Behavioral Health

Barometer

Region 4, Volume 6

Indicators as measured through the 2019 National Survey on Drug Use and Health 

and the National Survey of Substance Abuse Treatment Services
R4 

Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) under 

contract No. 283–17–3101 with SAMHSA, U.S. Department of Health and Human Services (HHS). 

Public Domain Notice 

All material appearing in this report is in the public domain and may be reproduced or copied without permission 

from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed 

for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS. 

Electronic Access 

This publication may be downloaded at https://store.samhsa.gov. 

Recommended Citation 

Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Region 4, Volume 6: 

Indicators as measured through the 2019 National Survey on Drug Use and Health and the National Survey of 

Substance Abuse Treatment Services. HHS Publication No. SMA–20–Baro–19–R4. Rockville, MD: Substance Abuse 

and Mental Health Services Administration, 2020.

Originating Office 

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 

5600 Fishers Lane, Rockville, MD 20857.

Nondiscrimination Notice 

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, 

national origin, age, disability, or sex. 

SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, 

nacionalidad, edad, discapacidad o sexo.

HHS Publication No. SMA–20–Baro–19–R4

Published 2020
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iii

Contents

Foreword...................................................................................................................................................................................................................................................................................................................v

Introduction.......................................................................................................................................................................................................................................................................................................vi

Youth Substance Use...........................................................................................................................................................................................................................................................................1

Cigarette Use ..........................................................................................................................................................................................................................................................................................................1

Marijuana Use........................................................................................................................................................................................................................................................................................................3

Alcohol Use................................................................................................................................................................................................................................................................................................................5

Illicit Drug Use.......................................................................................................................................................................................................................................................................................................7

Initiation of Substance Use...................................................................................................................................................................................................................................................................9

Youth Mental Health and Service Use...................................................................................................................................................................................................................12

Depression.............................................................................................................................................................................................................................................................................................................12

Depression Care..............................................................................................................................................................................................................................................................................................14

Young Adult Substance Use and Use Disorders....................................................................................................................................................................................15

Tobacco Use.........................................................................................................................................................................................................................................................................................................15

Marijuana Use....................................................................................................................................................................................................................................................................................................17

Marijuana Use Disorder..........................................................................................................................................................................................................................................................................19

Opioid Use Disorder....................................................................................................................................................................................................................................................................................21

Illicit Drug Use Disorder........................................................................................................................................................................................................................................................................23

Binge Alcohol Use..........................................................................................................................................................................................................................................................................................25

Alcohol Use Disorder.................................................................................................................................................................................................................................................................................27

Substance Use Disorder........................................................................................................................................................................................................................................................................29

Young Adult Mental Health....................................................................................................................................................................................................................................................31

Serious Thoughts of Suicide.............................................................................................................................................................................................................................................................31

Serious Mental Illness..............................................................................................................................................................................................................................................................................33

Substance Use, Misuse, and Use Disorders..................................................................................................................................................................................................35

Tobacco Use.........................................................................................................................................................................................................................................................................................................35

Marijuana Use....................................................................................................................................................................................................................................................................................................37

Marijuana Use Disorder..........................................................................................................................................................................................................................................................................39

Heroin Use..............................................................................................................................................................................................................................................................................................................41

Misuse of Prescription Pain Relievers....................................................................................................................................................................................................................................43

Opioid Use Disorder....................................................................................................................................................................................................................................................................................45

Illicit Drug Use Disorder........................................................................................................................................................................................................................................................................47

Alcohol Use Disorder.................................................................................................................................................................................................................................................................................49

Substance Use Disorder........................................................................................................................................................................................................................................................................51
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iv

Contents

Substance Use Treatment ........................................................................................................................................................................................................................................................53

Enrollment and Treatment Focus...............................................................................................................................................................................................................................................53

Opioids (Medication-Assisted Therapy [MAT])..........................................................................................................................................................................................................55

Adult Mental Health and Service Use.....................................................................................................................................................................................................................57

Serious Thoughts of Suicide.............................................................................................................................................................................................................................................................57

Serious Mental Illness..............................................................................................................................................................................................................................................................................59

Mental Health Service Use among Adults with Any Mental Illness..................................................................................................................................................61

Figure Notes...................................................................................................................................................................................................................................................................................................63

Definitions .........................................................................................................................................................................................................................................................................................................65

References and Sources..............................................................................................................................................................................................................................................................67
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v

Foreword

The Substance Abuse and Mental Health Services Administration (SAMHSA), an operating division within the U.S. 

Department of Health and Human Services (HHS), is charged with reducing the impact of substance abuse and 

mental illness on America’s communities. SAMHSA is pursuing this mission at a time of significant change. 

The Behavioral Health Barometer: Region 4, Volume 6: Indicators as measured through the 2019 National Survey on 

Drug Use and Health and the National Survey of Substance Abuse Treatment Services is one of a series of national, 

regional, and state reports that provide a snapshot of behavioral health in the United States. The reports present a 

set of substance use and mental health indicators as measured through the National Survey on Drug Use and Health 

(NSDUH) and the National Survey of Substance Abuse Treatment Services (N–SSATS), sponsored by SAMHSA.

This array of indicators provides a unique overview of the nation’s behavioral health at a point in time as well as a 

mechanism for tracking changes over time. Behavioral Health Barometers for the nation, 10 regions, and all 50 states 

and the District of Columbia are published as part of SAMHSA’s behavioral health quality improvement approach. Most 

importantly, the Behavioral Health Barometers provide critical information in support of SAMHSA’s mission of reducing 

the impact of substance abuse and mental illness on America’s communities. 

Elinore F. McCance-Katz, M.D., Ph.D.

Assistant Secretary for Mental Health and Substance Use 

Substance Abuse and Mental Health Services Administration 

U.S. Department of Health and Human Services
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vi

Introduction

Purpose of This Report 

Behavioral Health Barometer: Region 4, Volume 6: Indicators as measured through the 2019 National Survey on 

Drug Use and Health and the National Survey of Substance Abuse Treatment Services provides an annual update on 

a series of topics that focus on substance use and mental health (collectively referred to as behavioral health) in the 

United States. SAMHSA selected specific topics and indicators in this report to represent a cross-section of the key 

behavioral health indicators that are assessed in SAMHSA data collections, including NSDUH and N–SSATS. This report 

is intended to provide a concise, reader-friendly summary of key behavioral health measures for lay and professional 

audiences. 

Organization of This Report

This report is divided into sections based on content areas and age groups. It begins with sections on substance 

use, mental health, and mental health treatment among youth aged 12–17, followed by a section on substance use 

and mental health among young adults aged 18–25. Next are sections on substance use, misuse, use disorders, and 

treatment among youth and adults combined and on mental health and treatment among adults aged 18 or older. 

Figure titles are included above all graphics, including callouts for figure notes that are presented on pages 63–64. 

These figure notes include additional information about the measures, populations, and analyses presented in the 

graphics and text. Definitions of key measures and terms included in the report are presented on pages 65–66. 

Methodological Information

Statistical tests (t-tests) have been conducted for all statements appearing in the text of the report based on NSDUH 

data that compare estimates between years or population subgroups. These tests properly account for the variances 

of each estimate being tested, as well as any joint variability (covariance) due to sample design or among nonmutually exclusive groups (e.g., each state is a subgroup of its respective region, and each region is a subgroup 

of the total United States). Positive covariance reduces the overall variance of the test statistic and may produce 

statistically significant results, even when the confidence intervals of each estimate overlap. Unless explicitly stated 

that a difference is not statistically significant, all statements based on NSDUH data that describe differences are 

significant at the .05 level. Standard NSDUH suppression rules have been applied for all NSDUH estimates in this 

report. Pages 53–56 present N–SSATS data, and because N–SSATS provides counts of people enrolled at all treatment 

facilities (as opposed to providing estimates based on a sample of treatment facilities), conducting significance tests 

is not necessary. Tables that display all data points included in this report, including tests of statistical significance and 

standard errors, are available upon request. To request these tables or to ask any questions regarding how to use or 

interpret the data included in this report, please contact CBHSQRequest@samhsa.hhs.gov.
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1

Youth Substance Use

Cigarette Use

Past-Month Cigarette Use among Youth Aged 12–17 in Region 4 (Annual 

Average, 2017–2019)1

3.6%

During 2017–2019, among youth aged 12–17 in Region 4, 3.6% (or 177,000) used 

cigarettes in the past month, higher than the national average (2.7%).

Compared to the national average, the estimate was higher in Alabama, Kentucky, 

Mississippi, South Carolina, and Tennessee and similar in Florida, Georgia, and 

North Carolina. 

