SpeedyCeus

7. 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 (i.e., dependence on or abuse of a substance) in the past 12 months. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-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. Although individuals may meet the criteria specified here for both dependence and abuse, persons meeting the criteria for both are classified as having dependence, but not abuse. Persons defined with abuse in this report do not meet the criteria for dependence.

This chapter provides estimates of the prevalence and patterns of substance use disorders occurring in the past year from the 2007 NSDUH and compares these estimates against the results from the 2002, 2003, 2004, 2005, and 2006 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.

7.1. Substance Dependence or Abuse

• In 2007, an estimated 22.3 million persons aged 12 or older were classified with substance dependence or abuse in the past year (9.0 percent of the population aged 12 or older) (Figure 7.1). Of these, 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.7 million were dependent on or abused illicit drugs but not alcohol, and 15.5 million were dependent on or abused alcohol but not illicit drugs.

Below is a bar graph. Click here for the text describing this graph.

Figure 7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2007

Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

• The number of persons with substance dependence or abuse was stable between 2002 and 2007 (22.0 million in 2002, 21.6 million in 2003, 22.5 million in 2004, 22.2 million in 2005, 22.6 million in 2006, and 22.3 million in 2007).
• In 2007, 18.6 million persons aged 12 or older were classified with dependence on or abuse of alcohol. This represents 7.5 percent of the population. The number and the percentage have remained similar since 2002.
• Marijuana was the illicit drug that had the highest rate of past year dependence or abuse in 2007, followed by pain relievers and cocaine. Of the 6.9 million persons aged 12 or older classified with dependence on or abuse of illicit drugs in 2007, 3.9 million were dependent on or abused marijuana or hashish (representing 1.6 percent of the total population aged 12 or older, and 57.4 percent of all those classified with illicit drug dependence or abuse), 1.7 million persons were classified with dependence on or abuse of pain relievers, and 1.6 million persons were classified with dependence on or abuse of cocaine (Figure 7.2). These estimates for pain relievers and cocaine did not change significantly between 2006 and 2007 and between 2002 and 2007. The rate for marijuana decreased from 2002 to 2007 but was stable from 2006 to 2007, while the number of people dependent on or abusing marijuana did not change significantly between 2006 and 2007 and between 2002 and 2007.
• The percentages of persons with dependence on or abuse of illicit drugs remained stable between 2006 (2.9 percent) and 2007 (2.8 percent). Between 2002 and 2007, the rate declined from 3.0 to 2.8 percent. During the 6-year period, the percentages of persons with dependence on or abuse of alcohol remained stable (7.7 percent in 2002, 7.6 percent in 2006, and 7.5 percent in 2007).

Below is a bar graph. Click here for the text describing this graph.

Figure 7.2 Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2007

Age at First Use

• In 2007, among adults aged 18 or older who first tried marijuana at age 14 or younger, 12.9 percent were classified with illicit drug dependence or abuse, higher than the 2.7 percent of adults who had first used marijuana at age 18 or older.
• Among adults, age at first use of alcohol was associated with dependence on or abuse of alcohol. In 2007, among adults aged 18 or older who first tried alcohol at age 14 or younger, 15.9 percent were classified with alcohol dependence or abuse compared with only 3.9 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 (9.6 vs. 2.2 percent) (Figure 7.3).

Below is a bar graph. Click here for the text describing this graph.

