By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. Col

By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J.
Colpe
Prevalence, Treatment, And Unmet
Treatment Needs Of US Adults
With Mental Health And
Substance Use Disorders
ABSTRACT We examined prevalence, treatment patterns,
trends, and
correlates of mental health and substance use treatments among
adults
with co-occurring disorders. Our data were from the 325,800
adults who
participated in the National Survey on Drug Use and Health in
the period
2008–14. Approximately 3.3 percent of the US adult population,
or
7.7 million adults, had co-occurring disorders during the twelve
months
before the survey interview. Among them, 52.5 percent received
neither
mental health care nor substance use treatment in the prior year.
The
9.1 percent who received both types of care tended to have more
serious
psychiatric problems and physical comorbidities and to be
involved with
the criminal justice system. Rates of receiving care only for
mental
health, receiving treatment only for substance use, and
receiving both

types of care among adults with co-occurring disorders
remained
unchanged during the study period. Low perceived need and
barriers to
care access for both disorders likely contribute to low treatment
rates of
co-occurring disorders. Future studies are needed to improve
treatment
rates among this population.
S
ubstance use disorders and mental
disorders influence each other, and
their combined presentation (here-
after referred to as co-occurring
disorders) results in more profound
functional impairment; worse treatment out-
comes; higher morbidity and mortality; in-
creased treatment costs; and higher risk for
homelessness, incarceration, and suicide than
each of the individual disorders.1–4 Current treat-
ment guidelines recommend that people with co-
occurring disorders receive treatments for both
disorders.5–7 However, little is known about the
twelve-month prevalence, service use patterns,
correlates of mental health and substance use
treatments, and unmet treatment need among
US adults with co-occurring disorders.
Recent studies indicate that the prevalence of
opioid use disorders and marijuana use among
adults has increased in recent years.8,9 It is im-
portant to determine whether these specific in-
creases led to greater overall prevalence of co-

occurring disorders, because adults with opioid
or marijuana use disorders are likely to have co-
occurring mental illness.8,9 Also, two recent stud-
ies reported that between 2005–07 and 2014 and
between 2004 and 2013, respectively, among the
overall US adult population, receipt of mental
health care increased (primarily as a result of
increasing use of psychiatric medications), and
receipt of substance use treatment remained
stable.10,11 However, it is unknown whether there
have been similar changes in patterns of care for
adults with co-occurring disorders.
The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008
required insurance coverage of mental health
and substance use treatments to be equal to cov-
erage of general medical care.12 Moreover, pro-
visions of the Affordable Care Act (ACA) may
doi: 10.1377/hlthaff.2017.0584
HEALTH AFFAIRS 36,
NO. 10 (2017): 1739–1747
©2017 Project HOPE—
The People-to-People Health
Foundation, Inc.
Beth Han is a researcher at
the Substance Abuse and
Mental Health Services
Administration, in Rockville,
Maryland.
Wilson M. Compton
([email protected]) is
deputy director of the

National Institute on Drug
Abuse, in Rockville.
Carlos Blanco is director of
the Division of Epidemiology,
Services, and Prevention
Research, National Institute
on Drug Abuse.
Lisa J. Colpe is chief of the
Office of Clinical and
Population Epidemiology
Research, National Institute of
Mental Health, in Bethesda,
Maryland.
October 2017 36:10 Health Affairs 1739
Behavioral Health Care
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http://content.healthaffairs.org/
facilitate access to and integration of mental
health care and substance use treatment for
adults with co-occurring disorders.13–17 The ACA
expanded and highlighted parity of insurance
coverage of treatments for mental illness and
substance use disorders. It also emphasized
expanding coverage and improving quality