Compared to the regional average, the estimate was higher in Kentucky; lower in 

Florida and Georgia; and similar in Alabama, Mississippi, North Carolina, South Carolina, 

and Tennessee.

4.7%

5.2%

3.0%

4.8%

6.0%

2.6% 2.6%

4.8%

3.6%

2.7%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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2

Youth Substance Use

Cigarette Use

Changes in Past-Month Cigarette Use among Youth Aged 12–17 in Region 4

(Annual Averages, 2002–2004 and 2017–2019)1

Among youth aged 12–17 in Region 4, the annual average percentage of cigarette use in the past month 

decreased between 2002–2004 (13.6%) and 2017–2019 (3.6%). The percentage decreased in every state in 

Region 4.

% 2002–2004, % 2017–2019

14.0%, 4.7%

11.8%, 5.2%

17.0%, 3.0%

12.2%, 4.8%

18.8%, 6.0%

13.1%, 2.6%

11.3%, 2.6%

14.0%, 4.8%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
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3

Youth Substance Use

Marijuana Use

Past-Month Marijuana Use among Youth Aged 12–17 in Region 4 (Annual 

Average, 2017–2019)1

6.2%

During 2017–2019, among youth aged 12–17 in Region 4, 6.2% (or 305,000) used 

marijuana in the past month, lower than the national average (6.8%).

Compared to the national average, the estimate was similar in every state in Region 4. 

Compared to the regional average, the estimate was similar in every state in Region 4.

5.1%

6.6% 7.1%

6.7% 5.8% 6.0% 5.0% 5.2% 6.8% 6.2%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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4

Youth Substance Use

Marijuana Use

Changes in Past-Month Marijuana Use among Youth Aged 12–17 in Region 4

(Annual Averages, 2002–2004 and 2017–2019)1

Among youth aged 12–17 in Region 4, the annual average percentage of marijuana use in the past month 

decreased between 2002–2004 (7.0%) and 2017–2019 (6.2%). The percentage decreased in Kentucky.

% 2002–2004, % 2017–2019

5.0%, 5.1%

6.2%, 6.6%

8.8%, 7.1%

5.0%, 5.0%

8.6%, 6.0%

6.3%, 5.8%

7.9%, 6.7%

5.7%, 5.2%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
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5

Youth Substance Use

Alcohol Use

Past-Month Alcohol Use among Youth Aged 12–17 in Region 4 (Annual Average, 

2017–2019)1

9.2%

During 2017–2019, among youth aged 12–17 in Region 4, 9.2% (or 455,000) used 

alcohol in the past month, similar to the national average (9.4%).

Compared to the national average, the estimate was lower in Georgia and similar in 

Alabama, Florida, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. 

Compared to the regional average, the estimate was lower in Georgia and similar in 

Alabama, Florida, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.

9.1% 9.4%

9.6%

9.3%

10.7%

7.3%

10.0% 8.4%

9.4% 9.2%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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6

Youth Substance Use

Alcohol Use

Changes in Past-Month Alcohol Use among Youth Aged 12–17 in Region 4

(Annual Averages, 2002–2004 and 2017–2019)1

Among youth aged 12–17 in Region 4, the annual average percentage of alcohol use in the past month decreased 

between 2002–2004 (15.8%) and 2017–2019 (9.2%). The percentage decreased in Alabama, Florida, Georgia, 

Kentucky, Mississippi, and North Carolina.

% 2002–2004, % 2017–2019

12.6%, 9.1%

12.5%, 9.4%

15.9%, 9.6%

15.0%, 9.3%

19.4%, 10.7%

15.2%, 7.3%

17.3%, 10.0%

15.6%, 8.4%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
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7

Youth Substance Use

Illicit Drug Use

Past-Month Illicit Drug Use among Youth Aged 12–17 in Region 4 (Annual 

Average, 2017–2019)1

7.5%

During 2017–2019, among youth aged 12–17 in Region 4, 7.5% (or 370,000) used 

illicit drugs in the past month, lower than the national average (8.2%).

Compared to the national average, the estimate was lower in Georgia and similar in 

Alabama, Florida, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. 

Compared to the regional average, the estimate was similar in every state in Region 4.

6.4%

8.4%

8.3% 6.6%

6.5% 6.7%

7.2% 8.2%

7.5% 8.2%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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8

Youth Substance Use

Illicit Drug Use

Changes in Past-Month Illicit Drug Use among Youth Aged 12–17 in Region 4

(Annual Averages, 2015–2017 and 2017–2019)1

Among youth aged 12–17 in Region 4, the annual average percentage of illicit drug use in the past month did not 

significantly change between 2015–2017 (7.8%) and 2017–2019 (7.5%). The percentage did not significantly 

change in every state in Region 4.

% 2015–2017, % 2017–2019

6.8%, 6.4%

8.2%, 8.4%

6.7%, 8.3%

6.3%, 6.6%

8.2%, 6.5%

7.8%, 6.7%

8.9%, 8.2%

7.2%, 7.2%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
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9

Youth Substance Use

Initiation of Substance Use

Past-Year Initiation (First Lifetime Use) of Alcohol among Youth Aged 12–17 in 

Region 4 (Annual Average, 2017–2019)1

% 2017–2019

9.9%

8.7%

8.6%

10.3%

8.7%

7.2%

9.6%

6.3%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

During 2017–2019, among youth aged 12–17 in 

Region 4, 8.7% (or 430,000) used alcohol for 

the first time in their lives, similar to the national 

average (9.3%).

Compared to the national average, the estimate 

was lower in Alabama and Georgia and similar 

in Florida, Kentucky, Mississippi, North Carolina, 

South Carolina, and Tennessee. 

Compared to the regional average, the estimate 

was lower in Alabama and Georgia and similar 

in Florida, Kentucky, Mississippi, North Carolina, 

South Carolina, and Tennessee.

9.9%

8.6% 8.7%

10.3%

8.7%

7.2%

9.6%

6.3%

9.3% 8.7%

U.S. KYGAFLALR4 MS TNSCNC

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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10

Youth Substance Use

Initiation of Substance Use

Past-Year Initiation (First Lifetime Use) of Marijuana among Youth Aged 12–17 

in Region 4 (Annual Average, 2017–2019)1

% 2017–2019

4.6%

4.7%

4.7%

4.9%

4.6%

5.8%

4.7%

4.0%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

During 2017–2019, among youth aged 12–17 in 

Region 4, 4.8% (or 239,000) used marijuana for 

the first time in their lives, similar to the national 

average (5.2%).

Compared to the national average, the estimate 

was similar in every state in Region 4. 

Compared to the regional average, the estimate 

was similar in every state in Region 4.

4.7% 4.7% 4.6% 4.9%

4.6%

5.8%

5.2% 4.8% 4.0% 4.7%

U.S. KYGAFLALR4 MS TNSCNC

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4

11

Youth Substance Use

Initiation of Substance Use

Past-Year Initiation (First Lifetime Use) of Cigarettes among Youth Aged 12–17 

in Region 4 (Annual Average, 2017–2019)1

% 2017–2019

3.1%

3.6%

2.8%

3.7%

4.3%

1.5%

2.2%

3.2%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

During 2017–2019, among youth aged 12–17 in 

Region 4, 2.7% (or 132,000) used cigarettes for 

the first time in their lives, higher than the national 

average (2.3%).

Compared to the national average, the estimate 

was higher in Kentucky and similar in Alabama, 

Florida, Georgia, Mississippi, North Carolina, 

South Carolina, and Tennessee. 

Compared to the regional average, the estimate 

was lower in Georgia and similar in Alabama, 

Florida, Kentucky, Mississippi, North Carolina, 

South Carolina, and Tennessee.

3.6% 3.1%

2.8%

3.7% 4.3%

2.2% 1.5%

3.2%

2.7% 2.3%

U.S. KYGAFLALR4 MS TNSCNC

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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12

Youth Mental Health 

and Service Use

Depression

Past-Year Major Depressive Episode (MDE) among Youth Aged 12–17 in 

Region 4 (Annual Average, 2016–2019)1,2

13.1%

During 2016–2019, among youth aged 12–17 in Region 4, 13.1% (or 623,000) had 

an MDE in the past year, lower than the national average (14.0%).

Compared to the national average, the estimate was lower in Georgia and Mississippi 

and similar in Alabama, Florida, Kentucky, North Carolina, South Carolina, and 

Tennessee. 

Compared to the regional average, the estimate was higher in North Carolina and 

similar in Alabama, Florida, Georgia, Kentucky, Mississippi, South Carolina, and 

Tennessee.

