National and State Estimates of Drug Abuse Treatment Gap

Chapter 2. National Estimates of Treatment Need and the Treatment Gap

The 2000 National Household Survey on Drug Abuse (NHSDA) included a series of questions to assess dependence on and abuse of substances, as well as questions that asked whether respondents had received treatment for a problem related to substance use. The dependence and abuse questions were designed to measure dependence and abuse based on the diagnostic criteria specified in the 4^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994). Questions on dependence asked about health, emotional problems, attempts to cut down on use, tolerance, withdrawal, and other symptoms associated with the substances used. Questions on abuse asked about problems at work, home and school; problems with family or friends; physical danger; and trouble with the law due to substances used. Dependence reflects a more severe substance use problem than abuse; persons were classified with abuse of a particular substance only if they were not dependent on that substance.

This report provides estimates of the prevalence and patterns of the need for and receipt of treatment specifically for problems associated with illicit drug use. It presents estimates of the "treatment gap," defined as persons who needed treatment in the past year but did not receive that treatment. An individual was defined as needing treatment if he or she was dependent on or had abused an illicit drug or received treatment for an illicit drug problem at a "specialty" substance abuse facility in the past 12 months (i.e., during the 12 months before being interviewed). "Specialty" facilities include drug and alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient only), and mental health centers. It should be noted that respondents who were not dependent on or abusing drugs but who had received specialty treatment were counted as needing treatment under this definition. This was appropriate because it was assumed that a diagnostic assessment determining treatment need was done prior to entry into treatment.

This chapter presents estimates of the treatment gap at the national level, including estimates of the need for and receipt of treatment for an illicit drug problem by demographic characteristics (see Tables 1 to 5 at the end of the chapter). Due to changes to the NHSDA questionnaire and to the definitions and estimation methods used for measuring treatment need, the estimates in this report are not comparable with prior estimates. Based on cognitive testing, questions to measure dependence in 1999 were revised to improve how well the questions were understood by respondents. These questions were also revised based on a review by experts in the field to determine how well the questions capture the meaning of the DSM-IV criteria. In addition, starting with the 2000 NHSDA, questions to measure abuse based on the DSM-IV were added to the NHSDA and a new method for estimating treatment need and the gap was employed. This new method uses a simpler and more widely accepted definition of treatment need (abuse and dependence) and does not employ a ratio adjustment to inflate the NHSDA numbers based on separate counts of the treatment and arrestee populations (Wright, Gfroerer, & Epstein, 1997). This adjustment did not produce estimates as accurate as those generated by the new approach. Therefore, the treatment gap estimate of 3.9 million in 2000 cannot be compared with earlier estimates from 1991 to 1998 that ranged from 2.5 million to 3.6 million individuals. Additionally, the previous ratio-adjusted treatment need and gap estimates were made only at the national level and were used by the Office of National Drug Control Policy (ONDCP) in its annual National Drug Control Strategy (see ONDCP, 2000). A more detailed description of the changes to the NHSDA methods for generating these estimates is given in Appendix A.

• In 2000, an estimated 4.7 million people aged 12 or older (2.1 percent of the total population) needed treatment for an illicit drug abuse problem. This includes 2.8 million classified by the survey with illicit drug dependence, 1.5 million classified with illicit drug abuse, and another 0.3 million who received specialty treatment but were not classified as dependent or abusing.

• Of the 4.7 million people needing treatment, 0.8 million people (16.6 percent of the people who needed treatment) received treatment at a specialty facility.

• The treatment gap was estimated to be 3.9 million people in 2000, or 1.7 percent of the total population.

• Of the 3.9 million people who needed but did not receive treatment in 2000, an estimated 381,000 reported that they felt they needed treatment for their drug problem. This includes an estimated 129,000 who reported that they had made an effort but were unable to get treatment and 252,000 who reported making no effort to get treatment.

• Among the 3.9 million people who needed but did not receive treatment in 2000, 62.3 percent were classified with drug dependence and 37.7 percent were classified with drug abuse. However, among the estimated 381,000 persons who felt they needed treatment for a drug problem, 88.5 percent were classified with drug dependence and 11.5 percent were classified with drug abuse.