through better integration of behavioral with
general medical services.14–17 It is unknown
whether these policies have led to changes in
treatment rates of co-occurring disorders.
Thus, using a large, nationally representative
data set on co-occurring disorders and mental
health and substance use treatments, we exam-
ined the following understudied questions:What
was the recent prevalence of twelve-month co-
occurring disorders among adults in the United
States? What were the patterns of mental health
and substance use treatments received by adults
with co-occurring disorders? Did these patterns
change during the period 2008–14? What rea-
sons for not receiving mental health and sub-
stance use treatments were reported by adults
with co-occurring disorders who perceived un-
met treatment needs?
Addressing the gaps in knowledge inherent
in our research questions may identify where
specialized services or targeted outreach efforts
might be developed and may improve treatment
rates for both disorders among this population.
Study Data And Methods
Data Sources We examined data on adults ages
eighteen and older who participated in the Na-
tional Survey on Drug Use and Health in the
period 2008–14. We used that study period be-
cause data on mental illness are available start-
ing with 2008 and because data on substance use
disorders after 2015 are not comparable with
previous data, because of changes in the survey
items.

The National Survey on Drug Use and Health
was conducted each year by the Substance Abuse
and Mental Health Services Administration
(SAMHSA). It provides nationally representative
data on mental illness, mental health care, sub-
stance use disorders, and substance use treat-
ment among the US civilian noninstitutional-
ized population ages eighteen and older. We
calculated an annual mean weighted response
rate of 63.5 percent for the 2008–14 surveys,
according to the definition of response rate 2
of the American Association for Public Opinion
Research.19 Details regarding survey methods
have been published elsewhere.18
Measures
▸ MENTAL ILLNESS: Mental illness among
adults ages eighteen and older was defined as
currently having or at any time in the past year
having had a diagnosable mental disorder (ex-
cluding developmental disorders and substance
use disorders) of sufficient duration to meet the
diagnostic criteria specified in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edi-
tion (DSM-IV).20
Based on data from the 2008–12 Mental
Health Surveillance Study, a model was devel-
oped to predict both past-year mental illness sta-
tus (yes or no) and serious mental illness status
(yes or no) for each respondent in the adult
samples of the National Survey on Drug Use
and Health since 2008.21 We used the mental

illness variable to identify respondents with
mental disorders, and we used the serious men-
tal illness variable to control for the severity of
mental illness in multivariable models.
▸ SUBSTANCE USE DISORDERS: The surveys
estimated substance use disorders (dependence
on or abuse of alcohol or an illicit drug) during
the previous twelve months based on assess-
ments of individual diagnostic criteria in the
DSM-IV.20 The severity of substance use disor-
ders was measured by the number of criteria met
across these substances.22–25
▸ MENTAL HEALTH CARE AND PERCEIVED UN-
MET NEED: All adult survey respondents were
asked to report on their receipt of inpatient or
outpatient care or receipt of prescription medi-
cations for mental health problems in the past
year. Inpatient care includes services received at
the following locations: a psychiatric hospital,
the psychiatric unit of a general hospital, the
medical unit of a general hospital for mental
health treatment, or another type of hospital
for mental health care. Outpatient care includes
services received at following locations: a com-
munity mental health center, the office of a pri-
vate therapist for mental health care (a psychol-
ogist, psychiatrist, social worker, or counselor),
the office of a private physician (nonpsychia-
trist), an outpatient medical clinic for mental
health care, a day treatment program for mental
health care, or another type of facility for mental
health care.
The surveys asked all adult respondents

whether they perceived that they had had unmet
need for mental health care in the past year.
Those who perceived this need for care and did
not receive it were asked to report reasons why
they did not receive it.
▸ SUBSTANCE USE TREATMENT AND PER-
CEIVED UNMET NEED: Substance use treatment
refers to treatment received for the use of illicit
drugs or alcohol or for medical problems associ-
ated with that use.26 It includes treatment re-
ceived in the past year at a hospital (inpatient),
rehabilitation facility (outpatient or inpatient),
1740 Health Affairs October 2017 36:10
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mental health center, emergency department
(ED), the office of a private physician, or prison
or jail. The surveys asked adults with substance
use problems whether they perceived that they
had had unmet need for substance use treatment
in the past year. Those who perceived unmet
need for that treatment and who had not received
it were asked to report reasons why they did not
receive it.
▸ HEALTH STATUS: The surveys captured

