June 23, 2004
Adults with Co-Occurring
Serious Mental Illness and a
Substance Use Disorder
T
he National Survey on Drug Use and
In Brief Health (NSDUH) includes questions for
adults aged 18 or older to assess serious
● In 2002, more than half of adults mental illness (SMI) during the year prior to the
with co-occurring serious mental survey interview. SMI is defined for this report
illness (SMI) and a substance as having had at some time during the past year
use disorder (a total of 2 million a diagnosable mental, behavioral, or emotional
adults) received neither disorder that met criteria specified in the
specialty substance use Diagnostic and Statistical Manual of Mental
treatment nor mental health Disorders, 4th edition (DSM-IV),1 and resulted in
treatment during the past year functional impairment that substantially
interfered with or limited one or more major life
● Among adults with co-occurring activities. NSDUH measures SMI using the K-6
SMI and a substance use distress questions.2,3 NSDUH also includes a
disorder, women were more series of questions to assess dependence on or
likely to receive mental health abuse of alcohol or an illicit drug. Illicit drugs
treatment in the past year than include marijuana/hashish, cocaine (including
men crack), inhalants, hallucinogens, heroin, or
prescription-type drugs used nonmedically.
● The rate of perceived unmet These questions are designed to measure
need for mental health treat- dependence and abuse based on criteria specified
ment was higher than the rate of in the DSM-IV. For the purpose of this report,
perceived unmet need for individuals with either alcohol or drug
substance use treatment dependence or abuse are said to have a
among adults with co-occurring substance use disorder, and individuals with
SMI and a substance use both SMI and a substance use disorder are said
disorder to have co-occurring SMI and a substance use
disorder.4
The NSDUH Report (formerly The NHSDA Report) is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health
Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission
from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available on-line:
http://www.oas.samhsa.gov. Citation of the source is appreciated.
NSDUH REPORT: ADULTS WITH CO-OCCURING SERIOUS MENTAL ILLNESS AND A SUBSTANCE USE DISORDER June 23, 2004
Figure 2. Receipt of Mental Health or Substance Use
Figure 1. Percentages with Substance Dependence
Treatment in the Past Year among Adults Aged 18 or
or Abuse in the Past Year, among Adults Aged 18 or
Older with Co-Occurring SMI and a Substance Use
Older, by Past Year SMI: 2002
Disorder: 2002
25%
23.2
Mental Health
Treatment Only
52.1% 34.2% Specialty
20%
SubstanceUse
Treatment Only
Both Mental
15% Health and
Specialty
SubstanceUse
Treatment
10%
8.2 Neither Mental
Health nor
Specialty
5% 1.9% SubstanceUse
Treatment
11.8%
0%
Past Year SMI No Past Year SMI
NSDUH respondents also were substance use disorder). Among 25 (53 vs. 36 percent). 7 The rate of
asked about their experiences with adults without SMI, the rate of de- mental health treatment received
mental health or specialty substance pendence or abuse was only about 8 during the past year among adults
use treatment during the past year. percent (Figure 1). with co-occurring disorders was
Mental health treatment is defined More than half of adults (a total similar in metropolitan counties
as the receipt of treatment or coun- of 2 million persons) with co-occur- (47 percent) and in non-metropolitan
seling for any problem with emo- ring SMI and a substance use disor- counties (44 percent).
tions, “nerves”, or mental health in der received neither mental health
the 12 months prior to the interview nor specialty substance use treat-
in any inpatient or outpatient set- ment during the past year (Figure 2). Receipt of Specialty
ting; it also includes the use of pre- Among adults with co-occurring dis-
scription medication for treatment orders, 34 percent received mental
Substance Use
of a mental or emotional condition.5 health treatment only, 2 percent re- Treatment
Specialty substance use treatment is ceived specialty substance use treat-
Among adults with co-occurring
defined as treatment received at al- ment only, and 12 percent received
SMI and a substance use disorder,
cohol or drug rehabilitation facilities both mental health and specialty
the rate of specialty substance use
(inpatient or outpatient), hospitals substance use treatment during the
treatment received during the past
(inpatient only), or mental health past year.
year was similar among males (16
centers.6
percent) and females (11 percent).
Adults aged 26 to 49 with co-occur-
Receipt of Mental ring disorders were more likely to
Prevalence of Co- Health Treatment have received specialty substance use
Occurring Disorders treatment during the past year than
Among adults with co-occurring those aged 18 to 25 (18 vs. 6 per-
In 2002, 17.5 million adults aged 18 SMI and a substance use disorder, cent). The rate of specialty sub-
or older were estimated to have SMI the following persons were more stance use treatment during the past
in the past year. This represents likely to have received mental health year among adults with co-occurring
about 8 percent of all adults. About treatment during the past year: fe- disorders was higher in metropolitan
23 percent (4 million) of adults with males were more likely than males counties than in non-metropolitan
SMI in 2002 also were dependent (54 vs. 39 percent, Figure 3) and counties (15 vs. 8 percent).
