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2003 State Estimates of Substance Use

5. Substance Dependence, Abuse, and Treatment Need

An estimated 22.0 million Americans aged 12 or older in 2002 were classified with dependence on or abuse of either alcohol or illicit drugs. In 2003, this number remained relatively unchanged at 21.6 million (Office of Applied Studies [OAS] 2004c, Table 5.25A). The dependence or abuse status is based on the criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994). The questions on dependence ask about health and emotional problems, attempts to cut down on use, tolerance, withdrawal, and other symptoms associated with substances used. 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 reflects a more severe substance problem than abuse, and persons are classified with abuse of a particular substance only if they are not dependent on that substance.

5.1. Alcohol Dependence or Abuse

Nationally in 2002–2003, 7.6 percent of the population aged 12 or older were classified with dependence on or abuse of alcohol in the past year. Persons aged 18 to 25 had the highest rate of alcohol dependence or abuse (17.4 percent) in the Nation (Table B.14).

State estimates for past year alcohol dependence or abuse among persons aged 12 or older ranged from 6.0 percent in Tennessee to 10.8 percent in North Dakota. States in the highest fifth among persons aged 12 or older tended to be Western (four States) or Midwestern (four States), while States in the lowest fifth were mostly Southern (seven States) (Table B.14, Figure 5.1). In the 12 to 17 age group, the estimated percentage of those identified as having an alcohol abuse or dependence problem ranged from 3.0 percent in the District of Columbia to 11.2 percent in Montana. Among persons aged 18 to 25, the lowest percentage was found in Utah (13.0 percent), and the highest State percentage was in North Dakota (27.1 percent) (Table B.14). Five Midwestern or Western States were in the highest fifth for the 12 to 17, 18 to 25, and 26 or older age groups (Montana, Nebraska, New Mexico, North Dakota, and South Dakota) (Figures 5.2 to 5.4).

In 2002–2003, 44 percent of those who were determined to be dependent on or abusing alcohol in the past year were estimated to be dependent on alcohol in the past year (Tables B.14 and B.15). State estimates for alcohol dependence for persons aged 12 or older ranged from 2.7 percent in Tennessee to 4.8 percent in the District of Columbia (Table B.15). Six of the States in the top fifth for dependence on or abuse of alcohol also could be found in the top fifth for dependence on alcohol for persons aged 12 or older (Figures 5.1 and 5.5). The highest rates for alcohol dependence occurred in the 18 to 25 age group, with Rhode Island having the highest rate (10.7 percent) (Table B.15).

 

5.2. Illicit Drug Dependence or Abuse

Nationally in 2002–2003, about 3.0 percent of persons aged 12 or older were dependent on or had abused illicit drugs in the past year. The District of Columbia had the highest rate of past year illicit drug dependence or abuse (4.0 percent) among persons aged 12 or older, and Kansas had the lowest rate (2.5 percent). Most of the States in the highest fifth were in the West (four States) or the Northeast (four States) (Table B.16, Figure 5.9). The highest rates for past year illicit drug dependence or abuse occurred in the 18 to 25 age group, with Rhode Island having the highest rate (12.7 percent) (Table B.16).

The percentage of persons estimated to be dependent on illicit drugs in the past year was about 65 percent of those who were estimated to be dependent on or abused illicit drugs in the past year (Tables B.16 and B.17). State estimates for illicit drug dependence for persons aged 12 or older ranged from 1.6 percent in Iowa to 3.0 percent in the District of Columbia. The highest rates of illicit drug dependence were among persons aged 18 to 25, with the highest rate in Massachusetts (8.3 percent) (Table B.17).

There was a slight relationship between high rates of past year illicit drug dependence and high rates of past year cocaine use for persons aged 12 or older at the State level. Seven States ranked in the highest fifth for both measures. The relationship between low rates of past year illicit drug dependence and low rates of past year cocaine use for persons aged 12 or older at the State level was not as strong. Only three States (Hawaii, North Dakota, and South Dakota) ranked in the lowest quintile for both the measures. Interestingly, Washington, which ranked in the highest fifth for past year dependence on illicit drugs, ranked in the lowest fifth for past year use of cocaine among persons aged 12 or older (Figures 2.24 and 5.13).

