Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.
The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. SAMHSA’s 2019 National Survey on Drug Use and Health (PDF | 4.9 MB) reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.
- The 2019 National Survey on Drug Use and Health reports that 139.7 million Americans age 12 or older were past month alcohol users, 65.8 million people were binge drinkers in the past month, and 16 million were heavy drinkers in the past month.
- About 2.3 million adolescents aged 12 to 17 in 2019 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period (2019 NSDUH).
- Approximately 14.5 million people age 12 or older had an alcohol use disorder (2019 NSDUH).
- Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions.
- Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily.
- STOP Underage Drinking interagency portal – Interagency Coordinating Committee on the Prevention of Underage Drinking
- Interagency Coordinating Committee on the Prevention of Underage Drinking
- Talk. They Hear You. – underage drinking media campaign
- Underage Drinking: Myths vs. Facts
- Talking with your College-Bound Young Adult About Alcohol
- Sober Truth on Preventing Underage Drinking (STOP Act) Grants
- National Association of State Alcohol and Drug Abuse Directors
- Department of Transportation Office of Drug & Alcohol Policy & Compliance
- Alcohol Policy Information Systems Database (APIS)
- National Institute on Alcohol Abuse and Alcoholism
- Data from the 2019 NSDUH reports that 58.1 million people were current (i.e., past month) tobacco users. Specifically, 45.9 million people aged 12 or older in 2019 were past month cigarette smokers.
- Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States.
- The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes.
Electronic cigarette (e-cigarette) use data:
- Data from the Centers for Disease Control and Prevention’s 2018 National Youth Tobacco Survey indicate a 78 percent increase in current e-cigarette use among high school students and a 49 percent increase among middle school students from 2017 to 2018.
- E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals.
- Tips for Teens: Tobacco
- Tips for Teens: E-cigarettes
- Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
- Synar Amendment Program
- Truth Initiative
- FDA Center for Tobacco Products
- CDC Office on Smoking and Health
- National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
- National Institute on Drug Abuse: E-Cigarettes
- An estimated 745,000 people had used heroin in the past year, based on 2019 NSDUH data.
- In 2019, there were 10.1 million people age 12 or older who misused opioids in the past year. The vast majority of people misused prescription pain relievers (2019 NSDUH).
- An estimated 1.6 million people aged 12 or older had an opioid use disorder based on 2019 NSDUH data.
- Opioid use, specifically injection drug use, is a risk factor for contracting HIV, Hepatitis B, and Hepatitis C. The CDC reports that people who inject drugs accounted for 9 percent of HIV diagnoses in the United States in 2016.
- According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose.
- Medication-Assisted Treatment
- Opioid Overdose Prevention Toolkit
- TIP 63: Medications for Opioid Use Disorder
- Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
- Opioid Use Disorder and Pregnancy
- Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
- The Facts about Buprenorphine for Treatment of Opioid Addiction
- Pregnancy Planning for Women Being Treated for Opioid Use Disorder
- Tips for Teens: Opioids
- Rural Opioid Technical Assistance Grants
- First Responders—Comprehensive Addiction and Recovery Act (FR-CARA) Grant
- Tribal Opioid Response Grants
- Provider’s Clinical Support System – Medication Assisted Treatment Grant Program
- National Institute on Drug Abuse: Opioids
- National Institute on Drug Abuse: Heroin
- HHS Prevent Opioid Abuse
- Community Anti-Drug Coalitions of America
- Addiction Technology Transfer Center (ATTC) Network
- Prevention Technology Transfer Center (PTTC) Network
- 2019 NSDUH data indicates that 48.2 million Americans aged 12 or older, 17.5 percent of the population, used marijuana in the past year.
- Approximately 4.8 million people aged 12 or older in 2019 had a marijuana use disorder in the past year (2019 NSDUH).
- Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term.
- Marijuana can have significant health effects on youth and pregnant women.
