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Daley Minute or Two #1: Current Trends in Alcohol and Drug Use in the U.S.

Each year the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes a National Survey on Drug Use and Health.  This is a comprehensive household survey of substance use, substance use disorders, mental health, and the receipt of treatment services for these disorders in the U.S.  It includes respondents in households, college dorms, homeless shelters and civilians on military bases and involves a representative sample from all 50 states and DC (n=67,500).  This survey helps us see trends of these problems in the U.S. and helps to guide policy decisions by government agencies. 

Since 1975, the National Institute on Drug Abuse (NIDA) has conducted an annual Monitoring the Future survey of drug and alcohol use and related attitudes among adolescent students nationwide.  In 2018,  42,531 students in 396 public and private schools participated in this survey, which is representative of the population of youth.

Following are highlights from these two recent surveys. Results show both improvements and continued challenges, especially among young people’s use of marijuana and vaping nicotine or marijuana.  Both reports can be accessed and printed on-line, and include many charts and figures with specific data related to substances, substance use disorders, select mental health disorders, treatment involvement, and age groups from 12-17, 18-25 and ages 26 or older.

1. Summary of substance use in 2018

  • 164.8 million people (60.2% of population) ages 12 or older used one or more substances in the past month during 2018

  • 47 million smoked cigarettes, including 27.3 million who smoked daily

  • 139.8 million drank alcohol; 67.1 were binge drinkers (3 or more drinks per drinking episode for women, 4 or more for men); 16.6 million were heavy drinkers (multiple binges)

  • 19.4% used an illicit drug in the past year with marijuana being the most commonly used drug (used by 43.5 million)

  • 10.3 million used heroin (808,000) or misused prescription opioids (9.9 million)

2. Opioids

  • In 2017 an estimated 2.0 million people had an opioid use disorder, which declined from 2.1 million in 2017

  • Four-tenths  of one percent (.04) of students used heroin in the past year

  • New users of heroin significantly decreased

  • There were significant decreases in pain reliever misuse (over half of pain relievers are given by, bought from and stolen from a friend or relative)  

3. Marijuana (cannabis)

  • There was a significant increase in young adults (18-25 years old) including young adult women

  • Frequent marijuana use was associated with opioid misuse, heavy alcohol use, and depression among those 12-25 years old

  • Past year use among students was 35.7%; daily use among students in grades 8, 10 and 12 increased significantly

  • Vaping marijuana among high school seniors increased from 7.5% in 2018 to 14% in 2019.

4. Cocaine or methamphetamine

  • There was a significant decline of cocaine use among young adults ages 18-25

  • There was a decrease in methamphetamine use among young adults 18-25, but a significant increase in use in adults ages 26 or older

  • Use among students in the past year was 2.2%.

5. Substance use including vaping among students in grades 8, 10, 12

  • Use of illicit drugs in the past year remained steady overall with 38% reporting the use of an illicit drug

  • Marijuana continues to be the most common illicit drug used by students

  • Prescription drug misuse continues to decline

  • Alcohol use continues to decline among youth; binge drinking episodes have decreased significantly in the past several years

  • Nicotine and tobacco use have declined significantly during the past 5 years, but vaping nicotine has increased

  • Daily, past month and past year vaping tobacco and marijuana have increased significantly (2018 is first year vaping was measured)

6. There was an increased rate of serious mental illness, major depressive illness, and suicidality among young adults.

  • About 14.4% of adolescents had a major depressive illness in the past year, an increase over past years

  • About 13.8% of young adults ages 18-25 had a major depressive episode in the past year, which was similar to 2017 but higher than previous years

  • Co-occurring substance use and mental disorders are common (called co-occurring disorders or CODs)

  • Use of alcohol or illicit drugs is strongly correlated with polysubstance use, major depression, and serious mental illness.

7. In 2018, 57.8 million Americans had a mental health and/or substance use disorder.

  • 20.3 million (about 8%) had a substance use disorder, which is a slight decline from 2017. 

  • 14.8 million or 74.5% had an alcohol use disorder

  • 8.1 million or 38.3% had an illicit drug use disorder

  • 2.5 million or 12.9% had illicit drug use and alcohol use disorder

8. Rates of alcohol use disorder are decreasing among middle school and high school students, and young adults ages 18-25.

9. More healthcare programs, medical and psychiatric residencies are providing SBIRT (screening, brief intervention, and referral to treatment) training to screen for substance use and potential problems. 

10. Treatment Engagement

  • Only 11.1% of those with a SUD received treatment in a specialty addiction program

  • Individuals with opioid use disorders engaged in treatment at the highest rates among all SUDs (19.7%)

  • Nearly 95% with a SUD did not think they needed treatment for their disorder

  • Rates of treatment for serious mental illness or other types of mental illness are significantly higher than rates of treatment for substance use disorders.


1. Trends in substance use and substance use disorders often change.  It is best to view these as “people” problems, look for reasons for use, effects of use, strategies to stop or reduce use, and focus less on the specific substance.

2. The rates of treatment engagement for those with substance use disorders is extremely low, which means that medical, psychiatric, social service providers and other professionals have to help identify individuals in need of treatment and facilitate linkages to care when possible.

3. Although these surveys focus on individuals with SUDs, we know that each person with a problem affects many family members and significant others.  Family members and others benefit from education, support, and referral to treatment.

4. Depressive disorders are common young people ages 12-25.  And, many have co-occurring SUDs and need help with both disorders.

5. There is good news: many studies, surveys of individuals and families, and other reports show that many people with these disorders improve significantly; more specific details will be provided in future summaries.

6. All of us can make a difference in our work with PR clients through providing education, support, brief interventions, and linkages to specialized substance use disorder treatment when needed.

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