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SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
    Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).



  • Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
  • Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44.4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31. 4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily


  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism



  • In 2020, 20. 7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
  • Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3.4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH)
  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals


  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program


  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes



  • Among people aged 12 or older in 2021, 3. 3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH)
  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose


  • Medication-Assisted Treatment
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program


  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network



  • In 2021, marijuana was the most commonly used illicit drug, with 18. 7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people).
  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.


  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.


  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 01/05/2023

I feel superfluous | PSYCHOLOGIES


Knowing Yourself A Man among People

“I feel out of place”, “no one is happy with me” - someone who constantly feels rejected, is distrustful of contacts with other people. The slightest inattention on their part makes you feel helpless again and again. “Once having experienced this painful feeling, such a person unconsciously expects that everything will happen again: he will be betrayed, abandoned,” explains existential psychotherapist Svetlana Krivtsova. nine0003

Trying to avoid such a development of events, each time he tests the strength of the relationship and, as a result, he remains alone again. “Trying to arouse interest in himself, to please him, he gradually becomes dependent on the opinions and assessments of other people,” continues Svetlana Krivtsova, “and his suspiciousness simply exhausts those who are nearby. Relationships become formal, often full of hostility, and eventually end.” To live in constant expectation of a break is to provoke a break.

Child injury

“When I was four, my older brother became seriously ill and my mother sent me to stay with my grandmother for a few months,” says 29-year-old Yaroslav. “I was very worried: it seemed to me that I behaved so badly that my mother had to abandon me.”

The fear of being abandoned first appears in childhood and is usually associated with sudden (often prolonged) separation from parents.

“Little children cannot understand the meaning of adults' actions and suffer from loneliness,” explains Svetlana Krivtsova. “The memory that you didn’t please your parents in some way and therefore turned out to be unnecessary remains for many years.” Those whom their parents really “abandoned” in childhood, without supporting them in a difficult situation, can also feel their abandonment. nine0003

“I am learning to talk about my feelings”

Valeriya, 33 years old

“I know well what it means to be unwanted. When my little sister was born, my mother quit her job to take care of it. Maybe my fears appeared then? I always felt that I was not with them. At school, too, no one wanted to be friends with me, and as a teenager, I was absolutely sure that I was unworthy of love. And indeed, no one paid attention to me, I was invisible.

At some point, the feeling of rejection became too painful, but it helped me to see myself from the outside: I turned out to be so closed, gloomy. Now I try to be more sociable, to speak more openly about my feelings, to articulate more clearly what worries me. Surprisingly, my loved ones now talk about restraint and vulnerability as the best features of my strong character. nine0003

Early sacrifices

Sometimes parents force a child very early to take on “adult” responsibilities, to sacrifice their interests in favor of a brother or sister, and the child grows up, confident that no one cares about him. “We feel the most severe pain in those moments when we experience our own worthlessness,” says Svetlana Krivtsova. “If they do this, it means that it is possible with me, it means that I am not worthy of another.” Feeling “worst of all”, building relationships with others is excruciatingly difficult. There are unconscious "filters" through which the growing child "reinterprets" the world in his own way ... and always not in his favor. nine0003

The ugly duckling

Some people are always preoccupied with adjusting their behavior to the expectations of others. “The reason is the feeling “I ended up here by chance, I am an ugly duckling among white swans,” explains psychoanalyst Marie-Dominique Linder. - This painful feeling is especially strong in adolescence. The teenager is trying with all his might to hide his dissimilarity so that his peers do not push him away, do not expel him from his company. Becoming an adult means overcoming this crisis and asserting yourself as a person. nine0003

What to do?

Understand the “history” of your feeling

Try to remember when the painful feeling of rejection first arose. What event changed your attitude towards yourself? Once you understand this, you can begin to control your experiences.

Do not dramatize

Try to talk freely about your feelings, write down your story. Humor helps you connect with people. By saying what you feel, you will slightly weaken the power of the image in whose captivity you live. nine0003

Open up to people

Don't wait for someone to help you. It takes serious effort to build relationships. Take the first step by trying to see the other person as an ally rather than a potential offender.

Grow up

Accept it as a fact: you are different from others (just like they are from you) and you don't need their approval to be yourself. By refusing to live dependent on the judgmental gaze of others, you can finally grow up. nine0003

Advice to a stranger

How to help someone who feels rejected in any situation? In a conversation, focus on his opinion, emphasizing that his point of view is important to you. But at the same time, do not indulge, this will lead to the opposite effect: your interlocutor may feel dependent on you, which will increase his feeling of rejection, because you cannot be with him all the time.

Be sincere in your intentions. The fact is that a person who considers himself useless doubts that he can arouse interest in himself. You can convince him that he is really worthy of attention and love only by sincerely communicating with him. nine0003

Text: Tatyana Galesa Photo credit: Getty Images

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What is it like to live when you don't feel reality

Imagine: one day you wake up, look in the mirror and try to recognize yourself in it. Worse, you feel like you're watching your life from the sidelines, like you're watching a bad and boring movie. It becomes increasingly difficult for you to interact with others, because too much energy is spent trying to deal with strange sensations. nine0003

These are all frightening symptoms of a dissociative disorder called depersonalization/derealization syndrome, or DP-DR. It appears as a result of psychological trauma or drug use and can last from a couple of hours to several years. This strange, little-talked about condition causes people to lose touch with their body, emotions, environment, and even family. From the moment the first symptoms appear, life turns into a constant struggle with a sense of the unreality of what is happening, in which it is almost impossible to catch one's own "I". nine0003

As part of Mental Health Week, we interviewed several people to find out what it's like to constantly feel out of touch with reality.