- National Institute on Drug Abuse: Marijuana
- Addiction Technology Transfer Centers on Marijuana
- CDC Marijuana and Public Health
Emerging Trends in Substance Misuse:
- Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse reports that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
- Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
- Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.
More SAMHSA publications on substance use prevention and treatment.
Last Updated: 02/23/2021
Mental Health and Substance Use Disorders
SAMHSA works to reduce the impact of the most common mental health and substance use disorders on America’s communities.
Mental health and substance use disorders affect people from all walks of life and all age groups. These illnesses are common, recurrent, and often serious, but they are treatable and many people do recover. Mental disorders involve changes in thinking, mood, and/or behavior. These disorders can affect how we relate to others and make choices. Reaching a level that can be formally diagnosed often depends on a reduction in a person’s ability to function as a result of the disorder. For example:
- Serious mental illness is defined by someone over 18 having (within the past year) a diagnosable mental, behavior, or emotional disorder that causes serious functional impairment that substantially interferes with or limits one or more major life activities.
- For people under the age of 18, the term “Serious Emotional Disturbance” refers to a diagnosable mental, behavioral, or emotional disorder in the past year, which resulted in functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities.
- Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.
The coexistence of both a mental health and a substance use disorder is referred to as co-occurring disorders. The National Institute for Mental Health’s Mental Health Information page has information about specific conditions and disorders as well as their symptoms.
SAMHSA’s mission is to reduce the impact of mental and substance use disorders on America’s communities. SAMHSA works to prevent and treat mental and substance use disorders and provide supports for people seeking or already in recovery.
Last Updated: 04/30/2020
Prevention of Substance Use and Mental Disorders
Prevention and early intervention strategies can reduce the impact of substance use and mental disorders in America’s communities.
Prevention activities work to educate and support individuals and communities to prevent the use and misuse of drugs and the development of substance use disorders. Substance use and mental disorders can make daily activities difficult and impair a person’s ability to work, interact with family, and fulfill other major life functions. Mental and substance use disorders are among the top conditions that cause disability in the United States. Preventing mental and/or substance use disorders or co-occurring disorders and related problems is critical to behavioral and physical health.
- Substance Use Disorder Prevention
- Mental Disorder Prevention
- Workforce/Practitioner Training and Education
- Resources and Publications
- Related SAMHSA Grant Programs
- Related Organizations
SAMHSA’s Center for Mental Health Services (CMHS) leads federal efforts to promote the prevention and treatment of mental disorders. SAMHSA’s Center for Substance Abuse Prevention (CSAP) aims to develop comprehensive systems through providing national leadership in the development of policies, programs, and services to prevent the onset of substance misuse.
SAMHSA’S Evidence-Based Practices Resource Center works to provide communities, clinicians, policymakers, and others in the field with the information they need to incorporate evidence-based practices in their communities for prevention, treatment, and recovery services.
The 2018 National Survey on Drug Use and Health (PDF | 1.6 MB) reports that approximately 20.3 million people aged 12 or older had a substance use disorder in the past year. Also, in 2018, an estimated 47.6 million adults in the U.S. had any mental illness in the past year, which represents 19.1 percent of the adult population. Evidence-based prevention can work to prevent substance misuse and the development of substance use and mental disorders.
SAMHSA’s prevention and early intervention efforts promote evidence-based decision-making. Some of SAMHSA’s prevention campaigns and initiatives include:
- Talk. They Hear You. Campaign—Aims to reduce underage drinking and substance use among youths under the age of 21 by providing parents and caregivers with resources to discuss substance use with their children.
- Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD)—Coordinates federal efforts to reduce underage drinking and served as a resource for the development of A Comprehensive Plan for Preventing and Reducing Underage Drinking. This committee is comprised of 15 federal agencies and is led by SAMHSA.
- STOP Underage Drinking —This interagency website portal of the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) provides research, federal and state resources, and funding opportunities to reduce and prevent underage drinking and its consequences.
