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2003 National Survey on Drug Use & Health:  Results

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

Acknowledgments

This report was prepared by the Division of Population Surveys, Office of Applied Studies, SAMHSA, and by RTI International, a trade name of Research Triangle Institute, Research Triangle Park, North Carolina. Work by RTI was performed under Contract No. 283–98–9008. Contributors and reviewers at RTI listed alphabetically include Jeremy Aldworth, Katherine R. Bowman, Walter R. Boyle, Janice M. Brown, Jessica Duncan Cance, Patrick Chen, James R. Chromy, Andrew Clarke, Elizabeth Copello, David B. Cunningham, Teresa R. Davis, Steven L. Emrich, Ralph E. Folsom, Jr., Misty Foster, G. G. Frick, Eric A. Grau, Jennie L. Harris, David C. Heller, Erica Hirsch, Laurel Hourani, Susan Hunter, Jennifer J. Kasten, Larry A. Kroutil, Judith T. Lessler, Amy Licata, Mary Ellen Marsden, Christine Murtha, Brian Newquist, Dawn Odom, Lisa E. Packer, Michael R. Pemberton, Kristine L. Rae, Avinash C. Singh, Thomas G. Virag (Project Director), Michael Vorburger, and Jill Webster. Contributors at SAMHSA listed alphabetically include Peggy Barker, Joan Epstein, Joseph Gfroerer, Joe Gustin, Arthur Hughes (Project Officer), Joel Kennet, Dicy Painter, and Doug Wright. At RTI, Richard S. Straw edited the report with assistance from K. Scott Chestnut and Kathleen B. Mohar. Also at RTI, Diane G. Caudill prepared the graphics; Brenda K. Porter and Keri V. Kennedy formatted the tables; Joyce Clay-Brooks and Danny Occoquan formatted and word processed the report; and Pamela Couch Prevatt, Teresa F. Gurley, Kim Cone, David Belton, and Shari B. Lambert prepared its press and Web versions. Final report production was provided by Beatrice A. Rouse, Coleen Sanderson, and Jane Feldmann at SAMHSA.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration. However, this publication may not be reproduced or distributed for a fee without specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services. Citation of the source is appreciated. Suggested citation:

Substance Abuse and Mental Health Services Administration. (2004). Results from the 2003 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H–25, DHHS Publication No. SMA 04–3964). Rockville, MD.

Obtaining Copies of Publications from SAMHSA's Office of Applied Studies

Web Access:  http://samhsa.gov/data/

Originating Office:  SAMHSA, Office of Applied Studies
 

September 2004

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2003 National Survey on Drug Use & Health:  Results

Table of Contents

List of Figures
List of Tables

Highlights

1. Introduction
     1.1. Summary of NSDUH
     1.2. Trend Measurement
     1.3. Format of Report and Explanation of Tables
     1.4. Other NSDUH Reports

2. Illicit Drug Use
     Age
     Gender
     Pregnant Women
     Race/Ethnicity
     Education
     College Students
     Employment
     Geographic Area
     Criminal Justice Populations
     Frequency of Use
     Association with Cigarette and Alcohol Use
     Driving Under the Influence of Illicit Drugs
     How Marijuana Is Obtained

3. Alcohol Use
     Age
     Underage Alcohol Use
     Gender
     Pregnant Women
     Race/Ethnicity
     Education
     College Students
     Employment
     Geographic Area
     Association with Illicit Drug and Tobacco Use
     Driving Under the Influence of Alcohol

4. Tobacco Use
     Age
     Gender
     Pregnant Women
     Race/Ethnicity
     Education
     College Students
     Employment
     Geographic Area
     Frequency of Cigarette Use
     Association with Illicit Drug and Alcohol Use
     Usual Brand of Cigarettes Smoked
     Youth Access to Cigarettes
     Nicotine Dependence

5. Trends in Initiation of Substance Use
     Marijuana
     Cocaine
     Heroin
     Hallucinogens
     Inhalants
     Psychotherapeutics
     Alcohol
     Tobacco

6. Youth Prevention-Related Measures
     Perceptions of Risk
     Availability
     Parental Disapproval of Substance Use
     Attitudes about School
     Delinquent Behavior
     Participation in Religious and Other Activities
     Exposure to Prevention Messages and Programs

7. Substance Dependence, Abuse, and Treatment
     7.1 Substance Dependence and Abuse
          Age at First Use
          Age
          Gender
          Race/Ethnicity
          Education/Employment
          Criminal Justice Populations
          Geographic Area
     7.2 Past Year Treatment for a Substance Use Problem
          Age, Gender, and Race/Ethnicity
          Location of Treatment and Substance Treated
     7.3 Needing and Receiving Specialty Treatment
          Illicit Drug Treatment and Treatment Need
          Alcohol Treatment and Treatment Need

8. Prevalence and Treatment of Mental Health Problems
     8.1 Serious Mental Illness
          Prevalence of Serious Mental Illness
          Serious Mental Illness and Substance Use
          Co-Occurrence of Serious Mental Illness with Substance Dependence/Abuse
          Serious Mental Illness among Adults on Probation or Parole
     8.2 Treatment and Unmet Need for Treatment among Adults
          Treatment and Unmet Need for Treatment among Adults with Serious Mental Illness
     8.3 Treatment among Adults with Co-Occurring Serious Mental Illness and Substance Use Disorders
     8.4 Treatment for Mental Health Problems among Youths

Tables on mental health treatment:  (Tables G.61 to G.65)

Table B.21 Serious Mental Illness in Past Year, by Age Group and State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

9. Discussion
     Recent Trends in Youth and Young Adult Substance Use

Appendix

A. Description of the Survey
B. Statistical Methods and Measurement
C. Key Definitions, 2003
D. Other Sources of Data
E. References
F. Sample Size and Population Tables
G. Selected Prevalence Tables

Overview of Findings

Detailed Tables from the 2003 NSDUH

Available at SAMHSA's website:
     http://www.oas.samhsa.gov/nsduh.htm
     http://www.oas.samhsa.gov

 

 

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List of Figures

2.1 Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2003

2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002 and 2003

2.3 Numbers (in Millions) of Past Year Users of Selected Hallucinogens among Persons Aged 12 or Older: 2002 and 2003

2.4 Numbers (in Millions) of Lifetime Nonmedical Users of Selected Pain Relievers among Persons Aged 12 or Older: 2002 and 2003

