Substance Abuse > Chapter 3, Part B - Trends cont'd Alcohol & Tabacco Use

III. Substance Abuse Trends( Part B )

D. Initiation of Substance Use

Estimates of substance use initiation (also known as incidence or first-time use) are often considered leading indicators that can be used to assess the volume of new users by drug or drug category, track emerging patterns of use, and forecast the associated treatment needs in various population subgroups. These estimates can also be useful to target prevention efforts and evaluate prevention programs.

With its large sample size and oversampling of youths aged 12 to 17 and young adults aged 18 to 25, the National Survey on Drug Use and Health (NSDUH) provides estimates of recent (i.e., past year) initiation of use of illicit drugs, tobacco, and alcohol based on reported age and on year and month at first use. Recent initiates are defined as those who reported use of a particular substance for the first time within 12 months preceding the date of interview. There is a caveat to the past year initiation measure worth mentioning. Because survey respondents are aged 12 or older, the past year initiation estimates reflect only a portion of the initiation that occurred at age 11 and none of the initiation that occurred at age 10 or younger. This underestimation primarily affects estimates of initiation for cigarettes, alcohol, and inhalants because they tend to be initiated at a younger age than other substances. See Section B.4.1 in Appendix B for further discussion of the methods and bias in initiation estimates.

This chapter includes estimates of the number and rate of past year initiation of illicit drug, tobacco, and alcohol use among the total population aged 12 or older and by selected age and gender categories from the 2012 NSDUH, comparing with prior years. Also included are initiation estimates that pertain to persons at risk for initiation. Persons at risk for initiation of use of a particular substance are those who never used the substance in their lifetime plus those who used that substance for the first time in the 12 months prior to the interview. In other words, persons at risk are those who had never used as of 12 months prior to the interview date. Some analyses are based on the age at the time of interview, and others focus on the age at the time of first substance use. Readers need to be aware of these alternative estimation approaches when interpreting NSDUH incidence estimates and pay close attention to the approach used in each situation. Titles and notes on figures and associated detailed tables document which method applies.

For trend measurement, initiation estimates for each year (2002 to 2012) are produced independently based on the data from the survey conducted that year. Estimates of trends in incidence based on longer recall periods have not been considered because of concerns about their validity (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004).

Regarding the age at first use estimates, means, as measures of central tendency, are heavily influenced by the presence of extreme values in the data for persons aged 12 or older. To reduce the effect of extreme values, the mean age at initiation was calculated for persons aged 12 to 49, leaving out those few respondents who were past year initiates at age 50 or older. Including data from initiates aged 26 to 49 in this broad age group also can cause instability of estimates of the mean age at initiation among persons aged 12 to 49, but this effect is less than that of including data from initiates aged 50 or older. Nevertheless, caution is needed in interpreting these trends for persons aged 12 to 49. Section B.4.1 in Appendix B also discusses this issue. Note, however, that this constraint affects only the estimates of mean age at initiation. Other estimates in this chapter, including the numbers and percentages of past year initiates, are not affected by extreme ages at initiation and therefore are reported for all persons aged 12 or older.

Another important consideration in examining incidence estimates across different drug categories is that substance users typically initiate use of different substances at different times in their lives. Thus, the estimates for past year initiation of each specific illicit drug cannot be added to obtain the total number of overall illicit drug initiates because some of the initiates previously had used other drugs. The initiation estimate for any illicit drug represents the past year initiation of use of a specific drug that was not preceded by use of other illicit drugs. For example, a respondent who reported initiating marijuana use in the past 12 months is counted as a marijuana initiate. The same respondent also can be counted as an illicit drug initiate with marijuana as the first drug only if his or her marijuana use initiation was not preceded by use of any other drug (cocaine, heroin, hallucinogens, inhalants, pain re lievers, tranquilizers, stimulants, or sedatives).2. In addition, past year initiates of lysergic acid diethylamide (LSD), phencyclidine (PCP), or Ecstasy use are counted as past year initiates of any hallucinogen use only if they had not previously used other hallucinogens. Similarly, past year initiates of crack cocaine, OxyContin,or methamphetamine use are counted as past year initiates for the broader category (i.e., any cocaine, pain relievers, or stimulants, respectively) only if they did not report previous use for the broader category.


2Initiation for pain relievers, tranquilizers, stimulants, or sedatives refers to first nonmedical use.


Initiation of Illicit Drug Use

  • In 2012, about 2.9 million persons aged 12 or older used an illicit drug for the first time within the past 12 months; this averages to about 7,900 new users per day. This estimate was not significantly different from the number in 2011 (3.1 million). Over half of initiates (55.1 percent) were younger than age 18 when they first used, and 53.7 percent of new users were female. The 2012 average age at initiation among persons aged 12 to 49 was 18.7 years, which was similar to the 2011 estimate (18.1 years). See Section B.4.1 in Appendix B for a discussion of the effects of older adult initiates on estimates of mean age at first use.
  • Of the estimated 2.9 million persons aged 12 or older in 2012 who used illicit drugs for the first time within the past 12 months, a majority reported that their first drug was marijuana (65.6 percent) (Figure 5.1). More than 1 in 4 initiated with nonmedical use of psychotherapeutics (26.0 percent, including 17.0 percent with pain relievers, 4.1 percent with tranquilizers, 3.6 percent with stimulants, and 1.3 percent with sedatives). A notable proportion reported inhalants (6.3 percent) as their first illicit drug, and a small proportion used hallucinogens (2.0 percent). All of the above 2012 percentages of first illicit drug use were similar to the corresponding percentages in 2011.




Comparison, by Drug

  • In 2012, the specific illicit drug category with the largest number of recent initiates among persons aged 12 or older was marijuana use (2.4 million), followed by nonmedical use of pain relievers (1.9 million), then nonmedical use of tranquilizers (1.4 million), followed by Ecstasy use (0.9 million), then use of stimulants, cocaine, and inhalants (0.6 million to 0.7 million) (Figure 5.2).
  • Among persons aged 12 to 49 in 2012, the average age at first use was 16.6 years for PCP, 16.9 years for inhalants, 17.9 years for marijuana, 19.0 years for LSD, 20.0 years for cocaine, 20.3 years for Ecstasy, 22.1 years for stimulants, 22.3 years for pain relievers, 23.0 years for heroin, 23.6 years for tranquilizers, and 26.2 years for sedatives (Figure 5.3).







Marijuana

  • In 2012, there were 2.4 million persons aged 12 or older who had used marijuana for the first time within the past 12 months; this averages to about 6,600 new users each day. The 2012 estimate was similar to the estimates in 2008 through 2011 (ranging from 2.2 million to 2.6 million), but was higher than the estimates in 2003, 2004, 2006, and 2007 (ranging from 2.0 million to 2.1 million) (Figure 5.4).
  • In 2012, among persons aged 12 or older, an estimated 1.4 million first-time past year marijuana users initiated prior to the age of 18. This estimate was similar to the corresponding estimate in 2011 (1.5 million). The estimated 1.4 million persons in 2012 who initiated prior to the age of 18 represented the majority (57.3 percent) of the 2.4 million recent marijuana initiates.
  • Among all youths aged 12 to 17, an estimated 5.0 percent had used marijuana for the first time within the past year in 2012, which was similar to the rate in 2011 (5.5 percent). As a percentage of those aged 12 to 17 who had not used marijuana prior to the past year (i.e., those at risk for initiation), the youth marijuana initiation rate in 2012 (5.7 percent) was similar to the rate in 2011 (6.3 percent).
  • In 2012, the average age at first marijuana use among recent initiates aged 12 to 49 was 17.9 years, which was similar to the average ages in 2011 (17.5 years), 2010, and 2005 through 2008, but was higher than the average ages in 2002 through 2004 and in 2009 (Figure 5.4). Section B.4.1 in Appendix B discusses the potential instability of estimates of older adult initiation and the impact on estimates of mean age at first use.
  • In 2012, among recent initiates aged 12 or older who initiated marijuana use prior to the age of 21, the mean age at first use was 16.3 years, which was similar to the 2011 estimate.




Cocaine

  • In 2012, there were 639,000 persons aged 12 or older who had used cocaine for the first time within the past 12 months; this averages to approximately 1,800 initiates per day. This estimate was similar to the number in 2008 to 2011 (ranging from 623,000 to 724,000). The annual number of cocaine initiates declined from 0.9 million or 1.0 million in 2002 through 2007 to 639,000 in 2012.
  • The number of initiates of crack cocaine ranged from 209,000 to 353,000 in 2002 to 2008 and declined to 95,000 in 2009. The number of initiates of crack cocaine has been similar each year since 2009 (e.g., 84,000 in 2012).
  • In 2012, most (76.2 percent) of the 0.6 million recent cocaine initiates were 18 or older when they first used. The average age at first use among recent initiates aged 12 to 49 was 20.0 years. The average age estimates have remained fairly stable since 2002.



Heroin

  • In 2012, there were 156,000 persons aged 12 or older who had used heroin for the first time within the past 12 months. This estimated number in 2012 was similar to the numbers in 2002, 2004, 2005, and 2007 to 2011 (ranging from 106,000 to 187,000), but was higher than the numbers in 2003 and 2006 (92,000 and 90,000, respectively). The 2012 average age at first use among recent heroin initiates aged 12 to 49 was 23.0 years, which was similar to the 2011 estimate (22.1 years).


Hallucinogens

  • In 2012, there were 1.1 million persons aged 12 or older who had used hallucinogens for the first time within the past 12 months (Figure 5.5). This estimate was similar to the estimates for 2002, 2004 to 2008, and 2011 (ranging from 0.9 million to 1.2 million). However, this estimate for 2012 was higher than the 2003 estimate (886,000) and was lower than the estimates in 2009 and 2010 (1.3 million and 1.2 million, respectively).
  • The number of past year initiates of LSD aged 12 or older was 421,000 in 2012, which was similar to the numbers in 2002 and in 2008 to 2011 (ranging from 338,000 to 400,000), but was higher than the numbers in 2003 to 2007 (ranging from 200,000 to 271,000) (Figure 5.5).
  • The number of past year initiates of PCP aged 12 or older was 90,000 in 2012. This number was higher than the 2009 estimate (45,000), but was similar to the estimates from 2002 to 2008 (ranging from 53,000 to 123,000) and also was similar to the 2010 and 2011 estimates (46,000 and 48,000, respectively).



