{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:13:59Z","timestamp":1791314039826,"version":"4.3.1"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"\n Importance<\/jats:title>\n Prevalence estimates of substance use disorders in the US rely on general population surveys. However, major population groups, such as homeless individuals and institutionalized individuals, are not captured by these surveys, and participants may underreport substance use.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate the prevalence of substance use disorders in the US.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n The benchmark multiplier method was used to estimate the prevalence of alcohol, cannabis, opioid, and stimulant use disorders based on data from the Transformed Medicaid Statistical Information System (T-MSIS) (the benchmark) and the National Survey on Drug Use and Health (NSDUH) (the multiplier) for 2018 and 2019. T-MSIS collects administrative data on Medicaid beneficiaries 12 years and older with full or comprehensive benefits. NSDUH is a nationally representative annual cross-sectional survey of people 12 years and older. Data were analyzed from February to June 2022.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Prevalence of substance use disorders was estimated using the benchmark multiplier method based on T-MSIS and NSDUH data. Confidence intervals for the multiplier method estimates were computed using Monte Carlo simulations. Sensitivity of prevalence estimates to variations in multiplier values was assessed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n This study included Medicaid beneficiaries 12 years and older accessing treatment services in the past year with diagnoses of alcohol (n\u2009=\u20091\u202f017\u202f308 in 2018; n\u2009=\u20091\u202f041\u202f357 in 2019), cannabis (n\u2009=\u2009643\u202f737; n\u2009=\u2009644\u202f780), opioid (n\u2009=\u20091\u202f406\u202f455; n\u2009=\u20091\u202f575\u202f219), and stimulant (n\u2009=\u2009610\u202f858; n\u2009=\u2009657\u202f305) use disorders and NSDUH participants with 12-month\n DSM-IV<\/jats:italic>\n alcohol (n\u2009=\u20093390 in 2018; n\u2009=\u20093363 in 2019), cannabis (n\u2009=\u20091426; n\u2009=\u20091604), opioid (n\u2009=\u2009448; n\u2009=\u2009369), and stimulant (n\u2009=\u2009545; n\u2009=\u2009559) use disorders. The benchmark multiplier prevalence estimates were higher than NSDUH estimates for every type of substance use disorder in both years and in the combined 2018 to 2019 sample: 20.27% (95% CI, 17.04-24.71) vs 5.34% (95% CI, 5.10-5.58), respectively, for alcohol; 7.57% (95% CI, 5.96-9.93) vs 1.68% (95% CI, 1.59-1.79) for cannabis; 3.46% (95% CI, 2.97-4.12) vs 0.68% (0.60-0.78) for opioid; and 1.91% (95% CI, 1.63-2.30) vs 0.85% (95% CI, 0.75-0.96) for stimulant use disorders. In sensitivity analyses, the differences between the benchmark multiplier method and NSDUH estimates persisted over a wide range of potential multiplier values.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings in this study reflect a higher national prevalence of substance use disorders than that represented by NSDUH estimates, suggesting a greater burden of these conditions in the US.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2022.2756","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T11:01:14Z","timestamp":1663758074000},"page":"1074","source":"Crossref","is-referenced-by-count":32,"title":["Estimating the Prevalence of Substance Use Disorders in the US Using the Benchmark Multiplier Method"],"prefix":"10.1001","volume":"79","author":[{"given":"Ramin","family":"Mojtabai","sequence":"first","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 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survey.","volume":"116","author":"Reuter","year":"2021","journal-title":"Addiction"},{"issue":"3-6","key":"yoi220058r9","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1081\/JA-120017387","article-title":"Alcohol use and other psychiatric disorders in the formerly homeless and never homeless: prevalence, age of onset, comorbidity, temporal sequencing, and service utilization.","volume":"38","author":"Reardon","year":"2003","journal-title":"Subst Use Misuse"},{"issue":"4","key":"yoi220058r10","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1176\/appi.ajp.2009.09081087","article-title":"The effect of inmate populations on estimates of DSM-IV alcohol and drug use disorders in the United States.","volume":"167","author":"Compton","year":"2010","journal-title":"Am J Psychiatry"},{"issue":"2","key":"yoi220058r11","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1093\/oxfordjournals.aje.a114534","article-title":"Difficult-to-recruit respondents and their effect on prevalence estimates in an epidemiologic survey.","volume":"125","author":"Cottler","year":"1987","journal-title":"Am J Epidemiol"},{"issue":"3","key":"yoi220058r12","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/j.1360-0443.1995.tb03786.x","article-title":"Assessing