Index Manuals Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health
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Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
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and pain relievers. In NSDUH, misuse of prescription drugs
Figure 15. Past Year Prescription Stimulant Misuse: Among
People Aged 12 or Older; 2015-2020
was defined as use in any way not directed by a doctor,
including use without a prescription of one’s own; use in
9
greater amounts, more often, or longer than told to take
8
a drug; or use in any other way not directed by a doctor.
7
Misuse of over-the-counter (OTC) drugs was not included.
6
5
Among people aged 12 or older in 2020, 5.8 percent (or
4
16.1 million people) misused prescription psychotherapeutic
3
drugs in the past year (Table A.12B). Te percentage was
2
highest among young adults aged 18 to 25 (9.5 percent
1
or 3.2 million people), followed by adults aged 26 or
0
older (5.6 percent or 12.2 million people), then by
2015
2016
2017
2018
2019
2020
Years
adolescents aged 12 to 17 (2.8 percent or 688,000 people)
Age Category:
12 or Older
12 to 17
18 to 25
26 or Older
(Tables A.13B to A.15B).
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
Of the prescription drugs presented in this report,
comparing estimates between 2020 and prior years because of methodological changes for 2020.
Due to these changes, significance testing between 2020 and prior years was not performed.
prescription pain relievers were the most commonly misused
by people aged 12 or older. Te 16.1 million people in
Figure 15 Table. Past Year Prescription Stimulant Misuse: Among People
Aged 12 or Older; 2015-2020
2020 who misused prescription psychotherapeutic drugs
in the past year included 9.3 million people who misused
Age
2015
2016
2017
2018
2019
2020
prescription pain relievers, 6.2 million people who misused
12 or Older
2.0
2.1
2.1
1.9
1.8
1.8
prescription tranquilizers or sedatives (including 4.8 million
12 to 17
2.0
1.7
1.8
1.5
1.7
1.2
past year misusers of benzodiazepines), and 5.1 million
18 to 25
7.3
7.5
7.4
6.5
5.8
4.8
26 or Older
1.1
1.3
1.3
1.2
1.2
1.5
people who misused prescription stimulants (Figure 9).
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
Stimulant Misuse
between 2020 and prior years was not performed.
Te 2020 NSDUH assessed the misuse of prescription
Tranquilizer or Sedative Misuse
stimulants in the following categories: amphetamine
products, methylphenidate products, anorectic (weight-loss)
Estimates of the misuse of prescription tranquilizers or
stimulants, Provigil®, or any other prescription stimulant.
sedatives are presented together because prescription drugs in
Te amphetamine and methylphenidate products included in
both categories have a common effect on specific activity in
the NSDUH questionnaire are primarily prescribed for the
the brain. Prescription tranquilizers include benzodiazepine
treatment of attention-deficit/hyperactivity disorder (ADHD).
tranquilizers (e.g., as alprazolam, lorazepam, clonazepam,
Since 2015, methamphetamine has not been included as
or diazepam products), muscle relaxants, or any other
a prescription stimulant, unless respondents specified the
prescription tranquilizer. Prescription sedatives include
prescription form of methamphetamine (Desoxyn®) as some
zolpidem products, eszopiclone products, zaleplon products,
other stimulant they had misused in the past year.38
benzodiazepine sedatives (e.g., as flurazepam and temazepam
products or triazolam products), barbiturates, or any other
Among people aged 12 or older in 2020, 1.8 percent
prescription sedative.
(or 5.1 million people) misused prescription stimulants
in the past year (Figures 9 and 15). Te percentage was
Among people aged 12 or older in 2020, 2.2 percent (or
higher among young adults aged 18 to 25 (4.8 percent or
6.2 million people) misused tranquilizers or sedatives in the
1.6 million people) than among adolescents aged 12 to 17
past year (Figure 9 and Table A.12B). Te percentage was
(1.2 percent or 288,000 people) or adults aged 26 or older
highest among young adults aged 18 to 25 (3.7 percent or
(1.5 percent or 3.2 million people).
1.2 million people), followed by adults aged 26 or older
(2.2 percent or 4.7 million people), then by adolescents aged
12 to 17 (0.9 percent or 226,000 people) (Tables A.13B to
A.15B).
Key Substance Use and Mental Health Indicators in the United States:
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Results from the 2020 National Survey on Drug Use and Health
Benzodiazepine Misuse
the pain relievers Vicodin® or hydrocodone were classified as
misusers of hydrocodone products.
Prescription benzodiazepines are a subcategory of drugs
that may be prescribed either as tranquilizers for the
Tis section presents two ways of examining the misuse of
relief of anxiety or as sedatives for the relief of insomnia.
subtypes of pain relievers. First, it presents estimates of the
Benzodiazepines prescribed as tranquilizers are typically
misuse of subtypes among the total population aged 12 or
metabolized more slowly than benzodiazepines prescribed
older. Ten it presents estimates of the misuse of subtypes
as sedatives.39 Nevertheless, benzodiazepines are chemically
of pain relievers among people who used that subtype in the
similar, regardless of whether they are prescribed as
past year.
tranquilizers or sedatives.
Among people aged 12 or older in 2020, 1.7 percent (or
Among people aged 12 or older in 2020, 1.7 percent (or
4.7 million people) misused hydrocodone products in the
4.8 million people) misused prescription benzodiazepines
past year (Figure 17). Hydrocodone products were the most
in the past year (Table A.12B). Te percentage was highest
commonly misused subtype of prescription pain relievers
among young adults aged 18 to 25 (3.3 percent or 1.1 million
for 2020, including Vicodin®, Lortab®, Norco®, Zohydro®
people), followed by adults aged 26 or older (1.6 percent
ER, and generic hydrocodone. In addition, 1.1 percent (or
or 3.5 million people), then by adolescents aged 12 to 17
3.2 million people) misused oxycodone products in the
(0.6 percent or 157,000 people) (Tables A.13B to A.15B).
past year, including OxyContin®, Percocet®, Percodan®,
Roxicodone®, and generic oxycodone. Also, 0.2 percent
Pain Reliever Misuse
of people aged 12 or older (or 690,000 people) misused
Te 2020 NSDUH assessed the misuse of prescription pain
buprenorphine products in the past year.
relievers in the following categories: products containing
hydrocodone, oxycodone, tramadol, codeine, morphine,
Figure 16. Past Year Prescription Pain Reliever Misuse: Among
prescription fentanyl,40 buprenorphine, oxymorphone,
People Aged 12 or Older; 2015-2020
and hydromorphone, as well as Demerol®, methadone, or
any other prescription pain reliever. Tis 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 2020, 3.3 percent (or
9.3 million people) misused prescription pain relievers
in the past year (Figures 9 and 16). Te percentage was
highest among young adults aged 18 to 25 (4.1 percent or
1.4 million people), followed by adults aged 26 or older
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
(3.4 percent or 7.5 million people), then by adolescents aged
comparing estimates between 2020 and prior years because of methodological changes for 2020.
12 to 17 (1.6 percent or 396,000 people).
Due to these changes, significance testing between 2020 and prior years was not performed.
Figure 16 Table. Past Year Prescription Pain Reliever Misuse: Among People
Misuse of Subtypes of Pain Relievers
Aged 12 or Older; 2015-2020
Te 2020 NSDUH asked respondents to identify specific
Age
2015
2016
2017
2018
2019
2020
prescription pain relievers they used in the past year, then
12 or Older
4.7
4.3
4.1
3.6
3.5
3.3
asked whether they misused those pain relievers in the
12 to 17
3.9
3.5
3.1
2.8
2.3
1.6
past year. Te specific pain relievers people misused in the
18 to 25
8.5
7.1
7.2
5.5
5.2
4.1
past year were categorized into subtypes, such as hydrocodone
26 or Older
4.1
3.9
3.7
3.4
3.4
3.4
products. For example, respondents who reported misusing
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
between 2020 and prior years was not performed.
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
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Figure 17. Past Year Prescription Pain Reliever Misuse: Among
reliever they misused. Respondents who reported more than
People Aged 12 or Older; by Selected Pain Reliever Subtype, 2020
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 2020 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 (64.6 percent) (Table A.16B). 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.
Other common main reasons for misuse were to feel good
or get high (11.3 percent) and to relax or relieve tension
(8.1 percent). Less common main reasons among past year
misusers of pain relievers included to help with feelings or
emotions (5.6 percent), to help with sleep (4.5 percent),
* Low precision; no estimate reported.
because they were “hooked” or needed to have the drug
(2.3 percent), to experiment or see what the drug was like
An estimated 0.1 percent of people aged 12 or older (or
(1.4 percent), and to increase or decrease the effects of other
356,000 people) misused prescription fentanyl products.
drugs (0.9 percent).