Inhalants

  • In 2012, there were 584,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months, which was lower than the numbers in 2002 to 2011 (ranging from 719,000 to 877,000). An estimated 62.5 percent of past year initiates of inhalants in 2012 were younger than age 18 when they first used. The average age at first use among recent initiates aged 12 to 49 was similar in 2011 and 2012 (16.4 and 16.9 years, respectively).


Psychotherapeutics

  • Nonmedical use of psychotherapeutics includes nonmedical use of any preblockedion-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included. In 2012, there were approximately 2.4 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year, which averages to about 6,700 initiates per day. The number of new nonmedical users of psychotherapeutics in 2012 was similar to estimates for 2002, 2003, and 2005 through 2011 (ranging from 2.3 million to 2.6 million), but was lower than the 2004 estimate (2.8 million).
  • The number of new nonmedical users of pain relievers in 2012 (1.9 million) was similar to the estimates in 2007, 2010, and 2011, but was lower than the numbers in 2002 through 2006 and in 2008 and 2009 (ranging from 2.2 million to 2.5 million). In 2012, the numbers of initiates were 1.4 million for tranquilizers, 676,000 for stimulants, and 166,000 for sedatives.
  • In 2012, the average age at first nonmedical use of any psychotherapeutics among recent initiates aged 12 to 49 was 22.9 years. Average ages at first nonmedical use were 22.1 years for stimulants, 22.3 years for pain relievers, 23.6 years for tranquilizers, and 26.2 years for sedatives. All of these 2012 estimates were similar to the corresponding estimates in 2011.
  • In 2012, the number of new nonmedical users of OxyContin aged 12 or older was 372,000,which was similar to the 2011 estimate of 483,000, but was lower than the 2010 estimate (600,000). The average age at first use of OxyContin among past year initiates aged 12 to 49 was similar in 2011 and 2012 (22.8 and 22.0 years, respectively).
  • The number of recent new users of methamphetamine among persons aged 12 or older was 133,000 in 2012 (Figure 5.6), which also was the 2011 estimate and was similar to the 2010 estimate (107,000). However, the number of initiates in 2012 was lower than the estimates in 2002 to 2004 and in 2006 (ranging from 259,000 to 318,000). The average age at first use among new methamphetamine users aged 12 to 49 in 2012 was 19.7 years, which was similar to the corresponding estimates from 2002 to 2011 (ranging from 17.8 to 22.2 years).




Alcohol

  • In 2012, there were 4.6 million persons aged 12 or older who had used alcohol for the first time within the past 12 months; this averages to approximately 12,600 initiates per day.
  • In 2012, most (81.4 percent) of the 4.6 million recent alcohol initiates were younger than age 21 at the time of initiation. Approximately 58.3 percent initiated prior to age 18.
  • In 2012, the average age at first alcohol use among recent initiates aged 12 to 49 was 17.4 years, which was similar to the 2008, 2010, and 2011 estimates, but was higher than the estimates in 2002 to 2007 and in 2009 (ranging from 16.4 to 16.9 years). The mean age at first use among recent initiates aged 12 or older who initiated use prior to the age of 21 was 16.0 years, which was similar to the 2011 estimate of 15.9 years. to the corresponding estimates from 2002 to 2011 (ranging from 17.8 to 22.2 years).



Tobacco

  • The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was approximately 2.3 million in 2012, which was similar to the estimates from 2004 through 2011 (ranging from 2.1 million to 2.5 million), but was higher than the estimates for 2002 and 2003 (1.9 million and 2.0 million, respectively) (Figure 5.7). The 2012 estimate averages to about 6,400 new cigarette smokers every day. About half of new cigarette smokers in 2012 (51.4 percent) initiated prior to age 18.
  • In 2002 and 2012, the numbers of cigarette initiates who were younger than age 18 when they first used were similar (1.3 million and 1.2 million, respectively). However, the number of cigarette initiates who began smoking at age 18 or older increased from 623,000 in 2002 to 1.1 million in 2012.




  • In 2012, among recent initiates aged 12 to 49, the average age of first cigarette use was 17.8 years, which was higher than the corresponding average age in 2011 (17.2 years).
  • Of those aged 12 or older who had not smoked cigarettes prior to the past year (i.e., those at risk for initiation), the past year initiation rate for cigarettes was 2.3 percent in 2012, which was similar to the rate in 2011 (2.4 percent).
  • Among youths aged 12 to 17 who had not smoked cigarettes prior to the past year (i.e., youths at risk for initiation), the incidence rate in 2012 was 4.8 percent, which was lower than the 2011 rate (5.5 percent). However, past year initiation rates in 2012 of 4.7 percent for males aged 12 to 17 and 4.8 percent for females in this age group who had never smoked prior to the past year were not significantly different from corresponding rates in 2011 (5.4 percent for males and 5.5 percent for females) (Figure 5.8). Past year initiation rates in 2012 among males and females aged 12 to 17 who were at risk for initiation of cigarette use were lower than the rates in 2002 to 2010.




  • In 2012, the number of persons aged 12 or older who had started smoking cigarettes daily within the past 12 months was 778,000 (Figure 5.9). This estimate was similar to the 2011 estimate (878,000), but was lower than the estimates from 2002 through 2010 (ranging from 0.9 million to 1.1 million). Of the new daily smokers in 2012, 33.0 percent, or 257,000 persons, were younger than age 18 when they started smoking daily. This number is equivalent to an average of approximately 700 persons per day under the age of 18 who started smoking cigarettes on a daily basis.
  • The average age of first daily cigarette smoking among new daily smokers aged 12 to 49 was similar in 2011 and 2012 (19.1 and 19.9 years, respectively). Among males, the average age at first daily use was similar in 2011 and 2012 (19.2 and 19.1 years, respectively). Among females, the estimates for those 2 years also were similar (19.0 and 21.0 years, respectively).
  • In 2012, there were 2.7 million persons aged 12 or older who had used cigars for the first time in the past 12 months, which was similar to the 2011 estimate (2.8 million) (Figure 5.9). However, the 2012 estimate was lower than the estimates from 2004 through 2007 and for 2009 (ranging from 3.1 million to 3.3 million). Among past year cigar initiates aged 12 to 49, the average age at first use was 20.5 years in 2012, which was similar to the estimate in 2011 (19.6 years).




  • The number of persons aged 12 or older initiating use of smokeless tobacco in the past year was 1.0 million in 2012, which was similar to the estimates from 2002 through 2005 (ranging from 0.9 million to 1.1 million), but was lower than the estimates from 2006 through 2011 (ranging from 1.3 million to 1.5 million) (Figure 5.9). In 2012, about three quarters (74.2 percent) of new initiates were male, and over two fifths (46.3 percent) were younger than age 18.
  • In 2012, the average age at first smokeless tobacco use among recent initiates aged 12 to 49 was 18.8 years, which was similar to the estimates from 2002 to 2011 (ranging from 18.0 to 19.8 years).


E. Youth Prevention-Related Measures

Research has shown that substance use by adolescents can often be prevented through interventions involving risk and protective factors associated with the onset or escalation of use (Catalano, Hawkins, Berglund, Pollard, & Arthur, 2002). Risk and protective factors include variables that operate at different stages of development and reflect different domains of influence, including the individual, family, peer, school, community, and society levels (Hawkins, Catalano, & Miller, 1992; Robertson, David, & Rao, 2003). Interventions to prevent substance use generally are designed to ameliorate the influence of risk factors and enhance the effectiveness of protective factors.

The National Survey on Drug Use and Health (NSDUH) includes questions for youths aged 12 to 17 to measure the risk and protective factors that may affect the likelihood that they will engage in substance use. This chapter presents findings on youth prevention-related measures. Where applicable, findings from 2012 are compared with estimates from prior years since 2002. Included in this chapter are measures of the perceived risk of substance use (cigarettes, alcohol, and specific illicit drugs), perceived availability of substances (including being approached by someone selling drugs), perceived parental disapproval of youth substance use, attitudes about peer substance use, involvement in fighting and delinquent behavior, religious involvement and beliefs, exposure to substance use prevention messages and programs, and parental involvement. Also presented are findings on the associations between selected measures of risk and protective factors and substance use from NSDUH. However, the cross- sectional nature of these data precludes making any causal connections between these risk and protective factors and substance use.

[Qn.No.16.The youth prevention-related measures of substance use include:]

Perceived Risk of Substance Use

    One factor that can influence whether youths will use tobacco, alcohol, or illicit drugs is the extent to which they believe these substances might cause them harm. NSDUH respondents were asked how much they thought people risk harming themselves physically and in other ways when they use various substances in certain amounts or frequencies. Response choices for these items were "great risk," "moderate risk," "slight risk," or "no risk."
  • In 2012, 65.7 percent of youths aged 12 to 17 perceived great risk in smoking one or more packs of cigarettes per day, 63.9 percent perceived great risk in having four or five drinks of an alcoholic beverage nearly every day, and 39.7 percent perceived great risk in having five or more drinks once or twice a week. For marijuana, 43.6 percent of youths perceived great risk in smoking marijuana once or twice a week, and 26.5 percent perceived great risk in smoking marijuana once a month. The percentages of youths who perceived great risk in using other drugs once or twice a week were 80.0 percent for heroin, 78.9 percent for cocaine, and 70.6 percent for LSD.
  • The percentages of youths reporting binge alcohol use and the use of cigarettes and marijuana in the past month were lower among those who perceived great risk in using these substances than among those who did not perceive great risk. For instance, in 2012, past month binge drinking (consumption of five or more drinks of an alcoholic beverage on a single occasion on at least 1 day in the past 30 days) was reported by 4.0 percent of youths aged 12 to 17 who perceived great risk from "having five or more drinks of an alcoholic beverage once or twice a week," which was lower than the rate (9.5 percent) for youths who saw moderate, slight, or no risk from having five or more drinks of an alcoholic beverage once or twice a week (Figure 6.1). Past month marijuana use was reported by 1.0 percent of youths who saw great risk in smoking marijuana once a month compared with 9.6 percent of youths who saw moderate, slight, or no risk.