2.5 Past Month Illicit Drug Use, by Age: 2003

2.6 Past Month Use of Selected Illicit Drugs among Youths, by Age: 2003

2.7 Past Month Use of Ecstasy and Nonmedical Use of Pain Relievers among Young Adults Aged 18 to 25: 2002 and 2003

2.8 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2002 and 2003

2.9 Past Month Illicit Drug Use among Youths Aged 12 to 17, by Race/Ethnicity: 2002 and 2003

2.10 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2002 and 2003

2.11 Numbers (in Thousands) of Daily or Almost Daily Marijuana Users in the Past Year and Past Month among Youths Aged 12 to 17: 2002 and 2003

3.1 Current, Binge, and Heavy Alcohol Use, by Age: 2003

3.2 Past Month Alcohol Use among Persons Aged 12 to 20, by Geographic Region: 2002 and 2003

3.3 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Race/Ethnicity: 2003

3.4 Heavy Alcohol Use, by College Attendance and Age: 2003

3.5 Current, Binge, and Heavy Alcohol Use among Adults Aged 18 or Older, by Employment Status: 2003

3.6 Driving Under the Influence of Alcohol in the Past Year, by Age: 2003

4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002 and 2003

4.2 Past Month Tobacco Use among Youths Aged 12 to 17: 2002 and 2003

4.3 Past Month Cigarette Use among Youths Aged 12 to 17, by Age: 2002 and 2003

4.4 Past Month Cigarette Use, by Age Group and Gender: 2002 and 2003

4.5 Past Month Cigarette Use among Youths Aged 12 to 17, by Race/Ethnicity: 2003

4.6 Past Month Cigarette Use among Persons Aged 12 or Older, by County Type: 2003

4.7 Past Month Cigarette Use and Nicotine Dependence, by Age: 2003

5.1 Annual Numbers of New Users of Marijuana: 1965–2002

5.2 Annual Numbers of New Users of Ecstasy, LSD, and PCP: 1965–2002

5.3 Annual Numbers of New Nonmedical Users of Pain Relievers: 1965–2002

5.4 Annual Numbers of New Users of Tobacco: 1965–2002

6.1 Past Month Use of Cigarettes and Marijuana among Youths Aged 12 to 17, by Perceptions of Risk: 2003

6.2 Perceived Great Risk of Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002 and 2003

6.3 Marijuana Use among Youths Aged 12 to 17, by Recency of Use: 2002 and 2003

6.4 Perceived Great Risk of Cigarette and Alcohol Use among Youths Aged 12 to 17: 2002 and 2003

6.5 Perceived Availability of Marijuana and LSD among Youths Aged 12 to 17, by Age: 2002 and 2003

6.6 Past Month Illicit Drug Use among Youths Aged 12 to 17, by Participation in Delinquent Behaviors: 2003

7.1 Past Year Substance Dependence or Abuse among Persons Aged 12 or Older: 2002 and 2003

7.2 Dependence or Abuse of Specific Substances among Past Year Users of Substances: 2003

7.3 Past Year Illicit Drug or Alcohol Dependence or Abuse, by Age Group and Substance: 2002 and 2003

7.4 Past Year Illicit Drug or Alcohol Dependence or Abuse, by Age and Gender: 2003

7.5 Past Year Illicit Drug or Alcohol Dependence or Abuse among Persons Aged 12 or Older, by County Type: 2002 and 2003

7.6 Locations Where Past Year Substance Treatment Was Received among Persons Aged 12 or Older: 2002 and 2003

7.7 Substances for Which Persons Aged 12 or Older Received Treatment in the Past Year: 2003

7.8 Past Year Need for and Receipt of Specialty Treatment for Any Illicit Drug or Alcohol Use among Persons Aged 12 or Older: 2002 and 2003

7.9 Past Year Perceived Need and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drugs or Alcohol: 2003

7.10 Reasons for Not Receiving Treatment among Persons Aged 12 or Older Who Needed But Did Not Receive Treatment and Felt They Needed Treatment: 2003

7.11 Source of Payment for Most Recent Specialty Illicit Drug Treatment among Persons Aged 12 or Older Who Received Specialty Illicit Drug Treatment in the Past Year: 2003

7.12 Source of Payment for Most Recent Specialty Alcohol Treatment among Persons Aged 12 or Older Who Received Specialty Alcohol Treatment in the Past Year: 2003

8.1 Rates of Serious Mental Illness among Adults Aged 18 or Older, by Age: 2002 and 2003

8.2 Past Year Serious Mental Illness among Adults Aged 18 or Older, by Race/Ethnicity: 2003

8.3 Substance Use among Adults Aged 18 or Older, by Serious Mental Illness: 2003

8.4 Past Year Substance Dependence or Abuse among Adults Aged 18 or Older, by Serious Mental Illness: 2003

8.5 Past Year Treatment for Mental Health Problems among Adults Aged 18 or Older, by Type of Treatment: 2002 and 2003

8.6 Reasons for Not Receiving Treatment in the Past Year among Persons Aged 18 or Older with an Unmet Need for Treatment Who Did Not Receive Treatment: 2003

8.7 Past Year Treatment among Adults Aged 18 or Older with Both Serious Mental Illness and a Substance Use Disorder: 2003

8.8 Past Year Treatment for Mental Health Problems among Youths Aged 12 to 17: 2002 and 2003

8.9 Past Year Treatment for Mental Health Problems among Youths Aged 12 to 17, by Age and Gender: 2003

8.10 Past Year Treatment for Mental Health Problems among Youths Aged 12 to 17 Who Received Treatment, by Reason for Most Recent Treatment: 2003

B.1 Required Effective Sample as a Function of the Proportion Estimated

 

 

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List of Tables

9.1 Comparison of NSDUH and MTF Prevalence Rates

B.1 Summary of 2003 NSDUH Suppression Rules

B.2 Weighted Percentages and Sample Sizes for 2002 and 2003 NSDUHs, by Screening Result Code

B.3 Weighted Percentages and Sample Sizes for 2002 and 2003 NSDUHs, by Final Interview Code

