SpeedyCEUS

Substance Abuse

Chapter 3: Substance Abuse Trends

III. Substance Abuse Trends

 The Substance Abuse and Mental Health Services Administration (SAMHSA) provides current trends of substance use and abuse through their reports on the National Survey on Drug Use and Health.  Excerpts of this report are provided here.  The report provides some very interesting material on various demographic aspects and frequency of substance abuse in the United States.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Office of Applied Studies

Highlights

This report presents the first information from the 2004 National Survey on Drug Use and Health (NSDUH). This survey, formerly called the National Household Survey on Drug Abuse (NHSDA), is a project of the Substance Abuse and Mental Health Services Administration (SAMHSA). This survey was initiated in 1971 and is the primary source of information on the use of illicit drugs, alcohol, and tobacco by the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year.

Introduction

This report presents the first information from the 2004 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, non-institutionalized population of the United States aged 12 years old or older. Prior to 2002, the survey was called the National Household Survey on Drug Abuse (NHSDA). This initial report on the 2004 data presents national estimates of rates of use, numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products.

A. Estimates of Illicit Drug Use

The National Survey on Drug Use and Health (NSDUH) obtains information on nine different categories of illicit drug use: any use of marijuana, cocaine, heroin, hallucinogens, and inhalants; and the nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives. In these categories, hashish is included with marijuana, and crack is considered a form of cocaine. Several drugs are grouped under the hallucinogens category, including LSD, PCP, peyote, mescaline, mushrooms, and "Ecstasy" (MDMA). Inhalants include a variety of substances, such as amyl nitrite, cleaning fluids, gasoline, paint, and glue. The four categories of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives) cover numerous drugs available through prescriptions as well as drugs within these groupings that may be manufactured illegally, such as methamphetamine, which is included under stimulants. Respondents are asked to report only uses of drugs that were not prescribed for them or drugs they took only for the experience or feeling they caused; therefore, over-the-counter drugs and legitimate uses of prescription drugs are not included. NSDUH reports combine the four prescription-type drug groups into a category referred to as "psychotherapeutics."

Estimates of "illicit drug use" reported from NSDUH reflect the use of any of the nine drug categories listed above. Use of alcohol and tobacco products, while illegal for youths, is not included in these estimates, but is discussed in Chapters 3 and 4.

• In 2004, an estimated 19.1 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 7.9 percent of the population aged 12 years old or older.
• The overall rate of current illicit drug use among persons aged 12 or older in 2004 (7.9 percent) was similar to the rate in 2003 (8.2 percent) and in 2002 (8.3 percent).
• Marijuana was the most commonly used illicit drug (14.6 million past month users). In 2004, it was used by 76.4 percent of current illicit drug users. An estimated 56.8 percent of current illicit drug users used only marijuana, 19.7 percent used marijuana and another illicit drug, and the remaining 23.6 percent used only an illicit drug other than marijuana in the past month (Figure 2.1).

 Figure 2.1 Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2004

• Among persons aged 12 or older, the overall rate of past month marijuana use was about the same in 2004 (6.1 percent) as it was in 2003 (6.2 percent) and 2002 (6.2 percent).
• In 2004, an estimated 2.0 million persons (0.8 percent) were current cocaine users (Figure 2.2); of these, 467,000 used crack during the same time period (0.2 percent). Hallucinogens were used by 929,000 persons (0.4 percent). There were an estimated 166,000 current heroin users (0.1 percent). All of these estimates are similar to estimates for 2003.

 Figure 2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2004

• An estimated 8.2 million people (3.4 percent of the population) were current users of illicit drugs other than marijuana in 2004. Most (6.0 million, 2.5 percent of the population) used psychotherapeutic drugs nonmedically (Figure 2.2). An estimated 4.4 million used pain relievers, 1.6 million used tranquilizers, 1.2 million used stimulants (including 583,000 using methamphetamine), and 0.3 million used sedatives. These estimates are all similar to the corresponding estimates for 2003. 
• The number of current users of Ecstasy remained the same in 2004 (450,000) as it had been in 2003 (470,000), after it had decreased significantly between 2002 (676,000) and 2003. There were no significant changes in the past month use of other hallucinogens between 2003 and 2004. Although an estimated 23.4 million persons had tried LSD in their lifetime, only 141,000 were current users in 2004.
• There was no significant change in past month, past year, or lifetime nonmedical use of pain relievers among persons aged 12 or older between 2003 and 2004. The rate of past month use was 2.0 percent in 2003 and 1.8 percent in 2004.

Age

• Rates of drug use showed substantial variation by age. For example, 3.8 percent of youths aged 12 or 13 reported current illicit drug use in 2004 (Figure 2.3). As in prior years, illicit drug use in 2004 tended to increase with age among young persons, peaking among 18 to 20 year olds (21.7 percent) and generally declining after that point with increasing age.