  • Trends in substance use often coincide with trends in perceived risk. Increases in perceived risk typically precede or occur simultaneously with decreases in use, and vice versa. For example, the percentage of youths aged 12 to 17 indicating great risk in smoking marijuana once a month decreased from 34.4 percent in 2007 to 26.5 percent in 2012 (Figure 6.2). The rate of youths perceiving great risk in smoking marijuana once or twice a week also decreased from 54.6 percent in 2007 to 43.6 percent in 2012. Consistent with these decreasing trends in the perceived risk of marijuana use, the prevalence of past month marijuana use among youths increased between 2007 (6.7 percent) and 2011 (7.9 percent). However, the rate declined between 2011 and 2012 (7.2 percent).




  • The proportion of youths aged 12 to 17 who reported perceiving great risk from smoking one or more packs of cigarettes per day increased from 63.1 percent in 2002 to 69.5 percent in 2008, then declined to 65.5 percent in 2009; this rate remained unchanged between 2009 and 2012 (65.7 percent) (Figure 6.3). Although rates of use often decrease as perceptions of risk increase, the rate of past month adolescent cigarette smoking decreased from 13.0 percent in 2002 to 6.6 percent in 2012.
  • The percentage of youths aged 12 to 17 indicating great risk in having four or five drinks of an alcoholic beverage nearly every day increased from 62.2 percent in 2002 to 65.6 percent in 2008; this rate remained unchanged between 2009 (64.1 percent) and 2012 (63.9 percent) (Figure 6.3). The percentage of youths perceiving great risk in having five or more drinks of an alcoholic beverage once or twice a week increased from 38.2 percent in 2002 to 39.7 percent in 2012. Consistent with the increases in perceived risk among youths aged 12 to 17 between 2002 and 2008, there were decreases between 2002 and 2009 in the rate of binge alcohol use (from 10.7 to 8.9 percent). Although perceived risk among youths was unchanged between 2009 and 2012, the rates of binge and past month heavy alcohol use declined (from 8.9 to 7.2 percent and from 2.1 to 1.3 percent, respectively).
  • Between 2003 and 2012, the percentage of youths aged 12 to 17 perceiving great risk from using an illicit drug once or twice a week declined for the following substances: heroin (from 82.6 to 80.0 percent), cocaine (from 80.7 to 78.9 percent), LSD (from 76.9 to 70.6 percent), and marijuana (from 54.4 to 43.6 percent) (Figure 6.4). The rates remained unchanged between 2011 and 2012 for heroin, cocaine, LSD, and marijuana. Youths were less likely to perceive great risk for smoking marijuana once or twice a week than for corresponding use of the other listed illicit drugs.





Perceived Availability

  • In 2012, about half (47.8 percent) of youths aged 12 to 17 reported that it would be "fairly easy" or "very easy" for them to obtain marijuana if they wanted some (Figure 6.5). About 1 in 10 (9.9 percent) indicated that heroin would be fairly or very easily available, and 11.5 percent reported so for LSD. Between 2002 and 2012, there were decreases in the perceived easy availability of marijuana (from 55.0 to 47.8 percent), cocaine (from 25.0 to 16.0 percent), crack (from 26.5 to 16.7 percent), LSD (from 19.4 to 11.5 percent), and heroin (from 15.8 to 9.9 percent).


[Qn.No.17.Most easily available illicit drug is:]



  • Youths aged 12 to 17 in 2012 who perceived that it was easy to obtain specific illicit drugs were more likely to be past month users of those illicit drugs than were youths who perceived that obtaining specific illicit drugs would be fairly difficult, very difficult, or probably impossible. For example, 17.4 percent of youths who reported that marijuana would be easy to obtain were past month illicit drug users, but only 2.9 percent of those who thought marijuana would be more difficult to obtain were past month users. Similarly, 14.4 percent of youths who reported that marijuana would be easy to obtain were past month marijuana users, but only 1.1 percent of those who thought marijuana would be more difficult to obtain were past month users.
  • The percentage of youths who reported that marijuana, cocaine, crack, heroin, and LSD would be easy to obtain increased with age in 2012. For instance, 19.5 percent of those aged 12 or 13 said it would be fairly or very easy to obtain marijuana compared with 50.1 percent of those aged 14 or 15 and 71.0 percent of those aged 16 or 17.
  • In 2012, 13.2 percent of youths aged 12 to 17 indicated that they had been approached by someone selling drugs in the past month. This rate declined between 2002 (16.7 percent) and 2012, although the 2012 rate was similar to the 2011 rate (13.8 percent).


Perceived Parental Disapproval of Substance Use

  • Most youths aged 12 to 17 believed their parents would "strongly disapprove" of their using substances. In 2012, 89.3 percent of youths reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice, which also was the rate in 2011 and was similar to the 89.1 percent reported in 2002. Most youths in 2012 (90.5 percent) reported that their parents would strongly disapprove of their having one or two drinks of an alcoholic beverage nearly every day, which also was the rate in 2011, but was higher than the rate in 2002 (89.0 percent). In 2012, 93.1 percent of youths reported that their parents would strongly disapprove of their smoking one or more packs of cigarettes per day, which was similar to the rate reported in 2011 (93.2 percent), but was higher than the 89.5 percent reported in 2002.
  • Youths aged 12 to 17 who believed their parents would strongly disapprove of their using specific substances were less likely to use these substances than were youths who believed their parents would somewhat disapprove or neither approve nor disapprove. For instance, in 2012, past month cigarette use was reported by 4.6 percent of youths who perceived strong parental disapproval if they were to smoke one or more packs of cigarettes per day compared with 31.9 percent of youths who believed their parents would not strongly disapprove. Also, past month marijuana use was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than among those who did not perceive this level of disapproval (4.3 vs. 31.0 percent, respectively).


Attitudes toward Peer Substance Use

  • A majority of youths aged 12 to 17 reported that they disapproved of their peers using substances. In 2012, 91.4 percent of youths "strongly" or "somewhat" disapproved of their peers smoking one or more packs of cigarettes per day, which was similar to the rate of 91.0 percent in 2011, but was higher than the 87.1 percent in 2002. Also in 2012, 80.3 percent strongly or somewhat disapproved of peers using marijuana or hashish once a month or more, which also was the rate reported in 2011 and was similar to the 80.4 percent reported in 2002. In addition, 88.7 percent of youths strongly or somewhat disapproved of peers having one or two drinks of an alcoholic beverage nearly every day in 2012, which was similar to the rate of 88.1 percent in 2011, but was higher than the 84.7 percent reported in 2002.
  • In 2012, youths aged 12 to 17 who strongly or somewhat disapproved of their peers using marijuana once a month or more were less likely to be past month marijuana users than those who neither approved nor disapproved of this behavior from their peers (2.0 vs. 28.3 percent).


Fighting and Delinquent Behavior

  • NSDUH includes questions for youths aged 12 to 17 about the number of times they had engaged in fighting or other delinquent behavior in the 12 months prior to the interview. In 2012, 18.3 percent of youths aged 12 to 17 reported that they had gotten into a serious fight at school or at work in the past year; 11.8 percent had taken part in a group-against- group fight; 5.6 percent attacked others in at least one instance with the intent to harm or seriously hurt them; 3.5 percent had carried a handgun at least once; 3.5 percent had, at least once, stolen or tried to steal something worth more than $50; and 2.7 percent sold illegal drugs in the past year. The 2012 rates for fighting or other delinquent behaviors among youths aged 12 to 17 were similar to the 2011 rates.
  • Rates of the following behaviors in the past year among youths aged 12 to 17 were lower in 2012 than in 2002: getting into a serious fight at school or work (18.3 vs. 20.6 percent); taking part in a group-against-group fight (11.8 vs. 15.9 percent); attacking others with the intent to harm or seriously hurt them (5.6 vs. 7.8 percent); stealing or trying to steal something worth more than $50 (3.5 vs. 4.9 percent); and selling illegal drugs (2.7 vs. 4.4 percent). Percentages of youths who had carried a handgun in the past year were similar in 2012 and 2002 (3.5 and 3.3 percent).
  • Youths aged 12 to 17 who had engaged in fighting or other delinquent behaviors were more likely than other youths to have used illicit drugs in the past month. In 2012, past month illicit drug use was reported by 17.5 percent of youths who had gotten into a serious fight at school or work in the past year compared with 7.6 percent of those who had not engaged in fighting at school or work. An estimated 43.8 percent of youths who had stolen or tried to steal something worth over $50 in the past year used illicit drugs in the past month compared with 8.2 percent of those who had not attempted or engaged in such theft


Religious Involvement and Beliefs

  • In 2012, 30.4 percent of youths aged 12 to 17 reported that they had attended religious services 25 or more times in the past year; 74.4 percent agreed or strongly agreed with the statement that religious beliefs are a very important part of their lives; and 33.7 percent agreed or strongly agreed with the statement that it is important for their friends to share their religious beliefs. These rates were similar to corresponding rates in 2011.
  • Percentages in 2012 for youths aged 12 to 17 were lower than in 2002 for attending religious services 25 or more times in the past year (30.4 vs. 33.0 percent); agreeing or strongly agreeing that religious beliefs are a very important part of their lives (74.4 vs. 78.2 percent); and agreeing or strongly agreeing that it is important for their friends to share their religious beliefs (33.7 vs. 35.8 percent).
  • The rates of past month use of illicit drugs and cigarettes and binge alcohol use were lower among youths aged 12 to 17 who agreed with statements about the importance of religious beliefs than among those who disagreed. In 2012, past month illicit drug use was reported by 7.3 percent of those who agreed or strongly agreed that religious beliefs are a very important part of their lives compared with 15.6 percent of those who disagreed with that statement. Similar differences were found between those two subgroups for the past month use of cigarettes (5.0 vs. 10.9 percent) and past month binge alcohol use (5.8 vs. 11.3 percent).