B.4 Response Rates and Sample Sizes for 2002 and 2003 NSDUHs, by Demographic Characteristics

B.5 Number of Days Used Hallucinogens in the Past Year among Past Year Users and the Number of Days Used Hallucinogens in the Past Month among Past Month Users, with and without Follow-Up Questions, by Age Group: Percentages, 2002 and 2003

B.6 Native Hawaiian (NH) and Other Pacific Islander (OPI) Respondents Aged 18 or Older: 2002 and 2003

B.7 Estimates of Key Measures for Native Hawaiians (NH) and Other Pacific Islanders (OPI) in 2002 and 2003

D.1 Use of Specific Substances in Lifetime, Past Year, and Past Month among 8th, 10th, and 12th Graders in NSDUH and MTF: Percentages, 2002 and 2003

D.2 Past Year and Past Month Marijuana Use among Youths Aged 12 to 18 in NSPY and NSDUH, by Age Group: 2002 and 2003

D.3 Past Month Cigarette Use among Persons Aged 18 or Older in NHIS and NSDUH, by Gender and Age Group: Percentages, 2002 and 2003

F.1 Survey Sample Size for All Respondents Aged 12 or Older, by Gender and Detailed Age Categories: 2002 and 2003

F.2 Numbers (in Thousands) of Persons Aged 12 or Older, by Gender and Detailed Age Categories: 2002 and 2003

F.3 Survey Sample Size for All Respondents Aged 12 or Older, by Age Group and Demographic Characteristics: 2002 and 2003

F.4 Numbers (in Thousands) of Persons Aged 12 or Older, by Age Group and Demographic Characteristics: 2002 and 2003

F.5 Survey Sample Size for All Respondents Aged 12 or Older, by Age Group and Geographic Characteristics: 2002 and 2003

F.6 Numbers (in Thousands) of Persons Aged 12 or Older, by Age Group and Geographic Characteristics: 2002 and 2003

G.1 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2002 and 2003

G.2 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Percentages, 2002 and 2003

G.3 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 17: Percentages, 2002 and 2003

G.4 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 18 to 25: Percentages, 2002 and 2003

G.5 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 26 or Older: Percentages, 2002 and 2003

G.6 Any Illicit Drug Use in Lifetime, Past Year, and Past Month, by Detailed Age Categories: Percentages, 2002 and 2003

G.7 Any Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.8 Any Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2002 and 2003

G.9 Any Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 18 to 25, by Demographic Characteristics: Percentages, 2002 and 2003

G.10 Any Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 26 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.11 Nonmedical Use of Specific Pain Relievers in Lifetime, by Age Group: Percentages, 2002 and 2003

G.12 Nonmedical Use of Specific Tranquilizers in Lifetime, by Age Group: Percentages, 2002 and 2003

G.13 Nonmedical Use of Specific Stimulants in Lifetime, by Age Group: Percentages, 2002 and 2003

G.14 Nonmedical Use of Specific Sedatives in Lifetime, by Age Group: Percentages, 2002 and 2003

G.15 Tobacco and Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2002 and 2003

G.16 Tobacco and Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Percentages, 2002 and 2003

G.17 Tobacco and Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 17: Percentages, 2002 and 2003

G.18 Tobacco and Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 18 to 25: Percentages, 2002 and 2003

G.19 Tobacco and Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 26 or Older: Percentages, 2002 and 2003

G.20 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month, by Detailed Age Categories: Percentages, 2002 and 2003

G.21 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.22 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2002 and 2003

G.23 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month among Persons Aged 18 to 25, by Demographic Characteristics: Percentages, 2002 and 2003

G.24 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month among Persons Aged 26 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.25 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month among Persons Aged 12 to 20, by Demographic Characteristics: Percentages, 2002 and 2003

G.26 Cigarette Use in Lifetime, Past Year, and Past Month, by Detailed Age Categories: Percentages, 2002 and 2003

G.27 Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.28 Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2002 and 2003

G.29 Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 18 to 25, by Demographic Characteristics: Percentages, 2002 and 2003

G.30 Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 26 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.31 Numbers (in Thousands) of Persons Who First Used Marijuana in the United States, Their Mean Age at First Use, and Rates of First Use (Per 1,000 Person-Years of Exposure): 1965–2002, Based on 2002 and 2003 NSDUHs

G.32 Numbers (in Thousands) of Persons Who First Used Cocaine in the United States, Their Mean Age at First Use, and Rates of First Use (Per 1,000 Person-Years of Exposure): 1965–2002, Based on 2002 and 2003 NSDUHs

G.33 Numbers (in Thousands) of Persons Who First Used Hallucinogens in the United States, Their Mean Age at First Use, and Rates of First Use (Per 1,000 Person-Years of Exposure): 1965–2002, Based on 2002 and 2003 NSDUHs

G.34 Numbers (in Thousands) of Persons Who First Used Ecstasy in the United States, Their Mean Age at First Use, and Rates of First Use (Per 1,000 Person-Years of Exposure): 1965–2002, Based on 2002 and 2003 NSDUHs

G.35 Numbers (in Thousands) of Persons Who First Used Pain Relievers Nonmedically in the United States, Their Mean Age at First Use, and Rates of First Use (Per 1,000 Person-Years of Exposure): 1965–2002, Based on 2002 and 2003 NSDUHs

G.36 Numbers (in Thousands) of Persons Who First Used Any Cigarettes in the United States, Their Mean Age at First Use, and Rates of First Use (Per 1,000 Person-Years of Exposure): 1965–2002, Based on 2002 and 2003 NSDUHs

G.37 Numbers (in Thousands) of Persons Who Began Daily Cigarette Use in the United States, Their Mean Age at First Use, and Rates of First Use (Per 1,000 Person-Years of Exposure): 1965–2002, Based on 2002 and 2003 NSDUHs

G.38 Perceived Risk and Availability of Drugs, by Age Group: Percentages, 2002 and 2003

G.39 Substance Dependence or Abuse for Specific Substances in the Past Year, by Age Group: Numbers in Thousands, 2002 and 2003

G.40 Substance Dependence or Abuse for Specific Substances in the Past Year, by Age Group: Percentages, 2002 and 2003