Figure 2.3 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2004

Youths Aged 12 to 17

• Among youths, the types of drugs used differed by age in 2004, as was the case in prior years. Among 12 or 13 year olds, 1.7 percent used prescription-type drugs nonmedically, 1.2 percent used inhalants, and 1.1 percent used marijuana. Among 14 or 15 year olds, marijuana was the dominant drug used (7.3 percent), followed by prescription-type drugs used nonmedically (4.1 percent) and inhalants (1.6 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (14.5 percent), followed by prescription-type drugs used nonmedically (5.1 percent), hallucinogens (1.7 percent), and cocaine (1.1 percent). Only 0.9 percent of youths aged 16 or 17 used inhalants.
• Among all youths aged 12 to 17 in 2004, 10.6 percent were current illicit drug users: 7.6 percent used marijuana, 3.6 percent used prescription-type drugs nonmedically, 1.2 percent used inhalants, 0.8 percent used hallucinogens, and 0.5 percent used cocaine.
• The rate of current illicit drug use among youths aged 12 to 17 gradually declined between 2002 and 2004. The rate was 11.6 percent in 2002, 11.2 percent in 2003, and 10.6 percent in 2004 (Figure 2.4). This represents a statistically significant change between 2002 and 2004, but not between 2002 and 2003 or between 2003 and 2004.

Figure 2.4 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2004

• The rate of current marijuana use among youths was 8.2 percent in 2002, 7.9 percent in 2003, and 7.6 percent in 2004, indicating a steady but not statistically significant decline. However, declines in past year and lifetime use of marijuana among youths from 2002 to 2004 were statistically significant.

Young Adults Aged 18 to 25

• Rates of current use of illicit drugs were highest for the young adult age group (18 to 25 years) at 19.4 percent, with 16.1 percent using marijuana, 6.1 percent using prescription-type drugs nonmedically, 2.1 percent using cocaine, and 1.5 percent using hallucinogens.
• There were no changes in past month use of any drugs among young adults between 2003 and 2004. However, declines between 2002 and 2004 occurred for marijuana (17.3 percent in 2002, 17.0 percent in 2003, and 16.1 percent in 2004) and hallucinogens (1.9, 1.7, and 1.5 percent, respectively).
• Past year use of Ecstasy among young adults declined from 5.8 percent in 2002 to 3.7 percent in 2003 and to 3.1 percent in 2004.
• Current nonmedical use of prescription-type drugs showed no signs of decreasing among young adults, remaining at 6.1 percent in 2004, compared with 6.0 percent in 2003 and 5.4 percent in 2002. There were increases in lifetime prevalence of use from 2002 to 2004 of several categories of pain relievers among those aged 18 to 25: Vicodin^®, Lortab^®, or Lorcet^®; Percocet^®, Percodan^®, or Tylox^®; hydrocodone products; OxyContin^®; and oxycodone products (Figure 2.5).

Figure 2.5 Lifetime Nonmedical Use of Selected Pain Relievers among Young Adults Aged 18 to 25: 2002-2004

Adults Aged 26 or Older

• Among adults aged 26 or older, 5.5 percent reported current illicit drug use in 2004: 4.1 percent used marijuana, and 1.7 percent used prescription-type drugs. In this age group, less than 1 percent used cocaine (0.7 percent), hallucinogens (0.1 percent), and inhalants (0.1 percent). Rates of lifetime, past year, and past month illicit drug use for adults aged 26 or older were unchanged between 2003 and 2004.

Gender

• As in 2002 and 2003, males were more likely in 2004 to report current illicit drug use than females (9.9 vs. 6.1 percent, respectively). Males were almost twice as likely to use marijuana as females (8.0 vs. 4.3 percent). However, rates of nonmedical use of any prescription-type psychotherapeutic were similar for males (2.6 percent) and females (2.4 percent).
• Among youths aged 12 to 17, the rate of current illicit drug use was similar for boys and girls (10.6 percent for both). While boys aged 12 to 17 had a higher rate of marijuana use than girls (8.1 vs. 7.1 percent) (Figure 2.6), the rate for nonmedical use of prescription-type psychotherapeutics was higher for girls (4.1 vs. 3.2 percent).

Figure 2.6 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2004

• Between 2002 and 2004, past month marijuana use declined for male youths (9.1 percent in 2002, 8.6 percent in 2003, and 8.1 percent in 2004), but it remained level for female youths (7.2, 7.2, and 7.1 percent) during the same time span.