Exposure to Substance Use Prevention Messages and Programs

  • In 2012, approximately one in eight youths aged 12 to 17 (11.9 percent) reported that they had participated in drug, tobacco, or alcohol prevention programs outside of school in the past year. This rate was similar to the 11.7 percent reported in 2011, but was lower than the rate reported in 2002 (12.7 percent). In 2012, youths who did or did not participate in these programs had similar rates of past month use for illicit drugs (9.5 percent for both groups), marijuana (6.7 and 7.3 percent), cigarettes (7.2 and 6.4 percent), and binge alcohol use (7.8 and 7.1 percent).
  • In 2012, 75.9 percent of youths aged 12 to 17 reported having seen or heard drug or alcohol prevention messages in the past year from sources outside of school, such as from posters or pamphlets, on the radio, or on television. This rate in 2012 was similar to the 75.1 percent reported in 2011, but was lower than the 83.2 percent reported in 2002 (Figure 6.6). In 2012, the prevalence of past month use of illicit drugs among those who reported having such exposure (9.4 percent) was not significantly different from the prevalence among those who reported having no such exposure (10.0 percent).
  • In 2012, 75.0 percent of youths aged 12 to 17 enrolled in school in the past year reported having seen or heard drug or alcohol prevention messages at school, which was similar to the 74.6 percent reported in 2011, but was lower than the 78.8 percent reported in 2002 (Figure 6.6). In 2012, the prevalence of past month use of illicit drugs or marijuana was lower among those who reported having such exposure in school (8.9 and 6.7 percent for illicit drugs and marijuana, respectively) than among youths who were enrolled in school but reported having no such exposure (12.3 and 9.7 percent).



Parental Involvement

  • Youths aged 12 to 17 were asked several questions related to the extent of support, oversight, and control that they perceived their parents provided or exercised over them in the year prior to the survey interview. In 2012, among youths aged 12 to 17 who were enrolled in school in the past year, 70.3 percent reported that their parents limited the amount of time that they spent out with friends on school nights. This rate in 2012 was similar to the rate reported in 2011 (69.9 percent) and also in 2002 (70.7 percent). In 2012, 81.3 percent reported that in the past year their parents always or sometimes checked on whether or not they had completed their homework, and 80.6 percent reported that their parents always or sometimes provided help with their homework. Both of these rates reported in 2012 were similar to the rates in 2011 (81.1 and 80.4 percent, respectively). The rate in 2012 for parents checking on whether youths had completed their homework was higher than in 2002 (78.4 percent). However, the rate for parents providing help with homework in 2012 was similar to the rate in 2002 (81.4 percent).
  • In 2012, 88.5 percent of youths aged 12 to 17 reported that their parents always or sometimes made them do chores around the house in the past year, which was similar to the rate in 2011 (88.4 percent), but was slightly higher than the rate in 2002 (87.4 percent). In 2012, 85.6 percent of youths reported that their parents always or sometimes let them know that they had done a good job, and 85.8 percent reported that their parents always or sometimes let them know they were proud of something they had done. These percentages in 2012 were similar to those reported in 2011 and 2002. In 2012, 41.0 percent of youths reported that their parents limited the amount of time that they watched television, which was similar to the rate in 2011 (40.5 percent), but was higher than the 36.9 percent reported in 2002.
  • In 2012, past month use of illicit drugs and cigarettes and binge alcohol use were lower among youths aged 12 to 17 who reported that their parents always or sometimes engaged in supportive or monitoring behaviors than among youths whose parents seldom or never engaged in such behaviors. For instance, the rate of past month use of any illicit drug in 2012 was 7.6 percent for youths whose parents always or sometimes helped with homework compared with 18.1 percent among youths who indicated that their parents seldom or never helped. Rates of current cigarette smoking and pa st month binge alcohol use also were lower among youths whose parents always or sometimes helped with homework (5.1 and 5.9 percent, respectively) than among youths whose parents seldom or never helped (12.8 and 13.4 percent).

F. Substance Dependence, Abuse, and Treatment

The National Survey on Drug Use and Health (NSDUH) includes a series of questions to assess the prevalence of substance use disorders (substance dependence or abuse) in the past 12 months. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of preblockedion-type psychotherapeutic drugs. These questions are used to classify persons as dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994).

The questions related to dependence ask about health and emotional problems associated with substance use, unsuccessful attempts to cut down on use, tolerance, withdrawal, reducing other activities to use substances, spending a lot of time engaging in activities related to substance use, or using the substance in greater quantities or for a longer time than intended. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use.Dependence is considered to be a more severe substance use problem than abuse because it involves the psychological and physiological effects of tolerance and withdrawal.

This chapter provides estimates of the prevalence and patterns of substance use disorders occurring in the past year from the 2012 NSDUH and compares these estimates against the results from the 2002 through 2011 surveys. It also provides estimates of the prevalence and patterns of the receipt of treatment in the past year for problems related to substance use. This chapter concludes with a discussion of the need for and the receipt of treatment at specialty facilities for problems associated with substance use.



Substance Dependence or Abuse

  • In 2012, an estimated 22.2 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8.5 percent of the population aged 12 or older) (Figure 7.1). Of these, 2.8 million were classified with dependence or abuse of both alcohol and illicit drugs, 4.5 million had dependence or abuse of illicit drugs but not alcohol, and 14.9 million had dependence or abuse of alcohol but not illicit drugs. Overall, 17.7 million had alcohol dependence or abuse, and 7.3 million had illicit drug dependence or abuse.
  • The annual number of persons with substance dependence or abuse in 2012 (22.2 million) was similar to the number in each of the years from 2002 to 2010 (22.0 million in 2002, 21.6 million in 2003, 22.5 million in 2004, 22.2 million in 2005, 22.7 million in 2006, 22.4 million in 2007, 22.4 million in 2008, 22.6 million in 2009, and 22.2 million in 2010), but it was higher than the number in 2011 (20.6 million).




  • The rate of persons aged 12 or older who had substance dependence or abuse in 2012 (8.5 percent) was lower than the rate in each year from 2002 through 2006 (9.4 percent in 2002, 9.1 percent in 2003, 9.4 percent in 2004, 9.1 percent in 2005, and 9.2 percent in 2006), was similar to the rate in each year from 2007 through 2010 (9.0 percent in 2007, 2008, and 2009 and 8.8 percent in 2010), and was higher than the rate in 2011 (8.0 percent).
  • In 2012, 6.8 percent of the population aged 12 or older had alcohol dependence or abuse,which was similar to the rates in 2011 (6.5 percent) and in 2010 (7.1 percent) and was lower than the rate in each year from 2002 through 2009 (7.7 percent in 2002, 7.5 percent in 2003, 7.8 percent in 2004, 7.7 percent in 2005 and 2006, 7.5 percent in 2007, 7.4 percent in 2008, and 7.5 percent in 2009).
  • The rate of persons aged 12 or older who had illicit drug dependence or abuse in 2012 (2.8 percent) was similar to the rate in each year from 2002 to 2010 (3.0 percent in 2002,2.9 percent in 2003, 3.0 percent in 2004, 2.8 percent in 2005, 2.9 percent in 2006, and 2.8 percent in 2007, 2008, 2009, and 2010), but it was higher than the rate in 2011 (2.5 percent).
  • Marijuana was the illicit drug with the largest number of persons with past year dependence or abuse in 2012, followed by pain relievers, then by cocaine. Of the 7.3 million persons aged 12 or older classified with illicit drug dependence or abuse in 2012, 4.3 million persons had marijuana dependence or abuse (representing 1.7 percent of the total population aged 12 or older, and 58.9 percent of all those classified with illicit drug dependence or abuse), 2.1 million persons had pain reliever dependence or abuse, and 1.1 million persons had cocaine dependence or abuse (Figure 7.2).




  • The number of persons who had marijuana dependence or abuse remained similar between 2002 (4.3 million) and 2012 (4.3 million) and between 2011 (4.2 million) and 2012 (Figure 7.3). The rate of marijuana dependence or abuse in 2012 (1.7 percent) was similar to the rate in each year from 2005 through 2011 (ranging from 1.6 to 1.8 percent).
  • The number of persons who had pain reliever dependence or abuse in 2012 (2.1 million) was similar to the number in each year from 2007 through 2011 (1.7 million in 2007 and 2008, 1.9 million in 2009 and 2010, and 1.8 million in 2011) and was higher than the number in each year from 2002 through 2006 (1.5 million in 2002, 1.4 million in 2003 and 2004, 1.5 million in 2005, and 1.6 million in 2006).
  • The rate of pain reliever dependence or abuse in 2012 (0.8 percent) was similar to the rate in 2002 (0.6 percent) and in each year from 2006 through 2011 (0.7 percent in 2006, 2007, 2008, and 2009; 0.8 percent in 2010; and 0.7 percent in 2011) and was higher than the rate in each year from 2003 through 2005 (0.6 percent in 2003, 2004, and 2005).
  • The rate and the number of persons who had cocaine dependence or abuse in 2012 (0.4 percent and 1.1 million) were higher than those in 2011 (0.3 percent and 821,000) and were similar to those in 2009 (0.4 percent and 1.1 million) and 2010 (0.4 percent and 1.0 million). However, the rate and the number in 2012 were lower than those in each year from 2002 through 2007 (0.6 percent and 1.5 million in 2002, 0.6 percent and 1.5 million in 2003, 0.7 percent and 1.6 million in 2004, 0.6 percent and 1.5 million in 2005, 0.7 percent and 1.7 million in 2006, and 0.6 percent and 1.6 million in 2007).
  • The rate and the number of persons who had heroin dependence or abuse were stable between 2011 (0.2 percent and 426,000) and 2012 (0.2 percent and 467,000). However, the numbers of persons with heroin dependence or abuse in 2011 and 2012 were approximately twice those in 2002 (214,000) and 2003 (189,000).