Figure 7.3 Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or Older, by Age at First Use of Alcohol: 2007

Age

• Rates of substance dependence or abuse were associated with age. In 2007, the rate of substance dependence or abuse among adults aged 18 to 25 (20.7 percent) was higher than that among youths aged 12 to 17 (7.7 percent) and among adults aged 26 or older (7.2 percent). None of these estimates changed significantly between 2006 and 2007. For youths aged 12 to 17, the rate decreased from 8.9 percent in 2002 to 7.7 percent in 2007. There were no changes from 2002 to 2007 for adults aged 18 to 25 and those 26 or older.
• In 2007, among persons with substance dependence or abuse, the proportion with dependence on or abuse of illicit drugs also was associated with age: 56.3 percent of youths aged 12 to 17, 38.3 percent of young adults aged 18 to 25, and 23.3 percent of adults aged 26 or older. For young adults aged 18 to 25 and adults aged 26 or older, these estimates did not change significantly between 2006 and 2007 and between 2002 and 2007. For youths aged 12 to 17, the rate decreased between 2002 and 2007, but did not change significantly between 2006 and 2007.
• The rate of substance dependence or abuse among youths aged 12 to 17 remained stable between 2006 and 2007 (7.7 percent in 2007 and 8.0 percent in 2006), but the rate in 2007 was lower than the rate in 2002 (8.9 percent). The rate of alcohol dependence or abuse among youths aged 12 to 17 remained stable between 2006 and 2007 and between 2002 and 2007 (5.4 percent in 2007, 5.4 percent in 2006, and 5.9 percent in 2002).

Gender

• As was the case from 2002 through 2006, the rate of substance dependence or abuse for males aged 12 or older in 2007 was about twice as high as the rate for females. For males in 2007, the rate was 12.5 percent, which was similar to the 12.3 percent in 2006, while for females, it was 5.7 percent, which was lower than the 6.3 percent in 2006 (Figure 7.4). Among youths aged 12 to 17, however, the rate of substance dependence or abuse among males was similar to the rate among females during the 6-year period (7.7 vs. 7.7 percent in 2007; 8.0 vs. 8.1 percent in 2006; and 9.3 vs. 8.6 percent in 2002).

Below is a bar graph. Click here for the text describing this graph.

Figure 7.4 Substance Dependence or Abuse in the Past Year, by Age and Gender: 2007

• The rate of illicit drug dependence or abuse among males aged 12 or older was similar between 2006 and 2007 and between 2002 and 2007 (3.8 percent in 2007, 3.7 percent in 2006, and 4.0 percent in 2002). The rate for females remained stable between 2006 and 2007, but decreased between 2002 and 2007 (1.8 percent in 2007, 2.0 percent in 2006, and 2.1 percent in 2002).

Race/Ethnicity

• In 2007, among persons aged 12 or older, the rate of substance dependence or abuse was the lowest among Asians (4.7 percent). Racial/ethnic groups with similar rates included American Indians or Alaska Natives (13.4 percent), persons reporting two or more races (10.8 percent), Native Hawaiians or Other Pacific Islanders (9.9 percent), whites (9.4 percent), blacks (8.5 percent), and Hispanics (8.3 percent). These rates in 2007 were similar to the rates in 2002 and 2006, except that the rate of substance dependence or abuse among Hispanics in 2007 was lower than the rate in 2002 (10.4 percent) and 2006 (10.0 percent).

Education/Employment

• Rates of substance dependence or abuse were associated with level of education in 2007. Among adults aged 18 or older, those who graduated from a college or university had a lower rate of dependence or abuse (7.5 percent) than those who graduated from high school (9.3 percent), those who did not graduate from high school (9.8 percent), and those with some college (10.3 percent).
• Rates of substance dependence or abuse were associated with current employment status in 2007. A higher percentage of unemployed adults aged 18 or older were classified with dependence or abuse (20.0 percent) than were full-time employed adults (10.1 percent) or part-time employed adults (10.6 percent).
• Most adults aged 18 or older with substance dependence or abuse were employed full time in 2007. Of the 20.4 million adults classified with dependence or abuse, 12.3 million (60.4 percent) were employed full time.

Criminal Justice Populations

• In 2007, adults aged 18 or older who were on parole or a supervised release from jail during the past year had higher rates of dependence on or abuse of a substance (37.2 percent) than their counterparts who were not on parole or supervised release during the past year (8.9 percent).
• In 2007, probation status was associated with substance dependence or abuse. The rate of substance dependence or abuse was 37.4 percent among adults who were on probation during the past year, which was significantly higher than the rate among adults who were not on probation during the past year (8.5 percent).