Because NSDUH respondents were asked only about
the misuse of prescription forms of fentanyl, estimates of
Source of the Last Pain Reliever That Was Misused
fentanyl misuse for 2020 may underrepresent people who
Among people aged 12 or older in 2020 who misused
used illicitly manufactured fentanyl (IMF) from clandestine
prescription pain relievers in the past year, the most common
laboratories (i.e., as opposed to the misuse of diverted
source for the last pain reliever they misused was from a
prescription fentanyl produced by the pharmaceutical
friend or relative in some way (i.e., being given them, buying
industry) and may not include those who used IMF mixed
them, or taking them without asking) (Figure 18). A little
with heroin or sold as heroin (but contained only IMF).
less than half (47.2 percent) of people who misused pain
Although prescription pain reliever misuse was the
relievers in the past year obtained the pain relievers the last
second most common form of illicit drug use for 2020
time from a friend or relative in some way. Specifically,
(Figure 9), most past year users of prescription pain relievers
34.4 percent of people who misused pain relievers in the
did not misuse them in the past year (Figure 17). For
past year obtained pain relievers the last time by getting them
example, among past year users of hydrocodone products,
from a friend or relative for free, 9.2 percent bought their
12.6 percent misused them in the past year. Among past year
last pain reliever from a friend or relative, and 3.7 percent
users of buprenorphine products, 26.5 percent misused
took their last pain reliever from a friend or relative without
them. Stated another way, almost three fourths of past year
asking. About two fifths of people who misused pain relievers
users of buprenorphine products did not misuse them in that
in the past year (43.6 percent) obtained pain relievers the
period.
last time through prescription(s) or stole pain relievers from
a health care provider, typically getting the pain relievers
Main Reasons for the Last Misuse of Pain Relievers
through a prescription from one doctor (42.0 percent).
Respondents in the 2020 NSDUH who reported
About 1 in 16 people who misused pain relievers in the
prescription pain reliever misuse in the past year were asked
past year (6.2 percent) bought the last pain reliever they
to report the reasons for misusing the last prescription pain
misused from a drug dealer or other stranger.
Key Substance Use and Mental Health Indicators in the United States:
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Results from the 2020 National Survey on Drug Use and Health
Figure 18. Source Where Pain Relievers Were Obtained for Most Recent Misuse: Among People Aged
12 or Older Who Misused Pain Relievers in the Past Year; 2020
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.
Note: The percentages do not add to 100 percent due to rounding.
Opioid Misuse
relievers and used heroin in the past year, and 235,000
people had used heroin in the past year but had not misused
Opioids are a group of chemically similar drugs that include
prescription pain relievers.
heroin and prescription opioids, such as hydrocodone (e.g.,
Vicodin®), oxycodone (e.g., OxyContin®), and morphine. In
Central Nervous System Stimulant Misuse
this report, opioid misuse includes the misuse of prescription
pain relievers or the use of heroin. Prescription pain relievers
Central nervous system (CNS) stimulants are a group
could include some nonopioids because respondents could
of drugs that include cocaine, methamphetamine, and
occasionally specify the misuse of other prescription pain
prescription stimulants. Tese drugs act in similar ways to
relievers that are not opioids.
stimulate the brain. Tey produce stimulant effects, such
Among people aged 12 or older in 2020, 3.4 percent (or
Figure 19. Past Year Opioid Misuse: Among People Aged 12 or
9.5 million people) misused opioids in the past year (Figure 19
Older; 2020
and Table A.12B). Te percentage was highest among young
adults aged 18 to 25 (4.1 percent or 1.4 million people),
followed by adults aged 26 or older (3.5 percent or 7.7 million
people), then by adolescents aged 12 to 17 (1.6 percent or
396,000 people) (Tables A.13B to A.15B).
Te vast majority of people who misused opioids in the
past year misused prescription pain relievers (Figure 19).
Specifically, 9.3 million people aged 12 or older misused
prescription pain relievers in the past year compared with
902,000 people who used heroin. In 2020, the majority
of the 9.3 million misusers of prescription pain relievers
misused only prescription pain relievers in the past year
(8.6 million people), but they had not used heroin. An
estimated 667,000 people misused prescription pain
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
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as increased alertness, wakefulness, or energy. Tey also can
(10.5 percent of CNS stimulant misusers), 391,000
produce physical side effects of rapid or irregular heartbeat
used cocaine and methamphetamine but did not misuse
or increased blood pressure and body temperature.41,42,43
prescription stimulants (3.8 percent of CNS stimulant
In this report, CNS stimulant misuse includes the use of
misusers), and 326,000 used methamphetamine and misused
cocaine or methamphetamine or the misuse of prescription
prescription stimulants but did not use cocaine (3.2 percent
stimulants.
of CNS stimulant misusers).
Among people aged 12 or older in 2020, 3.7 percent (or
10.3 million people) misused CNS stimulants in the past year
Other Substance Use in the Past Year
(Figure 20 and Table A.12B). Te percentage was highest
Te 2020 NSDUH obtained information for the use and
among young adults aged 18 to 25 (7.7 percent or 2.6 million
misuse of additional substances that can produce mind-
people), followed by adults aged 26 or older (3.4 percent
altering effects. Not including these substances in estimates
or 7.4 million people), then by adolescents aged 12 to 17
from prior years has allowed the creation of consistent illicit
(1.4 percent or 346,000 people) (Tables A.13B to A.15B).
drug use measures over time. Tese substances include
Of the 10.3 million people in 2020 who misused CNS
GHB, the misuse of nonprescription cold and cough
stimulants in the past year, 353,000 used or misused all
medicine, kratom, synthetic marijuana (fake weed, K2, or
three CNS stimulants in the past year (3.4 percent of
Spice), and synthetic stimulants (“bath salts” or flakka).
people who misused CNS stimulants) (Figure 20).13 About
Te 2020 NSDUH marks the first time that information
one third of people who misused CNS stimulants in the
was collected on the use of synthetic cannabinoids (referred
past year used only cocaine (32.4 percent of CNS stimulant
to in the NSDUH questionnaire as “synthetic marijuana”)
misusers or 3.3 million people), about one third misused
and synthetic cathinones (referred to in the questionnaire as
only prescription stimulants (32.3 percent of CNS stimulant
“synthetic stimulants”).
misusers or 3.3 million people), and about 1 in 7 used
only methamphetamine (14.4 percent of CNS stimulant
GHB Use
misusers or 1.5 million people). In addition to the 353,000
Gamma hydroxybutyrate (GHB, also called “G,” “Georgia
people who used or misused all three CNS stimulants in
Home Boy,” “Grievous Bodily Harm,” or “Liquid G,”)
the past year, 1.1 million people used cocaine and misused
is a CNS depressant. GHB can produce hallucinations,
prescription stimulants but did not use methamphetamine
euphoria, drowsiness, decreased anxiety, and excited and
aggressive behavior. It also is addictive. GHB that is not
Figure 20. Past Year Central Nervous System (CNS) Stimulant
produced as a pharmaceutical product with approval from
Misuse: Among People Aged 12 or Older; 2020
the U.S. Food and Drug Administration is classified as a
Schedule I controlled substance in the United States.44,45
Among people aged 12 or older in 2020, 0.1 percent (or
183,000 people) used GHB in the past year (Table A.8B).
In addition, 0.1 percent each of young adults aged 18 to
25 and adults aged 26 or older used GHB in the past year
(Tables A.10B and A.11B). Corresponding estimated
numbers of people who used GHB in the past year were
24,000 young adults and 158,000 adults aged 26 or older.
Estimates for adolescents aged 12 to 17 could not be
calculated with sufficient precision (Table A.9B).
Nonprescription Cough and Cold Medicine Misuse
Te cough suppressant dextromethorphan (DXM) is
found in many cough and cold medicines. Tese medicines
are available without a prescription (i.e., OTC) in the
United States and are generally considered safe when used
Key Substance Use and Mental Health Indicators in the United States:
22 | October 2021
Results from the 2020 National Survey on Drug Use and Health
appropriately. When taken in large amounts, however,
Synthetic Marijuana Use
DXM can produce hallucinations or dissociative, “out-
Synthetic cannabinoids are human-made chemicals that
of-body” experiences. Tese effects are similar to those
are similar to chemicals found in the marijuana plant. For
caused by the hallucinogens PCP and ketamine. Other
this reason, these drugs are sometimes called “synthetic
drugs found in OTC cough and cold medicines also
marijuana” or “fake weed.” Tey can be contained in plant
can have psychoactive effects. For example, the OTC
material that is later smoked. Tey are also sold as liquids
antihistamine diphenhydramine (found in the brand-name
to be vaporized (i.e., vaped) and inhaled in e-cigarettes and
drug Benadryl®) can produce sedative side effects, such as
other devices.44,50 Several synthetic cannabinoids have been
drowsiness.46 Te OTC decongestant phenylephrine (found
categorized as Schedule I controlled substances.45
in the brand-name drug Sudafed PE®) can produce stimulant
For simplicity, the 2020 NSDUH questionnaire asked
side effects, such as nervousness and sleeplessness.47
respondents about their use of “synthetic marijuana” and
Te 2020 NSDUH questionnaire asked respondents aged
included the slang terms “fake weed,” “K2,” and “Spice.”
12 or older about their use of nonprescription cough or cold
Te 2020 NSDUH asked respondents aged 12 or older
medicines in the past 12 months for the purpose of getting
about their use of synthetic marijuana or fake weed in the
high (i.e., “misuse”). Respondents who reported that they
12 months before the interview.
used nonprescription (i.e., OTC) cough or cold medicines
Among people aged 12 or older in 2020, 0.4 percent (or
to get high in the past 12 months could specify the names of
1.1 million people) used synthetic marijuana in the past year
up to five OTC medicines that they had misused.
