Understanding Substance Use and Mental Health Problem Recognition and Recovery: Evidence from a National Sample

Background and Purpose: Despite the high prevalence of substance use (SU) and mental health (MH) problems among U.S. adults, epidemiological understanding of SU recovery, MH recovery, and dual recovery remains limited. Population-level data on differences in problem recognition between SU and MH, as well as single versus dual recovery, are scarce. Existing national estimates often focus on treatment utilization or disorder prevalence rather than recovery identification. To address this gap, this study sought to establish an epidemiological understanding of SU recovery, MH recovery, and dual recovery in a nationally representative sample. Specific objectives included estimating the prevalence of problem recognition and recovery status, comparing SU and MH differences in recognition and recovery, and examining dual recovery.

Methods: Data were drawn from the 2022–2023 National Survey on Drug Use and Health. The analytic sample included 31,182 adults reporting a lifetime SU or MH problem, including a subsample of 7,557 adults with co-occurring SU and MH problems. Key measures included self-reported problem recognition (SU and/or MH), recovery status (no recovery, SU recovery-only, MH recovery-only, or both), past-year severity indicators (e.g., SUD, mental illness, suicidality), service utilization (SU treatment, MH treatment, support group participation), and demographic and clinical covariates. Recovery status was the primary outcome. Design-adjusted chi-square tests were used to examine bivariate associations between covariates and recovery status categories.

Results: SU problem recognition was substantially lower (40%) than MH problem recognition (84%) among adults with either an SU or MH problem. Recovery rates were also lower for SU than MH, with 15% reporting SU recovery-only compared to 42% reporting MH recovery-only, 29% reporting no recovery, and 14% reporting both. Among individuals with co-occurring SU and MH problems, 55% reported dual recovery, while 17% reported no recovery. In this subgroup, SU recovery-only (17%) slightly exceeded MH recovery-only (11%).

Past-year SU support group participation was the strongest correlate of dual recovery (73% vs. 52% for non-participants, p < .001). Past-year SU and MH treatment were also linked to higher dual recovery. Additional positive correlates of dual recovery included a greater number of chronic health conditions, probation or parole involvement, and older age. In contrast, current severity indicators, including past-year SUD, serious mental illness, and suicidality, were associated with higher rates of no recovery.

Conclusions and Implications: Findings highlight important differences in how problem recognition and recovery are experienced, with substantially lower problem recognition and recovery reported for substance use than mental health in the overall sample. However, among individuals with co-occurring problems, dual recovery was common and exceeded rates of no recovery. Engagement in SU support groups and treatment services was strongly associated with dual recovery, whereas SU and MH severity indicators were associated with no recovery, highlighting the role of peer-based and formal supports. These findings denote the importance of improving understanding of recovery and dual recovery. Efforts to increase problem recognition, expand service access, and support engagement in recovery-oriented resources are needed. Future research should identify mechanisms that support recovery from both substance use and mental health conditions.