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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37
Figure 40. Youths Aged 12 to 17 with Serious Thoughts of Suicide, Suicide Plans, or Suicide
Attempts in the Past Year; 2020
3.0 Million Youths Had Serious
Had Serious Thoughts of Suicide
Thoughts of Suicide
and Made Suicide Plans, but Did
Not Attempt Suicide
Had Serious Thoughts
1.6
1.3 Million Youths
of Suicide Only
Million
Made Suicide Plans
733K
Had Serious Thoughts of Suicide and
Made Suicide Plans Only (30K)
Attempted Suicide, but Did Not Make
502K
Suicide Plans
85K
Made Suicide Plans and Attempted Suicide, but
Did Not Have Serious Thoughts of Suicide (35K)
629,000 Youths
Attempted Suicide Only (8K)
Attempted Suicide
Had Serious Thoughts of Suicide, Made
Suicide Plans, and Attempted Suicide
3.0 Million Youths Aged 12 to 17 Had Serious Thoughts of Suicide, Made Suicide Plans, or Attempted Suicide in the Past Year
Substance Use Treatment in the Past Year
health services was allowed before 2020, reimbursement for
additional virtual services (including substance use treatment)
Substance use treatment is intended to help people address
was expanded during the COVID-19 pandemic, including
problems associated with their use of alcohol or illicit drugs
reimbursement for services delivered over the phone (i.e.,
(i.e., not counting tobacco use), including medical problems
using only audio).101 Virtual substance use treatment has
associated with the use of alcohol or illicit drugs.98 Te
been shown to be effective102,103 and has been proposed as an
2020 NSDUH provided two principal measures related to
alternative to in-person services for some time, particularly
substance use treatment in the past year: (a) the need for
in instances where access to such services is limited.104 In
substance use treatment and (b) the receipt of substance
light of these changes to substance use treatment delivery and
use treatment. Te survey also collected information on the
reimbursement, questions were added to the 2020 NSDUH
types of settings where people received treatment and issues
questionnaire for Quarter 4 (i.e., October to December) to
associated with people needing substance use treatment but
assess the use of virtual substance use treatment services. Te
not receiving it.14
Receipt of Virtual (Telehealth) Services for Substance Use
As noted in the Substance Use Disorders in the Past Year
Treatment section presents estimates from Quarter 4 on the
section, the change from DSM-IV18 to DSM-517 criteria
receipt of virtual services for substance use treatment.
for estimating SUD led to breaks in the comparability
of 2020 SUD estimates with estimates from prior years;
Need for Substance Use Treatment
therefore, data prior to 2020 are not shown. Also, because
SAMHSA classifies people as having a need for substance
some estimates for substance use treatment (e.g., need for
use treatment if they had an SUD in the past year or if they
substance use treatment) are based on whether people had
received substance use treatment at a specialty facility105 in
an SUD in the past year, this report presents substance use
the past year (regardless of whether they had an SUD).106,107
treatment estimates for 2020 only.
Among people aged 12 or older in 2020, 14.9 percent (or
Before the COVID-19 pandemic, substance use treatment
41.1 million people) needed substance use treatment in the
was typically delivered in person. Te COVID-19 pandemic
past year (Figure 41 and Table A.38AB). Consistent with
required changes in substance use treatment to include
SUD data, the percentage of people needing substance use
expansion of virtual treatments. To support this need,
treatment was highest among young adults aged 18 to 25
regulations for opioid treatment were relaxed for take-home
(24.6 percent or 8.2 million people), followed by adults aged
medications and requirements for in-person treatment.99,100
26 or older (14.3 percent or 31.3 million people), then by
Although reimbursement for some virtual behavioral
adolescents aged 12 to 17 (6.4 percent or 1.6 million people).
Key Substance Use and Mental Health Indicators in the United States:
38 | October 2021
Results from the 2020 National Survey on Drug Use and Health
Figure 41. Need for Substance Use Treatment in the Past Year:
Receipt of Any Substance Use Treatment
Among People Aged 12 or Older; 2020
Among people aged 12 or older in 2020, 1.4 percent (or
4.0 million people) received any substance use treatment
30
in the past year (Table A.38AB). An estimated 1.8 million
24.6
25
people aged 12 or older received substance use treatment
20
in the past year at a self-help group, 1.8 million received
14.9
14.3
treatment at a rehabilitation facility as an outpatient,
15
1.4 million received treatment at a mental health center as an
10
outpatient, 1.1 million received treatment at a rehabilitation
6.4
facility as an inpatient, and 1.1 million received treatment
5
at a private doctor’s office (Figure 42). Smaller numbers of
0
people received treatment at a hospital as an inpatient, in an
12 or Older
12 to 17
18 to 25
26 or Older
emergency room, or in a prison or jail.
Receipt of Substance Use Treatment
In 2020, 1.6 percent of adults aged 26 or older (or
3.4 million people) and 1.3 percent of young adults aged
NSDUH respondents who used alcohol or illicit drugs
18 to 25 (or 445,000 people) received any substance use
in their lifetime were asked whether they ever received
treatment in the past year. Tese percentages were higher
substance use treatment, and those who received substance
than the corresponding percentage among adolescents aged
use treatment in their lifetime were asked whether they
12 to 17 (0.7 percent or 169,000 people).
received treatment in the 12 months prior to the survey
interview (i.e., in the past year). Receipt of any substance
Receipt of Any Substance Use Treatment
use treatment includes substance use treatment received in
among People with a Past Year SUD
the past year at any location, such as a hospital (inpatient),
Among people aged 12 or older in 2020 with a past year
rehabilitation facility (outpatient or inpatient), mental
SUD, 6.5 percent (or 2.6 million people) received any
health center, emergency room, private doctor’s office, prison
substance use treatment in the past year (Figure 43 and
or jail, or self-help group (e.g., Alcoholics Anonymous or
Table A.38AB). Percentages were similar among age groups:
Narcotics Anonymous). Also, respondents in Quarter 4 of
7.6 percent of adolescents aged 12 to 17, 4.4 percent of
2020 who reported receiving substance use treatment in the
young adults aged 18 to 25, and 7.0 percent of adults aged
past year were asked if they received professional counseling,
26 or older with a past year SUD. Corresponding numbers of
medication, or treatment in the past 12 months for their
people with a past year SUD who received any substance use
alcohol or drug use over the phone, by e-mail, or through
video calling (i.e., virtual or telehealth services).
Figure 42. Locations Where Substance Use Treatment in the Past
Te 2020 NSDUH also collected information on the receipt
Year Was Received: Among People Aged 12 or Older; 2020
of substance use treatment at a specialty facility. Substance
use treatment at a specialty facility is included in the
estimates of any substance use treatment because a subset of
the treatment locations was categorized as specialty facilities.
Receipt of substance use treatment at a specialty facility was
defined as substance use treatment received by a respondent
at a hospital (only as an inpatient), a drug or alcohol
rehabilitation facility (as an inpatient or outpatient), or a
mental health center. Substance use treatment at a specialty
facility did not include virtual services that Quarter 4
respondents reported receiving. Substance use treatment at a
specialty facility also excluded self-help groups (regardless of
when data were collected).
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
39
treatment in the past year were 120,000 adolescents, 363,000
In comparison, among the 1.6 million adolescents aged 12
young adults, and 2.1 million adults aged 26 or older.
to 17 in 2020 who needed substance use treatment in the
past year, 3.5 percent (or 55,000 people) received substance
Receipt of Substance Use Treatment at a Specialty Facility
use treatment at a specialty facility in the past year. Among
Among people aged 12 or older in 2020, 1.0 percent (or
the 8.2 million young adults aged 18 to 25 in 2020 who
2.7 million people) received substance use treatment at a
needed substance use treatment in the past year, 3.7 percent
specialty facility in the past year (Table A.38AB). Among
(or 301,000 people) received substance use treatment at a
adolescents aged 12 to 17, 0.2 percent (or 55,000 people)
specialty facility in the past year.
received substance use treatment at a specialty facility in the
Receipt of Virtual (Telehealth) Services
past year. Tis percentage among adolescents was somewhat
for Substance Use Treatment
lower than corresponding percentages for young adults aged
18 to 25 (0.9 percent or 301,000 people) and for adults aged
Among people aged 12 or older in Quarter 4 of 2020
26 or older (1.1 percent or 2.3 million people). As noted
who received substance use treatment in the past year,
previously, however, adolescents were less likely than young
58.0 percent (or 2.2 million people) received virtual
adults or adults aged 26 or older to need substance use
(i.e., telehealth) services for substance use treatment
treatment in the past year.