(Table A.8B). Te percentage was lower among adults aged
Among people aged 12 or older in 2020, 0.9 percent (or
26 or older (0.3 percent or 546,000 people) than among
2.4 million people) misused nonprescription cough and
adolescents aged 12 to 17 (0.8 percent or 207,000 people) or
cold medicines in the past year (Table A.8B). Similar
young adults aged 18 to 25 (0.9 percent or 313,000 people)
percentages of people in each age group misused cough and
(Tables A.9B to A.11B).
cold medicines in the past year (0.9 percent of adolescents
aged 12 to 17, 1.2 percent of young adults aged 18 to 25,
Synthetic Stimulant Use
and 0.8 percent of adults aged 26 or older) (Tables A.9B to
Synthetic cathinones are human-made CNS stimulants that
A.11B). Corresponding estimated numbers of people who
are chemically related to cathinone, a substance found in
misused cough and cold medicines in the past year were
the khat plant. Tese substances can be marketed as “bath
223,000 adolescents, 389,000 young adults, and 1.8 million
salts” or “flakka.”44,51 Several synthetic cathinones have been
adults aged 26 or older.
categorized as Schedule I controlled substances.45
Kratom Use
For simplicity, the 2020 NSDUH questionnaire asked
respondents about their use of “synthetic stimulants” and
Kratom is an herbal extract from the leaves of the Mitragyna
included the slang terms “bath salts” and “flakka.” Te 2020
speciosa tree that is native to Southeast Asia. Te leaves
NSDUH asked respondents aged 12 or older about their use
contain chemicals with mind-altering effects. Kratom can
of synthetic stimulants, also called “bath salts” or flakka, in
come in forms such as powders, pills, or leaves.48,49 Te
the 12 months before the interview.
2020 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 2020, less than
0.1 percent (or 118,000 people) used synthetic stimulants
Among people aged 12 or older in 2020, 0.8 percent
in the past year (Table A.8B). Similar percentages of people
(or 2.1 million people) used kratom in the past year
in each age group used synthetic stimulants (less than
(Table A.8B). Te percentage was lower among adolescents
0.1 percent each of adolescents aged 12 to 17 and adults
aged 12 to 17 (0.2 percent or 48,000 people) than among
aged 26 or older; 0.1 percent of young adults aged 18 to 25)
young adults aged 18 to 25 (0.9 percent or 286,000 people)
(Tables A.9B to A.11B). In each age group, 75,000 or fewer
or adults aged 26 or older (0.8 percent or 1.8 million people)
people used synthetic stimulants.
(Tables A.9B to A.11B).
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
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Initiation of Substance Use
Figure 21. Past Year Initiates of Substances: Among People Aged
12 or Older; 2020
Te 2020 NSDUH included questions to measure the
initiation of substance use, that is, use of particular substances
for the first time during a person’s lifetime.52 Tis report
presents the estimated number of recent substance use initiates
or prescription drug misuse initiates.53 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.14,54,55
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. Te report does not present estimates for
past year initiation of any opioid (heroin or prescription pain
reliever) misuse, any illicit drug use (including prescription
Rx = prescription.
Note: Estimates for prescription pain relievers, prescription tranquilizers, prescription stimulants, and
drug misuse), and any prescription tranquilizer or sedative
prescription sedatives are for the initiation of misuse.
misuse because respondents who underreported lifetime
(but not past year) misuse of prescription drugs might
Initiation of Cigarette Use
not truly be past year initiates of the use or misuse of any
Among people aged 12 or older in 2020, 1.3 million people
drug in these aggregate categories.56 Estimates for the past
initiated cigarette smoking in the past year (i.e., never
year initiation of benzodiazepine misuse are not presented
smoked cigarettes before the past 12 months) (Figure 21).
because some benzodiazepines in NSDUH were included as
Relatively few people (approximately 10 percent of past year
tranquilizers, and others were included as sedatives.57
initiates) tried cigarettes for the first time after age 25.
Because only limited data were collected from April to
Corresponding numbers of initiates of cigarette smoking by
September 2020, this report does not present estimates for
age group were 385,000 adolescents aged 12 to 17, 752,000
2020 for the average numbers of initiates per day. In prior
young adults aged 18 to 25, and 127,000 adults aged 26 or
years, these averages were calculated by dividing the total
older (Tables A.19A to A.21A).
number of past year initiates by 365 days and assumed
generally continuous data collection across the entire
Initiation of Alcohol Use
12 months. Estimates from the 2020 NSDUH for the
Among people aged 12 or older in 2020, 4.1 million people
average number of initiates per day also could be misleading
initiated alcohol use in the past year, not counting sips from
because 2020 included periods when people in certain states
another person’s drink (Figure 22). Among young adults
and localities were under increased restrictions to contain
aged 18 to 25 in 2020, 2.1 million people initiated alcohol
the spread of COVID-19. Tese periods of restrictions could
use in the past year. Corresponding numbers for initiation
have changed the opportunities to initiate substance use
of alcohol use for adolescents aged 12 to 17 and adults aged
among members of certain subgroups.
26 or older were 1.8 million people and 176,000 people,
Figure 21 provides an overview of the numbers of people
respectively (Table A.21A). Consistent with the pattern of
aged 12 or older in 2020 who were past year initiates for the
cigarette smoking initiation, relatively few people in 2020
substances discussed in this section. In the past 12 months,
started to use alcohol after age 25.
4.1 million people initiated alcohol use and 1.3 million
Initiation of Marijuana Use
people tried a cigarette for the first time in their lifetime.58
Tere also were 2.8 million new marijuana users, 1.4 million
Among people aged 12 or older in 2020, 2.8 million people
new hallucinogen users, 1.2 million new misusers of
initiated marijuana use in the past year (Figure 23). Among
prescription pain relievers, 950,000 new misusers of
adolescents aged 12 to 17, 1.0 million people initiated
prescription tranquilizers, and 734,000 new misusers of
marijuana use in the past year. Corresponding numbers
prescription stimulants.
for young adults aged 18 to 25 and adults aged 26 or older
Key Substance Use and Mental Health Indicators in the United States:
24 | October 2021
Results from the 2020 National Survey on Drug Use and Health
were 1.1 million people and 664,000 people, respectively
low statistical precision (Table A.19A). Nearly 90 percent of
(Table A.21A). Unlike people who initiated cigarette or
past year initiates in 2020 tried heroin for the first time after
alcohol use, almost 25 percent of people in 2020 who
age 25. Among young adults aged 18 to 25, 12,000 people
initiated marijuana use in the past year were aged 26 or older.
initiated heroin use in the past year (Table A.20A). Among
adults aged 26 or older, 91,000 people initiated heroin use in
Initiation of Cocaine Use
the past year (Table A.21A).
Among people aged 12 or older in 2020, 489,000 people
Initiation of Methamphetamine Use
initiated cocaine use in the past year (Figure 21).59
Approximately 70 percent of past year initiates tried cocaine
Among people aged 12 or older in 2020, 153,000 people
for the first time between ages 18 and 25. Among young
initiated methamphetamine use in the past year (Figure 21).
adults aged 18 to 25, 341,000 people initiated cocaine
Relative to people in other age groups, few adolescents aged
use (Table A.20A). Corresponding numbers of initiates
12 to 17 initiated methamphetamine use in the past year.
for adolescents aged 12 to 17 and adults aged 26 or older
Numbers of initiates of methamphetamine use by age
were 82,000 people and 66,000 people, respectively
group were 6,000 adolescents aged 12 to 17, 51,000 young
(Tables A.19A and A.21A).
adults aged 18 to 25, and 97,000 adults aged 26 or older
(Tables A.19A to A.21A).
Initiation of Heroin Use
Initiation of Hallucinogen Use
Among people aged 12 or older in 2020, 103,000 people
initiated heroin use in the past year (Figure 21). Among
Among people aged 12 or older in 2020, 1.4 million people
adolescents aged 12 to 17, the number of people who
initiated hallucinogen use in the past year (Figure 21).59
initiated heroin use in the past year was not reported due to
Corresponding numbers of initiates of hallucinogen use by
Figure 22. Past Year Alcohol Initiates: Among People Aged 12 or
Figure 23. Past Year Marijuana Initiates: Among People Aged 12
Older; 2002-2020
or Older; 2002-2020
5
4
3
2
1
0
02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
Years
Age Category:
12 or Older
12 to 17
18 to 25
26 or Older
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
comparing estimates between 2020 and prior years because of methodological changes for 2020.
comparing estimates between 2020 and prior years because of methodological changes for 2020.
Due to these changes, significance testing between 2020 and prior years was not performed.
Due to these changes, significance testing between 2020 and prior years was not performed.
Figure 22 Table. Past Year Alcohol Initiates: Among People Aged 12 or Older
Figure 23 Table. Past Year Marijuana Initiates: Among People Aged 12 or
(in Millions); 2002-2020
Older (in Millions); 2002-2020
Age
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
Age
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
≥12
3.9
4.1
4.4
4.3
4.4
4.6
4.5
4.6
4.7
4.7
4.6
4.6
4.7
4.8
4.6
4.9
4.9
4.9
4.1
≥12
2.2
2.0
2.1
2.1
2.1
2.1
2.2
2.4
2.4
2.6
2.4
2.4
2.6
2.6
2.6
3.0
3.1
3.5
2.8
12-17
2.6
2.6
2.7
2.7
2.7
2.7
2.6
2.7
2.5
2.6
2.4
2.4
2.3
2.4
2.3
2.3
2.4
2.3
1.8
12-17
1.4
1.2
1.3
1.1
1.2
1.2
1.2
1.3
1.3
1.4
1.3
1.2
1.2
1.2
1.2
1.2
1.3
1.4
1.0
18-25
1.2
1.4
1.5
1.4
1.6
1.7
1.7
1.8
2.0
2.0
1.9
2.1
2.2
2.2
2.2
2.4
2.4
2.4
2.1
18-25
0.7
0.7
0.7
0.7
0.7
0.8
0.8
1.0
0.9
1.1
1.0
1.0
1.1
1.0
1.0
1.3
1.2
1.2
1.1
≥26
0.1
0.1
0.2
0.1
0.1
0.1
0.2
0.1
0.2
0.1
0.2
0.1
0.1
0.2
0.2
0.1
0.1
0.2
0.2
≥26
0.1
0.1
0.2
0.3
0.1
0.1
0.2
0.0
0.2
0.2
0.2
0.2
0.3
0.4
0.4
0.5
0.5
0.9
0.7
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
between 2020 and prior years was not performed.
between 2020 and prior years was not performed.