13.2% 12.4%

15.3%

11.3%

12.2%

12.1% 13.2% 12.7%

13.1% 14.0%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2016–2019.
R4

13

Youth Mental Health 

and Service Use

Depression

Changes in Past-Year Major Depressive Episode (MDE) among Youth Aged 

12–17 in Region 4 (Annual Averages, 2004–2007 and 2016–2019)1,2

Among youth aged 12–17 in Region 4, the annual average percentage with an MDE in the past year increased 

between 2004–2007 (8.5%) and 2016–2019 (13.1%). The percentage increased in Alabama, Florida, Georgia, 

Mississippi, North Carolina, South Carolina, and Tennessee.

% 2004–2007, % 2016–2019

8.9%, 12.4%

8.6%, 13.2%

9.2%, 15.3%

7.2%, 11.3%

11.1%, 12.2%

7.8%, 12.1%

8.2%, 13.2%

8.2%, 12.7%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2004–2007 to 2016–2019

No Significant Change from 2004–2007 to 2016–2019

Decreased from 2004–2007 to 2016–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2004–2007 and 2016–2019.
R4 

14

Youth Mental Health 

and Service Use

Depression Care

Past-Year Depression Care among Youth Aged 12–17 with Major Depressive 

Episode (MDE) in Region 4 (Annual Average, 2016–2019)1,3

% 2016–2019

39.6%

40.3%

47.3%

41.7%

49.1%

33.3%

38.4%

36.7%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

During 2016–2019, among youth aged 12–17 

with an MDE in Region 4, 40.2% (or 248,000) 

received depression care in the past year, similar 

to the national average (41.8%).

Compared to the national average, the estimate 

was lower in Georgia and similar in Alabama, 

Florida, Kentucky, Mississippi, North Carolina, 

South Carolina, and Tennessee. 

Compared to the regional average, the estimate 

was lower in Georgia and similar in Alabama, 

Florida, Kentucky, Mississippi, North Carolina, 

South Carolina, and Tennessee.

40.3% 39.6%

47.3% 41.7%

49.1%

38.4% 33.3%

36.7% 41.8% 40.2%

U.S. KYGAFLALR4 MS TNSCNC

0%

100%

75%

50%

25%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2016–2019.
R4

15

Young Adult Substance Use 

and Use Disorders

Tobacco Use

Past-Year Tobacco Use among Young Adults Aged 18–25 in Region 4 (Annual 

Average, 2017–2019)1

38.3%

During 2017–2019, among young adults aged 18–25 in Region 4, 38.3% (or 

2.5 million) used tobacco in the past year, similar to the national average (37.2%).

Compared to the national average, the estimate was higher in Alabama, Kentucky, 

North Carolina, and Tennessee; lower in Florida and Georgia; and similar in Mississippi 

and South Carolina. 

Compared to the regional average, the estimate was higher in Kentucky, North Carolina, 

and Tennessee; lower in Florida and Georgia; and similar in Alabama, Mississippi, and 

South Carolina.

45.1%

41.0% 42.1% 40.4%

44.9%

33.8% 32.8%

41.9%

37.2% 38.3%

U.S. R4 AL FL GA KY MS NC SC TN

0%

100%

75%

50%

25%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

16

Young Adult Substance Use 

and Use Disorders

Tobacco Use

Changes in Past-Year Tobacco Use among Young Adults Aged 18–25 in Region 4

(Annual Averages, 2002–2004 and 2017–2019)1

Among young adults aged 18–25 in Region 4, the annual average percentage of tobacco use in the past year 

decreased between 2002–2004 (54.0%) and 2017–2019 (38.3%). The percentage decreased in every state in 

Region 4.

% 2002–2004, % 2017–2019

52.9%, 45.1%

59.0%, 40.4%

58.0%, 42.1%

56.4%, 41.0%

66.6%, 44.9%

47.6%, 33.8%

50.7%, 32.8%

53.6%, 41.9%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
R4

17

Young Adult Substance Use 

and Use Disorders

Marijuana Use

Past-Year Marijuana Use among Young Adults Aged 18–25 in Region 4 (Annual 

Average, 2017–2019)1

30.6%

During 2017–2019, among young adults aged 18–25 in Region 4, 30.6% (or 

2.0 million) used marijuana in the past year, lower than the national average 

(35.0%).

Compared to the national average, the estimate was lower in Alabama, Georgia, 

Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee and similar in 

Florida. 

Compared to the regional average, the estimate was higher in Florida; lower 

in Kentucky, Mississippi, and South Carolina; and similar in Alabama, Georgia, 

North Carolina, and Tennessee.

30.1%

26.7%

30.5%

23.9% 27.2%

34.1% 31.2% 30.6% 28.4%

35.0%

U.S. R4 AL FL GA KY MS NC SC TN

0%

100%

75%

50%

25%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

18

Young Adult Substance Use 

and Use Disorders

Marijuana Use

Changes in Past-Year Marijuana Use among Young Adults Aged 18–25 in 

Region 4 (Annual Averages, 2002–2004 and 2017–2019)1

Among young adults aged 18–25 in Region 4, the annual average percentage of marijuana use in the past year 

increased between 2002–2004 (25.3%) and 2017–2019 (30.6%). The percentage increased in Florida, Georgia, 

and Tennessee.

% 2002–2004, % 2017–2019

21.2%, 30.1%

27.6%, 26.7%

25.7%, 30.5%

20.5%, 23.9%

25.4%, 27.2%

22.3%, 31.2%

29.1%, 34.1%

24.7%, 28.4%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
R4

19

Young Adult Substance Use 

and Use Disorders

Marijuana Use Disorder

Past-Year Marijuana Use Disorder among Young Adults Aged 18–25 in Region 4

(Annual Average, 2017–2019)1

4.6%

During 2017–2019, among young adults aged 18–25 in Region 4, 4.6% (or 306,000) 

had marijuana use disorder in the past year, lower than the national average (5.6%).

Compared to the national average, the estimate was lower in Kentucky, Mississippi, 

South Carolina, and Tennessee and similar in Alabama, Florida, Georgia, and 

North Carolina. 

Compared to the regional average, the estimate was lower in Kentucky and similar in 

Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee.

3.3% 3.4%

5.8%

3.4%

2.8%

5.2%

5.0%

5.0%

4.6%

5.6%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

20

Young Adult Substance Use 

and Use Disorders

Marijuana Use Disorder

Changes in Past-Year Marijuana Use Disorder among Young Adults Aged 18–25 

in Region 4 (Annual Averages, 2002–2004 and 2017–2019)1

Among young adults aged 18–25 in Region 4, the annual average percentage of marijuana use disorder in the past 

year did not significantly change between 2002–2004 (5.2%) and 2017–2019 (4.6%). The percentage decreased 

in Florida.

% 2002–2004, % 2017–2019

5.8%, 3.3%

5.2%, 3.4%

4.8%, 5.8%

4.5%, 3.4%

4.4%, 2.8%

4.1%, 5.2%

6.4%, 5.0%

4.7%, 5.0%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
R4

21

Young Adult Substance Use 

and Use Disorders

Opioid Use Disorder

Past-Year Opioid Use Disorder among Young Adults Aged 18–25 in Region 4

(Annual Average, 2017–2019)1

1.3%

During 2017–2019, among young adults aged 18–25 in Region 4, 1.3% (or 83,000) 

had opioid use disorder in the past year, higher than the national average (1.0%).

Compared to the national average, the estimate was similar in every state in Region 4. 

Compared to the regional average, the estimate was similar in every state in Region 4.

1.9%

1.4%

1.1%

1.4%

1.1%

1.1%

1.1%

1.9%

1.3%

1.0%

U.S. R4 AL FL GA KY MS NC SC TN

0%

5%

4%

3%

2%

1%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

22

Young Adult Substance Use 

and Use Disorders

Opioid Use Disorder

Changes in Past-Year Opioid Use Disorder among Young Adults Aged 18–25 in 

Region 4 (Annual Averages, 2015–2017 and 2017–2019)1

Among young adults aged 18–25 in Region 4, the annual average percentage of opioid use disorder in the past 

year did not significantly change between 2015–2017 (1.4%) and 2017–2019 (1.3%). The percentage did not 

significantly change in every state in Region 4.

% 2015–2017, % 2017–2019

2.1%, 1.9%

1.9%, 1.4%

1.2%, 1.1%

1.4%, 1.4%

1.4%, 1.1%

0.7%, 1.1%

1.1%, 1.1%

2.9%, 1.9%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
R4

23

Young Adult Substance Use 

and Use Disorders

Illicit Drug Use Disorder

Past-Year Illicit Drug Use Disorder among Young Adults Aged 18–25 in Region 4

(Annual Average, 2017–2019)1

6.6%

During 2017–2019, among young adults aged 18–25 in Region 4, 6.6% (or 436,000) 

had illicit drug use disorder in the past year, lower than the national average (7.5%).

