A massive new survey data set from the federal government shows that illicit substance use among adults in the U.S. is on the rise.
However, this has not yet translated into increased rates of what researchers could classify as substance use disorder (SUD), which remained stable in 2022, according to the latest National Survey on Drug Use and Health (NSDUH).
On Monday, the U.S. Department of Health and Human Services (HHS) and the behavioral health-focused Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of the NSDUH. The report provides population-level intelligence about the behavioral health needs providers and policymakers must address.
The Biden administration used the data release to reemphasize its focus on addressing the behavioral health issues of the nation, an issue President Joe Biden prioritized early in his tenure.
“This is not a red state or a blue state issue: as the data shows, there are tens of millions of Americans in every state across the country affected by this public health crisis,” White House Drug Policy Director Dr. Rahul Gupta said in a news release. “And the President is fighting for more funding to expand access to treatment and keep deadly drugs like fentanyl out of our communities. We know Congress can and must come together on this issue — the American people deserve no less.”
Several behavioral health regulatory and funding issues are before Congress. Recently, a Senate committee cleared a bill that its proponents described as a “game changer” for the industry.
The NSDUH surveys people ages 12 and older. Researchers completed 71,369 interviews for a nationally representative data set in 2022.
Year over year, the data show few dramatic increases or decreases in self-reported use of tobacco, alcohol, and illicit substance use; substance use disorders; mental health conditions; suicidal thoughts and behaviors; and substance use and mental health treatment.
The 162-page final report and 441 data tables released as part of the package provide incredible granularity about how Americans assess their behavioral health.
Here are a handful of numbers that jumped out to Behavioral Health Business on a first read-through. BHB focused on data from adult respondents, where possible, in our analysis.
Illicit substance use jumps up among adults
For those aged 18 and older, illicit substance use in the previous year jumped up to 26% in 2022, compared to 22.9% in 2021.
The increased use of marijuana appears to be the driving force behind this. All other substances appeared to be used at comparable rates year over year.
Marijuana was widely found to be the most commonly used illicit substance: About 59 million reported using it, compared to the No. 2 substance, misused prescription psychotherapeutics (13.6 million users). The most common mode of consumption of marijuana was smoking. Seventy-eight percent of marijuana users reported smoking, while 47% reported eating it.
A growing number of states are legalizing the recreational use of marijuana. Last week, voters in Ohio legalized recreational use, making it the 24th state to do so. Yet, it remains a Schedule I substance, according to the Drug Enforcement Administration.
The rate of increase in illicit substance use is similar between females and males. But the data do not show a jump in those reporting substance use disorders.
The rate of self-reported SUD among adults was about 18% in 2022, up half a percentage point from a year earlier, according to the report. That translates to roughly 46.5 million adults.
Mental illness rates appear stable
Rates of any mental illness (AMI), including serious mental illness (SMI), remained steady in 2022, with only tiny fluctuations across female and male respondents. The overall AMI rate stands at 23.1%. It was found to be 23% in 2021.
Female respondents report higher rates of AMI: 26.4% compared to 19.7%, respectively. This is true for SMIs and AMIs, excluding SMIs, with the largest gap being present in the latter.
About 19% of female respondents reported AMIs, excluding SMIs, compared to about 15% of male respondents.
An SMI is one that results in “serious functional impairment, which substantially interferes with or limits one or more major life activities,” according to the National Institute for Mental Health.
Rates of SMIs nearly doubled in completely rural counties, according to the report. These increased from a rate of 4.6% in 2021 to 9% in 2022. This was the largest jump in rate among any region or level of mental illness.
Based on race and ethnicity, those identified as non-Hispanic multiracial had the highest rates of mental illness among adults at 35.2%, the only group to be significantly higher than the overall adult AMI rate of 23.1%.
Who received treatment — and why some didn’t
The 2022 NSDUH report did not include historical data on adults who received mental health treatment in 2021.
However, the data highlight a gap between the rates at which female and male adult respondents report receiving mental health treatment, regardless of severity.
Across sex and severity, 21.8% of respondents reported receiving mental health treatment. Half (51%) of those reporting AMIs, inclusive of SMIs, received mental health treatment within a year of taking the survey. That number drops to 41.6% for male respondents and jumps to 56.9% for female respondents.
The most dramatic gap in mental health treatment between the genders was among AMIs, excluding SMIs: 51.6% for female respondents and 35.8% for male respondents, a 15.8% percentage point gap.
The report delved into assessing which respondents could be considered to have an SUD, apart from what respondents self-reported. It also assessed who needed treatment and did or didn’t get it. These data were broken down by age.
Those aged 12 to 17 saw the highest rate of respondents who required treatment and got it at 40%.
But across ages, there is a wide gulf between the numbers of people that could be considered as needing SUD treatment and actually getting it. Only 4.6% of the 19.4% of those aged 12 or older who were classified as needing SUD treatment got it.
The group that shows the lowest rate of needing and getting SUD treatment are those aged 18 to 25 years at 16.4%.
The report also digs into the reasons why people didn’t seek SUD or mental health treatment. The most common reasons are remarkably similar between SUD and mental health treatment.
The top reason between the two is believing that the respondent should be able to handle their condition on their own. The No. 2 reason is not being ready to start treatment.
Other top concerns include access issues that include the time it takes to get treatment, not knowing where to get treatment, and worries about the cost of treatment.
Nearly all adults (94.7%) who did not get SUD treatment don’t think they needed it. Less than 1% of those who sought treatment didn’t receive it. The remainder thought that they should get treatment but didn’t seek it.
For mental health, a large majority (73.4%) of those who had AMIs that didn’t get treatment said they didn’t need it; 4.1% of those who didn’t get mental health treatment did seek it but didn’t get it, while about 22.4% of those that didn’t get treatment thought they needed it.
