 2.1, 2.3.4, and

3.3.1 of CBHSQ (2022), including changes to the sample design

and weighting procedures because of the COVID-19 pandemic. In

particular, Tables 2.1 and 2.2 in CBHSQ (2022) provide sample design

information on the targeted numbers of completed interviews by state

and by age group, respectively. See the following reference: Center for

Behavioral Health Statistics and Quality. (2022). 2021 National Survey

on Drug Use and Health: Methodological summary and deﬁnitions. https://

www.samhsa.gov/data/report/2021-methodological-summary-and

-deﬁnitions

8. Center for Systems Science and Engineering, Johns Hopkins University.

(2022). Coronavirus resource center: Global map: COVID-19 dashboard.

https://coronavirus.jhu.edu/map.html

9. Details about the multimode data collection procedures for the 2021

NSDUH are provided in Section 2.2.1 of CBHSQ (2022). See the

following reference: Center for Behavioral Health Statistics and Quality.

(2022). 2021 National Survey on Drug Use and Health: Methodological

summary and deﬁnitions. https://www.samhsa.gov/data/report/2021

-methodological-summary-and-deﬁnitions

10. Ages reported in household screenings were used in the response rate

calculations. Numbers of adolescent respondents aged 12 to 17 and

adult respondents aged 18 or older changed slightly based on ﬁnal ages

from the interview data (13,239 adolescents and 56,611 adults).

11. Overall response rates are not calculated for adolescents or adults

because the screening response rate is not speciﬁc to age groups.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 73

12. Center for Behavioral Health Statistics and Quality. (2022). 2021

National Survey on Drug Use and Health: Methodological summary and

deﬁnitions. https://www.samhsa.gov/data/report/2021-methodological

-summary-and-deﬁnitions

13. 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. (2022). 2021 National

Survey on Drug Use and Health: Methodological summary and deﬁnitions.

https://

www.samhsa.gov/data/report/2021-methodological-summary

-and-deﬁnitions

14. 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.

15. Oﬃce of Management and Budget. (1997, October 30). Revisions to

the standards for the classiﬁcation of federal data on race and ethnicity.

Federal Register, 62(210), 58782-58790. https://www.govinfo.gov/

content/pkg/FR-1997-10-30/pdf/97-28653.pdf

16. See Section 3.2.3 in the following reference: Center for Behavioral

Health Statistics and Quality. (2022). 2021 National Survey on Drug Use

and Health: Methodological summary and deﬁnitions. https://www.samhsa

.gov/data/report/2021-methodological-summary-and-deﬁnitions

17. Survey modes included data collection in person or via the web.

18. Please refer to the 2021 Detailed Tables (available at https://www

.samhsa.gov/data/report/2021-nsduh-detailed-tables) for population

estimates cited in this report that do not appear in the report ﬁgures or

the appendix tables.

19. Gentzke, A. S., Wang, T. W., Cornelius, M., Park-Lee, E., Ren, C.,

Sawdey, M. D., Cullen, K. A., Loretan, C., Jamal, A., & Homa, D. M.

(2022). Tobacco product use and associated factors among middle and

high school students — National Youth Tobacco Survey, United States,

2021. Morbidity and Mortality Weekly Report Surveillance Summaries,

71(SS-5), 1-29. https://

doi.org/

10.15585/mmwr.ss7105a1

20. See Chapter 5 in the following reference: Center for Behavioral Health

Statistics and Quality. (2022). 2021 National Survey on Drug Use and

Health: Methodological summary and deﬁnitions. https://www.samhsa

.gov/data/report/2021-methodological-summary-and-deﬁnitions

21. Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G.,

Schulenberg, J. E., & Patrick, M. E. (2020). Monitoring the Future

national survey results on drug use 1975–2019: 2019 overview, key ﬁndings

on adolescent drug use. University of Michigan, Institute for Social

Research. http://

www.monitoringthefuture.org/pubs/monographs/mtf

-overview2019.pdf

22. U.S. Food and Drug Administration. (2020). 2019 National Youth

Tobacco Survey shows youth e-cigarette use at alarming levels. https://www

.fda.gov/media/132299/download

23. Wang, T. W., Gentzke, A. S., Creamer, M. R., Cullen, K. A., Holder-

Hayes, E., Sawdey, M. D., Anic, G. M., Portnoy, D. B., Hu, S., Homa,

D. M., Jamal, A., & Neﬀ, L. J. (2019). Tobacco product use and

associated factors among middle and high school students — United

States, 2019. Morbidity and Mortality Weekly Report Surveillance

Summaries, 68(SS-12), 1-22. https://

doi.org/10.15585/mmwr

.ss6812a1

24. Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G.,

Schulenberg, J. E., & Patrick, M. E. (2022). Monitoring the Future

national survey results on drug use, 1975–2021: Volume I, secondary school

students. University of Michigan, Institute for Social Research. http://

www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2021.pdf

25. Schulenberg, J. E., Patrick, M. E., Johnston, L. D., O’Malley, P. M.,

Bachman, J. G., & Miech, R. A. (2021). Monitoring the Future national

survey results on drug use, 1975–2020: Volume II, College students and

adults ages 19–60. University of Michigan, Institute for Social Research.

http://

www.monitoringthefuture.org/pubs/monographs/mtf-vol2_2020

.pdf

26. 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). https://www.samhsa.gov/data/report/

results-2013-national-survey-drug-use-and-health-summary-national

-ﬁndings

27. ese estimates (or selected estimates being cited) were calculated from

special analyses but are not included in the appendix tables or in the

2021 Detailed Tables.

28. U.S. Food and Drug Administration. (2021). Rules, regulations and

guidance. https://www.fda.gov/tobacco-products/products-guidance

-regulations/rules-regulations-and-guidance

29. In the 2021 NSDUH, a “drink” was deﬁned as a can or bottle of beer,

a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with

liquor in it. Times when respondents had only a sip or two from a drink

were not considered to be alcohol consumption.

30. 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. https://pubs.niaaa.nih.gov/publications/Newsletter/

winter2004/Newsletter_Number3.pdf

National Institute on Alcohol Abuse and Alcoholism. (2019). Drinking

levels deﬁned. https://www.niaaa.nih.gov/alcohol-health/overview

-alcohol-consumption/moderate-binge-drinking

31. Alcohol Policy Information System, National Institute on Alcohol Abuse

and Alcoholism. (n.d.). Possession/consumption/internal possession of

alcohol. https://alcoholpolicy.niaaa.nih.gov/apis-policy

-topics/possessio

nconsumptioninternal-possession-of-alcohol/42

32. Alcohol Policy Information System, National Institute on Alcohol

Abuse and Alcoholism. (n.d.). Highlight on underage drinking. https://

alcoholpolicy.niaaa.nih.gov/underage-drinking

33. For more information on marijuana vaping and the use of data on

marijuana vaping to edit data for overall marijuana use in the 2021

NSDUH, see Sections 2.3.2 and 3.4.10.3 of CBHSQ (2022). See the

following reference: Center for Behavioral Health Statistics and Quality.

(2022). 2021 National Survey on Drug Use and Health: Methodological

summary and deﬁnitions. https://www.samhsa.gov/data/report/2021

-methodological-summary-and-deﬁnitions

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

Results from the 2021 National Survey on Drug Use and Health74 | December 2022

34. e 2021 NSDUH questionnaire included separate sections for

tranquilizer misuse and sedative misuse. Data from these sections

were combined to produce aggregate estimates for the misuse of any

tranquilizer or sedative.

35. 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.

36. 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. (2022). 2021 National Survey

on Drug Use and Health: Methodological summary and deﬁnitions. https://

www.samhsa.gov/data/report/2021-methodological-summary-and

-deﬁnitions

37. Desoxyn

was not mentioned in 2021 as some other stimulant.

Desoxyn

is grouped with the other amphetamines because it is

chemically similar to other prescription amphetamines (e.g., Adderall

38. 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 Xanax

is available on FDA’s Center

for Drug Evaluation and Research website at https://www.accessdata

.fda.gov/drugsatfda_docs/label/2021/018276s055lbl.pdf. Product

label information for Halcion

is available on FDA’s Center for Drug

Evaluation and Research website at https://www.accessdata.fda.gov/

drugsatfda_docs/label/2021/017892s056lbl.pdf.