(Table A.39AB). In addition, 58.4 percent of adults aged 26
or older in Quarter 4 who received substance use treatment
Receipt of Substance Use Treatment at a Specialty Facility
in the past year (or 1.9 million people) received virtual
among People Who Needed Substance Use Treatment
substance use services. Estimates for adolescents aged 12
Among the 41.1 million people aged 12 or older in 2020
to 17 and for young adults aged 18 to 25 who received
who needed substance use treatment in the past year,
substance use treatment in the past year could not be
6.5 percent (or 2.7 million people) received substance use
calculated with sufficient precision.
treatment at a specialty facility in the past year (Figure 44
and Table A.38AB). Adults aged 26 or older who needed
Perceived Need for Substance Use Treatment
substance use treatment in the past year were more likely
NSDUH respondents were classified as having a perceived
than their counterparts aged 12 to 17 or aged 18 to 25 to
need for substance use treatment (i.e., treatment for
have received substance use treatment at a specialty facility
problems related to their use of alcohol or illicit drugs)
in the past year. Among the 31.3 million adults aged 26
if they indicated that they felt they needed substance
or older in 2020 who needed substance use treatment in
use treatment in the past year. Respondents may have a
the past year, 7.4 percent (or 2.3 million people) received
perceived need for substance use treatment, regardless of
substance use treatment at a specialty facility in the past year.
whether they had an SUD in the past year. In this report,
Figure 43. Received Any Substance Use Treatment in the Past
Figure 44. Received Substance Use Treatment at a Specialty
Year: Among People Aged 12 or Older Who Had a Substance Use
Facility in the Past Year: Among People Aged 12 or Older Who
Disorder in the Past Year; 2020
Needed Substance Use Treatment in the Past Year; 2020
8
7.6
10
7.0
6.5
8
7.4
6
6.5
4.4
6
4
4
3.5
3.7
2
2
0
0
12 or Older
12 to 17
18 to 25
26 or Older
12 or Older
12 to 17
18 to 25
26 or Older
Key Substance Use and Mental Health Indicators in the United States:
40 | October 2021
Results from the 2020 National Survey on Drug Use and Health
estimates for the perceived need for substance use treatment
an SUD and did not receive substance use treatment at a
are discussed only among people aged 12 or older who were
specialty facility, only 2.5 percent perceived that they needed
classified as having an SUD in the past year108 but did not
treatment.109 For people who perceived a need for treatment,
receive substance use treatment at a specialty facility.106,107
information on common reasons for not receiving substance
use treatment is important for identifying and addressing
Among the 38.4 million people aged 12 or older in 2020 with
barriers to treatment receipt.
an SUD in the past year who did not receive substance use
treatment at a specialty facility, 97.5 percent (or 37.5 million
Among people aged 12 or older in 2020 with a past year
people) did not feel they needed treatment, 1.9 percent (or
SUD who did not receive treatment at a specialty facility and
737,000 people) felt they needed treatment but did not make
perceived a need for treatment, the following were common
an effort to get treatment, and 0.5 percent (or 211,000 people)
reasons for not receiving substance use treatment:
felt they needed treatment and made an effort to get treatment
• having no health care coverage and not being able to
(Figure 45 and Table A.40AB).109 Similar patterns were
afford the cost of treatment (19.1 percent),
observed by age group. For example, among people in different
age groups in 2020 with a past year SUD who did not receive
• not finding a program that offered the type of treatment
substance use treatment at a specialty facility, 98.4 percent of
they wanted (14.4 percent), and
adolescents aged 12 to 17 (or 1.5 million people), 98.1 percent
• being concerned that getting treatment might cause their
of young adults aged 18 to 25 (or 7.8 million people), and
neighbors or community to have a negative opinion of
97.3 percent of adults aged 26 or older (or 28.2 million
them (11.9 percent) (Table A.44B).
people) did not feel they needed treatment.
Medication-Assisted Treatment for Alcohol Use or
Reasons for Not Receiving Substance Use Treatment
Opioid Misuse
NSDUH respondents who did not receive substance use
Beginning with the 2019 NSDUH, questions were included
treatment in the past 12 months but felt they needed
in the interview to assess the receipt of medication-assisted
treatment were asked to report the reasons for not receiving
treatment (MAT) for problems with alcohol use or opioid
treatment.110 As noted in the previous section, among people
misuse. NSDUH respondents aged 12 or older who reported
aged 12 or older in 2020 who were classified as having
receiving any treatment in the past year for problems
related to their use of alcohol were asked to report whether
Figure 45. Perceived Need for Substance Use Treatment: Among
a doctor or other health professional prescribed them
People Aged 12 or Older with a Past Year Substance Use Disorder
medication in the past year to help reduce or stop their use
(SUD) Who Did Not Receive Substance Use Treatment at a
of alcohol. Questions on MAT for opioid misuse were asked
Specialty Facility in the Past Year; 2020
if respondents aged 12 or older reported ever using heroin
or ever misusing prescription pain relievers and reported
receiving any treatment in the past year for illicit drug use
problems. Tese respondents were asked whether a doctor or
211,000 Felt They Needed
Treatment and Made an Effort
other health professional prescribed them medication in the
to Get Treatment
37.5 Million
past year to help reduce or stop their use of heroin, misuse
(0.5%)
Did Not Feel They
of prescription pain relievers, or both. Respondents also were
Needed Treatment
(97.5%)
informed that MAT for opioid misuse was different from
737,000 Felt They Needed
Treatment and Did Not Make
medications given to stop a drug overdose.
an Effort to Get Treatment
(1.9%)
Medication-Assisted Treatment for Alcohol Use
Among the 28.3 million people aged 12 or older in 2020
with a past year alcohol use disorder, 1.0 percent (or
38.4 Million People with an SUD Who Did Not Receive Substance Use
292,000 people) received MAT in the past year for their
Treatment at a Specialty Facility
alcohol use (Table A.45AB). Among the 2.1 million people
Note: People who had an SUD were classified as needing substance use treatment.
aged 12 or older in 2020 who received alcohol use treatment
Note: The percentages do not add to 100 percent due to rounding.
at any location in the past year111 (regardless of whether
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
41
they had a past year alcohol use disorder), 17.2 percent (or
Treatment for Depression among Adolescents
362,000 people) received MAT in the past year for alcohol
Adolescents aged 12 to 17 who had met the criteria for
use. Estimates in 2020 for people who received MAT in
having a past year MDE were asked whether they had
the past year for alcohol use among those with a past year
received treatment for their depression in the past year.
alcohol use disorder and who received alcohol use treatment
Adolescents were classified as having received treatment
at any location in the past year could not be calculated with
for their depression in the past year if they reported seeing
sufficient precision.
or talking to a health professional or taking prescription
114
medication for their depression in that period.
Medication-Assisted Treatment for Opioid Misuse
Among the 2.6 million people aged 12 or older in 2020 who
Among the 4.1 million adolescents aged 12 to 17 in 2020 who
received illicit drug use treatment (i.e., not necessarily for
had a past year MDE, 41.6 percent (or 1.7 million people)
opioid misuse) in the past year, 30.5 percent (or 798,000
received treatment for depression in the past year (Figure 46).
people) received MAT in the past year for opioid misuse
Among the 2.9 million adolescents in 2020 who had a past year
(Table A.46AB). Among the 2.5 million people aged 12 or
MDE with severe impairment, 46.9 percent (or 1.4 million
older with a past year opioid use disorder, 11.2 percent (or
people) received treatment for depression in the past year.
278,000 people) received MAT in the past year for opioid
Stated another way, however, most adolescents in 2020 who
misuse.111
had a past year MDE or an MDE with severe impairment did
not receive treatment for depression in the past year.
Mental Health Service Use in the Past Year
Figure 46. Received Treatment in the Past Year for Depression:
Te 2020 NSDUH included questions to estimate the use
Among Youths Aged 12 to 17 with a Past Year Major Depressive
of mental health services in the United States among the
Episode (MDE) or MDE with Severe Impairment; 2004-2020
adolescent and adult populations. In addition to estimating
100
the use of mental health services among the overall
adolescent and adult populations, these questions allowed
80
for the estimation of the use of mental health services among
60
adolescents and adults with mental health issues (i.e., MDE,
AMI, and SMI).14
40
Similar to its effect on substance use treatment, the
COVID-19 pandemic has affected the availability of
20
services and the modes of mental health service delivery.
0
Even before then, virtual (i.e., telehealth) mental health care
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
has been proposed as an alternative to in-person mental
Years
health services as a means to increase access, particularly
MDE Status:
MDE
MDE with Severe Impairment
in areas where services are limited.112 Mental health care
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.
delivered virtually has been shown to be effective.113 In light
Due to these changes, significance testing between 2020 and prior years was not performed.
of these changes to the delivery of mental health services,
Figure 46 Table. Received Treatment in the Past Year for Depression: Among
questions were added to the 2020 NSDUH questionnaire
Youths Aged 12 to 17 with a Past Year Major Depressive Episode (MDE) or
for Quarter 4 (i.e., October to December) to assess the use
MDE with Severe Impairment; 2004-2020
of virtual mental health services. Te following subsections
MDE
present estimates of the receipt of virtual mental health
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
Status
services: Receipt of Virtual (Telehealth) Mental Health
MDE
40.3
37.8
38.8
39.0
37.7
34.6
37.8
38.4
37.0
38.1
41.2
39.3
40.9
41.5
41.4
43.3
41.6
Services among Adolescents, Receipt of Virtual (Telehealth)
MDE with
Severe
N/A N/A
46.5
43.9
42.6
38.8
41.1
43.5
41.0
45.0
44.7
44.6
46.7
47.5
46.9
49.7
46.9
Mental Health Services among Adults, Receipt of Virtual
Impairment
(Telehealth) Mental Health Services among Adults with
N/A = not available.
AMI, and Receipt of Virtual (Telehealth) Mental Health
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
Services among Adults with SMI.
between 2020 and prior years was not performed.