Age at First Use

  • In 2012, among adults aged 18 or older, age at first use of marijuana was associated with illicit drug dependence or abuse. Among those who first tried marijuana at age 14 or younger, 13.2 percent were classified with illicit drug dependence or abuse, which was higher than the 2.2 percent of adults who had first used marijuana at age 18 or older.
  • Among adults, age at first use of alcohol was associated with alcohol dependence or abuse. In 2012, among adults aged 18 or older who first tried alcohol at age 14 or younger, 16.1 percent were classified with alcohol dependence or abuse, which was higher than the 3.6 percent of adults who had first used alcohol at age 18 or older.
  • Adults aged 21 or older who had first used alcohol before age 21 were more likely than adults who had their first drink at age 21 or older to be classified with alcohol dependence or abuse. In particular, adults aged 21 or older who had first used alcohol at age 14 or younger were more than 7 times as likely to be classified with alcohol dependence or abuse than adults who had their first drink at age 21 or older (15.2 vs. 2.1 percent) (Figure 7.4).



Age

  • Rates of substance dependence or abuse were associated with age. In 2012, the rate of substance dependence or abuse among adults aged 18 to 25 (18.9 percent) was higher than that among youths aged 12 to 17 (6.1 percent) and among adults aged 26 or older (7.0 percent). From 2002 to 2012, the rate decreased for youths aged 12 to 17 (from 8.9 to 6.1 percent) (Figure 7.5) and for young adults aged 18 to 25 (from 21.7 to 18.9 percent).
  • The rate of alcohol dependence or abuse among youths aged 12 to 17 was 3.4 percent in 2012, which was similar to the rate of 3.8 percent in 2011, but declined from 4.6 percent in 2010 and from 5.9 percent in 2002 (Figure 7.5). Among young adults aged 18 to 25, the rate of alcohol dependence or abuse was 14.3 percent in 2012, which also was similar to the rate of 14.4 percent in 2011. However, the rate in 2012 declined from 2010 (15.7 percent) and 2002 (17.7 percent). Among adults aged 26 or older, the rate has been stable since 2010 (5.9 percent in 2010, 5.4 percent in 2011, and 5.9 percent in 2012) and between 2002 (6.2 percent) and 2012.
  • The rate of illicit drug dependence or abuse among youths aged 12 to 17 was 4.0 percent in 2012, which was lower than the rates in 2011 (4.6 percent), 2010 (4.7 percent), and 2002 (5.6 percent) (Figure 7.5). Among young adults aged 18 to 25, the rate of illicit drug dependence or abuse was 7.8 percent in 2012, which was similar to the rates in 2011 (7.5 percent), 2010 (7.9 percent), and 2002 (8.2 percent). Among adults aged 26 or older, the rate of illicit drug dependence or abuse increased between 2011 (1.4 percent) and 2012 (1.8 percent), but the rate in 2012 was similar to the rate in 2010 (1.7 percent) and 2002 (1.8 percent).



Gender

  • As was the case from 2002 through 2011, the rate of substance dependence or abuse for males aged 12 or older in 2012 was about twice the rate for females. For males in 2012, the rate was 11.5 percent (Figure 7.6). For females, it was 5.7 percent in 2012. Among youths aged 12 to 17, however, the rate of substance dependence or abuse among males was not different from the rate among females in 2012 (6.1 percent for each).



Race/Ethnicity

  • In 2012, among persons aged 12 or older, the rate of substance dependence or abuse was lower among Asians (3.2 percent) and Native Hawaiians or Other Pacific Islanders (5.4 percent) than among other racial/ethnic groups. The rates for the other racial/ethnic groups were 8.7 percent for whites, 8.8 percent for Hispanics, 8.9 percent for blacks, 10.1 percent for persons reporting two or more races, and 21.8 percent for American Indians or Alaska Natives.

Education

  • Rates of substance dependence or abuse were associated with level of education in 2012. Among adults aged 18 or older, those who graduated from a college or university had a lower rate of substance dependence or abuse (7.2 percent) than those who did not graduate from high school (10.3 percent), those with some college education (9.7 percent), and those who graduated from high school but did not have any college education (8.8 percent).

Employment

  • Rates of substance dependence or abuse were associated with current employment status in 2012. A higher percentage of unemployed adults aged 18 or older were classified with dependence or abuse (16.9 percent) than were full-time employed adults (9.1 percent) or part-time employed adults (10.3 percent). About half of the adults aged 18 or older with substance dependence or abuse were employed full time in 2012. Of the 20.7 million adults classifie

Criminal Justice Populations

  • In 2012, adults aged 18 or older who were on parole or a supervised release from jail during the past year had a higher rate of illicit drug or alcohol dependence or abuse (34.0 percent) than their counterparts who were not on parole or supervised release during the past year (8.6 percent). In 2012, probation status was associated with s ubstance dependence or abuse. The rate of substance dependence or abuse was 37.0 percent among adults who were on probation during the past year, which was higher than the rate among adults who were not on probation during the past year (8.2 percent).

Geographic Area

  • In 2012, rates of substance dependence or abuse for persons aged 12 or older were 9.3 percent in the West, 8.8 percent in the Midwest, 8.3 percent in the Northeast, and 8.0 percent in the South.
  • Rates for substance dependence or abuse among persons aged 12 or older in 2012 were similar in large metropolitan counties (8.7 percent) and small metropolitan counties (8.8 percent), but were higher than in nonmetropolitan counties (7.4 percent).


Past Year Treatment for a Substance Use Problem

Estimates described in this section refer to treatment received for illicit drug or alcohol use, or for medical problems associated with the use of illicit drugs or alcohol. This includes treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous. Persons could report receiving treatment at more than one location. Note that the definition of treatment in this section is different from the definition of specialty treatment described in Section 7.3. Specialty treatment includes treatment only at a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or a mental health center.

Individuals who reported receiving substance use treatment but were missing information on whether the treatment was specifically for alcohol use or illicit drug use were not counted in estimates of either illicit drug use treatment or alcohol use treatment; however, they were counted in estimates for "drug or alcohol use" treatment.

  • In 2012, 4.0 million persons aged 12 or older (1.5 percent of the population) received treatment for a problem related to the use of alcohol or illicit drugs. Of these, 1.2 million received treatment for the use of both alcohol and illicit drugs, 1.0 million received treatment for the use of illicit drugs but not alcohol, and 1.4 million received treatment for the use of alcohol but not illicit drugs. (Note that estimates by substance do not sum to the total number of persons receiving treatment because the total includes persons who reported receiving treatment but did not report for which substance the treatment was received.)
  • The rate and the number of persons in the population aged 12 or older receiving any substance use treatment within the past year was stable between 2011 (1.5 percent and 3.8 million) and 2012 (1.5 percent and 4.0 million) and between 2002 (1.5 percent and 3.5 million) and 2012.
  • In 2012, among the 4.0 million persons aged 12 or older who received treatment for alcohol or illicit drug use in the past year, 2.1 million persons received treatment at a self-help group, and 1.5 million received treatment at a rehabilitation facility as an outpatient (Figure 7.7). The numbers of persons who received treatment at other locations were 1.0 million at a rehabilitation facility as an inpatient, 1.0 million at a mental health center as an outpatient, 861,000 at a hospital as an inpatient, 735,000 at a private doctor's office, 597,000 at an emergency room, and 388,000 at a prison or jail. None of these estimates changed significantly between 2011 and 2012 or between 2002 and 2012.




  • In 2012, 2.4 million persons aged 12 or older reported receiving treatment for alcohol use during their most recent treatment in the past year, 973,000 persons received treatment for pain relievers, and 957,000 persons received treatment for marijuana use (Figure 7.8). Estimates for receiving treatment for the use of other drugs were 658,000 for cocaine, 458,000 for tranquilizers, 450,000 for heroin, 366,000 for hallucinogens, and 357,000 for stimulants. None of these estimates changed significantly between 2011 and 2012, except that the number of persons who received the most recent treatment for nonmedical use of pain relievers increased from 726,000 persons in 2011 to 973,000 persons in 2012 and between 2002 (360,000 persons) and 2012 (Figure 7.9).
  • The numbers of persons aged 12 or older who received the most recent treatment in the past year for marijuana, cocaine, hallucinogens, and stimulants were stable between 2002 and 2012. However, the number of persons who received treatment for tranquilizers increased from 2002 (197,000 persons) to 2012 (458,000 persons), and the number who received treatment for heroin increased from 2002 (277,000 persons) to 2012 (450,000 persons). (Note that respondents could indicate that they received treatment for more than one substance during their most recent treatment.)





Need for and Receipt of Specialty Treatment

This section discusses the need for and receipt of treatment for a substance use problem at a "specialty" treatment facility. Specialty treatment is defined as treatment received at any of the following types of facilities: hospitals (inpatient only), drug or alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers . It does not include treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient. An individual is defined as needing treatment for an alcohol or drug use problem if he or she met the DSM-IV (APA, 1994) diagnostic criteria for alcohol or illicit drug dependence or abuse in the past 12 months or if he or she received specialty treatment for alcohol use or illicit drug use in the past 12 months.