39. Examples of forms of fentanyl presented to NSDUH respondents

are available by prescription. NSDUH respondents were not asked

speciﬁcally about the use of fentanyl illicitly manufactured in

clandestine laboratories.

40. National Institute on Drug Abuse. (2021, April). Cocaine DrugFacts.

https://nida.nih.gov/publications/drugfacts/cocaine

41. National Institute on Drug Abuse. (2019, May). Methamphetamine

DrugFacts. https://nida.nih.gov/publications/drugfacts/

methamphetamine

42. National Institute on Drug Abuse. (2018, June). Prescription stimulants

DrugFacts. https://nida.nih.gov/publications/drugfacts/prescription

-stimulants

43. Drug Enforcement Administration. (2020). Drugs of abuse, a DEA

resource guide: 2020 edition. https://www

.dea.gov/sites/default/ﬁles/

2020-04/Drugs%20of%20Abuse%202020-Web%20Version-508%20

compliant-4-24-20_0.pdf

44. Schedule I controlled substances have no currently accepted medical use

and have a high potential for abuse. See the following reference: Drug

Enforcement Administration. (2020). Drugs of abuse, a DEA resource

guide: 2020 edition. https://www.dea.gov/sites/default/ﬁles/2020-04/

Drugs%20of%20Abuse%202020-Web%20Version-508%20compliant

-4-24-20_0.pdf

45. U.S. National Library of Medicine. (2022). Diphenhydramine. https://

medlineplus.gov/druginfo/meds/a682539.html

46. U.S. National Library of Medicine. (2022). Phenylephrine. https://

medlineplus.gov/druginfo/meds/a606008.html

47. National Institute on Drug Abuse. (n.d.). Kratom. https://nida.nih.gov/

drug-topics/kratom

48. Although kratom is not scheduled nationally as a controlled substance,

the Drug Enforcement Administration includes kratom as a drug of

concern because it poses risks to people who use it. However, some

states may prohibit the possession and use of kratom. See the following

reference: Drug Enforcement Administration. (2020). Drugs of abuse,

a DEA resource guide: 2020 edition. https://www.dea.gov/sites/default/

ﬁles/2020-04/Drugs%20of%20Abuse%202020-Web%20Version-508

%20compliant-4-24-20_0.pdf

49. National Institute on Drug Abuse. (2020, June). Synthetic cannabinoids

(K2/Spice) DrugFacts. https://nida.nih.gov/publications/drugfacts/

synthetic-cannabinoids-k2spice

50. National Institute on Drug Abuse. (2020, July). Synthetic cathinones

(“bath salts”) DrugFacts. https://nida.nih.gov/publications/drugfacts/

synthetic-cathinones-bath-salts

51. 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.

52. 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).

U.S. Department of Health and Human Services, Public Health Service,

Centers for Disease Control and Prevention, National Center for Health

Statistics.

53. 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.

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | 75

54. Assessing whether respondents in the 2021 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 2021 were asked questions about

initiation of misuse only for the speciﬁc prescription drugs they misused

in the past 12 months, including their age when they ﬁrst misused a

drug and (if the ﬁrst misuse occurred within a year of the current age)

the year and month of ﬁrst misuse for that drug. Respondents who

reported they initiated misuse in the past 12 months for all of the

speciﬁc prescription drugs in a given category they misused in that

period were asked a follow-up question to establish whether they had

ever misused prescription drugs in that category more than 12 months

before being interviewed. Respondents who answered this follow-up

question as “no” were classiﬁed as being past year initiates of the misuse

of any prescription drug in the overall category. is answer meant

respondents had never misused any prescription drug in that category

more than 12 months prior to the interview date.

55. Section 3.4.2 in the following reference discusses the potential for

NSDUH respondents in 2021 to underreport lifetime (but not

past year) misuse of prescription psychotherapeutic drugs: Center for

Behavioral Health Statistics and Quality. (2022). 2021 National Survey

on Drug Use and Health: Methodological summary and deﬁnitions. https://

www.samhsa.gov/data/report/2021-methodological-summary-and

-deﬁnitions

56. 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. (2022). 2021 National Survey

on Drug Use and Health: Methodological summary and deﬁnitions. https://

www.samhsa.gov/data/report/2021-methodological-summary-and

-deﬁnitions

57. 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.

58. Past year initiates of crack cocaine use are counted as past year initiates

of cocaine use only if they initiated any use of cocaine in the past year.

Likewise, past year initiates of LSD, PCP, or Ecstasy use are counted as

past year initiates of hallucinogen use only if respondents had previously

not used other hallucinogens.

59. 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.

60. Center for Behavioral Health Statistics and Quality. (2022). 2021

National Survey on Drug Use and Health: Detailed tables. https://www

.samhsa.gov/data/report/2021-nsduh-detailed-tables

61. American Psychiatric Association. (2013). Diagnostic and statistical

manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books

.9780890425596

62. For more information about the DSM-5 criteria for SUDs, see Section

3.4.3 and the substance-speciﬁc SUD deﬁnitions in Appendix A of the

following reference: Center for Behavioral Health Statistics and Quality.

(2022). 2021 National Survey on Drug Use and Health: Methodological

summary and deﬁnitions. https://www.samhsa.gov/data/report/2021

-methodological-summary-and-deﬁnitions

63. For more information on the 2020 CVS, see Section 3.4.3.4 in the

following reference: Center for Behavioral Health Statistics and Quality.

(2021). 2020 National Survey on Drug Use and Health: Methodological

summary and deﬁnitions. https://

www.samhsa.gov/data/report/2020

-methodological-summary-and-deﬁnitions

64. For alcohol, for example, withdrawal symptoms include (but are not

limited to) trouble sleeping, hands trembling, hallucinations (seeing,

feeling, or hearing things that were not really there), or feeling anxious.

65. For alcohol use disorder, for example, this criterion involves the use

of alcohol, sedatives, or tranquilizers to get over or avoid alcohol

withdrawal symptoms.

66. Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K.,

Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M.,

Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use

disorders: Recommendations and rationale. American Journal of

Psychiatry, 170(8), 834-851. https://

doi.org/10.1176/appi.ajp.2013

.12060782

67. NSDUH respondents in 2021 were asked the respective questions for

alcohol use disorder or marijuana use disorder if they reported use of

these substances on 6 or more days in the past year.

68. 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 their experience with the nine symptoms of

MDE in their lifetime. Adolescents were classiﬁed as having an MDE

in their lifetime if they experienced at least ﬁve of the nine symptoms in

the same 2-week period in their lifetime; at least one of the symptoms

needed to be having a depressed mood or loss of interest or pleasure in

activities that had been enjoyable. Adolescents who reported gaining

weight without trying were asked if their weight gain occurred because

they were growing; this question was not asked of adult respondents.

Adolescent respondents who had a lifetime MDE were asked if they

had a period of 2 weeks or longer in the past 12 months when they felt

depressed or lost interest or pleasure in previously enjoyable activities,

and they reported having some of their other MDE symptoms. ese

adolescents were classiﬁed as having a past year MDE.

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

Results from the 2021 National Survey on Drug Use and Health76 | December 2022

69. 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 their experience with

the nine symptoms of MDE in their lifetime. Adults were classiﬁed

as having an MDE in their lifetime if they experienced at least ﬁve

of the nine symptoms in the same 2-week period in their lifetime; at

least one of the symptoms needed to be having a depressed mood or

loss of interest or pleasure in activities that had been enjoyable. Adult

respondents who had a lifetime MDE were asked if they had a period of

2 weeks or longer in the past 12 months when they felt depressed or lost

interest or pleasure in previously enjoyable activities, and they reported

having some of their other MDE symptoms. ese adults were classiﬁed

as having a past year MDE.

70. Details about the criteria for deﬁning a NSDUH interview as usable

are provided in Section 2.3.1 of CBHSQ (2022). See the following

reference: Center for Behavioral Health Statistics and Quality.

(2022). 2021 National Survey on Drug Use and Health: Methodological

summary and deﬁnitions. https://www.samhsa.gov/data/report/2021

-methodological-summary-and-deﬁnitions

71. Details about imputation procedures, including imputation of adult

MDE data, are provided in Sections 2.3.3 and 3.4.8 of CBHSQ (2022).