- National Prevention Week—Held in May, NPW promotes community involvement, resource sharing, and partnership engagement to increase public awareness of substance use and mental disorders. In addition, NPW provides resources to communities so they can highlight their prevention successes throughout the year. Communities Talk: Town Hall Meetings to Prevent Underage Drinking—This nationwide initiative provides community-based organizations with the resources they need to start, or support, a conversation about evidence-based underage drinking prevention. Held every two years, Communities Talk events engage multiple stakeholders within each community to mobilize action in underage drinking prevention or strengthen existing prevention programs.
- National Children’s Mental Health Awareness Day—Held in May, Awareness Day works to increase public awareness about the needs of children with serious mental illness and severe emotional disturbance. The day also demonstrates how children’s mental health initiatives promote positive youth development, recovery, and resilience.
- Federal Commission on School Safety—This federal commission, established in 2018, works to address school safety by recommending policy and best practices for school violence prevention. It includes various federal cabinet members, including current Assistant Secretary for Mental Health and Substance Use.
- National Child Traumatic Stress Initiative (NCTSI)—This initiative raises awareness about the impact of trauma on children and adolescents as a behavioral health concern. NCTSI develops and implements evidence-based interventions to reduce the mental health impact of traumatic experiences on children and adolescents.
- Prevention Technology Transfer Center (PTTC) Network — Provides training and technical assistance to the substance use prevention field through 10 regional centers, 2 National focus area centers, and a Network Coordinating Office.
- Mental Health Technology Transfer Centers (MHTTC) Network— Provides training and technical assistance to organizations and behavioral health treatment providers to deliver evidence-based practices in mental illness prevention, treatment, and recovery support.
- SAMHSA’s Suicide Prevention Resource Center – This web portal, supported by a SAMHSA CMHS grant, provides resources, programs, training, and research on suicide prevention best practices.
- Center of Excellence for Infant and Early Childhood Mental Health Consultation (IECMHC)—Helps communities support the success of the next generation by increasing access to evidence-based infant and early childhood mental health consultation.
- National Training and Technical Assistance Center for Child, Youth, and Family Mental Health (NTTAC)—Provides states, tribes, and communities with training and technical assistance on children’s behavioral health, with a focus on systems of care.
- National Survey on Drug Use and Health
- Opioid Overdose Prevention Toolkit
- Tips for Teens Series
- Report to Congress on the Prevention and Reduction of Underage Drinking, 2018 (PDF | 3.8 MB)
- Talking With Your College-Bound Young Adult About Alcohol
- Know the Risks of Marijuana
- Get Connected: Linking Older Adults with Resources on Medication, Alcohol, and Mental Health
- Keeping Youth Drug Free
- Focus on Prevention
- Tips for Health Care Practitioners and Responders: Helping Survivors Cope with Grief after a Disaster or Traumatic Event
- Substance Use and Suicide: A Nexus Requiring A Public Health Approach
- National Strategy for Suicide Prevention Implementation Assessment Report
- Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior Centers
- Preventing Suicide: A Toolkit for High Schools
- Substance Abuse Prevention and Treatment Block Grant—Provides funding to states, territories, and tribal entities for efforts in prevention and treatment of substance misuse.
- Community Mental Health Services Block Grant—Supports grantees in carrying out plans for providing comprehensive community mental health services.
- Synar Amendment—As part of the Substance Abuse Prevention and Treatment Block Grant, SAMHSA’s Center for Substance Abuse Prevention oversees the implementation of the Synar Amendment, which requires states to have laws prohibiting the sale and distribution of tobacco products to minors.
- Strategic Prevention Framework – Partnerships for Success grants—Provides funding to prevent the onset and reduce the progression of substance abuse and its related problems while strengthening prevention capacity at the community level. This grant is targeted for interventions to prevent underage drinking among persons age 9 to 20.
- First Responders-Comprehensive Addiction and Recovery Act (FR-CARA) Grants—Provides funding to train and provide resources to first responders on carrying and administering naloxone, an opioid overdose reversal drug.