Pregnant Women

• Among pregnant women aged 15 to 44 years, an estimated 4.6 percent reported using illicit drugs in the past month based on combined 2003 and 2004 NSDUH data. This rate was significantly lower than the rate among women aged 15 to 44 who were not pregnant (10.2 percent). The combined 2002-2003 rate of illicit drug use among pregnant women (4.3 percent) was not significantly different from the 2003-2004 combined rate.

Race/Ethnicity

• Rates of current illicit drug use varied significantly among the major racial/ethnic groups in 2004. The rate was highest among persons reporting two or more races (13.3 percent) and American Indians or Alaska Natives (12.3 percent). Rates were 8.1 percent for whites, 7.2 percent for Hispanics, and 8.7 percent for blacks. Asians had the lowest rate at 3.1 percent.
• Among youths aged 12 to 17, the rate of current illicit drug use was highest among American Indians or Alaska Natives, more than twice the overall rate among youths (26.0 vs. 10.6 percent). Rates for other groups were 12.2 percent among those reporting two or more races, 11.1 percent among whites, 10.2 percent among Hispanics, 9.3 percent among blacks, and 6.0 percent among Asians.
• There were no statistically significant changes between 2003 and 2004 in the rates of current illicit drug use for any racial/ethnic subgroup. This was the case both for all persons aged 12 or older and for youths aged 12 to 17.
• The overall decline in current marijuana use among male youths from 2002 to 2004 was consistent across major racial/ethnic groups. Among white male youths, rates were 9.7, 9.5, and 8.5 percent in 2002, 2003, and 2004, respectively. Rates were 8.7, 6.8, and 7.6 percent for black male youths and 8.6, 7.2, and 7.3 percent among Hispanic male youths in those 3 years.

Education

• Illicit drug use rates in 2004 were correlated with educational status. Among adults aged 18 or older, the rate of current illicit drug use was lower among college graduates (5.6 percent) compared with those who did not graduate from high school (8.6 percent), high school graduates (7.8 percent), and those with some college (8.7 percent). However, adults who had completed 4 years of college were more likely to have tried illicit drugs in their lifetime when compared with adults who had not completed high school (51.8 vs. 37.2 percent).

College Students

• In the college-aged population (persons aged 18 to 22 years old), the rate of current illicit drug use was slightly lower among full-time undergraduate college students (20.2 percent) than among other persons aged 18 to 22 years, including part-time students, students in other grades, and nonstudents (22.3 percent). The rate of current illicit drug use among college students and other 18 to 22 year olds did not change between 2002 and 2003 or between 2003 and 2004.

Employment

• Current employment status was correlated with rates of illicit drug use in 2004. An estimated 19.2 percent of unemployed adults aged 18 or older were current illicit drug users compared with 8.0 percent of those employed full time and 10.3 percent of those employed part time. These rates are all similar to the corresponding rates in 2003.
• Although the rate of drug use was higher among unemployed persons compared with those from other employment groups, most drug users were employed. Of the 16.4 million illicit drug users aged 18 or older in 2004, 12.3 million (75.2 percent) were employed either full or part time.

Geographic Area

• Among persons aged 12 or older, the rate of current illicit drug use in 2004 was 8.9 percent in the West, 8.4 percent in the Northeast, 7.5 percent in the Midwest, and 7.3 percent in the South. Similar patterns were evident in 2003 and 2002.
• The rate of illicit drug use in metropolitan areas was higher than the rate in nonmetropolitan areas in 2004. Rates were 8.1 percent in large metropolitan counties, 8.5 percent in small metropolitan counties, and 6.3 percent in nonmetropolitan counties as a group (Figure 2.7). Within nonmetropolitan areas, counties that were urbanized had a rate of 7.6 percent, less urbanized counties had a rate of 5.6 percent, while completely rural counties had a rate of 4.6 percent.
  

Figure 2.7 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2002-2004

     D

• The rate of current illicit drug use in completely rural counties had declined between 2002 and 2003, from 6.7 to 3.1 percent, but was 4.6 percent in 2004. The rate in 2004 was not significantly different from the rate in 2003 or 2002.
• Among youths aged 12 to 17, there was evidence of regional differences in trends of marijuana use between 2002 and 2004. Rates of current marijuana use were lower in 2004 than in 2002 in the Northeast, Midwest, and South (although the decrease was not statistically significant in the Northeast and Midwest) (Figure 2.8). However, in the West, rates were 8.0 percent in 2002, 8.7 percent in 2003, and 9.3 percent in 2004.

