Key Substance Use and Mental Health Indicators in the United States:
Results from the 2018 National Survey on Drug Use and Health August 2019
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41. Survey questions for the perceived risk from using different substances
vary in terms of the frequency (e.g., use once or twice a week, use nearly
every day or daily) and quantity of use (e.g., having five or more drinks of
alcohol, any use of marijuana, cocaine, or heroin), making comparisons
difficult for perceptions of risk from using different substances.
42. American Psychiatric Association. (1994). Diagnostic and statistical
manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: Author.
43.
e DSM-IV criteria for SUDs include separate criteria for dependence
or abuse. Individuals who met the criteria for abuse for a given substance
(e.g., alcohol) did not meet the criteria for dependence for that substance.
For more information, see Section 3.4.3 and the definitions for abuse
and dependence in Appendix A of the following reference: Center for
Behavioral Health Statistics and Quality. (2019). 2018 National Survey on
Drug Use and Health: Methodological summary and definitions. Retrieved
from https://www.samhsa.gov/data/
44. Respondents who reported any use of prescription drugs in a given
prescription psychotherapeutic category in the past 12 months (e.g.,
prescription pain relievers) but did not report misuse of any drugs in that
category in the past 12 months were not asked the SUD questions for
that category.
45. American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (DSM-5) (5th ed.). Arlington, VA: Author.
46. Adolescents were first asked whether they ever had a period in their
lifetime lasting several days or longer when any of the following was true
for most of the day: (a) feeling sad, empty, or depressed; (b) feeling very
discouraged or hopeless about how things were going in their lives; or
(c) losing interest and becoming bored with most things they usually
enjoy. Adolescents who reported any of these problems were asked further
questions about having an MDE in their lifetime, including whether they
had at least five of nine symptoms in the same 2-week period in their
lifetime; at least one of the symptoms needed to be having a depressed
mood or loss of interest or pleasure in daily activities. Unlike questions
for adults, adolescents who reported gaining weight without trying were
asked if this occurred because they were growing. ose who had lifetime
MDE were asked if they had a period of time in the past 12 months
when they felt depressed or lost interest or pleasure in daily activities for
2 weeks or longer, and they reported they had some of their other lifetime
MDE symptoms in the past 12 months. ese adolescents were defined as
having past year MDE.
47. Adults were first asked whether they ever had a period in their lifetime
lasting several days or longer when any of the following was true for most
of the day: (a) feeling sad, empty, or depressed; (b) feeling discouraged
about how things were going in their lives; or (c) losing interest in most
things they usually enjoy. Adults who reported any of these problems
were asked further questions about having an MDE in their lifetime,
including whether they had at least five of nine symptoms in the same
2-week period in their lifetime; at least one of the symptoms needed to be
having a depressed mood or loss of interest or pleasure in daily activities.
ose who had lifetime MDE were asked if they had a period of time in
the past 12 months when they felt depressed or lost interest or pleasure in
daily activities for 2 weeks or longer, and they reported they had some of
their other lifetime MDE symptoms in the past 12 months. ese adults
were defined as having past year MDE. Data on MDE in the past year for
adults are available in NSDUH since 2005.
48. Data on MDE with severe impairment for adults are available since 2009.
49. Questions measuring adolescents’ impairment in carrying out life
activities because of MDE were added to the survey in 2006.
33. Estimates relating to the periods prior to the 12-month reference period
have not been considered here because of concerns about their validity
resulting from recall bias. See the following reference: Gfroerer, J.,
Hughes, A., Chromy, J., Heller, D., & Packer, L. (2004, July). Estimating
trends in substance use based on reports of prior use in a cross-sectional
survey. In S. B. Cohen & J. M. Lepkowski (Eds.), Eighth Conference on
Health Survey Research Methods: Conference proceedings [Peachtree City,
GA] (HHS Publication No. PHS 04-1013, pp. 29-34). Hyattsville, MD:
U.S. Department of Health and Human Services, Public Health Service,
Centers for Disease Control and Prevention, National Center for Health
Statistics.
34. For substances other than prescription psychotherapeutic drugs,
respondents who had ever used the substance (e.g., marijuana) were
asked to report when they first used the substance, and respondents who
reported first use within a year of their current age were asked to report
the year and month when they first used it. us, past year initiates of
the use of substances other than prescription psychotherapeutic drugs
reported their first use within 12 months of the interview date.
35. Assessing whether respondents in the 2018 NSDUH had initiated
misuse of a prescription psychotherapeutic drug in the past 12 months
differed from assessing whether respondents had initiated the use of
other substances in that period because the psychotherapeutic drug
categories (e.g., prescription pain relievers) include many different types
of prescription drugs in a given category (e.g., pain relievers containing
hydrocodone, such as Vicodin®, Lortab®, Norco®, Zohydro® ER, or
generic hydrocodone). Respondents in 2018 were asked questions about
initiation of misuse only for the specific prescription drugs they misused
in the past 12 months, including their age when they first misused a drug
and (if the first misuse occurred within a year of the current age) the year
and month of first misuse for that drug. Respondents who reported they
initiated misuse in the past 12 months for all of the specific prescription
drugs in a given category they misused in that period were asked a follow-
up question to establish whether they had ever misused prescription
drugs in that category more than 12 months before being interviewed.
Respondents who answered this follow-up question as “no” were defined
as being past year initiates of the misuse of any prescription drug in the
overall category. is answer meant respondents had never misused any
prescription drug in that category more than 12 months prior to the
interview date.
36.
More information about the methods for measuring and estimating the
initiation of substance use and prescription drug misuse in NSDUH
can be found in Section 3.4.2 of the following reference: Center for
Behavioral Health Statistics and Quality. (2019). 2018 National Survey on
Drug Use and Health: Methodological summary and definitions. Retrieved
from https://www.samhsa.gov/data/
37. Numbers in Figure 26 refer to people who used a specific substance for
the first time in the past year, regardless of whether the initiation of use of
other substances occurred prior to the past year.
38. Past year initiates of crack cocaine use were counted as past year initiates
of cocaine use only if they had not previously used cocaine in any form.
39. For more information, see Section B.2.3 in the following reference:
Center for Behavioral Health Statistics and Quality. (2017). 2016
National Survey on Drug Use and Health: Methodological summary and
definitions. Retrieved from https://www.samhsa.gov/data/
40. Past year initiates of LSD, PCP, or Ecstasy use are counted as past year
initiates of hallucinogen use only if respondents had previously not used
other hallucinogens.