Data show COVID’s impact on nation’s mental health, substance use

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released findings from the 2020 National Survey on Drug Use and Health (NSDUH). The data suggest that the COVID-19 pandemic had a negative impact on the nation’s well-being. Americans responding to the NSDUH survey reported that the coronavirus outbreak adversely impacted their mental health, including by exacerbating use of alcohol or drugs among people who had used drugs in the past year. 

Several changes to the 2020 NSDUH prevent its findings from being directly comparable to recent past-year surveys, as explained below.

Based on data collected nationally from October to December 2020, it is estimated that 25.9 million past-year users of alcohol and 10.9 million past-year users of drugs other than alcohol reported they were using these substances “a little more or much more” than they did before the COVID-19 pandemic began. During that same time period, youths ages 12 to 17 who had a past-year major depressive episode (MDE) reported they were more likely than those without a past-year MDE to feel that the COVID-19 pandemic negatively affected their mental health “quite a bit or a lot.” Adults 18 or older who had any mental illness (AMI) or serious mental illness (SMI) in the past year were more likely than adults without mental illness to report that the pandemic negatively affected their mental health “quite a bit or a lot.” 

The 2020 data also estimate that 4.9 percent of adults aged 18 or older had serious thoughts of suicide, 1.3 percent made a suicide plan, and 0.5 percent attempted suicide in the past year. These findings vary by race and ethnicity, with people of mixed ethnicity reporting higher rates of serious thoughts of suicide. Among people of mixed ethnicity 18 or older, 11 percent had serious thoughts of suicide, 3.3 percent made a suicide plan and 1.2 percent attempted suicide in the past year. Among Whites 18 or older, 5.3 percent had serious thoughts of suicide, 1.4 percent made a suicide plan, and 0.5 percent attempted suicide in the past year. Among Hispanics or Latinos 18 or older, 4.2 percent had serious thoughts of suicide, 1.2 percent made a suicide plan and 0.6 percent attempted suicide in the past year. Among adolescents 12 to 17, 12 percent had serious thoughts of suicide, 5.3 percent made a suicide plan, and 2.5 percent attempted suicide in the past year.

“SAMHSA’s annual NSDUH provides helpful data on the extent of substance use and mental health issues in the United States,” said Health and Human Services (HHS) Assistant Secretary for Mental Health and Substance Use Miriam E. Delphin-Rittmon, Ph.D., who leads SAMHSA. “These data help to guide our policy directions in addressing such priorities as addiction, suicide prevention, and the intersection of substance use and mental health issues.”

“These data show the urgent need to intervene at every opportunity to reduce substance use disorder and meet people where they are,” said Acting Director of National Drug Control Policy Regina LaBelle. “The Biden-Harris Administration is taking steps to quickly reduce barriers to evidence-based prevention, harm reduction, treatment and recovery services. Over the long term, we must build an addiction infrastructure that can prevent addiction, link people to quality treatment, and support long-term recovery.”

The Biden-Harris Administration continues to prioritize the behavioral health needs of Americans. In May, Health and Human Services Secretary Xavier Becerra reestablished the Behavioral Health Coordinating Council to facilitate collaborative, innovative, transparent, equitable, and action-oriented approaches to addressing the HHS’s behavioral health agenda. Also, HHS announced the use of American Rescue Plan Act (ARP) funding to distribute $3 billion through SAMHSA’s Substance Abuse Prevention and Treatment and Community Mental Health Services block grants. SAMHSA has used additional COVID-related funding – through ARP, the Consolidated Appropriations Act (CAA) of 2021 and the Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act of 2021 – to amplify the reach of its grant programs. The agency is on pace to direct more than $8 billion in COVID-related funding to states, territories and tribal organizations this federal fiscal year. 

SAMHSA has awarded $250 million in grants to 100 Certified Community Behavioral Health Clinics to increase access to facilities throughout the nation that provide community-based support for Americans in need of substance use disorder and mental health treatment services. More recently, the agency announced distributing $825 million to Community Mental Health Centers, community-based facilities or groups of facilities that provide prevention, treatment and rehabilitation mental health services. SAMHSA is requiring those 231 centers throughout the nation to address behavioral health disparities among historically under-resourced communities. SAMHSA also awarded $54.3 million for its Project AWARE (Advancing Wellness and Resilience in Education) State Education Agency (SEA) program, which helps build or expand state and local governments’ coordination to increase awareness of mental health issues among school-aged youths. 

Policy innovations complement these funding increases: Opioid treatment programs seeking to establish mobile methadone units now have streamlined registration that expedites getting medication to the people who need it; likewise, treatment providers seeking to treat up to 30 people per month with buprenorphine for opioid use disorder no longer have to meet onerous training requirements; and SAMHSA/CDC (or federal) grant funding now may be used to purchase fentanyl test strips, an important harm reduction tool to prevent unintentional fentanyl exposure. 

Other findings from the NSDUH revealed that:

• Among the 138.5 million people who were current alcohol users, 61.6 million were classified as binge drinkers and 17.7 million (28.8 percent of current binge drinkers and 12.8 percent of current alcohol users) were classified as heavy drinkers. 
• More than 59.3 million people 12 or older used illicit drugs in the past year, including 49.6 million who used marijuana. 
• In 2020, 4.2 million adolescents 12 to 17 received mental health services in a specialty setting in the past year. 
• An estimated 41.4 million adults 18 or older in 2020 received inpatient or outpatient mental health services or took prescription medication for a mental health issue in the past year. 

Several changes to the 2020 NSDUH prevent its findings from being directly comparable to recent past-year surveys. First, the COVID-19 pandemic impacted the collection of what has historically been an in-person survey. Although some in-person data were collected in early 2020 before the pandemic hit the United States, no data were collected from mid-March through September 2020. Web data collection began in October 2020 coupled with very limited in-person data collection. Second, questionnaire changes beginning in October 2020 made some questions not comparable to earlier years’ surveys. For example, questions were added to the substance use disorder (SUD) section that assessed craving or a strong urge to use various substances. Third, the criteria used to categorize SUD among NSDUH respondents changed from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to the fifth edition (DSM-5), causing differences in who is classified as having an SUD. For this alone, the DSM-5 SUD estimates from 2020 are not comparable with the DSM-IV SUD estimates from previous years. 

SAMHSA’s Center for Behavioral Health Statistics and Quality, which produces the NSDUH, will be releasing reports on NSDUH data on racial and ethnic demographic trends in the near future.

Read the entire 2020 NSDUH report, highlights from it or frequently asked questions about it. People searching for treatment for mental or substance use disorders can find treatment by visiting findtreatment.samhsa.gov or by calling SAMHSA’s National Helpline, 1-800-662-HELP (4357).