respondents’ self-rated health and the number
of ED visits in the past year. Physical co-
morbidities were assessed by asking adult
respondents if they had been told by a doctor
or other health care professional in the past year
that they had hypertension, heart disease, diabe-
tes, stroke, asthma, bronchitis, sinusitis, pneu-
monia, hepatitis, sexually transmitted diseases,
HIV/AIDS, ulcers, tuberculosis, sleep apnea, tin-
nitus, pancreatitis, cirrhosis, or lung cancer.We
used this list to compute the total number of
physical comorbidities.
▸ SOCIODEMOGRAPHIC CHARACTERISTICS
AND CRIMINAL JUSTICE INVOLVEMENT: We ana-
lyzed respondents’ age, sex, race/ethnicity, edu-
cation, employment status, health insurance sta-
tus, marital status, annual family income as a
percentage of the federal poverty level, residence
in any Metropolitan Statistical Area, census re-
gion, and survey year. We also assessed justice
involvement, which was defined by having had
any arrest and booking, probation, or parole in
the past year.27
Item response rates on the surveys are high.
Moreover, missing values are imputed in the
survey using predictive mean neighborhoods28,29
or a modified version of that method.29
Statistical Analyses Analyses were con-
ducted in four stages. First, we estimated the
twelve-month prevalence of co-occurring disor-
ders among US adults, the twelve-month preva-

lence of receiving mental health care and sub-
stance use treatment, and detailed treatment
patterns among adults with co-occurring disor-
ders. Second, we assessed the twelve-month
prevalenceof receipt of neithertype of care, men-
tal health care only, substance use treatment
only, and both types of care among this popula-
tion, according to sociodemographic character-
istics, health status, serious mental illness, se-
verity of substance use disorders, and criminal
justice involvement.
Third, we used bivariable and multivariable
multinomial logistic regression models to assess
correlates of receipt of mental health and sub-
stance use treatments. Multicollinearity (using
variance inflation factors) and potential interac-
tion effects between examined factors were as-
sessed and were not found in the final multivari-
able model.
Finally, we assessed the prevalence of per-
ceived unmet treatment needs for mental health
care and for substance use treatment among
adults with co-occurring disorders who did not
receive the corresponding care and who pre-
sented their commonly reported reasons for
not receiving the care.We used SUDAAN, version
11.0.1,30 to account for the complex sample de-
sign and sampling weights of the survey data.
Limitations This study had several limita-
tions. First, the surveys did not cover homeless
people not living in shelters, active-duty mem-
bers of the military, or people residing in insti-

tutions. However, the surveys covered homeless
people who lived in shelters and included adults
who had been discharged from institutions at the
time of the survey interview.
Second, the surveys did not measure the qual-
ity and exact timing of receipt of mental health
care and substance use treatment at different
settings. Third, the surveys did not ask about
substance use treatment provided in outpatient
medical clinics.
Fourth, the surveys did not measure the fre-
quency or duration of substance use treatment.
Fifth, they did not query for specific mental dis-
orders, except for major depressive episode and
substance use disorders. However, mood disor-
ders, anxiety disorder, eating disorder, adjust-
ment disorder, and psychotic symptoms (delu-
sions, hallucinations, or both) are likely to be
represented among adults with mental illness in
the sample.31
Finally, the survey data were self-reported and
subject to recall bias.
Study Results
Based on the 325,800 sampled adults ages eigh-
teen and older from the 2008–14 surveys, we
estimated that an annual average of 3.3 percent
of the US adult population, or 7.7 million adults,
Our findings
document a large gap
between the
prevalence of co-