Geographic Area

• In 2007, rates of substance dependence or abuse for persons aged 12 or older showed evidence of differences by region, with the Midwest (10.0 percent) having a higher rate than the South (8.7 percent) and the Northeast (8.1 percent), but a similar rate to the West (9.2 percent). Rates for substance dependence or abuse among persons aged 12 or older in 2007 also varied by county type, with small metropolitan counties (9.4 percent) having a significantly higher rate than nonmetropolitan counties (8.3 percent), but a similar rate when compared with large metropolitan counties (9.0 percent).

7.2. 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 only includes treatment 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 illicit drug use treatment or in estimates of alcohol use treatment; however, they were counted in estimates for "drug or alcohol use" treatment.

• In 2007, 3.9 million persons aged 12 or older (1.6 percent of the population) received some kind of treatment for a problem related to the use of alcohol or illicit drugs. Of these, 1.4 million received treatment for the use of both alcohol and illicit drugs, 0.8 million received treatment for the use of illicit drugs but not alcohol, and 1.3 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 number and the percentage of the population aged 12 or older receiving substance use treatment within the past year remained stable between 2006 and 2007 and between 2002 and 2007 (3.9 million, 1.6 percent in 2007; 4.0 million, 1.6 percent in 2006; and 3.5 million, 1.5 percent in 2002).
• In 2007, among the 3.9 million persons aged 12 or older who received treatment for alcohol or illicit drug use in the past year, 2.2 million persons received treatment at a self-help group, and 1.7 million received treatment at a rehabilitation facility as an outpatient (Figure 7.5). There were 1.0 million persons who received treatment at a rehabilitation facility as an inpatient, 889,000 persons who received treatment at a mental health center as an outpatient, 779,000 at a hospital as an inpatient, 593,000 at a private doctor's office, 523,000 at an emergency room, and 302,000 at a prison or jail. None of these estimates changed significantly between 2006 and 2007 or between 2002 and 2007.
• In 2007, during their most recent treatment in the past year, 2.5 million persons aged 12 or older reported receiving treatment for alcohol use, and 936,000 persons reported receiving treatment for marijuana use (Figure 7.6). Accordingly, estimates on receiving treatment for the use of other drugs were 809,000 persons for cocaine, 558,000 for pain relievers, 335,000 for heroin, 311,000 for stimulants, and 303,000 for hallucinogens. None of these estimates changed significantly between 2006 and 2007, except that the numbers who received treatment for marijuana use and for nonmedical use of stimulants in 2007 were lower than the numbers in 2006 (1.2 million and 535,000 persons, respectively). None of these estimates changed significantly between 2002 and 2007, except that the number who received treatment for the use of pain relievers in 2007 was higher than the number in 2002 (360,000 persons). (Note that respondents could indicate that they received treatment for more than one substance during their most recent treatment.)

Below is a bar graph. Click here for the text describing this graph.

Figure 7.5 Locations Where Past Year Substance Use Treatment Was Received among Persons Aged 12 or Older: 2007

Below is a bar graph. Click here for the text describing this graph.

Figure 7.6 Substances for Which Most Recent Treatment Was Received in the Past Year among Persons Aged 12 or Older: 2007

top

7.3. 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 dependence on or abuse of alcohol or illicit drugs 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.

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 drug use in the past year. Thus, an individual who needed treatment for illicit drug use but only received specialty treatment 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 drug use. Similarly, an individual who needed treatment for an alcohol use problem was only counted as receiving alcohol use treatment if the treatment was received for alcohol use at a specialty 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 only discussed 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 only discussed for persons who felt the need for treatment.