Key Substance Use and Mental Health Indicators in the United States:
42 | October 2021
Results from the 2020 National Survey on Drug Use and Health
Treatment for Depression among Adults
age. Specifically, the percentage of adults with a past year
MDE who received treatment for depression in the past year
Adults aged 18 or older who had met the criteria for having
was highest among adults aged 50 or older (75.3 percent
a past year MDE were asked whether they had received
or 4.7 million people out of 6.2 million people with an
treatment for their depression in the past year. Adults were
MDE), followed by adults aged 26 to 49 (64.8 percent
classified as having received treatment for their depression
or 5.9 million people out of 9.2 million people with an
in the past year if they reported seeing or talking to a health
MDE), then by young adults aged 18 to 25 (57.6 percent or
professional or taking prescription medication for their
3.2 million people out of 5.6 million people with an MDE).
depression in that period.114
Similarly, the percentage of adults in 2020 with a past year
Among the 21.0 million adults aged 18 or older in 2020
MDE with severe impairment who received treatment for
who had a past year MDE, 66.0 percent (or 13.8 million
depression in the past year was highest among adults aged
people) received treatment for depression in the past year
50 or older (80.9 percent or 3.5 million people out of
(Figure 47). Among the 14.8 million adults aged 18 or older
4.4 million people with an MDE with severe impairment),
in 2020 who had a past year MDE with severe impairment,
followed by adults aged 26 to 49 (68.7 percent or
71.0 percent (or 10.5 million people) received treatment for
4.5 million people out of 6.5 million people with an MDE
depression in the past year (Table A.48B).
with severe impairment), then by young adults (63.8 percent
Te percentage of adults in 2020 with a past year MDE
or 2.5 million people out of 4.0 million people with an
or a past year MDE with severe impairment who received
MDE with severe impairment).
treatment for depression in the past year increased with
Mental Health Service Use among Adolescents
Figure 47. Received Treatment in the Past Year for Depression:
In addition to asking adolescents aged 12 to 17 about
Among Adults Aged 18 or Older with a Past Year Major
treatment for depression, the 2020 NSDUH included
Depressive Episode; 2009-2020
questions for adolescents that asked about the receipt of
100
any service for emotional or behavioral problems (i.e., not
just depression) not caused by substance use. Te youth
80
mental health service utilization section of the interview
asked respondents aged 12 to 17 whether they received
60
any treatment or counseling within the 12 months prior
to the interview for problems with emotions or behavior
40
in the following settings: (a) specialty mental health
20
settings,115 (b) education settings (talked with a school social
worker, psychologist, or counselor about an emotional or
0
behavioral problem; participated in a program for students
09
10
11
12
13
14
15
16
17
18
19
20
Years
with emotional or behavioral problems while in a regular
Age Category:
18 or Older
18 to 25
26 to 49
50 or Older
school; or attended a school for students with emotional
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
or behavioral problems), (c) general medical settings (care
comparing estimates between 2020 and prior years because of methodological changes for 2020.
from a pediatrician or family physician for emotional or
Due to these changes, significance testing between 2020 and prior years was not performed.
behavioral problems), (d) juvenile justice settings (services for
Figure 47 Table. Received Treatment in the Past Year for Depression: Among
an emotional or behavioral problem in a detention center,
Adults Aged 18 or Older with a Past Year Major Depressive Episode; 2009-
prison, or jail), or (e) child welfare settings (foster care or
2020
therapeutic foster care).116
Age
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Also, adolescents in Quarter 4 of 2020 (i.e., October to
18 or Older
64.3
68.2
68.1
68.0
68.6
68.6
67.2
65.3
66.8
64.8
66.3
66.0
18 to 25
47.0
48.7
47.8
49.8
50.8
49.5
46.8
44.1
50.7
49.6
50.9
57.6
December) were asked new questions on the receipt of
26 to 49
64.8
68.1
68.1
68.8
66.7
67.9
67.4
67.4
67.3
64.4
68.9
64.8
any professional counseling, medication, or treatment in
50 or Older
73.8
78.4
80.0
76.8
81.3
80.8
80.9
77.3
79.7
78.9
76.5
75.3
the past 12 months for their mental health, emotions, or
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
behavior over the phone, by e-mail, or through video calling
2020 and prior years because of methodological changes for 2020. Due to these changes, significance testing
between 2020 and prior years was not performed.
(i.e., virtual or telehealth services). Virtual mental health
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
43
services were categorized separately from the mental health
school psychologist, or school counselor, or as part of a
settings described in the preceding paragraph.
special school or program), 3.1 percent (or 762,000 people)
who received mental health services in a general medicine
Receipt of Mental Health Services in Specialty and
setting, 0.3 percent (or 66,000 people) who received mental
Nonspecialty Settings among Adolescents
health services in a child welfare setting, and 0.1 percent
In 2020, 17.3 percent of adolescents aged 12 to 17 (or
(or 22,000 people) who received mental health services
4.2 million people) received mental health services in a
in a juvenile justice setting.5 Additionally, 6.9 percent of
specialty setting, including 16.6 percent (or 4.1 million
adolescents received mental health services in a combination
people) who received mental health treatment in an
of specialty and nonspecialty settings.33
outpatient setting and 2.1 percent (or 510,000 people) who
received mental health treatment in an inpatient setting
Receipt of Virtual (Telehealth) Mental Health
Services among Adolescents
(Figure 48 and Table A.49B). An estimated 15.0 percent of
adolescents (or 3.7 million people) received mental health
In Quarter 4 of 2020, 10.1 percent of adolescents aged 12 to
services in a nonspecialty setting, including 12.8 percent (or
17 received mental health services as virtual (i.e., telehealth)
3.1 million people) who received mental health services in
services (Table A.50B). Tis percentage corresponds to
an educational setting (such as from a school social worker,
2.5 million adolescents.
Figure 48. Sources of Mental Health Services in the Past Year:
Mental Health Service Use among Adults
Among Youths Aged 12 to 17; 2002-2020
Adult respondents aged 18 or older were asked whether
20
they received treatment or counseling for any problem
with emotions, “nerves,” or mental health in the past year
in any inpatient or outpatient setting or if they used
15
prescription medication in the past year for a mental or
emotional condition. All adult respondents (i.e., not just
10
those with mental illness) were asked these questions about
their use of mental health services. Respondents were asked
5
not to include treatment for their use of alcohol or illicit
drugs. Unlike the previously discussed questions about
0
02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
treatment for depression, general questions about the
Years
receipt of treatment or counseling for mental health issues
Source:
Specialty Mental Health Setting
Child Welfare Setting
among adults did not ask about treatment for a particular
Education Setting
Juvenile Justice Setting
mental disorder. Consequently, references in this section to
General Medical Setting
treatment or counseling for any problem with emotions,
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
nerves, or mental health are described broadly as “mental
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.
health services” or “mental health care.”
Figure 48 Table. Sources of Mental Health Services in the Past Year: Among
Also, adults in Quarter 4 of 2020 (i.e., October to
Youths Aged 12 to 17; 2002-2020
December) were asked if they received any professional
Source
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
counseling, medication, or treatment for their mental health,
Specialty Mental
emotions, or behavior over the phone, by e-mail, or through
11.8 12.4 13.4 13.4 13.0 12.4 12.7 12.0 12.1 12.6 12.7 13.6 13.7 13.3 14.7 14.8 16.0 16.7 17.3
Health Setting
video calling in the past 12 months (i.e., virtual or telehealth
Education Setting N/A N/A N/A N/A N/A N/A N/A 12.1 12.4 11.9 12.9 13.0 13.2 13.2 13.1 13.3 14.2 15.4 12.8
General Medical
services). Virtual mental health services were categorized
2.7
2.9
3.4
3.2
2.8
2.8
2.9
2.5
2.5
2.5
2.5
2.8
2.9
2.7
2.9
3.3
3.1
3.7
3.1
Setting
separately from services in inpatient or outpatient settings or
Child Welfare
N/A N/A N/A N/A N/A N/A N/A
0.4
0.4
0.6
0.4
0.4
0.4
0.3
0.4
0.4
0.4
0.4
0.3
Setting
the receipt of prescription medication.
Juvenile Justice
N/A N/A N/A N/A N/A N/A N/A
0.4
0.3
0.4
0.3
0.2
0.3
0.2
0.2
0.2
0.2
0.2
0.1
Setting
Receipt of Inpatient or Outpatient Mental Health
N/A = not available.
Services or Prescription Medication among Adults
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
In 2020, 16.9 percent of adults aged 18 or older (or
between 2020 and prior years was not performed.
41.4 million people) received inpatient or outpatient mental
Key Substance Use and Mental Health Indicators in the United States:
44 | October 2021
Results from the 2020 National Survey on Drug Use and Health
health services or took prescription medication in the
Receipt of Virtual (Telehealth) Mental
past year for a mental health issue, including 0.9 percent
Health Services among Adults
(or 2.2 million people) who received inpatient services,
In 2020, 11.0 percent of adults aged 18 or older (or
8.8 percent (or 21.5 million people) who received outpatient
26.3 million people) received virtual (i.e., telehealth) services
services, and 13.8 percent (or 33.8 million people) who
in the past year for a mental health issue (Table A.52B).111
took prescription medication (Figure 49). Adults aged 50
Adults aged 50 or older were less likely than young adults
or older were less likely than young adults aged 18 to 25 or
aged 18 to 25 or adults aged 26 to 49 to have received
adults aged 26 to 49 to have received any of these mental
virtual mental health services in the past year. Specifically,
health services in the past year (Table A.51B). Specifically,
7.8 percent of adults aged 50 or older (or 8.8 million people)
15.0 percent of adults aged 50 or older (or 17.1 million
received virtual mental health services in the past year
people) received any of these mental health services
compared with 14.9 percent of young adults (or 4.8 million
compared with 19.5 percent of young adults (or 6.3 million
people) and 13.4 percent of adults aged 26 to 49 (or
people) and 18.3 percent of adults aged 26 to 49 (or
12.8 million people).
18.0 million people).
Mental Health Service Use among Adults with AMI
Figure 49. Type of Mental Health Services Received in the Past
Receipt of Inpatient or Outpatient Mental Health Services
Year: Among Adults Aged 18 or Older; 2002-2020
or Prescription Medication among Adults with AMI
20
Among the 52.9 million adults aged 18 or older in 2020
with AMI in the past year, 46.2 percent (or 24.3 million
people) received inpatient or outpatient mental health
15
services or took prescription medication to treat a mental
health condition in the past year (Figure 50). Young adults
10
aged 18 to 25 with AMI were less likely than adults aged
26 to 49 or adults aged 50 or older with AMI to receive any
5
of these services in the past year. An estimated 42.1 percent
of young adults with AMI in the past year (or 4.3 million
0
02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20
people) received any of these mental health services in the
Years
past year compared with 46.6 percent of adults aged 26 to
Service Type:
Mental Health Services
Outpatient
49 with AMI (or 11.9 million people) and 48.0 percent of
Inpatient
Prescription Medication
adults aged 50 or older with AMI (or 8.1 million people).