occurring disorders
and treatment rates.
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had co-occurring mental illness and substance
use disorders in the past year (data not shown).
In particular, among the 42.1 million adults with
mental illness, 18.2 percent also had substance
use disorders. Among the 20.3 million adults
with substance use disorders (annual average),
37.9 percent also had mental illness. The overall
prevalence of co-occurring disorders was gener-
ally stable during the study period (for the over-
all trend, p = 0.7785).
Patterns Of Mental Health And Substance
Use Treatments Among adults with co-occur-
ring disorders, 43.6 percent received any mental
health care in the prior year (Exhibit 1), which
was slightly higher than the corresponding
mental health treatment rate among adults with
mental illness, regardless of co-occurring status
(42.1 percent; data not shown). Also among
adults with co-occurring disorders, 13.0 percent
received substance use treatment in the past year
(Exhibit 1), which was 67 percent higher than
the corresponding substance use treatment rate
among adults with substance use disorders re-

gardless of co-occurring status (7.8 percent; data
not shown).
Among adults with co-occurring disorders,
9.1 percent received both mental health care
and substance use treatment, 34.5 percent
received mental health care only, 3.9 percent
received substance use treatment only, and
52.5 percent received neither mental health care
nor substance use treatment (Exhibit 1). For de-
tailed patterns of receiving outpatient and in-
patient mental health care and substance use
treatment, see the online Appendix Exhibit.32
Twelve-Month Prevalence Of Treatments
Exhibit 2 shows that among US adults with co-
occurring disorders, the annual rates of receiv-
ing neither type of care, mental health care only,
substance use treatment only, and both types of
care remained stable during the study period.
Correlates Of Treatments Consistent with
the bivariable results, our multivariable results
showed that the adjusted prevalence of receiving
neither type of care, mental health care only,
substance use treatment only, and both types
of care remained stable during the study period
(Exhibit 3).
Compared to receiving both types of care, after
adjustment for covariates, the following charac-
Exhibit 1
Mental health and substance use treatment received in the prior
year by US adults with

co-occurring disorders, 2008–14
Treatment received in the prior year
Annual average
weighted percentage
Any mental health or substance use treatment 47.5
Any mental health treatment 43.6
Any outpatient treatment 24.1
Any inpatient treatment 5.5
Any prescription medication for mental health problems 37.2
Any substance use treatment 13.0
Both mental health and substance use treatment 9.1
Mental health only 34.5
Substance use only 3.9
Neither mental health nor substance use treatment 52.5
SOURCE Authors’ analysis of data for 2008–14 from the
National Survey on Drug Use and Health.
NOTES N = 15,800. The Substance Abuse and Mental Health
Services Administration requires that
any description of overall sample sizes based on the restricted-
use data files be rounded to the
nearest 100 to minimize potential disclosure risk. “Any mental
health care” is inpatient or
outpatient mental health care or prescription medication for
mental health problems (for a fuller
definition, see the text).
Exhibit 2

Mental health and substance use treatment received in the prior
year by US adults with co-occurring disorders, 2008–14
Adults who received:
Versus receiving both types of care, odds
ratio of receiving:
Year Neither
Mental
health only
Substance
use only Both Neither
Mental
health only
Substance
use only
2008 (ref) 54.0% 33.1% 4.1% 8.9% 1.0 1.0 1.0
2009 51.3 35.5 3.9 9.3 0.9 1.0 0.9
2010 51.1 35.8 3.1 10.0 0.8 1.0 0.7
2011 53.2 33.7 4.0 9.2 0.9 1.0 0.9
2012 53.1 33.0 4.9 9.0 1.0 1.0 1.2
2013 51.7 36.9 3.3 8.0 1.1 1.2 0.9
2014 53.3 33.4 3.9 9.5 0.9 0.9 0.9

National Survey on Drug Use and Health. NOTES N = 15,800.
The Substance
Abuse and Mental Health Services Administration requires that
any description of overall sample sizes based on the restricted-
use
data files has to be rounded to the nearest 100 to minimize
potential disclosure risk. Percentages might not sum to 100
because of
rounding. The odds ratios were calculated from bivariable
multinomial logistic regressions. None of the differences
between the
reference year and other years was significant (p < 0:05). None
of the unadjusted odds ratios was significant.
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teristics were associated with receiving neither
type of care: having no physical comorbidities,
having no serious mental illness, meeting three
or fewer substance use disorder criteria across
substances, having no criminal justice involve-
ment, and being uninsured. Similarly, the fol-
lowing characteristics were associated with re-
ceiving mental health care only: meeting three or
fewer substance use disorder criteria across sub-
stances and having no criminal justice involve-
ment. And the following characteristics were as-
sociated with receiving substance use treatment