With DP-DR, looking at your reflection in the mirror or hearing your own voice is quite strange, because they seem not real. Then this feeling grows, and everything around seems unreal. You feel like a thread of emotions and thoughts, alone in this alien world. Usually this condition goes away in a few hours or days, but I have been living like this for two and a half years. nine0003

DP-DR often complements and exacerbates nervousness and depression. In fact, symptoms are common. Many experience similar feelings due to overwork or stress. Smoking weed or using hallucinogenic drugs can also trigger self-perception disorders. Sensation of complete exhaustion of consciousness, like a fog in the head. Right now my head is wadded, my eyes are sticking together, I want to lie down. Thoughts are scattered, it is difficult to focus on something that requires critical thinking or memory work. I tried to practice mindfulness, but it only got worse. nine0003

Mental illness dooms a person to loneliness. Friends can accept your feelings and support, but this is of little use. At school, it seems to me, everyone only pretended to understand. Despite the support system, I had the feeling that others believed that I was playing the victim. It seems to me that such judgments are a label that society hangs on everyone with a mental illness. You know, kind of like the typical Tumblr teen talking about anxiety, depression, and "reveling in self-pity" all the time. nine0003

It is unfortunate that the words "depersonalization" and "derealization" are so long and difficult to pronounce - it is not easy to use them in speech and discuss these disorders with people in ordinary conversation.


I remember the fear and confusion I felt when I first experienced the symptoms of DP-DR. I told my parents that something was wrong with me. Everything around me and in my head felt wrong. Many who suffer from this disorder describe the condition as a dream or the feeling of watching a movie about themselves. I was walking. It was already late when I got home and lay down with depressive thoughts, trying to sleep. Then I suddenly had a panic attack. My heart was beating fast and there was no air in my chest. Rolling onto my back, I tried to control my breathing. And then a switch seemed to flip in my head, and almost instantly the state of DP-DR set in. nine0003

At first I noticed that I had completely lost my emotions. I felt nothing but horror. Looking in the mirror, it was as if I could not recognize myself in the reflection - I knew who I was, but did not understand. I was so excited that I decided to wake up my parents. Mom tried to calm me down, and I felt her hand on my body, but only as a physical sensation of her attempts to calm me down. I didn't realize that I knew her. I thought I would never feel my mother's love again. I looked out the window and looked at the backyard where I spent my childhood, and I was not sure that this place was familiar to me. It felt like my memories no longer belonged to me. nine0003

Depersonalization is a terrifying condition. According to psychologists, the brain uses it as a tool for survival or protection. By "paralyzing" emotions, DP-DR allows people to think rationally in stressful situations. For example, during a fire, DP-DR syndrome would help a person not to panic, but to focus on escaping. But then the dissociative state must pass. However, if this does not happen, then DP-DR develops into a disorder, life with which is a nightmare.

I'm on medication and sometimes I feel like I'm crazy. I worry about the constant confusion in my head. My ambitions and hopes for the future seem lost. Lately I've begun to wonder how strange my feelings are. My own brain is against me. How can all my sensations and emotions be the product of gray matter under my skull? Nothing else makes sense. nine0003

I am trying to distract myself by reading. I also do music. It's a good way - the music really pulls me in. I bought a self-help book about DP-DR syndrome, and it, along with stories of people who have successfully overcome depersonalization, helps the most.

For those who also suffer from DP-DR, I would advise you to keep yourself busy, even if it is extremely difficult in the beginning. Even if the world seems different, go back to your old hobbies. It will get better after a while. If you feel that you are on the verge of insanity, just breathe and try to focus on your surroundings. Chat with friends and don't avoid people. nine0003


I had DP-DR symptoms very early, at 15 years old. Of course, initially they were rare and did not bring significant harm. I had a kind of feeling when you look around and think "What?" or when life seems somehow unreal. At the age of 17, they began to manifest themselves stronger and more often. I began to wonder at times if there was something wrong with me or if this is a normal state of any person. I allowed the thought that perhaps this is how adults perceive reality. nine0003

Last year, when I graduated from college, my condition worsened dramatically. Now I don't feel alive. I don’t feel emotions and I don’t worry about relationships. I have problems with long term memory. Everything around me seems flat and blurry. It is hard to explain. In this state, you get the feeling that you are a small person inside your own head and looking at the world as if through a TV screen. Communication is very difficult for me, because there is a direct relationship between interest in people and symptoms of DP-DR. It also seems that time flies very quickly. nine0003

As a result, my life deteriorated significantly. I became more depressed and less sociable, interested and self-confident. It is hard for me to maintain friendly relations with anyone, because the disease robs me of emotions, and I am simply not able to experience love or affection. But that doesn't mean I feel at ease. The only benefit is that I can keep my cool in stressful situations. I am quite efficient, but I am in a state of constant discomfort 24 hours 7 days a week. I go to a psychotherapist to try to understand the causes of my condition. nine0003

It is difficult for me to make friends or make new acquaintances. I had to literally fight with myself in order to maintain a relationship that lasted for four whole years, due to the fact that it is difficult for me to experience love or affection. As friendships begin to fade, I have to remind myself that deep down I love these people and that it's my mental illness that makes me think I don't care about them. But despite this, my friends are happy that I try to be better.

As an artist, I have to work hard to feel inspired. It is very difficult when something that was previously inspiring ceases to cause a surge of dopamine. Escapism is a great way out of this situation. Since reality only provokes discomfort, Netflix and the Internet immerse me in alternate realities over which I have more control.

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