DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Office of Applied Studies 

Serious Mental Illness and Its Co-Occurrence 

with Substance Use Disorders, 2002 

Joan Epstein 

Peggy Barker 

Michael Vorburger 

Christine Murtha 
 ii

Acknowledgments 

This report was prepared by the Division of Population Surveys, Office of Applied Studies (OAS), 

Substance Abuse and Mental Health Services Administration (SAMHSA), and by RTI International, a 

trade name of Research Triangle Institute, of Research Triangle Park, North Carolina, under Contract No. 

283-98-9008. At SAMHSA, Joan Epstein and Peggy Barker authored the report. Joseph Gfroerer 

provided review comments. At RTI, Christine Murtha was the task leader for its production and 

coauthored the report with Michael Vorburger. Mary Ellen Marsden reviewed the report; other 

contributors and reviewers at RTI include Jeremy Aldworth, Katherine R. Bowman, Walter R. Boyle, 

James R. Chromy, Andrew Clarke, Steven L. Emrich, Jennie L. Harris, David C. Heller, Jennifer J. 

Kasten, Larry A. Kroutil, Brian Newquist, Lisa E. Packer, Michael R. Pemberton, Michael A. Penne, Jill 

Webster, and Li-Tzy Wu. At RTI, Richard S. Straw edited the report; Diane G. Caudill and Dayle 

Johnson prepared the graphics; Brenda K. Porter formatted the tables; Joyce Clay-Brooks, Debbie F. 

Bond, and Loraine G. Monroe formatted and word processed the report; and Pamela Couch Prevatt, 

Teresa F. Gurley, Kim Cone, Sonja E. Douglas, and Shari B. Lambert prepared its Web and press 

versions. Final report production was provided by Beatrice Rouse, Coleen Sanderson, and Jane Feldmann 

at SAMHSA. 

Public Domain Notice 

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

permission from the Substance Abuse and Mental Health Services Administration. However, this 

publication may not be reproduced or distributed for a fee without specific, written authorization of the 

Office of Communications, SAMHSA, U.S. Department of Health and Human Services. Citation of the 

source is appreciated. Suggested citation: 

Epstein J., Barker, P., Vorburger, M., & Murtha, C. (2004). Serious mental illness and its 

co-occurrence with substance use disorders, 2002 (DHHS Publication No. SMA 04-

3905, Analytic Series A-24). Rockville, MD: Substance Abuse and Mental Health 

Services Administration, Office of Applied Studies. 

Obtaining Additional Copies of Publication 

Copies may be obtained, free of charge, from the National Clearinghouse for Alcohol and Drug 

Information (NCADI), a service of SAMHSA. Write or call NCADI at: 

National Clearinghouse for Alcohol and Drug Information 

P.O. Box 2345, Rockville, MD 20847-2345 

1-301-468-2600, 1-800-729-6686, TDD 1-800-487-4889 

Electronic Access to Publication 

This publication can be accessed electronically through the Internet connections listed below: 

http://www.samhsa.gov

http://www.oas.samhsa.gov

Originating Office 

SAMHSA, Office of Applied Studies 

5600 Fishers Lane, Room 16-105 

Rockville, MD 20857 

June 2004 
Table of Contents 

Chapter Page 

 iii

List of Figures..................................................................................................................... v 

List of Tables .................................................................................................................... vii 

Highlights........................................................................................................................................ 1 

1. Introduction......................................................................................................................... 5 

1.1. Purpose of This Report ........................................................................................... 5 

1.2. Background on the Definition of Serious Mental Illness........................................ 6 

1.3. Prior Estimates of Serious Mental Illness and Its Co-Occurrence with a 

Substance Use Disorder and Treatment.................................................................. 6 

1.4. Prior Estimates of Co-Occurring Disorders............................................................ 6 

1.5. Organization of This Report ................................................................................... 7 

2. Data and Methods ............................................................................................................... 9 

2.1. Summary of National Survey on Drug Use and Health.......................................... 9 

2.2. Limitations of the Data ......................................................................................... 10 

2.3. Measures and Statistical Methods......................................................................... 10 

2.3.1 Definition and Measurement of Serious Mental Illness ........................... 10 

2.3.2 Definition of Substance Use Disorder and Nicotine (Cigarette) 

Dependence............................................................................................... 11 

2.3.3 Definitions of Mental Health Treatment and Substance Use 

Treatment .................................................................................................. 11 

2.3.4 Social and Demographic Variables........................................................... 12 

2.3.5 Use of Alcohol, Cigarettes, Tobacco, and Illicit Drugs............................ 13 

2.4. Statistical Methods................................................................................................ 13 

2.4.1 Descriptive Analysis ................................................................................. 13 

2.4.2 Model-Based Analysis.............................................................................. 14 

3. Serious Mental Illness....................................................................................................... 15 

3.1. Characteristics of Adults With and Without Serious Mental Illness .................... 15 

3.2. Prevalence of Serious Mental Illness among Demographic and 

Socioeconomic Subgroups.................................................................................... 15 

3.3. Serious Mental Illness and Substance Use............................................................ 18 

3.3.1 Serious Mental Illness and Illicit Drug Use.............................................. 20 

3.3.1.1 Characteristics of Adults with Serious Mental Illness 

and Illicit Drug Use.................................................................... 20 

3.3.1.2 Prevalence of Serious Mental Illness among Illicit 

Drug Users ................................................................................. 21 

3.3.2 Serious Mental Illness among Cigarette and Alcohol Users .................... 21 

3.4. Serious Mental Illness and a Co-Occurring Substance Use Disorder................... 22 

3.4.1 Characteristics of Adults with Co-Occurring Serious Mental Illness 

and a Substance Use Disorder................................................................... 23 

3.4.2 Prevalence of Serious Mental Illness among Adults with a 

Substance Use Disorder ............................................................................ 25
Table of Contents (continued) 

Chapter Page 

 iv

3.5. Multiple Logistic Regression Models for Serious Mental Illness ........................ 26 

4. Mental Health Treatment and Substance Use Treatment ................................................. 29 

4.1. Mental Health Treatment among Adults with Serious Mental Illness.................. 29 

4.1.1 Characteristics of Adults with Serious Mental Illness, by Receipt 

of Mental Health Treatment in the Past Year ........................................... 29 

4.1.2 Rates of Mental Health Treatment among Adults with Serious 

Mental Illness, by Sociodemographic Characteristics.............................. 29 

4.1.3 Mental Health Treatment among Adults with Serious Mental 

Illness Who Did and Did Not Use Illicit Drugs........................................ 32 

4.2. Use of Treatment Services among Adults with Serious Mental Illness 

and/or a Co-Occurring Substance Use Disorder................................................... 34 

4.3. Multiple Logistic Regression Models................................................................... 36 

4.4. Discussion............................................................................................................. 38 

5. Summary and Conclusions ............................................................................................... 39 

References..................................................................................................................................... 41 

Appendix 

A Description of the Survey, Limitations of the Data, and Statistical Methods................... 47 

B Selected Tables ................................................................................................................. 65 
v

List of Figures 

Figure Page 

1. Serious Mental Illness among Adults Aged 18 or Older, by Age and Gender: 2002....... 16 

2. Serious Mental Illness among Adults Aged 18 or Older, by Perceived Health 

Status: 2002....................................................................................................................... 17 

3. Serious Mental Illness among Adults Aged 18 or Older, by Social Support: 2002 ......... 17 

4. Serious Mental Illness among Adults Aged 26 to 49, by Marital Status: 2002................ 18 

5. Serious Mental Illness among Adults Aged 26 to 49, by Family Income: 2002.............. 19 

6. Serious Mental Illness among Adults Aged 26 to 49, by Health Insurance Status: 

2002................................................................................................................................... 19 

7. Serious Mental Illness among Adults Aged 26 to 49, by Current Employment 

Status: 2002....................................................................................................................... 20 

8. Serious Mental Illness and Past Year Illicit Drug Use among Adults Aged 18 or 

Older: 2002 ....................................................................................................................... 21 

9. Serious Mental Illness, by Type of Substance Used among Adults Aged 18 or 

Older: 2002 ....................................................................................................................... 22 

10. Co-Occurrence of Serious Mental Illness and Substance Use Disorders among 

Adults Aged 18 or Older: 2002......................................................................................... 23 

11. Type of Substance Use Disorder among Adults Aged 18 or Older with Both 

Serious Mental Illness and a Co-Occurring Substance Use Disorder: Numbers in 

Thousands, 2002 ............................................................................................................... 24 

12. Substance Use Disorders and Illicit Drug Use among Adults Aged 18 or Older 

with Serious Mental Illness: Numbers in Thousands, 2002 ............................................. 25 

13. Serious Mental Illness among Adults Aged 18 or Older, by Substance 

Dependence or Abuse: 2002 ............................................................................................. 25 

14. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by Age: 2002 ........................................................................................................ 30

15. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by Gender: 2002 ................................................................................................... 31
List of Figures (continued) 

Figure Page 

vi

16. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by Race/Ethnicity: 2002 ....................................................................................... 31 

17. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by Perceived Health Status: 2002......................................................................... 32 

18. Mental Health Treatment among Adults Aged 26 to 49 with Serious Mental 

Illness, by Health Insurance Status: 2002......................................................................... 33 

19. Mental Health Treatment among Adults Aged 26 to 49 with Serious Mental 

Illness, by Marital Status: 2002 ........................................................................................ 33 

20. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by County Type: 2002.......................................................................................... 34 

21. Mental Health Treatment and Substance Use Treatment at a Specialty Facility 

among Adults Aged 18 or Older with Serious Mental Illness and/or a Substance 

Use Disorder: 2002 ........................................................................................................... 35

22. Mental Health and Specialty Substance Use Treatment among Adults Aged 18 or 

Older with Both Serious Mental Illness and a Substance Use Disorder: 2002................. 36 

A.1 Required Effective Sample as a Function of the Proportion Estimated............................ 55 
vii

List of Tables 

Table Page 

A.1 Summary of 2002 NSDUH Suppression Rules ................................................................ 61 

A.2 Weighted Percentages and Sample Sizes for 2002 NSDUH, by Screening Result 

Code .................................................................................................................................. 62 

A.3 Weighted Percentages and Sample Sizes for 2002 NSDUH, by Final Interview 

Code .................................................................................................................................. 63 

A.4 Response Rates and Sample Sizes for 2002 NSDUH, by Demographic 

Characteristics................................................................................................................... 64 

B.1a Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic 

Characteristics: Numbers in Thousands, 2002.................................................................. 66 

B.1b Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic 

Characteristics: Percentage Distributions, 2002 ............................................................... 67 

B.2a Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic 

Characteristics: Numbers in Thousands, 2002.................................................................. 68 

B.2b Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic 

Characteristics: Percentage Distributions, 2002 ............................................................... 69 

B.3a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age 

Group and Demographic Characteristics: Numbers in Thousands, 2002......................... 70 

B.3b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age 

Group and Demographic Characteristics: Percentages, 2002........................................... 71 

B.4a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age 

Group and Geographic Characteristics: Numbers in Thousands, 2002............................ 72 

B.4b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age 

Group and Geographic Characteristics: Percentages, 2002.............................................. 73 

B.5a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age 

Group and by Socioeconomic and Health Characteristics: Numbers in Thousands, 

2002................................................................................................................................... 74 

B.5b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age 

Group and by Socioeconomic and Health Characteristics: Percentages, 2002 ................ 75 

B.6a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past 

Year Any Illicit Drug Use and Demographic Characteristics: Numbers in 

Thousands, 2002 ............................................................................................................... 76 

B.6b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past 

Year Any Illicit Drug Use and Demographic Characteristics: Percentage 

Distributions, 2002............................................................................................................ 77
List of Tables (continued) 

Table Page 

viii

B.7a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past 

Year Any Illicit Drug Use and Geographic Characteristics: Numbers in 

Thousands, 2002 ............................................................................................................... 78 

B.7b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past 

Year Any Illicit Drug Use and Geographic Characteristics: Percentage 

Distributions, 2002............................................................................................................ 79 

B.8a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Any Illicit Drug Use and by Socioeconomic and Health Characteristics: 

Numbers in Thousands, 2002 ........................................................................................... 80 

B.8b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Any Illicit Drug Use and by Socioeconomic and Health Characteristics: 

Percentages, 2002 ............................................................................................................. 81 

B.9a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Any Illicit Drug Use and Demographic Characteristics: Numbers in 

Thousands, 2002 ............................................................................................................... 82 

B.9b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Any Illicit Drug Use and Demographic Characteristics: Percentages, 2002 ........... 83 

B.10a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Use of Illicit Drugs: Numbers in Thousands, 2002.................................................. 84 

B.10b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Use of Illicit Drugs: Percentages, 2002.................................................................... 85 

B.11a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year and Past Month Tobacco and Alcohol Use: Numbers in Thousands, 2002............. 86 

B.11b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year and Past Month Tobacco and Alcohol Use: Percentages, 2002............................... 87 

B.12a Serious Mental Illness and/or a Substance Use Disorder among Persons Aged 18 

or Older with a Serious Mental Illness or a Substance Use Disorder in the Past 

Year: Numbers in Thousands, 2002.................................................................................. 88 

B.12b Serious Mental Illness and/or a Substance Use Disorder among Persons Aged 18 

or Older with a Serious Mental Illness or a Substance Use Disorder in the Past 

Year: Percentage Distributions, 2002 ............................................................................... 89 

B.13a Substance Dependence or Abuse in the Past Year among Persons Aged 18 or 

Older, by Past Year Serious Mental Illness: Numbers in Thousands, 2002..................... 90 

B.13b Substance Dependence or Abuse in the Past Year among Persons Aged 18 or 

Older, by Past Year Serious Mental Illness: Percentages, 2002....................................... 91 
List of Tables (continued) 

Table Page 

 ix

B.14a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past 

Year Substance Use Disorder and Demographic Characteristics: Numbers in 

Thousands, 2002 ............................................................................................................... 92 

B.14b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past 

Year Substance Use Disorder and Demographic Characteristics: Percentage 

Distributions, 2002............................................................................................................ 93 

B.15a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past 

Year Substance Use Disorder and Geographic Characteristics: Numbers in 

Thousands, 2002 ............................................................................................................... 94 

B.15b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past 

Year Substance Use Disorder and Geographic Characteristics: Percentage 

Distributions, 2002............................................................................................................ 95 

B.16a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Substance Use Disorder, Gender, and Age Group: Numbers in Thousands, 

2002................................................................................................................................... 96 

B.16b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Substance Use Disorder, Gender, and Age Group: Percentages, 2002.................... 97 

B.17a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Substance Dependence or Abuse: Numbers in Thousands, 2002............................ 98 

B.17b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past 

Year Substance Dependence or Abuse: Percentages, 2002.............................................. 99 

B.18a Persons Aged 18 or Older with Serious Mental Illness, by Receipt of Mental 

Health Treatment/Counseling and Demographic or Geographic Characteristics: 

Numbers in Thousands, 2002 ......................................................................................... 100 

B.18b Persons Aged 18 or Older with Serious Mental Illness, by Receipt of Mental 

Health Treatment/Counseling and Demographic or Geographic Characteristics: 

Percentage Distributions, 2002 ....................................................................................... 101 

B.19a Received Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older, by Past Year Serious Mental Illness and Demographic 

Characteristics: Numbers in Thousands, 2002................................................................ 102 

B.19b Received Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older, by Past Year Serious Mental Illness and Demographic 

Characteristics: Percentages, 2002.................................................................................. 103 

B.20a Received Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older with Past Year Serious Mental Illness, by Age Group and by 

Socioeconomic and Health Characteristics: Numbers in Thousands, 2002 ................... 104
List of Tables (continued) 

Table Page 

 x

B.20b Received Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older with Past Year Serious Mental Illness, by Age Group and by 

Socioeconomic and Health Characteristics: Percentages, 2002 ..................................... 105 

B.21a Received Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older, by Past Year Serious Mental Illness and Geographic 

Characteristics: Numbers in Thousands, 2002................................................................ 106 

B.21b Received Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older, by Past Year Serious Mental Illness and Geographic 

Characteristics: Percentages, 2002.................................................................................. 107 

B.22a Received Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older with Past Year Serious Mental Illness, by Past Year Any Illicit 

Drug Use and Demographic Characteristics: Numbers in Thousands, 2002.................. 108 

B.22b Received Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older with Past Year Serious Mental Illness, by Past Year Any Illicit 

Drug Use and Demographic Characteristics: Percentages, 2002.................................... 109 

B.23a Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment 

at a Specialty Facility in the Past Year among Persons Aged 18 or Older with Past 

Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: 

Numbers in Thousands, 2002 ......................................................................................... 110 

B.23b Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment 

at a Specialty Facility in the Past Year among Persons Aged 18 or Older with Past 

Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: 

Percentages, 2002 ........................................................................................................... 111

B.24a Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment 

in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental 

Illness and/or a Substance Use Disorder in the Past Year: Numbers in Thousands, 

2002................................................................................................................................. 112 

B.24b Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment 

in the Past Year among Persons Aged 18 or Older with Past Year Serious Mental 

Illness and/or a Substance Use Disorder in the Past Year: Percentages, 2002 ............... 113 

B.25a Receipt of Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older with Past Year Serious Mental Illness, by Type of Past Year 

Substance Use Disorder: Numbers in Thousands, 2002................................................. 114 

B.25b Receipt of Mental Health Treatment/Counseling in the Past Year among Persons 

Aged 18 or Older with Past Year Serious Mental Illness, by Type of Past Year 

Substance Use Disorder: Percentages, 2002................................................................... 115 
List of Tables (continued) 

Table Page 

 xi

B.M1 Adjusted Odds Ratios from Logistic Regression Models for Past Year Serious 

Mental Illness among Adults Aged 18 or Older, by Sociodemographic and 

Substance Use Characteristics: 2002 .............................................................................. 116 

B.M2 Adjusted Odds Ratios from Logistic Regression Models for Receipt of Mental 

Health Treatment/Counseling in the Past Year among Adults Aged 18 or Older 

with Past Year Serious Mental Illness, by Sociodemographic and Substance Use 

Characteristics: 2002....................................................................................................... 118
xii
1 

Highlights 

This report presents information on the prevalence and treatment of serious mental illness 

(SMI) and their association with substance use and co-occurring substance use disorders based 

on the 2002 National Survey on Drug Use and Health (NSDUH). The survey, formerly known as 

the National Household Survey on Drug Abuse (NHSDA), is a project of the Substance Abuse 

and Mental Health Services Administration (SAMHSA). For this report, a substance use disorder 

is defined as dependence on or abuse of alcohol or illicit drugs. 

NSDUH is an annual survey of the civilian, noninstitutionalized population of the United 

States aged 12 years old or older. Conducted by the Federal Government since 1971, it is the 

primary source of statistical information on the use of illegal drugs by the U.S. population. 

Estimates in this report are based on data from the 2002 survey for adults aged 18 or older. 

Because of changes to the 2002 survey, this report's estimates should not be compared with 

estimates from previous survey years. 

National estimates for the prevalence and treatment of SMI are presented. The prevalence 

of treatment for substance use and mental health disorders among persons with SMI and cooccurring substance use disorders also is examined by demographic, socioeconomic, substance 

use, and substance dependence or abuse characteristics. 

Serious Mental Illness 

! In 2002, there were 17.5 million adults aged 18 or older with SMI during the 12 months 

prior to being interviewed. This represents 8.3 percent of all adults in the United States. 

On average, adults with SMI were younger, less educated, and more likely to be female 

than adults without SMI (Table B.1a). 

! Adults with SMI were more likely to be either unemployed or not in the labor force (36.4 

percent) than were persons without SMI (31.2 percent) (Table B.1b). 

! Of the three age groups considered in this report, adults aged 18 to 25 had the highest rate 

of SMI (13.2 percent), followed by adults aged 26 to 49 (9.5 percent) and adults aged 50 or 

older (4.9 percent) (Table B.3b). 

! Overall, the rate of SMI was almost twice as high among females (10.5 percent) as it was 

among males (6.0 percent) (Table B.3b). 

! The two racial/ethnic groups with the highest prevalence of SMI were those reporting more 

than one race (13.6 percent) and American Indians and Alaska Natives (12.5 percent) 

(Table B.3b). 

! In 2002, there were 5 million adults aged 18 or older who had SMI and used an illicit drug 

in the past year. This represented 28.9 percent of all persons with SMI (Table B.6a). 
2 

! The prevalence of SMI was more than twice as high among those who used an illicit drug 

during the past year than it was among those who did not (17.1 vs. 6.9 percent). This 

relationship was observed across most demographic and socioeconomic subgroups and 

across most types of illicit drugs used (Table B.9b). 

! Although the rate of SMI did not vary by past year alcohol use (8.5 percent for users vs. 8.0 

percent for nonusers), adults who were heavy alcohol users in the past month were more 

likely to have SMI than those without heavy alcohol use in the past month (11.1 vs. 8.1 

percent) (Table B.11b). 

Co-Occurrence of Serious Mental Illness and Substance Use Disorder 

! In 2002, there were 33.2 million adults aged 18 or older with SMI or a substance use 

disorder. Of these adults, 13.4 million (40.4 percent) had only SMI, 15.7 million (47.4 

percent) had only a substance use disorder, and 4.0 million (12.2 percent) had SMI and a 

substance use disorder (Table B.12b). 

! The 4.0 million adults with SMI and a substance use disorder represented 23.2 percent of 

all adults with SMI and 20.4 percent of all adults with a substance use disorder in 2002 

(Tables B.12a and B.16b). 

! Rates of SMI were relatively low among adults who did not have a substance use disorder. 

The rate of SMI was 7.0 percent among adults with no substance use disorder. The rate was 

much higher among those with alcohol dependence or abuse (19.0 percent) and was even 

higher among those with illicit drug dependence or abuse (29.1 percent). The rate of SMI 

was highest among adults who met the criteria for both drug and alcohol dependence or 

abuse (30.1 percent) (Table B.17b). 

! Adults with illicit drug dependence or abuse in the past year were more likely to have SMI 

in the past year than adults who used illicit drugs but did not have dependence or abuse 

(Table B.M1). 

! Adults with past year illicit drug use who were not dependent on or abusing illicit drugs 

were more likely to have SMI in the past year than adults with no illicit drug use (OR = 

1.4) (Table B.M1). 

! Adults with alcohol dependence or abuse were more likely to have SMI than adults who 

had used alcohol but did not have dependence or abuse (OR = 2.0) (Table B.M1). 

! Adults with nicotine (cigarette) dependence in the past year had higher odds of having SMI 

than those without nicotine (cigarette) dependence (OR = 1.5) (Table B.M1). 
3 

Treatment for Mental Health and Substance Use Problems 

! In 2002, an estimated 8.4 million, or 48 percent, of the 17.5 million adults with SMI 

received treatment in the 12 months prior to the interview. When compared with adults 

with SMI who did not receive treatment, these adults were more likely to belong to the 

following sociodemographic groups: aged 26 or older, female, non-Hispanic whites, or 

college graduates (Tables B.18a and B.18b). 

! Among adults with SMI but no substance use disorder, almost half (48.4 percent) received 

treatment for their mental health problem in the past year (Table B.25b). 

! There was very little difference in the prevalence of treatment for a mental health problem 

in the past 12 months among adults with SMI by whether they did or did not have a 

substance use disorder. However, the prevalence of past year specialty substance use 

treatment was higher among adults with SMI and a substance use disorder than among 

adults with only a substance use disorder (13.7 vs. 5.4 percent, respectively) (Table B.23b). 

! The rate of treatment for a mental health problem among adults with SMI but no substance 

use disorder was roughly 9 times higher than the rate of specialty substance use treatment 

among adults with a substance use disorder but no SMI (48.4 vs. 5.4 percent) (Figure 21). 