See the following reference: Center for Behavioral Health Statistics

and Quality. (2022). 2021 National Survey on Drug Use and Health:

Methodological summary and deﬁnitions. https://www.samhsa.gov/data/

report/2021-methodological-summary-and-deﬁnitions

72. American Psychiatric Association. (1994). Diagnostic and statistical

manual of mental disorders (4th ed.).

73. Follow-up clinical interviews for classifying whether adults had a mental,

behavioral, or emotional disorder in the past year used the Structured

Clinical Interview for the DSM-IV-TR Axis I Disorders, Research

Version, Non-patient Edition (SCID-I/NP). See the following reference:

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002).

Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research

Version, Non-patient Edition (SCID-I/NP). New York State Psychiatric

Institute, Biometrics Research.

74. Hedegaard, H., Curtin, S. C., & Warner, M. (2021, February). Suicide

mortality in the United States, 1999–2019 (NCHS Data Brief No. 398).

https://www.cdc.gov/nchs/products/databriefs/db398.htm

75. Curtin, S. C., Hedegaard, H., & Ahmad, F. B. (2021, November).

Provisional numbers and rates of suicide by month and demographic

characteristics: United States, 2020 (Vital Statistics Rapid Release No.

16). National Center for Health Statistics. https://

doi.org/10.15620/

cdc:110369

76. More recent data from the NVSS indicate an updated number of

45,979 people in 2020 who died by suicide, or an increase of 124

people relative to the provisional data. See Centers for Disease Control

and Prevention, National Center for Health Statistics. National Vital

Statistics System, Mortality 1999-2020 on CDC WONDER Online

Database, released in 2021. Data are from the Multiple Cause of Death

Files, 1999-2020, as compiled from data provided by the 57 vital

statistics jurisdictions through the Vital Statistics Cooperative Program.

Retrieved August 19, 2022, from https://wonder.cdc.gov/ucd-icd10

.html

77. Garnett, M. F., Curtin, S. C., & Stone, D. M. (2022). Suicide mortality

in the United States, 2000–2020 (NCHS Data Brief No. 433). https://

doi.org/10.15620/cdc:114217

78. 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. https://www.cdc.gov/

mmwr/preview/mmwrhtml/ss6013a1.htm

79. Han, B., Kott, P. S., Hughes, A., McKeon, R., Blanco, C., & Compton,

W. M. (2016). Estimating the rates of deaths by suicide among adults

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80. Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur,

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81. McGinty, E. E., Presskreischer, R., Han, H., & Barry, C. L. (2022).

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82. Ettman, C. K., Cohen, G. H., Abdalla, S. M., Sampson, L., Trinquart,

L., Castrucci, B. C., Bork, R. H., Clark, M. A., Wilson, I., Vivier, P. M.,

& Galea, S. (2022). Persistent depressive symptoms during COVID-19:

A national, population-representative, longitudinal study of U.S. adults.

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83. Vahratian, A., Blumberg, S. J., Terlizzi, E. P., & Schiller, J. S. (2021).

Symptoms of anxiety or depressive disorder and use of mental health

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84. orndike, A. N., Fung, V., McCurley, J. L., Clark, C. R., Howard, S.,

& Levy, D. E. (2022). COVID-19 stressors and one-year changes in

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85. Wang, J., Sumner, S. A., Simon, T. R., Crosby, A. E., Annor, F. B.,

Gaylor, E., Xu, L., & Holland, K. M. (2020). Trends in the incidence

and lethality of suicidal acts in the United States, 2006 to 2015. JAMA

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86. Miron, O., Yu, K.-H., Wilf-Miron, R., & Kohane, I. S. (2019). Suicide

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2000-2017. JAMA, 321, 2362-2364. https://doi.org/10.1001/jama

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87. Curtin, S. C. (2020, September). State suicide rates among adolescents

and young adults aged 10–24: United States, 2000–2018. National Vital

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88. Mojtabai, R., & Olfson, M. (2020). National trends in mental health

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89. Mojtabai, R., Olfson, M., & Han, B. (2016). National trends in the

prevalence and treatment of depression in adolescents and young adults.

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90. Examples of ACEs include abuse, neglect, and negative family

interactions. ACEs can occur anytime from birth to age 17.

91. ompson, M. P., Kingree, J. B., & Lamis, D. (2019). Associations of

adverse childhood experiences and suicidal behaviors in adulthood in a

US nationally representative sample. Child: Care, Health and

Development, 45(1), 121-128. https://doi.org/10.1111/cch.12617

92. Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D.

F., & Giles, W. H. (2001). Childhood abuse, household dysfunction,

and the risk of attempted suicide throughout the life span: Findings

from the Adverse Childhood Experiences Study. JAMA, 286(24),

3089-3096. https://doi.org/10.1001/jama.286.24.3089

93. Yard, E., Radhakrishnan, L., Ballesteros, M. F., Sheppard, M., Gates, A.,

Stein, Z., Hartnett, K., Kite-Powell, A., Rodgers, L., Adjemian, J.,

Ehlman, D. C., Holland, K., Idaikkadar, N., Ivey-Stephenson, A.,

Martinez, P., Law, R., & Stone, D. M. (2021). Emergency department

visits for suspected suicide attempts among persons aged 12–25 years

before and during the COVID-19 pandemic — United States, January

2019–May 2021. Morbidity and Mortality Weekly Report, 70(24),

888-894. https://doi.org/10.15585/mmwr.mm7024e1

94. Radhakrishnan, L., Leeb, R. T., Bitsko, R. H., Carey, K., Gates, A.,

Holland, K. M., Hartnett, K. P., Kite-Powell, A., De Vies, J., Smith, A.

R., van Santen, K. L., Crossen, S., Sheppard, M., Wotiz, S., Lane, R. I.,

Njai, R., Johnson, A. G., Winn, A., Kirking, H. L., … Anderson, K. N.

(2022). Pediatric emergency department visits associated with mental

health conditions before and during the COVID-19 pandemic —

United States, January 2019–January 2022. Morbidity and Mortality

Weekly Report, 71(8), 319-324. https://

doi.org/10.15585/mmwr

.mm7108e2

95. Respondents were eligible to be asked the substance use treatment

questions if they reported lifetime use of alcohol, marijuana,

cocaine (including crack), heroin, hallucinogens, inhalants,

or methamphetamine, or the lifetime misuse of prescription

psychotherapeutic drugs (i.e., pain relievers, tranquilizers, stimulants, or

sedatives). Respondents who were lifetime users of tobacco products or

other substances (e.g., kratom) but who did not report lifetime use or

misuse of the substances mentioned in the previous sentence were not

asked the substance use treatment questions.

96. Substance use treatment at a specialty facility refers to substance

use treatment at a hospital (only as an inpatient), a drug or alcohol

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

health center. is NSDUH deﬁnition historically has not considered

emergency rooms, private doctors’ oﬃces, prisons or jails, and self-

help groups to be specialty facilities for the receipt of substance use

treatment.

97. e NSDUH deﬁnition of the need for treatment does not explicitly

indicate the need for treatment at a specialty facility. People with an

illicit drug or alcohol use disorder in the past year can be considered to

need some form of assistance for their problems with substance use. For

more information about having an illicit drug or alcohol use disorder

based on DSM-5 criteria, see Section 3.4.3 and the deﬁnition for illicit

drug or alcohol use disorder in Appendix A of CBHSQ (2022). See the

following references:

American Psychiatric Association. (2013). Diagnostic and statistical

manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books

.9780890425596

Center for Behavioral Health Statistics and Quality. (2022). 2021

National Survey on Drug Use and Health: Methodological summary and

deﬁnitions. https://www.samhsa.gov/data/report/2021-methodological

-summary-and-deﬁnitions

98. ere were 42.9 million people aged 12 or older in 2021 with an

illicit drug or alcohol use disorder in the past year. Approximately

98 percent of the people in 2021 who needed treatment for a substance

use problem were classiﬁed as such because they had an illicit drug or

alcohol use disorder in the past year, regardless of whether they received

substance use treatment at a specialty facility.

