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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

A Finnish woman cleans up the "terrible houses" of those who are completely desperate

Auri opened the door and did not see the floor - it was evenly covered with scattered things, garbage and dust. It seemed that people did not live here, they simply could not live... The husband of the owner of the house died, leaving her with three small children. She did not have time to grieve, she worked around the clock to feed her family, pay utility bills, and pay taxes. Cleaning was simply not enough.

“When she DMed me, I was happy to help. Over the weekend I got behind the wheel and drove off. Cleaned for two days in a row while she was at work and the kids were at grandma's. When the woman saw the result, she cried, and the kids did not stop hugging me and thanking me,” says Auri Katarina. nine0003

A 29-year-old Finnish woman has quit her job and is now mopping floors, cleaning homes around the world full-time for free and says she feels completely happy. Her clients are special - they have experienced the death of a loved one, loss, failed to recover from grief or suffer from depression for years.

“Houses of horror are not uncommon, perhaps someone close to you needs help” Photo: SWNS, JAM Press

But such a reaction to Auri's cleaning was not always the case. Parents were embarrassed by their daughter's hobbies, who had an inexplicable love for cleanliness as a teenager. At first she put things in order at home, then switched to friends and relatives. “I gave them a ‘gift card’ for cleaning every Christmas. They know that I'm crazy, and still love me, ”Katarina admits. nine0003

She likes to find the worst mess and mess and fix it. Finca studied recommendations for quick cleaning, tried and left only working methods.

She once cleaned up an ex-boyfriend when he was on vacation with a new girlfriend. Then she herself found a new love in a dating app, and on the first date she wiped the dust everywhere, and on the second she turned the guy’s gray sneakers into snow-white ones.

Relatives resigned themselves to the fact that she could wash signs at bus stops, terrible stains on the floor in the shopping center. Fortunately, Katharina always has something with her to wipe, wash, and clean. nine0003

For the peace of mind of her parents, Auri has a bachelor's degree in hospitality management. After she even got a job in a cleaning company and grew to the position of a personnel manager, she had several dozen people under her command.

My house is my dump: why old people become horders

Read more

Two years ago, she started posting videos on the Internet about cleaning the houses of family and friends, sharing life hacks. Her impressive "before and after" videos went viral and quickly gained popularity. Now the Finnish has millions of followers around the world on Youtube, TikTok and Instagram (*Meta's activities are recognized as extremist and terrorist, banned in the Russian Federation). The highest grossing videos collect up to 30 million views. nine0003

“Why am I filming cleaning? There are two reasons. First, people watch my videos and understand that they are not alone in their own dirty apartment. And dare to ask for help. Secondly, it is important that people without depression and psychological problems see that "horror houses" are not uncommon. See if someone near you needs help. In my videos, I talk about mental health problems and try to save people from feeling shame about the mess in the house,” says Auri Katarina. nine0003

“She didn’t have the strength to take a shower, so she cut her hair so as not to wash it” Photo:

Cleaning other people’s houses is not cheap, each trip cost Auri about 250 euros. Auri could afford to help 2-3 people a month.

This went on for about half a year. She worked full time, and on weekends she cleaned subscribers' houses. Thanks to the viral videos, sponsors appeared who began to pay for travel expenses and washing equipment. And in the summer of 2021, Katarina quit her job. nine0003

Now every week, Auri gets into her car and leaves her small town of Tampere for a trip. Her ultimate goal is the dirtiest houses in Europe. Each of its objects is a new difficult case, the owners first of all need psychological help, and only then cleanliness.

Auri helps them take the first step towards a new life. She has helped sick old people, a single mother with two children, a 26-year-old father who wants to start communicating with a child, people who have psychological problems or depression . ..

Recently tidied up a house that had not been cleaned for more than five years. The girl was diagnosed with depression, she had financial problems. “It got to the point where she didn’t have the energy to take a shower, so she cut her hair so she didn’t have to wash it,” Auri explained.

Disorder can be both a cause and a consequence of psychological problems

Unwashed dishes, scattered things, dust and debris everywhere - this is not just a disorder, it is a symptom of psychological problems, on the one hand. On the other hand, the chaos in the house itself is the strongest source of stress. For example, a 2009 studyshowed that women who described their home as a “mess” had elevated levels of the stress hormone cortisol. In another study, it was found that clutter changes perception and makes it more negative, plus reduces life satisfaction.