G.41 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.42 Received Substance Use Treatment in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.43 Received Substance Use Treatment in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.44 Received Substance Use Treatment at a Specialty Facility in the Past Year among Persons Aged 12 or Older, by Past Year Dependence and/or Abuse Status: Numbers in Thousands, 2002 and 2003

G.45 Received Substance Use Treatment at a Specialty Facility in the Past Year among Persons Aged 12 or Older, by Past Year Dependence and/or Abuse Status: Percentages, 2002 and 2003

G.46 Received Substance Use Treatment at a Specialty Facility in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.47 Received Substance Use Treatment at a Specialty Facility in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.48 Needed and Received Treatment for an Illicit Drug Problem in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.49 Needed and Received Treatment for an Illicit Drug Problem in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.50 Perceived Need for Illicit Drug Treatment and Whether Made an Effort to Get Treatment in the Past Year among Persons Aged 12 or Older Classified as Needing But Not Receiving Treatment for an Illicit Drug Problem, by Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.51 Needed and Received Treatment for an Alcohol Problem in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.52 Needed and Received Treatment for an Alcohol Problem in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.53 Perceived Need for Alcohol Treatment and Whether Made an Effort to Get Treatment in the Past Year among Persons Aged 12 or Older Classified as Needing But Not Receiving Treatment for an Alcohol Problem, by Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.54 Needed and Received Treatment for an Illicit Drug or Alcohol Problem in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.55 Needed and Received Treatment for an Illicit Drug or Alcohol Problem in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

G.56 Perceived Need for Illicit Drug or Alcohol Treatment and Whether Made an Effort to Get Treatment in the Past Year among Persons Aged 12 or Older Classified as Needing But Not Receiving Treatment for an Illicit Drug or Alcohol Problem, by Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.57 Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.58 Serious Mental Illness in the Past Year among Persons Aged 18 or Older, by Age Group and Demographic Characteristics: Percentages, 2002 and 2003

G.59 Substance Dependence or Abuse in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness: Numbers in Thousands, 2002 and 2003

G.60 Substance Dependence or Abuse in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness: Percentages, 2002 and 2003

G.61 Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Numbers in Thousands, 2002 and 2003

G.62 Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Past Year Serious Mental Illness and Demographic Characteristics: Percentages, 2002 and 2003

G.63 Received Mental Health Treatment/Counseling and/or Illicit Drug or Alcohol Treatment at a Specialty Facility in the Past Year among Persons Aged 18 or Older With Serious Mental Illness and/or Illicit Drug or Alcohol Dependence or Abuse in the Past Year: Numbers in Thousands, 2002 and 2003

G.64 Received Mental Health Treatment/Counseling and/or Illicit Drug or Alcohol Treatment at a Specialty Facility in the Past Year among Persons Aged 18 or Older With Serious Mental Illness and/or Illicit Drug or Alcohol Dependence or Abuse in the Past Year: Percentages, 2002 and 2003

G.65 Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 12 to 17, by Age Group and Demographic Characteristics: Percentages, 2002 and 2003

G.66 Drove Under the Influence of Any Illicit Drug or Alcohol in the Past Year, by Detailed Age Categories: Percentages, 2002 and 2003

G.67 Drove Under the Influence of Any Illicit Drug or Alcohol in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2002 and 2003

 

 

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Highlights

This report presents the first information from the 2003 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), part of the U.S. Department of Health and Human Services. 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.

Illicit Drug Use

Alcohol Use

Tobacco Use

Trends in Initiation of Substance Use (Incidence)

Youth Prevention-Related Measures

Substance Dependence or Abuse

Treatment and Treatment Need for Substance Problems

Serious Mental Illness among Adults

Co-Occurrence of Serious Mental Illness and Substance Use Disorders

Treatment for Mental Health Problems

 

 

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1. Introduction

This report presents the first information from the 2003 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized 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 2003 data presents national estimates of rates of use, numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products. Measures related to mental health problems also are included. State-level estimates from NSDUH will be presented in a separate report.

A major focus of this report is changes in substance use between 2002 and 2003. Because of improvements to the survey in 2002, the 2002 data constitute a new baseline for tracking trends in substance use and other measures. Therefore, estimates from the 2002 and 2003 NSDUHs should not be compared with estimates from the 2001 and earlier NHSDAs to assess changes in substance use over time.

 

1.1. Summary of NSDUH

NSDUH is the primary source of statistical information on the use of illegal drugs by the U.S. population. Conducted by the Federal Government since 1971, the survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their places of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services and is planned and managed by SAMHSA's Office of Applied Studies (OAS). Data collection is conducted under contract with RTI International, Research Triangle Park, North Carolina.1 This section briefly describes the survey methodology; a more complete description is provided in Appendix A.

NSDUH collects information from residents of households, noninstitutional group quarters (e.g., shelters, rooming houses, dormitories), and civilians living on military bases. Persons excluded from the survey include homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails and hospitals. Appendix D describes surveys that cover populations outside the NSDUH sampling frame.

Since 1999, the NSDUH interview has been carried out using computer-assisted interviewing (CAI). Most of the questions are administered with audio computer-assisted self-interviewing (ACASI). ACASI is designed to provide the respondent with a highly private and confidential means of responding to questions to increase the level of honest reporting of illicit drug use and other sensitive behaviors. Less sensitive items are administered by interviewers using computer-assisted personal interviewing (CAPI).

Consistent with the 2002 survey, the 2003 NSDUH employed a 50–State sample design with an independent, multistage area probability sample for each of the 50 States and the District of Columbia. The eight States with the largest population (which together account for 48 percent of the total U.S. population aged 12 or older) were designated as large sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas). For these States, the design provided a sample sufficient to support direct State estimates. For the remaining 42 States and the District of Columbia, smaller, but adequate, samples were selected to support State estimates using small area estimation (SAE) techniques. The design also oversampled youths and young adults, so that each State's sample was approximately equally distributed among three major age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.

Nationally, 130,605 addresses were screened for the 2003 survey, and 67,784 completed interviews were obtained. The survey was conducted from January through December 2003. Weighted response rates for household screening and for interviewing were 90.72 and 77.39 percent, respectively. See Appendix B for more information on NSDUH response rates.