99. Substance Abuse and Mental Health Services Administration. (2020).

Opioid treatment program (OTP) guidance. https://www.samhsa.gov/

sites/default/ﬁles/otp-guidance-20200316.pdf

100. Drug Enforcement Administration. (2020). Use of telephone evaluations

to initiate buprenorphine prescribing. https://www.deadiversion.usdoj

.gov/GDP/(DEA-DC-022)(DEA068)%20DEA%20SAMHSA%20

buprenorphine%20telemedicine%20%20(Final)%20+Esign.pdf

101. Centers for Medicare & Medicaid Services. (2022). Billing & payment:

COVID-19: CMS allowing audio-only calls for OTP therapy, counseling,

and periodic assessments. https://www.cms.gov/Medicare/Medicare-Fee

-for-Service-Payment/Opioid-Treatment-Program/billing-payment

102. U.S. Department of Health and Human Services. (2021). Best practice

guide: Telehealth for behavioral health care: Billing for telebehavioral

health. https://telehealth.hhs.gov/providers/telehealth-for

-behavioral

-health/billing-for-telebehavioral-health/

103. Centers for Medicare & Medicaid Services. (2022). Opioid treatment

programs (OTP). https://www.cms.gov/Medicare/Medicare-Fee-for

-Service-Payment/Opioid-Treatment-Program

104. Lin, L., Casteel, D., Shigekawa, E., Weyrich, M. S., Roby, D. H., &

McMenamin, S. B. (2019). Telemedicine-delivered treatment

interventions for substance use disorders: A systematic review. Journal of

Substance Abuse Treatment, 101, 38-49. https://

doi.org/10.1016/j.jsat

.2019.03.007

105. Fiacco, L., Pearson, B. L., & Jordan, R. (2021). Telemedicine works for

treating substance use disorder: e STAR clinic experience during

COVID-19. Journal of Substance Abuse Treatment, 125. https://doi.org/

10.1016/j.jsat.2021.108312

106. Weintraub, E., Seneviratne, C., Anane, J., Coble, K., Magidson, J.,

Kattakuzhy, S., Greenblatt, A., Welsh, C., Pappas, A., Ross, T. L., &

Belcher, A. M. (2021). Mobile telemedicine for buprenorphine

treatment in rural populations with opioid use disorder. JAMA Network

Open, 4(8), e2118487. https://

doi.org/10.1001/jamanetworkopen.2021

.18487

107. Benavides-Vaello, S., Strode, A., & Sheeran, B. C. (2013). Using

technology in the delivery of mental health and substance abuse

treatment in rural communities: A review. Journal of Behavioral Health

Services & Research, 40, 111-120. https://

doi.org/10.1007/s11414-012

-9299-6

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

Results from the 2021 National Survey on Drug Use and Health78 | December 2022

108. Cantor, J., McBain, R. K., Kofner, A., Hanson, R., Stein, B. D., & Yu,

H. (2022). Telehealth adoption by mental health and substance use

disorder treatment facilities in the COVID-19 pandemic. Psychiatric

Services, 73

(4), 411-417. https://doi.org/10.1176/appi.ps

.202100191

109. e estimated number of adults who received substance use treatment

at a specialty facility in the past year is the same regardless of whether

the estimate is among the total population or among people who needed

treatment. Percentages diﬀer depending on whether the denominator

is among the total population or among the subgroup of people who

needed treatment.

110. As per the deﬁnition of the need for substance use treatment, people

with an illicit drug or alcohol use disorder were classiﬁed as needing

substance use treatment.

111. Due to rounding, estimated numbers and percentages of people in

Figure 60 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.

112. Respondents who did not report receiving substance use treatment

in the past year were not asked if they received telehealth services as

substance use treatment. erefore, reasons for not receiving treatment

in 2021 can include reasons for not receiving telehealth services.

113. Waugh, M., Voyles, D., & omas, M. R. (2015). Telepsychiatry:

Beneﬁts and costs in a changing health-care environment. International

Review of Psychiatry, 27, 558-568. https://doi.org/10.3109/09540261

.2015.1091291

114. Spivak, S., Spivak, A., Cullen, B., Meuchel, J., Johnston, D., Chernow,

R., Green, C., & Mojtabai, R. (2019). Telepsychiatry use in U.S. mental

health facilities, 2010–2017. Psychiatric Services, 71(2), 121-127.

https://

doi.org/10.1176/appi.ps.201900261

115. Reay, R. E., Looi, J. C. L., & Keightley, P. (2020). Telehealth mental

health services during COVID-19: Summary of evidence and clinical

practice. Australasian Psychiatry, 28, 514-516. https://doi.org/10.1177/

1039856220943032

116. Guaiana, G., Mastrangelo, J., Hendrikx, S., & Barbui, C. (2021). A

systematic review of the use of telepsychiatry in depression. Community

Mental Health Journal, 57, 93-100. https://doi.org/10.1007/s10597-020

-00724-2

117. 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.

118. 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.

119. Compton, W. M., omas, Y. F., Stinson, F. S., & Grant, B. F. (2007).

Prevalence, correlates, disability, and comorbidity of DSM-IV drug

abuse and dependence in the United States: Results from the National

Epidemiologic Survey on Alcohol and Related Conditions. Archives of

General Psychiatry, 64, 566-576. https://

doi.org/10.1001/archpsyc.64.5

.566

120. Mojtabai, R., Chen, L.-Y., Kaufmann, C. N., & Crum, R. M. (2014).

Comparing barriers to mental health treatment and substance use

disorder treatment among individuals with comorbid major depression

and substance use disorders. Journal of Substance Abuse Treatment, 46,

268-273. https://

doi.org/10.1016/j.jsat.2013.07.012

121. Hartz, S. M., Pato, C. N., Medeiros, H., Cavazos-Rehg, P., Sobell, J. L.,

Knowles, J. A., Bierut, L. J., & Pato, M. T. (2014). Comorbidity of

severe psychotic disorders with measures of substance use. JAMA

Psychiatry, 71, 248-254. https://doi.org/10.1001/jamapsychiatry.2013

.3726

122. Watkins, K. E., Hunter, S. B., Burnam, M. A., Pincus, H. A., &

Nicholson, G. (2005). Review of treatment recommendations for

persons with a co-occurring aﬀective or anxiety and substance use

disorder. Psychiatric Services, 56, 913-926. https://doi.org/10.1176/appi

.ps.56.8.913

123. Pettinati, H. M., O’Brien, C. P., & Dundon, W. D. (2013). Current

status of co-occurring mood and substance use disorders: A new

therapeutic target. American Journal of Psychiatry, 170, 23-30. https://

doi.org/10.1176/appi.ajp.2012.12010112

124. Han, B., Compton, W. M., Blanco, C., & Colpe, L. J. (2017).

Prevalence, treatment, and unmet treatment needs of US adults with

mental health and substance use disorders. Health Aﬀairs (Millwood),

36, 1739-1747. https://

doi.org/10.1377/hlthaﬀ.2017.0584

125. Centers for Disease Control and Prevention. (n.d.). COVID Data

Tracker: Trends in number of COVID-19 cases and deaths in the US

reported to CDC, by state/territory. Retrieved June 18, 2021, from

https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases

126. National Institute on Alcohol Abuse and Alcoholism. (2022). Digest of

state alcohol-related laws during the COVID-19 emergency for on-premise

and oﬀ-premise establishments. Alcohol Policy Information System

(APIS). https://

alcoholpolicy.niaaa.nih.gov/resource/covid-19/98

127. Use of drugs included the use of marijuana, cocaine (including crack),

heroin, hallucinogens, inhalants, or methamphetamine in the past year

or any use (i.e., not necessarily misuse) of prescription pain relievers,

tranquilizers, stimulants, or sedatives in the past year. Drugs did not

include tobacco products or nicotine vaping.