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of
prescription medication.
Receipt of Virtual (Telehealth) Mental Health
Note: There is no connecting line between 2019 and 2020 to indicate caution should be used when
Services among Adults with AMI
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.
In 2020, 33.7 percent of adults aged 18 or older with AMI
Figure 49 Table. Type of Mental Health Services Received in the Past Year:
in the past year (or 18.5 million people) received virtual
Among Adults Aged 18 or Older; 2002-2020
(i.e., telehealth) mental health services in the past year
Service
(Table A.54B). In each age group, similar percentages of
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
Type
adults with AMI received virtual mental health services in
Mental
the past year (35.9 percent of young adults aged 18 to 25,
Health
13.0 13.2 12.8 13.0 12.9 13.3 13.5 13.4 13.8 13.6 14.5 14.6 14.8 14.2 14.4 14.8 15.0 16.1 16.9
Services
34.9 percent of adults aged 26 to 49, and 30.9 percent of
Inpatient
0.7
0.8
0.9
1.0
0.7
1.0
0.9
0.8
0.8
0.8
0.8
0.9
1.0
0.9
0.9
1.0
1.0
1.0
0.9
Outpatient
7.4
7.1
7.1
6.8
6.7
7.0
6.8
6.4
6.6
6.7
6.6
6.6
6.7
7.1
6.9
7.5
7.9
8.3
8.8
adults aged 50 or older).
Prescription
10.5 10.9 10.5 10.7 10.9 11.2 11.4 11.3 11.7 11.5 12.4 12.5 12.6 11.8 12.0 12.1 12.2 13.1 13.8
Medication
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription
medication.
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
|
45
Mental Health Service Use among Adults with SMI
and 72.9 percent of adults aged 50 or older with SMI (or
2.9 million people). Adults aged 50 or older with SMI also
Receipt of Inpatient or Outpatient Mental Health Services
were more likely than those aged 26 to 49 with SMI to have
or Prescription Medication among Adults with SMI
received any of these mental health services in the past year.
Among the 14.2 million adults aged 18 or older in 2020
with SMI in the past year, 64.5 percent (or 9.1 million
Receipt of Virtual (Telehealth) Mental Health
people) received inpatient or outpatient mental health
Services among Adults with SMI
services or took prescription medication to treat a mental
In 2020, 49.8 percent of adults aged 18 or older with SMI
health condition in the past year (Figure 51). As with adults
in the past year (or 7.2 million people) received virtual
with AMI, young adults aged 18 to 25 with SMI in the
(i.e., telehealth) mental health services in the past year
past year were less likely than adults aged 26 to 49 or adults
(Table A.56B). Similar percentages of young adults aged 18
aged 50 or older with SMI to receive any of these services in
to 25 (49.3 percent) and adults aged 26 to 49 (50.3 percent)
the past year. Specifically, 57.6 percent of young adults with
with SMI received virtual mental health services in the
SMI (or 1.9 million people) received any of these mental
past year. Estimates for adults aged 50 or older with an
health services in the past year compared with 63.0 percent
SMI in the past year could not be calculated with sufficient
of adults aged 26 to 49 with SMI (or 4.4 million people)
precision.
Figure 50. Mental Health Services Received in the Past Year:
Figure 51. Mental Health Services Received in the Past Year:
Among Adults Aged 18 or Older with Any Mental Illness in the
Among Adults Aged 18 or Older with Serious Mental Illness in the
Past Year; 2008-2020
Past Year; 2008-2020
80
80
60
60
40
40
20
20
0
0
08
09
10
11
12
13
14
15
16
17
18
19
20
08
09
10
11
12
13
14
15
16
17
18
19
20
Years
Years
Age Category:
18 or Older
18 to 25
26 to 49
50 or Older
Age Category:
18 or Older
18 to 25
26 to 49
50 or Older
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of
prescription medication.
prescription medication.
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 51 Table. Mental Health Services Received in the Past Year: Among
Figure 50 Table. Mental Health Services Received in the Past Year: Among
Adults Aged 18 or Older with Serious Mental Illness in the Past Year; 2008-2020
Adults Aged 18 or Older with Any Mental Illness in the Past Year; 2008-2020
Age
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Age
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
18 or Older
65.7
66.5
67.5
64.9
62.9
68.5
68.5
65.3
64.8
66.7
64.1
65.5
64.5
18 or Older
40.9
40.2
42.4
40.8
41.0
44.7
44.7
43.1
43.1
42.6
43.3
44.8
46.2
18 to 25
45.9
55.0
53.7
52.1
53.1
54.0
53.9
50.7
51.5
57.4
53.8
56.4
57.6
18 to 25
30.3
32.0
32.6
32.9
34.5
34.7
33.6
32.0
35.1
38.4
37.3
38.9
42.1
26 to 49
67.2
64.5
67.4
63.6
63.5
68.4
66.2
66.1
66.1
66.2
63.7
65.1
63.0
26 to 49
41.4
40.8
43.3
41.1
42.0
43.5
44.2
43.3
43.1
43.3
43.9
45.4
46.6
50 or Older
73.2
76.1
74.0
73.2
66.3
74.9
79.2
72.2
71.5
75.6
74.4
74.3
72.9
50 or Older
45.2
42.8
45.1
43.6
42.4
50.5
49.9
48.3
46.8
44.2
45.8
47.2
48.0
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of prescription
medication.
medication.
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.
Key Substance Use and Mental Health Indicators in the United States:
46 | October 2021
Results from the 2020 National Survey on Drug Use and Health
Perceived Unmet Need for Mental Health Services
people) perceived an unmet need for mental health services
among Adults with Mental Illness
in the past year (Figure 53). Among these 7.0 million adults
with SMI and a perceived unmet need for mental health
Tis section discusses estimates of the perceived unmet need
services, 37.6 percent (or 2.6 million people) did not receive
for mental health services among adults aged 18 or older
any mental health services in the past year (Table A.58B).
with AMI or SMI in the past year. Te section also discusses
the reasons adults with AMI or SMI did not receive these
Te percentage of adults in 2020 with SMI in the past year
services in the past year if they had a perceived unmet need.
who had a perceived unmet need for mental health services
was highest among young adults aged 18 to 25 (63.4 percent
Perceived unmet need for mental health services among
or 2.1 million people), followed by adults aged 26 to 49
adults is estimated from a question that asked all adults
(48.0 percent or 3.3 million people), then by adults aged 50 or
aged 18 or older whether there was any time in the
older (41.4 percent or 1.6 million people) (Figure 53). Tus,
past 12 months when they thought they needed treatment
nearly two thirds of young adults with SMI had a perceived
or counseling for mental health issues but did not receive
unmet need for mental health services. Furthermore, nearly half
services. However, this section presents estimates of the
of adults aged 26 to 49 with SMI and about 2 in 5 adults aged
perceived unmet need for mental health services among
50 or older with SMI had a perceived unmet need for mental
adults with AMI or SMI, regardless of whether they received
health services. Similar percentages of young adults and adults
mental health services in the past 12 months. Terefore,
aged 26 to 49 with SMI had a perceived unmet need for mental
this measure for the perceived unmet need for mental
health services and did not receive any mental health services
health services includes adults with AMI or SMI who may
(Table A.58B). Estimates for adults aged 50 or older with SMI
have received some type of mental health service in the
past 12 months but felt an unmet need for services before or
after they received services.
Figure 52. Perceived Unmet Need for Mental Health Services in
the Past Year: Among Adults Aged 18 or Older with Any Mental
Perceived Unmet Need for Mental Health
Illness in the Past Year; 2008-2020
Services among Adults with AMI
80
Among the 52.9 million adults aged 18 or older in 2020
with AMI in the past year, 30.5 percent (or 16.1 million
60
people) perceived an unmet need for mental health services
in the past year (Figure 52). Among these 16.1 million adults
40
with AMI and a perceived unmet need for mental health
services, 48.0 percent (or 7.7 million people) did not receive
any mental health services in the past year (Table A.58B).
20
Te percentage of adults in 2020 with AMI in the past year
0
who had a perceived unmet need for mental health services
08
09
10
11
12
13
14
15
16
17
18
19
20
was highest among young adults aged 18 to 25 (47.1 percent
Years
Age Category:
18 or Older
18 to 25
26 to 49
50 or Older
or 4.8 million people), followed by adults aged 26 to 49
(30.5 percent or 7.8 million people), then by adults aged 50
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.
or older (20.3 percent or 3.4 million people) (Figure 52).
Due to these changes, significance testing between 2020 and prior years was not performed.
Tus, nearly half of young adults with AMI had a perceived
Figure 52 Table. Perceived Unmet Need for Mental Health Services in the
unmet need for mental health services. Percentages of adults
Past Year: Among Adults Aged 18 or Older with Any Mental Illness in the
in 2020 with AMI and a perceived unmet need for mental
Past Year; 2008-2020
health services who did not receive any mental health
Age
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
services were similar across age groups (Table A.58B).
18 or Older
20.6
22.1
21.0
20.7
20.8
19.3
20.8
20.3
20.7
23.7
23.6
26.0
30.5
18 to 25
30.2
29.4
29.8
28.8
28.1
27.8
28.9
29.0
32.4
35.3
37.9
40.7
47.1
Perceived Unmet Need for Mental Health
26 to 49
23.3
24.8
22.5
24.6
24.4
21.7
23.3
22.5
23.0
24.5
25.3
28.0
30.5
Services among Adults with SMI
50 or Older
11.8
14.8
15.2
12.0
13.2
12.6
14.3
13.0
12.3
16.1
13.2
13.9
20.3
Among the 14.2 million adults aged 18 or older in 2020
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
with SMI in the past year, 49.7 percent (or 7.0 million
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
|
47
and a perceived unmet need who did not receive any mental
Receipt of Services for Co-Occurring Substance
health services could not be calculated with sufficient precision.