 

1.2. Trend Measurement

Although the design of the 2002 and 2003 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are important methodological differences that impact comparability of 2002 and 2003 estimates with estimates from prior surveys. In addition to the name change, each NSDUH respondent is now given an incentive payment of $30. These changes, both implemented in 2002 and continued in 2003, resulted in a substantial improvement in the survey response rate. The changes also affected respondents' reporting of many critical items that are the basis of prevalence measures reported by the survey each year. Comparability also could be affected by improved data collection quality control procedures that were introduced in the survey beginning in 2001, and by incorporating new population data from the 2000 decennial census into NSDUH sample weighting procedures. Analyses of the effects of each of these factors on NSDUH estimates have shown that 2002 and 2003 data should not be compared with 2001 and earlier NHSDA data to assess changes over time. Therefore, this report presents data only from the 2002 and 2003 NSDUHs.

Using only the 2002 and 2003 data, however, limited trend assessment can be done using information collected in NSDUH on prior substance use. Specifically, questions on age at first use of substances, in conjunction with respondents' ages and interview dates, provide data that can be used to estimate the rates of first-time use (incidence) for years prior to 2002 and 2003. Trends for 1965 to 2002 in these incidence measures for youths and young adults are discussed in Chapter 5. Estimates of lifetime prevalence rates for years prior to 2002 were produced from 2002 NSDUH data on age at first use and included in last year's NSDUH report (OAS, 2003). However, a recent evaluation assessing the validity of those estimates determined they were subject to significant bias (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004). Therefore, they are not included in this report. Further discussion of incidence estimates is given in Chapter 5 and Appendix B.

 

1.3. Format of Report and Explanation of Tables

The results from the 2003 NSDUH are given in this report, which has separate chapters that discuss the national findings on seven topics: use of illicit drugs; use of alcohol; use of tobacco products; trends in initiation of substance use; prevention-related issues; substance dependence, abuse, and treatment; and mental health. A final chapter summarizes the results and discusses key findings in relation to other research and survey results. Technical appendices describe the survey (Appendix A), provide technical details on the statistical methods and measurement (Appendix B), offer key NSDUH definitions (Appendix C), discuss other sources of related data (Appendix D), list the references cited in the report (as well as other relevant references) (Appendix E), and present selected tabulations of estimates (Appendices F and G).

Tables, text, and figures present prevalence measures for the population in terms of both the number of substance users and the rate of use for illicit drugs, alcohol, and tobacco products. Tables show estimates of drug use prevalence by lifetime (i.e., ever used), past year, and past month use. Analyses focus primarily on past month use, which also is referred to as "current use." Tables and figures have footnotes indicating whether the 2003 and 2002 estimates were significantly different.

Data are presented for racial/ethnic groups in several categorizations, based on current standards for collecting and reporting race and ethnicity data (Office of Management and Budget [OMB], 1997) and on the level of detail permitted by the sample. Because respondents were allowed to choose more than one racial group, a "two or more races" category is presented that includes persons who reported more than one category among the seven basic groups listed in the survey question (white, black/African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, Other). It should be noted that, except for the "Hispanic or Latino" group, the racial/ethnic groups discussed in this report include only non-Hispanics. The category "Hispanic or Latino" includes Hispanics of any race. Also, more detailed categories describing specific subgroups were obtained from survey respondents if they reported either Asian race or Hispanic ethnicity. Data on Native Hawaiians and Other Pacific Islanders are combined in this report.

Data also are presented for four U.S. geographic regions and nine geographic divisions within these regions. These regions and divisions, defined by the U.S. Bureau of the Census, consist of the following groups of States:

Northeast Region - New England Division: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont; Middle Atlantic Division: New Jersey, New York, Pennsylvania.

Midwest Region - East North Central Division: Illinois, Indiana, Michigan, Ohio, Wisconsin; West North Central Division: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota.

South Region - South Atlantic Division: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia; East South Central Division: Alabama, Kentucky, Mississippi, Tennessee; West South Central Division: Arkansas, Louisiana, Oklahoma, Texas.

West Region - Mountain Division: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming; Pacific Division: Alaska, California, Hawaii, Oregon, Washington.

Geographic comparisons for 2002 and 2003 also are made based on county type, which reflects different levels of urbanicity and metropolitan area inclusion of counties. For this purpose, counties are grouped based on the 2003 rural-urban continuum codes. These codes were originally developed by the U.S. Department of Agriculture (Butler & Beale, 1994). Each county is either inside or outside a metropolitan statistical area (MSA), as defined by the OMB.

Large metropolitan areas have a population of 1 million or more. Small metropolitan areas have a population of fewer than 1 million. Nonmetropolitan areas are areas outside MSAs. Small metropolitan areas are further classified as having either fewer than or greater than 250,000 population. Counties in nonmetropolitan areas are classified based on the number of people in the county who live in an urbanized area, as defined by the Census Bureau at the subcounty level. "Urbanized" counties have 20,000 or more population in urbanized areas, "less urbanized" counties have at least 2,500 but fewer than 20,000 population in urbanized areas, and "completely rural" counties have fewer than 2,500 population in urbanized areas.

In June 2003, the OMB issued revised definitions for metropolitan areas (OMB, 2003), and these revised definitions are reflected in the county type variable used in this report. Counties no longer have to meet certain urban characteristics to be considered part of an MSA. Simplified commuting criteria concerning the percentage of residents who work in the central county of an MSA determine the metropolitan status for outlying counties. As a result of these changes, analyses based on county type information for 2003 are not fully comparable with analyses based on county type information in prior years. To make the analyses by county type presented in this report comparable for 2002 and 2003 data, county type classifications for both years are based on the 2003 rural-urban continuum codes. The 2002 county type analyses presented in this report are therefore not directly comparable with those presented in the 2002 NSDUH report (OAS, 2003).

 

1.4. Other NSDUH Reports

This report provides a comprehensive summary of the 2003 NSDUH, including results, technical appendices, and selected data tables. A companion report, Overview of Findings from the 2003 National Survey on Drug Use and Health, is a shorter, more concise report that highlights the most important findings of the survey and includes only a brief discussion of the methods. A report on State-level estimates for 2003 will be available in 2005.