 

5.3. Alcohol or Illicit Drug Dependence or Abuse

The national rate in 2002–2003 for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older was about 9.2 percent (Table B.18). When examining dependence on or abuse of alcohol or illicit drugs at the State level, the States with high rates for alcohol dependence or abuse tended to dominate the top fifth for alcohol and illicit drug dependence or abuse combined because alcohol accounts for the vast majority of substance dependence or abuse. Seven States that ranked in the highest fifth for past year alcohol dependence or abuse also ranked in the top fifth for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older (Figures 5.1 and 5.17).

State percentages for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older ranged from a low of 7.4 percent in Alabama to a high of 12.0 percent in New Mexico. Rhode Island's rate of 29.4 percent was the highest among States for persons aged 18 to 25 (Table B.18).

 

5.4. Needing But Not Receiving Treatment for Illicit Drug Problems

The definition of a person needing but not receiving treatment for an illicit drug problem is that he or she meets the criteria for abuse of or dependence on illicit drugs according to the DSM-IV, but has not received specialty treatment for an illicit drug problem in the past year. Specialty treatment is treatment received at a drug and alcohol rehabilitation facility (inpatient or outpatient), hospital (inpatient only), or mental health center.

In 2002–2003, New Mexico had the highest percentage of persons aged 12 or older needing but not receiving treatment for an illicit drug use problem (3.5 percent). The States in the top fifth for needing but not receiving treatment for an illicit drug use problem were mainly in the West (five States) or in the Northeast (four States) (Table B.19, Figure 5.21). California had the largest total number of persons aged 12 or older needing but not receiving treatment for an illicit drug use problem, approximately 798,000 (see http://www.oas.samhsa.gov/2k3State/lot.htm).

 

5.5. Needing But Not Receiving Treatment for Alcohol Problems

The definition of a person needing but not receiving treatment for an alcohol problem is that he or she meets the criteria for abuse of or dependence on alcohol according to the DSM-IV, but has not received specialty treatment for an alcohol problem in the past year. The percentage of persons aged 12 or older needing but not receiving treatment for alcohol problems (7.2 percent) in 2002–2003 was almost 3 times larger than the corresponding percentage for persons with illicit drug problems (2.7 percent) (Tables B.19 and B.20).

States in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older were primarily Western (four States) or Midwestern (four States). Montana, Nebraska, New Mexico, and South Dakota ranked in the top fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) for needing but not receiving treatment for alcohol problems (Table B.20, Figures 5.25 to 5.28). Arizona, the District of Columbia, New Mexico, and Rhode Island were ranked in the highest quintile for both needing but not receiving treatment for an alcohol problem and needing but not receiving treatment for an illicit drug problem among persons aged 12 or older. Similarly, Alabama, New Jersey, and West Virginia were the only three States that ranked in the lowest quintile for both measures among all persons aged 12 or older. South Dakota, Wisconsin, and Wyoming ranked in the lowest fifth for needing but not receiving treatment for illicit drug problems, but ranked in the highest fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older (Figures 5.21 and 5.25).

 

Figure 5.1 Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.1     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.2 Alcohol Dependence or Abuse in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.2     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.3 Alcohol Dependence or Abuse in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.3     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.4 Alcohol Dependence or Abuse Use in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.4     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.5 Alcohol Dependence in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.5     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.6 Alcohol Dependence in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.6     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.7 Alcohol Dependence in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.7     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.8 Alcohol Dependence in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.8     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.9 Any Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.9     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.10 Any Illicit Drug Dependence or Abuse in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.10     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.11 Any Illicit Drug Dependence or Abuse in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.11     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.12 Any Illicit Drug Dependence or Abuse in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.12     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.13 Any Illicit Drug Dependence in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.13     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.14 Any Illicit Drug Dependence in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.14     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.15 Any Illicit Drug Dependence in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.15     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.16 Any Illicit Drug Dependence in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.16     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.17 Dependence on or Abuse of Any Illicit Drug or Alcohol in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.17     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.18 Dependence on or Abuse of Any Illicit Drug or Alcohol in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.18     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.19 Dependence on or Abuse of Any Illicit Drug or Alcohol in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.19     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.20 Dependence on or Abuse of Any Illicit Drug or Alcohol in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.20     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.21 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.21     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.22 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.22     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.23 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.23     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.24 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.24     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.25 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.25     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.26 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.26     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.27 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.27     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

 

Figure 5.28 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.28     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.

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This page was last updated on June 03, 2008.