Use Disorder and Mental Health Issues
Reasons for Not Receiving Mental Health Services among
Te relationship between SUDs and mental disorders is
Adults with Mental Illness and a Perceived Unmet Need
known to be bidirectional. Te presence of a mental disorder
may contribute to the development or exacerbation of an
Among adults aged 18 or older in 2020 who had mental
SUD. Likewise, the presence of an SUD may contribute to
illness in the past year and a perceived unmet need for mental
the development or exacerbation of a mental disorder. Te
health services but did not receive services in the past year,
combined presence of SUDs and mental disorders (hereafter
the most common reason for not receiving services was they
referred to as co-occurring disorders) results in more
could not afford the cost of care (44.9 percent for these
profound functional impairment; worse treatment outcomes;
adults with AMI and 49.5 percent for these adults with SMI)
higher morbidity and mortality; increased treatment costs;
(Table A.59B). Other common reasons for not receiving
and higher risk for homelessness, incarceration, and suicide
services included not knowing where to go for services
than if people had only one of these disorders but not
(32.7 percent for these adults with AMI and 33.5 percent
both.117,118,119 Current treatment guidelines recommend
for these adults with SMI) and believing they could handle
that people with co-occurring disorders receive treatment for
the problem without treatment (29.7 percent for these adults
both disorders.120,121,122
with AMI and 25.0 percent for these adults with SMI).
In addition, 25.9 percent of these adults with SMI were
Tis section presents estimates of the receipt of services
concerned about being committed to a psychiatric hospital or
among adolescents and adults with co-occurring SUD and
having to take medication.
mental health issues. Estimates for the receipt of virtual
(i.e., telehealth) services among adolescents and adults with
Figure 53. Perceived Unmet Need for Mental Health Services
co-occurring SUD and mental health issues are presented
in the Past Year: Among Adults Aged 18 or Older with Serious
separately from estimates for the receipt of other services
Mental Illness in the Past Year; 2008-2020
because data on the receipt of virtual services were only
80
added during Quarter 4 (i.e., October to December 2020).
Receipt of Services among Adolescents with
60
Co-Occurring SUD and an MDE
40
Among the 644,000 adolescents aged 12 to 17 in 2020
with a co-occurring SUD and an MDE in the past year,
69.0 percent (or 438,000 people) received either substance
20
use treatment at a specialty facility or mental health services
in the past year, 66.8 percent (or 424,000 people) received
0
08
09
10
11
12
13
14
15
16
17
18
19
20
only mental health services, and 0.9 percent (or 6,000
Years
people) received both substance use treatment at a specialty
Age Category:
18 or Older
18 to 25
26 to 49
50 or Older
facility and mental health services (Table A.60B).
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.
Receipt of Services among Adults with Co-Occurring
Due to these changes, significance testing between 2020 and prior years was not performed.
SUD and AMI
Figure 53 Table. Perceived Unmet Need for Mental Health Services in the
Past Year: Among Adults Aged 18 or Older with Serious Mental Illness in the
Among the 17.0 million adults aged 18 or older in 2020
Past Year; 2008-2020
with a co-occurring SUD and AMI in the past year,
Age
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
50.5 percent (or 8.5 million people) received either substance
18 or Older
43.7
46.3
42.0
43.1
41.6
38.6
42.9
38.2
39.7
44.2
45.1
47.7
49.7
use treatment at a specialty facility or mental health services
18 to 25
50.0
52.2
53.1
55.0
49.8
51.5
53.6
50.3
53.7
55.9
59.5
62.5
63.4
in the past year, and 49.5 percent (or 8.4 million people)
26 to 49
44.8
49.2
44.3
45.2
46.2
42.4
45.4
43.3
39.7
45.2
45.2
47.6
48.0
received neither service (Figure 54). Stated another way,
50 or Older
38.2
37.5
32.7
33.9
30.1
27.1
33.9
23.2
30.4
32.5
31.9
35.1
41.4
nearly half of adults with a co-occurring SUD and AMI did
Note: The estimate in 2020 is italicized to indicate caution should be used when comparing estimates between
not receive substance use treatment at a specialty facility
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:
48 | October 2021
Results from the 2020 National Survey on Drug Use and Health
or mental health services for either condition. In addition,
co-occurring SUD and AMI in the past year received both
42.3 percent of adults with a co-occurring SUD and AMI
services in the past year compared with 6.0 percent of adults
(or 7.2 million people) received only mental health services,
aged 26 to 49 (or 560,000 people) and 8.2 percent of adults
2.5 percent (or 423,000 people) received only substance use
aged 50 or older (or 296,000 people) with a co-occurring
treatment at a specialty facility, and 5.7 percent (or 960,000
SUD and AMI (Table A.62B).
people) received both substance use treatment at a specialty
facility and mental health services.
Receipt of Services among Adults with Co-Occurring
SUD and SMI
Among adults aged 18 or older in 2020 with a co-occurring
Among the 5.7 million adults aged 18 or older in 2020 with
SUD and AMI in the past year, adults aged 50 or older were
a co-occurring SUD and SMI in the past year, 66.4 percent
more likely than young adults aged 18 to 25 or adults aged
(or 3.7 million people) received either substance use
26 to 49 to have received either substance use treatment at
treatment at a specialty facility or mental health services
a specialty facility or mental health services in the past year.
in the past year, and 33.6 percent (or 1.9 million people)
Specifically, 63.0 percent of adults aged 50 or older with a
received neither service (Figure 55). Stated another way,
co-occurring SUD and AMI (or 2.3 million people) received
about one third of adults with a co-occurring SUD and
either service compared with 44.9 percent of young adults
SMI (representing nearly 2 million people) did not receive
(or 1.8 million people) and 48.1 percent of adults aged
substance use treatment at a specialty facility or mental
26 to 49 (or 4.4 million people) with a co-occurring SUD
health services for either condition. In addition, 55.4 percent
and AMI.
of adults with a co-occurring SUD and SMI (or 3.1 million
In addition, young adults aged 18 to 25 in 2020 with a
people) received only mental health services, 1.6 percent
co-occurring SUD and AMI in the past year were less likely
(or 89,000 people) received only substance use treatment
than corresponding adults in older age groups to have
at a specialty facility, and 9.3 percent (or 529,000 people)
received both substance use treatment at a specialty facility
received both substance use treatment at a specialty facility
and mental health services in the past year. An estimated
and mental health services.
2.6 percent of young adults (or 104,000 people) with a
Figure 54. Receipt of Substance Use Treatment at a Specialty
Figure 55. Receipt of Substance Use Treatment at a Specialty
Facility and Mental Health Services in the Past Year: Among
Facility and Mental Health Services in the Past Year: Among
Adults Aged 18 or Older with Past Year Substance Use Disorder
Adults Aged 18 or Older with Past Year Substance Use Disorder
and Any Mental Illness; 2020
and Serious Mental Illness; 2020
SU Tx, but no MH Services
Both SU Tx and MH Services
SU Tx, but no MH Services
Both SU Tx and MH Services
423,000 Adults (2.5%)
1.0 Million Adults (5.7%)
89,000 Adults (1.6%)
529,000 Adults (9.3%)
SU Tx or
SU Tx or
No Treatment
No Treatment
MH Services
MH Services
MH Services,
MH Services,
8.4 Million Adults
1.9 Million Adults
but no SU Tx
8.5 Million Adults
but no SU Tx
3.7 Million Adults
(49.5%)
(33.6%)
7.2 Million Adults
(50.5%)
3.1 Million Adults
(66.4%)
(42.3%)
(55.4%)
17.0 Million Adults with a Substance Use Disorder and Any Mental Illness
5.7 Million Adults with a Substance Use Disorder and Serious Mental Illness
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of
Note: Mental Health Services include any combination of inpatient or outpatient services or receipt of
prescription medication.
prescription medication.
MH = mental health; SU Tx = substance use treatment.
MH = mental health; SU Tx = substance use treatment.
Note: The percentages do not add to 100 percent due to rounding.
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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49
Perceived Recovery
Among the 55.0 million adults in 2020 who perceived
that they ever had a problem with their mental health,
Since 2018, respondents aged 18 or older have been asked
65.9 percent (or 35.8 million people) considered themselves
whether they thought they ever had a problem with their use
to be in recovery or to have recovered from their mental
of alcohol or other drugs or whether they ever had a problem
health issue (Table A.65B). Young adults aged 18 to 25
with their mental health. Respondents who reported that they
who perceived that they ever had a problem with their
ever had a problem with their alcohol or other drug use were
mental health were somewhat less likely than corresponding
asked whether they considered themselves (at the time they
adults aged 26 or older to consider themselves to be in
were interviewed) to be in recovery or to have recovered from
recovery or to have recovered from their mental health
their alcohol or other drug use problem. Similarly, respondents
issue (61.8 percent of young adults or 7.1 million people
aged 18 or older who reported that they had a problem with
vs. 66.9 percent of adults aged 26 or older or 28.8 million
their mental health were asked whether they considered
people).
themselves (at the time they were interviewed) to be in
recovery or to have recovered from their mental health issue.