In addition to the tables included in Appendices F and G of this report, a more extensive set of tables, including standard errors, is available upon request from OAS or through the Internet at http://www.oas.samhsa.gov. Additional methodological information on NSDUH, including the questionnaire, is available electronically at the same Web address. Brief descriptive reports and in-depth analytic reports focusing on specific issues or population groups also are produced by OAS. A complete listing of previously published reports from NSDUH and other data sources is available from OAS. Most of these reports also are available through the Internet (http://www.oas.samhsa.gov). In addition, OAS makes public use data files available to researchers through the Substance Abuse and Mental Health Data Archive (SAMHDA, 2004). Currently, files are available from the 1979 to 2002 surveys at http://www.icpsr.umich.edu/SAMHDA/index.html. The NSDUH 2003 public use file will be available by the end of 2004.

 

 

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2. Illicit Drug Use

The National Survey on Drug Use and Health (NSDUH) obtains information on nine different categories of illicit drug use: marijuana, cocaine, heroin, hallucinogens, inhalants, and 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 and sometimes illegally "on the street." Methamphetamine is included under stimulants. Over-the-counter drugs and legitimate uses of prescription drugs are not included. 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. NSDUH reports combine the four prescription-type drug groups into a category referred to as "any psychotherapeutics."

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

Age

Gender

Pregnant Women

Race/Ethnicity

Education

College Students

Employment

Geographic Area

Criminal Justice Populations

Frequency of Use

Association with Cigarette and Alcohol Use

Driving Under the Influence of Illicit Drugs

How Marijuana Is Obtained

 

 

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3. Alcohol Use

The National Survey on Drug Use and Health (NSDUH) includes questions about the recency and frequency of consumption of alcoholic beverages, such as beer, wine, whiskey, brandy, and mixed drinks. An extensive list of examples of the kinds of beverages covered is given to respondents prior to the question administration. A "drink" is defined as a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. Times when the respondent only had a sip or two from a drink are not considered as consumption. For this report, estimates for the prevalence of alcohol use are reported primarily at three levels defined for both males and females and for all ages as follows:

Current use - At least one drink in the past 30 days (includes binge and heavy use).

Binge use - Five or more drinks on the same occasion at least once in the past 30 days (includes heavy use).

Heavy use - Five or more drinks on the same occasion on at least 5 different days in the past 30 days.

Age

Underage Alcohol Use

Gender

Pregnant Women

Race/Ethnicity

Education

College Students

Employment

Geographic Area

Association with Illicit Drug and Tobacco Use

Driving Under the Influence of Alcohol

 

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4. Tobacco Use

The National Survey on Drug Use and Health (NSDUH) includes a series of questions about the use of tobacco products, including cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco. For analytic purposes, data for chewing tobacco and snuff are combined as "smokeless tobacco." Cigarette use is defined as smoking "part or all of a cigarette." Questions to determine nicotine dependence among current cigarette smokers also are included in the NSDUH. Nicotine dependence is based on criteria from the Nicotine Dependence Syndrome Scale (NDSS) or the Fagerstrom Test of Nicotine Dependence (FTND) (see Appendix B, Section B.4.2, of this report).

Age

Gender

Pregnant Women

Race/Ethnicity

Education

College Students

Employment

Geographic Area

Frequency of Cigarette Use

Association with Illicit Drug and Alcohol Use

Usual Brand of Cigarettes Smoked

Youth Access to Cigarettes

Nicotine Dependence

 

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5. Trends in Initiation of Substance Use

Estimates of substance use incidence, or initiation, describe the number of new users of illicit drugs, alcohol, or tobacco during a given year. Where prevalence estimates describe the extent of use of substances over some period of time, incidence data describe emerging patterns of use, particularly among young people. The incidence estimates are based on data from the combined 2002 and 2003 National Survey on Drug Use and Health (NSDUH). As the 2002 NSDUH constitutes a new baseline year for the survey, these data should not be compared with previously published data from the National Household Survey on Drug Abuse (NHSDA).

Incidence estimates are based on questions about age at first use, year and month of first use for recent initiates, the respondent's date of birth, and the interview date. Using this information along with editing and imputation when necessary, the date of first use is determined for each substance used by each respondent. By applying sample weights to incidents of first use, estimates of the number of new users of each substance are developed for each year. Responses to questions on country of birth and years lived in the United States are used to restrict estimates to initiation occurring only within the United States. This adjustment was not included in estimates shown in prior reports.

The estimates discussed in this chapter include the number of new users at any age (including those younger than age 12), by age group and gender, and the average age of new users. Estimates for the years from 1965 to 2002 are covered. Although they are not discussed in this chapter, estimates of age-specific incidence rates also are available. These rates are defined as the number of new users per 1,000 potential new users. More precisely, the rates are actually the number of new users per 1,000 person-years of exposure. This measure is widely used in describing the incidence of disease. The method used for computing these rates is described in Section B.4.4 in Appendix B.

The incidence estimates reported in this chapter are based on retrospective reporting; therefore, they may be subject to several sources of bias. These include bias due to differential mortality of users and nonusers of each substance, memory errors (recall decay and telescoping), and underreporting due to desire for social acceptability or fear of disclosure. A recent evaluation of the NSDUH retrospective estimates of incidence and lifetime prevalence (no longer produced) suggests that bias is significant and differs by substance and length of recall (Gfroerer et al., 2004). For very recent time periods, bias in estimates of marijuana, cocaine, alcohol, and cigarettes appears to be small, but for all other substances there is significant downward bias. Bias for all substances increases the further back in time the estimates are made, suggesting a relationship with the length of recall. Nevertheless, these estimates, when used cautiously, are useful in describing the number and characteristics of recent initiates, as well as identifying broad historical periods of increasing or decreasing initiation. They should not be used to compare levels of initiation between two separate time periods many years apart, such as the 1990s versus the 1960s. The description of the initiation data given in this chapter is made with these limitations in mind. See Section B.4.4 in Appendix B for further discussion.

Because the incidence estimates are based on retrospective reports of age at first use, the most recent year available for these estimates is 2002, based on the 2003 NSDUH. For two of the measures, first alcohol use and first cigarette use, initiation before age 12 is common. A 2–year lag in reporting for "all ages" estimates is applied for these measures because the NSDUH sample does not cover youths under age 12. The 2–year lag ensures that initiation at ages 10 and 11 is captured in the estimation.

