of alcohol, inappropriate use of prescription medications, or illegal drugs. About 28 million Americans aged 18 or older (13 percent of this population) received mental health treatment in an inpatient or outpatient setting in 20032 (SAMHSA, 2004a), and more than 6 percent of American children and adolescents aged 5–17 had contact with a mental health professional in a 12-month period according to the 1998–1999 National Health Interview survey (Simpson et al., 2004). The rates are higher still for adolescents and working-age adults: 5 million (20.6 percent) of those aged 12–17 received treatment or counseling for emotional or behavioral problems in 2003 (SAMHSA, 2004a), and a nearly identical proportion (20.1 percent) of those aged 18–54 received treatment for mental and/or substance-use (M/SU)3 problems and illnesses in 2001–2003 (Kessler et al., 2005). More than 3 million (1.4 percent) of those aged 12 or older reported receiving some kind of treatment during 2003 for a problem related to alcohol or drug use (SAMHSA, 2004a). Millions more reported that they needed treatment for M/SU conditions but did not receive it (Mechanic and Bilder, 2004; SAMHSA, 2004a; Wu et al., 2003). From 2001 to 2003, only 40.5 percent of those aged 18–54 who met a specific definition of severe mental illness received any treatment (Kessler et al., 2005). And, in contrast with the more than 3 million Americans aged 12 or older who received treatment during 2003 for a problem related to alcohol or drug use, more than six times that number (9.1 percent of this age group) reported abusing or being physiologically dependent on alcohol; illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, or stimulants; prescription drugs used for nonmedical purposes; or a combination of these (SAMHSA, 2004a).

We know these people, and we know why they contact health care providers for M/SU treatment. We do so ourselves—for our own M/SU problems and illnesses and for those of our parents, our children, our spouses, our loved ones. We know about these conditions from other family members and from our neighbors, friends, teachers, and coworkers—and from the homeless people we pass on the street. What we can see for ourselves—our teenager’s friend battling anorexia, our friend’s spouse with a drinking problem, our own family member recovering from depression, or our child with attention deficit hyperactivity disorder (ADHD)—is reflected daily in the first-person accounts of public figures about their own M/SU illnesses and recovery. We hear of newswoman Jane Pauley’s treatment for and recovery from bipolar illness; astronaut Buzz Aldrin’s recovery from alcoholism and depression; former First Lady Betty Ford’s recovery from alcoholism; actress Drew Barrymore’s recovery from depression,


This figure does not include treatment solely for substance use.


Throughout this report, the committee uses the acronym M/SU to refer to “mental and/or substance use.”

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