only: having no physical comorbidities, having
no serious mental illness, having criminal justice
involvement, and being uninsured.
Perceived Unmet Need For Mental Health
Care Among the 7.7 million US adults with co-
occurring disorders, 4.3 million (56.4 percent)
did not receive mental health care in the past
year. Among those who did not receive care,
1.1 million (24.3 percent) perceived an unmet
need for it in the past year (data not shown)
and reported their reasons. The most common
were inability to afford the treatment cost
(52.2 percent), not knowing where to go for
treatment (23.8 percent), and believing at the
time that the problem could be handled without
treatment (23.0 percent) (Exhibit 4).
Perceived Unmet Need For Substance Use
Treatment Among the 7.7 million US adults
with co-occurring disorders, 6.1 million
(87.0 percent) did not receive substance use
treatment in the past year. Among those who
did not receive treatment, only 633,000 (9.5 per-
cent) perceived an unmet need for it in the past
year (data not shown) and reported their rea-
sons. The most common was not being ready
to stop using the substance(s) (38.4 percent),
and the second most common was having no
health insurance and being unable to afford
the cost (35.1 percent) (Exhibit 5).
Discussion
Using recent nationally representative data, we
examined the annual prevalence, treatment pat-
terns, correlates, and unmet treatment needs

for co-occurring disorders among adults in the
United States. Approximately 3.3 percent of the
US adult population (or 7.7 million adults) had
twelve-month co-occurring disorders (annual
averages). In contrast to our earlier findings
on the increases in opioid use disorders and
marijuana use,8,9 the prevalence of alcohol use
disorders among US adults declined33—which
may help explain why the prevalence of co-occur-
ring disorders was stable during the period
2008–14.
Despite current treatment guidelines that call
for both types of disorders to be treated when
they co-occur,5–7 only 9.1 percent of adults with
co-occurring disorders received both types of
care in the past year, and 52.5 percent received
neither mental health care nor substance use
treatment. Our findings document a large gap
between the prevalence of co-occurring disor-
ders and treatment rates among adults with
those disorders in the United States.
Compared to adults with mental illness, adults
with co-occurring disorders had a slightly higher
mental health treatment rate (43.6 percent ver-
Exhibit 3
Treatment patterns among US adults with co-occurring
disorders, by selected
characteristics, 2008–14
Versus receiving both types of treatment, adjusted odds
ratio of receiving:

Neither type
of treatment
Mental health
treatment only
Substance use
treatment only
Year
2008 (ref) 1.0 1.0 1.0
2009 1.0 1.1 0.9
2010 1.0 1.1 0.8
2011 1.2 1.1 1.1
2012 1.1 1.1 1.4
2013 1.2 1.3 1.0
2014 0.9 0.9 1.2
Number of physical comorbidities
0 (ref) 1.0 1.0 1.0
1 0.7* 1.1 0.5**
2 0.5*** 0.9 0.6
3 or more 0.9 1.0 0.9
Serious mental illness
Yes 0.3**** 0.8* 0.4****
No (ref) 1.0 1.0 1.0
Number of substance use disorder criteriaa met
1–3 (ref) 1.0 1.0 1.0
4–6 0.4*** 0.4*** 1.1
7–9 0.1**** 0.2**** 0.9