 

 

Marijuana

 

 

Cocaine

 

 

 

Heroin

 

 

Hallucinogens

Inhalants

 

 

Psychotherapeutics

 

 

 

Alcohol

 

 

Tobacco

 

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6. Youth Prevention-Related Measures

This chapter presents results from the 2003 National Survey on Drug Use and Health (NSDUH) for various measures related to the prevention of substance use among youths aged 12 to 17. These measures include perceptions of risk from substance use (cigarettes, alcohol, and illicit drugs), availability of substances, perceived parental disapproval of substance use, attitudes about school, involvement in delinquent behavior, participation in religious and other activities, and exposure to substance abuse prevention messages and programs.

NSDUH includes an extensive set of questions about risk and protective factors directed at youths aged 12 to 17. Risk factors include those individual characteristics or social environments associated with an increased likelihood of substance use, while protective factors are related to a decreased likelihood of substance use. These factors derive from circumstances, influences, and perceptions at many levels, such as the individual, peer, family, school, and community levels (Hawkins, Catalano, & Miller, 1992).

Perceptions of Risk

Availability

Parental Disapproval of Substance Use

Attitudes about School

Delinquent Behavior

Participation in Religious and Other Activities

Exposure to Prevention Messages and Programs

 

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7. Substance Dependence, Abuse, and Treatment

The National Survey on Drug Use and Health (NSDUH) includes a series of questions to assess dependence on and abuse of substances, including alcohol and illicit drugs, which include nonmedical use of prescription-type drugs. These questions are designed to measure dependence and abuse 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.

This chapter provides estimates of the prevalence and patterns of substance dependence and abuse in the Nation from the 2003 NSDUH and compares these estimates against the results from the 2002 NSDUH. It also provides estimates of the prevalence and patterns of the receipt of treatment for problems related to substance use and discusses the need for and receipt of treatment at specialty facilities for problems associated with substance use.

 

7.1 Substance Dependence and Abuse

Age at First Use

Age

Gender

Race/Ethnicity

Education/Employment

Criminal Justice Populations

Geographic Area

 

7.2 Past Year Treatment for a Substance Use Problem

Estimates described in this section refer to treatment received to reduce or stop 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 in a hospital, at a rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, self-help group, or prison or jail. The definition of treatment in this section is different from the definition of treatment described in Section 7.3 (specialty treatment) that excludes treatment at an emergency room, private doctor's office, self-help group, prison or jail, or at a hospital as an outpatient.

Age, Gender, and Race/Ethnicity

Location of Treatment and Substance Treated

 

7.3 Needing and Receiving Specialty Treatment

This section discusses the need for and receipt of treatment for a substance use problem at a "specialty" treatment facility. It includes estimates of the number of persons needing and receiving treatment, as well as those needing but not receiving treatment. These estimates are specified separately for alcohol, for illicit drugs, and for illicit drugs or alcohol. Specialty treatment is treatment received at drug or alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient only), or mental health centers. It excludes 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 problem if he or she was dependent on or abused alcohol or drugs or received specialty treatment for alcohol or drugs in the past 12 months.

An individual needing treatment for an illicit drug problem is defined as receiving treatment for his or her drug problem only if he or she reported receiving specialty treatment for drugs in the past year. Thus, an individual who needed treatment for illicit drugs but only received specialty treatment for alcohol in the past year was not counted as receiving treatment for drugs. Similarly, an individual who needed treatment for an alcohol problem who only received specialty treatment for drugs was not counted as receiving alcohol treatment. Individuals who reported receiving specialty substance abuse treatment but were missing information on whether the treatment was specifically for alcohol or drugs were not counted in estimates of specialty drug treatment or in estimates of specialty alcohol treatment; however, they were counted in estimates for "drug or alcohol" treatment.

Illicit Drug Treatment and Treatment Need

Alcohol Treatment and Treatment Need

 

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8. Prevalence and Treatment of Mental Health Problems

This chapter presents national estimates of the prevalence and characteristics of persons aged 18 or older with serious mental illness (SMI) and of persons aged 12 or older who received treatment for mental health problems. In the National Survey on Drug Use and Health (NSDUH), different questions and definitions of treatment and counseling are used for adults aged 18 or older and youths aged 12 to 17. Both the youth and the adult questions specifically exclude treatment for problems with substance use, which is covered elsewhere in the interview. Because the survey covers the civilian, noninstitutionalized population, persons who reside in long-term psychiatric or other institutions at the time of interview are excluded from the sample and from the estimates presented in this chapter.

 

8.1 Serious Mental Illness

This section presents national estimates of the prevalence and characteristics of adults who had SMI in 2003. SMI is defined for this report as having at some time during the past year a diagnosable mental, behavioral, or emotional disorder that met the criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994) and that resulted in functional impairment substantially interfering with or limiting one or more major life activities. A scale consisting of six questions is used to measure SMI. These questions ask how frequently a respondent experienced symptoms of psychological distress during the 1 month in the past year when he or she was at his or her worst emotionally. Use of this scale to estimate SMI is supported by methodological research that determined the scale to be a good predictor of SMI, based on clinical assessments done on survey respondents (Kessler et al., 2003). The six questions and further discussion of this scale are given in Section B.4.5 of Appendix B.

Prevalence of Serious Mental Illness

Serious Mental Illness and Substance Use

Co-Occurrence of Serious Mental Illness with Substance Dependence/Abuse

Serious Mental Illness among Adults on Probation or Parole

 

8.2 Treatment and Unmet Need for Treatment among Adults

This section presents national estimates of the prevalence and characteristics of adults aged 18 or older who received treatment for mental health problems in 2003. Estimates are presented for the total adult population and separately for the adult population with SMI. Treatment is defined as the receipt of treatment or counseling for any problem with emotions, "nerves," or mental health in the 12 months prior to the interview in any inpatient or outpatient setting. It also includes the use of prescription medication for treatment of a mental or emotional condition. Treatment for only a substance abuse problem is not included. Unmet need is defined as a perceived need for treatment at any time in the 12 months prior to the interview that was not received.