Figure 2.8 Past Month Marijuana Use among Youths Aged 12 to 17, by Geographic Region: 2002-2004

     D

Criminal Justice Populations

• In 2004, among the estimated 1.5 million adults aged 18 or older on parole or other supervised release from prison during the past year, 25.3 percent were current illicit drug users compared with 7.5 percent among adults not on parole or supervised release.
• Among the estimated 4.7 million adults on probation at some time in the past year, 26.2 percent reported current illicit drug use in 2004. This compares with a rate of 7.2 percent among adults not on probation in 2004.

Frequency of Use

• In 2004, 12.7 percent of past year marijuana users used marijuana on 300 or more days in the past 12 months. This translates into 3.2 million persons using marijuana on a daily or almost daily basis over a 12-month period, similar to the estimates in 2002 and 2003.
• The number of youths aged 12 to 17 using marijuana daily or almost daily in the past year declined from 358,000 in 2002 to 282,000 in 2003, but the estimate for 2004 was 342,000, which was not significantly different from the estimates for 2002 or 2003. Similarly, the number of youths using marijuana on 20 or more days in the past month declined from 603,000 in 2002 to 482,000 in 2003, but was 536,000 in 2004.
• The number of past month daily or almost daily cocaine users increased from 133,000 in 2003 to 263,000 in 2004. Most of these daily users were aged 26 or older (96,000 in 2003, 203,000 in 2004).

Association with Cigarette and Alcohol Use

• In 2004, the rate of current illicit drug use was approximately 8 times higher among youths aged 12 to 17 who smoked cigarettes (47.5 percent) than it was among youths who did not smoke cigarettes (5.6 percent).
• Illicit drug use also was associated with the level of alcohol use. Among youths aged 12 to 17 who were heavy drinkers (i.e., drank five or more drinks on the same occasion on at least 5 different days in the past 30 days), 65.6 percent also were current illicit drug users, whereas among nondrinkers, the rate was only 5.0 percent.
• Among youths who were both smokers and heavy drinkers, 70.1 percent used illicit drugs compared with only 3.5 percent among youths who did not drink or smoke.

Driving Under the Influence of Illicit Drugs

• In 2004, an estimated 10.6 million persons reported driving under the influence of an illicit drug during the past year. This corresponds to 4.4 percent of the population aged 12 or older, which was similar to the rates in 2002 (4.7 percent) and 2003 (4.6 percent). In 2004, the rate was highest (13.3 percent) among young adults aged 18 to 25, a decrease from 14.7 percent in 2002.

How Marijuana Is Obtained

• NSDUH includes questions asking marijuana users how, from whom, and from where they obtained the marijuana they used most recently. In 2004, most users (55.1 percent) got the drug for free or shared someone else's marijuana. About 40 percent of marijuana users bought it.
• Most marijuana users obtained the drug from a friend; 76.0 percent of those who bought their marijuana and 81.1 percent of those who obtained the drug for free had acquired it from a friend.
• More than half (52.7 percent) of users who bought their marijuana purchased it inside a home, apartment, or dorm. This also was the most common location for obtaining marijuana for free (65.1 percent).
• Among youths aged 12 to 17, 60.4 percent got the drug for free and 33.1 percent bought it. Among youths who bought their marijuana, 33.6 percent bought it inside a home, apartment, or dorm. Among youths who obtained their marijuana for free, 47.4 percent obtained it inside a home, apartment, or dorm.
• Among youths aged 12 to 17 who bought their marijuana, 10.5 percent obtained it inside a school building, and 4.0 percent bought it outside on school property.

Prior Marijuana Use History

• Among the 25.5 million past year users of marijuana in 2004, an estimated 2.1 million (8.4 percent) were first-time users during the past year and 19.2 million (75.5 percent) were "continuing" users (i.e., they had used during the prior year, which is the period from 12 to 23 months ago, and had continued to use in the past year). Additionally, 4.1 million (16.1 percent) "resumed" use in the past 12 months (i.e., they had used marijuana prior to 24 months ago, did not use during the prior year, but did use in the past 12 months). These percentages are similar to the percentages among past year marijuana users in 2003 (7.8 percent first-time users, 77.0 percent "continuing" users, and 15.1 percent "resumed" users).
• Among the 3.7 million past year marijuana users aged 12 to 17 in 2004, an estimated 1.3 million (34.2 percent) were first-time users, 2.1 million (57.0 percent) were "continuing" users, and 0.3 million (8.7 percent) had "resumed" their marijuana use in the past 12 months. These percentages are similar to the percentages among past year marijuana users in 2003.
• A measure of "discontinuation" of marijuana use is obtained as the percentage of those who did not use marijuana in the past 12 months among those who did use in the prior year. Based on this calculation, marijuana discontinuation rates in 2004 were 27.2 percent among persons aged 12 or older, and 19.9 percent among youths aged 12 to 17. These rates are essentially the same as the rates in 2003.