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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., substance dependence or abuse) 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 in this report 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 use 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.10 in Appendix A.

Nationally, 22.4 million persons aged 12 or older in 2009-2010 were classified with illicit drug or alcohol dependence or abuse in the past year. Of these, 7.1 million had illicit drug dependence or abuse, and 18.4 million had alcohol dependence or abuse (see Tables 16, 18, and 20 at http://www.samhsa.gov/data/NSDUH/2k10State/WebOnlyTables/NSDUHsaeCountTabs2010.htm).

5.1  Alcohol Dependence or Abuse

In 2009-2010, 7.3 percent of the population aged 12 or older was classified with alcohol dependence or abuse 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 (15.9 percent) in the Nation. At the State level among persons 12 or older, the District of Columbia had the highest rate (9.5 percent), and Utah had the lowest rate (5.7 percent). While the District of Columbia had the highest rate of past year alcohol dependence or abuse among persons aged 26 or older (8.3 percent), it had the lowest rate among youths aged 12 to 17 along with Maryland (3.3 percent). Three States (Colorado, Montana, and South Dakota) ranked in the highest fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) and among persons aged 12 or older (Figures 5.1 to 5.4).

Nationally, the rate for past year dependence or abuse of alcohol dropped from 16.8 percent in 2008-2009 to 15.9 percent in 2009-2010 among young adults 18 to 25 (see Table C.16 in Appendix C). Among 18 to 25 year olds, seven States showed decreases (Delaware, Minnesota, Missouri, New Mexico, New York, South Dakota, and Wisconsin). For the 12 or older age group, decreases were observed in Minnesota and Missouri. A decrease also was seen in the Midwest region among the 12 to 17 age group (from 5.1 percent in 2008-2009 to 4.6 percent in 2009-2010), the 18 to 25 age group (from 18.2 to 16.8 percent), and 12 or older age group (from 7.8 to 7.5 percent). No increases in the past year alcohol dependence or abuse rates were observed for any State or age group.

In 2009-2010, 3.4 percent of persons aged 12 or older nationwide were estimated to be alcohol dependent in the past year, representing about 47 percent of those with alcohol dependence or abuse in the past year (Tables B.16 and B.17). State estimates for alcohol dependence for persons aged 12 or older ranged from 2.9 percent in Georgia, Kentucky, and Utah to 4.6 percent in the District of Columbia. The highest rates for alcohol dependence occurred in the 18 to 25 age group (6.6 percent nationally) compared with the rates for 12 to 17 year olds (1.8 percent nationally) and persons aged 26 or older (3.1 percent nationally). In 2009-2010 among young adults aged 18 to 25, these rates ranged from 5.3 percent in Georgia to 9.8 percent in Montana.

Two States that ranked in the highest fifth in the 12 or older population for alcohol dependence or abuse in the past year also were ranked in the highest fifth for past year alcohol dependence (District of Columbia and Rhode Island) (Figures 5.1 and 5.5). Among young adults aged 18 to 25, there were decreases in alcohol dependence from 2008-2009 to 2009-2010 in three States: Michigan (from 6.9 to 6.1 percent), Ohio (from 7.8 to 7.0 percent), and Wisconsin (from 8.3 to 6.9 percent). Decreases in alcohol dependence also were seen in the Midwest region among young adults and youths (Table C.17). No increases in past year alcohol dependence were observed for any State or age group.

5.2  Illicit Drug Dependence or Abuse

Nationally in 2009-2010, 2.8 percent of persons aged 12 or older had illicit drug dependence or abuse in the past year, a rate that remained unchanged from 2008-2009 (Table C.18). The District of Columbia had the highest rate of past year illicit drug dependence or abuse (3.9 percent) among persons aged 12 or older, and North Dakota had the lowest rate (2.0 percent). The highest rates for past year illicit drug dependence or abuse occurred in the 18 to 25 age group (7.8 percent nationally), with the highest rate occurring in Vermont (11.0 percent) and the lowest rate in North Dakota (5.2 percent). Among young adults aged 18 to 25, decreases in the rates of past year illicit drug dependence or abuse occurred in the District of Columbia (from 8.8 to 7.1 percent) and Nevada (from 8.9 to 7.0 percent) between 2008-2009 and 2009-2010 (Table C.18). Among persons aged 12 or older, decreases were observed in Kentucky, Nevada, Rhode Island, and West Virginia, but an increase was seen in Mississippi.

The percentage of persons aged 12 or older in 2009-2010 estimated to have illicit drug dependence in the past year was 1.9 percent (more than two thirds of those who were estimated to have illicit drug dependence or abuse in the past year) (Tables B.18 and B.19). The District of Columbia had the highest percentage of persons aged 12 or older with illicit drug dependence in the past year (2.6 percent), and Iowa had the lowest rate (1.4 percent). Seven States (District of Columbia, Idaho, Massachusetts, New Hampshire, Oregon, Rhode Island, and Vermont) that were in the highest group for illicit drug dependence or abuse among persons aged 12 or older were also in the highest group for illicit drug dependence (Figures 5.9 and 5.13).