• For the youngest age group (12 to 17), an estimated 1.1 million persons (4.6 percent of this population) needed treatment for an illicit drug abuse problem in 2000. Of this group, only 0.1 million people (11.4 percent of the people aged 12 to 17 years who needed treatment) received treatment, leaving an estimated treatment gap for youths of 1.0 million (Figures 1 and 2).

• The percent of the population in 2000 who needed treatment for an illicit drug use problem was highest among persons aged 18 to 25 years (5.7 percent) and lowest among persons aged 26 and older (1.1 percent). An estimated 1.6 million persons aged 18 to 25 and 1.9 million persons aged 26 and older needed treatment for an illicit drug problem in 2000.

• Among the estimated 381,000 persons who did not receive treatment but reported that they felt they needed treatment for their drug problem in 2000, 74,000 were aged 12 to 17, 103,000 were aged 18 to 25, and 204,000 were aged 26 and older. Thus, the percentage of the treatment gap that felt they needed treatment was 7.8 percent for those aged 12 to 17, 6.9 percent for those aged 18 to 25, and 14.3 percent for those aged 26 and older.

• Among persons aged 12 or older in 2000, the percentage of males needing treatment for an illicit drug problem was higher than the percentage of females needing treatment (2.6 vs. 1.6 percent). This translates to 2.7 million males and 1.9 million females needing treatment. On the other hand, the percentage receiving specialty treatment among those needing treatment was higher for females than males (19.0 vs. 15.0 percent). However, this was not a statistically significant difference.

• Among youths aged 12 to 17 in 2000, the percentage of males needing treatment for an illicit drug problem was higher than the percentage of females needing treatment (5.0 vs. 4.2 percent). The percentage receiving specialty treatment among youths needing treatment was higher for males than females (13.0 vs. 9.4 percent). This was not a statistically significant difference.

Figure 1 Percentages of Persons with Past Year Illicit Drug Abuse Treatment Need and Receipt, by Age: 2000

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000.

Figure 2 Numbers of Persons with Past Year Illicit Drug Abuse Treatment Need and Receipt, by Age: 2000

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000.

• In 2000, 2.0 percent of whites aged 12 or older needed treatment for an illicit drug problem. The percentage needing treatment was about the same among blacks and Hispanics (2.5 and 2.4 percent, respectively). The highest rates of those needing treatment were for persons reporting more than one race (5.5 percent) and for American Indians/Alaska Natives (4.3 percent); the lowest rate was for Asians (0.7 percent).

• Among whites needing treatment, 17.8 percent received treatment at a specialty facility. Only 9.0 percent of all Hispanics needing treatment received treatment. The percentage receiving treatment among blacks who needed treatment was 18.6 percent, although the sampling error associated with this estimate is large and the estimate is not shown in the tables.

• Whites accounted for most of the illicit drug treatment need in 2000. Of the 4.7 million persons needing treatment, 3.2 million (69 percent) were white. Whites accounted for 75 percent of the persons who received specialty treatment for an illicit drug problem in 2000.

• The percentage of persons needing treatment for an illicit drug problem was lowest in the East South Central division (1.6 percent) and highest in the New England division (3.2 percent) in 2000.

• The percentage of persons needing treatment for an illicit drug problem in 2000 was essentially the same for persons in large metropolitan counties, small metropolitan counties, and urbanized nonmetropolitan counties (2.3, 2.0, and 2.0 percent, respectively). The percentage needing treatment was lowest in completely rural counties (1.2 percent).

• Needing treatment is inversely related to educational status. Among adults aged 18 or older in 2000, those who had not completed high school had the highest percentage of persons needing treatment (2.9 percent), while college graduates had the lowest percentage of persons needing treatment for illicit drugs (1.1 percent). The percentage who received treatment among persons who needed treatment was 25.4 percent among those with less than a high school education.

• Current employment status also correlated with treatment need in 2000. An estimated 7.7 percent of unemployed adults aged 18 or older needed treatment for illicit drugs, while only 1.6 percent of full-time employed adults needed treatment for an illicit drug problem.

• Most of the adult population needing treatment for an illicit drug problem in 2000 was employed. Of the estimated 3.6 million persons aged 18 or older who needed treatment, 1.9 million were employed full time and 0.6 million were employed part time. Thus, an estimated 70 percent of adults needing treatment were employed. An estimated 359,000 unemployed adults needed treatment.