10 or more 0.1**** 0.1**** 0.9
Criminal justice involvementb in prior year
Yes 0.3**** 0.4**** 1.5**
No (ref) 1.0 1.0 1.0
Type of health insurance
Private only (ref) 1.0 1.0 1.0
None 2.1**** 1.0 1.7**
Medicaid 0.9 1.0 1.3
Other 1.0 0.9 1.3
SOURCE Authors’ analysis of data from the 2008–2014
Services Administration requires
that any description of overall sample sizes based on the
restricted-use data files be rounded to
the nearest 100 to minimize potential disclosure risk. Odds
ratios were adjusted for all of the
variables in Exhibit 3 and also controlled for age, sex,
race/ethnicity, education, employment,
marital status, family income as a percentage of the federal
poverty level, census region,
residence in any Metropolitan Statistical Area, self-rated health,
and the number of emergency
department visits in the past year. aCriteria for substance use
disorder from American
Psychiatric Association, Diagnostic and Statistical Manual of
Mental Disorders (Note 20 in text).
bAny arrest and booking, probation, or parole. *p < 0:10 **p <
0:05 ***p < 0:01 ****p < 0:001

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sus 42.1 percent). Compared to adults with sub-
stance use disorders, adults with co-occurring
disorders had a 67 percent higher substance
use treatment rate (13.0 percent versus 7.8 per-
cent). We found that adults with co-occurring
disorders who received both types of care tended
to have more serious psychiatric problems and
physical comorbidities and to be more likely to
be involved with the criminal justice system than
those who did not receive both types of care. This
suggests that appropriate services are reaching
some of the people in most need. However, low
perceived need (especially for treating substance
use disorders) and barriers to care access for
both disorders likely contribute to low treatment
rates of co-occurring disorders.
Low perceived need has consistently been a
major barrier to treatment seeking.34 The Na-
tional Comorbidity Survey Replication studies
found that low perceived need was reported by
44.8 percent of respondents with a disorder who
did not seek treatment34 and that 23.1–47.3 per-
cent of people with lifetime substance use disor-
ders never made treatment contact.35 We found
that almost a quarter of adults with co-occurring
disorders who did not receive mental health care
perceived an unmet need for that care. Of those,

more than half reported an inability to afford the
treatment cost, and almost another quarter did
not know where to go for treatment—which sug-
gests a need to improve the awareness of treat-
ment locations. By contrast, among adults with
co-occurring disorders who did not receive sub-
stance use treatment, fewer than a tenth per-
ceived an unmet need for substance use treat-
ment. This indicates that increasing the
perception of need for treatment may be even
more critical in the case of substance use disor-
ders to increase treatment rates.Without perceiv-
ing need for treatments for both types of disor-
ders, it is unlikely that these adults will seek or
receive timely substance use treatment and men-
tal health care.
In addition to low perceived need among
adults with co-occurring disorders, financial bar-
riers can impede treatment seeking.13–15,36,37 Con-
sistent with the results of these previous studies,
we found that among adults with co-occurring
disorders who perceived a need for mental health
care but did not receive it, 52.2 percent reported
that they could not afford the cost. Also among
adults with co-occurring disorders who per-
ceived a need for substance use treatment but
did not receive it, 35.1 percent reported that they
had no health insurance and could not afford
the cost.
Importantly, this study found that treatment
rates of all types for adults with co-occurring
disorders did not change significantly during
the period 2008–14. Although barriers may be
greater for substance use treatment than for

mental health care,11 for adults with co-occurring
disorders, we did not find an increase in receipt
of only mental health care, either. In contrast,
other research has found that receipt of mental
health treatment increased among the overall
Exhibit 4
Percentages of adults with co-occurring disorders and a
perceived unmet need for mental
health care who reported common reasons for not receiving that
care in the prior year
Services Administration requires that any
description of overall sample sizes based on the restricted-use
data files be rounded to the nearest
100 to minimize potential disclosure risk. The percentages were
annual average weighted estimates.
Exhibit 5
Percentages of adults with co-occurring disorders and a
perceived unmet needs for
substance use treatment who reported common reasons for not
receiving that treatment
in the past year
Authors’ analysis of data for 2008–14 from the National Survey
on Drug Use and Health. NOTES
N = 600. The Substance Abuse and Mental Health Services
Administration requires that any descrip-
tion of overall sample sizes based on the restricted-use data
files be rounded to the nearest 100 to