Substance Use, Mental Health Issues, and the
Among adults aged 18 or older in 2020, 11.6 percent (or
COVID-19 Pandemic
29.2 million people) perceived that they ever had a problem
with their use of alcohol or other drugs (Table A.64B). As
Te COVID-19 pandemic and the requisite measures taken
noted in prior sections of this report, young adults aged 18
to combat it created challenges in the everyday lives of
to 25 in 2020 tended to be more likely than adults aged 26
Americans. To describe effects of the COVID-19 pandemic
or older to be binge alcohol users in the past month, to have
on people’s substance use, mental health, and other parts
used illicit drugs in the past year, or to have had an SUD in
of their lives, SAMHSA added questions to the 2020
the past year. However, only 7.5 percent of young adults (or
NSDUH for Quarter 4 (i.e., October to December). Tese
2.5 million people) perceived that they ever had a problem with
questions asked respondents to describe how the COVID-19
their use of alcohol or other drugs compared with 12.3 percent
pandemic affected their mental health; substance use;
of adults aged 26 or older (or 26.7 million people).
financial security; housing; and access to substance use
treatment, mental health services, and medical care. Tis
Among the 29.2 million adults in 2020 who perceived that
section provides an overview of estimates of the effect of the
they ever had a substance use problem, 72.5 percent (or
COVID-19 pandemic on substance use and mental health
21.0 million people) considered themselves to be in recovery
issues according to how NSDUH respondents aged 12 or
or to have recovered from their alcohol or other drug use
older answered these questions during Quarter 4.14
problem (Table A.65B). Adults aged 26 or older who
perceived that they ever had a substance use problem were
Data from most of these questions reflect respondents’
more likely than corresponding young adults aged 18 to 25
subjective perceptions of how their lives changed during the
to consider themselves to be in recovery or to have recovered
COVID-19 pandemic. Te questions concerning mental
from their substance use problem. About three fourths of
health and substance use asked respondents to rate the effects
adults aged 26 or older who perceived that they ever had
of the COVID-19 pandemic on their mental or emotional
a substance use problem considered themselves to be in
health using a scale of responses (“not at all,” “a little,”
recovery or to have recovered (73.4 percent or 19.5 million
“some,” “quite a bit,” or “a lot”). Similarly, respondents were
people) compared with about two thirds of young adults
asked how much the COVID-19 pandemic affected their
who perceived that they ever had a substance use problem
substance use, with responses for using a substance “much
(63.4 percent or 1.6 million people).
less,” “a little less,” “about the same,” “a little more,” or “a lot
more” than they did before the COVID-19 pandemic began.
In 2020, 22.0 percent of adults aged 18 or older (or
55.0 million people) perceived that they ever had a problem
However, there are no objective indicators to define the
with their mental health (Table A.64B). Young adults aged
categories on these subjective measures. For example,
18 to 25 were more likely than adults aged 26 or older to
one respondent could define the same negative effects
perceive that they ever had a problem with their mental health
on mental health as having “some” negative effect, and
(34.7 percent of young adults or 11.5 million people vs.
another respondent could define these effects as negatively
20.0 percent of adults aged 26 or older or 43.5 million people).
affecting their mental health “quite a bit.” Similarly, one
Key Substance Use and Mental Health Indicators in the United States:
50 | October 2021
Results from the 2020 National Survey on Drug Use and Health
respondent could define the same change in substance use
Adolescents aged 12 to 17 who had a past year MDE or a
as “much less,” and another respondent could define the
past year MDE with severe impairment were more likely
change as “a little less.” Also, these are sensitive questions,
than those without a past year MDE to perceive that the
and some respondents may have given responses they felt
COVID-19 pandemic negatively affected their mental
were more socially desirable. Some respondents may have
health “quite a bit or a lot.” Among adolescents with a
been reluctant to report increased mental health issues, and
past year MDE, nearly half (48.7 percent or 1.9 million
some respondents whose substance use increased during the
people) perceived that the COVID-19 pandemic negatively
COVID-19 pandemic might have been reluctant to report
affected their mental health “quite a bit or a lot,” as did more
that they were using substances more than they did before
than half of adolescents who had a past year MDE with
the COVID-19 pandemic began.
severe impairment (55.3 percent or 1.5 million people).
In comparison, 12.7 percent of adolescents without a
An additional consideration is that data from the Centers
past year MDE (or 2.6 million people) perceived this level
for Disease Control and Prevention showed three peaks in
of a negative effect on their mental health because of the
the number of new COVID-19 cases in the United States
COVID-19 pandemic. For adolescents who had a past year
in 2020: (1) in March and April, (2) in July, and (3) in late
MDE or a past year MDE with severe impairment, however,
November and December.123 Terefore, these NSDUH
it is not known from these data whether they had an MDE
data from Quarter 4 could depend on the period(s) of the
before the COVID-19 pandemic or a new MDE that began
COVID-19 pandemic respondents recalled when answering
during the COVID-19 pandemic.
the questions.
In addition, about half of adolescents who did not have
Perceived Negative Effects on Mental Health Because
a past year MDE (52.2 percent or 10.6 million people),
of the COVID-19 Pandemic
40.8 percent (or 1.5 million people) of adolescents with a
past year MDE, and 35.1 percent (or 944,000 people) of
As mentioned previously, respondents were asked to rate the
adolescents with a past year MDE with severe impairment
COVID-19 pandemic’s negative effect on their mental health
perceived that the COVID-19 pandemic negatively affected
on a scale ranging from “not at all” to “a lot.” To facilitate
their mental health “a little or some.” It is unclear whether
analysis, responses were collapsed into three categories:
these negative effects were temporary or longer lasting.
“not at all,” “a little or some,” and “quite a bit or a lot.” As
Even if adolescents did not have a past year MDE, some of
also noted previously, the resulting data reflect respondents’
them could have needed mental health services during the
subjective perceptions and are not objective indicators
COVID-19 pandemic.
of mental health issues. In addition, asking respondents
how much (if at all) the COVID-19 pandemic negatively
Figure 56. Perceived COVID-19 Pandemic Negative Effect on
affected their mental health presupposes that the COVID-19
Emotional or Mental Health: Among Youths Aged 12 to 17; by Past
pandemic had a negative effect. Respondents were not
Year Major Depressive Episode (MDE) Status, Quarter 4, 2020
offered a choice to indicate improvement in mental health
(for whatever reason) since the COVID-19 pandemic began.
70
60
Perceived Negative Effects on Mental Health Because of the
55.3
52.2
50.8
COVID-19 Pandemic among Adolescents Aged 12 to 17
48.7
50
In Quarter 4 of 2020, most adolescents aged 12 to 17
40.8
40
perceived a negative effect of the COVID-19 pandemic on
35.1
35.1
30.8
their mental health. About 1 in 5 adolescents (18.3 percent or
30
4.5 million people) perceived that the COVID-19 pandemic
18.3
20
negatively affected their mental health “quite a bit or a lot,”
12.7
10.5
9.6
and an additional 50.8 percent (or 12.5 million people)
10
perceived “a little or some” negative effect on their mental
0
health (Figure 56). About 1 in 3 adolescents (30.8 percent
Total
Had MDE
Had MDE with Did Not Have MDE
or 7.6 million people) perceived no negative effect on their
Severe Impairment
Not at all
A little or some
Quite a bit or a lot
mental health because of the COVID-19 pandemic.
Note: The percentages do not add to 100 percent due to rounding.
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
51
Perceived Negative Effects on Mental Health Because of
However, it is not known from these data whether adults
the COVID-19 Pandemic among Adults Aged 18 or Older
had pre-existing AMI or SMI that they perceived to have
Similar to adolescents, most adults aged 18 or older
worsened or whether they had AMI or SMI for the first time
in Quarter 4 of 2020 perceived a negative effect of the
during the COVID-19 pandemic. Nevertheless, these data
COVID-19 pandemic on their mental health. About 1 in 5
indicate the need for adults with AMI and SMI to receive
adults (18.3 percent or 45.2 million people) perceived that
mental health services during the COVID-19 pandemic.
the COVID-19 pandemic negatively affected their mental
health “quite a bit or a lot,” and another 54.7 percent (or
Perceived Effects on Substance Use Because of the
135.2 million people) perceived “a little or some” negative
COVID-19 Pandemic
effect on their mental health (Figure 57). However, slightly
Stressors and feelings of social isolation during the
more than 1 in 4 adults (27.0 percent or 66.8 million
COVID-19 pandemic could have negatively affected
people) perceived no negative effect on their mental health
Americans’ substance use. In many states, establishments
because of the COVID-19 pandemic. Because these data
that sold alcohol for off-premises consumption (e.g., liquor
were collected in Quarter 4, these estimates might not reflect
stores, grocery stores) remained open as “essential businesses”
temporary negative effects on mental health that occurred
during periods when stay-at-home orders were in effect.
early in the COVID-19 pandemic.
During the COVID-19 pandemic, some states also changed
laws to allow “to-go” drinks from bars and restaurants and
In Quarter 4 of 2020, adults aged 18 or older with AMI
loosened restrictions on home delivery of alcohol.124 Czeisler
or SMI in the past year were more likely than those who
and colleagues reported estimates from June 2020 showing
did not have mental illness in the past year to perceive that
certain groups of adults started to use substances or increased
the COVID-19 pandemic negatively affected their mental
their substance use to cope with the COVID-19 pandemic.21
health “quite a bit or a lot.” Among adults with AMI in the
Other studies conducted in May and June 2020 also showed
past year, 45.2 percent (or 24.3 million people) perceived
at least short-term increases in alcohol consumption,
the COVID-19 pandemic to have negatively affected their
especially among some population subgroups.125,126
mental health “quite a bit or a lot,” as did more than half of
adults with SMI in the past year (54.9 percent or 7.9 million
However, individuals also could have decreased their
people). In comparison, about 1 in 10 adults with no
substance use in the short or long term in response to the
mental illness in the past year (10.8 percent or 20.9 million
COVID-19 pandemic. For example, data from Europe
people) perceived the COVID-19 pandemic to have
indicated some temporary decreases in substance use during
negatively affected their mental health “quite a bit or a lot.”
the COVID-19 pandemic due to disruptions in illicit drug
markets, but these reductions began to disappear as social
Figure 57. Perceived COVID-19 Pandemic Negative Effect on
distancing measures were eased.127 Adolescents and college-
Emotional or Mental Health: Among Adults Aged 18 or Older; by
aged young adults living at home may have had fewer
Past Year Mental Illness Status, Quarter 4, 2020
opportunities to use substances regardless of their desire or
70
intent to use them. It does not appear that respondents in
the study by Czeisler and colleagues were asked whether
60
57.6
54.7
54.9
they reduced their substance use or stopped using specific
50
substances during the COVID-19 pandemic.21 Terefore,
44.5
45.2
a more complete picture of how people’s substance use
40
35.8
changed during the COVID-19 pandemic also would
31.7
30
27.0
include information on people who reduced their substance
use.
