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5. Substance Dependence, Abuse, and Treatment Need

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 drugs. These questions are used to classify persons as being 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 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. For details, see Section A.9 in Appendix A.

Nationally, 22.3 million persons aged 12 or older in 2007-2008 were classified with dependence on or abuse of illicit drugs or alcohol in the past year. Of these, 6.9 million were dependent on or had abused illicit drugs, and 18.5 million were dependent on or had abused alcohol (see Tables 16, 18, and 20 at http://www.samhsa.gov/data/2k8state/ageTabs.htm).

5.1 Alcohol Dependence or Abuse

In 2007-2008, 7.4 percent of the population aged 12 or older was classified with dependence on or abuse of alcohol nationwide in the past year (see Table B.16 in Appendix B). Persons aged 18 to 25 had the highest rate of alcohol dependence or abuse (17.0 percent) in the Nation. At the State level, Minnesota had the highest rate (10.0 percent) among persons aged 12 or older, and Kentucky had the lowest rate (5.7 percent). Seven States (Colorado, Minnesota, Montana, Nebraska, South Dakota, Wisconsin, and Wyoming) ranked in the highest fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) and among persons 12 or older (Figures 5.1 to 5.4).

Nationally, past year dependence on or abuse of alcohol remained relatively unchanged between 2006-2007 and 2007-2008 at 7.6 and 7.4 percent, respectively, for persons aged 12 or older (see Table C.16 in Appendix C). Among 12 to 17 year olds, Arizona's rate increased, while rates in Arkansas and Tennessee decreased. Among 18 to 25 year olds, Delaware's rate increased, while Maryland's rate decreased. Oregon's rate increased among persons aged 26 or older. For the 12 or older age group, Oregon had an increase, while a decrease was observed in Arkansas.

In 2007-2008, 3.5 percent of persons aged 12 or older nationwide were estimated to be dependent on alcohol in the past year, representing about 47 percent of those who were dependent on or had abused alcohol in the past year (Tables B.16 and B.17). State estimates for alcohol dependence for persons aged 12 or older ranged from a low of 3.0 percent in New Jersey to a high of 4.9 percent in the District of Columbia. The highest rates for alcohol dependence occurred in the 18 to 25 age group (7.2 percent nationally). In 2007-2008 among young adults aged 18 to 25, these rates ranged from a low of 5.6 percent in New Jersey to a high of 11.2 percent in Montana. Five States that ranked in the highest fifth in the 12 or older population for dependence on or abuse of alcohol in the past year also were ranked in the highest fifth for past year alcohol dependence (Colorado, District of Columbia, Minnesota, Montana, and Wisconsin) (Figures 5.1 and 5.5). Among youths aged 12 to 17, Arkansas had a decrease in the alcohol dependence rate from 2006-2007 (Table C.17). Among young adults aged 18 to 25, Iowa and Michigan had decreases in alcohol dependence rates. North Carolina was the only State that had an increase among the 12 or older age group (from 2.8 to 3.4 percent).

5.2 Illicit Drug Dependence or Abuse

Nationally in 2007-2008, about 2.8 percent of persons aged 12 or older were dependent on or had abused illicit drugs in the past year (Table B.18). The District of Columbia had the highest rate of past year illicit drug dependence or abuse (4.5 percent) among persons aged 12 or older, and Iowa had the lowest rate (1.7 percent). The highest rates for past year illicit drug dependence or abuse occurred in the 18 to 25 age group (7.9 percent nationally), with the highest rate occurring in Rhode Island (12.5 percent) and the lowest rate in Iowa (4.9 percent). Among young adults aged 18 to 25, decreases in the rates of past year illicit drug dependence or abuse occurred in Washington and Wyoming between 2006-2007 and 2007-2008 (Table C.18). Increases occurred in Oregon among all age groups other than youths aged 12 to 17.

The percentage of persons aged 12 or older in 2007-2008 estimated to be dependent on illicit drugs in the past year was 1.9 percent (more than two thirds of those who were estimated to be dependent on or had abused illicit drugs in the past year) (Tables B.18 and B.19). The District of Columbia had the highest percentage of persons aged 12 or older who were dependent on illicit drugs in the past year (3.1 percent). Iowa had the lowest rate (1.3 percent). Among the 18 to 25 year old age group, a decline in past year illicit drug dependence occurred in Wyoming from 2006-2007 to 2007-2008. Oregon had increases in all age groups other than youths aged 12 to 17 (Table C.19).

5.3 Alcohol or Illicit Drug Dependence or Abuse

The national rate in 2007-2008 for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older was 9.0 percent (Table B.20). 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 rank in the top fifth for alcohol and illicit drug dependence or abuse combined because alcohol accounts for most of the substance dependence or abuse. Of the 10 States that ranked in the highest fifth for past year alcohol dependence or abuse, 8 States also ranked in the top fifth for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older: Colorado, District of Columbia, Minnesota, Montana, North Dakota, South Dakota, Wisconsin, and Wyoming (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 in 2007-2008 ranged from a low of 7.5 percent in Mississippi to a high of 11.6 percent in the District of Columbia (Table B.20). Only three States (Colorado, Minnesota, and Wisconsin) were in the highest fifth for three age groups (12 to 17, 18 to 25, and 26 or older) and among persons 12 or older (Figures 5.17 to 5.20).