Note: Estimates of less than 0.05 million round to 0.0 million when shown to the nearest tenth of a million.
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
25
age group were 251,000 adolescents aged 12 to 17, 785,000
Initiation of Prescription Sedative Misuse
young adults aged 18 to 25, and 376,000 adults aged 26 or
Among people aged 12 or older in 2020, 343,000 people
older (Tables A.19A to A.21A).
initiated prescription sedative misuse (Figure 21). Nearly
three fourths of past year initiates tried prescription sedatives
Initiation of Inhalant Use
for the first time after age 25. Corresponding numbers of
Among people aged 12 or older in 2020, 678,000 people
initiates of prescription sedative misuse by age group were
initiated inhalant use in the past year (Figure 21). About half
18,000 adolescents aged 12 to 17, 77,000 young adults aged
of past year initiates tried inhalants for the first time between
18 to 25, and 249,000 adults aged 26 or older (Tables A.19A
age 12 and 17. Numbers of initiates of inhalant use by age
to A.21A).
group were 360,000 adolescents aged 12 to 17, 201,000
young adults aged 18 to 25, and 117,000 adults aged 26 or
Initiation of Prescription Pain Reliever Misuse
older (Tables A.19A to A.21A).
Among people aged 12 or older in 2020, 1.2 million people
initiated prescription pain reliever misuse in the past year
Initiation of Prescription Stimulant Misuse
(Figure 24). Nearly two thirds of past year initiates tried
Among people aged 12 or older in 2020, 734,000 initiated
prescription pain relievers for the first time after age 25.
prescription stimulant misuse in the past year (Figure 21).
Among adults aged 26 or older, 774,000 people initiated
Among adults aged 26 or older, 324,000 people initiated
prescription pain reliever misuse. Among young adults
prescription stimulant misuse in the past year (Table A.21A).
aged 18 to 25 and adolescents aged 12 to 17, the numbers
Corresponding numbers for young adults aged 18 to 25 and
of people who initiated prescription pain reliever misuse
adolescents aged 12 to 17 were 294,000 people and 116,000
in the past year were 290,000 people and 158,000 people,
people, respectively (Tables A.19A and A.20A).
respectively.
Initiation of Prescription Tranquilizer or Sedative
Figure 24. Past Year Prescription Pain Reliever Misuse Initiates:
Among People Aged 12 or Older; 2015-2020
Misuse
Although this report includes combined estimates for the
2,500
past year misuse of prescription tranquilizers or sedatives,
2,000
estimates for the initiation of misuse of these substances are
presented separately in this section. As noted previously, it
1,500
cannot be determined unambiguously whether respondents
were past year initiates for the aggregate category of any
1,000
tranquilizer or sedative misuse because of the potential for
respondents to underreport the misuse of prescription drugs
500
that occurred more than 12 months ago.
0
2015
2016
2017
2018
2019
2020
Initiation of Prescription Tranquilizer Misuse
Years
Among people aged 12 or older in 2020, 950,000 people
Age Category:
12 or Older
12 to 17
18 to 25
26 or Older
initiated prescription tranquilizer misuse in the past year
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
comparing estimates between 2020 and prior years because of methodological changes for 2020.
(Figure 21). Among adults aged 26 or older, 557,000 people
Due to these changes, significance testing between 2020 and prior years was not performed.
initiated prescription tranquilizer misuse (Table A.21A).
Figure 24 Table. Past Year Prescription Pain Reliever Misuse Initiates:
Among young adults aged 18 to 25 and adolescents
Among People Aged 12 or Older; 2015-2020
aged 12 to 17, 290,000 and 103,000 people initiated
Age
2015
2016
2017
2018
2019
2020
prescription tranquilizer misuse in the past year, respectively
(Tables A.19A and A.20A).
12 or Older
2,126
2,139
2,010
1,908
1,607
1,223
12 to 17
415
423
316
310
245
158
18 to 25
596
585
465
464
404
290
26 or Older
1,114
1,130
1,229
1,134
958
774
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
between 2020 and prior years was not performed.
Key Substance Use and Mental Health Indicators in the United States:
26 | October 2021
Results from the 2020 National Survey on Drug Use and Health
Perceived Risk from Substance Use
NSDUH detailed tables include additional measures of risk
perceptions from substance use.
One factor that can influence whether people will use
tobacco, alcohol, or illicit drugs is the extent to which
Among people aged 12 or older in 2020, 70.7 percent of
they believe that using these substances might cause harm.
people perceived great risk of harm from smoking one or
In 2020, NSDUH respondents were asked how much they
more packs of cigarettes a day, and 68.7 percent perceived
thought people risk harming themselves physically and
great risk from having four or five alcoholic drinks nearly
in other ways when they use various substances in certain
every day. (For brevity, this level of alcohol consumption
amounts or frequencies. Response choices for these items
on a single day is subsequently referred to as “daily binge
were “great risk,” “moderate risk,” “slight risk,” or “no risk.”
drinking.”) Percentages of people who perceived great risk
Depending on the substance, respondents were asked about
from cocaine or heroin use once or twice a week were 84.7
their perceived risk of harm from using a substance daily or
and 93.2 percent, respectively. In contrast, about one fourth
using a substance once or twice a week (i.e., weekly use).
of people (27.4 percent) perceived great risk from smoking
marijuana once or twice a week.
Figure 25 presents the percentages of people aged 12 or older
in 2015 to 2020 who perceived great risk of harm from the
In 2020, perceptions of great risk of harm from substance
use of various substances. Risk perceptions across substances
use varied by substance and age. For example, adults aged
are not compared because of variations in the quantity
26 or older were more likely than adolescents aged 12 to
and frequency of use across these substances.60 Te 2020
17 or young adults aged 18 to 25 to perceive great risk of
harm from smoking one or more packs of cigarettes per day
Figure 25. Perceived Great Risk from Substance Use: Among
or to perceive great risk of harm from daily binge drinking
People Aged 12 or Older; 2015-2020
(Tables A.23B to A.25B).
100
Young adults aged 18 to 25 in 2020 were less likely than
adolescents aged 12 to 17 or adults aged 26 or older to
80
perceive great risk of harm from smoking marijuana weekly.
Research has identified associations among adults between
60
decreases in perceptions of great risk of harm from smoking
40
marijuana weekly and increases in marijuana use.61,62
Nevertheless, people can experience adverse effects from
20
marijuana use, such as marijuana use disorder or injury
resulting from operating a motor vehicle while impaired by
0
2015
2016
2017
2018
2019
2020
marijuana.63,64 Terefore, it is necessary to educate young
Years
adults about adverse effects of marijuana use.
Substance Use:
Smoking Marijuana Weekly
Having 4 or 5 Drinks of
Finally, adolescents aged 12 to 17 in 2020 were less likely
Alcohol Daily
Using Cocaine Weekly
Smoking One or More
than young adults aged 18 to 25 or adults aged 26 or older
Using Heroin Weekly
Packs of Cigarettes per Day
to perceive great risk from using heroin or cocaine weekly.
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
Additional data on finer age group categories that can be
comparing estimates between 2020 and prior years because of methodological changes for 2020.
Due to these changes, significance testing between 2020 and prior years was not performed.
found in the 2020 detailed tables (available at https://www.
samhsa.gov/data/) indicate that the lower likelihood of
Figure 25 Table. Perceived Great Risk from Substance Use: Among People
adolescents than adults to perceive great risk of harm from
Aged 12 or Older; 2015-2020
cocaine and heroin use may be attributable to a general lack
Substance Use
2015
2016
2017
2018
2019
2020
of knowledge about these substances among adolescents
Smoking Marijuana Once or Twice a Week
36.3
34.0
31.9
30.6
29.2
27.4
because younger adolescents aged 12 or 13 tended to have
Using Cocaine Once or Twice a Week
87.4
87.1
86.8
86.5
85.7
84.7
lower perceptions of the risk of harm compared with older
Using Heroin Once or Twice a Week
94.2
94.1
94.5
94.3
93.8
93.2
adolescents or adults. Tus, age-specific communications are
Having 4 or 5 Drinks of Alcohol Nearly Every Day
68.7
68.3
68.9
68.5
67.9
68.7
Smoking One or More Packs of Cigarettes per Day
72.8
72.8
71.6
71.8
71.2
70.7
imperative from a public health perspective to help people
fully understand important harms associated with the use of
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
specific substances.
between 2020 and prior years was not performed.
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
27
Substance Use Disorders in the Past Year
5. Tere is recurrent substance use resulting in a failure
to fulfill major role obligations at work, school, or
Substance use disorders (SUDs) are characterized by
home.
impairment caused by the recurrent use of alcohol or other
drugs (or both), including health problems, disability, and
6. Tere is continued substance use despite having
failure to meet major responsibilities at work, school, or
persistent or recurrent social or interpersonal problems
home. Te 2020 NSDUH included a series of questions
caused by or exacerbated by the effects of the
to estimate the percentage of the population aged 12 or
substance.
older who had at least one SUD in the past 12 months
7. Important social, occupational, or recreational
(subsequently referred to as “an SUD” or “a past year SUD,”
activities are given up or reduced because of substance
except when “SUDs” refer to more than one substance,
use.
such as SUDs for the misuse of specific prescription drugs).
