National Drug Survey Takes First-Time Look at Serious Mental Illness, Finds Strong Link With Substance Abuse

The latest National Household Survey on Drug Abuse estimates that in 2001 a total of 14.8 million adults aged 18 years or older—or 7.3 percent of the adult population—had a serious mental illness other than a substance use disorder. Among these Americans, the rate of substance abuse or dependence was 20.3 percent, compared with a rate of 6.3 percent among adults who did not have a serious mental illness.

Of the 14.8 million adults who had a serious mental illness, 6.9 million—about 47 percent—received some type of mental health treatment, including support from self-help groups. Overall rates of mental illness among adults decreased with age, but the likelihood of treatment increased. The rate of illness among persons aged 18 to 25 was 11.7 percent, compared with 7.9 percent among those aged 26 to 49 years and 4.9 percent among those 50 years or older. Treatment rates increased from 32.7 percent for young adults to 53.3 percent for those aged 50 or older.

In 2001, an estimated 4.3 million youths aged 12 to 17—or 18.4 percent of this population—received treatment or counseling for emotional or behavioral problems in the 12 months before the survey interview. This estimate is significantly higher than the 2000 estimate of 14.6 percent cited in the report.

These findings were made possible by the inclusion for the first time since the annual survey began in 1971 of questions about serious mental illness and its treatment. Only adults were asked about serious mental illness, which is defined as having a diagnosable mental, behavioral, or emotional disorder other than a substance-related disorder and functional impairment that interferes with major life activities. Both youths and adults were asked about mental health treatment. For adults, treatment is defined as treatment or counseling for any problem with emotions, nerves, or mental health, including the use of prescription medication. Treatment for a substance use problem alone is not included. For youths, treatment is defined as receiving treatment or counseling for problems with behaviors or emotions from mental health or other health professionals in school, home, outpatient, or inpatient settings.

Another major finding of the 2001 survey is the level of denial among Americans who have a significant drug use problem. By survey estimates, 5 million people needed but did not receive treatment for a drug problem in 2001. However, only about 377,000 of these—7.5 percent—reported that they felt they needed treatment, including 101,000 who made an unsuccessful effort to obtain treatment and 276,000 who made no effort.

The 2001 survey found that 15.9 million Americans aged 12 years or older—or 7.1 percent of this population—used an illicit drug during the past month (current drug use). The rate for 2000 was 6.3 percent. Significant increases were noted in the use of marijuana (from 4.8 percent in 2000 to 5.4 percent in 2001) and cocaine (.5 to .7 percent) and the nonmedical use of pain relievers (1.2 to 1.6 percent) and tranquilizers (.4 to .6 percent).

Significant increases in illicit drug use were found by age group. In 2001 an estimated 10.8 percent of youths aged 12 to 17 years were current users, compared with 9.7 percent in 2000. Among adults aged 18 to 25 years, the rate increased from 15.9 to 18.8 percent. No significant changes were found among adults aged 26 and older.

Adults who used illicit drugs were more than twice as likely to have a serious mental illness as adults who did not use illicit drugs. Among adults who used an illicit drug in the past year, 16.6 percent had a serious mental illness during that period. Among adults who did not use an illicit drug, the rate of serious mental illness was 6.1 percent.

The rate of alcohol use and the number of drinkers increased significantly between 2000 and 2001. In 2001 almost half of all Americans aged 12 years or older—48.3 percent, or 109 million persons—were current drinkers, compared with 46.6 percent of this population in 2000. No significant changes were found in heavy drinking (drinking five or more drinks on the same occasion on each of five or more days in the past 30 days) or binge drinking (drinking five or more drinks on the same occasion on at least one day in the past 30 days).

The rate of alcohol use among adults who had a serious mental illness was almost the same as the rate among adults who did not (71.1 and 69.7 percent, respectively). However, having a serious mental illness was correlated with binge alcohol use. Among adults who had a serious mental illness, 28.8 percent were binge drinkers, compared with 23.9 percent of adults who did not have a mental illness.

Among adolescents aged 12 to 20 years, 10.1 million reported current alcohol use—a rate of 28.5 percent. Nearly 6.8 million, or 19 percent, of adolescent alcohol users were binge drinkers, and 2.1 million, or 6 percent, were heavy drinkers.

The survey included questions designed to measure substance dependence and abuse on the basis of DSM-IV criteria. Overall, an estimated 16.6 million persons aged 12 or older—or 7.3 percent of this population—were classified as having substance abuse or dependence, which represents a significant increase over the rate of 6.5 percent found in the 2000 survey. In 2001 about 2.4 million persons were dependent on or abused both alcohol and illicit drugs, 3.2 million were dependent on or abused illicit drugs but not alcohol, and 11 million were dependent on or abused alcohol but not illicit drugs.