Illicit Drug or Alcohol Use Treatment and Treatment Need

• In 2007, 23.2 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (9.4 percent of the persons aged 12 or older). Of these, 2.4 million (1.0 percent of persons aged 12 or older and 10.4 percent of those who needed treatment) received treatment at a specialty facility. Thus, 20.8 million persons (8.4 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 substance abuse facility in the past year. These estimates are similar to the estimates for 2006 and for 2002.
• Of the 2.4 million people aged 12 or older who received specialty substance use treatment in 2007, 952,000 received treatment for alcohol use only, 728,000 received treatment for illicit drug use only, and 615,000 persons received treatment for both alcohol and illicit drug use. These estimates are similar to the estimates for 2006 and for 2002.
• In 2007, among persons who received their last or current substance use treatment at a specialty facility in the past year, 53.3 percent reported using their "own savings or earnings" as a source of payment for their most recent specialty treatment, 34.9 percent reported using private health insurance, 26.3 percent reported using public assistance other than Medicaid, 19.7 percent reported using Medicare, 19.6 percent reported using funds from family members, and 18.2 percent reported using Medicaid. None of these estimates changed significantly between 2006 and 2007 and between 2002 and 2007, except that the 53.3 percent reported using their "own savings or earnings" as a source of payment in 2007 was higher than the 42.1 percent reported in 2006. (Note that persons could report more than one source of payment.)
• Of the 20.8 million persons in 2007 who were classified as needing substance use treatment but not receiving treatment at a specialty facility in the past year, 1.3 million persons (6.4 percent) reported that they perceived a need for treatment for their illicit drug or alcohol use problem (Figure 7.7). Of these 1.3 million persons who felt they needed treatment but did not receive treatment in 2007, 380,000 (28.5 percent) reported that they made an effort to get treatment, and 955,000 (71.5 percent) reported making no effort to get treatment.

Below is a pie chart. Click here for the text describing this chart.

Figure 7.7 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2007

• The number and the percentage of youths aged 12 to 17 who needed treatment for an illicit drug or alcohol use problem remained unchanged between 2006 and 2007; however, there was a significant decrease between 2002 and 2007 (2.0 million youths and 7.9 percent of the population in 2007; 2.1 million and 8.2 percent in 2006; and 2.3 million and 9.1 percent in 2002). Of the 2.0 million youths who needed treatment in 2007, 150,000 received treatment at a specialty facility (about 7.6 percent of the youths who needed treatment), leaving 1.8 million who needed treatment for a substance use problem but did not receive it at a specialty facility.
• Based on 2004-2007 combined data, five of the most often reported reasons for not receiving illicit drug or alcohol use treatment among persons who needed but did not receive treatment at a specialty facility and perceived a need for treatment included (a) not ready to stop using (38.7 percent), (b) no health coverage and could not afford cost (31.1 percent), (c) possible negative effect on job (11.6 percent), (d) not knowing where to go for treatment (11.6 percent), and (e) concern that receiving treatment might cause neighbors/community to have negative opinion (11.1 percent).
• Based on 2004-2007 combined data, among persons who needed but did not receive illicit drug or alcohol use treatment, made an effort to receive treatment, and felt a need for treatment, some of the most often reported reasons for not receiving treatment were (a) no health coverage and could not afford cost (35.9 percent), (b) not ready to stop using (26.6 percent), (c) able to handle the problem without treatment (12.5 percent), (d) no transportation/inconvenient (10.5 percent), (e) might cause neighbors/community to have negative opinion (8.9 percent), (f) no program having type of treatment (8.1 percent), (g) might have negative effect on job (7.0 percent), and (h) did not know where to go for treatment (6.9 percent) (Figure 7.8).

Below is a bar graph. Click here for the text describing this graph.