Compared to the national average, the estimate was lower in Kentucky and Mississippi 

and similar in Alabama, Florida, Georgia, North Carolina, South Carolina, and 

Tennessee. 

Compared to the regional average, the estimate was lower in Kentucky and Mississippi 

and similar in Alabama, Florida, Georgia, North Carolina, South Carolina, and 

Tennessee.

5.9% 5.9%

7.5%

4.5% 4.7%

6.7%

6.9%

7.9%

6.6% 7.5%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

24

Young Adult Substance Use 

and Use Disorders

Illicit Drug Use Disorder

Changes in Past-Year Illicit Drug Use Disorder among Young Adults Aged 18–25 

in Region 4 (Annual Averages, 2015–2017 and 2017–2019)1

Among young adults aged 18–25 in Region 4, the annual average percentage of illicit drug use disorder in the past 

year did not significantly change between 2015–2017 (7.2%) and 2017–2019 (6.6%). The percentage decreased 

in Kentucky and South Carolina.

% 2015–2017, % 2017–2019

7.6%, 5.9%

8.5%, 5.9%

8.6%, 7.5%

5.0%, 4.5%

7.0%, 4.7%

5.5%, 6.7%

7.1%, 6.9%

8.1%, 7.9%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
R4

25

Young Adult Substance Use 

and Use Disorders

Binge Alcohol Use

Past-Month Binge Alcohol Use among Young Adults Aged 18–25 in Region 4

(Annual Average, 2017–2019)1,4

30.1%

During 2017–2019, among young adults aged 18–25 in Region 4, 30.1% (or 

2.0 million) reported binge alcohol use in the past month, lower than the national 

average (35.4%).

Compared to the national average, the estimate was lower in Alabama, Florida, 

Georgia, Kentucky, Mississippi, and Tennessee and similar in North Carolina and 

South Carolina. 

Compared to the regional average, the estimate was higher in North Carolina; lower 

in Alabama, Mississippi, and Tennessee; and similar in Florida, Georgia, Kentucky, and 

South Carolina.

26.2%

33.8% 33.1%

23.5%

30.7% 31.3% 28.9% 30.1% 26.3%

35.4%

U.S. R4 AL FL GA KY MS NC SC TN

0%

100%

75%

50%

25%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

26

Young Adult Substance Use 

and Use Disorders

Binge Alcohol Use

Changes in Past-Month Binge Alcohol Use among Young Adults Aged 18–25 in 

Region 4 (Annual Averages, 2015–2017 and 2017–2019)1,4

Among young adults aged 18–25 in Region 4, the annual average percentage of binge alcohol use in the past 

month decreased between 2015–2017 (33.4%) and 2017–2019 (30.1%). The percentage decreased in Florida, 

Georgia, and South Carolina.

% 2015–2017, % 2017–2019

26.2%, 26.2%

38.6%, 33.1%

33.9%, 33.8%

23.0%, 23.5%

33.1%, 30.7%

34.7%, 28.9%

35.9%, 31.3%

31.3%, 26.3%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
R4

27

Young Adult Substance Use 

and Use Disorders

Alcohol Use Disorder

Past-Year Alcohol Use Disorder among Young Adults Aged 18–25 in Region 4

(Annual Average, 2017–2019)1

7.8%

During 2017–2019, among young adults aged 18–25 in Region 4, 7.8% (or 517,000) 

had alcohol use disorder in the past year, lower than the national average (9.8%).

Compared to the national average, the estimate was lower in Florida, Georgia, 

Kentucky, Mississippi, and North Carolina and similar in Alabama, South Carolina, and 

Tennessee. 

Compared to the regional average, the estimate was similar in every state in Region 4.

8.8%

10.8%

7.7% 7.2% 6.9% 6.6% 7.6%

7.5%

7.8%

9.8%

U.S. R4 AL FL GA KY MS NC SC TN

0%

50%

40%

30%

20%

10%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

28

Young Adult Substance Use 

and Use Disorders

Alcohol Use Disorder

Changes in Past-Year Alcohol Use Disorder among Young Adults Aged 18–25 in 

Region 4 (Annual Averages, 2002–2004 and 2017–2019)1

Among young adults aged 18–25 in Region 4, the annual average percentage of alcohol use disorder in the past 

year decreased between 2002–2004 (15.0%) and 2017–2019 (7.8%). The percentage decreased in every state 

in Region 4.

% 2002–2004, % 2017–2019

14.3%, 8.8%

18.7%, 10.8%

14.7%, 7.6%

12.5%, 6.6%

13.9%, 6.9%

13.3%, 7.2%

16.8%, 7.7%

13.2%, 7.5%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
R4

29

Young Adult Substance Use 

and Use Disorders

Substance Use Disorder

Past-Year Substance Use Disorder among Young Adults Aged 18–25 in Region 4

(Annual Average, 2017–2019)1

12.3%

During 2017–2019, among young adults aged 18–25 in Region 4, 12.3% (or 

814,000) had a substance use disorder in the past year, lower than the national 

average (14.7%).

Compared to the national average, the estimate was lower in Florida, Georgia, 

Kentucky, and Mississippi and similar in Alabama, North Carolina, South Carolina, and 

Tennessee. 

Compared to the regional average, the estimate was similar in every state in Region 4.

13.1% 14.3%

12.9% 12.5% 11.5% 10.3% 9.9%

12.3%

12.3%

14.7%

U.S. R4 AL FL GA KY MS NC SC TN

0%

50%

40%

30%

20%

10%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

30

Young Adult Substance Use 

and Use Disorders

Substance Use Disorder

Changes in Past-Year Substance Use Disorder among Young Adults Aged 18–25 

in Region 4 (Annual Averages, 2015–2017 and 2017–2019)1

Among young adults aged 18–25 in Region 4, the annual average percentage of substance use disorder in the past 

year decreased between 2015–2017 (13.5%) and 2017–2019 (12.3%). The percentage decreased in Florida.

% 2015–2017, % 2017–2019

13.7%, 13.1%

17.8%, 14.3%

13.4%, 12.9%

10.3%, 9.9%

12.7%, 10.3%

11.4%, 11.5%

14.4%, 12.5%

13.0%, 12.3%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
R4

31

Young Adult Mental Health

Serious Thoughts of Suicide

Past-Year Serious Thoughts of Suicide among Young Adults Aged 18–25 in 

Region 4 (Annual Average, 2017–2019)1,5

10.3%

During 2017–2019, among young adults aged 18–25 in Region 4, 10.3% (or 

671,000) had serious thoughts of suicide in the past year, lower than the national 

average (11.1%).

Compared to the national average, the estimate was similar in every state in Region 4. 

Compared to the regional average, the estimate was similar in every state in Region 4.

10.1%

10.5%

9.8%

10.7%

10.5%

9.1% 10.6%

11.8%

10.3% 11.1%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

32

Young Adult Mental Health

Serious Thoughts of Suicide

Changes in Past-Year Serious Thoughts of Suicide among Young Adults Aged 

18–25 in Region 4 (Annual Averages, 2008–2010 and 2017–2019)1,5

Among young adults aged 18–25 in Region 4, the annual average percentage with serious thoughts of suicide in 

the past year increased between 2008–2010 (5.5%) and 2017–2019 (10.3%). The percentage increased in every 

state in Region 4.

% 2008–2010, % 2017–2019

4.5%, 10.1%

5.9%, 10.5%

5.3%, 9.8%

6.2%, 10.7%

5.9%, 10.5%

4.5%, 9.1%

5.9%, 10.6%

6.9%, 11.8%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2008–2010 to 2017–2019

No Significant Change from 2008–2010 to 2017–2019

Decreased from 2008–2010 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008–2010 and 2017–2019.
R4

33

Young Adult Mental Health

Serious Mental Illness

Past-Year Serious Mental Illness (SMI) among Young Adults Aged 18–25 in 

Region 4 (Annual Average, 2017–2019)1,6

6.9%

During 2017–2019, among young adults aged 18–25 in Region 4, 6.9% (or 458,000) 

had SMI in the past year, lower than the national average (7.9%).

Compared to the national average, the estimate was lower in Georgia and similar in 

Alabama, Florida, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. 

Compared to the regional average, the estimate was similar in every state in Region 4.