bias in community-based prevalence estimates: towards an unduplicated count of problem drinkers and drug users.","volume":"90","author":"Weisner","year":"1995","journal-title":"Addiction"},{"issue":"10","key":"yoi220058r13","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.1111\/add.15607","article-title":"Pathways to drug prevalence estimation: synthesizing three comments on triangulation.","volume":"116","author":"Midgette","year":"2021","journal-title":"Addiction"},{"issue":"9","key":"yoi220058r14","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1111\/add.14651","article-title":"Accuracy of five self-report screening instruments for substance use in 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Psychiatry"},{"key":"yoi220058r19","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2019.05.008","article-title":"Cannabis use disorders among adults in the United States during a time of increasing use of cannabis.","volume":"204","author":"Compton","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"10","key":"yoi220058r20","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1111\/add.15596","article-title":"Data triangulation for substance abuse research.","volume":"116","author":"van Hasselt","year":"2021","journal-title":"Addiction"},{"issue":"2","key":"yoi220058r23","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1214\/16-STS584","article-title":"Combining survey data with other data sources.","volume":"32","author":"Lohr","year":"2017","journal-title":"Stat Sci"},{"key":"yoi220058r24","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1186\/1471-2458-12-443","article-title":"Estimating the prevalence of illicit opioid use in New York 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Res"},{"issue":"12","key":"yoi220058r39","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.0050225","article-title":"The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis.","volume":"5","author":"Fazel","year":"2008","journal-title":"PLoS Med"},{"issue":"11","key":"yoi220058r40","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.2105\/AJPH.2013.301283","article-title":"Medicaid expansion initiative in Massachusetts: enrollment among substance-abusing homeless adults.","volume":"103","author":"Zur","year":"2013","journal-title":"Am J Public Health"},{"issue":"2","key":"yoi220058r41","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s10900-017-0405-9","article-title":"Expanded Medicaid provides access to substance use, mental health, and physician visits to homeless and precariously housed persons.","volume":"43","author":"Parker","year":"2018","journal-title":"J Community 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Behavioral health barometer: United States, volume 6: indicators as measured through the 2019 National Survey on Drug Use and Health. Accessed April 10, 2022. https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/reports\/rpt32815\/National-BH-Barometer_Volume6.pdf"},{"key":"yoi220058r22","unstructured":"European Monitoring Centre for Drugs and Drug Addiction. Key epidemiological indicator: prevalence of problem drug use. Accessed April 10, 2022. https:\/\/www.emcdda.europa.eu\/system\/files\/publications\/321\/Guidelines_Prevalence_Revision_280704_b-1_124620.pdf"},{"key":"yoi220058r31","unstructured":"U.S. Department of Health and Human Services. Report to congress: T-MSIS substance use disorder (SUD) data book-treatment of SUD in Medicaid, 2018. Accessed February 21, 2022. https:\/\/www.medicaid.gov\/medicaid\/data-systems\/downloads\/2018-sud-data-book.pdf"},{"key":"yoi220058r32","unstructured":"U.S. Department of Health and Human Services. Report to congress: T-MSIS substance use disorder (SUD) data book-treatment of SUD in Medicaid, 2019. Accessed February 21, 2022. https:\/\/www.medicaid.gov\/medicaid\/data-systems\/downloads\/2019-sud-data-book.pdf"},{"key":"yoi220058r33","unstructured":"Center for Behavioral Health Statistics and Quality. 2019 National Survey on Drug Use and Health: methodological summary and definitions. Accessed April 5, 2022. https:\/\/www.samhsa.gov\/data\/report\/2019-methodological-summary-and-definitions"},{"key":"yoi220058r34","unstructured":"The American Association for Public Opinion Research. Standard definitions: final dispositions of case codes and outcome rates for surveys. Accessed February 21, 2022. https:\/\/www.aapor.org\/aapor_main\/media\/publications\/standard-definitions20169theditionfinal.pdf"},{"key":"yoi220058r35","unstructured":"Pascale? J, Call? K, Fertig? A, Ollerich? D. Validating self-reported health insurance coverage: preliminary results on CPS and ACS. Accessed June 4, 2022. https:\/\/www.census.gov\/newsroom\/blogs\/research-matters\/2016\/05\/validating-self-reported-health-insurance-coverage-preliminary-results-on-cps-and-acs.html"},{"key":"yoi220058r47","unstructured":"Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: results from the 2020 National Survey on Drug Use and Health. 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