2004a). Combining mental and substance-use problems and illnesses, more than 20 percent of U.S. adults aged 18–54 received care for these conditions during a 12-month period between 2001 and 2003 (Kessler et al., 2005). Millions more reported that they needed treatment for their mental and/or substance-use (M/SU)4 problems or illnesses but did not receive it (Mechanic and Bilder, 2004; SAMHSA, 2004a; Wu et al., 2003). Fewer than half of adults aged 18–54 who met a definition of severe mental illness received treatment for the condition during a 12-month period between 2001 and 2003 (Kessler et al., 2005). And in contrast to the more than 3 million Americans aged 12 or older who received treatment during 2003 for a problem related to alcohol or other drug use, more than six times that number (approximately 21.6 million, or 9.1 percent of this age group) reported abusing or being physiologically dependent upon alcohol; illicit drugs such as marijuana, cocaine, heroin, hallucinogens, or stimulants; prescription drugs used for nonmedical purposes; or a combination of these (SAMHSA, 2004a).

Many individuals using services to address their mental or substance-use problems require only a short-term intervention to address their condition (Bernstein et al., 2005; Fleming et al., 1997; Ockene et al., 1999). They may be experiencing, for example, anxiety or other distress over the loss of a loved one or a job or some other life-changing event. They may be engaging in occasional heavy drinking or be teenagers experimenting with drugs. These and other less severe problems that many individuals encounter at some point in their lives are not considered mental illnesses or drug dependence but are occasions during which an individual might need assistance to cope with a stressful situation, change unhealthy behaviors, and prevent the condition from worsening. Mental illnesses and substance dependence, in contrast, involve significantly more distress, disability, chronicity, and physical risk and interfere with performing routine activities such as working, attending school, or participating fully in relationships.

Individuals with M/SU problems and illnesses represent a wide range of diagnoses, severity of illness, and disability. What they all have in common, however, is the hope that when they seek help for their condition, they will receive care that is safe, effective, and of good overall quality. They expect that such care will enable them either to recover completely from an acute mental or substance-use illness or manage the illness successfully so they can live happy, productive, and satisfying lives. As articulated in the 1999 Surgeon General’s report on mental health (Anthony, 1993 as cited in DHHS, 1999:98):


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

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