128. U.S. Department of Health and Human Services. (2021, May). What

is telehealth? Retrieved July 27, 2021, from https://telehealth.hhs.gov/

patients/understanding-telehealth/

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

Results from the 2021 National Survey on Drug Use and Health December 2022 | A-1

Appendix A: Special Tables of Estimates for Substance Use and Mental Health Indicators

in the United States

A-2

Table A.1B Use of Illicit Drugs, Tobacco Products, Alcohol, and Vaping Devices in the Past Month:

Among People Aged 12 or Older; by Age Group, 2021

Substance 12 or Older 12 to 17 18 to 25 26 or Older 12 to 20

GENERAL SUBSTANCE USE

Illicit Drugs, Tobacco Products,

or Alcohol 57.8 (0.41) 11.8 (0.50) 58.5 (0.76) 63.1 (0.48) 21.4 (0.52)

Illicit Drugs or Alcohol 51.8 (0.41) 11.3 (0.49) 56.5 (0.76) 55.9 (0.49) 20.5 (0.52)

Tobacco Products or Alcohol 55.5 (0.40) 8.2 (0.44) 54.3 (0.76) 61.2 (0.48) 17.2 (0.47)

ILLICIT DRUGS 14.3 (0.28) 7.1 (0.39) 25.3 (0.65) 13.5 (0.32) 11.6 (0.42)

Marijuana 13.0 (0.27) 5.8 (0.36) 24.1 (0.64) 12.2 (0.31) 10.5 (0.40)

TOBACCO PRODUCTS

OR NICOTINE VAPING

1,2

22.0 (0.34) 6.7 (0.37) 24.7 (0.59) 23.4 (0.42) 11.0 (0.37)

Tobacco Products

19.5 (0.34) 2.6 (0.25) 16.8 (0.51) 22.0 (0.41) 5.4 (0.26)

Cigarettes 15.6 (0.32) 1.5 (0.19) 11.5 (0.43) 17.9 (0.38) 3.4 (0.22)

Daily Cigarette Smoking

61.9 (0.96) * (*) 27.6 (1.66) 65.8 (1.02) 19.0 (2.72)

Smoked 1+ Packs

of Cigarettes per Day

41.9 (1.32) * (*) 24.2 (2.71) 42.7 (1.37) 13.1 (3.79)

Smokeless Tobacco 2.6 (0.13) 0.6 (0.11) 2.9 (0.21) 2.8 (0.16) 0.9 (0.11)

Cigars 3.7 (0.15) 0.7 (0.12) 5.3 (0.29) 3.8 (0.18) 1.8 (0.16)

Pipe Tobacco 0.6 (0.06) 0.2 (0.07) 1.0 (0.13) 0.6 (0.08) 0.4 (0.08)

Nicotine Vaping

4.7 (0.14) 5.2 (0.33) 14.1 (0.50) 3.2 (0.16) 8.1 (0.34)

ALCOHOL 47.5 (0.41) 7.0 (0.42) 50.1 (0.77) 51.9 (0.49) 15.1 (0.46)

Binge Alcohol Use 21.5 (0.31) 3.8 (0.32) 29.2 (0.69) 22.4 (0.37) 8.3 (0.36)

Heavy Alcohol Use 5.8 (0.18) 0.4 (0.11) 7.1 (0.36) 6.3 (0.22) 1.6 (0.16)

ANY VAPING

6.6 (0.17) 6.5 (0.38) 17.3 (0.52) 5.0 (0.20) 9.7 (0.37)

Marijuana

2.7 (0.10) 2.3 (0.22) 6.5 (0.33) 2.1 (0.12) 3.7 (0.23)

Flavoring (with No Other

Substance)

1.3 (0.08) 1.8 (0.19) 3.3 (0.26) 0.9 (0.10) 2.3 (0.18)

* Low precision; no estimate reported.

NOTE: Estimates shown are percentages with standard errors included in parentheses.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

Tobacco products include cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or

pipe tobacco. Use of any tobacco product does not include nicotine vaping because people could have used a

vaping device to vape nicotine-containing products other than tobacco.

Nicotine vaping refers to the use of an e-cigarette or other vaping device to vape nicotine or tobacco.

Percentages for daily cigarette smoking are among past month cigarette smokers.

Percentages for smoking one or more packs of cigarettes per day are among daily cigarette smokers in the past

month. Respondents with missing data for the number of cigarettes smoked per day were excluded from the

analysis.

NSDUH respondents were asked if they vaped anything with an e-cigarette or other vaping device. People who

vaped any substance could have used vaping devices to vape substances other than nicotine, marijuana, or

flavoring.

Marijuana vaping refers to the use of an e-cigarette or other vaping device to vape marijuana.

Vaping of flavoring refers to the use of an e-cigarette or other vaping device to vape flavoring.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-3

Table A.2B Type of Nicotine Product Use: Among Past Month Nicotine Product Users Aged 12 or Older;

by Age Group, 2021

Nicotine Product Use

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

Only Nicotine Vaping

11.2 (0.43) 60.5 (2.74) 32.2 (1.35) 6.2 (0.41)

Nicotine Vaping and Tobacco Products

2,3

10.2 (0.44) 18.2 (2.36) 25.0 (1.22) 7.6 (0.49)

Nicotine Vaping and Only Cigarettes

6.2 (0.36) 8.9 (1.73) 12.6 (0.89) 5.1 (0.42)

Nicotine Vaping, Cigarettes, and Noncigarette

Tobacco Products

2,4

1.9 (0.19) 1.8 (0.69) 4.9 (0.50) 1.4 (0.20)

Nicotine Vaping and Only Noncigarette

Tobacco Products

2,4

2.1 (0.19) 7.6 (1.62) 7.5 (0.82) 1.1 (0.17)

Only Tobacco Products

78.6 (0.61) 21.2 (2.37) 42.8 (1.38) 86.2 (0.64)

NOTE: Estimates shown are percentages with standard errors included in parentheses. Percentages for only

nicotine vaping, nicotine vaping and tobacco products, and only tobacco products in an age group category

may not add to 100 percent due to rounding.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables

. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

Nicotine product use refers to the use of tobacco or nicotine vaping.

Nicotine vaping refers to the use of an e-cigarette or other vaping device to vape nicotine or tobacco.

Tobacco products include cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or

pipe tobacco. Use of any tobacco product does not include nicotine vaping because people could have used a

vaping device to vape nicotine-containing products other than tobacco.

Noncigarette tobacco products include smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or

pipe tobacco.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

Table A.3B Type of Tobacco Product Use: Among Past Month Tobacco Product Users Aged 12 or Older;

by Age Group, 2021

Tobacco Product Use

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

Only Cigarettes 67.5 (0.85) 48.0 (5.10) 51.2 (1.58) 69.6 (0.92)

Cigarettes and Noncigarette Tobacco Products

12.3 (0.57) 9.5 (2.43) 17.2 (1.13) 11.8 (0.63)

Only Noncigarette Tobacco Products

20.3 (0.73) 42.5 (4.84) 31.6 (1.50) 18.6 (0.78)

NOTE: Estimates shown are percentages with standard errors included in parentheses. Percentages in an age group

category may not add to 100 percent due to rounding.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

Tobacco products include cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or

pipe tobacco. Use of any tobacco product does not include nicotine vaping because people could have used a

vaping device to vape nicotine-containing products other than tobacco.

Noncigarette tobacco products include smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, or

pipe tobacco.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-4

Table A.4B Type of Marijuana Use: Among Past Month Marijuana Users Aged 12 or Older; by Age Group,

2021

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

Marijuana Vaping 20.5 (0.68) 40.0 (2.87) 27.0 (1.17) 17.4 (0.84)

Marijuana Use but Not Marijuana Vaping 79.5 (0.68) 60.0 (2.87) 73.0 (1.17) 82.6 (0.84)

NOTE: Estimates shown are percentages with standard errors included in parentheses.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

Table A.5B Type of Vaping Use: Among Past Month Users Aged 12 or Older Who Vaped Any Substance;

by Age Group, 2021

Vaping Use

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

Nicotine Vaping

71.1 (1.14) 80.6 (2.14) 81.9 (1.26) 64.1 (1.76)

Marijuana Vaping

40.1 (1.24) 35.5 (2.90) 37.7 (1.63) 42.0 (1.78)

Vaping of Flavoring

19.2 (1.09) 27.3 (2.41) 19.3 (1.36) 18.0 (1.62)

ONLY ONE OF THE THREE SUBSTANCES 65.0 (1.20) 52.5 (2.75) 57.3 (1.58) 70.9 (1.70)