[Qn.No.18.An individual is defined as needing treatment for an alcohol or drug use problem if he or she met the criteria specified in:]

In this section, an individual needing treatment for an illicit drug use problem is defined as receiving treatment for his or her drug use problem only if he or she reported receiving specialty treatment for illicit drug use in the past year. Thus, an individual who needed treatment for illicit drug use but received specialty treatment only for alcohol use in the past year or who received treatment for illicit drug use only at a facility not classified as a specialty facility was not counted as receiving treatment for illicit drug use. Similarly, an individual who needed treatment for an alcohol use problem was counted as receiving alcohol use treatment only if the treatment was received for alcohol use at a speci alty treatment facility. Individuals who reported receiving specialty substance use treatment but were missing information on whether the treatment was specifically for alcohol use or drug use were not counted in estimates of specialty drug use treatment or in estimates of specialty alcohol use treatment; however, they were counted in estimates for "drug or alcohol use" treatment.

In addition to questions about symptoms of substance use problems that are used to classify respondents' need for treatment based on DSM-IV criteria, NSDUH includes questions asking respondents about their perceived need for treatment (i.e., whether they felt they needed treatment or counseling for illicit drug use or alcohol use). In this report, estimates for perceived need for treatment are discussed only for persons who were classified as needing treatment (based on DSM-IV criteria) but did not receive treatment at a specialty facility. Similarly, estimates for whether a person made an effort to get treatment are discussed only for persons who felt the need for treatment and did not receive it.

Illicit Drug or Alcohol Use Treatment and Treatment Need

  • In 2012, 23.1 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (8.9 percent of persons aged 12 or older). The number in 2012 was similar to the number in each year from 2002 to 2010 (ranging from 22.2 million to 23.6 million), but it was higher than the number in 2011 (21.6 million). The rate in 2012 was similar to the rate in 2003 and the rate in each year from 2007 through 2010 (ranging from 9.2 to 9.4 percent), was lower than the rate in 2002 and the rate in each year from 2004 through 2006 (ranging from 9.5 to 9.8 percent), and was higher than the rate in 2011 (8.4 percent).
  • In 2012, 2.5 million persons (1.0 percent of persons aged 12 or older and 10.8 percent of those who needed treatment) received treatment at a specialty facility. The rate and the number in 2012 were not different from the rates and numbers in 2002 and in each year from 2004 through 2011 (ranging from 0.9 to 1.0 percent and from 2.3 million to 2.6 million), but they were higher than those in 2003 (0.8 percent and 1.9 million).
  • In 2012, 20.6 million persons (7.9 percent of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty facility in the past year. The number in 2012 was similar to the number in each year from 2002 through 2010 (ranging from 20.3 million to 21.1 million) and was higher than the number in 2011 (19.3 million). The rate in 2012 was similar to the rate in each year from 2009 through 2011 (ranging from 7.5 to 8.3 percent), but was lower than the rate in each year from 2002 through 2008 (ranging from 8.4 to 8.8 percent).
  • Of the 2.5 million persons aged 12 or older who received specialty substance use treatment in 2012, 859,000 received treatment for alcohol use only, 899,000 received treatment for illicit drug use only, and 633,000 received treatment for both alcohol and illicit drug use. These estimates were similar to the estimates for 2011 and 2002.
  • Among persons in 2012 who received their most recent substance use treatment at a specialty facility in the past year, 50.2 percent reported using their "own savings or earnings" as a source of payment for their most recent specialty treatment, 41.0 percent reported using private health insurance, 30.2 percent reported using public assistance other than Medicaid, 28.7 percent reported using Medicaid, 24.7 percent reported using funds from family members, and 24.1 percent reported using Medicare. None of these estimates changed significantly between 2011 and 2012.
  • The number of persons aged 12 or older in 2012 who were classified as needing substance abuse treatment but not receiving treatment in a specialty facility in the past year was greater than the number in 2011 (20.6 million vs. 19.3 million).
  • Of the 20.6 million persons aged 12 or older in 2012 who were classified as needing substance use treatment but not receiving treatment at a specialty facility in the past year, 1.1 million persons (5.4 percent) reported that they perceived a need for treatment for their illicit drug or alcohol use problem (Figure 7.10). Of these 1.1 million persons who felt they needed treatment but did not receive treatment in 2012, 347,000 (31.3 percent) reported that they made an effort to get treatment, and 760,000 (68.7 percent) reported making no effort to get treatment. These estimates were stable between 2011 and 2012.
  • The rate and the number of youths aged 12 to 17 who needed treatment for an illicit drug or alcohol use problem in 2012 (6.3 percent and 1.6 million) were lower than those in 2011 (7.0 percent and 1.7 million), 2010 (7.5 percent and 1.8 million), and 2002 (9.1 percent and 2.3 million). Of the 1.6 million youths who needed treatment in 2012, 157,000 received treatment at a specialty facility (about 10.0 percent of the youths who needed treatment), leaving about 1.4 million who needed treatment for a substance use problem but did not receive it at a specialty facility.




  • Based on 2009-2012 combined data, the six most often reported reasons for not receiving illicit drug or alcohol use treatment among persons aged 12 or older who needed and perceived a need for treatment but did not receive treatment at a specialty facility were (a) not ready to stop using (40.4 percent), (b) no health coverage and could not afford cost (34.0 percent), (c) possible negative effect on job (12.0 percent), (d) concern that receiving treatment might cause neighbors/community to have a negative opinion (11.6 percent), (e) not knowing where to go for treatment (9.1 percent), and (f) had health coverage but did not cover treatment or did not cover cost (7.9 percent).
  • Based on 2009-2012 combined data, among persons aged 12 or older who needed but did not receive illicit drug or alcohol use treatment, felt a need for treatment, and made an effort to receive treatment, the most often reported reasons for not receiving treatment were (a) no health coverage and could not afford cost (38.2 percent), (b) not ready to stop using (26.3 percent), (c) had health coverage but did not cover treatment or did not cover cost (10.1 percent), (d) might have negative effect on job (9.5 percent), (e) did not know where to go for treatment (8.9 percent), (f) no transportation or inconvenient (8.2 percent), (g) might cause neighbors/community to have a negative opinion (7.9 percent), and (h) did not have time for treatment (7.1 percent) (Figure 7.11).




Illicit Drug Use Treatment and Treatment Need

  • In 2012, the number of persons aged 12 or older needing treatment for an illicit drug use problem was 8.0 million (3.1 percent of the total population). The number in 2012 was similar to the number in 2002 and the number in each year from 2004 through 2010 (ranging from 7.6 million to 8.1 million) and was higher than the numbers in 2003 (7.3 million) and 2011 (7.2 million). The rate of persons needing treatment for an illicit drug use problem in 2012 was similar to the rate in each year from 2002 through 2010 (ranging from 3.0 to 3.3 percent) and was higher than the rate in 2011 (2.8 percent).
  • Of the 8.0 million persons aged 12 or older who needed treatment for an illicit drug use problem in 2012, 1.5 million (0.6 percent of the total population and 19.1 percent of persons who needed treatment) received treatment at a specialty facility for an illicit drug use problem in the past year. The number in 2012 was similar to the number in 2002 and the number in each year between 2004 and 2007 and each year from 2009 through 2011 (ranging from 1.3 million to 1.6 million), but it was higher than the numbers in 2003 (1.1 million) and in 2008 (1.2 million). The rate in 2012 was similar to the rate in 2002 and the rate in each year from 2004 to 2011 (ranging from 0.5 to 0.6 percent), but it was higher than rate in 2003 (0.5 percent).
  • There were 6.5 million persons (2.5 percent of the total population) who needed but did not receive treatment at a specialty facility for an illicit drug use problem in 2012. The number in 2012 was similar to the number in each year from 2002 through 2010 (ranging from 6.2 million to 6.6 million), but was higher than the number in 2011 (5.8 million). The rate in 2012 was similar to the rates in 2002 and 2003 and the rate in each year from 2005 through 2010 (ranging from 2.5 to 2.7 percent), was lower than the rate in 2004 (2.8 percent), and was higher than the rate in 2011 (2.3 percent).
  • Of the 6.5 million persons aged 12 or older who needed but did not receive specialty treatment for illicit drug use in 2012, 588,000 (9.0 percent) reported that they perceived a need for treatment for their illicit drug use problem, and 5.9 million did not perceive a need for treatment. The number of persons who needed treatment for an illicit drug use problem but did not perceive the need in 2012 was similar to the number in 2010 (6.0 million), but was higher than the number in 2011 (5.3 million).
  • Of the 588,000 persons who felt a need for treatment in 2012, 204,000 reported that they made an effort to get treatment, and 385,000 reported making no effort to get treatment. These estimates were similar to the estimates in 2010 and 2011, except that the number making no effort to get treatment was higher than in 2010 (201,000 persons).
  • Among youths aged 12 to 17, there were 1.0 million persons (4.2 percent) who needed treatment for an illicit drug use problem in 2012. Of this group, only 121,000 received treatment at a specialty facility (11.6 percent of youths aged 12 to 17 who needed treatment), leaving 920,000 youths who needed treatment but did not receive it at a specialty facility.
  • Among persons aged 12 or older who needed but did not receive illicit drug use treatment and felt they needed treatment (based on 2009-2012 combined data), the most often reported reasons for not receiving treatment were (a) no health coverage and could not afford cost (44.8 percent), (b) not ready to stop using (30.5 percent), (c) concern that receiving treatment might cause neighbors/community to have negative opinion (15.2 percent), (d) possible negative effect on job (14.1 percent), (e) not knowing where to go for treatment (10.6 percent), and (f) having health coverage that did not cover treatment or did not cover cost (9.0 percent).