Although 48.0 percent of the adults with both a mental health and substance use disorder 

received some type of treatment, only 11.8 percent of these adults received both types of 

services (Tables B.23a and B.23b). 

! Among adults with SMI, adults aged 26 to 49 were more likely to receive treatment for 

their mental health problem than those aged 50 or older (OR = 1.7) (Table B.M2). 

! Females with SMI were more likely to receive treatment for their mental health problem 

than men with SMI, and non-Hispanic whites were more likely to receive treatment for 

their mental health problem than any other racial/ethnic group (Table B.M2). 

! The results of modeling showed that when controlling for confounding variables, illicit 

drug or alcohol dependence or abuse was not associated with receipt of treatment for a 

mental health problem among adults with SMI (Table B.M2). 
4 
5 

1. Introduction 

1.1. Purpose of This Report 

Estimates of the prevalence of serious mental illness (SMI) provide a measure of the 

population with the most severe mental health problems and indicate those persons who are most 

in need of treatment. SMI is defined in this report as having at some time in the past year a 

diagnosable mental, behavioral, or emotional disorder that met the criteria specified in the 

Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American 

Psychiatric Association [APA], 1994), that resulted in functional impairment that substantially 

interfered with or limited one or more major activities. Studies have shown that mental disorders 

co-occurring with substance use disorders are more chronic than mental disorders alone and that 

the co-occurrence between a mental disorder and a substance use disorder can create serious 

complications for treatment (Kranzler & Liebowitz, 1988). Adults with SMI and a co-occurring 

substance use disorder may have a greater need for treatment than adults with a less severe 

mental disorder co-occurring with a substance use disorder. 

This report presents national estimates from the 2002 National Survey on Drug Use and 

Health (NSDUH)1

 of the prevalence and treatment of SMI and of co-occurring SMI and 

substance use disorders (dependence on or abuse of illicit drugs or alcohol) among adults aged 

18 or older. The prevalence of treatment for substance use and mental health problems among 

persons with co-occurring SMI and substance use disorders also is examined by socioeconomic 

and demographic characteristics. The following is a list of the major research questions 

addressed by this report. 

! What are the characteristics of adults with SMI, and how do they differ from those without 

SMI? 

! What are the characteristics of adults with SMI who use illicit drugs, and how do they 

differ from those who do not use illicit drugs? 

! Does the prevalence of SMI vary by the use of specific substances, including the use of 

specific illicit drugs? 

! What are the characteristics of persons with SMI and a co-occurring substance use 

disorder, and how are they different from adults with SMI who do not have a substance use 

disorder? 

! What are the characteristics of adults with SMI who received mental health treatment in the 

past year, and how are they different from adults with SMI who did not receive treatment 

in the past year? 

! Are adults with SMI who also used illicit drugs more likely to receive mental health 

treatment than those with SMI who did not use illicit drugs? 

 1

 Prior to 2002, NSDUH was named the National Household Survey on Drug Abuse (NHSDA). 
6 

! Are adults with SMI and a co-occurring substance use disorder more likely to receive 

mental health treatment than adults with only SMI? 

! Are adults with SMI and a co-occurring substance use disorder more likely to receive 

specialty substance abuse treatment than those with only a substance use disorder? 

1.2. Background on the Definition of Serious Mental Illness 

Public Law (P.L.) 102-321, the Alcohol, Drug Abuse, and Mental Health Administration 

(ADAMHA) Reorganization Act, established a block grant for States to fund community mental 

health services for adults with SMI. The law required States to include incidence and prevalence 

estimates in their annual applications for block grant funds. The law also required SAMHSA to 

develop an operational definition of SMI and to establish an advisory group of technical experts 

to develop an estimation methodology based on this definition for use by the States. The 

definition of SMI stipulated in P.L. 102-321 requires the person to have at least one 12-month 

disorder, other than a substance use disorder, that met DSM-IV criteria (APA, 1994) and to have 

"serious impairment." A SAMHSA advisory group suggested that the term "serious impairment" 

be defined as impairment equivalent to a Global Assessment of Functioning (GAF) score of less 

than 60 (Endicott, Spitzer, Fleiss, & Cohen, 1976). 

1.3. Prior Estimates of Serious Mental Illness and Its Co-Occurrence with a 

Substance Use Disorder and Treatment 

Based on the definition presented in Section 1.2, a group of technical experts developed a 

methodology for estimating SMI (Kessler et al., 1996a) that used data from the National 

Comorbidity Survey (NCS) and the Baltimore Epidemiologic Catchment Area (ECA) survey. 

Using this methodology, they estimated that 10.0 million adults aged 18 or older had SMI in 

1990 (5.4 percent of adults). Furthermore, they estimated that 1.1 percent of adults had both SMI 

and a substance use disorder. This represents 14.7 percent of all adults with SMI and 17.2 

percent of all adults with a substance use disorder. They also estimated that 46.6 percent of the 

persons with SMI used professional services for a mental health problem in the 12 months prior 

to the interview. 

Questions to measure SMI were added by SAMHSA to the NSDUH for the first time in 

2001 (Office of Applied Studies [OAS], 2002). These questions, which asked respondents how 

frequently they experienced symptoms of psychological distress, were based on a 

methodological study designed to evaluate several screening scales for measuring SMI in the 

NSDUH. Based on this study, which included clinical assessments on survey respondents, these 

questions were shown to be a valid indicator of SMI (Kessler et al., 2003). Although estimates of 

SMI were produced for 2001, due to changes in the study, the 2001 estimates cannot be 

compared with estimates from 2002, which are presented in this report. (See Section 2.1 for 

further details on the reasons why they cannot be compared.) 

1.4. Prior Estimates of Co-Occurring Disorders 

Although this report focuses on the population with the most severe mental problems, 

there also is interest in the larger population with any mental disorder and the co-occurrence of 
7 

substance use disorders among its members. According to a U.S. Surgeon General's report, cooccurring disorders have been estimated to affect from 7 million to 10 million adult Americans 

in any year (U.S. Department of Health and Human Services [DHHS], 1999; see also SAMHSA 

National Advisory Council, 1998). An estimated 41 to 65 percent of persons with a lifetime 

substance use disorder have a lifetime history of at least one mental disorder, and about 51 

percent of those with one or more lifetime mental disorders also have a lifetime history of at least 

one substance use disorder (U.S. DHHS, 1999). Studies in both clinical samples (Ross, Glaser, & 

Germanson, 1988; Rounsaville et al., 1991; Wolf et al., 1988) and general population studies 

(Boyd et al., 1984; Helzer & Pryzbeck, 1988; Kessler et al., 1994; Regier et al., 1990) show that 

comorbidity is highly prevalent among individuals with mental disorders. 

Data on co-occurring disorders can be obtained from the NCS, the ECA, and the 

NHSDA. These surveys define mental disorders and substance use disorders based on meeting 

specific DSM-IV criteria (APA, 1994). The NCS, carried out between 1990 and 1992, surveyed 

a nationally representative sample of persons aged 15 to 54. It found that 42.7 percent of 

individuals with a 12-month addictive disorder had at least one mental disorder, and 14.7 percent 

of individuals with a mental disorder had at least one 12-month addictive disorder (Kessler et al., 

1996b). The ECA was carried out between 1980 and 1984 in five geographic areas and included 

adults aged 18 or older living in the community and various institutional settings. It reported that 

47 percent of persons with schizophrenia also had a substance use disorder in their lifetime and 

61 percent of individuals with a bipolar disorder also had a substance use disorder in their 

lifetime (Regier et al., 1990). The 1994 through 1997 NHSDAs included questions on four 

mental disorders in addition to questions to measure dependence on alcohol or illicit drugs. The 

1994 survey found that 19 million adults in the population had dependence on illicit drugs or 

alcohol, and among these individuals, 13 percent had a major depressive episode disorder, 5.9 

percent had a panic attack, 3.8 percent had a generalized anxiety disorder, and 3.7 percent had 

agoraphobia in the past year (OAS, 1996). 

1.5. Organization of This Report 

This report is divided into five chapters. NSDUH measures and statistical methods are 

described in Chapter 2. Chapter 3 presents findings on the prevalence and correlates of SMI 

among adults, including substance use and substance use disorders. Chapter 4 presents findings 

on the prevalence of mental health treatment and substance use treatment among adults with SMI 

and a substance use disorder. A summary and conclusions are presented in Chapter 5. 

Appendices provide technical details on the survey methodology and selected tables. 
8 
9 

2. Data and Methods 

2.1. Summary of National Survey on Drug Use and Health 

This report uses data on adults aged 18 or older from the 2002 National Survey on Drug 

Use and Health (NSDUH). NSDUH is an annual survey of the civilian, noninstitutionalized 

population of the United States aged 12 or older. Prior to 2002, the survey was called the 

National Household Survey on Drug Abuse (NHSDA). 

NSDUH is the primary source of statistical information on the use of illegal drugs by the 

U.S. population. Conducted by the Federal Government since 1971, the survey collects data by 

administering questionnaires to a representative sample of the population through face-to-face 

interviews at the respondents' places of residence. The survey is sponsored by the Substance 

Abuse and Mental Health Services Administration (SAMHSA) and is planned and managed by 

SAMHSA's Office of Applied Studies (OAS). The data collection is conducted by RTI 

International. This section briefly describes the survey methodology. A more complete 

description is provided in Appendix A. 

NSDUH collects information from residents of households, noninstitutional group 

quarters (e.g., shelters, rooming houses, dormitories), and civilians living on military bases. 

Persons excluded from the survey include homeless persons who do not use shelters, military 

personnel on active duty, and residents of institutional group quarters, such as jails and hospitals. 

Since 1999, the NSDUH interview has been carried out using computer-assisted 

interviewing (CAI). The survey uses a combination of computer-assisted personal interviewing 

(CAPI) conducted by an interviewer and audio computer-assisted self-interviewing (ACASI). 

Use of ACASI is designed to provide a respondent with a highly private and confidential means 

of responding to questions and to increase the level of honest reporting of illicit drug use and 

other sensitive behaviors. 

Consistent with the 1999 through 2001 surveys, the 2002 NSDUH employed a 50-State 

sample design with an independent, multistage area probability sample for each of the 50 States 

and the District of Columbia. The eight States with the largest population (which together 

account for 48 percent of the total U.S. population aged 12 or older) were designated as large 

sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and 

Texas). For these States, the design provided a sample sufficient to support direct State 

estimates. For the remaining 42 States and the District of Columbia, smaller, but adequate, 

samples were selected to support State estimates using small area estimation (SAE) techniques. 

The design also oversampled youths and young adults, so that each State's sample was 

approximately equally distributed among three major age groups: 12 to 17 years, 18 to 25 years, 

and 26 years or older. 

Nationally, 136,349 addresses were screened for the 2002 survey, and 68,126 completed 

interviews were obtained. Among adults aged 18 or older, 54,351 persons were selected, with 

44,467 interviews completed. The survey was conducted from January through December 2002. 

Weighted response rates for household screening and for interviewing were 90.7 and 78.9 
10 

percent, respectively; the weighted interview response rate for adults aged 18 or older was 77.2 

percent. 

Although the design of the 2002 NSDUH is similar to the design of the 1999 through 

2001 surveys, important methodological differences in the 2002 survey affect the 2002 estimates. 

Besides the name change, each NSDUH respondent was given an incentive payment of $30. 

These changes, both implemented in 2002, resulted in a substantial improvement in the survey 

response rate. The changes also affected respondents' reporting of many critical items that are the 

basis of prevalence measures reported by the survey each year. Further, the 2002 data could have 

been affected by improved data collection quality control procedures that were introduced in the 

survey beginning in 2001. In addition, new population data from the 2000 decennial census 

recently became available for use in NSDUH sample weighting procedures, resulting in another 

discontinuity between the 2001 and 2002 estimates. Analyses of the effects of each of these 

factors on NSDUH estimates have shown that 2002 data should not be compared with 2001 and 

earlier NHSDA data to assess changes over time. 

2.2. Limitations of the Data 

All data from NSDUH are based on retrospective reports by survey respondents and are 

subject to recall and reporting biases. First, some degree of underreporting on drug use, mental 

health problems, and mental health treatment measures might occur because of the social 

unacceptability of drug use and the stigma of mental health problems and treatment. Selfreported data also are influenced by memory and recall errors, including recall decay (tendency 

to forget events occurring long ago) and forward telescoping (tendency to report that an event 

occurred more recently than it actually did). 

Second, the NSDUH target population focuses on civilian, noninstitutionalized household 

residents. Although it includes almost 98 percent of the U.S. population aged 12 or older, some 

population subgroups that may have different drug-using patterns are excluded, such as active 

military personnel, people living in institutional group quarters, and homeless persons not living 

in identifiable shelters. Thus, generalization of the findings to the excluded subgroups is limited. 

Further, the estimates for drug use should be considered conservative. 

See Appendix A for additional discussion of data limitations, including the effect of 

nonresponse on analyses presented in this report. 

2.3. Measures and Statistical Methods 

2.3.1 Definition and Measurement of Serious Mental Illness 

Serious mental illness, or SMI, is defined in this report according to the definition 

stipulated in Public Law (P.L.) 102-321, that is, having at some time during the past year a 

diagnosable mental, behavioral, or emotional disorder that met the criteria in the Diagnostic and 

Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association 

[APA], 1994) and resulted in functional impairment that substantially interfered with or limited 

one or more major life activities. 
11 

SMI was assessed in the 2002 NSDUH using the six-item K6 scale (Kessler et al., 2003) 

that was used for the first time in 2001. These six questions ask respondents how frequently they 

experienced symptoms of psychological distress during the 1 month in the past year when they 

were at their worst emotionally. This scale has been shown to be a valid indicator of SMI, based 

on clinical assessments done on survey respondents (Kessler et al., 2003). The six questions and 

a discussion of the scale are given in Appendix A. 

2.3.2 Definition of Substance Use Disorder and Nicotine (Cigarette) Dependence 

In this study, an adult is defined as having a substance use disorder in the past year if he 

or she was dependent on or abused alcohol or an illicit drug in the past year. The 2002 NSDUH 

included a series of questions to assess dependence on or abuse of an illicit drug or alcohol based 

on DSM-IV criteria (APA, 1994). The seven substance dependence criteria are (1) tolerance; (2) 

withdrawal or avoidance of withdrawal; (3) persistent desire or unsuccessful attempts to cut 

down or stop substance use; (4) spending a lot of time using the substance, obtaining the 

substance, or recovering from its effects; (5) reducing or giving up occupational, social, or 

recreational activities in favor of substance use; (6) impaired control over substance use; and (7) 

continuing to use the substance despite physical or psychological problems. A respondent was 

considered to be dependent on a substance when he or she reported having at least three of the 

dependence criteria. 

The four substance abuse criteria are (1) having serious problems due to substance use at 

home, work, or school; (2) the use of that substance putting the respondent in physical danger; 

(3) substance use causing the respondent to be in trouble with the law; and (4) continuing to use 

the substance despite having substance use–related problems with family and friends. A 

respondent was classified with abuse when he or she reported having at least one of the four 

abuse criteria. 

The 2002 NSDUH included a series of questions to assess nicotine (cigarette) 

dependence based on the Nicotine Dependence Syndrome Scale (NDSS) (Shiffman, Hickcox, 

Gnys, Paty, & Kassel, 1995; Shiffman, Paty, Kassel, Gnys, & Zettler-Segal, 1994; Shiffman, 

Waters, & Hickcox, 2003) and the Fagerstrom Test of Nicotine Dependence (FTND) 

(Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991). A respondent was classified with 

nicotine (cigarette) dependence based on criteria derived from the NDSS and the FTND. 

2.3.3 Definitions of Mental Health Treatment and Substance Use Treatment 

Mental health treatment is defined as treatment or counseling for problems with 

emotions, nerves, or mental health in any inpatient or outpatient setting or use of prescription 

medication to treat a mental or emotional condition in the 12 months prior to the interview. 

Specialty substance use treatment (for alcohol or illicit drug use) is treatment received at 

a specialty substance abuse facility to reduce or stop drug or alcohol use, or for medical 

problems associated with the use of drugs or alcohol in the past 12 months. "Specialty" substance 

abuse facilities include rehabilitation facilities (inpatient or outpatient), hospitals (inpatient 

services only), or mental health centers. "Any treatment" refers to treatment received to reduce or 

stop drug or alcohol use, or for medical problems associated with the use of drugs or alcohol in 
12 

the past 12 months at any location, including specialty facilities and emergency rooms, private 

doctor's offices, self-help groups, or prison/jails. 

2.3.4 Social and Demographic Variables 

The following set of social and demographic variables were included in both the 

descriptive analyses and the logistic regression models. The categories of the variable are in 

italics: 

! age of the respondent (at the time of the interview); 

! gender: male and female; 

! Hispanic origin and race: non-Hispanic whites, non-Hispanic blacks, Hispanics, and 

"other" ("other" race/ethnicity includes American Indian, Alaska Native, Native Hawaiian 

or Other Pacific Islander, Asian, and two or more races); 

! education (last grade completed): less than high school, high school graduate, some 

college, or college graduate; 

! family income (reported total family income for the previous calendar year): less than 

$20,000, $20,000 to $49,999, $50,000 to $74,999, or $75,000 or more;

! health insurance (currently): private, Medicaid/Children's Health Insurance Plan (CHIP),1

"other," no coverage ("other" includes Medicare, CHAMPUS, TRICARE, CHAMPVA, 

the VA, military health care, or any other type of health insurance); 

! marital status: widowed, divorced or separated, never married, and married; 

! employment (currently): unemployed, currently employed, or "other" ("other" includes 

persons who are not in the labor force, defined as not having a job or business and making 

no specific effort to find work in the past 30 days, such as those who are retired, 

homemakers, students, and others not looking for work); 

! geographic region: Northeast, Midwest, South, and West; 

! overall health (perceived health): fair/poor, good, very good, and excellent; 

! county type: large metropolitan statistical areas (MSAs) with a population of 1 million or 

more, small MSAs with a population of less than 1 million, and nonmetropolitan areas 

outside of MSAs; and 

 1

 CHIP is only available for persons aged 19 or younger; therefore, the term "Medicaid" is used in this 

report to refer to health insurance for those aged 20 or older, but "Medicaid/CHIP" is used for those aged 19 or 

younger. 
13 

! social support, which was based on three questions inquiring how many friends, not 

including family members, a person had for three different categories of friends (a person 

was defined as having social support if he or she reported having two or more friends for at 

least one of the following three categories: friends with whom they shared personal issues 

and concerns, friends they spent time with on shared interests and activities, and friends 

they really liked and cared about). 

2.3.5 Use of Alcohol, Cigarettes, Tobacco, and Illicit Drugs 

Use of alcohol refers to any use of alcohol in the past 12 months. Binge alcohol use is 

defined as drinking five or more drinks on the same occasion on at least 1 day in the past 30 

days. Heavy alcohol use is defined as drinking five or more drinks on the same occasion on at 

least 5 days in the past 30 days. 

Cigarette use refers to the use of cigarettes on at least 1 day in the 12 months preceding 

the interview date. 

Illicit drug use is defined as any use in the past year of the following drugs: 

marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any 

nonmedical use of a prescription-type psychotherapeutic. Psychotherapeutics includes pain 

relievers, tranquilizers, stimulants, or sedatives and does not include any over-the-counter drugs. 

2.4. Statistical Methods 

The statistical analysis used descriptive statistics to characterize the prevalence and 

distribution of SMI and of treatment for SMI, and logistic regression models were used to predict 

SMI and treatment for SMI. The descriptive analysis produced prevalence rates and percent 

distributions by various explanatory variables, while the logistic regression modeling produced 

odds ratios (ORs) in the prevalence rates for each of the explanatory variables. All estimates 

were weighted, and all standard errors (SEs) were calculated using Taylor series linearization for 

nonlinear statistics and an approach that recognized the sample structure. The software package 

used was SUDAAN® (RTI, 2001). In the modeling, an explanatory variable was identified as a 

statistically significant predictor of SMI if the associated Chi-square test was significant at the 

0.05 level. In the descriptive analyses, log-linear Chi-square tests of independence of the 

explanatory variables and SMI were conducted first to control the error level for multiple 

comparisons. If the Chi-square test indicated overall significant differences, comparisons 

between specific levels of the classification variables then were made using t tests. 

2.4.1 Descriptive Analysis 

Demographic and socioeconomic characteristics were compared for the following groups 

of adults: (1) those with and without SMI in the past year; (2) those who did and did not use 

illicit drugs among adults with SMI; (3) those with and without a substance use disorder among 

adults with SMI; and (4) those who received and did not receive mental health treatment in the 

past year among adults with SMI. 
14 

To examine how the prevalence of SMI in the past year varied among subgroups of 

adults, prevalence rates of SMI by demographic and socioeconomic characteristics are presented. 

To examine how the prevalence of SMI in the past year varied by use of substances, as well as 

by substance use disorders, prevalence rates of SMI are compared for use of alcohol, tobacco, 

any illicit drugs, and specific illicit drugs; dependence on or abuse of alcohol and/or illicit drugs; 

and cigarette dependence. Significant differences in rates among subgroups of persons also were 

identified with Chi-square tests and t tests. 

To examine how the prevalence of mental health treatment in the past year varied among 

subgroups of adults with SMI, prevalence rates of mental health treatment in the past year among 

adults with SMI by demographic and socioeconomic characteristics are presented. To examine 

how the prevalence of mental health treatment varied by illicit drug use and by a substance use 

disorder among adults with SMI, rates of mental health treatment among adults with past year 

SMI were compared for those using and not using illicit drugs and for those with and without a 

substance use disorder. Rates of specialty substance use treatment among adults with a substance 

use disorder were compared for those with and without SMI to examine how the prevalence of 

substance use treatment among adults with a substance use disorder varied by SMI. 

2.4.2 Model-Based Analysis 

Two logistic regression models were run using the SUDAAN LOGISTIC procedure. The 

first model was developed for all adults aged 18 or older to examine the ORs for each of the 

characteristics believed to be associated with SMI after controlling for confounding variables. 

For the first model, past year SMI was the dependent variable, and the independent variables 

included each of the characteristics believed to be associated with SMI. The second model was 

developed for all adults with past year SMI to determine the odds of receiving mental health 

treatment for characteristics believed to be associated with the receipt of treatment and 

controlling for potential confounding variables. For this model, receipt of mental health 

treatment was the dependent variable. 
15 

3. Serious Mental Illness 

This chapter presents national estimates from the 2002 National Survey on Drug Use and 

Health (NSDUH) of the prevalence of past year serious mental illness (SMI) by demographic 

and socioeconomic characteristics among adults aged 18 or older in 2002, and it examines the 

relationship of SMI to substance use and substance use disorders. Characteristics of adults with 

and without SMI in the past year are compared. Estimates of the past year prevalence of SMI are 

presented among demographic and socioeconomic subgroups, as well as by the type of substance 

used in the past year. Among adults with SMI, the characteristics of those using and not using 

illicit drugs are compared, and the characteristics of those with and without a substance use 

disorder are compared. 

3.1. Characteristics of Adults With and Without Serious Mental Illness 

In 2002, there were 17.5 million adults aged 18 or older with SMI during the 12 months 

prior to being interviewed. This represents 8.3 percent of all adults in the United States. On 

average, adults with SMI were younger, less educated, and more likely to be female than adults 

without SMI. The percentage of young adults aged 18 to 25 was higher among persons with SMI 

(23.4 percent) than among those without SMI (14.0 percent). In contrast, the percentage of older 

adults (aged 50 or older) was lower among those with SMI (22.1 percent) than among those 

without SMI (39.0 percent) (Table B.1b). 