8. Tere is recurrent substance use in situations in which
Te SUD questions assess the presence of an SUD in the
it is physically hazardous.
past 12 months based on criteria specified in the Diagnostic
9. Substance use is continued despite knowledge
and Statistical Manual of Mental Disorders, 5th edition
of having a persistent or recurrent physical or
(DSM-5).17,65 Respondents were asked SUD questions
psychological problem that is likely to have been
for any alcohol or illicit drugs they used in the 12 months
caused or exacerbated by the substance.
prior to the survey. Illicit drugs include marijuana, cocaine
(including crack), heroin, hallucinogens, inhalants, and
10. Tere is a need for markedly increased amounts of the
methamphetamine, as well as the misuse of prescription
substance to achieve intoxication or the desired effect,
stimulants, tranquilizers or sedatives (e.g., benzodiazepines),
or markedly diminished effect with continued use of
and pain relievers.14
the same amount of the substance (i.e., tolerance).
Te 2020 NSDUH marked the first year in which SUDs
11. Tere are a required number of withdrawal symptoms
were assessed using the DSM-5 criteria as opposed to the
that occur when substance use is cut back or stopped
DSM-IV criteria.18,66,67 In DSM-IV, the criteria are grouped
following a period of prolonged use.68 (Hallucinogen
into the diagnoses of dependence and abuse. Respondents
use disorder and inhalant use disorder do not have a
were categorized as having an SUD if they met either of the
withdrawal syndrome associated with discontinued
following: (1) the presence of three or more of the diagnostic
use. Terefore, withdrawal is not a criterion of either
criteria of dependence for a given substance or substance
of these two disorders.)
class (e.g., prescription tranquilizers), or (2) they met one
Questions were added to the 2020 NSDUH questionnaire
or more criteria of abuse for that substance or substance
to assess craving, marijuana withdrawal, and tranquilizer
class. Although DSM-5 assesses many of the same criteria as
withdrawal. Craving and marijuana withdrawal were not
DSM-IV, it does not include the diagnoses of dependence
assessed in prior surveys because they are not part of the
and abuse. A DSM-5 SUD diagnosis requires the presence
DSM-IV SUD criteria. Although tranquilizer withdrawal
of two or more of the following criteria (as measured in the
is part of the DSM-IV criteria, this symptom had not
2020 NSDUH) in a 12-month period:
been assessed in prior NSDUHs because some substances
1. Te substance is often taken in larger amounts or over
previously included in the questionnaire that were classified
a longer period than intended.
as tranquilizers do not have a withdrawal component.
2. Tere is a persistent desire or unsuccessful efforts to
Tis change from DSM-IV to DSM-5 criteria for assessing
cut down or control substance use.
SUDs led to breaks in the comparability of 2020 SUD
estimates with estimates from prior years. Consequently,
3. A great deal of time is spent in activities necessary to
this section presents SUD estimates for 2020 only. Readers
obtain the substance, use the substance, or recover
are cautioned that apparent differences between 2020 SUD
from its effects.
estimates based on DSM-5 criteria and published SUD
4. Tere is a craving, or a strong desire or urge, to use the
estimates from prior years based on DSM-IV criteria could
substance.
Key Substance Use and Mental Health Indicators in the United States:
28 | October 2021
Results from the 2020 National Survey on Drug Use and Health
reflect changes in definitions and measurement rather than
both alcohol use disorder and an illicit drug use disorder in the
real changes in SUD in the population.
past year (Figure 28).33
For example, Goldstein and colleagues demonstrated the
Te percentage of people in 2020 with a past year SUD
lack of concordance between estimates of SUD derived using
differed by age group. Te percentage was highest among
the DSM-IV criteria and those derived using the DSM-5
young adults aged 18 to 25 (24.4 percent or 8.2 million
criteria.69 Using data from the National Epidemiologic
people), followed by adults aged 26 or older (14.0 percent
Survey on Alcohol and Related Conditions-III (NESARC-
or 30.5 million people), then by adolescents aged 12 to 17
III) that were scored using both the DSM-IV and DSM-5
(6.3 percent or 1.6 million people) (Figure 26).
criteria, the authors found that the past year prevalence
estimates for DSM-5 alcohol use disorder, sedative/
Alcohol Use Disorder
tranquilizer use disorder, opioid use disorder, and heroin
Respondents who used alcohol on 6 or more days in the
use disorder were higher than the corresponding DSM-IV
past 12 months were classified as having alcohol use disorder
prevalence estimates for those disorders. Conversely, the
if they met two or more of the DSM-5 criteria for alcohol
past year prevalence estimates for cannabis use disorder,
use disorder. Relevant criteria for alcohol use disorder can be
cocaine use disorder, and stimulant use disorder were lower
found in a glossary of key definitions for the 2020 NSDUH.10
than the respective DSM-IV estimates for those disorders.
Among people aged 12 or older in 2020, 10.2 percent
In 2020, 40.3 million people aged 12 or older (or 14.5 percent
(28.3 million people) had a past year alcohol use disorder
of this population) had an SUD in the past year, including
(Figures 26 and 27). Te percentage of people who had
28.3 million who had alcohol use disorder and 18.4 million
past year alcohol use disorder was highest among young
who had an illicit drug use disorder (Figures 26 and 27).
adults aged 18 to 25 (15.6 percent or 5.2 million people),
Among the 28.3 million people with past year alcohol use
followed by adults aged 26 or older (10.3 percent or
disorder, 21.9 million had alcohol use disorder but not an
22.4 million people), then by adolescents aged 12 to 17
illicit drug use disorder. Among the 18.4 million people with
(2.8 percent or 712,000 people). Age group differences in
a past year illicit drug use disorder, 11.9 million had an illicit
the percentage of people with alcohol use disorder in the
drug use disorder but not alcohol use disorder. Among people
past year were consistent with the age group differences in
with a past year SUD, 16.0 percent (or 6.5 million people) had
the 2020 detailed tables for alcohol use in the past year70 and
differences described previously for binge and heavy alcohol
Figure 26. Substance Use Disorder, Alcohol Use Disorder, and
use in the past month.
Illicit Drug Use Disorder in the Past Year: Among People Aged 12
or Older; 2020
Illicit Drug Use Disorder
Tis section presents overall estimates for illicit drug use
disorder, then provides SUD estimates for selected specific
illicit drugs. Illicit drug use disorder was defined as meeting
DSM-5 SUD criteria for one or more of the following illicit
drugs: marijuana, cocaine, heroin, hallucinogens, inhalants,
methamphetamine, or prescription psychotherapeutic
drugs that were misused (i.e., stimulants, tranquilizers or
sedatives, and pain relievers).71 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). Respondents were classified as having
a central nervous system (CNS) stimulant use disorder
if they met DSM-5 criteria for cocaine use disorder,
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
29
Figure 27. People Aged 12 or Older with a Past Year Substance Use Disorder (SUD); 2020
Alcohol Use Disorder
28.3M
Illicit Drug Use Disorder
18.4M
Marijuana Use Disorder
14.2M
Pain Reliever Use Disorder
2.3M
No Past Year SUD
Past Year SUD
Methamphetamine Use Disorder
1.5M
236.6 Million People
40.3 Million People
(85.5%)
(14.5%)
Cocaine Use Disorder
1.3M
Stimulant Use Disorder
758,000
Heroin Use Disorder
691,000
0
10
20
30
Number of People with Specific Past Year SUD
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.
methamphetamine use disorder, or prescription stimulant
Marijuana Use Disorder
use disorder (or more than one of these disorders). Relevant
Among people aged 12 or older in 2020, 5.1 percent (or
definitions for SUDs for specific illicit drugs can be found in
14.2 million people) had a marijuana use disorder in the past
a glossary of key definitions for the 2020 NSDUH.10
year (Figures 27 and 29). Te percentage of young adults aged
18 to 25 (13.5 percent or 4.5 million people) was higher than
Among people aged 12 or older in 2020, 6.6 percent (or
the percentages of adolescents aged 12 to 17 (4.1 percent or
18.4 million people) had at least one illicit drug use disorder
1.0 million people) or adults aged 26 or older (4.0 percent or
in the past year (Figures 26 and 27). Te percentage of
8.7 million people). Te higher percentage of young adults
young adults aged 18 to 25 (14.6 percent or 4.9 million
with a marijuana use disorder was consistent with the higher
people) was higher than the percentages of adolescents aged
percentage among this age group for marijuana use in the
12 to 17 (4.9 percent or 1.2 million people) or adults aged
past year.
26 or older (5.6 percent or 12.3 million people). Te higher
percentage of young adults with at least one illicit drug use
Cocaine Use Disorder
disorder was consistent with the higher percentage among
Among people aged 12 or older in 2020, 0.5 percent
this age group for illicit drug use in the past year.
(or 1.3 million people) had a cocaine use disorder in the
past year (Figure 27 and Table A.26B). Te percentage of
Figure 28. Alcohol Use Disorder (AUD) and Illicit Drug Use
Disorder (IDUD) in the Past Year: Among People Aged 12 or Older
adolescents aged 12 to 17 (0.1 percent or 28,000 people)
with a Past Year Substance Use Disorder (SUD); 2020
was lower than the percentages of young adults aged 18 to
25 (0.7 percent or 234,000 people) or adults aged 26 or
28.3 Million People
People with AUD and IDUD
18.4 Million People
with AUD
(16.0% of People with SUD)
with IDUD
older (0.5 percent or 1.0 million people).
