SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021

By: The U.S. Department of Health and Human Services (HSS) Substance Abuse and Mental Health Services Administration (SAMHSA)

Today, the U.S. Department of Health and Human Services’ (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of its annual National Survey on Drug Use and Health (NSDUH), which shows how people living in America reported about their experience with mental health conditions, substance use, and pursuit of treatment in 2021. The 2021 NSDUH national report  includes selected estimates by race, ethnicity, and age group. It is the most comprehensive report on substance use and mental health indicators that SAMHSA has released to date.

“Every year since 1971, this survey has given us a window into our nation’s mental health and substance use challenges and 2021 was no different. As the findings make clear, millions of Americans young and old faced mental health and substance use challenges – sometimes both at once – during the second year of the pandemic,” said HHS Secretary Xavier Becerra. “As we work to improve behavioral health across the nation, HHS is committed to ensuring that all people facing mental health or substance use challenges are connected to appropriate services and supports.”

“A commitment to data and evidence is one of SAMHSA’s four core principles. The annual NSDUH results help inform our efforts to expand access to treatment options and recovery supports across the nation,” said HHS Assistant Secretary for Mental Health and Substance Use Miriam E. Delphin-Rittmon, Ph.D., the leader of SAMHSA. “Harnessing the power of data and evidence is critical to ensuring policies and programs have the greatest opportunity to achieve positive outcomes.”

Estimates from the 2021 NSDUH should not be compared with estimates from previous years because the COVID-19 pandemic necessitated methodological changes to the data collection process.

Key findings from the 2021 NSDUH include:

Drug Use and Substance Use Disorder

• Among people aged 12 or older in 2021, 61.2 million people (or 21.9 percent of the population) used illicit drugs in the past year. The most commonly used illicit drug was marijuana, which 52.5 million people used. Nearly 2 in 5 young adults 18 to 25 used illicit drugs in the past year; 1 in 3 young adults 18 to 25 used marijuana in the past year.
• 9.2 million people 12 and older misused opioids in the past year.
• 46.3 million people aged 12 or older (or 16.5 percent of the population) met the applicable DSM-5 criteria for having a substance use disorder in the past year, including 29.5 million people who were classified as having an alcohol use disorder and 24 million people who were classified as having a drug use disorder.
  • The percentage of people who were classified as having a past year substance use disorder, including alcohol use and/or drug use disorder, was highest among young adults aged 18 to 25 compared to youth and adults 26 and older.
• In 2021, 94% of people aged 12 or older with a substance use disorder did not receive any treatment. Nearly all people with a substance use disorder who did not get treatment at a specialty facility did not think they needed treatment.

Major Depressive Episodes (MDE) Among Adolescents

• In 2021, 1 in 5 adolescents had a major depressive episode in the past year. Of these, nearly 75 percent had symptoms consistent with severe impairment, which 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.
  • The prevalence of past year MDE among Black and Asian adolescents was lower compared to adolescents from most other racial/ethnic groups.
  • More than half of youth with an MDE did not receive treatment in the past year.

Mental Illness among Adults

• Nearly 1 in 4 adults 18 and older, and 1 in 3 among adults aged 18 to 25, had a mental illness in the past year.
• Adults with serious mental illness had higher rates of treatment compared to those with any mental illness.  Despite having the highest rate of serious mental illness, people aged 18 to 25 had the lowest rate of treatment in comparison to adults in other age groups.
• White and Multiracial adults were more likely to receive mental health services in the past year than Black, Hispanic or Latino, or Asian adults.

Co-Occurring Substance Use Disorder with Any Mental Illness

• 13.5 percent of young adults aged 18 to 25 had both a substance use disorder and any mental illness in the past year.
• Nearly 1 in 3 adults had either a substance use disorder or any mental illness in the past year, and 46 percent of young adults 18-25 had either a substance use disorder or any mental illness.
• The percentage of adults aged 18 or older who met criteria for both a mental illness and a substance use disorder in the past year was higher among Multiracial adults than among White, Black, Hispanic or Latino, or Asian adults. Asian adults were less likely to have had both AMI and a substance use disorder in the past year compared with adults in most other racial or ethnic groups.

Serious Thoughts of Suicide, Suicide Plans, and Suicide Attempts

• 12.3 million adults aged 18 or older had serious thoughts of suicide in the past year, 3.5 million made suicide plans, and 1.7 million attempted suicide.
• Hispanic or Latino adults were more likely than White or Asian adults to have attempted suicide in the past year, and Black adults were more likely than Asian adults to have they attempted to suicide in the past year.

Recovery

• 7 in 10 (72.2 percent or 20.9 million) adults who ever had a substance use problem considered themselves to be recovering or in recovery.
• 2 in 3 (66.5 percent or 38.8 million) adults who ever had a mental health issue considered themselves to be recovering or in recovery.

About the National Survey on Drug Use and Health

Conducted by the federal government since 1971, the NSDUH is a primary source of statistical information on substance use and mental health of the U.S. civilian, noninstitutionalized population 12 or older. The NSDUH measures:

• Use of illegal drugs, prescription drugs, alcohol, and tobacco,
• Substance use disorder and substance use treatment,
• Major depressive episodes, mental illness, and mental health care, and
• Perceived recovery from substance use and mental health issues.

Addressing the nation’s mental health crisis and drug overdose epidemic are core pillars of the Biden-Harris Administration’s Unity Agenda. The Administration has invested $3.8 billion through the American Rescue Plan and more than $800 million through the Bipartisan Safer Communities Act in SAMHSA grant programs as part of President Biden’s comprehensive effort to improve access to mental healthcare, prevent overdoses, and save lives. These investments enabled the expansion of lifesaving prevention, treatment, and recovery services and supports in communities throughout the country, including the transition to the 988 Suicide & Crisis Lifeline in July 2022.

U.S. Department of Health & Human Services. (January 2023). Press Release: SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021 Retrieved from Health & Human Services