Among those with SMI, 65.4 percent were female, which was higher than the percentage 

of females among those without SMI (50.8 percent). Adults with SMI were more likely to have 

not completed high school (20.5 percent) than those without SMI (17.4 percent) and less likely to 

have graduated from college (17.5 percent) than those without SMI (25.7 percent). Although a 

similar proportion of adults with and without SMI were employed full or part time, persons with 

SMI were more likely to be unemployed or not in the labor force (36.4 percent) than were 

persons without SMI (31.2 percent). 

Adults with SMI were less likely to be from large metropolitan areas (45.7 percent) than 

adults who did not have SMI (50.2 percent) (Table B.2b). There were no differences observed by 

geographic region. 

3.2. Prevalence of Serious Mental Illness among Demographic and 

Socioeconomic Subgroups 

Rates of SMI in the adult U.S. population varied by age and gender. Of the three age 

groups considered here, adults aged 18 to 25 had the highest rate of SMI (13.2 percent), followed 

by adults aged 26 to 49 (9.5 percent) and adults aged 50 or older (4.9 percent) (Table B.3b). 

Overall, the rate of SMI was almost twice as high among females (10.5 percent) as it was among 

males (6.0 percent). The rate of SMI by age and gender was highest for females aged 18 to 25 

(16.3 percent) (Figure 1). 
16 

Figure 1. Serious Mental Illness among Adults Aged 18 or Older, by Age and Gender: 

2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

Among racial and ethnic groups, adults reporting more than one race and American 

Indians and Alaska Natives had the highest prevalence of SMI (13.6 and 12.5 percent, 

respectively) (Table B.3b). 

Prevalence rates of SMI did not vary significantly by geographic region. The rate was 8.5 

percent in the Northeast and Midwest, 8.4 percent in the South, and 7.8 percent in the West 

(Table B.4b). 

The prevalence of SMI varied by perceived health status and social support (Table B.5b). 

Adults who perceived their overall health as fair or poor were more than 3 times as likely to have 

SMI (16.9 percent) than those who perceived their health to be excellent (5.1 percent) (Figure 2). 

Likewise, those who reported no social support were about twice as likely to have SMI as those 

who reported social support (15.2 vs. 7.6 percent, respectively) (Figure 3). 

Estimates of SMI by health insurance, marital status, and family income are only 

presented for persons aged 26 to 49. Among adults aged 26 to 49, divorced or separated adults 

were more than twice as likely to have SMI in the past year (16.0 percent) as married adults (7.1 

percent) (Table B.5b, Figure 4). 

10.0

6.7

3.2

16.3

12.2

6.3

0

2

4

6

8

10

12

14

16

18

18-25 26-49 50 or Older

Age

Percent with Serious Mental Illness

Male

Female
17 

Figure 2. Serious Mental Illness among Adults Aged 18 or Older, by Perceived Health 

Status: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

Figure 3. Serious Mental Illness among Adults Aged 18 or Older, by Social Support: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

16.9

9.6

6.7

5.1

0

2

4

6

8

10

12

14

16

18

Fair/Poor Good Very Good Excellent

Perceived Health Status

Percent with Serious Mental Illness

7.6

15.2

0

2

4

6

8

10

12

14

16

Received Did Not Receive 

Social Support

Percent with Serious Mental Illness
18 

Figure 4. Serious Mental Illness among Adults Aged 26 to 49, by Marital Status: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

SMI also varied with socioeconomic status (SES) among adults aged 26 to 49. In this age 

group, adults with lower SES were more likely to have SMI than those with higher SES (Table 

B.5b). The prevalence of SMI was highest among those with the lowest family income level (less 

than $20,000) at 16.3 percent and lowest among those with the highest income level ($75,000 or 

more) at 6.4 percent (Figure 5). Also, among adults aged 26 to 49, the prevalence of SMI was 

higher among persons with Medicaid coverage (20.7 percent) and lower among persons with 

private health insurance (8.1 percent) (Figure 6). Similarly, the SMI rate was higher among 

persons who were unemployed or had "other" employment status (i.e., not in the labor force)1

(14.2 and 15.5 percent, respectively) than among persons who worked full time (7.9 percent) 

(Table B.3b, Figure 7). 

3.3. Serious Mental Illness and Substance Use 

In this section, the characteristics of persons with SMI who used and did not use illicit 

drugs are compared. In addition, the prevalence rates of SMI are presented for persons using 

specific types of illicit drugs, heavy alcohol users, and cigarette users. 

 1

 "Other" includes retired persons, disabled persons, homemakers, students, or other persons not in the 

labor force. 

7.1

9.8

16.0

11.9

0

2

4

6

8

10

12

14

16

18

Married Widowed Divorced or

Separated

Never Married

Marital Status

Percent with Serious Mental Illness
19 

Figure 5. Serious Mental Illness among Adults Aged 26 to 49, by Family Income: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

Figure 6. Serious Mental Illness among Adults Aged 26 to 49, by Health Insurance Status: 

2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

16.3

9.9

8.1

6.4

0

2

4

6

8

10

12

14

16

18

Less Than

$20,000

$20,000 to

$49,999

$50,000 to

$74,999

$75,000 or

More

Family Income

Percent with Serious Mental Illness

8.1

20.7

11.2 11.7

0

5

10

15

20

25

Private Medicaid Other No Coverage

Health Insurance

Percent with Serious Mental Illness
20 

Figure 7. Serious Mental Illness among Adults Aged 26 to 49, by Current Employment 

Status: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

3.3.1 Serious Mental Illness and Illicit Drug Use 

3.3.1.1 Characteristics of Adults with Serious Mental Illness and Illicit Drug Use 

In 2002, there were 5 million adults aged 18 or older who had SMI and used an illicit 

drug in the past year (Table B.6a, Figure 8). This represented 28.9 percent of all persons with 

SMI. Adults with SMI who used illicit drugs were younger than those with SMI who did not use 

illicit drugs. Among adults with SMI and illicit drug use, 38.8 percent were 18 to 25 years old 

compared with 17.1 percent of persons with SMI but no illicit drug use; also, 7.2 percent of 

adults with SMI and illicit drug use were aged 50 or older compared with 28.2 percent with SMI 

but no illicit drug use (Table B.6b). 

Adults with SMI who used illicit drugs in the past year were more likely to be male than 

those with SMI who did not use illicit drugs (45.1 vs. 30.3 percent). They also were more likely 

to be in the labor force than those with SMI but no illicit drug use: 67.0 percent of adults with 

SMI and past year illicit drug use were employed full or part time compared with 62.2 percent of 

those with SMI only, and 10.8 percent were unemployed compared with 4.3 percent of adults 

with SMI only. Consequently, adults with SMI only were more likely to be out of the labor force 

(33.5 percent) than those who had SMI and used an illicit drug in the past year (22.2 percent). 

7.9

11.4

14.2

15.5

0

2

4

6

8

10

12

14

16

18

Full-Time Part-Time Unemployed Other

Current Employment Status

Percent with Serious Mental Illness

7.9

11.4

14.2

15.5

0

2

4

6

8

10

12

14

16

18

Full-Time Part-Time Unemployed Other

Current Employment Status

Percent with Serious Mental Illness
21 

Figure 8. Serious Mental Illness and Past Year Illicit Drug Use among Adults Aged 18 or 

Older: 2002 

Note: Circles are not drawn to scale. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

3.3.1.2 Prevalence of Serious Mental Illness among Illicit Drug Users 

SMI is correlated with illicit drug use. The prevalence of SMI was more than twice as 

high among those who used an illicit drug during the past year than it was among those who did 

not (17.1 vs. 6.9 percent). This relationship was observed across most demographic and 

socioeconomic subgroups (Tables B.8b and B.9b). 

The prevalence of SMI varied by the type of substance used. The rate of SMI was 16.7 

percent among those who used marijuana, 20.5 percent among those who used any illicit drug 

other than marijuana, 22.0 percent among those who used cocaine, and 29.9 percent among those 

who used crack cocaine (Table B.10b, Figure 9). For those who used hallucinogens, the SMI rate 

was 19.7 percent, and for inhalants, it was 20.6 percent. For all nonmedical use of 

psychotherapeutics, the rate of SMI was 21.8 percent; the rate of SMI was 33.6 percent for those 

who used sedatives, 28.8 percent for those who used stimulants, 26.5 percent for those who used 

tranquilizers, and 22.4 for those who used pain relievers. The rate for those who used 

methamphetamine was 31.8 percent. 

3.3.2 Serious Mental Illness among Cigarette and Alcohol Users 

The prevalence of SMI varied between past year cigarette smokers and nonsmokers, but 

no differences were observed between past year alcohol users and nonusers. The rate of SMI was 

13.0 percent among adults who smoked cigarettes in the past year and 6.1 percent among those 

who did not smoke (Table B.11b, Figure 9). Although the rate of SMI did not vary by past year 

alcohol use (8.5 percent for users vs. 8.0 percent for nonusers), adults who were heavy alcohol 

Serious Mental 

Illness Only

12.4 Million

Illicit Drug 

Use Only

24.6 Million

Serious 

Mental 

Illness and 

Illicit Drug 

Use

5.0 Million

Serious Mental 

Illness Only

12.4 Million

Illicit Drug 

Use Only

24.6 Million

Serious 

Mental 

Illness and 

Illicit Drug 

Use

5.0 Million
22 

Figure 9. Serious Mental Illness, by Type of Substance Used among Adults Aged 18 or 

Older: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

users in the past month were more likely to have SMI than those who were not heavy alcohol 

users in the past month (11.1 vs. 8.1 percent). 

3.4. Serious Mental Illness and a Co-Occurring Substance Use Disorder 

In this section, adults with SMI are classified by whether or not they had a substance use 

disorder, that is, whether they were dependent on or abused alcohol or illicit drugs. Those with 

SMI and a substance use disorder are further classified by whether they were dependent on or 

abused alcohol only, illicit drugs only, or both illicit drugs and alcohol. 

In 2002, there were 33.2 million adults aged 18 or older with SMI or a substance use 

disorder (Table B.12a). Of these adults, 13.4 million (40.4 percent) had SMI but no substance 

use disorder (SMI only), 15.7 million (47.4 percent) had a substance use disorder but no SMI 

(substance use disorder only), and 4.0 million (12.2 percent) had both SMI and a substance use 

disorder (i.e., co-occurring disorders) (Table B.12b, Figure 10). 

6.9

11.1

13.0

16.7

17.1

19.7

20.5

20.6

21.8

22.0

29.9

31.8

0 5 10 15 20 25 30 35

No Illicit Drug Use

Past Month Heavy Alcohol Use

Cigarettes

Marijuana

Any Illicit Drug Use

Hallucinogens

Any Illicit Drug Other Than Marijuana

Inhalants

Psychotherapeutics

Cocaine

Crack

Methamphetamine

Percent with Serious Mental Illness
23 

Figure 10. Co-Occurrence of Serious Mental Illness and Substance Use Disorders among 

Adults Aged 18 or Older: 2002 

Note: Circles are not drawn to scale. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

The 4.0 million adults with SMI and a co-occurring substance use disorder represented 

23.2 percent of all adults with SMI (Table B.13b) and 20.4 percent of all adults with a substance 

use disorder in 2002 (Table B.16b). Among these adults with SMI and a substance use disorder, 

0.9 million were dependent on or abused illicit drugs only, 2.4 million were dependent on or 

abused alcohol only, and 0.8 million were dependent on or abused alcohol and illicit drugs 

(Table B.13a, B.13b, and B.16b, Figure 11). 

The 17.5 million adults with SMI in 2002 can be examined as to whether they had a 

substance use disorder in the past year and by whether they used illicit drugs. As previously 

mentioned, there were 4.0 million adults with SMI who had a substance use disorder. Thus, 13.4 

million adults with SMI (76.8 percent) did not have a substance use disorder. Among these 

adults with SMI but without a substance use disorder, 2.3 million used an illicit drug in the past 

12 months and 11.1 million did not (Figure 12). 

3.4.1 Characteristics of Adults with Co-Occurring Serious Mental Illness and a Substance 

Use Disorder 

In 2002, adults with SMI and a substance use disorder were more likely to be younger 

and more likely to be male than adults with SMI but no substance use disorder. Among adults 

with SMI and a substance use disorder, 36.3 percent were aged 18 to 25 compared with 19.5 

percent among adults with SMI but no substance use disorder. The percentage of males among 

Co-Occurring

Disorders

4.0 Million

Serious Mental 

Illness Only

13.4 Million

Substance Use 

Disorder Only

15.7 Million

Co-Occurring

Disorders

4.0 Million

Serious Mental 

Illness Only

13.4 Million

Substance Use 

Disorder Only

15.7 Million
24 

Figure 11. Type of Substance Use Disorder among Adults Aged 18 or Older with Both 

Serious Mental Illness and a Co-Occurring Substance Use Disorder: Numbers 

in Thousands, 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

adults with SMI and a substance use disorder was higher than the corresponding percentage 

among adults with SMI but no substance use disorder (52.1 vs. 29.3 percent) (Table B.14b). 

Adults with SMI and a substance use disorder were more likely to be in the labor force 

than those with SMI only: 69.0 percent of adults with SMI and a substance use disorder were 

employed full or part time compared with 62.0 percent of those with SMI but no substance use 

disorder, and 10.1 percent were unemployed compared with 5.0 percent of adults with SMI but 

no substance disorder. Thus, adults with SMI but no substance disorder were more likely to be 

out of the labor force (33.1 percent) than adults with SMI and a substance use disorder (20.9 

percent) (Table B.14b). 

Among adults with SMI, the comparison of the socioeconomic and demographic 

characteristics between those with and without a substance use disorder is strikingly similar to 

the comparison in Section 3.3.1.1 between those who used and did not use illicit drugs (Table 

B.6b). 

Both Alcohol and 

Illicit Drug 

779

Illicit Drug 

Only 

893

Alcohol 

Only

2,377

4.0 Million Adults with Co-Occurring Serious 

Mental Illness and Substance Use Disorder

Substance Dependence or Abuse 

Both Alcohol and 

Illicit Drug 

779

Illicit Drug 

Only 

893

Alcohol 

Only

2,377

4.0 Million Adults with Co-Occurring Serious 

Mental Illness and Substance Use Disorder

Substance Dependence or Abuse 
25 

Figure 12. Substance Use Disorders and Illicit Drug Use among Adults Aged 18 or Older 

with Serious Mental Illness: Numbers in Thousands, 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

3.4.2 Prevalence of Serious Mental Illness among Adults with a Substance Use Disorder 

The prevalence of SMI among adults with a substance use disorder varied by age and 

gender. Among persons with any illicit drug or alcohol dependence or abuse, women had a 

higher prevalence of SMI than men (30.3 vs. 15.7 percent), and women aged 26 to 49 had the 

highest rate of SMI (32.2 percent) (Table B.16b). 

Rates of SMI were relatively low (7.0 percent) among adults who did not have a 

substance use disorder (Table B.17b, Figure 13). The rate was much higher among those with 

alcohol dependence or abuse (19.0 percent) and was even higher among those with illicit drug 

dependence or abuse (29.1 percent). The rate of SMI was highest among adults who met the 

criteria for both drug and alcohol dependence or abuse (30.1 percent). 

The rate of SMI among adults with dependence on or abuse of an illicit drug other than 

marijuana (33.4 percent) was higher than the rate for those with illicit drug dependence or abuse 

(29.1 percent) and the rate for those with marijuana dependence or abuse (27.3 percent) (Table 

B.17b). 

No Substance 

Use Disorder and 

No Illicit Drug Use

11,141

No Substance Use 

Disorder, but Past 

Year Illicit Drug Use

2,294

Illicit Drug 

Disorder Only

893

Both Illicit Drug and 

Alcohol Disorder

779

Alcohol 

Disorder Only

2,377

Substance Use Disorder and Illicit Drug Use 

17.5 Million Adults with Serious Mental Illness

No Substance 

Use Disorder and 

No Illicit Drug Use

11,141

No Substance Use 

Disorder, but Past 

Year Illicit Drug Use

2,294

Illicit Drug 

Disorder Only

893

Both Illicit Drug and 

Alcohol Disorder

779

Alcohol 

Disorder Only

2,377

Substance Use Disorder and Illicit Drug Use 

17.5 Million Adults with Serious Mental Illness
26 

Figure 13. Serious Mental Illness among Adults Aged 18 or Older, by Substance 

Dependence or Abuse: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

3.5. Multiple Logistic Regression Models for Serious Mental Illness 

The estimated strength of the associations between past year SMI with past year use of 

illicit drugs, illicit drug dependence or abuse, alcohol dependence or abuse, and socioeconomic 

and demographic characteristics was determined via a multiple logistic regression model. SMI 

was the dependent variable, and the other characteristics were the independent variables. 

Possible confounding variables are variables in the model other than the independent 

variable of interest that are believed to be associated with both the dependent variable and the 

independent variables of interest. Adjusted odds ratios (ORs) denote the estimated association 

between SMI and a particular category of a variable while controlling for possible confounding 

variables. This section discusses the associations between SMI and characteristics believed to be 

associated with SMI in terms of their ORs. (See Appendix A, Section A.5.4, for a discussion of 

logistic modeling and the interpretation of adjusted ORs.) 

Several sociodemographic variables were associated with SMI according to the 

descriptive analyses that also were associated with SMI based on their adjusted ORs. These 

variables included age, gender, race/ethnicity, marital status, perceived overall health, and social 

support. The ORs indicated that compared with adults aged 50 or older, adults aged 18 to 25 and 

adults aged 26 to 49 were more likely to have SMI in the past year (OR = 2.5 and 2.3, 

respectively) (Table B.M1). Females were more than twice as likely as males to have SMI. 

7.0

19.0

29.1 30.1

0

5

10

15

20

25

30

35

No Illicit Drug or

Alcohol

Dependence or

Abuse

Alcohol

Dependence or

Abuse

Any Illicit Drug

Dependence or

Abuse

Any Illicit Drug

and Alcohol

Dependence or

Abuse

Substance Dependence or Abuse

Percent with Serious Mental Illness
27 

Compared with non-Hispanic whites, non-Hispanic blacks (OR = 0.7) and Hispanics (OR = 0.6) 

were less likely to have had SMI (Table B.M1). 

The ORs for the levels of perceived health demonstrate that the more poorly persons 

perceived their health to be, the more likely they were to have had SMI. Compared with adults 

who perceived their health as excellent, adults who perceived their health as fair or poor (OR = 

4.1), those who perceived their health as good (OR = 1.9), and those who perceived their health 

as very good (OR = 1.3) were more likely to have had SMI (Table B.M1). 

SMI was highly correlated with illicit drug dependence or abuse and with alcohol 

dependence or abuse. It also was significantly associated with nicotine (cigarette) dependence. 

The ORs for use and for dependence on or abuse of illicit drugs show that adults with any illicit 

drug dependence or abuse in the past year were more likely to have SMI than adults with no 

illicit drug use in the past year (OR = 2.8) and than adults with illicit drug use but no dependence 

or abuse (OR = 1.9 calculated by dividing 2.75 by 1.43) (Table B.M1). Adults with past year 

illicit drug use who were not dependent on or abusing illicit drugs were more likely to have SMI 

in the past year than adults with no illicit drug use (OR = 1.4). The ORs for alcohol use and for 

dependence on or abuse of alcohol show that adults with alcohol dependence or abuse were more 

likely to have SMI than adults with no alcohol use (OR = 1.8) and more likely to have SMI than 

adults who used alcohol but who had no dependence or abuse (OR = 2.0 calculated by dividing 

1.77 by 0.89). Adults with nicotine (cigarette) dependence in the past year had higher odds of 

having SMI than those without nicotine (cigarette) dependence (OR = 1.5). 
28 
29 

4. Mental Health Treatment and Substance 

Use Treatment 

This chapter presents national estimates from the 2002 National Survey on Drug Use and 

Health (NSDUH) of the past year prevalence of mental health treatment and substance use 

treatment among adults with serious mental illness (SMI) and a substance use disorder. The 

social and demographic characteristics of adults with SMI who received mental health treatment 

are compared with those who did not receive mental health treatment. Prevalence rates of mental 

health treatment among adults with SMI by social and demographic characteristics also are 

presented. Estimates of mental health treatment are given for adults with SMI according to 

whether they used illicit drugs. Estimates of the prevalence of mental health treatment and/or 

specialty substance use treatment in 2002 also are presented for adults aged 18 or older with SMI 

and a substance use disorder, with SMI but no substance use disorder, and with a substance use 

disorder but no SMI. The prevalence of mental health treatment for those with SMI co-occurring 

with a substance use disorder is compared with the prevalence among those with SMI but no 

substance use disorder. Similarly, the prevalence of specialty substance use treatment for those 

with SMI co-occurring with a substance use disorder is compared with those having a substance 

use disorder but no SMI. 

4.1. Mental Health Treatment among Adults with Serious Mental Illness 

4.1.1 Characteristics of Adults with Serious Mental Illness, by Receipt of Mental Health 

Treatment in the Past Year 

In 2002, an estimated 8.4 million of the 17.5 million adults with SMI received mental 

health treatment in the 12 months prior to their interview (Table B.18a). When compared with 

adults with SMI who did not receive treatment, those who did receive treatment were more likely 

to belong to the following sociodemographic groups: aged 26 or older, female, non-Hispanic 

whites, and college graduates. About 62 percent of adults with SMI who received treatment were 

26 to 49 years of age compared with about 48 percent of those who did not receive treatment. 

Females accounted for 71.6 percent of those who received treatment and 59.9 percent of those 

who did not receive treatment. Non-Hispanic whites made up 78.4 percent of those who received 

treatment and 66.6 percent of those who did not (Table B.18b). An estimated 21 percent of adults 

with SMI who received treatment were college graduates compared with 14 percent of those who 

had not received treatment. Adults with SMI who received treatment were more likely than those 

who did not to be from small metropolitan counties (34.5 vs. 29.3 percent, respectively), but 

there were no significant differences by geographic region. 

4.1.2 Rates of Mental Health Treatment among Adults with Serious Mental Illness, by 

Sociodemographic Characteristics 

In 2002, an estimated 47.9 percent of adults with SMI received mental health treatment in 

the 12 months prior to their interview (Table B.19b). The prevalence of mental health treatment 

among adults with SMI varied by demographic, social, and health characteristics. Among adults 

with SMI, those aged 26 to 49 had the highest rate of mental health treatment of any age group 
30 

(54.4 percent) (Figure 14). The rates of mental health treatment among adults with SMI were 

46.4 percent for adults aged 50 or older and 34.2 percent for those aged 18 to 25. Females with 

SMI were more likely than males with SMI to receive mental health treatment (52.3 vs. 39.5 

percent, respectively) (Figure 15). More than half of white non-Hispanics with SMI received 

mental health treatment (51.9 percent) (Figure 16). In comparison, fewer than 40 percent of 

black non-Hispanics and Hispanics with SMI received mental health treatment (36.9 and 37.8 

percent, respectively). 

Figure 14. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by Age: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

In 2002, the prevalence of mental health treatment was 48.7 percent for adults with SMI 

who received social support and 44.0 percent for adults with SMI who did not receive social 

support (Table B.20b). Adults with SMI who perceived their health as poorer had higher rates of 

mental health treatment than those who perceived their health to be better. The rate of mental 

health treatment was highest at 56.0 percent for those with SMI who perceived their health as 

fair/poor and lowest at 38.7 percent for those who perceived their health as excellent (Figure 17). 

