National Survey on Drug Use and Health (NSDUH)

Millions of Americans are affected by behavioral health disorders, including substance use and mental health conditions. Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Survey on Drug Use and Health (NSDUH) gathers data on substance use and mental illness in the United States as a means of better understanding the issues and supporting the effective design and implementation of initiatives to reduce their impact.

NSDUH examines issues such as marijuana use; the use and misuse of prescription drugs such as opioid pain relievers; alcohol consumption; adolescent use of tobacco, alcohol, or other substances; substance use disorders; occurrences of mental illness; and the co-occurrence of mental illness and substance use disorders.

Since 1988, RTI has worked with SAMHSA to conduct NSDUH and research the nature, extent, and consequences of substance use and related mental health issues in the United States. Our role in this long-term effort has included collaboration with SAMHSA on study design, questionnaire development and programming, sample selection and weighting, data collection, data processing, analysis, preparation of data files, and reporting. Using complex computer-based questionnaires, we successfully administer more than 67,000 interviews nationwide for each annual iteration of NSDUH.

To best represent national and state-level statistics, NSDUH uses a stratified, multistage, area probability sample. For the current study, the sample is comprised of approximately 25 percent adolescents aged 12 to 17, 25 percent young adults aged 18 to 25, and 50 percent adults aged 26 or older. We train and manage professional interviewers, who visit each selected household and ask a few general questions. For some households, one or two residents are asked to participate in the survey by completing a more in-depth interview.

NSDUH is intended to collect and assess national and state-level data, not the answers of any specific individual. Maintaining individual privacy is key to the success of our efforts, and no full names are recorded or associated with any participant’s responses.

We administer interviews in the respondent’s home using a laptop computer. Respondents complete most of the survey directly on the computer, meaning the interviewer cannot see either the question or the answer, thus maximizing privacy.

To estimate the percentage of people who use various substances such as alcohol, tobacco products, or illicit drugs, our work under NSDUH must also determine how many people do not. For this reason, interviewers encourage selected individuals to participate whether or not they use or know anything about these substances. This broader participation also helps gather information on other health-related topics included in the NSDUH questionnaire.

Once collected, all data are coded, totaled, and used to generate statistics for analysis.

Formerly known as the National Household Survey on Drug Abuse, NSDUH is the federal government’s primary source of national data on substance use and mental health. Armed with accurate, wide-ranging information on the use of illicit drugs, tobacco, and alcohol—as well as mental health disorders and the co-occurrence of drug use and mental illness—SAMHSA and others in the substance use and mental health research community are able to take an evidence-based approach to preventing behavioral health problems and promoting recovery support services.

NSDUH results are used by a wide range of stakeholders, including the White House Office of National Drug Control Policy, the Partnership for Drug-Free Kids, the National Institute on Drug Abuse, university-based researchers, state and local substance use agencies and health departments, the U.S. Department of Education, the U.S. Department of Transportation, the Centers for Disease Control and Prevention, and the media.

NSDUH data help advance the epidemiological study of substance use, including identifying which substances are being used, prevalence of use, and trends in the use of specific licit and illicit substances. Our data also reveal connections between substance use and mental health and allow researchers to evaluate the effectiveness of and inform improvements in the use of health care resources for treatment of substance abuse and mental health problems.

Ultimately, our work in support of NSDUH allows federal, state, and local agencies to better allocate resources, and design and implement substance use prevention, treatment, and rehabilitation programs.

As a result of the COVID-19 pandemic, field data collection on NSDUH was suspended on March 16, 2020. Over the next several months, project leaders and RTI experts discussed the prospect of resuming field data collection, with public health being of the utmost concern. The team established maximum thresholds below which state and county COVID-19 infection rates must be before any fieldwork was conducted. A customized dashboard was updated weekly with Johns Hopkins data to identify eligible areas. New protective measures were implemented, including the use of hand sanitizer, disinfectant wipes, disposable face masks, plastic gloves, and a respondent information form summarizing health risks associated with COVID-19. In addition, methods were established to ensure procedures reflected the latest national, state, and local guidelines.

New procedures were tested in a small-scale pilot in July 2020. Procedures were tweaked before nationwide in-person data collection resumed in October 2020 where COVID-19 infection rates were below established thresholds. The questionnaire was updated to assess the impact of the COVID-19 pandemic on substance use frequency, the use of telehealth for treatment, and suicidal ideation and behavior. To provide all respondents with the opportunity to complete the questionnaire—even in areas where fieldwork was not permitted—a new web version of the questionnaire was launched.

With RTI leveraging its team of infectious disease experts as well as customizable online training, questionnaire, and dashboard platforms that were already in place, NSDUH was one of the first national field surveys to resume in-person data collection and was able to develop and launch a new web questionnaire in a matter of months. These serve as examples of how quickly RTI adapts to emerging public health concerns and changing societal circumstances to ensure policymakers and researchers continue receiving critical data on the nation’s behavioral health.