8.6%

6.1%

5.7% 6.5%

7.6%

5.9% 7.3%

7.4%

6.9% 7.9%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

34

Young Adult Mental Health

Serious Mental Illness

Changes in Past-Year Serious Mental Illness (SMI) among Young Adults Aged 

18–25 in Region 4 (Annual Averages, 2008–2010 and 2017–2019)1,6

Among young adults aged 18–25 in Region 4, the annual average percentage with SMI in the past year increased 

between 2008–2010 (2.8%) and 2017–2019 (6.9%). The percentage increased in every state in Region 4.

% 2008–2010, % 2017–2019

2.6%, 8.6%

3.3%, 6.1%

2.1%, 6.5%

2.3%, 5.7%

3.2%, 7.6%

1.8%, 5.9%

3.5%, 7.3%

3.8%, 7.4%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2008–2010 to 2017–2019

No Significant Change from 2008–2010 to 2017–2019

Decreased from 2008–2010 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008–2010 and 2017–2019.
R4

35

Substance Use, Misuse, 

and Use Disorders

Tobacco Use

Past-Year Tobacco Use among People Aged 12 or Older in Region 4 (Annual 

Average, 2017–2019)1

29.0%

During 2017–2019, among people aged 12 or older in Region 4, 29.0% (or 

16.2 million) used tobacco in the past year, higher than the national average 

(26.8%).

Compared to the national average, the estimate was higher in Alabama, Kentucky, 

Mississippi, North Carolina, South Carolina, and Tennessee; lower in Florida; and similar 

in Georgia. 

Compared to the regional average, the estimate was higher in Alabama, Kentucky, 

Mississippi, and Tennessee; lower in Florida and Georgia; and similar in North Carolina 

and South Carolina.

31.2% 31.9%

29.3%

35.6% 37.0%

27.1%

24.6%

34.6%

29.0% 26.8%

U.S. R4 AL FL GA KY MS NC SC TN

0%

100%

75%

50%

25%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

36

Substance Use, Misuse, 

and Use Disorders

Tobacco Use

Changes in Past-Year Tobacco Use among People Aged 12 or Older in Region 4

(Annual Averages, 2002–2004 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of tobacco use in the past year 

decreased between 2002–2004 (37.3%) and 2017–2019 (29.0%). The percentage decreased in Florida, Georgia, 

Kentucky, North Carolina, South Carolina, and Tennessee.

% 2002–2004, % 2017–2019

37.6%, 31.9%

36.2%, 31.2%

41.5%, 29.3%

38.3%, 35.6%

43.1%, 37.0%

37.6%, 27.1%

33.5%, 24.6%

38.1%, 34.6%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
R4

37

Substance Use, Misuse, 

and Use Disorders

Marijuana Use

Past-Year Marijuana Use among People Aged 12 or Older in Region 4 (Annual 

Average, 2017–2019)1

14.0%

During 2017–2019, among people aged 12 or older in Region 4, 14.0% (or 

7.8 million) used marijuana in the past year, lower than the national average 

(16.2%).

Compared to the national average, the estimate was lower in Alabama, Florida, 

Georgia, Mississippi, North Carolina, South Carolina, and Tennessee and similar in 

Kentucky. 

Compared to the regional average, the estimate was lower in Mississippi and similar in 

Alabama, Florida, Georgia, Kentucky, North Carolina, South Carolina, and Tennessee.

14.0% 13.7% 13.3%

11.8%

14.6% 13.7% 14.6% 14.1% 14.0%

16.2%

U.S. R4 AL FL GA KY MS NC SC TN

0%

50%

40%

30%

20%

10%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

38

Substance Use, Misuse, 

and Use Disorders

Marijuana Use

Changes in Past-Year Marijuana Use among People Aged 12 or Older in Region 4

(Annual Averages, 2002–2004 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of marijuana use in the past year 

increased between 2002–2004 (9.8%) and 2017–2019 (14.0%). The percentage increased in every state in 

Region 4.

% 2002–2004, % 2017–2019

7.9%, 13.3%

9.8%, 13.7%

9.1%, 14.0%

7.8%, 11.8%

10.8%, 14.6%

10.2%, 14.1%

10.9%, 14.6%

8.7%, 13.7%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
R4

39

Substance Use, Misuse, 

and Use Disorders

Marijuana Use Disorder

Past-Year Marijuana Use Disorder among People Aged 12 or Older in Region 4

(Annual Average, 2017–2019)1

1.3%

During 2017–2019, among people aged 12 or older in Region 4, 1.3% (or 746,000) 

had marijuana use disorder in the past year, lower than the national average (1.6%).

Compared to the national average, the estimate was lower in Florida, South Carolina, 

and Tennessee and similar in Alabama, Georgia, Kentucky, Mississippi, and 

North Carolina. 

Compared to the regional average, the estimate was similar in every state in Region 4.

1.1% 1.2%

1.3% 1.4%

1.5%

1.5%

1.3%

1.4%

1.3%

1.6%

U.S. R4 AL FL GA KY MS NC SC TN

0%

5%

4%

3%

2%

1%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

40

Substance Use, Misuse, 

and Use Disorders

Marijuana Use Disorder

Changes in Past-Year Marijuana Use Disorder among People Aged 12 or Older in 

Region 4 (Annual Averages, 2002–2004 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of marijuana use disorder in the 

past year decreased between 2002–2004 (1.8%) and 2017–2019 (1.3%). The percentage decreased in Florida, 

South Carolina, and Tennessee.

% 2002–2004, % 2017–2019

1.9%, 1.1%

1.9%, 1.2%

1.9%, 1.4%

1.2%, 1.3%

1.7%, 1.5%

1.6%, 1.5%

1.9%, 1.3%

1.6%, 1.4%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
R4

41

Substance Use, Misuse, 

and Use Disorders

Heroin Use

Past-Year Heroin Use among People Aged 12 or Older in Region 4 (Annual 

Average, 2017–2019)1

0.25%

During 2017–2019, among people aged 12 or older in Region 4, 0.25% (or 141,000) 

used heroin in the past year, similar to the national average (0.30%).

Compared to the national average, the estimate was lower in Georgia, Mississippi, 

and South Carolina and similar in Alabama, Florida, Kentucky, North Carolina, and 

Tennessee. 

Compared to the regional average, the estimate was lower in Georgia and 

South Carolina and similar in Alabama, Florida, Kentucky, Mississippi, North Carolina, 

and Tennessee.

0.34%

0.03%

0.32%

0.11%

0.42%

0.06%

0.28%

0.43%

0.30% 0.25%

U.S. R4 AL FL GA KY MS NC SC TN

0%

2%

1.5%

1%

0.5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

42

Substance Use, Misuse, 

and Use Disorders

Heroin Use

Changes in Past-Year Heroin Use among People Aged 12 or Older in Region 4

(Annual Averages, 2002–2004 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of heroin use in the past year 

increased between 2002–2004 (0.14%) and 2017–2019 (0.25%). The percentage increased in North Carolina 

and Tennessee.

% 2002–2004, % 2017–2019

0.05%, 0.34%

0.12%, 0.03%

0.07%, 0.32%

0.02%, 0.11%

0.22%, 0.42%

0.24%, 0.06%

0.15%, 0.28%

0.20%, 0.43%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
R4

43

Substance Use, Misuse, 

and Use Disorders

Misuse of Prescription Pain Relievers

Past-Year Misuse of Prescription Pain Relievers among People Aged 12 or Older 

in Region 4 (Annual Average, 2017–2019)1

3.9%

During 2017–2019, among people aged 12 or older in Region 4, 3.9% (or 2.2 million) 

misused prescription pain relievers in the past year, similar to the national average 

(3.7%).

Compared to the national average, the estimate was higher in Alabama and similar in 

Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. 

Compared to the regional average, the estimate was higher in Alabama and similar in 

Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.

3.5% 3.6% 3.4% 3.9% 4.4%

3.4%

4.1%

5.1%

3.7% 3.9%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

44

Substance Use, Misuse, 

and Use Disorders

Misuse of Prescription Pain Relievers

Changes in Past-Year Misuse of Prescription Pain Relievers among People Aged 

12 or Older in Region 4 (Annual Averages, 2015–2017 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of prescription pain reliever misuse 

in the past year decreased between 2015–2017 (4.3%) and 2017–2019 (3.9%). The percentage decreased in 

North Carolina.