18.3
20
10.4
10.8
As mentioned previously, new questions in Quarter 4 of
9.3
10
the 2020 NSDUH asked respondents to rate how the
0
COVID-19 pandemic affected their use of alcohol and other
Total
Any Mental Illness Serious Mental
No Mental Illness
drugs. Respondents who used alcohol or other drugs in the
Illness
past 12 months could report substance use ranging from
Not at all
A little or some
Quite a bit or a lot
“much less” to “a lot more” than use before the COVID-19
Note: The percentages do not add to 100 percent due to rounding.
Key Substance Use and Mental Health Indicators in the United States:
52 | October 2021
Results from the 2020 National Survey on Drug Use and Health
pandemic. Respondents answered separate questions
more” than they did before the COVID-19 pandemic was
about effects of the COVID-19 pandemic on their alcohol
higher than the corresponding percentage among past year
and other drug use. To facilitate analysis, responses were
alcohol users aged 26 or older (15.0 percent or 21.8 million
collapsed into three categories: “a little less or much less,”
people). In addition, 14.5 percent of adolescents aged 12 to
“about the same,” and “a little more or much more.”128
17 who drank alcohol in the past year (or 491,000 people)
perceived that they drank “a little more or much more” than
Perceived Effects on Alcohol Use
they did before the COVID-19 pandemic began. People who
Among people aged 12 or older in Quarter 4 of 2020 who
were drinking more than they did before the COVID-19
drank alcohol in the past year, most perceived that they
pandemic began might not return to their earlier patterns
drank “about the same” amount as they did before the
of alcohol consumption, or their level of alcohol use could
COVID-19 pandemic began (59.4 percent or 100.0 million
decrease over time.
people) (Figure 58). In addition, 25.2 percent of past year
In Quarter 4 of 2020, 38.7 percent of adolescents aged 12 to
alcohol users (or 42.5 million people) perceived that they
17 (or 1.3 million people) and 29.3 percent of young adults
drank “a little less or much less” alcohol than they did
aged 18 to 25 (or 5.9 million people) who drank alcohol in
before the COVID-19 pandemic began, and 15.4 percent
the past year perceived that they were drinking “a little less
(or 25.9 million people) perceived that they drank “a little
or much less” than they did before the COVID-19 pandemic
more or much more” than they did before. Because these
began. Tese percentages were higher than the corresponding
data were collected in Quarter 4, these estimates might not
percentage among adults aged 26 or older who used alcohol
reflect temporary increases in alcohol consumption early in
in the past year (24.3 percent or 35.3 million people). It is
the COVID-19 pandemic that were followed by a return to
unknown whether people who were drinking less than they
a pattern of alcohol use that was about the same as it was
did before the COVID-19 pandemic began will return to
before the COVID-19 pandemic began.
their earlier patterns of alcohol consumption. For example,
About 1 in 5 young adults aged 18 to 25 in Quarter 4 of
college-age young adults who were living with their parents
2020 who drank alcohol in the past year (18.2 percent
during the COVID-19 pandemic could resume their earlier
or 3.7 million people) perceived that they drank “a little
patterns of alcohol consumption once they return to their
more or much more” than they did before the COVID-19
campus environment, and adolescents may increase their
pandemic began. Te percentage of young adult alcohol
drinking as opportunities increase for unsupervised social
users who perceived that they drank “a little more or much
activities.
Perceived Effects on the Use of Drugs Other than Alcohol
Figure 58. Perceived COVID-19 Pandemic Effect on Alcohol Use:
Among people aged 12 or older in Quarter 4 of 2020 who
Among Past Year Alcohol Users Aged 12 or Older; Quarter 4, 2020
used drugs other than alcohol in the past year,128 about 1
70
in 3 (32.2 percent or 33.9 million people) perceived that
59.4
60.6
they used these drugs “a little less or much less” than they
60
52.4
did before the COVID-19 pandemic began, and more than
50
46.8
half (57.5 percent or 60.6 million people) perceived that
38.7
they used these drugs “about the same” as they did before
40
the COVID-19 pandemic began (Figure 59). An estimated
29.3
30
25.2
24.3
10.3 percent of past year users of drugs other than alcohol
18.2
(or 10.9 million people) perceived that they used these
20
15.4
14.5
15.0
drugs “a little more or much more” during the COVID-19
10
pandemic than they did before. It is not known, however,
0
whether people who reduced or increased their use of these
12 or Older
12 to 17
18 to 25
26 or Older
drugs will return to their earlier levels of use over time.
A little less or much less
About the same
A little more or much more
Note: The percentages do not add to 100 percent due to rounding.
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
53
Figure 59. Perceived COVID-19 Pandemic Effect on Drug Use:
began. It is unknown, however, whether these will be
Among Past Year Users of Drugs Other than Alcohol Aged 12 or
short- or long-term increases in other drug use that persist
Older; Quarter 4, 2020
beyond the COVID-19 pandemic. Further, because the data
were collected in Quarter 4 of 2020, there may have been
70
additional short-term increases in other drug use earlier in
59.7
60
57.5
2020 that are not reflected in these data.
49.5
50
46.4
Perceived Effects on Access to Services Because of
38.4
40
the COVID-19 Pandemic
32.2
31.8
31.5
30
Te COVID-19 pandemic could have affected access to
18.7
substance use treatment, mental health services, and medical
20
15.2
care in different ways. In response to the COVID-19
10.3
8.8
10
pandemic, for example, healthcare providers (including
behavioral healthcare providers) turned to virtual (i.e.,
0
12 or Older
12 to 17
18 to 25
26 or Older
telehealth) services (i.e., delivery of healthcare services over
the phone or Internet) as a means of delivering services
A little less or much less
About the same
A little more or much more
while also limiting in-person contact that could spread
Note: Use of drugs other than alcohol included the use of marijuana, cocaine (including crack), heroin,
COVID-19.129 As discussed in the section Substance Use
hallucinogens, inhalants, or methamphetamine in the past year or any use (i.e., not necessarily
misuse) of prescription pain relievers, tranquilizers, stimulants, or sedatives in the past year. Drugs
Treatment in the Past Year, reimbursement for virtual
other than alcohol did not include tobacco products or nicotine vaping.
Note: The percentages do not add to 100 percent due to rounding.
services was expanded during the COVID-19 pandemic,
including reimbursement for services delivered over the
In Quarter 4 of 2020, nearly half of adolescents aged 12
phone (i.e., using only audio).
to 17 who used drugs other than alcohol in the past year
To assess the various effects of the COVID-19 pandemic on
(46.4 percent or 2.0 million people) perceived that they used
access to behavioral health and medical services, NSDUH
these drugs “a little less or much less” than they did before
respondents in Quarter 4 were asked if they experienced
the COVID-19 pandemic began. Tis percentage among
the following because of the COVID-19 pandemic:
adolescents was higher than the corresponding percentages
(1) appointments moved from in-person to telehealth
among young adults aged 18 to 25 (31.8 percent or
format, (2) delays or cancellations in appointments, (3)
4.2 million people) and those aged 26 or older (31.5 percent
delays in getting prescriptions, and (4) inability to access
or 27.7 million people) who used these drugs. As previously
needed care resulting in moderate to severe impact on
noted in relation to perceived reductions in alcohol use, these
health. Respondents were asked separately about each of
adolescents could increase their use of other drugs as they have
these situations in relation to their access to substance
more opportunities to engage in social activities with peers.
use treatment, mental health treatment, and medical care
Adolescents and young adults in Quarter 4 of 2020
because of the COVID-19 pandemic.
who used drugs other than alcohol in the past year were
more likely than their counterparts aged 26 or older to
Access to Substance Use Treatment
perceive that they used these drugs “a little more or much
As noted previously, people were asked whether they
more” than they did before the COVID-19 pandemic.
experienced the following in their access to substance
Specifically, 15.2 percent of adolescents (or 665,000 people)
use treatment because of the COVID-19 pandemic: (1)
and 18.7 percent of young adults (or 2.5 million people)
appointments moved from in-person to telehealth format,
perceived that they used these drugs “a little more or much
(2) delays or cancellations in appointments, (3) delays in
more” than they did before the COVID-19 pandemic began.
getting prescriptions, and (4) inability to access needed care
In comparison, 8.8 percent of adults aged 26 or older who
resulting in moderate to severe impact on health. For people
used drugs other than alcohol in the past year (or 7.7 million
in Quarter 4 of 2020 who received substance use treatment
people) perceived that they used these drugs “a little more or
in the past year, several estimates of perceived changes in
much more” than they did before the COVID-19 pandemic
Key Substance Use and Mental Health Indicators in the United States:
54 | October 2021
Results from the 2020 National Survey on Drug Use and Health
access to substance use treatment because of the COVID-19
In addition, about 1 in 6 adults aged 18 or older in 2020
pandemic could not be calculated with sufficient precision.
who received mental health services in the past year
In addition, 97.5 percent of people aged 12 or older in 2020
(16.0 percent or 7.3 million people) experienced delays
with a past year SUD who did not receive substance use
in getting prescriptions, and 1 in 10 (10.7 percent or
treatment at a specialty facility in the past year did not think
4.9 million people) were unable to access needed care
that they needed substance use treatment. Te COVID-19
resulting in a perceived moderate to severe impact on health.
pandemic’s effect on access to substance use treatment would
Tat 4.9 million adults perceived their health to have been
not be relevant to people who did not feel that they needed
negatively affected because they were unable to access needed
those services. For these reasons, this section of the report
mental health services is an important indicator of adverse
does not present findings from Quarter 4 of 2020 on specific
impacts of changes in access to these services during the
effects of the COVID-19 pandemic on people’s access to
COVID-19 pandemic.
substance use treatment.
