Characteristics of Adults Aged ≥18 Years Evaluated for Substance use and Treatment Planning

United States, 2019

Akadia Kacha-Ochana, MPH; Christopher M. Jones, PharmD, DrPH; Jody L. Green, PhD; Christopher Dunphy, PhD; Taryn Dailey Govoni, MPH; Rebekkah S. Robbins, MPH; Gery P. Guy Jr., PhD


Morbidity and Mortality Weekly Report. 2022;71(23):749-756. 

In This Article


This study found that among adults assessed for substance use at 399 treatment centers during 2019, alcohol was the most commonly reported substance used during the past 30 days, followed by cannabis, prescription opioid misuse, and illicit stimulants. Nearly one third of all assessments involved polysubstance use, and co-occurring severe problems across multiple biopsychosocial domains were common. Consistent with previous research on substance use patterns in the general population,[1] men accounted for the majority of assessments for substance use treatment. Women were more likely than men to report use of each of the substances except alcohol; the prevalence of severe problems was higher among women than among men for each of the biopsychosocial domains except alcohol. These patterns might be due to differences in substance use motivation between men and women, how substance use disorders manifest in each sex, barriers to treatment faced by women related to child care and fear of authority involvement,[6] and differences in the way in which sexes perceive and self-report on biopsychosocial domains.

The observed high rates of polysubstance use among adults assessed for substance use treatment in 2019 are concerning and are consistent with recent drug overdose death data[7] and substance use patterns in the general population.[1] The finding that one third or more of assessments for substance use treatment reported more severe psychiatric problems is also consistent with previous research documenting high rates of mental illness among persons with substance use disorder.[8] This report focuses on data from 2019, preceding the COVID-19 pandemic; how these trends changed during the pandemic will be the subject of a future report.

Adults assessed in the Northeast U.S. Census Bureau region reported higher past 30-day use of cocaine, heroin, illicit fentanyl, and prescription sedatives, whereas those assessed in the Midwest reported higher past 30-day use of illicit stimulants. The geographic differences in specific substances used during the past 30 days correspond with regional variations in drug overdose deaths[9] and the illicit drug supply in the United States.[10] Continued surveillance of the illicit drug supply and substance use patterns to guide the tailored development of prevention, treatment, and harm reduction interventions will be important when devising public health strategies in U.S. communities.

The findings in this report are subject to at least three limitations. First, ASI-MV data are self-reported and subject to recall and social desirability biases. Second, although ASI-MV collects data from a geographically diverse set of states and treatment programs, it is a convenience sample; therefore, results might not be generalizable to all adults being assessed for substance use treatment.§§ Finally, in 2019, 7.4% of ASI-MV assessments were repeat assessments; thus, it is possible for one person to have contributed more than one assessment during 2019.¶¶

These findings highlight the complex nature of substance use in the United States, the interplay between substance use and mental illness, and the complex challenges that persons with substance use disorder face when seeking treatment. Actions to enhance comprehensive substance use programs that incorporate polysubstance use and co-occurring mental health problems into strategies for prevention, treatment, and response are needed, as is expanded linkage to services. CDC provides data and resources to equip and inform states, territories, and local jurisdictions to help improve opioid prescribing practices, improve linkage to care for the treatment of opioid use disorder, and prevent and reverse overdoses.

§§Geographic and site participation in NAVIPPRO changes over time, and the network is not formally designed to be nationally representative.
¶¶In 2019, 7.4% of ASI-MV assessments were repeat assessments, meaning they were completed by a person (represented by a unique identifier) who had already completed one assessment that year.