Among young adults aged 18 to 25, a decline in the past year illicit drug dependence rate occurred in the District of Columbia (from 6.6 to 4.7 percent) from 2008-2009 to 2009-2010 (Table C.19). Among persons 12 or older, decreases were observed in Kentucky and Rhode Island. Additionally, among persons aged 26 or older, a decrease was observed in Rhode Island. There were no significant changes in past year illicit drug dependence in any other State by age group combination.

5.3  Illicit Drug or Alcohol Dependence or Abuse

The national rate in 2009-2010 for past year illicit drug or alcohol dependence or abuse among persons aged 12 or older was 8.9 percent, similar to the rate in 2008-2009 (9.0 percent) (Table C.20). When examining illicit drug or alcohol dependence or abuse at the State level, the States with high rates for alcohol dependence or abuse tended to rank in the top fifth for illicit drug or alcohol 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, 7 States also ranked in the top fifth for past year illicit drug or alcohol dependence or abuse among persons aged 12 or older: Colorado, District of Columbia, Massachusetts, Montana, Nevada, Rhode Island, and South Dakota (Figures 5.1 and 5.17).

State percentages for past year illicit drug or alcohol dependence or abuse among persons aged 12 or older in 2009-2010 ranged from 7.4 percent in Utah to 12.0 percent in the District of Columbia (Table B.20). Four States (Colorado, Massachusetts, Montana, and South Dakota) were in the highest fifth for the three age groups (12 to 17, 18 to 25, and 26 or older) and among persons aged 12 or older (Figures 5.17 to 5.20). Four States (Georgia, Mississippi, North Carolina, and Utah) were in the lowest fifth for all age groups.

Among persons aged 12 or older, the rate of past year illicit drug or alcohol dependence or abuse at the State level decreased significantly from 2008-2009 to 2009-2010 for Georgia, Minnesota, and Missouri (Table C.20). In the Midwest census region, decreases were seen in the 12 to 17 age group (from 7.6 to 7.2 percent) and in the 18 to 25 age group (from 21.6 to 20.6 percent). At the State level, decreases occurred among young adults aged 18 to 25 in Minnesota, Missouri, South Dakota, and Wisconsin; all of these States are located in the Midwest region.

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 met the criteria for illicit drug dependence or abuse in the past year according to the DSM-IV (APA, 1994), 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 2009-2010 for needing but not receiving treatment for an illicit drug problem among persons aged 12 or older was 2.5 percent, which was similar to the rate in 2008-2009 (Table C.21).

In 2009-2010, California and Rhode Island had the highest percentage of persons aged 12 or older (3.0 percent) needing but not receiving treatment for an illicit drug use problem (Table B.21). North Dakota had the lowest rate among persons aged 12 or older (1.8 percent). Among persons aged 12 or older, decreases between the 2008-2009 and 2009-2010 estimates were observed in Kentucky, Nevada, Rhode Island, and West Virginia (Table C.21). Among persons aged 18 to 25, decreases were seen in the District of Columbia and Nevada, and an increase was seen in Washington.

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 met the criteria for alcohol dependence or abuse in the past year according to the DSM-IV (APA, 1994), 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 an alcohol problem was 6.9 percent in 2009-2010, which was similar to the rate of 7.0 percent in 2008-2009 (Table C.22).

Five States (California, Colorado, District of Columbia, Massachusetts, 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 (Figures 5.21 and 5.25). The District of Columbia had the highest rate of needing but not receiving treatment for an alcohol problem among persons aged 12 or older (9.2 percent), while Utah had the lowest rate (5.4 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 and among persons aged 12 or older, it ranked in the lowest quintile group among 12 to 17 year olds with a rate of 3.4 percent (among 12 to 17 year olds, Maryland's rate was the lowest at 3.3 percent).

At the State level, among persons 12 or older, declines in the rate of needing but not receiving treatment for an alcohol problem from 2008-2009 to 2009-2010 were seen in Minnesota and New Mexico (Table C.22). A decline also was seen in the Midwest region. Among young adults aged 18 to 25, a decrease was observed in the Northeast and Midwest regions, as well as nationally (from 16.1 percent in 2008-2009 to 15.3 percent in 2009-2010). At the State level, decreases among young adults occurred in Delaware, Minnesota, Missouri, New Mexico, South Dakota, and Wisconsin.

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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 2009 and 2010 NSDUHs

Figure 5.1

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.2

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.3

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.4

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.5

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.6

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.7

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.8

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.9

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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Figure 5.10 Illicit Drug Dependence or Abuse in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2009 and 2010 NSDUHs

Figure 5.10

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.11

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.12

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.13

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.14

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.15

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.16

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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Figure 5.17 Dependence or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2009 and 2010 NSDUHs

Figure 5.17

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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Figure 5.18 Dependence or Abuse of Illicit Drugs or Alcohol in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2009 and 2010 NSDUHs

Figure 5.18

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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Figure 5.19 Dependence or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2009 and 2010 NSDUHs

Figure 5.19

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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Figure 5.20 Dependence or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2009 and 2010 NSDUHs

Figure 5.20

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.21

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.22

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.23

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.24

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.25

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.26

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.27

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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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 2009 and 2010 NSDUHs

Figure 5.28

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2009 and 2010 (Revised March 2012).

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