Estimates of treatment by health insurance and marital status are presented for persons 

aged 26 to 49. Among adults aged 26 to 49 years of age with SMI in the past 12 months, rates of 

mental health treatment varied by health insurance and by marital status (Table B.20b). Those 

who received Medicaid were more likely to have received mental health treatment in the past 12 

months (65.1 percent) than those who had no insurance coverage (37.1 percent) (Figure 18). 

34.2

54.4

46.4 47.9

0

10

20

30

40

50

60

18 or Older 18 to 25 26 to 49 50 or Older

Age in Years

Percent Receiving Mental Health Treatment 

34.2

54.4

46.4 47.9

0

10

20

30

40

50

60

18 or Older 18 to 25 26 to 49 50 or Older

Age in Years

Percent Receiving Mental Health Treatment 
31 

Figure 15. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by Gender: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

Figure 16. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by Race/Ethnicity: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

52.3

39.5

0

10

20

30

40

50

60

Male Female

Percent Receiving Mental Health Treatment 

Gender

52.3

39.5

0

10

20

30

40

50

60

Male Female

Percent Receiving Mental Health Treatment 

Gender

51.9

36.9 37.8

0

10

20

30

40

50

60

White (Non-Hispanic) Black (Non-Hispanic) Hispanic

Percent Receiving Mental Health Treatment

Race/Ethnicity

51.9

36.9 37.8

0

10

20

30

40

50

60

White (Non-Hispanic) Black (Non-Hispanic) Hispanic

Percent Receiving Mental Health Treatment

Race/Ethnicity
32 

Figure 17. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by Perceived Health Status: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

The rate of mental health treatment among persons aged 26 to 49 who were divorced or 

separated (61.9 percent) was higher than the rate among those who were never married (42.9 

percent) (Figure 19). 

There was very little regional variation in the prevalence of mental health treatment 

among adults aged 18 or older with SMI. Rates by geographic region were 50.7 percent in the 

Northeast, 47.5 percent in the Midwest and South, and 46.3 percent in the West (Table B.21b). 

By county type, rates of treatment were highest among persons from small metropolitan areas 

(52.0 percent); rates were similar for large metropolitan areas and nonmetropolitan areas (46.1 

and 45.7 percent, respectively) (Figure 20). 

4.1.3 Mental Health Treatment among Adults with Serious Mental Illness Who Did and 

Did Not Use Illicit Drugs 

Among adults with SMI in 2002, the prevalence of mental health treatment did not differ 

significantly by illicit drug use in the past 12 months. Among the 17.5 million adults who had 

SMI, 46.0 percent of those using an illicit drug and 48.7 percent of those not using an illicit drug 

received mental health treatment in the past 12 months (Tables B.22a and B.22b). 

56.0

46.5

38.7

47.2

0

10

20

30

40

50

60

Fair/Poor Good Very Good Excellent

Perceived Health Status

Percent Receiving Mental Health Treatment 

56.0

46.5

38.7

47.2

0

10

20

30

40

50

60

Fair/Poor Good Very Good Excellent

Perceived Health Status

Percent Receiving Mental Health Treatment 
33 

Figure 18. Mental Health Treatment among Adults Aged 26 to 49 with Serious Mental 

Illness, by Health Insurance Status: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

Figure 19. Mental Health Treatment among Adults Aged 26 to 49 with Serious Mental 

Illness, by Marital Status: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

Marital Status

Percent Receiving Mental Health Treatment 

56.1

61.9

42.9

0

10

20

30

40

50

60

70

Married Divorced/Separated Never Married

Marital Status

Percent Receiving Mental Health Treatment 

56.1

61.9

42.9

0

10

20

30

40

50

60

70

Married Divorced/Separated Never Married

56.3

65.1

37.1

0

10

20

30

40

50

60

70

Private Medicaid No Coverage

Percent Receiving Mental Health Treatment

Health Insurance

56.3

65.1

37.1

0

10

20

30

40

50

60

70

Private Medicaid No Coverage

Percent Receiving Mental Health Treatment

Health Insurance
34 

Figure 20. Mental Health Treatment among Adults Aged 18 or Older with Serious Mental 

Illness, by County Type: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

4.2. Use of Treatment Services among Adults with Serious Mental Illness 

and/or a Co-Occurring Substance Use Disorder 

This section discusses the prevalence of mental health treatment and specialty substance 

use treatment received in the past 12 months by three groups: adults who had SMI but no 

substance use disorder (SMI only), adults who had a substance use disorder but no SMI 

(substance use disorder only), and adults who had both SMI and a substance use disorder in 

2002. Persons with a substance use disorder are those classified as dependent on or abusing 

alcohol and/or illicit drugs. Mental health treatment for adults with only SMI is described first. 

Specialty substance use treatment for adults with only a substance use disorder is described next, 

followed by mental health and specialty substance use treatment for those with both SMI and a 

substance use disorder. Comparisons of the rates of mental health treatment are made between 

those with only SMI and those with both SMI and a substance use disorder. Similar comparisons 

are made for receipt of specialty substance use treatment between adults with only a substance 

use disorder and with both SMI and a substance use disorder. 

As previously noted in Section 3.4, there were 33.2 million adults with either SMI or a 

substance use disorder in 2002. This includes 13.4 million adults who had only SMI, 4.0 million 

adults with both SMI and a substance use disorder, and 15.7 million adults who had only a 

substance use disorder (Figure 10). Among adults with only SMI, almost half (48.4 percent) 

received mental health treatment in the past year (mental health treatment only, or both mental 

health and substance use treatment) (Tables B.23a and B.23b). Among adults with SMI and a 

substance use disorder, 46.0 percent (1.9 million) received mental health treatment, and 13.7 Percent Receiving Mental Health Treatment 

County Type

46.1

52.0

45.7

0

10

20

30

40

50

60

Large Metro Small Metro Nonmetro

Percent Receiving Mental Health Treatment 

County Type

46.1

52.0

45.7

0

10

20

30

40

50

60

Large Metro Small Metro Nonmetro

County Type

46.1

52.0

45.7

0

10

20

30

40

50

60

Large Metro Small Metro Nonmetro
35 

percent (0.6 million) received specialty substance use treatment. An estimated 11.8 percent of 

adults with SMI and a substance use disorder (0.5 million) received both types of treatment 

(Figure 21). The prevalence of specialty substance use treatment among adults with only a 

substance use disorder was 5.3 percent. 

Figure 21. Mental Health Treatment and Substance Use Treatment at a Specialty Facility 

among Adults Aged 18 or Older with Serious Mental Illness and/or a Substance 

Use Disorder: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

As previously described in Section 3.4 and Figure 11, among the 4.0 million adults with 

SMI and a substance use disorder, there were 0.9 million adults who were dependent on or 

abused illicit drugs only, 2.4 million who were dependent on or abused alcohol only, and 0.8 

million who were dependent on or abused alcohol and illicit drugs. The prevalence of mental 

health treatment was 53.6 percent among those adults who had both SMI and were dependent on 

or abused only illicit drugs, but not alcohol (Table B.25b). This was higher than the prevalence 

of mental health treatment among those with SMI and dependence on or abuse of alcohol only 

(42.6 percent), but it was not significantly different from the prevalence of mental health 

treatment among adults with SMI and no substance use disorder (48.4 percent). 

There was very little difference in the prevalence of mental health treatment in the past 

12 months among adults with SMI who did or did not have a substance use disorder. Although 

Mental Health Treatment Only

Specialty Substance Use Treatment Only

Both Mental Health and Specialty Substance Use Treatment 

Serious Mental Illness/Substance Use Disorder

Percent Receiving Treatment 

29.8 47.7 34.2 13.3

3.3

1.9

0.3

1.9

2.7

0

10

20

30

40

50

60

SMI or Substance

Use Disorder

SMI Only SMI and Substance

Use Disorder

Substance Use

Disorder Only

0.7 11.8

2.0

Mental Health Treatment Only

Specialty Substance Use Treatment Only

Both Mental Health and Specialty Substance Use Treatment 

Serious Mental Illness/Substance Use Disorder

Percent Receiving Treatment 

29.8 47.7 34.2 13.3

3.3

1.9

0.3

1.9

2.7

0

10

20

30

40

50

60

SMI or Substance

Use Disorder

SMI Only SMI and Substance

Use Disorder

Substance Use

Disorder Only

0.7 11.8

2.0
36 

not significant, the prevalence of mental health treatment was lower among adults with SMI and 

any substance use disorder than among those with only SMI (46.0 vs. 48.4 percent, respectively) 

(Table B.25b). However, the prevalence of past year specialty substance use treatment was 

higher among adults with SMI and a substance use disorder than among adults with only a 

substance use disorder (13.7 vs. 5.3 percent, respectively) (Figure 21). 

The results also indicate that the rate of mental health treatment among adults with only 

SMI was roughly 9 times higher than the rate of specialty substance use treatment among adults 

with only a substance use disorder (48.4 vs. 5.4 percent) (Figure 21). Although about 48 percent 

of adults with both disorders received some type of treatment (mental health or specialty 

substance use treatment), only 11.8 percent of adults with both disorders received both types of 

services (Figures 21 and 22, Tables B.23a and B.23b). These results highlight the importance of 

treating more people who have co-occurring substance use and mental health disorders for both 

disorders. Similar results were obtained when the analysis was performed using any substance 

use treatment instead of specialty substance use treatment (Tables B.24a and B.24b). 

Figure 22. Mental Health and Specialty Substance Use Treatment among Adults Aged 18 

or Older with Both Serious Mental Illness and a Substance Use Disorder: 2002 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.

4.3. Multiple Logistic Regression Models 

The estimated strength of the association between the receipt of mental health treatment 

among adults with SMI in the past year and various characteristics believed to influence receipt 

of mental health treatment was determined via multiple logistic regression procedures. Past year 

Mental Health and 

Substance Use 

Treatment

11.8% Substance Use 

Treatment Only

1.9%

No Treatment

52.0%

4.0 Million Adults with Co-Occurring Serious 

Mental Illness and Substance Use Disorder

Mental Health 

Treatment Only

34.2%

Mental Health and 

Substance Use 

Treatment

11.8% Substance Use 

Treatment Only

1.9%

No Treatment

52.0%

4.0 Million Adults with Co-Occurring Serious 

Mental Illness and Substance Use Disorder

Mental Health 

Treatment Only

34.2%
37 

receipt of mental health treatment was the dependent variable in the model; any illicit drug or 

alcohol dependence or abuse, cigarette (nicotine) dependence, and various sociodemographic 

characteristics were among the independent variables in the model. Adjusted odds ratios (ORs) 

are presented. (See Appendix A, Section A.5.4, for a discussion of logistic modeling and the 

interpretation of adjusted ORs.) 

The adjusted ORs from the logistic regression models, which controlled for confounding 

variables, confirmed that, among adults with SMI, the odds of receiving mental health treatment 

varied by age, gender, Hispanic origin and race, education, employment status, marital status, 

health insurance coverage, and perception of overall health. However, the odds of receiving 

mental health treatment among this group did not vary significantly based on geographic region, 

county type, family income, receipt of social support, nicotine dependence, or any illicit 

drug/alcohol dependence or abuse. 

Examining the adjusted ORs from these models of receiving mental health treatment 

demonstrates that among adults with SMI, adults aged 26 to 49 were more likely to receive 

treatment than those aged 50 or older (OR = 1.7) (Table B.M2). No other age groups showed 

significant differences. With regard to gender and race/ethnicity, females were more likely to 

receive mental health treatment than men, with an OR of 1.6, and non-Hispanic whites were 

more likely to receive mental health treatment than any other category of Hispanic origin and 

race. (The ORs for each of these groups compared with whites are as follows: black or African 

American, 0.5; Hispanic or Latino, 0.7; and other or more than two races, 0.6.) 

When comparisons were made with adults with SMI who graduated from college, those 

with SMI who did not graduate from high school were less likely to receive mental health 

treatment (OR = 0.44), as were those with SMI who were high school graduates but had no 

further education (OR = 0.55). However, the odds of receiving treatment did not vary 

significantly between adults with SMI who had some college and those who graduated from 

college. 

Among adults with SMI, these models indicate that employment status had an effect on 

the odds of receiving mental health treatment. Those who were either employed part time or not 

in the labor force were more likely than those working full time to receive mental health 

treatment (ORs = 1.6 and 1.5, respectively). However, the odds of receiving treatment for those 

who were unemployed were not significantly different from those who were employed full time. 

Adults with SMI who were either divorced or separated were more likely to receive mental 

health treatment than those who were married (OR = 1.6) and those who had never married (OR 

= 2.0 calculated by dividing 1.60 by 0.81). 

Among adults with SMI, those with private health insurance had twice the odds of 

receiving mental health treatment as those with no insurance. Similar results were obtained when 

comparing adults who received Medicaid or adults in the Children's Health Insurance Program 

(CHIP) with adults having no insurance. 

These models also indicated that the perception of overall health status affected the odds 

of receiving mental health treatment for adults with SMI. When comparisons were made with 

adults with SMI who perceived their overall health as excellent, all other persons with SMI were 
38 

more likely to receive mental health treatment. Those who perceived their health as fair or poor 

had an OR of 2.6, whereas those who perceived their overall health as either good or very good 

had ORs of 1.6 and 1.4, respectively. 

The results of the modeling also showed that when controlling for confounding variables, 

illicit drug or alcohol dependence or abuse was not associated with receipt of mental health 

treatment among adults with SMI (χ

2

 = 6.0). 

4.4. Discussion 

Results from the 2002 NSDUH signifying that individuals with a substance use disorder 

are more likely to receive specialty substance use treatment if they have a co-occurring SMI are 

consistent with results from the National Comorbidity Survey-Replication (NCS-R) and 

Communities Survey (U.S. Department of Health and Human Services, 1999). 
39 

5. Summary and Conclusions 

According to the 2002 National Survey on Drug Use and Health (NSDUH), there were 

17.5 million adults estimated to have a serious mental illness (SMI) in 2002, representing 8.3 

percent of all adults in the United States. Adults with SMI were more likely to have each of the 

following demographic characteristics when compared with adults without SMI: they were 

younger, female, less educated, non-Hispanic white, unemployed, and not in the labor force. The 

prevalence of SMI was shown to vary by age, gender, race, education, and employment, as well 

as by perceived health, social support, marital status, and the use of specific substances. SMI was 

correlated with illicit drug use, and the prevalence of SMI varied by the type of illicit drug used. 

Among adults with SMI, almost 30 percent (5.0 million adults) used illicit drugs. Adults 

with SMI who used illicit drugs in the past year were more likely than those not using illicit 

drugs to have each of the following characteristics: male, some college, and employed full or 

part time. Among adults with SMI who used illicit drugs in the past year, 2.3 million had no 

substance use disorder. 

An estimated 4 million adults had SMI and a substance use disorder in 2002. There were 

13.4 million adults with only SMI and 15.7 million adults with only a substance use disorder. 

The characteristics of adults with SMI and a substance use disorder were similar to the 

characteristics of adults with SMI and illicit drug use. 

The adjusted odds ratios (ORs) from the modeling also showed that SMI is correlated 

with past year alcohol dependence or abuse, past year illicit drug dependence or abuse, and past 

year illicit drug use with no substance use disorder. The Chi-square tests of association from the 

modeling indicated that SMI also is associated with the following characteristics: age, gender, 

race/ethnicity, education, marital status, health insurance, perceived health, social support, and 

nicotine (cigarette) dependence. 

Almost 50 percent of adults with SMI received mental health treatment. When compared 

with adults with SMI who did not receive treatment, adults with SMI who received treatment 

were more likely to belong to each of the following demographic subgroups: aged 26 to 49, 

female, non-Hispanic white, and college graduates. The past year prevalence of mental health 

treatment among adults with SMI was highest in each of the following subgroups: aged 26 to 49, 

female, non-Hispanic white, college graduates, and perceived health fair or poor. For adults aged 

26 to 49 with SMI, the prevalence of mental health treatment was highest among those who 

received Medicaid and among those who were divorced or separated. 

The prevalence of mental health treatment in the past year among adults with SMI but no 

substance use disorder was shown to be much higher than the prevalence of substance use 

treatment among adults with a substance use disorder but no SMI. In addition, adults with SMI 

but no substance use disorder were just as likely to receive mental health treatment as those with 

both SMI and a substance use disorder. However, adults with a substance use disorder and SMI 

were more likely to receive specialty substance use treatment than adults with a substance use 

disorder but no SMI. Only a small proportion of persons with SMI and a substance use disorder 

received both specialty substance use treatment and mental health treatment. 
40 

The modeling showed that, among adults with SMI, mental health treatment is associated 

with each of the following characteristics: age, gender, race, education, current employment, 

marital status, health insurance, and perceived health, after controlling for possible confounding 

variables. 
41 

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46 
47 

Appendix A: Description of the Survey, 

Limitations of the Data, and Statistical 

Methods 

A.1. Sample Design 

The 2002 National Survey on Drug Use and Health (NSDUH) sample design was part of 

a coordinated 5-year sample design that will provide estimates for all 50 States plus the District 

of Columbia for the years 1999 through 2003. The coordinated design facilitates 50 percent 

overlap in first-stage units (area segments) between each 2 successive years. 

For the 5-year 50-State design, 8 States were designated as large sample States 

(California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas) with samples 

large enough to support direct State estimates. Sample sizes in these States ranged from 3,554 to 

3,792. For the remaining 42 States and the District of Columbia, smaller, but adequate, samples 

were selected to support State estimates using small area estimation (SAE)1

 techniques. Sample 

sizes in these States ranged from 6742

 to 977 in 2002. 

States were first stratified into a total of 900 field interviewer (FI) regions (48 regions in 

each large sample State and 12 regions in each small sample State). These regions were 

contiguous geographic areas designed to yield the same number of interviews on average. Within 

FI regions, adjacent census blocks were combined to form the first-stage sampling units, called 

area segments. A total of 96 segments per FI region were selected with probability proportional 

to population size in order to support the 5-year sample and any supplemental studies that the 

Substance Abuse and Mental Health Services Administration (SAMHSA) may choose to field.3

Eight sample segments per FI region were fielded during the 2002 survey year. 

These sampled segments were allocated equally into four separate samples, one for each 

3-month period during the year, so that the survey was essentially continuous in the field. In each 

of these area segments, a listing of all addresses was made, from which a sample of 178,013 

addresses was selected. Of the selected addresses, 150,162 were determined to be eligible sample 

units. In these sample units (which could be either households or units within group quarters), 

sample persons were randomly selected using an automated screening procedure programmed in 

a handheld computer carried by the interviewers. The number of sample units completing the 

screening was 136,349. Youths (aged 12 to 17 years) and young adults (aged 18 to 25 years) 

 1

 Small area estimation (SAE) is a hierarchical Bayes modeling technique used to make State-level 

estimates for approximately 20 substance use–related measures. See the State Estimates of Substance Use from the 

2001 National Household Survey on Drug Abuse (Wright, 2003a, 2003b) for more details. 2

 This small sample size was achieved in New Mexico following the decision to drop cases conducted by 

several interviewers in this State, Nevada, and Mississippi who were accused of completing fraudulent work. The 

next two smallest sample sizes were achieved in Mississippi and New Jersey with 839 and 854 completed cases, 

respectively. 3

 For more details on the 5-year sample, see the sample design report in the 2001 NHSDA Methodological 

Resource Book (Bowman, Chromy, Odom, & Penne, 2003). 
48 

were oversampled at this stage. Because of the large sample size associated with this sample, 

there was no need to oversample racial/ethnic groups, as was done on surveys4

 prior to 1999. A 

total of 80,581 persons were selected nationwide. Consistent with previous surveys, the final 

respondent sample of 68,126 persons was representative of the U.S. general population (since 

1991, the civilian, noninstitutionalized population) aged 12 or older. In addition, State samples 

were representative of their respective State populations. More detailed information on these 

topics can be found in the appendices of the 2002 NSDUH results report (Office of Applied 

Studies [OAS], 2003) as follows: (a) additional information on the disposition of the national 

screening and interview sample can be found in Appendix B, and (b) additional tables showing 

sample sizes and estimated population counts for various demographic and geographic 

subgroups are presented in Appendix G. 

The survey covered residents of households (living in houses/townhouses, apartments, 

condominiums, etc.), noninstitutional group quarters (e.g., shelters, rooming/boarding houses, 

college dormitories, migratory workers' camps, halfway houses), and civilians living on military 

bases. Although the survey covered these types of units (they were given a nonzero probability 

of selection), sample sizes of most specific groups were too small to provide separate estimates. 

Persons excluded from the survey included homeless people who did not use shelters, active 

military personnel, and residents of institutional group quarters, such as correctional facilities, 

nursing homes, mental institutions, and long-term hospitals. 

A.2. Data Collection Methodology 

The data collection method used in NSDUH involved in-person interviews with sample 

persons, incorporating procedures that would be likely to increase respondents' cooperation and 

willingness to report honestly about their illicit drug use behavior. Confidentiality was stressed in 

all written and oral communications with potential respondents, respondents' names were not 

collected with the data, and computer-assisted interviewing (CAI) methods, including audio 

computer-assisted self-interviewing (ACASI), were used to provide a private and confidential 

setting to complete the interview. 

Introductory letters were sent to sampled addresses, followed by an interviewer visit. A 

5-minute screening procedure conducted using a handheld computer involved listing all 

household members along with their basic demographic data. The computer used the 

demographic data in a preprogrammed selection algorithm to select zero to two sample 

person(s), depending on the composition of the household. This selection process was designed 

to provide the necessary sample sizes for the specified population age groupings. 

Interviewers attempted to immediately conduct the NSDUH interview with each selected 

person in the household. The interviewer requested the selected respondent to identify a private 

area in the home away from other household members to conduct the interview. The interview 

averaged about an hour and included a combination of CAPI (computer-assisted personal 

interviewing) and ACASI. The interview began in CAPI mode with the FI reading the questions 

from the computer screen and entering the respondent's replies into the computer. The interview 

then transitioned to the ACASI mode for the sensitive questions. In this mode, the respondent 

 4

 Prior to 2002, the survey was known as the National Household Survey on Drug Abuse (NHSDA). 
49 

could read the questions silently on the computer screen and/or listen to the questions read 

through headphones and enter his or her responses directly into the computer. At the conclusion 

of the ACASI section, the interview returned to the CAPI mode with the interviewer completing 

the questionnaire. Each respondent who completed a full interview was given a $30 cash 

payment as a token of appreciation for his or her time. 

No personal identifying information was captured in the CAI record for the respondent. 

At the end of the day when an interviewer had completed one or more interviews, he or she 

transmitted the data to RTI in Research Triangle Park, North Carolina, via home telephone lines. 

A.3. Data Processing 

Interviewers initiated nightly data transmissions of interview data and call records on 

days when they worked. Computers at RTI directed the information to a raw data file that 

consisted of one record for each completed interview. Even though editing and consistency 

checks were done by the CAI program during the interview, additional, more complex edits and 

consistency checks were completed at RTI. Cases were retained only if respondents provided 

data on lifetime use of cigarettes and at least nine other substances. An important aspect of 

subsequent editing routines involved assignment of codes when respondents legitimately skipped 

out of questions that definitely did not apply to them (e.g., if respondents never used a drug of 

interest). For key drug use measures, the editing procedures identified inconsistencies between 

related variables. Inconsistencies in variables pertaining to the most recent period that 

respondents used a drug were edited by assigning an "indefinite" period of use (e.g., use at some 

point in the lifetime, which could mean use in the past 30 days or past 12 months). 

Inconsistencies in other key drug use variables were edited by assigning missing data codes. 

These inconsistencies then were resolved through statistical imputation procedures, as discussed 

below. 