on or abused alcohol or an illicit adults aged 26 to 49 were more
drug (had co-occurring SMI and a likely than young adults aged 18 to
June 23, 2004 NSDUH REPORT: ADULTS WITH CO-OCCURING SERIOUS MENTAL ILLNESS AND A SUBSTANCE USE DISORDER
Figure 3. Percentages Who Received Mental Health Figure 4. Perceived Unmet Need for Past Year Mental
Treatment in the Past Year among Adults Aged 18 or Health and Substance Use Treatment among
Older with Co-Occurring SMI and a Substance Use Untreated Adults Aged 18 or Older with Co-
Disorder, by Gender: 2002 Occurring SMI and a Substance Use Disorder: 2002
60%
54.0 Perceived Unmet
Need for Mental
50% Health Treatment
60.9% 23.9% Only
Perceived Unmet
38.7 Need for Specialty
40%
Substance Use
Treatment Only
30% Perceived Unmet
Need for Both
6.3% Mental Health and
20% Specialty Substance
Use Treatment
Perceived No
8.9%
10% Unmet Need for
Mental Health or
Specialty Substance
0% Use Treatment
Male Female
6. Specialty substance use treatment excludes treatment in an emergency
Perceived Unmet Treatment Need room, private doctor’s office, self-help group, prison or jail, or hospital as an
outpatient. An individual who was dependent on or had abused an illicit drug
is defined as receiving specialty treatment only if he or she reported
In 2002, among the 2 million adults with co-occurring receiving specialty treatment in the past year for drugs. Similarly, an
SMI and a substance use disorder who had not received individual who was dependent on or had abused alcohol was counted as
treatment, 24 percent perceived an unmet need for mental receiving specialty treatment only if he or she received specialty treatment in
the past year for alcohol. Individuals who reported receiving specialty
health treatment in the past year, only 6 percent perceived substance use treatment but were missing information on whether the
an unmet need for specialty substance use treatment in treatment was specifically for alcohol or illicit drugs were not counted in
estimates of specialty substance use treatment.
the past year, and only 9 percent perceived an unmet need
for both specialty substance use treatment and mental 7. Estimates for adults aged 50 or older with co-occurring disorders are not
shown due to low precision.
health treatment in the past year (Figure 4). About 61 per-
cent of adults with co-occurring SMI and a substance use Figure Note
disorder who had not received treatment perceived no Source: SAMSHA 2002 NSDUH
unmet need for either specialty substance use treatment or
The National Survey on Drug Use and Health (NSDUH) is an annual survey
mental health treatment in the past year. sponsored by the Substance Abuse and Mental Health Services
Administration (SAMHSA). Prior to 2002, this survey was called the National
Household Survey on Drug Abuse (NHSDA). The 2002 data are based on
End Notes information obtained from 68,126 persons aged 12 or older, including 44,481
persons aged 18 or older. The survey collects data by administering
1. American Psychiatric Association. (1994). Diagnostic and statistical manual
th questionnaires to a representative sample of the population through face-to-
of mental disorders (4 ed.). Washington, DC: Author.
face interviews at their place of residence.
2. Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C.,
The NSDUH Report is prepared by the Office of Applied Studies (OAS),
Hiripi, E., Howes, M. J., Normand, S. L., Manderscheid, R. W., Walters, E.
SAMHSA, and by RTI International in Research Triangle Park, North Carolina
E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the
(RTI International is a trade name of Research Triangle Institute).
general population. Archives of General Psychiatry, 60, 184-189.
Information and data for this issue are based on the following publications
3. A discussion of the methodology used to generate SMI estimates can be
and statistics:
found in Appendix B of the following document: Office of Applied Studies.
(2003). Results from the 2002 National Survey on Drug Use and Health: Office of Applied Studies. (2003). Results from the 2002 National Survey on
National findings (DHHS Publication No. SMA 03-3836, NHSDA Series H-22). Drug Use and Health: Summary of national findings (DHHS Publication No.
Rockville, MD: Substance Abuse and Mental Health Services Administration. SMA 03-3836, NSDUH series H-22). Rockville, MD: Substance Abuse and
[Available at http://www.oas.samhsa.gov/p0000016.htm#Standard] Mental Health Services Administration.
4. Substance Abuse and Mental Health Services Administration. (2002). Report Also available online: http://www.oas.samhsa.gov
to Congress on the prevention and treatment of co-occurring substance
Because of improvements and modifications to the 2002 NSDUH, estimates
abuse disorders and mental disorders. Rockville, MD: U.S. Department of
from the 2002 survey should not be compared with estimates from the 2001
Health and Human Services. [Available at http://www.samhsa.gov/reports/
or earlier versions of the survey to examine changes over time.
congress2002/index.html]
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
5. Treatment for only a substance abuse problem is not included. Substance Abuse & Mental Health Services Administration
Office of Applied Studies
www.samsha.gov