- Sober Truth on Preventing Underage Drinking Act grants— Aims to prevent and reduce alcohol use among youth and young adults ages 12-20 in communities.
- Drug Free Communities (DFC) Support Program— Aims to reduce substance use among youth and reduce substance use among adults by addressing risk and protective factors.
- Tribal Behavioral Health Grant Program—Aims to prevent and reduce suicidal behavior and substance use, reduce the impact of trauma, and promote mental health among American Indian/Alaska Native youth through age of 24.
- Project AWARE (Advancing Wellness and Resiliency in Education) State Education Agency Grants—Aims to build the capacity of state education agencies to increase awareness of mental health issues among school-aged youth; provide training for school personnel to detect and respond to mental health issues; and connect school-aged youth and families to needed services.
- Garrett Lee Smith (GLS) Campus Suicide Prevention Grant—Aims to develop a coordinated approach to enhance behavioral health services for all college students, prevent mental and substance use disorders, promote help-seeking behaviors, and improve the identification and treatment of college students at-risk for suicide.
- Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention Grant Program—Supports states and tribes with implementing youth suicide prevention and early intervention strategies in schools, youth-serving organizations, and health care settings.
- National Center of Excellence for Infant and Early Childhood Mental Health Consultation—Works to promote the healthy social and emotional development of infants and young children and to prevent the onset of serious emotional disturbance through funding of public and private nonprofit entities.
- Linking Actions for Unmet Needs in Children’s Health Grant Program (Project LAUNCH)—Aims to promote the wellness of young children, from birth to age 8, by addressing the social, emotional, cognitive, physical and behavioral aspects of their development and prevent the development of serious emotional disturbances.
- National Institute on Drug Abuse
- National Institute on Alcohol Abuse and Alcoholism
- National Institute of Mental Health
- Community Anti-Drug Coalitions of America
- National Association of State Mental Health Program Directors
- National Council for Behavioral Health
Last Updated: 04/23/2020
Recovery and Recovery Support
Recovery-oriented care and recovery support systems help people with mental and substance use disorders manage their conditions successfully.
Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. There are four major dimensions that support recovery:
- Health—overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being.
- Home—having a stable and safe place to live.
- Purpose—conducting meaningful daily activities and having the independence, income, and resources to participate in society.
- Community—having relationships and social networks that provide support, friendship, love, and hope.
Hope, the belief that these challenges and conditions can be overcome, is the foundation of recovery. The process of recovery is highly personal and occurs via many pathways. Recovery is characterized by continual growth and improvement in one’s health and wellness that may involve setbacks. Because setbacks are a natural part of life, resilience becomes a key component of recovery.
The process of recovery is supported through relationships and social networks. This often involves family members who become the champions of their loved one’s recovery. Families of people in recovery may experience adversities that lead to increased family stress, guilt, shame, anger, fear, anxiety, loss, grief, and isolation. The concept of resilience in recovery is also vital for family members who need access to intentional supports that promote their health and well-being. The support of peers and friends is also crucial in engaging and supporting individuals in recovery.
Recovery services and supports must be flexible. What may work for adults may be very different for youth or older adults. For example, the nature of social supports, peer mentors, and recovery coaching for adolescents is different than for adults and older adults. Supporting recovery requires that mental health and addiction services:
- Be responsive and respectful to the health beliefs, practices, and cultural and linguistic needs of diverse people and groups.
- Actively address diversity in the delivery of services.
- Seek to reduce health disparities in access and outcomes.
SAMHSA established recovery support systems to promote partnering with people in recovery from mental and substance use disorders and their family members to guide the behavioral health system and promote individual, program, and system-level approaches that foster health and resilience (including helping individuals with behavioral health needs be well, manage symptoms, and achieve and maintain abstinence); increase housing to support recovery; reduce barriers to employment, education, and other life goals; and secure necessary social supports in their chosen community.
Last Updated: 04/23/2020