A.3.1 Statistical Imputation 

For some key variables that still had missing or ambiguous values after editing, statistical 

imputation was used to replace ambiguous or missing data with appropriate response codes. For 

example, the response was ambiguous if the editing procedures assigned a respondent's most 

recent use of a drug to "use at some point in the lifetime," with no definite period within the 

lifetime. In this case, the imputation procedures assigned a definite value for when the 

respondent last used the drug (e.g., in the past 30 days, more than 30 days ago but within the past 

12 months, more than 12 months ago). Similarly, if the response was completely missing, the 

imputation procedures replaced missing values with nonmissing ones. 

Missing or ambiguous values were imputed using a methodology called predictive mean 

neighborhoods (PMN), which was developed specifically for the survey in 1999. PMN is a 

combination of a model-assisted imputation methodology and a random nearest neighbor hotdeck procedure. Whenever feasible, the imputation of variables using PMN is multivariate, in 

which imputation is accomplished on several response variables at once. Variables requiring 

imputation were the core demographic variables, core drug use variables (recency of use, 

frequency of use, and age at first use), income, health insurance, and a variety of roster-derived 
50 

variables. Variables such as treatment, dependence, abuse, and serious mental illness (SMI) were 

not imputed. 

In the modeling stage of PMN, the model chosen depends on the nature of the response 

variable Y. In the 2002 NSDUH, the models included binomial logistic regression, multinomial 

logistic regression, Poisson regression, and ordinary linear regression, where the models 

incorporate the design weights. 

In general, hot-deck imputation replaces a missing or ambiguous value taken from a 

"similar" respondent who has complete data. For random nearest neighbor hot-deck imputation, 

the missing or ambiguous value is replaced by a responding value from a donor randomly 

selected from a set of potential donors. Potential donors are those defined to be "close" to the 

unit with the missing or ambiguous value, according to a predefined function, called a distance 

metric. In the hot-deck stage of PMN, the set of candidate donors (the "neighborhood") consists 

of respondents with complete data who have a predicted mean close to that of the item 

nonrespondent. In particular, the neighborhood consists of either the set of the closest 30 

respondents, or the set of respondents with a predicted mean (or means) within 5 percent of the 

predicted mean(s) of the item nonrespondent, whichever set is smaller. If no respondents are 

available who have a predicted mean (or means) within 5 percent of the item nonrespondent, the 

respondent with the predicted mean(s) closest to that of the item nonrespondent is selected as the 

donor. 

In the univariate case, the neighborhood of potential donors is determined by calculating 

the relative distance between the predicted mean for an item nonrespondent and the predicted 

mean for each potential donor, then choosing those means defined by the distance metric. The 

pool of donors is further restricted to satisfy logical constraints whenever necessary (e.g., age at 

first crack use must not be younger than age at first cocaine use). 

Whenever possible, missing or ambiguous values for more than one response variable are 

considered at a time. In this (multivariate) case, the distance metric is a Mahalanobis distance 

(Manly, 1986) rather than a relative Euclidean distance. Whether the imputation is univariate or 

multivariate, only missing or ambiguous values are replaced, and donors are restricted to be 

logically consistent with the response variables that are not missing. Furthermore, donors are 

restricted to satisfy "likeness constraints" whenever possible. That is, donors are required to have 

the same values for variables highly correlated with the response. If no donors are available that 

meet these conditions, these likeness constraints can be loosened. For example, donors for the 

age at first use variable are required to be of the same age as recipients, if at all possible. Further 

details on the PMN methodology are provided in RTI (2003) and Singh, Grau, and Folsom 

(2001, 2002). 

Although statistical imputation could not proceed separately within each State due to 

insufficient pools of donors, information about each respondent's State of residence was 

incorporated in the modeling and hot-deck steps. For most drugs, respondents were separated 

into three "State usage" categories as follows: respondents from States with high usage of a 

given drug were placed in one category, respondents from States with medium usage into 

another, and the remainder into a third category. This categorical "State rank" variable was used 

as one set of covariates in the imputation models. In addition, eligible donors for each item 
51 

nonrespondent were restricted to be of the same State usage category (i.e., the same "State rank") 

as the nonrespondent. 

A.3.2 Development of Analysis Weights 

The general approach to developing and calibrating analysis weights involved developing 

design-based weights, dk, as the inverse of the selection probabilities of the households and 

persons. Adjustment factors, ak (λ), then were applied to the design-based weights to adjust for 

nonresponse, to poststratify to known population control totals, and to control for extreme 

weights when necessary. In view of the importance of State-level estimates with the 50-State 

design, it was necessary to control for a much larger number of known population totals. Several 

other modifications to the general weight adjustment strategy that had been used in past surveys 

also were implemented for the first time beginning with the 1999 CAI sample. 

Weight adjustments were based on a generalization of Deville and Särndal's (1992) logit 

model. This generalized exponential model (GEM) (Folsom & Singh, 2000) incorporates unitspecific bounds (Rk, uk), k0s, for the adjustment factor a k (λ) as follows: 

( ) (u ) ( ) ( λ) λ , ( )( ) ( λ)

/

k k k k k k kk

k /

k k k k kk

c u c exp A x a

u c c exp A x

−+ − = −+−l l

l

where ck are prespecified centering constants, such that Rk < ck < uk and Ak = (uk - Rk) / (uk - ck)(ck - 

Rk). The variables Rk, ck, and uk are user-specified bounds, and λ is the column vector of p model 

parameters corresponding to the p covariates x. The λ-parameters are estimated by solving 

( ) 0, kkk s x ∑ xda T λ − = %

where Tx

~ denotes control totals that could be either nonrandom, as is generally the case with 

poststratification, or random, as is generally the case for nonresponse adjustment. 

The final weights wk = dkak(λ) minimized the distance function ∆(w,d) defined as 

∑∈ 











−

− + − −− ∆ = − k s k k

k k

k k

k k

k k

k k

k

k

u c

u a

u a

c

a

a

A

d (w,d) ( )log ( )log ll l . 

This general approach was used at several stages of the weight adjustment process, 

including (1) adjustment of household weights for nonresponse at the screener level, (2) 

poststratification of household weights to meet population controls for various demographic 

groups by State, (3) adjustment of household weights for extremes, (4) poststratification of 

selected person weights, (5) adjustment of person weights for nonresponse at the questionnaire 

level, (6) poststratification of person weights, and (7) adjustment of person weights for extremes. 

Every effort was made to include as many relevant State-specific covariates (typically 

defined by demographic domains within States) as possible in the multivariate models used to 

calibrate the weights (nonresponse adjustment and poststratification steps). Because further 

subdivision of State samples by demographic covariates often produced small cell sample sizes, 
52 

it was not possible to retain all State-specific covariates (even after meaningful collapsing of 

covariate categories) and still estimate the necessary model parameters with reasonable 

precision. Therefore, a hierarchical structure was used in grouping States with covariates defined 

at the national level, at the census division level within the Nation, at the State-group within 

census division, and, whenever possible, at the State level. In every case, the controls for total 

population within State and the six age groups (12-17, 18-25, 26-34, 35-49, 50-64, 65+) within 

State were maintained. Census control totals by age, race, gender, and Hispanicity were required 

for the civilian, noninstitutionalized population of each State. The Population Estimates Branch 

of the U.S. Bureau of the Census produced the necessary population estimates in response to a 

special request based on the 2000 census. Because of the additional multiple race category in the 

2000 census, it was possible to include an extra level for the race variable used in weight 

calibration both at the household and person levels. 

Consistent with the surveys from 1999 onward, control of extreme weights through 

separate bounds for adjustment factors was incorporated into the GEM calibration processes for 

both nonresponse and poststratification. This is unlike the traditional method of winsorization in 

which extreme weights are truncated at prespecified levels and the trimmed portions of weights 

are distributed to the nontruncated cases. In GEM, it is possible to set bounds around the 

prespecified levels for extreme weights, and then the calibration process provides an objective 

way of deciding the extent of adjustment (or truncation) within the specified bounds. A step was 

added to poststratify the household-level weights to obtain census-consistent estimates based on 

the household rosters from all screened households; these household roster-based estimates then 

provided the control totals needed to calibrate the respondent pair weights for subsequent 

planned analyses. An additional step poststratified the selected person sample to conform to the 

adjusted roster estimates. This additional step took advantage of the inherent two-phase nature of 

the NSDUH design. The final step poststratified the respondent person sample to external census 

data (defined within State whenever possible as discussed above). For more detailed information, 

see the 2001 NHSDA Methodological Resource Book (RTI, 2003). 

A.4. Target Population 

An important limitation of estimates of drug use prevalence from NSDUH was that they 

were only designed to describe the target population of the survey—the civilian, 

noninstitutionalized population aged 12 or older. Although this population included almost 98 

percent of the total U.S. population aged 12 or older, it excluded some important and unique 

subpopulations that may have very different drug use patterns. For example, the survey excluded 

active military personnel, who have been shown to have significantly lower rates of illicit drug 

use. Persons living in institutional group quarters, such as prisons and residential drug treatment 

centers, were not included in NSDUH and have been shown in other surveys to have higher rates 

of illicit drug use. Also excluded were homeless persons not living in a shelter on the survey 

date, another population shown to have higher than average rates of illicit drug use. 

A.5. Sampling Error and Statistical Significance 

The national estimates, along with the associated variance components, were computed 

using a multiprocedure package, SUrvey DAta ANalysis (SUDAAN®) Software for Statistical 

Analysis of Correlated Data, which was designed for the statistical analysis of sample survey 
53 

data from stratified, multistage cluster samples (RTI, 2001). The final, nonresponse-adjusted, and 

poststratified analysis weights were used to compute unbiased design-based drug use estimates. 

The sampling error (i.e., the standard error [SE]) of an estimate is the error caused by the 

selection of a sample instead of conducting a census of the population. Sampling error is reduced 

by selecting a large sample and by using efficient sample design and estimation strategies, such 

as stratification, optimal allocation, and ratio estimation. 

With the use of probability sampling methods in NSDUH, it was possible to develop 

estimates of sampling error from the survey data. These estimates were calculated in SUDAAN 

for all estimates presented in this report using a Taylor series linearization approach that takes 

into account the effects of the complex NSDUH design features. The sampling errors were used 

to identify unreliable estimates and to test for the statistical significance of differences between 

estimates. 

A.5.1 Variance Estimation for Totals 

Estimates of proportions, pd ˆ , such as prevalence rates for serious mental illness (SMI), 

take the form of nonlinear statistics where the variances cannot be expressed in closed form. 

Variance estimation for nonlinear statistics in SUDAAN is performed using a first-order Taylor 

series approximation of the deviations of estimates from their expected values. 

Corresponding to proportion estimates, pd ˆ , the number of persons with SMI, Yd

ˆ , could 

be estimated as 

d d d Y N pˆ ˆ ˆ = , 

where Nd

ˆ is the estimated population total for domain d, and pd ˆ is the estimated proportion for 

domain d. The SE for the total estimate was obtained by multiplying the SE of the proportion by 

Nd

ˆ , that is, 

( ˆ ) ˆ ) ˆ ( d d d SE Y = N SE p . 

This approach is theoretically correct when the domain size estimates, Nd

ˆ , are among those 

forced to U.S. Bureau of the Census population projections through the weight calibration 

process. In these cases, Nd

ˆ is clearly not subject to sampling error. For a more detailed 

explanation of the weight calibration process, see Section A.3.2. 

For domain totals, Yd

ˆ , where Ndˆ is not fixed, this formulation may still provide a good 

approximation if it can be reasonably assumed that the sampling variation in Nd

ˆ is negligible 

relative to the sampling variation in pd ˆ . This is a reasonable assumption in most cases. 

For a subset of the tables produced from the 2002 data, it was clear that the above 

approach yielded an underestimate of the variance of a total because Nd

ˆ was subject to 
54 

considerable variation. In these cases, a different method was used to estimate variances. 

SUDAAN provides an option to directly estimate the variance of the linear statistic that estimates 

a population total. Using this option did not affect the SE estimates for the corresponding 

proportions presented in the same sets of tables. 

A.5.2 Suppression Criteria for Unreliable Estimates 

As has been done in past reports from the survey, direct survey estimates from the 2002 

NSDUH considered to be unreliable due to unacceptably large sampling errors are not shown in 

this report and are noted by asterisks (*) in the tables containing such estimates. The criteria used 

for suppressing all direct survey estimates were based on the relative standard error (RSE), 

which is defined as the ratio of the standard error (SE) over the estimate, as well as on nominal 

sample size and on effective sample size. 

Proportion estimates ( pˆ ) within the range [0 < pˆ < 1], rates, and corresponding 

estimated number of users were suppressed if 

RSE[-ln( pˆ )] > 0.175 when pˆ # 0.5 

or 

RSE[-ln(1 - pˆ )] > 0.175 when pˆ > 0.5. 

Using a first-order Taylor series approximation to estimate RSE[-ln( pˆ )] and RSE[-ln(1 - 

pˆ )], the following was obtained and used for computational purposes: 

( )/ ˆ ˆ

ln( )ˆ

SE p p

− p

 > 0.175 when pˆ ≤ 0.5 

or 

( )/( ) ˆ ˆ

( )ˆ

SE p 1 p

ln 1 p

−

− − > 0.175 when pˆ > 0.5. 

The separate formulas for pˆ < 0.5 and pˆ > 0.5 produce a symmetric suppression rule 

(i.e., if pˆ is suppressed, then 1 - pˆ will be as well). This ad hoc rule requires an effective sample 

size in excess of 50. When 0.05 < pˆ < 0.95, the symmetric property of the rule produces a local 

maximum effective sample size of 68 at pˆ = 0.5. Thus, estimates with these values of pˆ along 

with effective sample sizes falling below 68 were suppressed. See Figure A.1 for a graphical 

representation of the required minimum effective sample sizes as a function of the proportion 

estimated. 

A minimum nominal sample size suppression criterion (n = 100) that protects against 

unreliable estimates caused by small design effects and small nominal sample sizes was 

employed. Prevalence estimates also were suppressed if they were close to 0 or 100 percent (i.e., 

if pˆ < .00005 or if pˆ > .99995). 
55 

Figure A.1 Required Effective Sample as a Function of the Proportion Estimated 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 

The suppression criteria for NSDUH estimates used in this report are summarized in 

Table A.1 at the end of this appendix. 

A.5.3 Statistical Significance of Differences 

This section describes the methods used to compare prevalence estimates in this report. 

Customarily, the observed difference between estimates is evaluated in terms of its statistical 

significance. "Statistical significance" refers to the probability that a difference as large as that 

observed would occur due to random error in the estimates if there were no difference in the 

prevalence rates for the population groups being compared. The significance of observed 

differences in this report was generally reported at the 0.05 and 0.01 levels. When comparing 

prevalence estimates, the null hypothesis (no difference between prevalence rates) was tested 

against the alternative hypothesis (there is a difference in prevalence rates) using the standard 

difference in proportions test expressed as follows: 

ˆ ˆ

var( ) var( ) cov( , ) ˆ ˆ ˆˆ

1 2

1 2 12

p p Z

p p 2 pp

− =

+ −

 , 

where 1 ˆ

p = first prevalence estimate, 2 ˆp = second prevalence estimate, var( 1 ˆp ) = variance of 

first prevalence estimate, var( 2 ˆ

p ) = variance of second prevalence estimate, and cov( 1 ˆp , 2 ˆp ) = 

covariance between 1 ˆp and 2 ˆp . 

Under the null hypothesis, Z is asymptotically distributed as a normal random variable. 

Calculated values of Z can therefore be referred to as the unit normal distribution to determine 

0

20

40

60

80

100

120

140

160

180

1 8 15 22 29 36 43 50 57 64 71 78 85 92 99

Proportion Estimated (P)

Required Effective Sample Size

Current Rule: NSDUH 2002
56 

the corresponding probability level (i.e., p value). The covariance term in the formula for Z will 

not always be 0. Estimates of Z, along with its p value, were calculated in SUDAAN, using the 

analysis weights and accounting for the sample design as described in Section A.1. A similar 

procedure and formula for Z were used for estimated totals. 

When comparing prevalence measures between population subgroups, a χ

2

 test of 

independence of the subgroup and the prevalence variable was conducted first to control the 

error level for multiple comparisons. If the χ

2

 test indicated some significant differences, the 

significance of each particular subgroup comparison discussed in the report was tested using 

SUDAAN. Using the published estimates and SEs to perform independent t tests for the 

difference of proportions will usually provide the same results as tests performed in SUDAAN. 

However, where the significance level is borderline, results may differ for two reasons: (1) the 

covariance term is included in SUDAAN tests whereas it is not included in independent t tests, 

and (2) the reduced number of significant digits shown in the published estimates may cause 

rounding errors in the independent t tests. 

A.5.4 Logistic Regression Models and Statistical Significance of Odds Ratios 

Because SMI is a binary response variable, one approach to investigate the relationship 

between SMI and several potential predictor variables (e.g., age, race) is through a logistic 

regression model. Consider an example where Y is a binary response variable (i.e., coded as 0 or 

1) and there are two predictor variables, one continuous and one categorical (consisting of k + 1 

groups). Then a logistic regression model expressing the relationship between Y (specifically, the 

proportion of times that Y = 1) and the two predictor variables can be written as 

1 1 21 2

1 1 21 2

exp( ) () , 1 exp( )

k k

k k

xx x

p

xx x

α +β +γ + +γ = + α+β +γ + +γ

x K

K

where p(x) represents the probability that Y = 1, given 1 21 2 1 (x , x , , x ) , x k x = K ′ represents the 

continuous predictor variable with its corresponding parameter β, and 21 2k x ,K, x represent the 

k contrasts of the categorical predictor variable with their corresponding parameters , , . 1 k γ K γ 

A simple transformation of the response variable changes this model to the more 

convenient form of a linear model, as follows: 

( ) 1 1 21 2

( ) ( ) log . 1 () k kp logit p x x x

p

  ≡ =α+β +γ + +γ     −

x

x

x K

Thus, in the transformed (or logit) scale, this model has many of the properties associated 

with linear models, although the interpretation of the parameters is not as straightforward. The 

"intercept" parameter α, is typically not of much interest. The "slope" parameter β,

corresponding to the continuous predictor variable , 1 x represents the change in logit( ) p(x) for a 

unit increase in 1 x (with k x x 21 2 ,K, held constant), but this does not have immediate intuitive 

appeal. However, it can be shown that 
57 

1 21 2 1 21 2

1 21 2 1 21 2

( 1, , , ) ( , , , ) exp( ) , 1 ( 1, , , ) 1 ( , , , )

k k

k k

px x x px x x

px x x px x x

  + β =     −+ −

K K

K K

which is a ratio of the odds that Y = 1, given k x x x 1 21 2 +1, ,K, , over the odds that Y = 1, given 

, , , . 1 21 2k x x K x So, for example, if Y represents SMI and 1 x represents the continuous variable 

age, then the odds of SMI occurring are increased/decreased by the odds ratio, exp(β), for each 

year of increase in age (with all other variables held constant). The odds are increased if β > 0

(i.e., exp(β) > 1) and are decreased if β < 0 (i.e., exp(β) < 1) . 

The categorical contrast parameters , , , 1 k γ K γ require a slightly different interpretation. 

The contrast variables, , , , 21 2k x K x are first constructed as follows: A reference group is specified 

from among the k +1 groups of the categorical predictor variable. Then k contrast variables are 

created so that the ith contrast variable represents a contrast between the ith nonreference group 

and the reference group, for i = 1,...,k. The odds ratio, exp( ), i γ then represents the increase or 

decrease in the odds that Y = 1 given nonreference group i, over the odds that Y = 1 given the 

reference group (with all other variables held constant). In addition, for any categorical predictor 

variable for which k ≥ 2, a Wald F-statistic (with k degrees of freedom) is also used to test the 

overall effect of this predictor variable. For example, if Y represents SMI, the predictor variable 

race is categorized into four groups (i.e., k = 3), and whites are specified as the reference group, 

then the model will have three contrast variables representing contrasts between the three 

nonwhite race groups and whites. And, the odds of SMI occurring are increased or decreased by 

the odds ratio, exp( ), i γ as the ith nonwhite race group is compared against the white race group 

(with all other variables held constant). Because k = 3, a Wald F-statistic (with three degrees of 

freedom) also will be used to test the overall effect of the race predictor variable. 

Several of the logistic regression models fitted with SMI as a response variable included 

multiple predictor variables, most of them categorical. For categorical predictor variables with 

two or more contrasts, individual contrasts were reported only if the overall Wald F-test of that 

predictor variable was significant at the 0.05 level. The purpose of this was to attempt to keep the 

Type I (i.e., false positive) error rate as close as possible to the nominal level of α= 0.05. 

A.6. Nonsampling Error 

Nonsampling errors can occur from nonresponse, coding errors, computer processing 

errors, errors in the sampling frame, reporting errors, and other errors not due to sampling. 

Nonsampling errors are reduced through data editing, statistical adjustments for nonresponse, 

close monitoring and periodic retraining of interviewers, and improvement in various quality 

control procedures. 

Although nonsampling errors often can be much larger than sampling errors, 

measurement of most nonsampling errors is difficult or impossible. However, some indication of 

the effects of some types of nonsampling errors can be obtained through proxy measures, such as 

response rates and from other research studies. 
58 

A.6.1 Screening and Interview Response Rate Patterns 

In 2002, response rates were improved over prior years by providing respondents with a 

$30 incentive. Of the 150,162 eligible households sampled for the 2002 NSDUH main study, 

136,349 were successfully screened, for a weighted screening response rate of 90.7 percent 

(Table A.2). In these screened households, a total of 80,581 sample persons were selected, and 

completed interviews were obtained from 68,126 of these sample persons, for a weighted 

interview response rate of 78.6 percent (Table A.3). A total of 7,583 (13.3 percent) sample 

persons were classified as refusals or parental refusals, 3,252 (4.5 percent) were not available or 

never at home, and 1,620 (3.7 percent) did not participate for various other reasons, such as 

physical or mental incompetence or language barrier (see Table A.3, which also shows the 

distribution of the selected sample by interview code and age group). The weighted interview 

response rate was highest among 12 to 17 year olds (90.0 percent), females (80.0 percent), blacks 

and Hispanics (82.2 and 80.9 percent, respectively), in nonmetropolitan areas (81.4 percent), and 

among persons residing in the Midwest and the South (both at 80.0 percent) (Table A.4). 

The overall weighted response rate, defined as the product of the weighted screening 

response rate and weighted interview response rate, was 71.3 percent in 2002. Nonresponse bias 

can be expressed as the product of the nonresponse rate (1-R) and the difference between the 

characteristic of interest between respondents and nonrespondents in the population (Pr - Pnr). 

Thus, assuming the quantity (Pr - Pnr) is fixed over time, the improvement in response rates in 

2002 over prior years will result in estimates with lower nonresponse bias. 

A.6.2 Inconsistent Responses and Item Nonresponse 

Among survey participants, item response rates were above 99 percent for most 

questionnaire items. However, inconsistent responses for some items, including the drug use 

items, were common. Estimates of substance use from NSDUH are based on responses to 

multiple questions by respondents, so that the maximum amount of information is used in 

determining whether a respondent is classified as a drug user. Inconsistencies in responses were 

resolved through a logical editing process that involved some judgment on the part of survey 

analysts and can be a potential source of nonsampling error. 

A.6.3 Validity of Self-Reported Use 

NSDUH estimates are based on self-reports of drug use, and their value depends on 

respondents' truthfulness and memory. Although many studies have generally established the 

validity of self-report data and the NSDUH procedures were designed to encourage honesty and 

recall, some degree of underreporting is assumed (Harrell, 1997; Harrison & Hughes, 1997; 

Rouse, Kozel, & Richards, 1985). No adjustment to NSDUH data is made to correct for this. The 

methodology used in NSDUH has been shown to produce more valid results than other selfreport methods (e.g., by telephone) (Aquilino, 1994; Turner, Lessler, & Gfroerer, 1992). 