“Disorder can be both a cause and a consequence of psychological problems. So many of my clients who “started up” at home were diagnosed with depression, attention deficit disorder and obsessive-compulsive disorder. For some, this happened as a result of grief, the loss of a loved one or even an animal,” says Cindy Glowinski, a psychotherapist and space organizer. nine0003

Nadezhda Dvoskina, a member of the Association for Cognitive Behavioral Psychotherapy, believes that constant clutter in an apartment can sometimes cause anxiety, low self-esteem and other emotional fluctuations in the person living there, and in the long run - anxiety and guilt. “Such disorders can appear when a person has an internal attitude of what he should be in order to consider himself good. These principles can be expressed in such ideas as “a good housewife’s kitchen always shines” or “you can’t live in such a pigsty,” the psychologist notes. According to her, those who tend to feel guilty and ashamed of the disorder and cannot cope with it on their own should contact a psychologist or psychotherapist. nine0003

“I only clean for free, my services cannot be bought”

Auri Katarina cleans houses full of garbage, mold and maggots. These are real household landfills, where empty bottles, cans, bags, leftover food, unwashed dishes occupy every square centimeter. The girl is not afraid of dirt, she methodically collects waste in bags, disinfects, cleans, sweeps, and in the end the house of horrors becomes perfectly well-groomed. Even under a microscope, not a single crumb or speck of dust can be found. nine0003

Do you criticize the owners of the houses? Do not rush, these are people who, for various reasons, cannot maintain order on their own. Auri sincerely sympathizes with them.

The fairy of order chooses places for cleaning from the requests she receives through social networks and the website. At the time of cleaning, he asks the owners to leave the house, since it usually takes about a day, less often 2-3 days in a row. She does not reveal the identity of her clients. All cleaning is done anonymously. If papers, photos get into the frame, then they are blurred at the time of editing. nine0003

With each client, Auri signs a contract for filming permission, garbage collection and insurance against breakdowns, damages up to one million euros. “Cleaning includes bringing the house to a habitable condition, it will become clean and fresh. Floors, furniture and other surfaces will be empty. Personal belongings and documents will not be viewed. I don't wash clothes, but I buy new blankets, pillows, sheets, and other essentials when needed. And sponsors donate cleaning products and other goods.” nine0003

What does Auri throw out? She collects clothes in boxes and sends them to the closet. Does not clean closets, but if there is enough time for this, he organizes storage in cabinets in the bathroom and in the kitchen. Garbage is taken away, but only what is 100 percent sure is thrown away. “Sometimes there can be something important for a person among the garbage, so I ask you to let me know about it so as not to throw away valuables by accident.

“I only clean for free, you can't buy my services. My dream is to clean for free and help people around the world. I love volunteering and cleaning is my way of contributing. I am happy that I can use my talent to help other people. I want to show the whole world that cleaning is fun, you just need to ask for help, and even the most impossible mess can be cleaned, - says Auri. “Many of them write to me six months or a year later, showing me their houses that are still clean, which is great.” nine0003

In addition to the shocking "Before and After" videos, Auri talks about how to clean up efficiently and quickly, how often to clean surfaces, why you shouldn't mix chlorine bleach with hot water. “Mostly I use the simplest products: vinegar, dishwashing detergent and oven cleaner. As tools, I use only a scraper, a dish brush that is great for small cracks, a rag, a microfiber cloth, a sponge and a washcloth,” explains the blogger. nine0003

Top 5 life hacks from Auri Katarina

Food wrap. This is Auri's signature cleaning technique: we apply the product and cover the surface with overlapping cling film, level it. We leave as long as we can. The film creates a greenhouse effect and allows the cleaner to work deeper and better. Suitable for cleaning stoves, baking sheets, oven, sanitary ware and other surfaces.

Scraper - power! Focus on using good tools, not fancy cleaners. Metal, plastic scrapers will easily wipe off any dirt, even limescale. nine0003

Descale. Pour water into the kettle, add 2 tablespoons of citric acid and boil. Leave the water for a couple of minutes, pour it out, rub it, rinse it, and the kettle is like new.

Remove limescale from the shower head. We use 9% table vinegar, soak a watering can in it for an hour and then wipe off the plaque with a hard sponge. Wash your shower with dishwashing liquid - it perfectly removes grease.

Clean little by little and often—don't feel compelled to clean everything at once. nine0003


Aurikacleaning. com

Auri Katarina's Youtube channel

How to get rid of depression in Project Zomboid with food, entertainment, communication and antidepressants

19096 Contents

how depression appears and what it affects in Project Zomboid
  • 2. How to treat "Deep depression" and remove it forever in Project Zomboid
  • In