% 2015–2017, % 2017–2019

4.4%, 3.4%

4.3%, 3.6%

4.4%, 3.5%

4.1%, 3.9%

4.9%, 4.4%

3.6%, 3.4%

4.2%, 4.1%

5.1%, 5.1%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
R4

45

Substance Use, Misuse, 

and Use Disorders

Opioid Use Disorder

Past-Year Opioid Use Disorder among People Aged 12 or Older in Region 4

(Annual Average, 2017–2019)1

0.8%

During 2017–2019, among people aged 12 or older in Region 4, 0.8% (or 448,000) 

had opioid use disorder in the past year, similar to the national average (0.7%).

Compared to the national average, the estimate was higher in Kentucky and similar in 

Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee. 

Compared to the regional average, the estimate was higher in Kentucky; lower in 

Georgia; and similar in Alabama, Florida, Mississippi, North Carolina, South Carolina, 

and Tennessee.

0.9%

0.7% 0.6%

0.6%

1.3%

0.5%

0.9%

1.0%

0.8% 0.7%

U.S. R4 AL FL GA KY MS NC SC TN

0%

5%

4%

3%

2%

1%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

46

Substance Use, Misuse, 

and Use Disorders

Opioid Use Disorder

Changes in Past-Year Opioid Use Disorder among People Aged 12 or Older in 

Region 4 (Annual Averages, 2015–2017 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of opioid use disorder in the past year 

did not significantly change between 2015–2017 (0.9%) and 2017–2019 (0.8%). The percentage decreased in 

South Carolina.

% 2015–2017, % 2017–2019

1.0%, 0.9%

1.1%, 0.6%

0.8%, 0.7%

1.1%, 0.6%

1.5%, 1.3%

0.6%, 0.5%

0.8%, 0.9%

1.2%, 1.0%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
R4

47

Substance Use, Misuse, 

and Use Disorders

Illicit Drug Use Disorder

Past-Year Illicit Drug Use Disorder among People Aged 12 or Older in Region 4

(Annual Average, 2017–2019)1

2.7%

During 2017–2019, among people aged 12 or older in Region 4, 2.7% (or 1.5 million) 

had illicit drug use disorder in the past year, lower than the national average (2.9%).

Compared to the national average, the estimate was lower in Georgia and 

South Carolina and similar in Alabama, Florida, Kentucky, Mississippi, North Carolina, 

and Tennessee. 

Compared to the regional average, the estimate was similar in every state in Region 4.

2.8%

2.2% 2.4% 2.7%

3.3%

2.7% 2.4%

3.2%

2.9% 2.7%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
R4 

48

Substance Use, Misuse, 

and Use Disorders

Illicit Drug Use Disorder

Changes in Past-Year Illicit Drug Use Disorder among People Aged 12 or Older in 

Region 4 (Annual Averages, 2015–2017 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of illicit drug use disorder in the past 

year did not significantly change between 2015–2017 (2.7%) and 2017–2019 (2.7%). The percentage decreased 

in South Carolina.

% 2015–2017, % 2017–2019

2.7%, 2.8%

2.9%, 2.2%

2.7%, 2.7%

2.5%, 2.4%

3.2%, 3.3%

2.4%, 2.4%

2.6%, 2.7%

3.1%, 3.2%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
R4

49

Substance Use, Misuse, 

and Use Disorders

Alcohol Use Disorder

Past-Year Alcohol Use Disorder among People Aged 12 or Older in Region 4

(Annual Average, 2017–2019)1

4.5%

During 2017–2019, among people aged 12 or older in Region 4, 4.5% (or 2.5 million) 

had alcohol use disorder in the past year, lower than the national average (5.3%).

Compared to the national average, the estimate was lower in Florida, Georgia, 

and Tennessee and similar in Alabama, Kentucky, Mississippi, North Carolina, and 

South Carolina. 

Compared to the regional average, the estimate was similar in every state in Region 4.

4.3%

4.9% 4.4% 4.7%

5.0%

4.2% 4.2%

5.3%

4.5%

5.3%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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Substance Use, Misuse, 

and Use Disorders

Alcohol Use Disorder

Changes in Past-Year Alcohol Use Disorder among People Aged 12 or Older in 

Region 4 (Annual Averages, 2002–2004 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of alcohol use disorder in the past 

year decreased between 2002–2004 (6.6%) and 2017–2019 (4.5%). The percentage decreased in Florida, 

Georgia, South Carolina, and Tennessee.

% 2002–2004, % 2017–2019

6.0%, 4.3%

8.4%, 4.9%

5.8%, 4.7%

6.2%, 4.4%

6.4%, 5.0%

6.9%, 4.2%

7.1%, 4.2%

5.3%, 5.3%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2002–2004 to 2017–2019

No Significant Change from 2002–2004 to 2017–2019

Decreased from 2002–2004 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002–2004 and 2017–2019.
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Substance Use, Misuse, 

and Use Disorders

Substance Use Disorder

Past-Year Substance Use Disorder among People Aged 12 or Older in Region 4

(Annual Average, 2017–2019)1

6.4%

During 2017–2019, among people aged 12 or older in Region 4, 6.4% (or 3.6 million) 

had a substance use disorder in the past year, lower than the national average (7.4%).

Compared to the national average, the estimate was lower in Florida and Georgia 

and similar in Alabama, Kentucky, Mississippi, North Carolina, South Carolina, and 

Tennessee. 

Compared to the regional average, the estimate was similar in every state in Region 4.

6.3% 6.5% 6.3% 6.5%

7.5%

6.3% 5.8%

7.6%

6.4%

7.4%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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Substance Use, Misuse, 

and Use Disorders

Substance Use Disorder

Changes in Past-Year Substance Use Disorder among People Aged 12 or Older in 

Region 4 (Annual Averages, 2015–2017 and 2017–2019)1

Among people aged 12 or older in Region 4, the annual average percentage of substance use disorder in the past 

year did not significantly change between 2015–2017 (6.6%) and 2017–2019 (6.4%). The percentage decreased 

in Florida.

% 2015–2017, % 2017–2019

6.2%, 6.5%

7.4%, 6.3%

6.1%, 6.5%

5.6%, 6.3%

7.7%, 7.5%

5.8%, 5.8%

7.3%, 6.3%

6.2%, 7.6%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2015–2017 to 2017–2019

No Significant Change from 2015–2017 to 2017–2019

Decreased from 2015–2017 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015–2019.
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Substance Use Treatment

Enrollment and Treatment Focus

Changes in the Number of People Enrolled in Substance Use Treatment in 

Region 4 (Single-Day Counts, 2015 and 2019)7,8

In a single-day count in March 2019, 228,967 people in Region 4 were enrolled in substance use treatment—

higher than 214,185 people in 2015.

2015 and 2019

22,445 | 28,899

18,236 | 20,539

42,026 | 49,520

4,699 | 6,179

23,565 | 28,452

25,379 | 23,465

63,287 | 57,335

14,548 | 14,578

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Higher in 2019 than in 2015

Lower in 2019 than in 2015

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey of Substance Abuse Treatment Services, 2015 and 2019.
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Substance Use Treatment

Enrollment and Treatment Focus

Substance Use Problems among People Enrolled in Substance Use Treatment in 

Region 4 (Single-Day Count, 2019)7,8,9

Among people in Region 4 enrolled in substance 

use treatment in March 2019, 57.8% (or 

128,782) were enrolled for drug use only. The 

national average was 52.2%.

61.8%

46.5%

62.0%

41.1%

61.0%

66.7%

51.0%

63.6%

57.8%

52.2%

U.S. KYGAFLALR4 MS TNSCNC

0%

100%

75%

50%

25%

Among people in Region 4 enrolled in substance 

use treatment in March 2019, 11.5% (or 

25,687) were enrolled for alcohol use only. The 

national average was 14.4%.

10.2%

16.4%

11.5% 9.7% 13.3% 9.7% 9.5% 11.5% 10.8% 14.4%

U.S. KYGAFLALR4 MS TNSCNC

0%

100%

75%

50%

25%

Among people in Region 4 enrolled in substance 

use treatment in March 2019, 30.7% (or 

68,366) were enrolled for both drug and 

alcohol use. The national average was 33.4%. 28.0%

37.2%

27.1%

47.4%

29.5%

23.6%

35.6%

26.7%

33.4% 30.7%

U.S. KYGAFLALR4 MS TNSCNC

0%

100%

75%

50%

25%

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey of Substance Abuse Treatment Services, 2019.
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Substance Use Treatment

Opioids (Medication-Assisted Therapy [MAT])

Changes in the Number of People Enrolled in Opioid Treatment Programs in 

Region 4 Receiving Methadone (Single-Day Counts, 2015 and 2019)7,8,10

In a single-day count in March 2019, 68,074 people in Region 4 were receiving methadone in opioid treatment 

programs as part of their substance use treatment—higher than 62,262 people in 2015.

