Patterns of Mental Health Service Utilization and Substance Use Among Adults, 2000 and 2001

6. Substance Use and Abuse among Adults Who Received Mental Health Treatment

Co-occurring mental health and substance use disorders affect millions of Americans (Substance Abuse and Mental Health Services Administration [SAMHSA], 2002). Several earlier studies indicate a clear relationship between mental health treatment and substance use and/or substance abuse treatment (Kessler, 1994; Wu, Kouzis, & Leaf, 1999). The Epidemiologic Catchment Area (ECA) study found that nearly 20 percent of patients seeking specialty mental health treatment reported substance abuse or dependence (Regier et al., 1990).

Using data from the 2000 and 2001 National Household Survey on Drug Abuse (NHSDA), this chapter investigates the relationships between the receipt of mental health treatment and substance use and abuse, as well as the relationship between mental health treatment and substance abuse treatment. Data on persons who receive both mental health treatment and drug abuse treatment also are presented. For alcohol, illicit drugs, and cigarettes, the prevalence of mental health treatment is compared among groups of substance users and nonusers.

Illicit drugs include marijuana and illicit drugs other than marijuana (cocaine [including crack], inhalants, hallucinogens, heroin, and prescription-type drugs used nonmedically). For alcohol and illicit drugs, five mutually exclusive measures are analyzed: no lifetime use, lifetime use (but not in the past year), past year use (but no heavy use or dependence or abuse), heavy use (but no dependence or abuse), and past year dependence or abuse. For cigarettes, four measures are utilized: no lifetime use, lifetime use but no use in the past year, past year use but not daily in the past month, and daily use. Definitions of heavy use vary by substance and are given in the section relating to that substance, and the cigarette smoking measures are defined in the cigarette section. The definitions of alcohol and illicit drug dependence and abuse are based on the criteria specified in the text revision of the 4^th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 2000). NHSDA measures of substance use, dependence, and abuse are described in Section 1.6.

6.1 Mental Health Treatment and Substance Use

6.1.1 Alcohol Use

Heavy alcohol use was defined as drinking five or more drinks on the same occasion on 5 or more days in the past 30 days, but having no dependence or abuse. As seen in Figure 6.1 and Table  6.1, adults with alcohol dependence or abuse in the past year were almost 3 times more likely (18.6 percent) to have had mental health treatment than past month heavy drinkers with no dependence or abuse (6.8 percent); they were almost 2½ times more likely to have had mental health treatment than those who had never used alcohol (7.6 percent). Those with dependence or abuse also had significantly higher prevalence of mental health treatment than those who had consumed alcohol in their lifetime but not in the past year (11.7 percent) and past year drinkers who were not heavy users or dependent/abusers (10.3 percent). However, lifetime but not past year drinkers were significantly more likely than past month heavy drinkers who were not dependent/abusers (6.8 percent) or never drinkers (7.6 percent) to have received mental health treatment. Thus, past year but not heavy drinkers had a higher prevalence of mental health treatment than past month heavy drinkers or never drinkers. Furthermore, the prevalence of mental health treatment was similar for never drinkers and past month heavy drinkers who were not dependent/abusers.

Figure 6.1 Past Year Mental Health Treatment, by Alcohol Use and Abuse

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6.1.2 Marijuana Use

Heavy use of marijuana was defined as marijuana use on 300 or more days in the past year (but no dependence or abuse). Adults with dependence on or abuse of marijuana were almost 3 times more likely (22.9 percent) than those who had never used it (7.9 percent) to have received mental health treatment in the past year (Figure 6.2 and Table  6.1). They also had a higher prevalence of treatment than those who had used marijuana in their lifetime but not in the past year (14.6 percent), past year users who were not heavy users or dependent/abusers (15.6 percent), and heavy users without dependence or abuse (14.0 percent). Adults with heavy use without dependence or abuse, past year use without heavy use or dependence or abuse, or lifetime marijuana use but not past year use had a similar prevalence of mental health service use. All of these groups had a greater probability of receiving mental health treatment in the past year compared with adults who never used marijuana.

Figure 6.2 Past Year Mental Health Treatment, by Marijuana Use and Abuse

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6.1.3 Illicit Drugs Other Than Marijuana

Heavy use of illicit drugs other than marijuana was defined as use of any illicit drug other than marijuana on at least 50 days in the past year (but no dependence or abuse). Figure 6.3 and Table  6.1 show that 34.7 percent of adults who abused or were dependent on illicit drugs other than marijuana had received mental health treatment in the past year. This is more than 4 times the prevalence of treatment among adults who had never used illicit drugs other than marijuana (8.2 percent), over 1½ times the treatment prevalence of heavy users (19.0 percent) who were not dependent or abusers, and more than twice that of those who used in the past year but were not heavy users or dependent or abusers or those who did not use these drugs in the past year (15.8 and 16.7 percent, respectively).

