Title : Trends in prevalence, treatment patterns, and barriers to care among U.S. adults with co-occurring mental disorders and substance use disorders: Findings from 2021–2023 NSDUH
Abstract:
Background: Adults with co-occurring mental disorders and substance use disorders (SUDs) experience poor health outcomes and face substantial barriers to treatment. Evaluating national trends in prevalence, treatment engagement, and barriers can inform pharmacist-led interventions.
Research Question: What are the trends in prevalence, treatment patterns, and perceived barriers among U.S. adults with co-occurring mental disorders and SUDs from 2021 to 2023?
Study Design: Repeated cross-sectional analysis using nationally representative survey data.
Methods: Data were obtained from the 2021–2023 National Survey on Drug Use and Health (NSDUH). Adults meeting criteria for both any mental illness (AMI) or serious mental illness (SMI) and SUD were included. Weighted prevalence estimates were calculated annually. Treatment patterns were categorized into four mutually exclusive groups: both SUD and mental health treatment, mental health only, SUD only, or neither. Among those with unmet treatment needs, weighted proportions of endorsed barriers were reported. Z-tests were used to assess changes across years.
Results: The prevalence of co-occurring AMI and SUD increased slightly from 7.8% (2021) to 8.4% (2023), while SMI and SUD remained stable at 2.6%. In 2023, 53.2% of adults with co-occurring conditions received no treatment, 34.7% received mental health treatment only, 3.4% SUD treatment only, and just 8.7% received both. Among those untreated, leading barriers included: treatment not a priority (85.0% for SUD, 80.8% for mental illness), stigma (71.8%, 67.9%), affordability (61.3%, 66.5%), access issues (64.2%, 72.3%), and lack of readiness (70.5%, 49.8%).
Conclusions: From 2021 to 2023, treatment engagement among adults with co-occurring mental disorders and SUDs remained critically low. Addressing modifiable barriers—particularly stigma, cost, and access—is essential. Clinical pharmacists are uniquely positioned to deliver targeted interventions, improve treatment linkage, and support integrated care.