2015 and 2019

4,421 | 5,566

4,524 | 5,667

13,665 | 14,360

176 | 797

2,955 | 4,282

11,212 | 12,230

17,670 | 18,079

7,639 | 7,093

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Higher in 2019 than in 2015

Lower in 2019 than in 2015

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey of Substance Abuse Treatment Services, 2015 and 2019.
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Substance Use Treatment

Opioids (Medication-Assisted Therapy [MAT])

Changes in the Number of People Enrolled in Substance Use Treatment in 

Region 4 Receiving Buprenorphine (Single-Day Counts, 2015 and 2019)7,8,10,11

In a single-day count in March 2019, 32,898 people in Region 4 were receiving buprenorphine as part of their 

substance use treatment—higher than 14,238 people in 2015.

2015 and 2019

1,179 | 7,558

799 | 1,500

5,637 | 9,217

97 | 824

2,158 | 6,256

659 | 1,183

2,922 | 5,086

787 | 1,274

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Higher in 2019 than in 2015

Lower in 2019 than in 2015

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey of Substance Abuse Treatment Services, 2015 and 2019.
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Adult Mental Health 

and Service Use

Serious Thoughts of Suicide

Past-Year Serious Thoughts of Suicide among Adults Aged 18 or Older in 

Region 4 (Annual Average, 2017–2019)1,5

4.2%

During 2017–2019, among adults aged 18 or older in Region 4, 4.2% (or 2.1 million) 

had serious thoughts of suicide in the past year, lower than the national average 

(4.5%).

Compared to the national average, the estimate was lower in Florida and similar 

in Alabama, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and 

Tennessee. 

Compared to the regional average, the estimate was similar in every state in Region 4.

4.5%

5.0%

4.1%

5.1%

4.7%

3.9% 3.8%

4.7%

4.5% 4.2%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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Adult Mental Health 

and Service Use

Serious Thoughts of Suicide

Changes in Past-Year Serious Thoughts of Suicide among Adults Aged 18 or 

Older in Region 4 (Annual Averages, 2008–2010 and 2017–2019)1,5

Among adults aged 18 or older in Region 4, the annual average percentage with serious thoughts of suicide in the 

past year increased between 2008–2010 (3.3%) and 2017–2019 (4.2%). The percentage increased in Georgia, 

Mississippi, and South Carolina.

% 2008–2010, % 2017–2019

3.6%, 4.5%

3.0%, 5.0%

3.5%, 4.1%

3.0%, 5.1%

3.6%, 4.7%

2.1%, 3.8%

3.5%, 3.9%

4.0%, 4.7%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2008–2010 to 2017–2019

No Significant Change from 2008–2010 to 2017–2019

Decreased from 2008–2010 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008–2010 and 2017–2019.
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Adult Mental Health 

and Service Use

Serious Mental Illness

Past-Year Serious Mental Illness (SMI) among Adults Aged 18 or Older in 

Region 4 (Annual Average, 2017–2019)1,6

4.7%

During 2017–2019, among adults aged 18 or older in Region 4, 4.7% (or 2.4 million) 

had SMI in the past year, similar to the national average (4.8%).

Compared to the national average, the estimate was higher in Kentucky; lower in 

Florida; and similar in Alabama, Georgia, Mississippi, North Carolina, South Carolina, 

and Tennessee. 

Compared to the regional average, the estimate was higher in Kentucky; lower in 

Florida; and similar in Alabama, Georgia, Mississippi, North Carolina, South Carolina, 

and Tennessee.

5.1%

4.6% 4.7%

5.4% 6.2%

4.1% 4.2%

6.2%

4.8% 4.7%

U.S. R4 AL FL GA KY MS NC SC TN

0%

20%

15%

10%

5%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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Adult Mental Health 

and Service Use

Serious Mental Illness

Changes in Past-Year Serious Mental Illness (SMI) among Adults Aged 18 or 

Older in Region 4 (Annual Averages, 2008–2010 and 2017–2019)1,6

Among adults aged 18 or older in Region 4, the annual average percentage with SMI in the past year increased 

between 2008–2010 (3.5%) and 2017–2019 (4.7%). The percentage increased in Georgia, Kentucky, and 

Mississippi.

% 2008–2010, % 2017–2019

3.6%, 5.1%

3.3%, 4.7%

3.1%, 4.6%

3.4%, 5.4%

4.1%, 6.2%

2.6%, 4.2%

3.6%, 4.1%

5.0%, 6.2%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2008–2010 to 2017–2019

No Significant Change from 2008–2010 to 2017–2019

Decreased from 2008–2010 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008–2010 and 2017–2019.
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Adult Mental Health 

and Service Use

Mental Health Service Use among Adults 

with Any Mental Illness

Past-Year Mental Health Service Use among Adults Aged 18 or Older with Any 

Mental Illness (AMI) in Region 4 (Annual Average, 2017–2019)1,6,12

42.0%

During 2017–2019, among adults aged 18 or older with AMI in Region 4, 42.0% (or 

4.0 million) received mental health services in the past year, similar to the national 

average (43.6%).

Compared to the national average, the estimate was lower in Florida and Georgia 

and similar in Alabama, Kentucky, Mississippi, North Carolina, South Carolina, and 

Tennessee. 

Compared to the regional average, the estimate was higher in Tennessee; lower in 

Florida and Georgia; and similar in Alabama, Kentucky, Mississippi, North Carolina, and 

South Carolina.

45.8% 47.8% 46.0% 42.9% 45.3%

38.9% 36.6%

41.0% 43.6% 42.0%

U.S. R4 AL FL GA KY MS NC SC TN

0%

100%

75%

50%

25%

Error bars indicate 95% confidence interval of the estimate.

U.S. = United States; R4 = Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); AL = Alabama; FL = Florida; 

GA = Georgia; KY = Kentucky; MS = Mississippi; NC = North Carolina; SC = South Carolina; TN = Tennessee.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017–2019.
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Adult Mental Health 

and Service Use

Mental Health Service Use among Adults 

with Any Mental Illness

Changes in Past-Year Mental Health Service Use among Adults Aged 18 or Older 

with Any Mental Illness (AMI) in Region 4 (Annual Averages, 2008–2010 and 

2017–2019)1,6,12

Among adults aged 18 or older in Region 4, the annual average percentage with AMI who received mental health 

services in the past year did not significantly change between 2008–2010 (42.6%) and 2017–2019 (42.0%). The 

percentage did not significantly change in every state in Region 4.

% 2008–2010, % 2017–2019

39.9%, 47.8%

49.0%, 45.8%

45.7%, 45.3%

33.1%, 42.9%

44.7%, 46.0%

45.2%, 36.6%

41.3%, 38.9%

39.6%, 41.0%

TN

SC

NC

MS

KY

GA

FL

AL

Key: 

Regional Office: Atlanta

Kentucky

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Tennessee

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Mississippi

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Alabama

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

North Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

South Carolina

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Georgia

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Florida

Down arrow indicating there was a decrease from 2002–2005 to 2014–2017.

Increased from 2008–2010 to 2017–2019

No Significant Change from 2008–2010 to 2017–2019

Decreased from 2008–2010 to 2017–2019

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008–2010 and 2017–2019.
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63

Figure Notes

1 Estimates are annual averages based on combined 2017–2019 NSDUH data or NSDUH data for other combined 

years as indicated. 

2 Respondents with unknown past-year major depressive episode (MDE) data were excluded. 

3 Respondents with unknown past-year MDE or unknown treatment data were excluded. 

4 Consistent with federal definitions and other federal data collections, the NSDUH definition for binge alcohol use 

since 2015 differs for males and females. Thus, this indicator is based only on the 2015–2019 NSDUH data. Binge 

drinking for males is defined as drinking five or more drinks on the same occasion on at least 1 day in the past 

30 days, which is unchanged from the threshold prior to 2015. Since 2015, binge alcohol use for females has been 

defined as drinking four or more drinks on the same occasion on at least 1 day in the past 30 days. 

5 Estimates were based only on responses to suicidality items in the NSDUH Mental Health module. Respondents 

with unknown suicidality information were excluded. 

6 For further information, see The NSDUH Report: Revised Estimates of Mental Illness from the National Survey on 

Drug Use and Health, which is available on the SAMHSA website at https://www.samhsa.gov/data/sites/default/

files/NSDUH148/NSDUH148/sr148-mental-illness-estimates.pdf.

7 Significance testing was not conducted on these data. Conducting statistical significance tests is not necessary 

because these are counts of people enrolled at all treatment facilities (rather than estimates from a sample of 

treatment facilities).