In the 12 months before the 2001 survey interview, an estimated 3.1 million persons aged 12 or older—1.4 percent of the population—received some kind of treatment for a problem related to the use of alcohol or illicit drugs. Of this number, 1.6 million received treatment at a self-help group. Between 2000 and 2001, a significant increase was noted in the estimated number of persons aged 12 or older who needed treatment for an illicit drug problem—from 4.7 million to 6.1 million. Overall, the number of persons who needed but did not receive drug treatment increased from 3.9 million in 2000 to 5 million in 2001.

An estimated 66.5 million Americans aged 12 years or older—or 29.5 percent of this population—reported current use of a tobacco product in 2001. No significant changes were found between 2000 and 2001 in rates of use of tobacco products among youths aged 12 to 17 years. The rate of youth cigarette use in 2001 was slightly below the rate for 2000, continuing a downward trend observed between 1999 and 2000. Rates in this age group were 14.9 percent in 1999, 13.4 percent in 2000, and 13 percent in 2001.

The National Household Survey on Drug Abuse, which is a project of the Substance Abuse and Mental Health Services Administration (SAMHSA), interviews approximately 70,000 people aged 12 years or older in every state over a 12-month period. Because of the size of the survey, it is possible to make relatively precise estimates of many variables of major interest. Findings from the 2001 survey are available on the SAMHSA web site at www.drug abusestatistics.samhsa.gov.

Institute of Medicine Report Calls for National Commitment to Reduce Underage Drinking

A new report from the National Research Council and Institute of Medicine details a multipronged strategy to reduce underage drinking. The sweeping plan represents an important shift away from prevention efforts focused primarily on youths to a nationwide adult-oriented initiative "that requires a deep, shared commitment from many institutions and individuals, including alcohol manufacturers and retail businesses, the entertainment industry, and parents and other adults in local communities."

The 304-page report, Reducing Underage Drinking: A Collective Responsibility, was produced by a committee created in 2002 that was directed by Congress to review a broad range of programs and develop a cost-effective strategy. The committee concluded that because youths drink "within the context of a society in which alcohol use is normative behavior and images about alcohol are pervasive" and because youths usually obtain alcohol from adults, efforts to reduce underage drinking need to focus on adults and must engage society at large.

The strategy detailed in the report has ten core components, with specific recommendations in each area. The components include a federally funded, adult-oriented media campaign and an independent nonprofit organization established and funded mainly by the alcohol industry with the sole mission of preventing and reducing underage drinking. Another key component of the strategy is to target alcohol advertising. Recommendations call on the alcohol industry to refrain from marketing practices that have substantial underage appeal, to strengthen advertising codes to preclude placement of commercial messages in venues in which more than 15 percent of the expected audience is under the age of 21, and to establish external review boards to enforce the codes.

The report focuses heavily on the entertainment media—film, recording, and television—stating that they have "a social responsibility to eschew displays or lyrics that portray underage drinking in a favorable light or that glamorize or promote alcohol consumption in products that are targeted toward or likely to be heard or viewed by large underage audiences." It recommends that the entertainment industry voluntarily adopt marketing codes and rating systems. For example, the film board is asked to consider alcohol content when assigning ratings, avoiding G or PG ratings for films with unsuitable alcohol content and assigning Mature ratings to films that portray underage drinking in a favorable light.

Limiting access to alcohol, which has been a component of past initiatives, would be strengthened by numerous recommendations in the report, many of which call for communities to intensify compliance checking programs in retail outlets. Strategies in this area include media campaigns targeted to sellers and servers; stronger penalties, including license revocation; mandatory completion by sellers and servers of state-approved training as a condition of employment; liability statutes to authorize negligence-based civil actions against commercial providers of alcohol to youths who subsequently cause injury to others; strict regulations on Internet sales of alcohol; and enforcement programs to deter adults from purchasing alcohol for minors.

The report points out that alcoholic beverages are far cheaper—after prices are adjusted for overall inflation—than they were in the 1960s or 1970s. It calls for higher excise taxes, with top priority given to raising beer taxes, and for excise taxes to be indexed to the consumer price index so that the cost keeps pace with inflation.

The report also recommends federal support for organizing and enhancing research. It calls for the formation of a federal, interagency coordinating committee led by the Health and Human Services Secretary and creation of a National Training and Research Center on Underage Drinking to collect more detailed data on the problem.

The full text of the report is available on the National Academies Press Web site at www.nap.edu, where copies can be ordered online for $50 plus shipping charges.