Treatment and Unmet Need for Treatment among Adults with Serious Mental Illness

 

8.3 Treatment among Adults with Co-Occurring Serious Mental Illness and Substance Use Disorders

 

8.4 Treatment for Mental Health Problems among Youths

This section presents national estimates of the receipt of treatment or counseling for mental health problems among youths aged 12 to 17. Data on reasons for the last treatment visit and sources or locations of past year treatment also are discussed. Treatment for youths is defined as receiving treatment or counseling for problems with behaviors or emotions from specific mental health or other health professionals in school, home, outpatient, or inpatient settings within the 12 months prior to the interview. Treatment for only a substance abuse problem is not included.

 

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9. Discussion

This report presents findings from the 2003 National Survey on Drug Use and Health (NSDUH). 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. As a result, the 2002 and 2003 estimates are not comparable with estimates from 2001 and earlier surveys. The primary focus of the report is on comparisons across subgroups of the U.S. population in 2003 and changes between 2002 and 2003 in the substance use and mental health measures addressed by the survey. Some of the key findings for 2003 are presented in the Highlights section of this report. This chapter provides additional discussion of the findings concerning one of the most important areas of concern, trends in substance use among youths and young adults.

An important step in the analysis and interpretation of NSDUH or any other survey data is to compare the results with results from other data sources. This can sometimes be difficult because the other surveys typically will have different purposes, definitions, and designs. Survey research has established that surveys of substance use and other sensitive topics often produce inconsistent results because of different methods 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 provide confirmation or support for conclusions, and inconsistent results can point to areas for further study. Further discussion of this issue is included in Appendix D, along with descriptions of methods and results from other substance use and mental health data sources.

Recent Trends in Youth and Young Adult Substance Use

This chapter presents some comparative analyses, focusing on the changes between 2002 and 2003 in substance use among youths and young adults. Unfortunately, there are few data sources that are available at this time to compare with NSDUH results. One established source is Monitoring the Future (MTF), a study sponsored by the National Institute on Drug Abuse (NIDA). The MTF surveys students in 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 earlier participated in the study as 12th graders. Historically, NSDUH rates of substance use have been lower than those of MTF, but the two sources have usually shown the same trends in substance use prevalence among youths and young adults. The trend in marijuana incidence shown in Chapter 5 (see Figure 5.1) also is consistent with the trends in MTF data since 1975.

A comparison of NSDUH and MTF estimates for 2002 and 2003 is shown in Table 9.1 for selected substances and age groups. MTF data on 8th and 10th graders combined give the closest match on age to NSDUH youth estimates. The NSDUH results are generally consistent with MTF trends. Both surveys show decreases in the use of Ecstasy and LSD among youths and young adults. This recent downturn in hallucinogen use also is evident in estimates of incidence from NSDUH (see Figure 5.2). The significant declines in lifetime and past year youth marijuana use reported by MTF were evident in NSDUH results, but the change was not statistically significant for past year use. Both surveys show little change in alcohol use among both groups and declines in cigarette use among youths. An important finding from the 2003 MTF was the increase in past year inhalant use among 8th graders between 2002 and 2003, from 7.7 to 8.7 percent. A comparative analysis of NSDUH data (see Appendix D), restricted to youths enrolled in 8th grade during January-June each year (similar to the data collection period for MTF), does show a statistically significant increase in past year inhalant use, from 4.8 percent in 2002 to 7.6 percent in 2003. However, the combined 8th and 10th grade data from MTF and the NSDUH data for youths aged 12 to 17 both show that past year inhalant use was stable between 2002 and 2003.

 

Table 9.1 Comparison of NSDUH and MTF Prevalence Rates
  NSDUH MTF NSDUH MTF
Age 12–17 8th and 10th Grades Age 18–25 Age 19–28
2002 2003 2002 2003 2002 2003 2002 2003
Marijuana                
     Lifetime 20.6a 19.6 29.0a 27.0 53.8 53.9 56.8 57.2
     Past Year 15.8 15.0 22.5a 20.5 29.8a 28.5 29.3 29.0
     Past Month 8.2 7.9 13.1 12.3 17.3 17.0 16.9 17.3
Cocaine                
     Lifetime 2.7 2.6 4.9 4.4 15.4 15.0 13.5 14.7
     Past Year 2.1 1.8 3.2 2.8 6.7 6.6 5.8 6.6
     Past Month 0.6 0.6 1.4 1.1 2.0 2.2 2.2 2.4
Ecstasy                
     Lifetime 3.3a 2.4 5.5a 4.3 15.1 14.8 14.6 15.3
     Past Year 2.2a 1.3 3.9a 2.6 5.8a 3.7 6.2a 4.5
     Past Month 0.5 0.4 1.6a 0.9 1.1a 0.7 1.3 0.8
LSD                
     Lifetime 2.7a 1.6 3.8a 2.8 15.9a 14.0 15.1 14.6
     Past Year 1.3a 0.6 2.1a 1.5 1.8a 1.1 1.8a 1.2
     Past Month 0.2 0.2 0.7 0.6 0.1 0.2 0.3 0.2
Inhalants                
     Lifetime 10.5 10.7 14.4 14.3 15.7 14.9 12.4 12.2
     Past Year 4.4 4.5 6.8 7.1 2.2 2.1 1.6 1.4
     Past Month 1.2 1.3 3.1 3.2 0.5 0.4 0.5 0.3
Alcohol                
     Lifetime 43.4 42.9 57.0 55.8 86.7 87.1 90.2 89.3
     Past Year 34.6 34.3 49.4 48.3 77.9 78.1 84.9a 83.3
     Past Month 17.6 17.7 27.5 27.6 60.5 61.4 68.3 67.0
Cigarettes                
     Lifetime 33.3a 31.0 39.4a 35.7 71.2 70.2 -- --
     Past Year 20.3a 19.0 -- -- 49.0a 47.6 39.1 38.6
     Past Month 13.0 12.2 14.2 13.5 40.8 40.2 29.2 28.4
-- Not available.
a Difference between 2002 and 2003 estimates is statistically significant at the 0.05 level.
Note: MTF data for 8th and 10th graders are simple averages of estimates for those two grades. Data for 8th and 10th graders and for persons aged 19 to 28 are reported in Johnston, O'Malley, Bachman, and Shulenberg (2004a).
Sources:
     SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003.
     The Monitoring the Future Study, University of Michigan, 2002 and 2003.

 


End Note

1 RTI International is a trade name of Research Triangle Institute.

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