8 Single-day counts reflect the number of individuals who were enrolled in substance use treatment on the last 

business day in March: March 31, 2015; March 31, 2016; March 31, 2017; and March 29, 2019. Single-day counts 

of the number of individuals enrolled in substance use treatment were not included in the 2018 National Survey of 

Substance Abuse Treatment Services (N–SSATS).

9 Enrollees whose substances were unknown were excluded. 

10 These counts reflect only individuals who were receiving these specific medication-assisted therapies (MATs) as 

part of their opioid treatment in specialty substance abuse treatment programs; they do not include counts of 

individuals who were receiving other types of treatment (such as those who received MAT from private physicians) 

for their opioid addiction on the reference dates. 
R4 

64

Figure Notes

11 Physicians who obtain specialized training per the Drug Addiction Treatment Act of 2000 (DATA 2000) may 

prescribe buprenorphine to treat opioid addiction. Some physicians are in private, office-based practices; others 

are affiliated with substance abuse treatment facilities or programs and may prescribe buprenorphine to clients at 

those facilities. Additionally, opioid treatment programs (OTPs) may also prescribe and/or dispense buprenorphine. 

The buprenorphine single-day counts include only those clients who received/were prescribed buprenorphine by 

physicians affiliated with substance abuse treatment facilities; they do not include clients from private practice 

physicians.

12 Respondents were not to include treatment for drug or alcohol use. Respondents with unknown service use 

information were excluded. Estimates were based only on responses to items in the NSDUH Adult Mental Health 

Service Utilization module. 
R4

65

Definitions

Alcohol use disorder and illicit drug use disorder are defined using diagnostic criteria specified within the 

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which include such symptoms as 

withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference with major obligations at 

work, school, or home during the past year. For details, see American Psychiatric Association (1994). 

Any mental illness (AMI) is defined in NSDUH as adults aged 18 or older who currently or at any time in the past 

year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use 

disorders) of sufficient duration to meet DSM-IV criteria. AMI estimates are based on a predictive model applied to 

NSDUH data and are not direct measures of diagnostic status. Adults estimated as having a diagnosable mental, 

behavioral, or emotional disorder in the past year, regardless of their level of functional impairment, were defined as 

having AMI. 

Depression care is defined as seeing or talking to a medical doctor or other professional or using prescription 

medication for depression in the past year.

Major depressive episode (MDE) is defined as in the Diagnostic and Statistical Manual of Mental Disorders, Fifth 

Edition (DSM-5), which specifies a period of at least 2 weeks in the past year when an individual experienced a 

depressed mood or loss of interest or pleasure in daily activities and had a majority of specified depression symptoms. 

For details, see American Psychiatric Association (2013).

Marijuana use disorder is defined using diagnostic criteria specified within the DSM-IV (APA, 1994), which 

include such symptoms as tolerance, use in dangerous situations, trouble with the law, and interference with major 

obligations at work, school, or home during the past year.

Mental health service use is defined in the National Survey on Drug Use and Health (NSDUH) for adults aged 18 or 

older as receiving treatment or counseling for any problem with emotions, nerves, or mental health in the 12 months 

before the interview in any inpatient or outpatient setting, or the use of prescription medication for treatment of any 

mental or emotional condition that was not caused by the use of alcohol or drugs. 

Number of individuals enrolled in substance use treatment refers to the number of clients in treatment at 

alcohol and drug abuse facilities (public and private) throughout the 50 states, the District of Columbia, and other 

U.S. jurisdictions.

Opioid use disorder is defined as heroin use disorder or prescription pain reliever use disorder using diagnostic 

criteria specified within the DSM-IV (APA, 1994), which include such symptoms as withdrawal, tolerance, use in 

dangerous situations, trouble with the law, and interference with major obligations at work, school, or home during 

the past year.
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66

Definitions

Prescription pain relievers include the following subcategories of pain relievers (examples of specific pain relievers 

shown in parentheses): hydrocodone products (e.g., Vicodin®, Lortab®, Norco®, Zohydro® ER, generic hydrocodone); 

oxycodone products (e.g., OxyContin®, Percocet®, Percodan®, Roxicodone®, generic oxycodone); tramadol products

(e.g., Ultram®, Ultram® ER, Ultracet®, generic tramadol, generic extended-release tramadol); codeine products

(e.g., Tylenol® with codeine 3 or 4, generic codeine pills); morphine products (e.g., Avinza®, Kadian®, MS Contin®, 

generic morphine, generic extended-release morphine); fentanyl products (e.g., Duragesic®, Fentora®, generic 

fentanyl); buprenorphine products (e.g., Suboxone®, generic buprenorphine, generic buprenorphine plus naloxone); 

oxymorphone products (e.g., Opana®, Opana® ER, generic oxymorphone, generic extended-release oxymorphone); 

Demerol®; hydromorphone products (e.g., Dilaudid® or generic hydromorphone, Exalgo® or generic extended-release 

hydromorphone); methadone; or any other prescription pain reliever. 

Prescription pain reliever misuse is defined as prescription pain reliever use in any way not directed by a doctor, 

including use without a prescription of one’s own; use in greater amounts, more often, or longer than told; or use in 

any other way not directed by a doctor.

Serious mental illness (SMI) is defined in NSDUH as adults aged 18 or older who currently or at any time in the 

past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance 

use disorders) of sufficient duration to meet diagnostic criteria specified in the DSM-IV and has resulted in serious 

functional impairment, which substantially interferes with or limits one or more major life activities. SMI estimates are 

based on a predictive model applied to NSDUH data and are not direct measures of diagnostic status. The estimation 

of SMI covers any mental disorders that result in serious impairment in functioning such as major depression and 

bipolar disorders. However, NSDUH data cannot be used to estimate the prevalence of specific mental disorders in 

adults. Also, it should be noted that SAMHSA has recently updated the definition of SMI for use in mental health block 

grants to include mental disorders as specified in the DSM-IV (APA, 1994).

Substance use disorder is defined as dependence on or abuse of alcohol, illicit drugs (e.g., marijuana, cocaine, 

hallucinogens, heroin, or inhalants), or psychotherapeutics (e.g., prescription pain relievers, sedatives, tranquilizers, 

or stimulants) in the past 12 months based on assessments of individual diagnostic criteria from the DSM-IV (APA, 

1994), which include such symptoms as withdrawal, tolerance, use in dangerous situations, trouble with the law, and 

interference with major obligations at work, school, or home during the past year.
R4

67

References and Sources

American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) 

(4th ed.). Washington, DC: Author.

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (DSM-5) 

(5th ed.). Arlington, VA: Author. 

The National Survey of Substance Abuse Treatment Services (N–SSATS) is an annual census designed to collect 

information from all public and private treatment facilities in the United States that provide substance abuse 

treatment. The objectives of N–SSATS are to collect multipurpose data that can be used to assist SAMHSA and state 

and local governments in assessing the nature and extent of services provided and in forecasting treatment resource 

requirements, to update SAMHSA’s Inventory of Behavioral Health Services, to analyze general treatment services 

trends, and to generate the Behavioral Health Treatment Services Locator (https://findtreatment.samhsa.gov/). Data 

presented in this report reflect all publicly available data in N–SSATS reports at the time of the writing of this report 

and may present data previously unavailable in prior barometer reports. Total U.S. single-day counts presented in this 

report include counts from U.S. territories and jurisdictions. Total single-day counts for HHS Regions are based only 

on the states included in each region. Additional information about N–SSATS is available at https://www.samhsa.gov/

data/all-reports.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse 

and Mental Health Services Administration (SAMHSA). NSDUH is the primary source of information on the use of 

illicit drugs, alcohol, and tobacco in the U.S. civilian, noninstitutionalized population aged 12 years or older and 

includes mental health issues and mental health service utilization for adolescents aged 12–17 and adults aged 18 

or older. Conducted by the federal government since 1971, NSDUH collects data by administering questionnaires to 

a representative sample of the population through face-to-face interviews at their place of residence. The data used 

in this report are based on information obtained from approximately 67,500 individuals aged 12 years or older per 

year in the United States. Additional information about NSDUH is available at https://www.samhsa.gov/data/data-wecollect/nsduh-national-survey-drug-use-and-health. 
HHS Publication No. SMA–20–Baro–19–R4 

Published 2020

U.S. Department of Health and Human Services 

Substance Abuse and Mental Health Services Administration 

Center for Behavioral Health Statistics and Quality 

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

1–877–SAMHSA–7 (1–877–726–4727) • 1–800–486–4889 (TDD) • www.samhsa.gov