Nicotine Vaping (No Marijuana Vaping

or Vaping of Flavoring)

2,3,4

41.8 (1.22) 40.2 (2.86) 44.7 (1.56) 40.5 (1.74)

Marijuana Vaping (No Nicotine Vaping

or Vaping of Flavoring)

2,3,4

20.0 (1.05) 5.8 (1.50) 10.1 (0.92) 27.3 (1.65)

Vaping of Flavoring (No Nicotine Vaping

or Marijuana Vaping)

2,3,4

3.2 (0.46) 6.5 (1.36) 2.4 (0.46) 3.1 (0.70)

TWO OF THE THREE SUBSTANCES 25.0 (1.11) 32.6 (2.65) 32.5 (1.51) 20.0 (1.57)

Nicotine Vaping and Marijuana Vaping

(No Vaping of Flavoring)

2,3,4

14.1 (0.78) 20.3 (2.29) 21.2 (1.41) 9.5 (1.01)

Nicotine Vaping and Vaping of Flavoring

(No Marijuana Vaping)

2,3,4

10.1 (0.94) 11.5 (1.70) 10.5 (1.12) 9.7 (1.39)

Marijuana Vaping and Vaping of Flavoring

(No Nicotine Vaping)

2,3,4

0.8 (0.22) 0.8 (0.49) 0.9 (0.32) 0.8 (0.32)

ALL THREE SUBSTANCES (Nicotine

Vaping, Marijuana Vaping, and Vaping

of Flavoring)

2,3,4

5.1 (0.52) 8.6 (1.38) 5.6 (0.70) 4.4 (0.74)

OTHER SUBSTANCES UNKNOWN

4.8 (0.48) 6.3 (1.37) 4.7 (0.73) 4.7 (0.66)

NOTE: Estimates shown are percentages with standard errors included in parentheses. Percentages in an age group

category corresponding to each bold header row may not add to 100 percent due to rounding.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables

. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

NOTE: Overall estimates for nicotine vaping, marijuana vaping, and vaping of flavoring are not mutually

exclusive.

NSDUH respondents were asked if they vaped anything with an e-cigarette or other vaping device. People who

vaped any substance could have used vaping devices to vape substances other than nicotine, marijuana, or

flavoring.

Nicotine vaping refers to the use of an e-cigarette or other vaping device to vape nicotine or tobacco.

Marijuana vaping refers to the use of an e-cigarette or other vaping device to vape marijuana.

Vaping of flavoring refers to the use of an e-cigarette or other vaping device to vape flavoring.

NSDUH respondents who reported that they vaped any substance were asked only about vaping of nicotine,

marijuana, or flavoring. If respondents reported that they vaped any substance but did not report vaping nicotine,

marijuana, or flavoring, then other substances respondents could have vaped are unknown.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-5

Table A.6B Types of Illicit Drug, Tobacco Product, Alcohol, and Other Substance Use in the Past Year:

Among People Aged 12 or Older; by Age Group, 2021

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

GENERAL SUBSTANCE USE

Illicit Drugs, Tobacco Products, or Alcohol 69.9 (0.38) 24.1 (0.62) 72.6 (0.68) 74.9 (0.44)

Illicit Drugs or Alcohol 65.9 (0.40) 23.4 (0.61) 71.1 (0.69) 70.1 (0.47)

Tobacco Products or Alcohol 67.8 (0.39) 19.3 (0.59) 69.7 (0.68) 73.2 (0.45)

ILLICIT DRUGS 21.9 (0.33) 14.1 (0.53) 38.0 (0.71) 20.3 (0.38)

TOBACCO PRODUCTS OR NICOTINE

VAPING 26.4 (0.36) 11.2 (0.47) 33.7 (0.66) 27.2 (0.44)

Tobacco Products

23.9 (0.36) 5.5 (0.35) 25.9 (0.61) 25.8 (0.43)

Cigarettes 18.7 (0.33) 3.6 (0.30) 18.6 (0.53) 20.5 (0.40)

Smokeless Tobacco 3.5 (0.15) 1.4 (0.17) 4.7 (0.26) 3.6 (0.18)

Cigars 6.7 (0.20) 2.1 (0.22) 11.3 (0.44) 6.5 (0.24)

Pipe Tobacco

-- -- -- --

Nicotine Vaping

6.8 (0.17) 8.5 (0.42) 19.8 (0.54) 4.6 (0.18)

ALCOHOL 62.3 (0.41) 17.8 (0.56) 67.1 (0.71) 66.8 (0.48)

OTHER SUBSTANCE USE

GHB 0.1 (0.04) 0.0 (0.02) 0.0 (0.02) 0.1 (0.05)

Nonprescription Cough or Cold Medicine 0.6 (0.05) 0.7 (0.13) 0.7 (0.10) 0.5 (0.06)

Kratom 0.6 (0.05) 0.2 (0.06) 0.8 (0.12) 0.6 (0.07)

Synthetic Marijuana (Fake Weed, K2, Spice) 0.2 (0.02) 0.4 (0.12) 0.5 (0.10) 0.1 (0.02)

Synthetic Stimulants (“Bath Salts,” Flakka) 0.0 (0.01) 0.1 (0.03) 0.1 (0.05) 0.0 (0.01)

-- = not available; GHB = gamma hydroxybutyrate.

NOTE: Estimates shown are percentages with standard errors included in parentheses.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.

Information about past year use of pipe tobacco was not collected. Tobacco product use in the past year excludes

past year pipe tobacco use but includes past month pipe tobacco use.

Nicotine vaping refers to the use of an e-cigarette or other vaping device to vape nicotine or tobacco.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-6

Table A.7B Types of Illicit Drug Use in the Past Year: Among People Aged 12 or Older; by Age Group, 2021

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

ILLICIT DRUGS 21.9 (0.33) 14.1 (0.53) 38.0 (0.71) 20.3 (0.38)

Marijuana 18.7 (0.32) 10.5 (0.46) 35.4 (0.70) 17.2 (0.37)

Cocaine

1.7 (0.09) 0.2 (0.05) 3.5 (0.29) 1.6 (0.10)

Crack 0.4 (0.05) 0.0 (0.01) 0.2 (0.08) 0.4 (0.06)

Heroin 0.4 (0.05) * (*) 0.2 (0.05) 0.5 (0.07)

Hallucinogens 2.6 (0.11) 1.3 (0.16) 7.1 (0.35) 2.1 (0.12)

LSD 0.9 (0.05) 1.0 (0.14) 3.0 (0.24) 0.6 (0.05)

PCP 0.1 (0.02) 0.1 (0.03) 0.2 (0.06) 0.0 (0.03)

Ecstasy 0.8 (0.06) 0.4 (0.08) 2.1 (0.19) 0.6 (0.07)

Inhalants 0.8 (0.05) 2.4 (0.20) 1.5 (0.16) 0.5 (0.06)

Methamphetamine 0.9 (0.08) 0.1 (0.05) 0.5 (0.09) 1.1 (0.10)

Misuse of Prescription Psychotherapeutics 5.1 (0.16) 3.3 (0.28) 7.4 (0.35) 5.0 (0.19)

Pain Relievers 3.1 (0.13) 1.9 (0.20) 3.0 (0.23) 3.3 (0.16)

Stimulants 1.3 (0.07) 1.2 (0.16) 3.7 (0.26) 1.0 (0.08)

Tranquilizers or Sedatives 1.7 (0.09) 0.9 (0.18) 2.6 (0.21) 1.7 (0.10)

Tranquilizers 1.5 (0.08) 0.8 (0.18) 2.4 (0.20) 1.5 (0.10)

Sedatives 0.3 (0.03) 0.2 (0.05) 0.4 (0.07) 0.3 (0.04)

Benzodiazepines 1.4 (0.08) 0.7 (0.17) 2.4 (0.20) 1.3 (0.09)

Misuse of Opioids 3.3 (0.13) 1.9 (0.20) 3.1 (0.23) 3.5 (0.16)

Misuse of Central Nervous System Stimulants 3.3 (0.13) 1.3 (0.17) 6.3 (0.35) 3.1 (0.15)

* Low precision; no estimate reported.

LSD = lysergic acid diethylamide; PCP = phencyclidine.