Alcohol Use Treatment and Treatment Need

  • In 2012, the number of persons aged 12 or older needing treatment for an alcohol use problem was 18.3 million (7.0 percent of the population aged 12 or older). The number in 2012 was similar to the number in each year since 2002 (ranging from 17.4 million to 19.4 million), except that it was lower than the number in 2006 (19.6 million). The percentage in 2012 was lower than the percentage in each year from 2002 through 2009 (ranging from 7.6 to 8.0 percent) and was similar to the percentages in 2010 (7.3 percent) and 2011 (6.8 percent).
  • Among the 18.3 million persons aged 12 or older who needed treatment for an alcohol use problem in 2012, 1.5 million (0.6 percent of the total population and 8.2 percent of the persons who needed treatment for an alcohol use problem) received alcohol use treatment at a specialty facility. The number and the rate of the need and receipt of treatment at a specialty facility for an alcohol use problem in 2012 did not change significantly since 2002 (ranging from 1.3 million to 1.7 million and from 0.5 to 0.7 percent).
  • The number of persons aged 12 or older who needed but did not receive treatment at a specialty facility for an alcohol use problem in 2012 (16.8 million) was similar to the number in each year since 2002 (ranging from 15.9 million to 17.8 million), except that it was lower than the number in 2006 (18.0 million). The rate in 2012 (6.5 percent of the population aged 12 or older) was similar to the rates in 2010 (6.7 percent) and 2011 (6.2 percent) and was lower than the rate in each year from 2002 through 2009 (ranging from 7.0 to 7.4 percent).
  • Among the 16.8 million persons aged 12 or older who needed but did not receive specialty treatment for an alcohol use problem in 2012, 665,000 persons (4.0 percent) felt they needed treatment for their alcohol use problem. The number and rate in 2012 were similar to those reported in 2011 (505,000 persons and 3.2 percent) and in 2002 (761,000 persons and 4.5 percent). Of the 665,000 persons in 2012 who perceived a need for treatment for an alcohol use problem but did not receive specialty treatment, 490,000 did not make an effort to get treatment, and 174,000 made an effort but were unable to get treatment.
  • In 2012, there were 889,000 youths aged 12 to 17 (3.6 percent) who needed treatment for an alcohol use problem. Of this group, only 76,000 received treatment at a specialty facility (0.3 percent of all youths and 8.5 percent of youths who needed treatment), leaving about 814,000 youths (3.3 percent) who needed but did not receive treatment.
  • Among persons aged 12 or older who needed but did not receive alcohol use treatment and felt they needed treatment (based on 2009-2012 combined data), the most commonly reported reasons for not receiving treatment were (a) not ready to stop using (49.5 percent), (b) no health coverage and could not afford cost (30.3 percent), (c) possible negative effect on job (10.6 percent), (d) not knowing where to go for treatment (8.9 percent), (e) concern that receiving treatment might cause neighbors/community to have negative opinion (8.6 percent), (f) having health coverage that did not cover treatment or did not cover cost (8.4 percent), and (g) could handle the problem without treatment (8.1 percent).

G. Discussion of Trends in Substance Use among Youths, Young Adults, and Older Adults

Previous chapters in this report presented findings from the 2012 National Survey on Drug Use and Health (NSDUH) that describe trends and demographic differences for the incidence and prevalence of use for a variety of substances. This chapter expands upon previous chapters by discussing, in more depth, trends for specific age groups of particular interest in recent years due to changes in rates of use. For youths and young adults, a comparison of NSDUH trend results with results from other surveys of youth and young adult substance use is presented. For older adults, an assessment is presented of the current impact on trends because of the aging baby boom and other cohorts.

Deblockedion of NSDUH and Other Data Sources

Conducted since 1971 and previously named the National Household Survey on Drug Abuse (NHSDA), the survey underwent several methodological improvements in 2002 that have affected prevalence estimates (see Chapter 1). As a result, the 2002 through 2012 estimates are not comparable with estimates from 2001 and earlier surveys. Therefore, the primary focus of this report is on comparisons of measures of substance use across subgroups of the U.S. population in 2012, changes between 2011 and 2012, and changes between 2002 and 2012. An important step in the analysis and interpretation of NSDUH or any other survey data is to compare the results with those from other data sources. This can be difficult because the other surveys typically have different purposes, definitions, and designs. Research has established that surveys of substance use and other sensitive topics often produce inconsistent results because of different methods that are used. Thus, it is important to understand that conflicting results often reflect differing methodologies, not incorrect results. Despite this limitation, comparisons can be very useful. Consistency across surveys can confirm or support conclusions about trends and patterns of use, and inconsistent results can point to areas for further study. Further discussion of this issue is included in Appendix C, along with deblockedions of methods and results from other sources of substance use data.

Unfortunately, few additional data sources are available to compare with NSDUH results. One established source is Monitoring the Future (MTF), a study sponsored by the National Institute on Drug Abuse (NIDA). MTF surveys students in the 8th, 10th, and 12th grades in classrooms during the spring of each year, and it also collects data by mail from a subsample of adults who had participated earlier in the study as 12th graders. Further details about MTF are available on the MTF Web site at http://www.monitoringthefuture.org/ . Historically, NSDUH rates of youth substance use have been lower than those of MTF. Although the two surveys occasionally have shown different trends in youth substance use over a short time period, these two sources of youth behavior have shown very similar long-term trends in prevalence. NSDUH and MTF rates of substance use generally have been similar among young adults, and the two sources also have shown similar trends for this age group.

Another source of data on trends in the use of drugs among youths is the Youth Risk Behavior Survey (YRBS), sponsored by the Centers for Disease Control and Prevention (CDC). YRBS surveys students in the 9th through 12th grades in classrooms every other year during the spring (Eaton et al., 2012). The most recent survey was completed in 2011. Generally, the YRBS has shown higher prevalence rates but similar trends when compared with NSDUH and MTF. However, trend comparisons between the YRBS and NSDUH or MTF can be less straightforward because of the different periodicity (i.e., biennially instead of annually) and ages covered, the limited number of drug use questions, and smaller sample size in the YRBS.

[Qn.No.19.A study sponsored by the Centers for Disease Control and Prevention (CDC), that surveys students in the 9th through 12th in classrooms during the spring of each year is:]

Comparison of NSDUH, MTF, and YRBS Trends for Youths and Young Adults

A comparison of NSDUH and MTF estimates for 2002 to 2012 is shown in Tables 8.1 through 8.6 at the end of this chapter for several substances that are defined similarly in the two surveys. For comparison purposes, MTF data on 8th and 10th graders are combined to give an age range close to 12 to 17 years, the standard youth age group for NSDUH. Table C.1 in Appendix C provides comparisons according to MTF definitions. MTF follow-up data on persons aged 19 to 24 provide the closest match on age to estimates for NSDUH young adults aged 18 to 25. The NSDUH results are remarkably consistent with MTF trends for both youths and young adults, as discussed in the following paragraphs.

Both surveys showed decreases between 2002 and 2012 in the percentages of youths who used marijuana, cocaine, Ecstasy, LSD, inhalants, alcohol, and cigarettes in the past month (Table 8.3). For youth alcohol use, both surveys showed no significant change between 2011 and 2012, but a decline between 2009 and 2012. Although the MTF rate has been consistently higher than the NSDUH rate because of differences in methodologies used, the relative changes over time have been similar. For example, NSDUH data for past month alcohol use showed a 13 percent decline between 2009 and 2012 (from 14.8 to 12.9 percent), and the MTF data showed a 15 percent decrease during those years (Figure 8.1). Over the long term, however, the two surveys have shown remarkably consistent trends in past month alcohol use.

There have been instances where the two surveys showed differing trends from 1 year to the next, but these discrepancies usually "correct" themselves with 1 or 2 more years of data, pointing to the need to use caution in the interpretation of 1-year shifts in prevalence levels. For example, 2010 MTF data indicated a leveling or possible increase in current cigarette use among youths, in contrast to the 2010 NSDUH data, which showed a continuing decline (Center for Behavioral Health Statistics and Quality [CBHSQ], 2011). The 2011 and 2012 MTF estimates, however, showed a continuing decline, consistent with the NSDUH trend in youth smoking. Over the long term, the two surveys showed consistent trends (Figure 8.2). During the 4-year period from 2009 to 2012, NSDUH showed a 27 percent decline and MTF showed a 19 percent decline in current cigarette use. Both surveys showed decreases in current cigarette use between 2011 and 2012.

For current marijuana use, both surveys showed declines from 2002 to 2006 and increases from 2008 to 2011 (Figure 8.3). The estimate of current marijuana use was lower in NSDUH in 2012 than in 2011, but the MTF change was not statistically significant. NSDUH and MTF data showed generally consistent trends for past month use of Ecstasy, with decreases in use from 2002 to the middle of the decade, then increases in use from 2007 to 2010, and declines between 2010 and 2012. Both surveys indicated declines in past month use of cocaine, LSD, and inhalants between 2008 and 2012.









NSDUH and MTF also collect data on perceived risk of harm. The extent to which youths believe that substances might cause them harm can influence whether or not they will use these substances. Declining levels of perceived risk among youths historically have been associated with subsequent increases in rates of use. Among youths aged 12 to 17, the percentage reporting in NSDUH that they thought there was a great risk of harm in smoking marijuana once or twice a week declined from 54.6 percent in 2007 to 43.6 percent in 2012. MTF data for combined 8th and 10th graders showed a similar decline in perceived great risk of harm of regular marijuana use over this time period, from 69.4 to 58.9 percent.

For the substances for which information on current use was collected in the YRBS, including alcohol, cigarettes, marijuana, and cocaine, the YRBS trend results between 2001 and 2011 were consistent with NSDUH and MTF (see http://www.cdc.gov/HealthyYouth/yrbs/; Grunbaum et al., 2002). YRBS data for the combined grades 9 through 12 showed decreases in past month alcohol use (47.1 percent in 2001 and 38.7 percent in 2011) and cigarette use (28.5 percent in 2001 and 18.1 percent in 2011). YRBS showed a decline in past month marijuana use between 2001 (23.9 percent) and 2007 (19.7 percent) and an increase between 2007 and 2011 (23.1 percent). This increase was consistent with the NSDUH and MTF increases during that period (CHBSQ, 2012c).