(70.3% of People
(45.7% of People
with SUD)
with SUD)
Heroin Use Disorder
Among people aged 12 or older in 2020, 0.2 percent (or
691,000 people) had a heroin use disorder in the past year
(Figure 27 and Table A.26B). Estimates for adolescents
21.9
6.5
11.9
Million
Million
Million
aged 12 to 17 who had a heroin use disorder in the
past year could not be calculated with sufficient precision.
People with
People with
Among young adults aged 18 to 25 in 2020, 0.1 percent
AUD Only
IDUD Only
(54.3% of People
(29.7% of People
(or 40,000 people) had a heroin use disorder in the
with SUD)
with SUD)
past year. Among adults aged 26 or older in 2020,
0.3 percent (or 652,000 people) had a heroin use disorder in
40.3 Million People Aged 12 or Older with Past Year SUD
the past year.
Key Substance Use and Mental Health Indicators in the United States:
30 | October 2021
Results from the 2020 National Survey on Drug Use and Health
Figure 29. Marijuana Use Disorder, Pain Reliever Use Disorder,
Prescription Tranquilizer Use Disorder
and Methamphetamine Use Disorder in the Past Year: Among
or Sedative Use Disorder
People Aged 12 or Older; 2020
Among people aged 12 or older in 2020, 0.4 percent
16
(or 1.2 million people) had a prescription tranquilizer
use disorder or sedative use disorder in the past year
14
13.5
(Table A.26B). Te percentage of young adults aged 18 to
12
25 (0.7 percent or 235,000 people) was higher than the
10
percentages of adolescents aged 12 to 17 (0.3 percent or
73,000 people) or adults aged 26 or older (0.4 percent or
8
845,000 people). Te higher percentage of young adults
6
5.1
with a prescription tranquilizer use disorder or sedative use
4.1
4.0
4
disorder was consistent with the higher percentage among
2
this age group for prescription tranquilizer or sedative misuse
0.8
0.8
0.9
0.6
0.6
0.3
0.1
0.3
in the past year.
0
Marijuana Use Disorder
Pain Reliever
Methamphetamine
Use Disorder
Use Disorder
Prescription Pain Reliever Use Disorder
Age Category:
12 or Older
12 to 17
18 to 25
26 or Older
Among people aged 12 or older in 2020, 0.8 percent (or
2.3 million people) had a prescription pain reliever use
Methamphetamine Use Disorder
disorder in the past year (Figures 27 and 29). Te percentage
Among people aged 12 or older in 2020, 0.6 percent (or
of adolescents aged 12 to 17 (0.3 percent or 80,000 people)
1.5 million people) had a methamphetamine use disorder in
was lower than the percentages of young adults aged 18 to
the past year (Figures 27 and 29). Te percentage of people
25 (0.8 percent or 269,000 people) or adults aged 26 or
who had a methamphetamine use disorder in the past year
older (0.9 percent or 2.0 million people).
was highest among adults aged 26 or older (0.6 percent or
Opioid Use Disorder
1.4 million people), followed by young adults aged 18 to 25
Among people aged 12 or older in 2020, 1.0 percent (or
(0.3 percent or 95,000 people), then by adolescents aged 12
2.7 million people) had an opioid use disorder in the
to 17 (0.1 percent or 21,000 people). Age group differences
past year (Table A.26B). Te percentage of adolescents aged
in the percentage of people with a methamphetamine use
12 to 17 (0.3 percent or 80,000 people) was lower than the
disorder in the past year were consistent with the age group
percentages of young adults aged 18 to 25 (0.9 percent or
differences described previously for methamphetamine use in
286,000 people) or adults aged 26 or older (1.1 percent or
the past year.
2.3 million people).
Prescription Stimulant Use Disorder
Central Nervous System Stimulant Use Disorder
Among people aged 12 or older in 2020, 0.3 percent (or
758,000 people) had a prescription stimulant use disorder
Among people aged 12 or older in 2020, 1.1 percent (or
in the past year (Figure 27 and Table A.26B). Among
3.2 million people) had a CNS stimulant use disorder in the
adolescents aged 12 to 17 in 2020, 0.2 percent (or 43,000
past year (Table A.26B). Te percentage of adolescents aged
people) had a prescription stimulant use disorder in the
12 to 17 (0.4 percent or 88,000 people) was lower than the
past year. Among young adults aged 18 to 25 in 2020,
percentages of young adults aged 18 to 25 (1.3 percent or
0.4 percent (or 141,000 people) had a prescription stimulant
423,000 people) or adults aged 26 or older (1.2 percent or
use disorder in the past year. Among adults aged 26 or older
2.7 million people).
in 2020, 0.3 percent (or 574,000 people) had a prescription
stimulant use disorder in the past year.
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
31
Major Depressive Episode in the Past Year
MDE and MDE with Severe Impairment among
Adolescents
In the 2020 NSDUH, respondents were classified as
having had a major depressive episode (MDE) in the
Among adolescents aged 12 to 17 in 2020, 17.0 percent (or
past 12 months if (1) they had at least one period of 2 weeks
4.1 million people) had a past year MDE (Figure 30). An
or longer in the past year when for most of the day nearly
estimated 12.0 percent of adolescents (or 2.9 million people)
every day, they felt depressed, or lost interest or pleasure in
in 2020 had a past year MDE with severe impairment.
daily activities; and (2) they also had problems with sleeping,
eating, energy, concentration, self-worth, or having recurrent
MDE and MDE with Severe Impairment among Adults
thoughts of death or recurrent suicidal ideation. Te MDE
Among adults aged 18 or older in 2020, 8.4 percent (or
questions are based on diagnostic criteria from the DSM-5,
21.0 million people) had a past year MDE (Table A.28B).
which require the presence of five or more symptoms during
Te percentage was highest among young adults aged 18 to
the same 2-week period.17 Te wording for some depression
25 (17.0 percent or 5.6 million people), followed by adults
questions asked of adolescent respondents aged 12 to 17
aged 26 to 49 (9.1 percent or 9.2 million people), then by
differed from the wording for similar questions asked of
adults aged 50 or older (5.4 percent or 6.2 million people).
adult respondents aged 18 or older. Terefore, the MDE
An estimated 6.0 percent of adults aged 18 or older
estimates for adults and youths are not directly comparable
(or 14.8 million people) in 2020 had a past year MDE
and are presented separately.14,72,73
with severe impairment (Figure 31). Te percentage was
Te 2020 NSDUH also collected data on whether an MDE
highest among young adults aged 18 to 25 (12.1 percent
in the past year caused respondents to experience severe
or 4.0 million people), followed by adults aged 26 to 49
impairment in four major life activities or role domains.
(6.5 percent or 6.5 million people), then by adults aged 50
Tese domains were defined separately for youths aged 12
or older (3.8 percent or 4.4 million people).
to 17 and adults aged 18 or older to reflect the different
roles associated with the two age groups. Adolescents were
Figure 30. Major Depressive Episode (MDE) and MDE with Severe
classified as having an MDE with severe impairment if their
Impairment in the Past Year: Among Youths Aged 12 to 17;
2004-2020
depression caused severe problems with their ability to do
chores at home, do well at work or school, get along with
20
their family, or have a social life.74 Adults were classified as
having an MDE with severe impairment if their depression
15
caused severe problems with their ability to manage at home
or work, have relationships with others, or have a social
10
life.75
As noted in the section titled Changes to Data Collection
5
Methods Because of the COVID-19 Pandemic, Quarter
4 of 2020 (i.e., October to December) marked the first
0
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
time that NSDUH used web-based interviewing. However,
Years
the number of adult web respondents in Quarter 4 who
MDE Status:
MDE
MDE with Severe Impairment
provided usable information on their substance use76 but
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
did not complete the mental health or later questions (i.e.,
comparing estimates between 2020 and prior years because of methodological changes for 2020.
Due to these changes, significance testing between 2020 and prior years was not performed.
“break-offs”) raised concerns about the 2020 mental health
estimates for adults. Specifically, mental health estimates
Figure 30 Table. Major Depressive Episode (MDE) and MDE with Severe
Impairment in the Past Year: Among Youths Aged 12 to 17; 2004-2020
for adults could be biased77 if the characteristics of adult
respondents who broke off the interview without completing
MDE Status
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
the mental health questions differed from the characteristics
MDE
9.0
8.8
7.9
8.2
8.3
8.1
8.0
8.2
9.1
10.7 11.4 12.5 12.8 13.3 14.4 15.7 17.0
of respondents who completed these questions. To reduce
MDE with Severe
N/A N/A
5.5
5.5
6.0
5.8
5.7
5.7
6.3
7.7
8.2
8.8
9.0
9.4 10.0 11.1 12.0
Impairment
the potential for bias, a set of break-off analysis weights was
N/A = not available.
developed for estimates of adults’ mental health data for
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
2020, including the estimates for MDE among adults.78
between 2020 and prior years was not performed.