Tese patterns were consistent among adult age groups.
Among adults aged 18 or older in Quarter 4 of 2020 who
Access to Mental Health Services
received mental health services in the past year, for example,
Among adults aged 18 or older in Quarter 4 of 2020 who
62.7 percent of young adults aged 18 to 25 (or 4.6 million
received mental health services in the past year, more than
people) and 57.4 percent of adults aged 26 or older (or
half (58.3 percent or 26.6 million people) had appointments
22.0 million people) had appointments moved from in
moved from in person to telehealth, and 1 in 3 (38.7 percent
person to telehealth. An estimated 9.7 percent of young
or 17.7 million people) experienced delays or cancellations in
adults (or 715,000 people) and 10.9 percent of adults aged
appointments (Figure 60). Te finding that more than half of
26 or older (or 4.2 million people) who received mental
adults aged 18 or older who received mental health services
health services in the past year were unable to access needed
in the past year had appointments moved from in person to
care resulting in a perceived moderate to severe impact on
telehealth likely reflects the use of virtual (i.e., telehealth)
health.
services to continue delivering mental health services and the
expansion of reimbursement for virtual services.
Access to Medical Services
Among people aged 12 or older in Quarter 4 of 2020,
Figure 60. Perceived COVID-19 Pandemic Effect on Mental Health
nearly 1 in 3 (31.3 percent or 84.6 million people) had
Services: Among Adults Aged 18 or Older Who Received Services;
medical appointments moved from in person to telehealth,
Quarter 4, 2020
and more than 1 in 4 (29.4 percent or 79.4 million people)
70
experienced delays or cancellations in medical appointments
62.7
58.3
or preventive services (Figure 61). About 1 in 11 people
60
57.4
(8.9 percent or 23.9 million people) experienced delays
50
in getting prescriptions, and 1 in 20 (5.6 percent or
38.7
38.6
38.7
15.1 million people) were unable to access needed medical
40
care resulting in a perceived moderate to severe impact on
30
health. Tat 15.1 million people whose health was negatively
affected because they were unable to access needed medical
20
16.0
16.2
14.8
10.7
10.9
care is particularly concerning. Issues discussed previously
9.7
10
regarding access to mental health services also would apply
0
if people’s in-person medical appointments were moved to
18 or Older
18 to 25
26 or Older
telehealth or if people experienced delays or cancellations
Appointments moved from in-person to telehealth
in their medical appointments during the COVID-19
Delays or cancellations in appointments
pandemic.
Delays in getting prescriptions
Unable to access needed care resulting in moderate to severe impact on health
Key Substance Use and Mental Health Indicators in the United States:
Results from the 2020 National Survey on Drug Use and Health
October 2021
|
55
Figure 61. Perceived COVID-19 Pandemic Effect on Access to
Medical Care: Among People Aged 12 or Older; Quarter 4, 2020
40
34.2
32.0
31.3
29.4
30
24.4
20.2
19.3
20
15.1
8.9
9.4
10
7.8
5.6
5.4
5.3
6.1
1.4
0
12 or Older
12 to 17
18 to 25
26 or Older
Appointments moved from in-person to telehealth
Delays or cancellations in appointments
Delays in getting prescriptions
Unable to access needed care resulting in moderate to severe impact on health
Adults aged 26 or older in 2020 (regardless of quarter) were
more likely than adolescents and young adults to have had
two or more outpatient medical visits in the past year.33
Terefore, perceptions of whether the COVID-19 pandemic
affected people’s access to medical care would be especially
relevant to adults aged 26 or older. Among adults aged 26
or older in Quarter 4 of 2020, 34.2 percent (or 72.9 million
people) had medical appointments moved from in person
to telehealth, 32.0 percent (or 68.2 million people)
experienced delays or cancellations in medical appointments
or preventive services, 9.4 percent (or 20.1 million people)
experienced delays in getting prescriptions, and 6.1 percent
(or 13.0 million people) were unable to access needed
medical care resulting in a perceived moderate to severe
impact on health.
Key Substance Use and Mental Health Indicators in the United States:
56 | October 2021
Results from the 2020 National Survey on Drug Use and Health
11. For methodological reasons, the 2020 NSDUH estimates in this report
Endnotes
are not comparable with NSDUH data collected prior to 2002. For
1. Hasin, D. S., & Grant, B. F. (2015). Te National Epidemiologic
more details, see Appendix C in the following report for the 2004
Survey on Alcohol and Related Conditions (NESARC) Waves 1 and
NSDUH: Office of Applied Studies. (2005). Results from the 2004
2: Review and summary of findings. Social Psychiatry and Psychiatric
National Survey on Drug Use and Health: National findings (HHS
Publication No. SMA 05-4062, NSDUH Series H-28). Rockville, MD:
1088-0
Substance Abuse and Mental Health Services Administration.
2. World Health Organization. (2013). Mental health action plan 2013 -
12. Estimates presented in this report have been weighted to reflect
characteristics of the civilian, noninstitutionalized population aged 12
action_plan/en/
or older in the United States. Te calculation of NSDUH weights for
analysis includes a step that yields weights consistent with population
3. Reeves, W. C., Strine, T. W., Pratt, L. A., Tompson, W., Ahluwalia, I.,
totals obtained from the U.S. Census Bureau based on the most recently
Dhingra, S. S., McKnight-Eily, L. R., Harrison, L., D’Angelo, D. V.,
available decennial census.
Williams, L., Morrow, B., Gould, D., & Safran, M. A. (2011). Mental
illness surveillance among adults in the United States. Morbidity and
13. For a discussion of the criteria for suppressing (i.e., not publishing)
Mortality Weekly Report CDC Surveillance Summaries, 60(Suppl. 3),
unreliable estimates, see Section 3.2.2 in the following reference: Center
1-29. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/
for Behavioral Health Statistics and Quality. (2021). 2020 National
su6003a1.htm
Survey on Drug Use and Health: Methodological summary and definitions.
Retrieved from https://www.samhsa.gov/data/
4. Murray, C. J. L., & Lopez, A. D. (2013). Measuring the global burden
org/10.1056/nejmra1201534
do not appear in the report figures, their accompanying data tables, or
5. Tis report occasionally presents estimated numbers of people with a
the appendix tables.
specific characteristic (e.g., estimated numbers of substance users). Some
of these estimated numbers are not included in figures or tables in the
15. Survey modes included data collection in person or through the web.
report but may be found in the detailed tables for the 2020 NSDUH
available at https://www.samhsa.gov/data/.
16. Chapters 3 and 6 of CBHSQ (2021) discuss data quality issues for
NSDUH in greater detail. See the following reference: Center for
6. Details about the sample design, weighting, and interviewing results
Behavioral Health Statistics and Quality. (2021). 2020 National Survey
for the 2020 NSDUH are provided in Sections 2.1, 2.3.4, and
on Drug Use and Health: Methodological summary and definitions.
3.3.1 of CBHSQ (2021), including changes to the sample design
Retrieved from https://www.samhsa.gov/data/
and weighting procedures because of the COVID-19 pandemic. In
particular, Tables 2.1 and 2.2 in CBHSQ (2021) provide sample design
17. American Psychiatric Association. (2013). Diagnostic and statistical
information on the targeted numbers of completed interviews by state
manual of mental disorders (DSM-5) (5th ed.). Arlington, VA: Author.
and by age group, respectively. See the following reference: Center
18. American Psychiatric Association. (1994). Diagnostic and statistical
for Behavioral Health Statistics and Quality. (2021). 2020 National
manual of mental disorders (DSM-IV) (4th ed.). Washington, DC:
Survey on Drug Use and Health: Methodological summary and definitions.
Author.
Retrieved from https://www.samhsa.gov/data/
19. Hossain, M. M., Tasnim, S., Sultana, A., Faizah, F., Mazumder,
7. Overall response rates are not calculated for adolescents or adults
H., Zou, L., McKyer, E. L. J., Ahmed, H. U., & Ma, P. (2020).
because the screening response rate is not specific to age groups.
Epidemiology of mental health problems in COVID-19: A
8. Center for Systems Science and Engineering, Johns Hopkins University.
(2021). Coronavirus resource center: Global map: COVID-19 dashboard.
f1000research.24457.1
Retrieved from https://coronavirus.jhu.edu/map.html
20. Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A.
9. Although the 2020 NSDUH sample size was smaller than the target
(2020). Te outbreak of COVID-19 coronavirus and its impact on
sample size of 67,500 completed interviews, relatively few estimates in
global mental health. International Journal of Social Psychiatry, 66(4),
this report did not meet the criteria for publication due to low statistical
precision. Numbers of final respondents in different age groups also
21. Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A.,
were sufficiently large to detect statistically significant differences for
Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K.,
several estimates presented in this report. For discussion of the criteria
Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. W. (2020). Mental
for suppressing (i.e., not publishing) unreliable estimates and for testing
health, substance use, and suicidal ideation during the COVID-19
for statistical significance, see Sections 3.2.2 and 3.2.3 in the following
pandemic — United States, June 24-30, 2020. Morbidity and Mortality
reference: Center for Behavioral Health Statistics and Quality. (2021).
2020 National Survey on Drug Use and Health: Methodological summary
mm6932a1
22. For information on the statistical testing procedures for the 2020
10. Center for Behavioral Health Statistics and Quality. (2021). 2020
NSDUH, see Section 3.2.3 in the following reference: Center for
National Survey on Drug Use and Health: Methodological summary and
Behavioral Health Statistics and Quality. (2021). 2020 National Survey
on Drug Use and Health: Methodological summary and definitions.
Retrieved from https://www.samhsa.gov/data/
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