Although changes in NSDUH survey methodology preclude direct comparisons of recent estimates with estimates before 2002, it is important to put the recent trends in context by reviewing longer term trends in use. NSDUH data (prior to the design changes in 1999 and 2002) on youths aged 12 to 17 and MTF data on high school seniors showed substantial increases in youth illicit drug use during the 1970s, reaching a peak in the late 1970s ( Figure 8.4). Both surveys then showed declines throughout the 1980s until about 1992, when rates reached a low point. These trends were driven by the trend in marijuana use. With the start of annual data collection in NSDUH in 1991, along with the biennial YRBS and the annual 8th and 10th grade samples in MTF, trends among youths are well documented since the low point that occurred in the early 1990s. Although they employ different survey designs and cover different age groups, the three surveys are consistent in showing incr easing rates of marijuana use during the early to mid-1990s, reaching a peak in the late 1990s (but lower than in the late 1970s). This peak in the late 1990s was followed by declines in use after the turn of the 21st century and increases in the most recent years.





Data on young adults also showed similar trends in NSDUH and MTF, although not as consistent as for the youth data (Tables 8.4 to 8.6). Potential reasons for differences from the data for youths are the relatively smaller MTF sample size for young adults and possible bias in the MTF sample due to noncoverage of school dropouts and a low overall response rate; the MTF response rate for young adults is affected by nonresponse by schools, by students in the 12th grade survey, and by young adults in the follow-up mail survey.





Both surveys showed an increase in past month marijuana use among young adults from 2008 to 2012 (16.6 to 18.7 percent in NSDUH; 17.3 to 19.8 percent in MTF) (Table 8.6). Both surveys showed declines in cigarette use between 2002 and 2012, with NSDUH showing a decline from 40.8 to 31.8 percent and MTF showing a decline from 31.4 to 18.7 percent. Both surveys also showed a decrease in rates of current cigarette use among young adults between 2011 and 2012. There was no significant change between 2002 and 2012 in the rate of current alcohol use among young adults in either survey. Both surveys showed declines in past year and past month cocaine use from 2002 to 2012, with no significant changes in rates between 2011 and 2012 (Tables 8.5 and 8.6, respectively). Similarly, past year and past month Ecstasy use among young adults increased between 2007 and 2010 and remained steady in 2011 and 2012, according to both NSDUH and MTF. Both surveys indicated declines in past year nonmedical use of pain relievers between 2010 and 2012 among young adults (Figure 8.5). The rate of past month nonmedical use of pain relievers for this age group also decreased between 2010 and 2012 in the NSDUH data, but these rates were not significantly different in the MTF data.




Trends in Marijuana and Nonmedical Preblockedion Drug Use,
by Age Group and Birth Cohort among Older Adults

As noted in Chapter 2 of this report, NSDUH data indicate that the rates of current illicit drug use among persons aged 50 to 64 increased from 2002 to 2012 (see Figure 2.10). Much of this increase can be attributed to the aging of the baby boom cohort (born between 1946 and 1964) into the 50 or older age group. This cohort, particularly those born after 1950, had much higher rates of illicit drug use as teenagers and young adults than older cohorts. This generational shift in drug use is still evident in the most recent data.

In 2012, only 19.3 percent of persons aged 65 or older (i.e., born before 1948) had ever used illicit drugs in their lifetime, while the lifetime rates of use were 47.6 percent for those aged 60 to 64 (born in 1948 to 1952) and were above 50 percent for each age group from ages 20 to 59 (born after 1952). By 2012, the 50 to 64 age group consisted entirely of the baby boom cohort. A previous study revealed that increases from 2002 to 2007 in past year illicit drug use among older adults were driven by the aging of the baby boom cohort (Han et al., 2009a). The members of this cohort began to reach age 50 in 1996, and the 50 to 59 age group consisted entirely of baby boomers in 2007.

The 2012 results and Han et al. (2009a) both show that marijuana and preblockedion psychotherapeutic drugs used nonmedically were the most commonly used illicit drugs among adults aged 50 or older in the past year (Figure 8.6). This section examines the trends in the past year use of those drugs from 2002 to 2012 by the standard 5-year age groups (plus persons aged 65 or older) published in NSDUH detailed tables (focusing on 5-year time intervals to allow an examination of trends by birth cohorts). To capture information on relationships between birth cohorts and estimates for adults aged 50 or older from 2002 through 2012, the analysis includes data for adults aged 40 or older.





The age group graph in Figure 8.7 shows the estimated rates of past year marijuana use by 5-year age groups for 2002, 2007, and 2012. Rates increased between 2002 and 2012 for adults aged 50 to 54, those aged 55 to 59, and those aged 60 to 64. The rate also increased between 2007 and 2012 for adults aged 60 to 64.

The birth cohort graph in Figure 8.7 examines trends in past year marijuana use among adults aged 40 or older by focusing on the year in which they were born. For example, the trend for adults born in 1958 to 1962 corresponds to the rates in the age group graph for 40 to 44 year olds in 2002, 45 to 49 year olds in 2007, and 50 to 54 year olds in 2012.





These comparisons showed no increases in use within any of these birth cohorts, which was consistent with the findings from the earlier study assessing trends from 2002 through 2007 (Han et al., 2009a). Thus, the increases in mariju ana use in adults aged 50 to 54 and those aged 55 to 59 appear to be largely due to the aging of the baby boom birth cohort. In contrast to the trends for these two age groups, the rate among adults aged 60 to 64 was 2.4 percent in 2002 and 1.9 percent in 2007, then increased to 4.4 percent in 2012. Again, these findings suggest that the aging of the baby boom cohort into this age group affected the trend. All persons aged 60 to 64 in 2002 (i.e., born approximately in 1938 to 1942) were born prior to the baby boom years. Persons in this age group in 2007 include persons born prior to the baby boom (i.e., approximately 1943 to 1945) and those who were born in the first 2 years of the baby boom (i.e., 1946 or 1947). By 2012, the 60 to 64 age group approximately consisted of adults born in 1948 to 1952 and consisted entirely of adults who were part of the baby boom cohort.

Trends in the nonmedical use of preblockedion drugs among adults aged 50 to 54 and those aged 55 to 59 also were consistent with the aging of the baby boom cohort (Figure 8.8). Comparisons of rates within birth cohorts in Figure 8.8 showed no overall changes between 2002 and 2012. In contrast to the marijuana trends, there was no increase in nonmedical preblockedion drug use among persons aged 60 to 64.

The continuing increases in illicit drug use among adults aged 50 or older have important implications for substance use treatment and for the health care delivery system in general. The higher rates of use, coupled with the increasing size of the older adult population in the United States as the baby boom cohort ages, suggest a greater need for health care providers to consider illicit drug use among their older patients while also diagnosing and treating their health problems. Additionally, it has been projected that the number of adults aged 50 or older who would need alcohol or drug treatment would increase from 2.8 million (annual average) in 2002 to 2006 to 5.7 million in 2020 (Han, Gfroerer, Colliver, & Penne, 2009b). The results of the 2012 NSDUH are consistent with this projection, showing an estimated 4.0 million older adults currently needing substance use treatment, including 0.4 million persons needing treatment only for illicit drugs, 3.2 million needing treatment only for alcohol, and 0.4 million needing treatment for both alcohol and illicit drugs.








H. References and Contributors

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List of Contributors

This National Survey on Drug Use and Health (NSDUH) report was prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), and by RTI International (a trade name of Research Triangle Institute), Research Triangle Park, North Carolina. Work by RTI was performed under Contract No. HHSS283201000003C.

Contributors at SAMHSA listed alphabetically, with chapter authorship noted, include Jonaki Bose (Chapter 1), Kathy Downey, Joseph Gfroerer (Chapter 8), Beth Han (Chapter 4 and Chapter 7), Sarra L. Hedden, Art Hughes, Joel Kennet (Chapter 3), Rachel Lipari (Chapter 6), Pradip Muhuri (Chapter 5), Grace O'Neill, Dicy Painter, and Peter Tice (Project Officer) (Chapter 2).

Contributors and reviewers at RTI listed alphabetically include Jeremy Aldworth, Heather J. Archambault, Katherine J. Asman, Stephanie N. Barnett, Kathryn R. Batts, Ellen Bishop, Lisa A. Carpenter, Pinliang (Patrick) Chen, James R. Chromy, Jennifer Cooney, Elizabeth A. P. Copello, Devon S. Cribb, Christine Davies, Teresa R. Davis, Ralph E. Folsom, Misty S. Foster, Peter Frechtel, Julia M. Gable, Rebecca A. Granger, Wafa Handley, Erica L. Hirsch, David Cunningham Hunter, Ilona S. Johnson, Greta A. Kilmer, Simon King, Phillip S. Kott, Larry A. Kroutil, Dan Liao, Peilan Chen Martin, Martin D. Meyer, Andrew S. Moore, Katherine B. Morton, Lisa E. Packer, Michael R. Pemberton, Jeremy Porter, Harley F. Rohloff, Neeraja S. Sathe, Victoria M. Scott, Kathryn Spagnola, Thomas G. Virag (Project Director), Jiantong (Jean) Wang, Lauren Klein Warren, and Cherie J. Winder.

Also at RTI, report and Web production staff listed alphabetically include Teresa F. Bass, Debbie F. Bond, Kimberly H. Cone, Valerie Garner, E. Andrew Jessup, Shari B. Lambert, Farrah Bullock Mann, Brenda K. Porter, Pamela Couch Prevatt, Margaret A. Smith, Roxanne Snaauw, Marissa R. Straw, Richard S. Straw, Pamela Tuck, and Cheryl L. Velez.

 
Substance Abuse > Chapter 3, Part B - Trends cont'd Alcohol & Tabacco Use
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