Key Substance Use and Mental Health Indicators in the United States:
32 | October 2021
Results from the 2020 National Survey on Drug Use and Health
Figure 31. Major Depressive Episode with Severe Impairment in
Among adults aged 18 or older in 2020, 21.0 percent
the Past Year: Among Adults Aged 18 or Older; 2009-2020
(or 52.9 million people) had AMI in the past year
(Table A.29B). Te percentage was highest among young
15
adults aged 18 to 25 (30.6 percent or 10.2 million
people), followed by adults aged 26 to 49 (25.3 percent
or 25.7 million people), then by adults aged 50 or older
10
(14.5 percent or 16.9 million people).
5
Serious Mental Illness among Adults in the
Past Year
0
Among adults aged 18 or older in 2020, 5.6 percent (or
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
14.2 million people) had SMI in the past year (Figure 32).
Years
Consistent with the age group pattern for AMI, the
Age Category:
18 or Older
18 to 25
26 to 49
50 or Older
percentage of adults with SMI was highest among young
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
comparing estimates between 2020 and prior years because of methodological changes for 2020.
adults aged 18 to 25 (9.7 percent or 3.3 million people),
Due to these changes, significance testing between 2020 and prior years was not performed.
followed by adults aged 26 to 49 (6.9 percent or 7.0 million
Figure 31 Table. Major Depressive Episode with Severe Impairment in the
people), then by adults aged 50 or older (3.4 percent or
Past Year: Among Adults Aged 18 or Older; 2009-2020
4.0 million people).
Age
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
18 or Older
4.0
4.2
4.2
4.5
4.3
4.3
4.3
4.3
4.5
4.7
5.3
6.0
Figure 32. Serious Mental Illness in the Past Year: Among Adults
18 to 25
5.2
5.2
5.2
5.8
5.7
6.0
6.5
7.0
8.5
8.9
10.3
12.1
Aged 18 or Older; 2008-2020
26 to 49
4.8
4.7
5.2
5.1
4.9
4.6
4.9
4.7
5.0
5.3
6.1
6.5
10
50 or Older
2.6
3.5
2.9
3.4
3.2
3.5
3.0
3.0
2.8
2.9
3.2
3.8
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
8
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
between 2020 and prior years was not performed.
6
Any Mental Illness among Adults in the Past Year
4
Te 2020 NSDUH provided estimates of any mental illness
(AMI) and serious mental illness (SMI) for adults aged 18 or
2
older. Adults aged 18 or older were classified as having AMI
0
if they had any mental, behavioral, or emotional disorder
08
09
10
11
12
13
14
15
16
17
18
19
20
in the past year of sufficient duration to meet DSM-IV
Years
criteria (excluding developmental disorders and SUDs).18,79
Age Category:
18 or Older
18 to 25
26 to 49
50 or Older
Adults who were classified as having AMI were classified as
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
comparing estimates between 2020 and prior years because of methodological changes for 2020.
having SMI if they had any mental, behavioral, or emotional
Due to these changes, significance testing between 2020 and prior years was not performed.
disorder that substantially interfered with or limited one or
Figure 32 Table. Serious Mental Illness in the Past Year: Among Adults Aged
more major life activities. Statistical prediction models that
18 or Older; 2008-2020
were developed using clinical interview data from a subset
Age
08
09
10
11
12
13
14
15
16
17
18
19
20
of NSDUH adult respondents in 2008 to 2012 were used
18 or Older
3.7
3.7
4.1
3.9
4.1
4.2
4.1
4.0
4.2
4.5
4.6
5.2
5.6
to classify whether respondents in the 2008 to 2020 adult
18 to 25
3.8
3.3
3.9
3.8
4.1
4.2
4.8
5.0
5.9
7.5
7.7
8.6
9.7
samples had AMI or SMI in the past year.80
26 to 49
4.8
4.9
5.2
5.0
5.2
5.3
4.9
5.0
5.3
5.6
5.9
6.8
6.9
50 or Older
2.5
2.5
3.0
2.8
3.0
3.2
3.1
2.8
2.7
2.7
2.5
2.9
3.4
As noted previously, a set of break-off analysis weights was
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
developed for adults’ mental health data for 2020. Estimates
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
of AMI and SMI for 2020 used these break-off analysis
between 2020 and prior years was not performed.
weights.
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
33
Co-Occurring MDE and SUD among Adolescents
In addition, among adolescents aged 12 to 17 in 2020,
1.8 percent (or 447,000 people) had both an MDE with
Adolescents aged 12 to 17 who had both a past year MDE
severe impairment and an SUD in the past year.
and a past year SUD (i.e., illicit drug use disorder, alcohol use
disorder, or both) were classified as having co-occurring MDE
and SUD. Te order of the onset of an SUD relative to the
Substance Use among Adolescents with MDE
onset of an MDE among adolescents cannot be established
Adolescents aged 12 to 17 who had a past year MDE
based on the NSDUH data (e.g., whether the onset of an
were more likely to use some substances in the past year
SUD preceded the onset of an MDE, or vice versa).
or past month compared with their counterparts who did
As noted previously, the 2020 NSDUH marked the first year
not have an MDE in the past year. In 2020, adolescents
in which SUDs were evaluated based on DSM-5 criteria as
with a past year MDE were more likely than adolescents
opposed to DSM-IV criteria.17,18 Te Substance Use Disorders
without a past year MDE to be past year illicit drug users
in the Past Year section in this report briefly describes the
(28.6 vs. 10.7 percent) or past year marijuana users (22.0 vs.
DSM-5 criteria and highlights key differences between the
7.9 percent) (Figure 34). Adolescents with a past year MDE
DSM-5 and DSM-IV criteria. Te breaks in the comparability
also were more likely than those without a past year MDE
of 2020 SUD estimates with estimates from prior years also
to be past month binge alcohol users (6.2 vs. 3.8 percent).
affected the comparability of 2020 estimates with previous
Adolescents with a past year MDE also were more likely than
years’ estimates for co-occurring MDE and SUD among
those without a past year MDE to use tobacco products or
adolescents. Consequently, estimates of co-occurring MDE
vape nicotine in the past month (12.9 vs. 5.1 percent).
and SUD among adolescents are presented for 2020 only.
Figure 34. Substance Use: Among Youths Aged 12 to 17; by Past
Among adolescents aged 12 to 17 in 2020, 20.9 percent (or
Year Major Depressive Episode (MDE) Status, 2020
5.1 million people) had either an SUD or an MDE in the
35
past year, 14.4 percent (or 3.5 million people) had an MDE
Had MDE
but not an SUD, 3.7 percent (or 900,000 people) had an
30
28.6+
Did Not Have MDE
SUD but not an MDE, and 2.7 percent (or 644,000 people)
25
had both an MDE and an SUD in the past year (Figure 33
22.0+
and Table A.30AB).
20
15
12.9+
Figure 33. Past Year Substance Use Disorder (SUD) and Major
10.7
Depressive Episode (MDE): Among Youths Aged 12 to 17; 2020
10
7.9
6.2+
Youths Had SUD and MDE
5.1
5
3.8
2.3
1.4
0
Illicit Drugs,
Marijuana,
Opioids,
Binge Alcohol,
Tobacco
Past Year
Past Year
Past Year
Past Month
Products or
Nicotine Vaping,
Youths Had
Youths Had
3.5
Past Month
SUD but
900,000
644,000
MDE but
Million
Not MDE
Not SUD
+ 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.
1.6 Million Youths
4.1 Million Youths
Had SUD
Had MDE
5.1 Million Youths Had Either SUD or MDE
Note: Youth respondents with unknown MDE data were excluded.
Key Substance Use and Mental Health Indicators in the United States:
34 | October 2021
Results from the 2020 National Survey on Drug Use and Health
Co-Occurring Mental Health Issues and SUD
Co-Occurring SMI and SUD
among Adults
Among adults aged 18 or older in 2020, 18.4 percent (or
46.5 million people) had either SMI or an SUD in the
Among adults aged 18 or older, having AMI and an SUD
past year, 3.4 percent (or 8.5 million people) had SMI but
in the past year is referred to as having co-occurring AMI
not an SUD, 12.8 percent (or 32.3 million people) had an
and SUD. Adults having SMI and an SUD in the past year
SUD but not SMI, and 2.2 percent (or 5.7 million people)
are referred to as having co-occurring SMI and SUD.
had both SMI and an SUD (Figure 36 and Table A.32B).
However, the order of the onset of SUDs relative to the
onset of mental disorders cannot be established based on the
Figure 36. Past Year Substance Use Disorder (SUD) and Serious
NSDUH data for adults (e.g., whether the onset of SUDs
Mental Illness (SMI): Among Adults Aged 18 or Older; 2020
preceded the onset of mental disorders, or vice versa).
Adults Had SUD and SMI
As noted previously, the 2020 NSDUH marked the first
year in which SUDs were evaluated based on DSM-5
criteria as opposed to DSM-IV criteria.17,18 Te Substance
Use Disorders in the Past Year section in this report briefly
Adults Had
Adults Had
32.3
5.7
8.5
SUD but
SMI but
describes the DSM-5 criteria and highlights key differences
Million
Million
Million
Not SMI
Not SUD
between the DSM-5 and DSM-IV criteria. Te breaks in the
comparability of 2020 SUD estimates with estimates from
prior years also affected the comparability of 2020 estimates
of co-occurring mental health issues and SUD among adults.
37.9 Million
14.2 Million
Consequently, estimates of co-occurring mental health issues
Adults Had SUD
Adults Had SMI
and SUD among adults are presented for 2020 only.