NOTE: Estimates shown are percentages with standard errors included in parentheses.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables

. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-7

Table A.8B Misuse of Prescription Pain Reliever Subtypes in the Past Year: Among People Aged 12 or

Older, Among Past Year Misusers of Prescription Pain Relievers Aged 12 or Older, and Among

All Past Year Users of Prescription Pain Reliever Subtypes Aged 12 or Older; Percentages, 2021

Prescription Pain Reliever

Subtype

Past Year Misuse

among People Aged

12 or Older

Misuse in the Past Year

among Past Year

Misusers of Prescription

Pain Relievers

Misuse in the Past Year

among All Past Year

Users of Prescription

Pain Reliever Subtypes

ANY PRESCRIPTION

PAIN RELIEVER 3.1 (0.13) 100.0 (0.00) 12.2 (0.48)

Hydrocodone Products

1.4 (0.09) 46.9 (2.13) 11.4 (0.71)

Oxycodone Products

0.9 (0.07) 30.4 (1.82) 12.8 (0.87)

Tramadol Products

0.5 (0.05) 16.1 (1.60) 9.7 (0.96)

Codeine Products

0.8 (0.07) 26.4 (2.06) 11.5 (0.98)

Morphine Products

0.2 (0.03) 4.9 (0.83) 8.7 (1.41)

Fentanyl Products

0.2 (0.04) 6.2 (1.09) 20.9 (3.40)

Buprenorphine Products

0.3 (0.04) 8.9 (1.29) 22.2 (2.95)

Oxymorphone Products

0.1 (0.02) 1.8 (0.51) 15.9 (4.19)

Demerol 0.0 (0.01) 0.7 (0.33) * (*)

Hydromorphone Products

0.1 (0.02) 2.2 (0.49) 11.8 (2.75)

Methadone

0.1 (0.03) 3.7 (1.03) * (*)

* Low precision; no estimate reported.

NOTE: Percentages for misuse in the past year among people aged 12 or older and among past year misusers of

prescription pain relievers are not mutually exclusive because people could have misused prescription pain

relievers in more than one subtype.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables

. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.

NOTE: Respondents with unknown prescription drug subtype information were excluded from the respective

analyses.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-8

Table A.9B Main Reason for the Last Episode of Misuse: Among People Aged 12 or Older Who Misused

Prescription Pain Relievers in the Past Year; 2021

Main Reason for Misuse

Past Year Misusers of

Prescription Pain Relievers

Relieve Physical Pain 64.3 (2.01)

Relax or Relieve Tension 7.3 (0.96)

Help with Sleep 4.8 (1.04)

Help with Feelings or Emotions 2.6 (0.41)

Experiment or See What It’s Like 2.8 (0.70)

Feel Good or Get High 10.7 (1.27)

Increase or Decrease Effect of Other Drug 1.2 (0.58)

Because I Am Hooked or Have to Have It 4.7 (1.19)

Some Other Reason

1.4 (0.46)

NOTE: Estimates shown are percentages with standard errors included in parentheses. Percentages may not add to

100 percent due to rounding.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables

. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

NOTE: Respondents with unknown information for their main reason for misuse were excluded from the analysis,

including respondents who reported some other reason but had unknown data in their write-in responses.

Responses to the Some Other Reason category for one drug type may fall into a response category that is asked

only for another drug type (e.g., “to relieve physical pain” for tranquilizer misuse).

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

Table A.10B Source Where Prescription Pain Relievers Were Obtained for Most Recent Misuse: Among

People Aged 12 or Older Who Misused Prescription Pain Relievers in the Past Year; 2021

Source for Most Recent Misuse

Past Year Misusers of

Prescription Pain Relievers

GOT THROUGH PRESCRIPTION(S) OR STOLE FROM A HEALTH

CARE PROVIDER 43.2 (2.28)

Prescription from One Doctor 39.3 (2.22)

Prescriptions from More Than One Doctor 3.2 (0.86)

Stole from Doctor’s Office, Clinic, Hospital, or Pharmacy 0.7 (0.31)

GIVEN BY, BOUGHT FROM, OR TOOK FROM A FRIEND OR

RELATIVE 44.9 (2.20)

From Friend or Relative for Free 33.9 (2.08)

Bought from Friend or Relative 7.3 (0.99)

Took from Friend or Relative without Asking 3.7 (0.76)

BOUGHT FROM DRUG DEALER OR OTHER STRANGER 7.9 (1.05)

SOME OTHER WAY

4.0 (0.88)

NOTE: Estimates shown are percentages with standard errors included in parentheses. Estimates for specific

sources may not add to the aggregate estimates for general sources shown in all capital letters due to

rounding.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables

. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

NOTE: Respondents were asked to choose one of eight sources as their best answer. Respondents with unknown

data on Source for Most Recent Misuse and respondents with unknown or invalid responses to the

corresponding other-specify questions were excluded from the analysis.

Some Other Way includes write-in responses not already listed in this table or responses with insufficient

information that could allow them to be placed in another category.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-9

Table A.11A Past Year Initiation of Specific Substance Use: Among People Aged 12 or Older; by Age

Group, 2021

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

ILLICIT DRUGS nr nr nr nr

Marijuana 2,616 (157) 869 (65) 1,128 (83) 620 (104)

Cocaine 478 (75) 20 (9) 277 (46) 181 (49)

Crack 50 (20) 3 (2) 19 (11) 28 (17)

Heroin 26 (9) * (*) 11 (6) 16 (7)

Hallucinogens 1,291 (99) 176 (28) 687 (65) 427 (67)

LSD 667 (68) 135 (26) 366 (45) 167 (40)

PCP 90 (61) 12 (8) 15 (8) 63 (60)

Ecstasy 533 (69) 56 (16) 259 (39) 218 (56)

Inhalants 385 (44) 160 (25) 157 (30) 68 (20)

Methamphetamine 101 (20) 24 (11) 25 (7) 52 (16)

Misuse of Prescription

Psychotherapeutics nr nr nr nr

Pain Relievers 1,821 (178) 130 (26) 269 (43) 1,421 (172)

Stimulants 773 (85) 154 (31) 310 (49) 309 (60)

Tranquilizers or Sedatives nr nr nr nr

Tranquilizers 881 (118) 61 (17) 225 (35) 595 (109)

Sedatives 188 (48) 14 (7) 46 (15) 128 (45)

CIGARETTES 1,187 (99) 362 (50) 705 (70) 120 (43)

Daily Cigarette Use 304 (58) 28 (10) 127 (23) 149 (52)

SMOKELESS TOBACCO 503 (61) 126 (24) 189 (34) 187 (43)

CIGARS 1,348 (88) 267 (41) 755 (69) 326 (55)

ALCOHOL 4,123 (163) 1,826 (98) 2,069 (108) 228 (66)

* Low precision; no estimate reported.

LSD = lysergic acid diethylamide; nr = not reported due to measurement issues; PCP = phencyclidine.

NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables

. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-10

Table A.12AB First Use before or after Age 21 of Marijuana, Cigarettes, and Alcohol: Among People Aged

12 or Older Who Initiated Use of Specific Substances in the Past Year, 2021

Substance Number of Past Year Initiates

Percentage of Past Year Initiates

Marijuana

First Use before Age 21 1,578 (102) 60.3 (3.05)

First Use at Age 21 or Older 1,038 (118) 39.7 (3.05)

Cigarettes

First Use before Age 21 875 (80) 73.7 (3.64)

First Use at Age 21 or Older 312 (54) 26.3 (3.64)

Alcohol

First Use before Age 21 3,000 (139) 72.8 (1.92)

First Use at Age 21 or Older 1,123 (98) 27.2 (1.92)

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

Estimates shown are numbers in thousands with standard errors included in parentheses.