However, comparisons of NSDUH data with data from surveys conducted in classrooms suggest 

that underreporting of drug use by youths in their homes may be substantial (Gfroerer, 1993; 

Gfroerer, Wright, & Kopstein, 1997). 
59 

A.7. Serious Mental Illness Estimates 

For the 2002 survey, mental health among adults was measured using a scale to ascertain 

serious mental illness (SMI). This scale consisted of six questions that ask respondents how 

frequently they experienced symptoms of psychological distress during the 1 month in the past 

year when they were at their worst emotionally. The use of this scale is based on a 

methodological study designed to evaluate several screening scales for measuring SMI in 

NSDUH. These scales consisted of a truncated version of the World Health Organization (WHO) 

Composite International Diagnostic Interview Short Form (CIDI-SF) scale (Kessler, Andrews, 

Mroczek, Üstün, & Wittchen, 1998), the K10/K6 scale of nonspecific psychological distress 

(Furukawa, Kessler, Slade, & Andrews, 2003), and the WHO Disability Assessment Schedule 

(WHO-DAS) (Rehm et al., 1999). 

The methodological study to evaluate the scales consisted of 155 respondents selected 

from a first-stage sample of 1,000 adults aged 18 or older. First-stage respondents were selected 

from the Boston metropolitan area and screened on the telephone to determine whether they had 

any emotional problems. Respondents reporting emotional problems at the first stage were 

oversampled when selecting the 155 respondents at the second stage. The selected respondents 

were interviewed by trained clinicians in respondents' homes using both the NSDUH 

methodology and a structured clinical interview. The first interview included the three scales 

described above using audio computer-assisted self-interviewing (ACASI). Respondents 

completed the ACASI portion of the interview without discussing their answers with the 

clinician. After completing the ACASI interview, respondents then were interviewed using the 

12-month nonpatient version of the Structured Clinical Interview for DSM-IV (SCID) (First, 

Spitzer, Gibbon, & Williams, 1997) and the Global Assessment of Functioning (GAF) (Endicott, 

Spitzer, Fleiss, & Cohen, 1976) to classify respondents as either having or not having SMI. 

The data from the 155 respondents were analyzed using logistic regression analysis to 

predict SMI from the scores on the screening questions. Analysis of the model fit indicated that 

each of the scales alone and in combination were significant predictors of SMI and the best 

fitting models contained either the CIDI-SF or the K10/K6 alone. Receiver operating 

characteristic (ROC) curve analysis was used to evaluate the precision of the scales to 

discriminate between respondents with and without SMI. This analysis indicated that the K6 was 

the best predictor. The results of the methodological study are described in more detail in a paper 

describing the K10/K6 scale of nonspecific psychological distress (Kessler et al., 2003). 

To score the items on the K6 scales, they were first coded from 0 to 4 and summed to 

yield a number between 0 and 24. This involved transforming response categories for the six 

questions (DSNERV1, DSHOPE, DSFIDG, DSNOCHR, DSEFFORT, and DSDOWN) given 

below so that "all of the time" was coded 4, "most of the time" was coded 3, "some of the time" 

2, "a little of the time" 1, and "none of the time" 0, with "don't know" and "refuse" also coded 0. 

Summing across the transformed responses resulted in a score with a range from 0 to 24. 

Respondents with a total score of 13 or greater were classified as having a past year SMI. This 

cutpoint was chosen to equalize false positives and false negatives. 
60 

The questions comprising the K6 scale are given as follows: 

DSNERV1 Most people have periods when they are not at their best emotionally. Think of 

one month in the past 12 months when you were the most depressed, anxious, or 

emotionally stressed. If there was no month like this, think of a typical month. 

During that month, how often did you feel nervous? 

1 All of the time 

2 Most of the time 

3 Some of the time 

4 A little of the time 

5 None of the time 

DK/REF 

Response categories are the same for the following questions: 

DSHOPE During that same month when you were at your worst emotionally . . . how often 

did you feel hopeless? 

DSFIDG During that same month when you were at your worst emotionally . . . how often 

did you feel restless or fidgety? 

DSNOCHR During that same month when you were at your worst emotionally . . . how often 

did you feel so sad or depressed that nothing could cheer you up? 

DSEFFORT During that same month when you were at your worst emotionally . . . how often 

did you feel that everything was an effort? 

DSDOWN During that same month when you were at your worst emotionally . . . how often 

did you feel down on yourself, no good, or worthless? 
61 

Table A.1 Summary of 2002 NSDUH Suppression Rules 

Estimate Suppress if: 

Prevalence rate, pˆ , 

with nominal sample 

size, n, and design 

effect, deff

(1) The estimated prevalence rate, pˆ , is < 0.00005 or $ 0.99995, or 

(2) > 0.175 -ln( ˆ)

SE( ˆ) / ˆ

p

p p when pˆ ≤ 0.5 , or 

 > 0.175 -ln(1 - ˆ)

SE( ˆ) / (1 - ˆ)

p

p p when pˆ > 0.5 , or 

(3) Effective n < 68 , where deff

n Effective n = , or 

(4) n <100 . 

Note: The rounding portion of this suppression rule for prevalence rates will produce 

some estimates that round at one decimal place to 0.0 or 100.0 percent but are 

not suppressed from the tables. 

Estimated number 

(numerator of pˆ ) 

The estimated prevalence rate, pˆ , is suppressed. 

Note: In some instances when pˆ is not suppressed, the estimated number may appear 

as a 0 in the tables; this means that the estimate is > 0 but < 500 (estimated 

numbers are shown in thousands). 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
62 

Table A.2 Weighted Percentages and Sample Sizes for 2002 NSDUH, by Screening Result 

Code 

Sample 

Size

Weighted 

Percentage

Total Sample of Dwelling Units 178,013 100.00 

Ineligible cases 27,851 15.27 

Eligible cases 150,162 84.73 

Ineligibles 27,851 15.27 

Vacant 14,417 51.55 

Not a primary residence 4,580 17.36 

Not a dwelling unit 2,403 8.16 

Resident < 1/2 of quarter 0 0.00 

All military personnel 289 1.08 

Other, ineligible 6,162 21.86 

Eligible Cases 150,162 84.73 

Screening complete 136,349 90.72 

No one selected 80,557 53.14 

One selected 30,738 20.58 

Two selected 25,054 17.00 

Screening not complete 13,813 9.28 

No one home 3,031 2.02 

Respondent unavailable 411 0.26 

Physically or mentally incompetent 307 0.20 

Language barrier—Hispanic 66 0.05 

Language barrier—other 461 0.35 

Refusal 8,556 5.86 

Other, access denied 471 0.30 

Other, eligible 12 0.01 

Segment not accessible 0 0.00 

Screener not returned 15 0.01 

Fraudulent case 479 0.21 

Electronic screening problem 4 0.00 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
63 

Table A.3 Weighted Percentages and Sample Sizes for 2002 NSDUH, by Final Interview 

Code 

Persons Aged 

12 or Older 

Persons Aged 

12 to 17 

Persons Aged 

18 or Older 

Final Interview Code

Sample 

Size 

Weighted 

Percentage 

Sample 

Size 

Weighted 

Percentage 

Sample 

Size 

Weighted 

Percentage 

Total 80,581 100.00 26,230 100.00 54,351 100.00 

Interview Complete 68,126 78.56 23,659 89.99 44,467 77.20 

No One at Dwelling Unit 1,359 1.81 182 0.70 1,177 1.94 

Respondent Unavailable 1,893 2.71 329 1.20 1,564 2.89 

Break-Off 48 0.10 9 0.04 39 0.11 

Physically/Mentally 

Incompetent 692 1.75 161 0.57 531 1.89 

Language Barrier - Spanish 138 0.19 9 0.04 129 0.21 

Language Barrier - Other 327 1.09 24 0.13 303 1.21 

Refusal 6,276 12.73 464 1.81 5,812 14.03 

Parental Refusal 1,307 0.55 1,307 5.15 0 0.00 

Other 415 0.52 86 0.38 329 0.53 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
64 

Table A.4 Response Rates and Sample Sizes for 2002 NSDUH, by Demographic 

Characteristics 

Selected 

Persons

Completed 

Interviews

Weighted 

Response Rate

Total 80,581 68,126 78.56%

Age in Years 

12-17 26,230 23,659 89.99% 

18-25 27,216 23,271 85.16% 

26 or older 27,135 21,196 75.81% 

Gender 

Male 39,453 32,766 77.06% 

Female 41,128 35,360 79.99% 

Race/Ethnicity 

Hispanic 10,250 8,692 80.93% 

White 55,594 46,834 78.23% 

Black 9,385 8,143 82.24% 

All other races 5,352 4,457 70.50% 

Region 

Northeast 16,490 13,706 75.57% 

Midwest 22,588 19,180 80.01% 

South 24,530 20,900 79.99% 

West 16,973 14,340 77.33% 

County Type 

Large metropolitan 32,294 26,792 76.85% 

Small metropolitan 28,121 23,944 79.50% 

Nonmetropolitan 20,166 17,390 81.38% 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
65 

Appendix B: Selected Tables 
66

31212 (6A)

Table B.1a Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Numbers in T

 SERIOUS MENTAL ILL

Demographic Characteristic Total Yes TOTAL 210,390 17,483 AGE 

18-25 31,024 4,085 26-49 100,287 9,534 50 or Older 79,079 3,865 

GENDER Male 100,955 6,041  Female 109,435 11,442 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 185,241 15,760  White 149,860 12,639  Black or African American 23,191 2,032  American Indian or Alaska Native 1,290 161  Native Hawaiian or Other Pacific Islander 731 40  Asian 8,048 600  Two or More Races 2,120 289  Hispanic or Latino 25,149 1,724 EDUCATION < High School 37,226 3,591  High School Graduate 67,985 5,839  Some College 52,574 4,991  College Graduate 52,605 3,062 CURRENT EMPLOYMENT Full-Time 116,508 8,453  Part-Time 27,442 2,664  Unemployed 7,585 1,078  Other2 58,854 5,289 *Low precision; no estimate reported. 1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
67

31212 (6B)

Table B.1b Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Percentage D

 SERIOUS MENTAL ILL

Demographic Characteristic Total Yes TOTAL 100.0 100.0 AGE 

18-25 14.7 23.4 26-49 47.7 54.5 50 or Older 37.6 22.1 

GENDER Male 48.0 34.6  Female 52.0 65.4 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 88.0 90.1  White 71.2 72.3  Black or African American 11.0 11.6  American Indian or Alaska Native 0.6 0.9  Native Hawaiian or Other Pacific Islander 0.3 0.2  Asian 3.8 3.4  Two or More Races 1.0 1.7  Hispanic or Latino 12.0 9.9 EDUCATION < High School 17.7 20.5  High School Graduate 32.3 33.4  Some College 25.0 28.5  College Graduate 25.0 17.5 CURRENT EMPLOYMENT Full-Time 55.4 48.4  Part-Time 13.0 15.2  Unemployed 3.6 6.2  Other2 28.0 30.2 *Low precision; no estimate reported. 1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
68

 31212 (7A) 

Table B.2a Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Numbers in Th

 SERIOUS MENTAL ILL

Geographic Characteristic Total Yes TOTAL 210,390 17,483 GEOGRAPHIC DIVISION Northeast 40,604 3,441  New England 10,649 1,007  Middle Atlantic 29,955 2,434  Midwest 47,737 4,048  East North Central 33,428 2,831  West North Central 14,309 1,217  South 74,996 6,325  South Atlantic 39,364 3,353  East South Central 12,729 1,195  West South Central 22,903 1,777  West 47,052 3,669  Mountain 13,607 1,117  Pacific 33,445 2,552 COUNTY TYPE Large Metro 104,867 7,995  Small Metro 63,448 5,554  250K - 1 Mil. Pop. 46,216 3,983  < 250K Pop. 17,232 1,571  Nonmetro 42,075 3,934  Urbanized 13,311 1,117  Less Urbanized 24,110 2,408  Completely Rural 4,654 410 *Low precision; no estimate reported. 1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
69

 31212 (7B) 

Table B.2b Persons Aged 18 or Older, by Past Year Serious Mental Illness and Geographic Characteristics: Percentage Dist

 SERIOUS MENTAL ILL

Geographic Characteristic Total Yes TOTAL 100.0 100.0 GEOGRAPHIC DIVISION Northeast 19.3 19.7  New England 5.1 5.8  Middle Atlantic 14.2 13.9  Midwest 22.7 23.2  East North Central 15.9 16.2  West North Central 6.8 7.0  South 35.6 36.2  South Atlantic 18.7 19.2  East South Central 6.1 6.8  West South Central 10.9 10.2  West 22.4 21.0  Mountain 6.5 6.4  Pacific 15.9 14.6 COUNTY TYPE Large Metro 49.8 45.7  Small Metro 30.2 31.8  250K - 1 Mil. Pop. 22.0 22.8  < 250K Pop. 8.2 9.0  Nonmetro 20.0 22.5  Urbanized 6.3 6.4  Less Urbanized 11.5 13.8  Completely Rural 2.2 2.3 *Low precision; no estimate reported. 1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
70

30804 (6.2A)

Table B.3a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Demographic Char

Thousands, 2002 

 AGE GROUP (Years) 

Demographic Characteristic Total 18-25 26-49 TOTAL 17,483 4,085 9,534 GENDER Male 6,041 1,560 3,322  Female 11,442 2,525 6,211 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 15,760 3,486 8,667  White 12,639 2,744 7,010  Black or African American 2,032 466 1,089  American Indian or Alaska Native 161 35 69  Native Hawaiian or Other Pacific Islander 40 * *  Asian 600 154 344  Two or More Races 289 63 139  Hispanic or Latino 1,724 599 867 EDUCATION < High School 3,591 944 1,506  High School Graduate 5,839 1,363 3,027  Some College 4,991 1,362 2,751  College Graduate 3,062 416 2,250 CURRENT EMPLOYMENT Full-Time 8,453 1,795 5,733  Part-Time 2,664 1,042 1,210  Unemployed 1,078 395 557  Other1 5,289 853 2,033 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
71

30804 (6.2B)

Table B.3b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Demographic Char

2002 

 AGE GROUP (Years) 

Demographic Characteristic Total 18-25 26-49 TOTAL 8.3 13.2 9.5 GENDER Male 6.0 10.0 6.7  Female 10.5 16.3 12.2 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 8.5 13.7 10.1  White 8.4 14.2 10.4  Black or African American 8.8 11.5 9.2  American Indian or Alaska Native 12.5 16.1 11.1  Native Hawaiian or Other Pacific Islander 5.4 * *  Asian 7.5 11.2 7.5  Two or More Races 13.6 15.7 13.8  Hispanic or Latino 6.9 10.9 6.1 EDUCATION < High School 9.6 13.7 10.9  High School Graduate 8.6 12.9 9.8  Some College 9.5 13.9 10.6  College Graduate 5.8 11.0 7.6 CURRENT EMPLOYMENT Full-Time 7.3 12.4 7.9  Part-Time 9.7 13.2 11.4  Unemployed 14.2 16.1 14.2  Other1 9.0 13.8 15.5 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
72

 30812 (6.3A) 

Table B.4a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Geographic Charac

Thousands, 2002 

 AGE GROUP (Years) 

Geographic Characteristic Total 18-25 26-49 TOTAL 17,483 4,085 9,534 GEOGRAPHIC DIVISION Northeast 3,441 784 1,943  New England 1,007 215 524  Middle Atlantic 2,434 569 1,419  Midwest 4,048 926 2,209  East North Central 2,831 619 1,588  West North Central 1,217 307 621  South 6,325 1,375 3,357  South Atlantic 3,353 647 1,763  East South Central 1,195 255 695  West South Central 1,777 473 900  West 3,669 1,000 2,024  Mountain 1,117 317 578  Pacific 2,552 683 1,446 COUNTY TYPE Large Metro 7,995 1,869 4,656  Small Metro 5,554 1,453 2,977  250K - 1 Mil. Pop. 3,983 979 2,151  <250K Pop. 1,571 474 827  Nonmetro 3,934 763 1,900  Urbanized 1,117 276 546  Less Urbanized 2,408 423 1,138  Completely Rural 410 63 216 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
73

 30812 (6.3B) 

Table B.4b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Geographic Charac

2002 

 AGE GROUP (Years) 

Geographic Characteristic Total 18-25 26-49 TOTAL 8.3 13.2 9.5 GEOGRAPHIC DIVISION Northeast 8.5 14.2 10.1  New England 9.5 15.0 10.3  Middle Atlantic 8.1 14.0 10.1  Midwest 8.5 12.9 9.8  East North Central 8.5 12.4 10.0  West North Central 8.5 13.8 9.4  South 8.4 12.5 9.5  South Atlantic 8.5 12.0 9.5  East South Central 9.4 13.4 11.7  West South Central 7.8 12.7 8.1  West 7.8 13.7 8.8  Mountain 8.2 14.5 8.9  Pacific 7.6 13.4 8.7 COUNTY TYPE Large Metro 7.6 12.7 8.8  Small Metro 8.8 13.9 10.2  250K - 1 Mil. Pop. 8.6 13.2 10.0  <250K Pop. 9.1 15.6 10.6  Nonmetro 9.4 13.1 10.6  Urbanized 8.4 13.0 9.0  Less Urbanized 10.0 13.4 11.4  Completely Rural 8.8 12.2 11.3 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
74

40316 (12A)

Table B.5a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and by Socioeconomic a

Characteristics: Numbers in Thousands, 2002 

 AGE GROUP (Years) 

Socioeconomic/Health Characteristic Total 18-25 26-49 

MARITAL STATUS Married 6,681 562 4,449  Widowed 842 * 107  Divorced or Separated 3,716 173 2,560  Never Married 6,244 3,343 2,419 FAMILY INCOME Less Than $20,000 5,415 1,467 2,405  $20,000 to $49,999 6,767 1,537 3,707  $50,000 to $74,999 2,612 530 1,684  $75,000 or More 2,689 551 1,738 HEALTH INSURANCE1 Private 10,562 2,317 6,071  Medicaid/CHIP2 2,356 477 1,242  Other3 1,176 181 396  No Coverage 3,389 1,110 1,824 OVERALL HEALTH Excellent 2,664 762 1,632  Very Good 5,183 1,675 2,985  Good 5,303 1,275 2,919  Fair/Poor 4,331 373 1,996 SOCIAL SUPPORT4 Yes 14,299 3,491 7,905  No 3,172 590 1,621 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Priva2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan. 3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance. 4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concern

interests and activities, or who really like and care about them. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
75

40316 (12B)

Table B.5b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and by Socioeconomic a

Characteristics: Percentages, 2002 

 AGE GROUP (Years) 

Socioeconomic/Health Characteristic Total 18-25 26-49 

MARITAL STATUS Married 5.6 11.4 7.1  Widowed 6.2 * 9.8  Divorced or Separated 13.0 25.5 16.0  Never Married 12.7 13.2 11.9 FAMILY INCOME Less Than $20,000 13.1 14.3 16.3  $20,000 to $49,999 8.4 13.0 9.9  $50,000 to $74,999 6.9 12.3 8.1  $75,000 or More 5.4 12.0 6.4 HEALTH INSURANCE1 Private 6.8 12.2 8.1  Medicaid/CHIP2 17.2 15.5 20.7  Other3 8.1 16.3 11.2  No Coverage 12.2 14.3 11.7 OVERALL HEALTH Excellent 5.1 8.0 5.8  Very Good 6.7 13.4 7.7  Good 9.6 17.1 11.7  Fair/Poor 16.9 23.6 24.6 SOCIAL SUPPORT4 Yes 7.6 12.5 8.8  No 15.2 19.6 15.6 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Priva2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan. 3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance. 4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concern

interests and activities, or who really like and care about them. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
76

 31212 (8A) 

Table B.6a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and D

Characteristics: Numbers in Thousands, 2002 

ANY ILLICIT DRUG 

Demographic Characteristic Total Yes TOTAL 17,483 5,061 AGE  18-25 4,085 1,965  26-49 9,534 2,730  50 or Older 3,865 366 GENDER Male 6,041 2,282  Female 11,442 2,779 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 15,760 4,492  White 12,639 3,751  Black or African American 2,032 547  American Indian or Alaska Native 161 39  Native Hawaiian or Other Pacific Islander 40 16  Asian 600 53  Two or More Races 289 86  Hispanic 1,724 569 EDUCATION < High School 3,591 1,115  High School Graduate 5,839 1,516  Some College 4,991 1,724  College Graduate 3,062 705 CURRENT EMPLOYMENT Full-Time 8,453 2,562  Part-Time 2,664 829  Unemployed 1,078 548  Other2 5,289 1,122 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
77

 31212 (8B) 

Table B.6b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and D

Characteristics: Percentage Distributions, 2002 

ANY ILLICIT DRUG 

Demographic Characteristic Total Yes TOTAL 100.0 100.0 AGE  18-25 23.4 38.8  26-49 54.5 53.9  50 or Older 22.1 7.2 GENDER Male 34.6 45.1  Female 65.4 54.9 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 90.1 88.8  White 72.3 74.1  Black or African American 11.6 10.8  American Indian or Alaska Native 0.9 0.8  Native Hawaiian or Other Pacific Islander 0.2 0.3  Asian 3.4 1.1  Two or More Races 1.7 1.7  Hispanic 9.9 11.2 EDUCATION < High School 20.5 22.0  High School Graduate 33.4 30.0  Some College 28.5 34.1  College Graduate 17.5 13.9 CURRENT EMPLOYMENT Full-Time 48.4 50.6  Part-Time 15.2 16.4  Unemployed 6.2 10.8  Other2 30.2 22.2 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
78

 31212 (9A) 

Table B.7a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and G

Characteristics: Numbers in Thousands, 2002 

ANY ILLICIT DRUG 

Geographic Characteristic Total Yes TOTAL 17,483 5,061 GEOGRAPHIC DIVISION Northeast 3,441 1,093  New England 1,007 326  Middle Atlantic 2,434 767  Midwest 4,048 1,054  East North Central 2,831 757  West North Central 1,217 297  South 6,325 1,662  South Atlantic 3,353 847  East South Central 1,195 288  West South Central 1,777 527  West 3,669 1,252  Mountain 1,117 329  Pacific 2,552 923 COUNTY TYPE Large Metro 7,995 2,474  Small Metro 5,554 1,759  250K - 1 Mil. Pop. 3,983 1,226  < 250K Pop. 1,571 534  Nonmetro 3,934 828  Urbanized 1,117 266  Less Urbanized 2,408 500  Completely Rural 410 62 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
79

 31212 (9B) 

Table B.7b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Any Illicit Drug Use and G

Characteristics: Percentage Distributions, 2002 

ANY ILLICIT DRUG 

Geographic Characteristic Total Yes TOTAL 100.0 100.0 GEOGRAPHIC DIVISION Northeast 19.7 21.6  New England 5.8 6.4  Middle Atlantic 13.9 15.1  Midwest 23.2 20.8  East North Central 16.2 15.0  West North Central 7.0 5.9  South 36.2 32.8  South Atlantic 19.2 16.7  East South Central 6.8 5.7  West South Central 10.2 10.4  West 21.0 24.7  Mountain 6.4 6.5  Pacific 14.6 18.2 COUNTY TYPE Large Metro 45.7 48.9  Small Metro 31.8 34.8  250K - 1 Mil. Pop. 22.8 24.2  < 250K Pop. 9.0 10.5  Nonmetro 22.5 16.4  Urbanized 6.4 5.2  Less Urbanized 13.8 9.9  Completely Rural 2.3 1.2 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
80