46.5 Million Adults Had Either SUD or SMI
Co-Occurring AMI and SUD
Among adults aged 18 or older in 2020, 29.3 percent (or
Substance Use among Adults, by Mental
73.8 million people) had either AMI or an SUD in the
Illness Status
past year, 14.2 percent (or 35.9 million people) had AMI but
Tis section discusses how the prevalence of substance use
not an SUD, 8.3 percent (or 20.9 million people) had an
among adults aged 18 or older differed based on past year
SUD but not AMI, and 6.7 percent (or 17.0 million people)
mental illness status. Among adults aged 18 or older in 2020,
had both AMI and an SUD (Figure 35 and Table A.32B).
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
Figure 35. Past Year Substance Use Disorder (SUD) and Any
users of illicit drugs (47.8 percent for SMI and 39.8 percent
Mental Illness (AMI): Among Adults Aged 18 or Older; 2020
for AMI vs. 17.0 percent for adults with no mental illness),
Adults Had SUD
and AMI
past year users of marijuana (39.2 and 32.8 percent vs.
14.6 percent), or past year misusers of opioids (i.e., heroin
users or misusers of prescription pain relievers) (11.6 and
8.1 percent vs. 2.3 percent). In addition, adults with SMI or
Adults Had SUD
20.9
17.0
35.9
Adults Had AMI
AMI were more likely than adults with no mental illness in
but Not AMI
Million
Million
Million
but Not SUD
the past year to be past month binge alcohol users (30.9 and
28.5 percent vs. 22.8 percent). Adults with SMI or AMI were
more likely to use tobacco products or vape nicotine in the
past month than adults with no mental illness in the past year
37.9 Million
52.9 Million Adults
(37.4 and 30.9 percent vs. 19.6 percent) (Figure 37).
Adults Had SUD
Had AMI
73.8 Million Adults Had Either SUD or AMI
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
35
Figure 37. Substance Use: Among Adults Aged 18 or Older; by
Serious Thoughts of Suicide among Adults
Mental Illness Status, 2020
Among adults aged 18 or older in 2020, 4.9 percent (or
60
12.2 million people) had serious thoughts of suicide in
Any Mental Illness
Serious Mental Illness
the past year (Figures 38 and 39). Te percentage was
50
47.8+
No Mental Illness
highest among young adults aged 18 to 25 (11.3 percent
39.8+
39.2+
or 3.8 million people), followed by adults aged 26 to 49
40
37.4+
(5.3 percent or 5.3 million people), then by adults aged 50
32.8+
30.9+
30.9+
28.5+
or older (2.7 percent or 3.1 million people).
30
22.8
19.6
20
17.0
Suicide Plans among Adults
14.6
11.6+
Among adults aged 18 or older in 2020, 1.3 percent (or
10
8.1+
3.2 million people) made a suicide plan in the past year
2.3
(Figures 38 and 39). Te percentage was highest among
0
Illicit Drugs,
Marijuana,
Opioids,
Binge Alcohol,
Tobacco
young adults aged 18 to 25 (4.0 percent or 1.3 million
Past Year
Past Year
Past Year
Past Month
Products or
Nicotine Vaping,
people), followed by adults aged 26 to 49 (1.3 percent
Past Month
or 1.4 million people), then by adults aged 50 or older
+ Difference between this estimate and the estimate for adults without mental illness is statistically
(0.4 percent or 519,000 people).
significant at the .05 level.
Suicide Attempts among Adults
Suicidal Thoughts and Behaviors among Adults
Among adults aged 18 or older in 2020, 0.5 percent (or
Suicide is a leading cause of death and an important public
1.2 million people) attempted suicide in the past 12 months
health problem in the United States.81 It is a tragedy
(Figures 38 and 39). Te percentage was highest among
for all involved—the people and their families, friends,
young adults aged 18 to 25 (1.9 percent or 627,000 people),
neighbors, colleagues, and communities. Provisional data
followed by adults aged 26 to 49 (0.4 percent or 452,000
from the National Vital Statistics System indicate that in
people), then by adults aged 50 or older (0.1 percent or
2020, 44,834 people in the United States died by suicide.82
124,000 people).
Moreover, suicide rates increased in most states between
1999 and 2016, including increases by more than 30 percent
Suicidal Thoughts and Behaviors among Adults
in 25 states over this period.83 Furthermore, suicide rates
Because of COVID-19
continued to increase nationally from 2016 to 2018.84,85
During the COVID-19 pandemic, people with mental
More than 90 percent of deaths by suicide in 2018 and 2019
illness may experience worsening mental health problems
were among adults aged 20 or older.86 However, people who
die by suicide represent a fraction of those who consider
Figure 38. Adults Aged 18 or Older with Serious Thoughts of
or attempt suicide.87 Out of every 31 adults in 2008 to
Suicide, Suicide Plans, or Suicide Attempts in the Past Year; 2020
2011 in the United States who attempted suicide in the
past 12 months, there was 1 death by suicide.88
920,000
Made Plans
and Attempted
Since 2008, NSDUH respondents aged 18 or older have
Suicide
been asked if at any time during the past 12 months they
had thought seriously about trying to kill themselves (serious
3.2 Million
1.2 Million
thoughts of suicide). Adults who had serious thoughts of
Made
Attempted
Suicide Plans
Suicide
suicide in the past 12 months were asked whether they
made a plan to kill themselves (suicide plan) or tried to kill
themselves (suicide attempt) in that period. Tis information
283,000
Made No Plans
helps guide suicide prevention programs and clinical
and Attempted
Suicide
intervention efforts.
12.2 Million Adults Had Serious Thoughts of Suicide
Key Substance Use and Mental Health Indicators in the United States:
36 | October 2021
Results from the 2020 National Survey on Drug Use and Health
Figure 39. Had Serious Thoughts of Suicide, Made a Suicide Plan,
or 802,000 young adults aged 18 to 25 and 19.1 percent or
or Attempted Suicide in the Past Year: Among Adults Aged 18 or
1.0 million adults aged 26 to 49). Corresponding estimates
Older; 2020
of adults aged 50 or older with serious thoughts of suicide
12
because of the COVID-19 pandemic are not presented due
11.3
to low statistical precision.13
10
8
Suicidal Thoughts and Behaviors among
Adolescents
6
5.3
4.9
Trends in suicide attempts and deaths by suicide have
4.0
4
been increasing among adolescents.90,91 Tese trends in
2.7
suicidal behaviors among adolescents are major public
1.9
2
1.3
1.3
health concerns in the United States.92,93 Vulnerable
0.4
0.5
0.4
0.1
adolescent populations exposed to adverse childhood
0
experiences (ACEs) are at greater risk of suicide and related
Had Serious Thoughts
Made a Suicide Plan
Attempted Suicide
of Suicide
behaviors.94,95,96 In the midst of the COVID-19 pandemic,
Age Category:
18 or Older
18 to 25
26 to 49
50 or Older
preliminary data suggest a rise in suicide-related emergency
department visits, particularly among adolescents.97
and associated symptoms, such as thoughts of suicide. Other
To better understand suicidal thoughts and behaviors
people may develop new mental health problems, such as
among adolescents, new questions were added to the
depression, anxiety, or posttraumatic stress disorder, all of
NSDUH questionnaire for Quarter 4 of 2020. Terefore,
which are associated with increased suicide risk.89
estimates are limited to data that were collected from
To better understand the potential impact of the COVID-19
adolescent respondents from October to December 2020.
pandemic on suicidal thoughts and behaviors among adults
In Quarter 4, adolescent respondents were asked if they
in the United States, new questions were added to the
seriously thought about trying to kill themselves, if they
NSDUH questionnaire for Quarter 4 of 2020. Terefore,
made plans to kill themselves, and if they had tried to kill
estimates are limited to data that were collected from adult
themselves in the past 12 months. Unlike the questions for
respondents from October to December 2020. If adult
adults, the questions for adolescent respondents included
respondents reported that they thought seriously about
the response options “I’m not sure” and “I don’t want to
trying to kill themselves in the past 12 months, they were
answer.”
asked if they had these suicidal thoughts because of the
Te new follow-up questions were such that if adolescent
COVID-19 pandemic. Adult respondents who reported
respondents reported that they thought seriously about trying
plans to kill themselves or who tried to kill themselves were
to kill themselves in the past 12 months, they were asked if
also asked if they made these plans or tried to kill themselves
they had these suicidal thoughts because of the COVID-19
because of the COVID-19 pandemic.
pandemic. Adolescent respondents who reported plans to kill
Among adults aged 18 or older in 2020 who had serious
themselves or who tried to kill themselves were also asked
thoughts of suicide in the past year, 21.1 percent (or
if they had these plans or tried to kill themselves because of
2.5 million people) had serious thoughts of suicide because
the COVID-19 pandemic. Due to low statistical precision,
of the COVID-19 pandemic. Among adults who made a
however, estimates are not presented for suicidal thoughts and
suicide plan in the past year, 8.5 percent (or 266,000 people)
behaviors because of the COVID-19 pandemic among all
made a suicide plan because of the COVID-19 pandemic
adolescents who reported suicidal thoughts and behaviors.13
(Table A.35B).
Among adolescents aged 12 to 17 in 2020, 12.0 percent
Among adults in 2020 who had serious thoughts of suicide
(or 3.0 million people) had serious thoughts of suicide,
in the past year, similar percentages of young adults aged
5.3 percent (or 1.3 million people) made a suicide plan, and
18 to 25 and adults aged 26 to 49 had serious thoughts of
2.5 percent (or 629,000 people) attempted suicide in the
suicide because of the COVID-19 pandemic (22.6 percent
past year (Figure 40 and Table A.36B).
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