Among persons aged 12 or older, the rate of past year dependence on or abuse of alcohol or illicit drugs nationwide remained nearly constant at 9.0 and 9.1 percent, respectively, in 2007-2008 and 2006-2007 (Table C.20). At the State level, across the 3 age groups (12 to 17, 18 to 25, and 26 or older) and among persons 12 or older, 14 significant changes were observed across 9 States. Decreases were noted in Arkansas, Connecticut, Iowa, Maine, Maryland, Tennessee, and Wyoming. Increases were noted in New York and Oregon.

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 the person meets the criteria for abuse of or dependence on illicit drugs in the past year according to the DSM-IV, but did not receive specialty treatment for an illicit drug problem in the past year. Specialty treatment is treatment received at a drug or alcohol rehabilitation facility (inpatient or outpatient), hospital (inpatient only), or mental health center. It does not include treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient. The national rate in 2007-2008 for needing but not receiving treatment for an illicit drug problem among persons aged 12 or older was 2.5 percent (Table B.21).

In 2007-2008, Rhode Island had the highest percentage of persons aged 12 or older (3.9 percent) and young adults aged 18 to 25 (12.0 percent) who were needing but not receiving treatment for an illicit drug use problem. Iowa had the lowest rate among persons 12 or older (1.5 percent), among young adults aged 18 to 25 (4.5 percent), and among persons 26 or older (0.8 percent) (Table B.21). At the State level, across the 3 age groups (12 to 17, 18 to 25, and 26 or older) and among persons 12 or older, 9 statistically significant changes were observed across 6 States in the percentage who were needing but not receiving treatment for illicit drug use between 2006-2007 and 2007-2008 (Table C.21). Declines occurred in North Carolina, Washington, and Wyoming; increases were noted in Nevada, New Mexico, and Oregon.

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 the person meets the criteria for abuse of or dependence on alcohol in the past year according to the DSM-IV, but did not receive 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 was 7.1 percent in 2007-2008, which was almost 3 times larger than the corresponding percentage of persons needing but not receiving treatment for illicit drug problems (2.5 percent) (Tables B.21 and B.22).

States in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older in 2006-2007 were primarily Midwestern (Illinois, Minnesota, Nebraska, North Dakota, South Dakota, and Wisconsin) or Western (Colorado, Montana, and Wyoming) (Figure 5.25). The District of Columbia rounded out the top 10. Colorado and the District of Columbia 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 (Figures 5.21 and 5.25). Minnesota had the highest rate of needing but not receiving treatment for an alcohol problem among persons aged 12 or older (9.4 percent), while Kentucky had the lowest rate (5.3 percent) (Table B.22). Although the District of Columbia ranked in the top fifth for needing but not receiving treatment for an alcohol problem among persons aged 26 or older (7.4 percent) and among persons 12 or older (9.0 percent), it had the lowest rate among 12 to 17 year olds (3.3 percent).

At the State level, across two age groups (12 to 17 and 18 to 25) and among persons 12 or older, declines in the rate of needing but not receiving treatment for an alcohol problem from 2006-2007 to 2007-2008 were seen in Arkansas, Idaho, Iowa, Massachusetts, and Tennessee. Increases were observed in Arizona and Delaware. No changes were noted in the 26 or older age group.

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Figure 5.1 Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.1

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.2 Alcohol Dependence or Abuse in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.2

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.3 Alcohol Dependence or Abuse in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.3

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.4 Alcohol Dependence or Abuse in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.4

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.5 Alcohol Dependence in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.5

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.6 Alcohol Dependence in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.6

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.7 Alcohol Dependence in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.7

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.8 Alcohol Dependence in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.8

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.9 Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.9

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.10 Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 to 17, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.10

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.11 Illicit Drug Dependence or Abuse in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.11

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.12 Illicit Drug Dependence or Abuse in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.12

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.13 Illicit Drug Dependence in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.13

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.14 Illicit Drug Dependence in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.14

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.15 Illicit Drug Dependence in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.15

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.16 Illicit Drug Dependence in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.16

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.17 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.17

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.18 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.18

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.19 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.19

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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Figure 5.20 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2007 and 2008 NSDUHs

Figure 5.20

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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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 2007 and 2008 NSDUHs

Figure 5.21

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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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 2007 and 2008 NSDUHs

Figure 5.22

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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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 2007 and 2008 NSDUHs

Figure 5.23

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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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 2007 and 2008 NSDUHs

Figure 5.24

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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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 2007 and 2008 NSDUHs

Figure 5.25

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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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 2007 and 2008 NSDUHs

Figure 5.26

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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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 2007 and 2008 NSDUHs

Figure 5.27

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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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 2007 and 2008 NSDUHs

Figure 5.28

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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