40316 (13A)

Table B.8a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and 

Health Characteristics: Numbers in Thousands, 2002 

 ANY ILLICIT DRUG 

Socioeconomic/Health Characteristic Total Yes 

MARITAL STATUS Married 6,681 1,258  Widowed 842 *  Divorced or Separated 3,716 1,180  Never Married 6,244 2,586 FAMILY INCOME Less Than $20,000 5,415 1,683  $20,000 to $49,999 6,767 2,036  $50,000 to $74,999 2,612 651  $75,000 or More 2,689 691 HEALTH INSURANCE2 Private 10,562 2,714  Medicaid/CHIP3 2,356 595  Other4 1,176 268  No Coverage 3,389 1,483 OVERALL HEALTH Excellent 2,664 757  Very Good 5,183 1,679  Good 5,303 1,573  Fair/Poor 4,331 1,051 SOCIAL SUPPORT5 Yes 14,299 4,174  No 3,172 883 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 2 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Priva3 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan. 4 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance. 5 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concern

interests and activities, or who really like and care about them. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
81

40316 (13B)

Table B.8b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and 

Health Characteristics: Percentages, 2002 

 ANY ILLICIT DRU

Socioeconomic/Health Characteristic Total Yes 

MARITAL STATUS Married 5.6 13.6  Widowed 6.2 *  Divorced or Separated 13.0 24.9  Never Married 12.7 16.9 FAMILY INCOME Less Than $20,000 13.1 21.5  $20,000 to $49,999 8.4 18.0  $50,000 to $74,999 6.9 13.6  $75,000 or More 5.4 12.1 HEALTH INSURANCE2 Private 6.8 14.5  Medicaid/CHIP3 17.2 23.5  Other4 8.1 23.8  No Coverage 12.2 20.6 OVERALL HEALTH Excellent 5.1 11.4  Very Good 6.7 14.6  Good 9.6 19.1  Fair/Poor 16.9 32.4 SOCIAL SUPPORT5 Yes 7.6 15.6  No 15.2 30.4 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited on

See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 2 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Priva3 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan. 4 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance. 5 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concern

interests and activities, or who really like and care about them. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
82

 30812 (6.8A)

Table B.9a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and 

Characteristics: Numbers in Thousands, 2002 

 ANY ILLICIT DRU

Demographic Characteristic Total Yes TOTAL 17,483 5,061 AGE  18-25 4,085 1,965  26-49 9,534 2,730  50 or Older 3,865 366 GENDER Male 6,041 2,282  Female 11,442 2,779 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 15,760 4,492  White 12,639 3,751  Black or African American 2,032 547  American Indian or Alaska Native 161 *  Native Hawaiian or Other Pacific Islander 40 *  Asian 600 53  Two or More Races 289 *  Hispanic or Latino 1,724 569 EDUCATION < High School 3,591 1,115  High School Graduate 5,839 1,516  Some College 4,991 1,724  College Graduate 3,062 705 CURRENT EMPLOYMENT Full-Time 8,453 2,562  Part-Time 2,664 829  Unemployed 1,078 548  Other2 5,289 1,122 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
83

 30812 (6.8B)

Table B.9b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Any Illicit Drug Use and 

Characteristics: Percentages, 2002 

 ANY ILLICIT DRU

Demographic Characteristic Total Yes TOTAL 8.3 17.1 AGE  18-25 13.2 17.9  26-49 9.5 17.0  50 or Older 4.9 14.0 GENDER Male 6.0 13.3  Female 10.5 22.2 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 8.5 17.2  White 8.4 17.9  Black or African American 8.8 14.3  American Indian or Alaska Native 12.5 *  Native Hawaiian or Other Pacific Islander 5.4 *  Asian 7.5 9.3  Two or More Races 13.6 *  Hispanic or Latino 6.9 16.0 EDUCATION < High School 9.6 19.8  High School Graduate 8.6 16.0  Some College 9.5 19.9  College Graduate 5.8 11.9 CURRENT EMPLOYMENT Full-Time 7.3 14.6  Part-Time 9.7 16.2  Unemployed 14.2 24.7  Other2 9.0 23.3 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
84

 30812 (6.4A) 

Table B.10a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Use of Illicit Drugs: Num

ILLICIT DRUG USE 

Drug Yes NAny Illicit Drug1 5,061 12,4 Marijuana and Hashish 3,653 13, Cocaine 1,187 16,2 Crack 435 17, Heroin * 17, Hallucinogens 751 16, LSD 127 17, PCP * 17,4 Ecstasy 540 16, Inhalants 207 17, Nonmedical Use of Any Psychotherapeutic2 2,707 14, Pain Relievers 2,040 15,4 Tranquilizers 1,136 16, Stimulants 730 16, Methamphetamine 418 17, Sedatives 283 17, Any Illicit Drug Other Than Marijuana1 3,500 13,*Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 

Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic u

2 Nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; does not include over-the-counter drugs. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
85

 30812 (6.4B) 

Table B.10b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Use of Illicit Drugs: Perc

ILLICIT DRUG USE 

Drug Yes NAny Illicit Drug1 17.1 6 Marijuana and Hashish 16.7 7 Cocaine 22.0 7 Crack 29.9 8 Heroin * 8 Hallucinogens 19.7  LSD 18.6 8 PCP * 8 Ecstasy 20.6  Inhalants 20.6 8 Nonmedical Use of Any Psychotherapeutic2 21.8 7 Pain Relievers 22.4 7 Tranquilizers 26.5 7 Stimulants 28.8  Methamphetamine 31.8 8 Sedatives 33.6  Any Illicit Drug Other Than Marijuana1 20.5 7*Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 

Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic u

2 Nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; does not include over-the-counter drugs. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
86

 30812 (6.6A)

Table B.11a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year and Past Month Tobacco 

Numbers in Thousands, 2002 

TOBACCO/ALCOHOL USE 

Drug Yes NPAST YEAR Any Tobacco1 9,357 8,1 Cigarettes 8,628 8,8 Smokeless Tobacco 825 16,6 Cigars 2,604 14,8 Pipes --  Alcohol 12,428 5,0 Binge Alcohol Use2 --  Heavy Alcohol Use2 -- PAST MONTH Any Tobacco1 8,428 9,0 Cigarettes 7,886 9,5 Smokeless Tobacco 575 16,9 Cigars 1,287 16,1 Pipes 219 17,2 Alcohol 9,234 8,2 Binge Alcohol Use2 5,037 12,4 Heavy Alcohol Use2 1,696 15,7*Low precision; no estimate reported. -- Not available. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Tobacco product includes cigarettes, smokeless tobacco (i.e., chewing tobacco or snuff), cigars, or pipe tobacco. Any Tobacco use in the past 

tobacco use, but includes past month pipe tobacco use. 

2 Binge Alcohol Use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) 

30 days. Heavy Alcohol Use is defined as drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days; all HeaBinge Alcohol Users. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
87

 30812 (6.6B)

Table B.11b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year and Past Month Tobacco 

Percentages, 2002 

TOBACCO/ALCOHOL USE 

Drug Yes NPAST YEAR Any Tobacco1 11.9 6. Cigarettes 13.0 6. Smokeless Tobacco 8.7 8. Cigars 11.1 8. Pipes -- - Alcohol 8.5 8. Binge Alcohol Use2 -- - Heavy Alcohol Use2 -- -PAST MONTH Any Tobacco1 12.4 6. Cigarettes 13.6 6. Smokeless Tobacco 7.9 8. Cigars 11.1 8. Pipes 13.0 8. Alcohol 8.0 8. Binge Alcohol Use2 9.8 7. Heavy Alcohol Use2 11.1 8.*Low precision; no estimate reported. -- Not available. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Tobacco product includes cigarettes, smokeless tobacco (i.e., chewing tobacco or snuff), cigars, or pipe tobacco. Any Tobacco use in the past 

tobacco use, but includes past month pipe tobacco use. 

2 Binge Alcohol Use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) 

30 days. Heavy Alcohol Use is defined as drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days; all HeaBinge Alcohol Users. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
88

40205 (33A)

Table B.12a Serious Mental Illness and/or a Substance Use Disorder among Persons Aged 18 or Older with a Serious Mental 

Use Disorder in the Past Year: Numbers in Thousands, 2002 

Serious Mental Illness/Substance Use Disorder Number 

Serious Mental Illness or Substance Use Disorder1,2 33,232  Serious Mental Illness Only1 13,435  Substance Use Disorder Only2 15,749  Serious Mental Illness and Substance Use Disorder1,2 4,048 *Low precision; no estimate reported. NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychothe1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnost

Mental Disorders (DSM-IV). 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
89

40205 (33B)

Table B.12b Serious Mental Illness and/or a Substance Use Disorder among Persons Aged 18 or Older with a Serious Mental 

Use Disorder in the Past Year: Percentage Distributions, 2002 

Serious Mental Illness/Substance Use Disorder Percentage 

Serious Mental Illness or Substance Use Disorder1,2 100.0  Serious Mental Illness Only1 40.4  Substance Use Disorder Only2 47.4  Serious Mental Illness and Substance Use Disorder1,2 12.2 *Low precision; no estimate reported. NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychothe1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnost

Mental Disorders (DSM-IV). 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
90

 30812 (6.11A) 

Table B.13a Substance Dependence or Abuse in the Past Year among Persons Aged 18 or Older, by Past Year Serious Menta

Thousands, 2002 

 SERIOUS MENTAL 

Dependence/Abuse Total Yes DEPENDENCE OR ABUSE2 Any Illicit Drug3 5,740 1,671  Marijuana 3,239 883  Any Illicit Drug Other Than Marijuana3 3,146 1,050  Alcohol 16,647 3,155  Any Illicit Drug or Alcohol3 19,797 4,048  Any Illicit Drug and Alcohol3 2,590 779 DEPENDENCE2 Any Illicit Drug3 3,855 1,260  Marijuana 2,006 573  Any Illicit Drug Other Than Marijuana3 2,052 790  Alcohol 7,695 2,013  Any Illicit Drug or Alcohol3 10,425 2,836  Any Illicit Drug and Alcohol3 1,125 438 *Low precision; no estimate reported. 1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

2 Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).3 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 

Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic u

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
91

 30812 (6.11B) 

Table B.13b Substance Dependence or Abuse in the Past Year among Persons Aged 18 or Older, by Past Year Serious Menta

2002 

 SERIOUS MENTAL 

Dependence/Abuse Total Yes DEPENDENCE OR ABUSE2 Any Illicit Drug3 2.7 9.6  Marijuana 1.5 5.1  Any Illicit Drug Other Than Marijuana3 1.5 6.0  Alcohol 7.9 18.0  Any Illicit Drug or Alcohol3 9.4 23.2  Any Illicit Drug and Alcohol3 1.2 4.5 DEPENDENCE2 Any Illicit Drug3 1.8 7.2  Marijuana 1.0 3.3  Any Illicit Drug Other Than Marijuana3 1.0 4.5  Alcohol 3.7 11.5  Any Illicit Drug or Alcohol3 5.0 16.2  Any Illicit Drug and Alcohol3 0.5 2.5 *Low precision; no estimate reported. 1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

2 Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).3 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 

Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic u

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
92

 31212 (10A) 

Table B.14a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder an

Characteristics: Numbers in Thousands, 2002 

Substance Use Disor

Demographic Characteristic Total Yes TOTAL 17,483 4,048 AGE  18-25 4,085 1,471  26-49 9,534 2,220  50 or Older 3,865 357 GENDER Male 6,041 2,109  Female 11,442 1,939 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 15,760 3,613  White 12,639 2,922  Black or African American 2,032 516  American Indian or Alaska Native 161 31  Native Hawaiian or Other Pacific Islander 40 7  Asian 600 69  Two or More Races 289 68  Hispanic or Latino 1,724 435 EDUCATION < High School 3,591 910  High School Graduate 5,839 1,349  Some College 4,991 1,176  College Graduate 3,062 613 CURRENT EMPLOYMENT Full-Time 8,453 2,114  Part-Time 2,664 679  Unemployed 1,078 410  Other2 5,289 845 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychother1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnost

Mental Disorders (DSM-IV). 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
93

 31212 (10B) 

Table B.14b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder an

Characteristics: Percentage Distributions, 2002 

Substance Use Disor

Demographic Characteristic Total Yes 

TOTAL 100.0 100.0 AGE  18-25 23.4 36.3  26-49 54.5 54.8  50 or Older 22.1 8.8 GENDER Male 34.6 52.1  Female 65.4 47.9 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 90.1 89.3  White 72.3 72.2  Black or African American 11.6 12.8  American Indian or Alaska Native 0.9 0.8  Native Hawaiian or Other Pacific Islander 0.2 0.2  Asian 3.4 1.7  Two or More Races 1.7 1.7  Hispanic or Latino 9.9 10.7 EDUCATION < High School 20.5 22.5  High School Graduate 33.4 33.3  Some College 28.5 29.1  College Graduate 17.5 15.1 CURRENT EMPLOYMENT Full-Time 48.4 52.2  Part-Time 15.2 16.8  Unemployed 6.2 10.1  Other2 30.2 20.9 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychother1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnost

Mental Disorders (DSM-IV). 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
94

 31212 (11A) 

Table B.15a Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder an

Characteristics: Numbers in Thousands, 2002 

Substance Use Disor

Geographic Characteristic Total Yes TOTAL 17,483 4,048 GEOGRAPHIC DIVISION Northeast 3,441 905  New England 1,007 291  Middle Atlantic 2,434 614  Midwest 4,048 878  East North Central 2,831 632  West North Central 1,217 246  South 6,325 1,487  South Atlantic 3,353 718  East South Central 1,195 286  West South Central 1,777 484  West 3,669 777  Mountain 1,117 261  Pacific 2,552 516 COUNTY TYPE Large Metro 7,995 1,859  Small Metro 5,554 1,369  250K - 1 Mil. Pop. 3,983 940  < 250K Pop. 1,571 429  Nonmetro 3,934 820  Urbanized 1,117 240  Less Urbanized 2,408 528  Completely Rural 410 52 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychother1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnost

Mental Disorders (DSM-IV). 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
95

 31212 (11B) 

Table B.15b Persons Aged 18 or Older with Serious Mental Illness in the Past Year, by Past Year Substance Use Disorder an

Characteristics: Percentage Distributions, 2002 

Substance Use Disor

Geographic Characteristic Total Yes TOTAL 100.0 100.0 GEOGRAPHIC DIVISION Northeast 19.7 22.4  New England 5.8 7.2  Middle Atlantic 13.9 15.2  Midwest 23.2 21.7  East North Central 16.2 15.6  West North Central 7.0 6.1  South 36.2 36.7  South Atlantic 19.2 17.7  East South Central 6.8 7.1  West South Central 10.2 12.0  West 21.0 19.2  Mountain 6.4 6.5  Pacific 14.6 12.7 COUNTY TYPE Large Metro 45.7 45.9  Small Metro 31.8 33.8  250K - 1 Mil. Pop. 22.8 23.2  < 250K Pop. 9.0 10.6  Nonmetro 22.5 20.3  Urbanized 6.4 5.9  Less Urbanized 13.8 13.1  Completely Rural 2.3 1.3 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychother1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnost

Mental Disorders (DSM-IV). 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
96

31212 (3A) Table B.16a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Use Disorder, G

Numbers in Thousands, 2002 

Substance Use Disorder

Gender/Age Total Yes TOTAL 17,483 4,048  18-25 4,085 1,471  26-49 9,534 2,220  50 or Older 3,865 357 MALE 6,041 2,109  18-25 1,560 700  26-49 3,322 1,138  50 or Older 1,159 270 FEMALE 11,442 1,939  18-25 2,525 770  26-49 6,211 1,082  50 or Older 2,706 * *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one activities. See Section A.7 of Appendix A of this report. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychother1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnost

Mental Disorders (DSM-IV). 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
97

31212 (3B) Table B.16b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Use Disorder, G

Percentages, 2002 

Substance Use Disorder

Gender/Age Total Yes TOTAL 8.3 20.4  18-25 13.2 21.8  26-49 9.5 21.2  50 or Older 4.9 13.8 MALE 6.0 15.7  18-25 10.0 16.3  26-49 6.7 16.0  50 or Older 3.2 13.6 FEMALE 10.5 30.3  18-25 16.3 31.7  26-49 12.2 32.2  50 or Older 6.3 * *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one activities. See Section A.7 of Appendix A of this report. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychother1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnost

Mental Disorders (DSM-IV). 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
98

 30812 (6.10A) 

Table B.17a Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Dependence o

Thousands, 2002 

 DEPENDENCE1 DEPENDE

Dependence/Abuse Total Yes No Yes Any Illicit Drug2 17,483 1,260 16,223 1,671  Marijuana 17,483 573 16,910 883  Any Illicit Drug Other Than Marijuana2 17,483 790 16,693 1,050 Alcohol 17,483 2,013 15,471 3,155 Any Illicit Drug or Alcohol2 17,483 2,836 14,648 4,048 Any Illicit Drug and Alcohol2 17,483 438 17,046 779 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 2 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 

Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic u

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
99

 30812 (6.10B) 

Table B.17b Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Past Year Substance Dependence o

2002 

 DEPENDENCE1 DEPENDE

Dependence/Abuse Total Yes No Yes Any Illicit Drug2 8.3 32.7 7.9 29.1  Marijuana 8.3 28.6 8.1 27.3  Any Illicit Drug Other Than Marijuana2 8.3 38.5 8.0 33.4 Alcohol 8.3 26.2 7.6 19.0 Any Illicit Drug or Alcohol2 8.3 27.2 7.3 20.4 Any Illicit Drug and Alcohol2 8.3 38.9 8.1 30.1 *Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Dependence or Abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 2 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 

Illicit Drug Other Than Marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic u

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
100

31205 (30A)

Table B.18a Persons Aged 18 or Older with Serious Mental Illness, by Receipt of Mental Health Treatment/Counseling and D

Geographic Characteristics: Numbers in Thousands, 2002 

 MENTAL HEALTH TREATMENT/COUNSELING

Demographic/Geographic Characteristic Received Not ReTOTAL 8,355 9,0AGE 

18-25 1,394 2,626-49 5,173 4,350 or Older 1,787 2,0

GENDER Male 2,376 3,6 Female 5,978 5,4HISPANIC ORIGIN AND RACE Not Hispanic or Latino 7,703 8,0 White 6,547 6,0 Black or African American 750 1,2 Hispanic or Latino 651 1,0EDUCATION < High School 1,404 2,1 High School Graduate 2,631 3,1 Some College 2,576 2,4 College Graduate 1,743 1,3CURRENT EMPLOYMENT Full-Time 3,796 4,6 Part-Time 1,346 1,3 Unemployed 457 6 Other2 2,756 2,5GEOGRAPHIC DIVISION Northeast 1,745 1,6 Midwest 1,912 2,1 South 2,999 3,3 West 1,699 1,9COUNTY TYPE Large Metro 3,681 4,2 Small Metro 2,879 2,6 Nonmetro 1,795 2,1*Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems wi

mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are e

2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
101

31205 (30B)

Table B.18b Persons Aged 18 or Older with Serious Mental Illness, by Receipt of Mental Health Treatment/Counseling and D

Geographic Characteristics: Percentage Distributions, 2002 

 MENTAL HEALTH TREATMENT/COUNSELING

Demographic/Geographic Characteristic Received Not ReTOTAL 100.0 10AGE 

18-25 16.7 226-49 61.9 450 or Older 21.4 2

GENDER Male 28.4 4 Female 71.6 5HISPANIC ORIGIN AND RACE Not Hispanic or Latino 92.2 8 White 78.4 6 Black or African American 9.0 14 Hispanic or Latino 7.8 1EDUCATION < High School 16.8 2 High School Graduate 31.5 3 Some College 30.8 2 College Graduate 20.9 1CURRENT EMPLOYMENT Full-Time 45.4 5 Part-Time 16.1 14 Unemployed 5.5  Other2 33.0 2GEOGRAPHIC DIVISION Northeast 20.9 1 Midwest 22.9 2 South 35.9 3 West 20.3 2COUNTY TYPE Large Metro 44.1 4 Small Metro 34.5 2 Nonmetro 21.5 2*Low precision; no estimate reported. NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for problems wi

mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling information are e

2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
102

 30804 (6.20A)

Table B.19a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year 

and Demographic Characteristics: Numbers in Thousands, 2002 

 SERIOUS MENTAL 

Demographic Characteristic Total Yes TOTAL 27,322 8,355 AGE  18-25 3,283 1,394  26-49 14,556 5,173  50 or Older 9,483 1,787 GENDER Male 8,784 2,376  Female 18,538 5,978 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 25,277 7,703  White 22,014 6,547  Black or African American 1,973 750  American Indian or Alaska Native 228 *  Native Hawaiian or Other Pacific Islander 29 *  Asian 682 *  Two or More Races 352 *  Hispanic or Latino 2,045 651 EDUCATION < High School 4,311 1,404  High School Graduate 7,912 2,631  Some College 7,528 2,576  College Graduate 7,571 1,743 CURRENT EMPLOYMENT Full-Time 13,090 3,796  Part-Time 3,901 1,346  Unemployed 1,077 457  Other2 9,255 2,756 *Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
103

 30804 (6.20B)

Table B.19b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year 

and Demographic Characteristics: Percentages, 2002 

 SERIOUS MENTAL 

Demographic Characteristic Total Yes TOTAL 13.0 47.9 AGE  18-25 10.6 34.2  26-49 14.6 54.4  50 or Older 12.0 46.4 GENDER Male 8.7 39.5  Female 17.0 52.3 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 13.7 49.0  White 14.7 51.9  Black or African American 8.5 36.9  American Indian or Alaska Native 17.8 *  Native Hawaiian or Other Pacific Islander 3.9 *  Asian 8.5 *  Two or More Races 16.6 *  Hispanic or Latino 8.2 37.8 EDUCATION < High School 11.7 39.3  High School Graduate 11.7 45.1  Some College 14.3 51.7  College Graduate 14.4 57.1 CURRENT EMPLOYMENT Full-Time 11.3 45.0  Part-Time 14.2 50.7  Unemployed 14.2 42.4  Other2 15.8 52.2 *Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
104

40316 (26A)

Table B.20a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Yea

by Age Group and by Socioeconomic and Health Characteristics: Numbers in Thousands, 2002 

 AGE GROUP (Years) 

Socioeconomic/Health Characteristic Total 18-25 26-49 

MARITAL STATUS Married 3,371 208 2,486  Widowed * * *  Divorced or Separated 2,272 * 1,583  Never Married 2,404 1,090 1,037 FAMILY INCOME Less Than $20,000 2,457 496 1,310  $20,000 to $49,999 3,270 520 1,970  $50,000 to $74,999 1,345 162 950  $75,000 or More 1,283 217 943 HEALTH INSURANCE1 Private 5,354 875 3,408  Medicaid/CHIP2 1,297 191 808  Other3 598 69 *  No Coverage 1,105 258 674 OVERALL HEALTH Excellent 1,026 240 685  Very Good 2,408 576 1,606  Good 2,502 426 1,690  Fair/Poor 2,416 152 1,191 SOCIAL SUPPORT4 Received Social Support 6,960 1,211 4,393  Did Not Receive Social Support 1,386 183 772 *Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Priva

2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan. 3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance. 