Figure 7.8 Reasons for Not Receiving Substance Use Treatment among Persons Aged 12 or Older Who Needed and Made an Effort to Get Treatment But Did Not Receive Treatment and Felt They Needed Treatment: 2004-2007 Combined

Illicit Drug Use Treatment and Treatment Need

• In 2007, the number of persons aged 12 or older needing treatment for an illicit drug use problem was 7.5 million (3.0 percent of the total population). Of these, 1.3 million (0.5 percent of the total population and 17.8 percent of the persons who needed treatment) received treatment at a specialty facility for an illicit drug use problem in the past year. Thus, there were 6.2 million persons (2.5 percent of the total population) who needed treatment but did not receive treatment at a specialty facility for an illicit drug use problem in 2007. None of these estimates changed significantly between 2006 and 2007 and between 2002 and 2007.
• The number of persons needing treatment for illicit drug use in 2007 (7.5 million) was similar to the number needing treatment in 2002 (7.7 million), 2003 (7.3 million), 2004 (8.1 million), 2005 (7.6 million), and 2006 (7.8 million). Also, the number of persons needing but not receiving specialty treatment in the past year for an illicit drug use problem in 2007 (6.2 million) was similar to the estimates in 2002 (6.3 million), 2003 (6.2 million), 2004 (6.6 million), 2005 (6.3 million), and 2006 (6.2 million).
• Of the 6.2 million people aged 12 or older who needed but did not receive specialty treatment for illicit drug use in 2007, 548,000 (8.9 percent) reported that they perceived a need for treatment for their illicit drug use problem. Of the 548,000 persons who felt a need for treatment in 2007, 205,000 (37.5 percent) reported that they made an effort and 343,000 (62.5 percent) reported making no effort to get treatment.
• Among youths aged 12 to 17, there were 1.1 million (4.5 percent) who needed treatment for an illicit drug use problem in 2007. Of this group, only 111,000 received treatment at a specialty facility (9.9 percent of youths aged 12 to 17 who needed treatment), leaving 1.0 million youths who needed treatment but did not receive it at a specialty facility.
• Among people aged 12 or older who needed but did not receive illicit drug use treatment and felt they needed treatment (based on 2004-2007 combined data), six of the most often reported reasons for not receiving treatment were (a) no health coverage and could not afford cost (34.3 percent), (b) not ready to stop using (31.8 percent), (c) concern that getting treatment might cause neighbors/community to have negative opinion (14.4 percent), (d) not knowing where to go for treatment (13.5 percent), (e) being able to handle the problem without treatment (12.7 percent), and (f) possible negative effect on job (11.7 percent).

Alcohol Use Treatment and Treatment Need

• In 2007, the number of persons aged 12 or older needing treatment for an alcohol use problem was 19.3 million (7.8 percent of the population aged 12 or older). Of these, 1.6 million (0.6 percent of the total population and 8.1 percent of the people who needed treatment for an alcohol use problem) received alcohol use treatment at a specialty facility. Thus, there were 17.7 million people who needed treatment but did not receive treatment at a specialty facility for an alcohol use problem. None of these estimates changed significantly between 2006 and 2007 and between 2002 and 2007.
• Among the 17.7 million people aged 12 or older who needed but did not receive treatment for an alcohol use problem in 2007, there were 859,000 (4.8 percent) who felt they needed treatment for their alcohol use problem. The number and the percentage were higher than those reported in 2006 (541,000 persons and 3.0 percent, respectively), but were similar to those reported in 2002 (761,000 persons and 4.5 percent, respectively). Of these, 619,000 (72.1 percent) did not make an effort to get treatment, and 240,000 (27.9 percent) made an effort but were unable to get treatment in 2007.
• In 2007, there were 1.4 million youths (5.5 percent) aged 12 to 17 who needed treatment for an alcohol use problem. Of this group, only 82,000 received treatment at a specialty facility (0.3 percent of all youths and 5.9 percent of youths who needed treatment), leaving 1.3 million youths who needed but did not receive treatment.

This concludes this section of the survey.  Just a couple more to go!! The next section is on Mental Health and Substance Use Issues.