Each year, the Substance Abuse and Mental Health Services Administration publishes a sweeping survey that examines the substance use and mental health issues affecting Americans age 12 and older. The goal: to spot trends in the hope of reducing the toll that drugs, alcohol and mental illness take on lives and communities.
The 2014 National Survey on Drug Use and Health is now in the books, and what it shows in terms of our country’s behavioral health both in 2014 and compared to the past dozen years is at turns heartening and discouraging. Here are some facts we now know:
- Too many of those struggling with drugs and alcohol continue to go it alone.
Substance use disorders can be prevented and treated, yet much too little of both is happening, the survey shows.A total of 22.5 million people age 12 and older needed help with their drug or alcohol use in 2014, but only 2.6 million — about 11.6% — got treatment at a specialty facility. This isn’t a sudden drop in assistance; the dismal numbers are comparable to recent years.Why almost 20 million people dealt with their drug or alcohol problem alone breaks down this way: 1.2% felt they needed help and made an effort to get it but weren’t successful; 2.9% felt they needed help but didn’t make an effort to get it; and 96% felt they didn’t need treatment.
Those who tried to get help and failed pointed to two main reasons: their health insurance wasn’t good enough or they couldn’t afford it.
Together, the data points to several needs: expanded access to long-term treatment, comprehensive coverage of addiction treatment at the same levels as treatment for medical conditions (many policies call for this but some insurers continue to skirt the requirement), and better sharing of addiction recovery stories so the public will come to understand that treatment really can work and is worth the effort.
- We’re only halfway there on mental health care.
The number of people struggling with mental illness has stayed stable over the past few years, at about 18% of the adult population. At the same time, more of that number — about 45% — are receiving treatment such as prescription medication and outpatient and inpatient care. That’s the good news.What’s not so encouraging is that this means more than half still aren’t getting help, and the population that appears hardest hit are those ages 18-25. In 2014, a full two-thirds of this age group did not receive mental health services, compared to more than half of those ages 26-49, and about half of those 50 or older. That’s problematic because mental illnesses often first come to light during adolescence and early adulthood.The survey also examined trends among those ages 12 to 17 (although it didn’t estimate the total number of adolescents with mental illness) and found this: 3.4 million adolescents ages 12-17 received specialty mental health services in 2014, and about half got help for depression. More than 29% were helped because they thought about or attempted suicide, 29% felt afraid or tense, 26.6% had family problems, 20.8% were seen for breaking rules or “acting out,” 18.1% were having problems at school, and 16.7% had trouble controlling their anger.
Of the adults, close to 12 million perceived an unmet need for mental health care at some point during the previous year, and of that number about half received no care at all. The main reason? Close to half said they simply couldn’t afford it. More than 28% percent thought they could handle the problem without treatment, close to 23% simply didn’t know where to turn, and 16.4% believed they couldn’t spare the time for care.
It’s information that should point us to a renewed effort to step up our mental health treatment offerings, increase access, and hold insurers accountable for living up to the coverage requirements found in most insurance policies since the passage of the Affordable Care Act and mental health parity laws.
- Kids still love alcohol, but not quite as much.
In the 2014 survey, 8.7 million of those ages 12-20 reported having a drink in the past month. That includes 5.3 million who binge drank (defined as having at least five drinks on one occasion), and 1.3 million who drank heavily (meaning they binge drank on five or more days in the past 30).These are troubling figures, but they start looking a little better when viewed over time. A decade ago, for example, 28.7% of the underage population drank, compared to 22.8% today; 19.6% were binge drinkers, compared to 13.8% today; and heavy drinkers numbered 6.3%, compared to 3.4% today.So there is cause for optimism about underage drinking, but it’s tempered by the fact that the 2014 numbers are at about the same level as they were in 2013. Has the downward trend stalled?
- Marijuana use is up — but it could be worse.
When several states OK’d recreational marijuana, some worried that the floodgates would open and use of the drug among kids would skyrocket. It hasn’t (although our experiment in legality remains young). Among those ages 12-17, 7.4% reported using marijuana in the past month. That’s up only slightly from 2013 figures and down from 8.2% in 2002.The overall numbers also inched up only slightly for the biggest marijuana users, those ages 18-25, when compared to the past few years — 19.6% in 2014 compared to 19.1% in 2013, for example. A decade ago, however, the percentage of users in this age group was at a 13-year low of 16.1%. For those 26 and older, use has ebbed and flowed since 2002 to reach its current high of 6.6%.It’s also encouraging to note that the percentage of those identified as having a marijuana use disorder stayed about the same from 2013 to 2014. And for those ages 12-17, the number with a marijuana use problem has dropped to 2.7% from a high of 4.3% in 2002.
Marijuana’s influence is most clearly seen when overall drug use is added up. It remains our most popular illicit drug, and marijuana helped drive U.S. drug use to a 13-year high of 10.2% of the 12 and older population. That translates to about 27 million people using illicit drugs, and it breaks down this way*:
- 22.2 million used marijuana in the month preceding the survey
- 4.3 million used prescription painkillers nonmedically
- 1.9 million used tranquilizers
- 1.6 million used stimulants
- 1.5 million used cocaine
- 1.2 million used hallucinogens
- 0.5 million used inhalants
- 0.4 million used heroin
- 0.3 million used sedatives
(*The numbers add up to more than 27 million because some people used more than one drug.)
To keep the figures in perspective, however, close to 140 million of those 12 and older used alcohol.
- Heroin’s share of drug use is small, but deadly.
Prescription painkillers such as OxyContin, Percocet and Vicodin are opioids. Heroin is an opioid. When our nation woke up several years ago to the rampant overprescribing and misuse of what turned out to be highly addictive and dangerous prescription painkillers, heroin became a cheap and easy-to-get substitute and supplement. As a result, the CDC reports, our prescription painkiller epidemic is now also a heroin epidemic. Heroin-related deaths, in fact, have quadrupled since 2002.The SAMHSA survey confirms that one drug is affecting the other. On one hand, nonmedical prescription painkiller use is down in all age groups from a decade ago and holding relatively steady, and that’s an encouraging sign. Heroin use, on the other hand, is up from a decade ago, especially in those ages 26 and older. And while the overall number of heroin users is small — 435,000 current users in 2014 (compare that to 22.2 million marijuana users, for example) — the dangers are severe. Because overdose is so easy on heroin, especially when you consider that it’s often cut with other substances such as fentanyl that can greatly magnify the risk, use becomes a game of Russian roulette.Another indication of heroin’s growing popularity: The number of those 18 and older in heroin addiction treatment has more than doubled since 2004. As someone who helps those with addictions, it’s a reality I’ve seen firsthand. At our young adult program in Northfield, New Jersey, for example, a specialized opioid addiction treatment track has been created to help deal with the pressing need.
A Snapshot in Time
Put together, the survey findings, which are broken down into a main report and several separate data reviews, provide a snapshot in time of a nation that has made progress in helping those with behavioral health issues but still has a long way to go before treatment availability catches up with demand and awareness overcomes stigma. Between the lines of the survey information is a clear message: Those who struggle with mental health and addiction issues aren’t just “others,” they are people we work with, people we live near and people we love, and policies that help them, help us all.