Estimates shown are percentages with standard errors included in parentheses.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

Table A.13B Perceived Great Risk of Harm Associated with Selected Substance Use: Among People Aged

12 or Older; by Age Group, 2021

Substance/Perception of Great Risk

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

Cigarettes

Smoke One or More Packs per Day 69.2 (0.38) 64.8 (0.70) 64.7 (0.67) 70.4 (0.45)

Marijuana

Smoke Once a Month 21.6 (0.38) 23.3 (0.67) 11.6 (0.46) 22.9 (0.47)

Smoke Once or Twice a Week 26.5 (0.38) 35.0 (0.75) 15.2 (0.55) 27.3 (0.46)

Cocaine

Use Once a Month 66.2 (0.36) 50.7 (0.70) 58.8 (0.74) 69.2 (0.43)

Use Once or Twice a Week 83.7 (0.27) 77.9 (0.60) 80.8 (0.58) 84.8 (0.32)

Heroin

Try Once or Twice 82.1 (0.26) 58.7 (0.75) 78.3 (0.65) 85.4 (0.31)

Use Once or Twice a Week 92.3 (0.20) 79.4 (0.60) 92.0 (0.45) 93.9 (0.23)

Alcohol

Have Four or Five Drinks Nearly Every Day 68.4 (0.35) 66.2 (0.68) 64.6 (0.69) 69.3 (0.42)

NOTE: Estimates shown are percentages with standard errors included in parentheses.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

Respondents with unknown Perception of Great Risk data were excluded.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-11

Table A.14B Comparison of Substance Use Disorder Estimates from All Past Year Users of Prescription

Drugs or Past Year Misusers of Prescription Drugs: Among People Aged 12 or Older; by Age

Group, 2021

Disorder

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

DRUGS OR ALCOHOL

1,2

16.5 (0.28) 8.5 (0.43) 25.6 (0.62) 16.1 (0.33)

DRUGS

1,2

8.6 (0.20) 6.8 (0.38) 16.3 (0.51) 7.6 (0.23)

Any Use of Prescription

Psychotherapeutics

2.6 (0.11) 2.1 (0.19) 2.7 (0.22) 2.7 (0.13)

Pain Relievers

1.8 (0.09) 1.0 (0.14) 1.2 (0.16) 2.0 (0.12)

Stimulants

0.5 (0.04) 0.9 (0.14) 1.1 (0.13) 0.4 (0.05)

Tranquilizers or Sedatives

0.8 (0.06) 0.5 (0.08) 0.9 (0.13) 0.8 (0.07)

Tranquilizers

0.6 (0.05) 0.3 (0.08) 0.7 (0.11) 0.6 (0.06)

Sedatives

0.3 (0.04) 0.2 (0.06) 0.3 (0.07) 0.3 (0.06)

Any Use of Opioids

2.0 (0.10) 1.0 (0.14) 1.3 (0.16) 2.2 (0.13)

Any Use of Central Nervous

System Stimulants

1.5 (0.09) 1.0 (0.14) 1.9 (0.17) 1.5 (0.11)

ILLICIT DRUGS OR

ALCOHOL 15.3 (0.27) 7.5 (0.40) 24.9 (0.61) 14.8 (0.32)

ILLICIT DRUGS 7.2 (0.18) 5.7 (0.36) 15.5 (0.52) 6.1 (0.21)

Misuse of Prescription

Psychotherapeutics 1.0 (0.06) 0.8 (0.13) 1.5 (0.15) 1.0 (0.08)

Pain Relievers

0.7 (0.06) 0.5 (0.09) 0.7 (0.10) 0.7 (0.07)

Stimulants

0.3 (0.03) 0.3 (0.09) 0.7 (0.10) 0.2 (0.03)

Tranquilizers

or Sedatives

0.3 (0.03) 0.2 (0.07) 0.5 (0.09) 0.3 (0.03)

Tranquilizers

0.3 (0.03) 0.2 (0.06) 0.5 (0.09) 0.2 (0.03)

Sedatives

0.1 (0.02) 0.0 (0.02) 0.1 (0.03) 0.1 (0.02)

Misuse of Opioids

0.9 (0.07) 0.5 (0.09) 0.8 (0.10) 1.0 (0.08)

Misuse of Central Nervous

System Stimulants

1.2 (0.08) 0.4 (0.09) 1.5 (0.15) 1.3 (0.10)

NOTE: Estimates shown are percentages with standard errors included in parentheses.

NOTE: Additional estimates may be found in Results from the 2021 National Survey on Drug Use and Health:

Detailed Tables at https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables. Measures and terms

are defined in Appendix A of the 2021 Detailed Tables.

NOTE: Estimates of 0.0 percent round to less than 0.1 percent when shown to the nearest tenth of a percent.

NOTE: Substance use disorder estimates are based on criteria from the Diagnostic and Statistical Manual of

Mental Disorders, 5th edition.

Drug use includes the use of marijuana (including vaping), cocaine (including crack), heroin, hallucinogens,

inhalants, or methamphetamine in the past year or any use (i.e., not necessarily misuse) of prescription pain

relievers, tranquilizers, stimulants, or sedatives in the past year.

Beginning with the 2021 NSDUH, questions on prescription drug use disorder were asked of all past year users of

prescription drugs, regardless of whether they misused prescription drugs. These estimates include prescription

drug use data from all past year users of prescription drugs. See the 2021 National Survey on Drug Use and Health

(NSDUH): Methodological Summary and Definitions for details on these changes.

Estimates for pain reliever, stimulant, tranquilizer or sedative, tranquilizer, and sedative use disorders are for

people who misused these prescription drugs in the past year. Estimates for opioid use disorder are for people who

used heroin or misused prescription pain relievers in the past year. Estimates for central nervous system stimulant

use disorder are for people who used cocaine or methamphetamine in the past year or who misused prescription

stimulants in the past year. See the 2021 Methodological Summary and Definitions for details on these changes.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health,

2021.

A-12

Table A.15B Substance Use Disorder for Specific Substances in the Past Year: Among People Aged 12 or

Older; by Age Group, 2021

Disorder

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

DRUGS OR

ALCOHOL

1,2

16.5 (0.28) 8.5 (0.43) 25.6 (0.62) 16.1 (0.33)

DRUGS

1,2

8.6 (0.20) 6.8 (0.38) 16.3 (0.51) 7.6 (0.23)

Marijuana 5.8 (0.16) 4.8 (0.34) 14.4 (0.50) 4.6 (0.18)

Cocaine 0.5 (0.05) 0.0 (0.01) 0.8 (0.12) 0.5 (0.07)

Heroin 0.4 (0.05) 0.0 (0.00) 0.2 (0.05) 0.4 (0.07)

Hallucinogens 0.2 (0.03) 0.2 (0.06) 0.6 (0.11) 0.1 (0.03)

Inhalants 0.1 (0.02) 0.3 (0.07) 0.3 (0.09) 0.1 (0.02)

Methamphetamine 0.6 (0.06) 0.1 (0.04) 0.3 (0.08) 0.7 (0.07)

Any Use

of Prescription

Psychotherapeutics

2.6 (0.11) 2.1 (0.19) 2.7 (0.22) 2.7 (0.13)

Pain Relievers

1.8 (0.09) 1.0 (0.14) 1.2 (0.16) 2.0 (0.12)

Stimulants

0.5 (0.04) 0.9 (0.14) 1.1 (0.13) 0.4 (0.05)

Tranquilizers

or Sedatives

0.8 (0.06) 0.5 (0.08) 0.9 (0.13) 0.8 (0.07)

Tranquilizers

0.6 (0.05) 0.3 (0.08) 0.7 (0.11) 0.6 (0.06)

Sedatives

0.3 (0.04) 0.2 (0.06) 0.3 (0.07) 0.3 (0.06)

Any Use of Opioids

2.0 (0.10) 1.0 (0.14) 1.3 (0.16) 2.2 (0.13)

Any Use of Central

Nervous System

Stimulants

1.5 (0.09) 1.0 (0.14) 1.9 (0.17) 1.5 (0.11)

ALCOHOL 10.6 (0.24) 3.4 (0.27) 15.0 (0.49) 10.7 (0.28)

BOTH DRUGS AND

ALCOHOL

1,2

2.6 (0.11) 1.7 (0.18) 5.8 (0.30) 2.2 (0.13)

DRUGS ONLY

(NO ALCOHOL

USE DISORDER)

1,2

6.0 (0.16) 5.1 (0.33) 10.6 (0.43) 5.4 (0.18)

ALCOHOL ONLY

(NO DRUG USE

DISORDER)

1,2

7.9 (0.21) 1.8 (0.21) 9.2 (0.41) 8.5 (0.25)