The prevalence of mental health treatment among adults who were heavy users, past year users, and lifetime users of illicit drugs other than marijuana and were not dependent/abusers was similar. All of these groups had a greater probability of receiving mental health treatment in the past year than adults who had never used drugs other than marijuana.

Figure 6.3 Past Year Mental Health Treatment, by Use and Abuse of Illicit Drugs Other Than Marijuana

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6.1.4 Cigarette Use

To assess the relationship between cigarette smoking and mental health treatment, four cigarette smoking measures were created: never smoked in lifetime, smoked in lifetime but not in the past year, smoked in the past year but not daily, and smoked daily in the past year.

Among adults aged 18 or older, significant differences in the proportions receiving mental health treatment were found between cigarette smokers and nonsmokers (Figure 6.4 and Table  6.1). Daily smokers (14.0 percent), those who smoked in the past year but not daily (13.2 percent), and those who smoked at some time in their lives but not in the past year (10.4 percent) were all more likely to receive mental health treatment than those who had never smoked in their lifetime (7.5 percent). Adults who reported daily and past year but not daily cigarette smoking also had higher rates of mental health treatment than adults who did not smoke in the past year.

Figure 6.4 Past Year Mental Health Treatment, by Cigarette Use

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6.2 Mental Health Treatment and Substance Abuse Treatment

Figure 6.5 and Table  6.2 present past year mental health treatment rates among those who never received substance abuse treatment, as well as for four categories of persons who received substance abuse treatment: (a) adults who received substance abuse treatment in their lifetime but not in the past year, or who received (b) past year alcohol treatment only, (c) past year drug treatment only, or (d) past year alcohol and drug treatment.

All adults who ever had substance abuse treatment had significantly higher prevalence of mental health treatment than adults who never had substance abuse treatment. About 21 percent of adults who had substance abuse treatment at some time in their lives but not in the past year received mental health treatment compared with 9.7 percent of adults who had never received substance abuse treatment. An estimated 39.4 percent of those who had alcohol-only treatment in the past year, 45.6 percent of those who had drug-only treatment in the past year, and 49.3 percent of adults who received treatment for both an alcohol and drug problem in the past year also received mental health treatment.

Figure 6.6 and Table  6.3 show that 22.2 million adults received substance abuse treatment and/or mental health treatment in the past year. Almost 20 million of these adults received mental health treatment only, another 1.3 million received substance abuse treatment only, and another 1 million received both substance abuse and mental health treatment.

Figure 6.5 Past Year Mental Health Treatment, by Treatment for a Substance Abuse Problem

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6.3 Summary

This chapter reported significant differences in rates of receipt of mental health treatment by substance use, abuse, and substance abuse treatment. Adults with dependence on or abuse of alcohol or illicit drugs had the highest prevalence rates of mental health treatment compared with users without dependence or abuse and nonusers of alcohol and illicit drugs. Adults who had never used alcohol, illicit drugs, or cigarettes had the lowest rates of mental health treatment across all substances. Adults who received substance use treatment were far more likely to receive mental health treatment than those who were never treated for substance use problems. Among adults who received treatment for substance use, those who had received both drug and alcohol treatment during the past year reported the highest rates of mental health treatment. Although the majority of the 22 million adults receiving mental health treatment and/or substance abuse treatment received mental health treatment only (20 million), there were 1 million adults who received both mental health and substance use treatment in the past year.

Figure 6.6 Estimated Numbers (in Thousands) of Adults Receiving Mental Health Treatment and Substance Abuse Treatment in the Past Year

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Table 6.1 Estimated Numbers (in Thousands) (with Standard Errors) and Percentages (with Standard Errors) of Adults Receiving Mental Health Treatment in the Past Year, by Categories of Substance Use and Abuse: 2000 and 2001

Table 6.2 Estimated Numbers (in Thousands) (with Standard Errors) and Percentages (with Standard Errors) of Adults Receiving Mental Health Treatment in the Past Year, by Category of Substance Treatment in the Past Year: 2000 and 2001

Table 6.3 Estimated Numbers (in Thousands) (with Standard Errors) and Percentages (with Standard Errors) of Adults Receiving Mental Health Treatment and Substance Treatment in the Past Year: 2000 and 2001

This page was last updated on June 16, 2008.

SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.