minimize potential disclosure risk. The percentages were annual
average weighted estimates.
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adult population10,11,38 and among mentally ill
baby boomers and Generation X38 during this
time period, although substance use treatment
in these groups remained unchanged.11 Also, we
found that the interaction effect between survey
year and health insurance status was not signifi-
cant, which indicates that the impact of health
insurance status on treatment outcomes among
adults with co-occurring disorders did not vary
by survey year.
Thus, it appears that implementing the Mental
Health Parity and Addiction Equity Act and the
ACA created incentives for health care systems
to address behavioral health issues14–16 that may
have had an impact on overall mental health
service delivery but might not yet have affected
people with substance use disorders, including
those with co-occurring disorders. Future re-
search is needed to continue to assess trends
in mental health care and substance use treat-
ments among this population and examine

whether current incentives in the parity law
and the ACA are insufficient, may need more
time to have an impact, or may vary across states.
The percentage of mental health facilities in
the United States offering programs for patients
with co-occurring disorders decreased from
58.4 percent in 2010 to 53.0 percent in 2014,
although the percentage of substance use treat-
ment facilities offering such programs increased
from 37.2 percent in 2008 to 44.2 percent in
2014.39,40 We found that among adults with co-
occurring disorders, 34.5 percent received men-
tal health care only, and 3.9 percent received
substance use treatment only. Thus, treatment
rates of co-occurring disorders could be im-
proved if patients entering treatment for mental
disorders were screened for substance use disor-
ders and given high-quality substance use treat-
ment in mental health care settings. Specialty
treatment programs for substance use problems
do increasingly offer evaluation and treatment of
co-occurring mental disorders. Adults who are
referred to specialty substance use treatment
may be more likely to receive treatment for co-
occurring mental disorders. Future research is
needed to understand why the percentage of US
mental health facilities offering programs for
patients with co-occurring disorders is declin-
ing, and why fewer than half of US substance
use treatment facilities offer programs for pa-
tients with co-occurring disorders.
Furthermore, we found that 52.5 percent of
adults with co-occurring disorders received nei-

ther mental health care nor substance use treat-
ment in the past year. Our results suggest a need
to screen for and treat co-occurring disorders.
Given the prevalence of these disorders, this ap-
proach should be taken not just by specialty be-
havioral health practitioners, but by clinicians
throughout medicine.16 Efforts to integrate be-
havioral health screening, referral, and treat-
ment into general medical settings may benefit
this vulnerable population. However, some pa-
tients with co-occurring disorders have complex
needs and may require specialty care.
Conclusion
This study provided recent national estimates on
the twelve-month prevalence of co-occurring dis-
orders among US adults, twelve-month patterns
and correlates of mental health care and sub-
stance use treatments, and unmet treatment
needs among adults with co-occurring disorders
in the United States. Despite current treatment
guidelines, fewer than 10 percent of adults with
co-occurring disorders receive treatment for
both disorders, and fewer than 50 percent re-
ceive treatment for just one disorder. Further-
more, these treatment rates do not seem to have
improved over time. Our study highlights the
fact that low perceived need (especially for treat-
ing substance use disorders) and barriers to care
access for both disorders likely contribute to low
treatment rates of co-occurring disorders. Our
results suggest a need to screen for and treat
these disorders. Future studies are needed to
identify effective approaches to increasing treat-
ment rates of co-occurring disorders among
adults in the United States. ▪

More than half of
adults with co-
occurring disorders
received neither
mental health care nor
substance use
treatment in the past
year.
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Unrelated to the submitted work, Wilson
Compton reports ownership of stock in
General Electric Co., 3M Co., and Pfizer
Inc. Carlos Blanco reports ownership of
stock in General Electric Co. and Eli Lilly
Inc. The findings and conclusions of this
study are those of the authors and do
not necessarily reflect the views of the
Substance Abuse and Mental Health
Services Administration, the National
Institute on Drug Abuse of the National
Institutes of Health, or the National
Institute of Mental Health of the
National Institutes of Health, within the
US Department of Health and Human
Services.

NOTES
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Reproduced with permission of copyright owner. Further
reproduction
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