4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concern

interests and activities, or who really like and care about them. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
105

40316 (26B)

Table B.20b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Yea

by Age Group and by Socioeconomic and Health Characteristics: Percentages, 2002 

 AGE GROUP (Years) 

Socioeconomic/Health Characteristic Total 18-25 26-49 

MARITAL STATUS Married 50.6 37.0 56.1  Widowed * * *  Divorced or Separated 61.1 * 61.9  Never Married 38.5 32.7 42.9 FAMILY INCOME Less Than $20,000 45.4 33.8 54.5  $20,000 to $49,999 48.5 33.9 53.3  $50,000 to $74,999 51.5 30.5 56.4  $75,000 or More 47.8 39.4 54.5 HEALTH INSURANCE1 Private 50.8 37.8 56.3  Medicaid/CHIP2 55.1 40.1 65.1  Other3 50.8 38.4 *  No Coverage 32.7 23.3 37.1 OVERALL HEALTH Excellent 38.7 31.5 42.3  Very Good 46.5 34.4 54.0  Good 47.2 33.4 57.9  Fair/Poor 56.0 41.2 59.7 SOCIAL SUPPORT4 Received Social Support 48.7 34.7 55.7  Did Not Receive Social Support 44.0 31.0 47.8 *Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Response categories are mutually exclusive. Respondents who reported both Private Health Insurance and Medicaid/CHIP are included in the Priva

2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan. 3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance. 

4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and concern

interests and activities, or who really like and care about them. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
106

 30813 (6.21A) 

Table B.21a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year 

and Geographic Characteristics: Numbers in Thousands, 2002 

 SERIOUS MENTAL 

Geographic Characteristic Total Yes TOTAL 27,322 8,355 GEOGRAPHIC DIVISION Northeast 5,597 1,745  New England 1,828 653  Middle Atlantic 3,769 1,092  Midwest 6,208 1,912  East North Central 4,192 1,330  West North Central 2,017 581  South 9,239 2,999  South Atlantic 4,846 1,594  East South Central 1,747 636  West South Central 2,646 769  West 6,278 1,699  Mountain 1,810 507  Pacific 4,468 1,191 COUNTY TYPE Large Metro 12,885 3,681  Small Metro 8,953 2,879  250K - 1 Mil. Pop. 6,628 2,027  <250K Pop. 2,325 852  Nonmetro 5,485 1,795  Urbanized 2,051 625  Less Urbanized 2,990 1,045  Completely Rural 443 * *Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
107

 30813 (6.21B) 

Table B.21b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year 

and Geographic Characteristics: Percentages, 2002 

 SERIOUS MENTAL 

Geographic Characteristic Total Yes TOTAL 13.0 47.9 GEOGRAPHIC DIVISION Northeast 13.8 50.7  New England 17.2 64.9  Middle Atlantic 12.6 44.9  Midwest 13.0 47.5  East North Central 12.6 47.4  West North Central 14.1 47.8  South 12.3 47.5  South Atlantic 12.3 47.6  East South Central 13.8 53.3  West South Central 11.6 43.5  West 13.4 46.3  Mountain 13.3 45.4  Pacific 13.4 46.7 COUNTY TYPE Large Metro 12.3 46.1  Small Metro 14.1 52.0  250K - 1 Mil. Pop. 14.4 51.1  <250K Pop. 13.5 54.2  Nonmetro 13.1 45.7  Urbanized 15.4 56.1  Less Urbanized 12.4 43.5  Completely Rural 9.6 * *Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th editi

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more m

Section A.7 of Appendix A of this report. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
108

 31117 (23A)

Table B.22a Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Yea

by Past Year Any Illicit Drug Use and Demographic Characteristics: Numbers in Thousands, 2002 

 ANY ILLICIT DRU

Demographic Characteristic Total Yes TOTAL 8,355 2,323 AGE  18-25 1,394 668  26-49 5,173 1,442  50 or Older 1,787 * GENDER Male 2,376 917  Female 5,978 1,406 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 7,703 2,116  White 6,547 1,813  Black or African American 750 *  American Indian or Alaska Native * *  Native Hawaiian or Other Pacific Islander * *  Asian * *  Two or More Races * *  Hispanic or Latino 651 * EDUCATION < High School 1,404 454  High School Graduate 2,631 651  Some College 2,576 819  College Graduate 1,743 400 CURRENT EMPLOYMENT Full-Time 3,796 1,045  Part-Time 1,346 422  Unemployed 457 *  Other2 2,756 601 *Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
109

 31117 (23B)

Table B.22b Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Yea

by Past Year Any Illicit Drug Use and Demographic Characteristics: Percentages, 2002 

 ANY ILLICIT DRU

Demographic Characteristic Total Yes TOTAL 47.9 46.0 AGE  18-25 34.2 34.1  26-49 54.4 52.8  50 or Older 46.4 * GENDER Male 39.5 40.3  Female 52.3 50.6 HISPANIC ORIGIN AND RACE Not Hispanic or Latino 49.0 47.2  White 51.9 48.4  Black or African American 36.9 *  American Indian or Alaska Native * *  Native Hawaiian or Other Pacific Islander * *  Asian * *  Two or More Races * *  Hispanic or Latino 37.8 * EDUCATION < High School 39.3 40.8  High School Graduate 45.1 43.0  Some College 51.7 47.5  College Graduate 57.1 56.7 CURRENT EMPLOYMENT Full-Time 45.0 40.8  Part-Time 50.7 50.9  Unemployed 42.4 *  Other2 52.2 53.7 *Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic 2 Retired person, disabled person, homemaker, student, or other person not in the labor force. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
110

40317 (31A) Table B.23a Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment at a Specialty Facility in the Pa

Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Numb

DISORDER 

Treatment 

SMI or Substance Use 

Disorder1,2 SMI Only1 

Substance Use Disorder 

Only2 

Mental Health or Specialty Substance  Treatment3 11,416 6,534 2,945  Mental Health Treatment Only 9,879 6,399 2,097  Specialty Substance Treatment  Only3 641 39 525  Mental Health and Specialty  Substance Treatment3 892 96 320 No Treatment 21,739 6,872 12,765 

*Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for proble

mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing mental health treatment/counseliexcept when information can be gained from responses regarding substance treatment. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychothera

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition 

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more ma

A.7 of Appendix A of this report. 2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic 

Mental Disorders (DSM-IV). 3 Received Substance Use Treatment at a Specialty Facility refers to treatment received at a hospital (inpatient), a rehabilitation facility (inpatient or ou

center in order to reduce or stop drug or alcohol use, or for medical problems associated with drug or alcohol use.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
111

40317 (31B) Table B.23b Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment at a Specialty Facility in the Pa

Aged 18 or Older with Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Percen

DISORDER 

Treatment 

SMI or Substance Use 

Disorder1,2 SMI Only1 

Substance Use Disorder 

Only2 

Mental Health or Specialty Substance  Treatment3 34.4 48.7 18.7  Mental Health Treatment Only 29.8 47.7 13.3  Specialty Substance Treatment  Only3 1.9 0.3 3.3  Mental Health and Specialty  Substance Treatment3 2.7 0.7 2.0 No Treatment 65.6 51.3 81.3 

*Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for proble

mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing mental health treatment/counseliexcept when information can be gained from responses regarding substance treatment. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychothera

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition 

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more ma

A.7 of Appendix A of this report. 2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic 

Mental Disorders (DSM-IV). 3 Received Substance Use Treatment at a Specialty Facility refers to treatment received at a hospital (inpatient), a rehabilitation facility (inpatient or ou

center in order to reduce or stop drug or alcohol use, or for medical problems associated with drug or alcohol use.

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
112

40317 (34A) Table B.24a Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment in the Past Year among Person

Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Numbers in Thousands, 2002 

DISORDER 

Treatment 

SMI or Substance Use 

Disorder1,2 SMI Only1 

Substance Use Disorder 

Only2 

Mental Health or Substance  Treatment3 11,842 6,560 3,306  Mental Health Treatment Only 9,722 6,386 2,024  Substance Treatment Only3 1,067 65 886  Mental Health and Substance  Treatment3 1,049 109 392 No Treatment 21,313 6,846 12,404 

*Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for proble

mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing mental health treatment/counseliexcept when information can be gained from responses regarding substance treatment. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychothera

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition 

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more ma

A.7 of Appendix A of this report. 2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic 

Mental Disorders (DSM-IV). 3 Received Substance Use Treatment refers to treatment received in order to reduce or stop drug or alcohol use, or for medical problems associated wit

includes treatment received at any location, such as a hospital, a rehabilitation facility (inpatient or outpatient), mental health center, emergency room

help group, or prison/jail. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
113

40317 (34B) Table B.24b Receipt of Mental Health Treatment/Counseling and/or Substance Use Treatment in the Past Year among Person

Past Year Serious Mental Illness and/or a Substance Use Disorder in the Past Year: Percentages, 2002 

DISORDER 

Treatment 

SMI or Substance Use 

Disorder1,2 SMI Only1 

Substance Use Disorder 

Only2 

Mental Health or Substance  Treatment3 35.7 48.9 21.0  Mental Health Treatment Only 29.3 47.6 12.9  Substance Treatment Only3 3.2 0.5 5.6  Mental Health and Substance  Treatment3 3.2 0.8 2.5 No Treatment 64.3 51.1 79.0 

*Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for proble

mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing mental health treatment/counseliexcept when information can be gained from responses regarding substance treatment. 

NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychothera

1 Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4th edition 

Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more ma

A.7 of Appendix A of this report. 2 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnostic 

Mental Disorders (DSM-IV). 3 Received Substance Use Treatment refers to treatment received in order to reduce or stop drug or alcohol use, or for medical problems associated wi

includes treatment received at any location, such as a hospital, a rehabilitation facility (inpatient or outpatient), mental health center, emergency room

help group, or prison/jail. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
114

40315 (32A)

Table B.25a Receipt of Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Ye

Illness, by Type of Past Year Substance Use Disorder: Numbers in Thousands, 2002 

SUBSTANCE USE DISORDER1 

Type of Substance Use Disorder Yes NAny Illicit Drug or Alcohol2 1,859 6,4 Alcohol Only 1,009 7,3 Any Illicit Drug Only2 477 7,8 Any Illicit Drug and Alcohol2 373 7,9*Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnos

Mental Disorders (DSM-IV). 2 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeuti

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
115

40315 (32B)

Table B.25b Receipt of Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older with Past Ye

Illness, by Type of Past Year Substance Use Disorder: Percentages, 2002 

SUBSTANCE USE DISORDER1 

Type of Substance Use Disorder Yes NAny Illicit Drug or Alcohol2 46.0 48 Alcohol Only 42.6 48 Any Illicit Drug Only2 53.6 47 Any Illicit Drug and Alcohol2 48.0 47*Low precision; no estimate reported. NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication for prob

or mental health. Respondents were not to include treatment for alcohol or drug use. Respondents with missing treatment/counseling inform

NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found in the 4

and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that substantially interfered with or limited onactivities. See Section A.7 of Appendix A of this report. 

1 Substance Use Disorder is defined as illicit drug or alcohol dependence or abuse and is based on definitions found in the 4th edition of the Diagnos

Mental Disorders (DSM-IV). 2 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeuti

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
116 

40205 

Table B.M1 Adjusted Odds Ratios from Logistic Regression Models for Past Year Serious Mental Illness 

among Adults Aged 18 or Older, by Sociodemographic and Substance Use Characteristics: 

2002 

Sociodemographic and Substance Use 

Characteristic Beta SE Beta P Value Odds Ratio 95% CI 

Age (χ2 = 83.0)† 

 18-25 0.9034 0.1166 < 0.0001 2.47 (1.96, 3.10) 

 26-49 0.8368 0.0920 < 0.0001 2.31 (1.93, 2.77) 

 50 or Older 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Gender (χ

2

 = 156.0)† 

 Female 0.7643 0.0612 < 0.0001 2.15 (1.90, 2.42) 

 Male 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Hispanic Origin and Race (χ2

 = 32.0)† 

 Black or African American -0.4218 0.1035 < 0.0001 0.66 (0.54, 0.80) 

 Hispanic or Latino -0.5189 0.1127 < 0.0001 0.60 (0.48, 0.74) 

 Other or Two or More Races -0.0581 0.1507 0.6999 0.94 (0.70, 1.27) 

 White 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Education (χ2

 = 12.9)† 

 < High School -0.2018 0.0973 0.0383 0.82 (0.68, 0.99) 

 High School Graduate -0.0777 0.0794 0.3279 0.93 (0.79, 1.08) 

 Some College 0.1037 0.0793 0.1911 1.11 (0.95, 1.30) 

 College Graduate 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Current Employment (χ2

 = 5.0) 

 Part-Time 0.0987 0.0792 0.2126 1.10 (0.94, 1.29) 

 Unemployed 0.1878 0.1156 0.1047 1.21 (0.96, 1.51) 

 Other1

 0.1342 0.0760 0.0779 1.14 (0.99, 1.33) 

 Full-Time 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Geographic Region (χ2 = 3.3) 

 Northeast 0.1545 0.0912 0.0905 1.17 (0.98, 1.40) 

 Midwest 0.0398 0.0790 0.6150 1.04 (0.89, 1.22) 

 South 0.0369 0.0769 0.6319 1.04 (0.89, 1.21) 

 West 0.0000 0.0000 . 1.00 (1.00, 1.00) 

County Type (χ

2

 = 5.2) 

 Large Metro -0.1700 0.0768 0.0272 0.84 (0.73, 0.98) 

 Small Metro -0.0838 0.0771 0.2777 0.92 (0.79, 1.07) 

 Nonmetro 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Marital Status (χ

2

 = 61.9)† 

 Widowed 0.0147 0.2038 0.9426 1.01 (0.68, 1.51) 

 Divorced or Separated 0.5694 0.0854 < 0.0001 1.77 (1.49, 2.09) 

 Never Married 0.4667 0.0825 < 0.0001 1.59 (1.36, 1.88) 

 Married 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Family Income (χ

2

 = 2.6) 

 Less Than $20,000 0.1695 0.1052 0.1076 1.18 (0.96, 1.46) 

 $20,000 to $49,999 0.1041 0.0862 0.2273 1.11 (0.94, 1.31) 

 $50,000 to $74,999 0.0808 0.1002 0.4202 1.08 (0.89, 1.32) 

 $75,000 or More 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Health Insurance (χ

2

 = 4.2) 

 Medicaid/CHIP2 0.1908 0.1003 0.0575 1.21 (0.99, 1.47) 

 Other3 0.1112 0.1413 0.4317 1.12 (0.85, 1.47) 

 No Coverage 0.0927 0.0810 0.2526 1.10 (0.94, 1.29) 

 Private 0.0000 0.0000 . 1.00 (1.00, 1.00) (continued)
117 

40205 

Table B.M1 Adjusted Odds Ratios from Logistic Regression Models for Past Year Serious Mental Illness 

among Adults Aged 18 or Older, by Sociodemographic and Substance Use Characteristics: 

2002 (continued) 

Sociodemographic and Substance Use 

Characteristic Beta SE Beta P Value Odds Ratio 95% CI 

Overall Health (χ

2

 = 216.6)† 

 Fair/Poor 1.4213 0.1087 < 0.0001 4.14 (3.35, 5.13) 

 Good 0.6468 0.0783 < 0.0001 1.91 (1.64, 2.23) 

 Very Good 0.2425 0.0771 0.0017 1.27 (1.10, 1.48) 

 Excellent 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Social Support4 (χ2 = 62.1)† 

 Not Received 0.6834 0.0868 < 0.0001 1.98 (1.67, 2.35) 

 Received 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Nicotine Dependence5 (χ2 = 31.2)† 

 Yes 0.4206 0.0754 < 0.0001 1.52 (1.31, 1.77) 

 No 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Any Illicit Drug Use/Dependence 

 or Abuse6,7 (χ2

 = 88.7)† 

 Any Illicit Drug Dependence or 

 Abuse 1.0112 0.1097 < 0.0001 2.75 (2.22, 3.41) 

 Any Illicit Drug Use and No 

 Dependence or Abuse 0.3555 0.0721 < 0.0001 1.43 (1.24, 1.64) 

 No Illicit Drug Use 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Alcohol Use/Dependence or 

 Abuse7

 (χ

2

 = 76.4)† 

 Alcohol Dependence or 

 Abuse 0.5735 0.0995 < 0.0001 1.77 (1.46, 2.16) 

 Alcohol Use and No 

 Dependence or Abuse -0.1116 0.0709 0.1158 0.89 (0.78, 1.03) 

 No Alcohol Use 0.0000 0.0000 . 1.00 (1.00, 1.00) 

NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found 

in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that 

substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report. 

NOTE: The number of degrees of freedom for a Wald χ2

 statistic is equal to the number of levels of the associated characteristic minus one. 

1 Retired person, disabled person, homemaker, student, or other person not in the labor force. 2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan. 3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance. 4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and 

concerns, spend time on shared interests and activities, or who really like and care about them (SEN11a, SEN11b, and SEN11c, 

respectively). 5 Nicotine (Cigarette) Dependence is based on criteria derived from the Nicotine Dependence Syndrome Scale (NDSS) or the Fagerstrom Test 

of Nicotine Dependence (FTND). See Section 2.3.2 of Chapter 2 of this report. 6 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type 

psychotherapeutic used nonmedically. 7 Dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV). 

† Significant at the .05 level. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
118 

40205 

Table B.M2 Adjusted Odds Ratios from Logistic Regression Models for Receipt of Mental Health 

Treatment/Counseling in the Past Year among Adults Aged 18 or Older with Past Year Serious 

Mental Illness, by Sociodemographic and Substance Use Characteristics: 2002 

Sociodemographic and Substance Use 

Characteristic Beta SE Beta P Value Odds Ratio 95% CI 

Age (χ2

 = 24.9)† 

 18-25 -0.0063 0.2165 0.9768 0.99 (0.65, 1.52) 

 26-49 0.5360 0.1964 0.0065 1.71 (1.16, 2.51) 

 50 or Older 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Gender (χ

2

 = 14.0)† 

 Female 0.4557 0.1218 0.0002 1.58 (1.24, 2.00) 

 Male 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Hispanic Origin and Race (χ2

 = 17.9)† 

 Black or African American -0.6484 0.1937 0.0008 0.52 (0.36, 0.76) 

 Hispanic or Latino -0.4066 0.1897 0.0324 0.67 (0.46, 0.97) 

 Other or Two or More Races -0.5198 0.2513 0.0389 0.59 (0.36, 0.97) 

 White 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Education (χ2

 = 21.9)† 

 < High School -0.8235 0.2029 < 0.0001 0.44 (0.29, 0.65) 

 High School Graduate -0.6000 0.1637 0.0003 0.55 (0.40, 0.76) 

 Some College -0.2755 0.1541 0.0741 0.76 (0.56, 1.03) 

 College Graduate 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Current Employment (χ2

 = 11.3)† 

 Part-Time 0.4461 0.1517 0.0034 1.56 (1.16, 2.10) 

 Unemployed 0.2099 0.2183 0.3366 1.23 (0.80, 1.89) 

 Other1

 0.4040 0.1605 0.0120 1.50 (1.09, 2.05) 

 Full-Time 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Geographic Region (χ2 = 1.5) 

 Northeast 0.1363 0.1670 0.4145 1.15 (0.83, 1.59) 

 Midwest -0.0416 0.1626 0.7979 0.96 (0.70, 1.32) 

 South 0.0077 0.1523 0.9599 1.01 (0.75, 1.36) 

 West 0.0000 0.0000 . 1.00 (1.00, 1.00) 

County Type (χ

2

 = 4.9) 

 Large Metro 0.1275 0.1458 0.3821 1.14 (0.85, 1.51) 

 Small Metro 0.3000 0.1441 0.0377 1.35 (1.02, 1.79) 

 Nonmetro 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Marital Status (χ

2

 = 19.7)† 

 Widowed -0.4640 0.4315 0.2825 0.63 (0.27, 1.47) 

 Divorced or Separated 0.4705 0.1556 0.0026 1.60 (1.18, 2.17) 

 Never Married -0.2068 0.1502 0.1689 0.81 (0.61, 1.09) 

 Married 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Family Income (χ

2

 = 2.9) 

 Less Than $20,000 0.0285 0.2005 0.8869 1.03 (0.69, 1.53) 

 $20,000 to $49,999 0.1851 0.1732 0.2855 1.20 (0.86, 1.69) 

 $50,000 to $74,999 0.2493 0.1875 0.1838 1.28 (0.89, 1.85) 

 $75,000 or More 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Health Insurance (χ2 = 22.8)† 

 Medicaid/CHIP2 0.1264 0.1908 0.5079 1.13 (0.78, 1.65) 

 Other3 0.0901 0.2608 0.7298 1.09 (0.66, 1.83) 

 No Coverage -0.7094 0.1548 < 0.0001 0.49 (0.36, 0.67) 

 Private 0.0000 0.0000 . 1.00 (1.00, 1.00) (continued)
119 

40205 

Table B.M2 Adjusted Odds Ratios from Logistic Regression Models for Receipt of Mental Health 

Treatment/Counseling in the Past Year among Adults Aged 18 or Older with Past Year Serious 

Mental Illness, by Sociodemographic and Substance Use Characteristics: 2002 (continued)

Sociodemographic and Substance Use 

Characteristic Beta SE Beta P Value Odds Ratio 95% CI 

Overall Health (χ2 = 18.9)† 

 Fair/Poor 0.9401 0.2246 < 0.0001 2.56 (1.65, 3.98) 

 Good 0.4781 0.1823 0.0089 1.61 (1.13, 2.31) 

 Very Good 0.3569 0.1723 0.0387 1.43 (1.02, 2.00) 

 Excellent 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Social Support4 (χ2 = 0.2) 

 Not Received -0.0793 0.1770 0.6540 0.92 (0.65, 1.31) 

 Received 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Nicotine Dependence5 (χ2 = 0.0) 

 Yes -0.0004 0.1205 1.0000 1.00 (0.79, 1.27) 

 No 0.0000 0.0000 . 1.00 (1.00, 1.00) 

Any Illicit Drug/Alcohol 

 Dependence or Abuse6,7 (χ2

 = 6.0) 

 Alcohol Dependence or Abuse 

 Only -0.0347 0.1356 0.7980 0.97 (0.74, 1.26) 

 Any Illicit Drug Dependence or 

 Abuse Only 0.5147 0.2547 0.0436 1.67 (1.01, 2.76) 

 Any Illicit Drug and Alcohol 

 Dependence or Abuse 0.3057 0.2138 0.1530 1.36 (0.89, 2.07) 

 No Dependence or Abuse 0.0000 0.0000 . 1.00 (1.00, 1.00) 

NOTE: Mental Health Treatment/Counseling is defined as having received inpatient care, outpatient care, or using prescription medication 

for problems with emotions, nerves, or mental health. Respondents were not to include treatment for alcohol or drug use. 

Respondents with missing treatment/counseling information are excluded. 

NOTE: Serious Mental Illness (SMI) is defined as having a diagnosable mental, behavioral, or emotional disorder that met the criteria found 

in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that 

substantially interfered with or limited one or more major life activities. See Section A.7 of Appendix A of this report. 

NOTE: The number of degrees of freedom for a Wald χ2

 statistic is equal to the number of levels of the associated characteristic minus one. 

1 Retired person, disabled person, homemaker, student, or other person not in the labor force. 2 Children's Health Insurance Plan. Individuals aged 20 or older are not eligible for this plan. 3 Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance. 4 Respondents are defined as receiving social support if they reported having two or more friends with whom they share personal issues and 

concerns, spend time on shared interests and activities, or who really like and care about them (SEN11a, SEN11b, and SEN11c, 

respectively). 5 Nicotine (Cigarette) Dependence is based on criteria derived from the Nicotine Dependence Syndrome Scale (NDSS) or the Fagerstrom Test 

of Nicotine Dependence (FTND). See Section 2.3.2 of Chapter 2 of this report. 6 Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type 

psychotherapeutic used nonmedically. 7 Dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV). 

† Significant at the .05 level. 

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002. 
120