 

Table 1. Estimated Numbers (in Thousands) of Persons Aged 12 or Older Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Demographic Characteristics: 2000
Demographic Characteristic	Needed Treatment for an Illicit Drug Problem in the Past Year			Percentage Who Received Treatment at a Specialty Facility Among Persons Who Needed Treatment
	Total	Received Treatment at a Specialty Facility	Did Not Receive Treatment at a Specialty Facility
Total	4,655	774	3,881	16.6
Age in Years
12-17	1,074	122	951	11.4
18-25	1,645	142	1,503	8.6
26 or older	1,937	510	1,427	26.3
Gender
Male	2,749	411	2,337	15.0
Female	1,907	363	1,544	19.0
Hispanic Origin and Race
Not Hispanic
White only	3,235	577	2,659	17.8
Black only	632	118	514	*
American Indian or Alaska Native only	46	4	42	*
Native Hawaiian or other Pacific Islander	10	3	7	*
Asian only	54	1	54	*
More than one race	103	21	82	*
Hispanic	574	51	523	9.0
*Low precision; no estimate reported. Note: Respondents were classified as needing treatment for an illicit drug problem if they met at least one of three criteria during the past year: (1) dependent on any illicit drug; (2) abuse of any illicit drug; or (3) received treatment for an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use). Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000.

 

Table 2. Percentages of Persons Aged 12 or Older Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Demographic Characteristics: 2000
Demographic Characteristic	Needed Treatment for an Illicit Drug Problem in the Past Year			Percentage Who Received Treatment at a Specialty Facility Among Persons Who Needed Treatment
	Total	Received Treatment at a Specialty Facility	Did Not Receive Treatment at a Specialty Facility
Total	2.1	0.3	1.7	16.6
Age in Years
12-17	4.6	0.5	4.1	11.4
18-25	5.7	0.5	5.2	8.6
26 or older	1.1	0.3	0.8	26.3
Gender
Male	2.6	0.4	2.2	15.0
Female	1.6	0.3	1.3	19.0
Hispanic Origin and Race
Not Hispanic
White only	2.0	0.4	1.6	17.8
Black only	2.5	0.5	2.0	*
American Indian or Alaska Native only	4.3	0.4	3.9	*
Native Hawaiian or other Pacific Islander	1.8	0.5	1.4	*
Asian only	0.7	0.0	0.7	*
More than one race	5.5	1.1	4.4	*
Hispanic	2.4	0.2	2.2	9.0
*Low precision; no estimate reported. NOTE: Respondents were classified as needing treatment for an illicit drug problem if they met at least one of three criteria during the past year: (1) dependent on any illicit drug; (2) abuse of any illicit drug; or (3) received treatment for an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use). Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000.

 

Table 3. Percentages of Persons Aged 12 or Older Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Geographic Characteristics: 2000
Geographic Characteristic	Needed Treatment for an Illicit Drug Problem in the Past Year			Percentage Who Received Treatment at a Specialty Facility Among Persons Who Needed Treatment
	Total	Received Treatment at a Specialty Facility	Did Not Receive Treatment at a Specialty Facility
Total	2.1	0.3	1.7	16.6
Geographic Division
Northeast	2.4	0.4	2.0	17.2
New England	3.2	0.7	2.6	*
Middle Atlantic	2.1	0.3	1.8	15.3
Midwest	1.8	0.3	1.5	17.8
East North Central	1.9	0.3	1.6	16.1
West North Central	1.7	0.4	1.4	*
South	1.7	0.3	1.4	17.3
South Atlantic	1.7	0.3	1.4	20.0
East South Central	1.6	0.2	1.4	10.1
West South Central	1.8	0.3	1.5	16.6
West	2.7	0.4	2.3	14.7
Mountain	2.8	0.4	2.4	13.9
Pacific	2.7	0.4	2.3	*
County Type
Large metro	2.3	0.4	1.9	16.2
Small metro	2.0	0.3	1.7	15.5
250K - 1 mil. pop.	2.0	0.3	1.7	15.1
<250K pop .	2.0	0.3	1.7	16.7
Nonmetro	1.7	0.3	1.4	20.0
Urbanized	2.0	0.5	1.5	*
Less urbanized	1.7	0.3	1.4	*
Completely rural	1.2	0.2	1.0	*
*Low precision; no estimate reported. NOTE: Respondents were classified as needing treatment for an illicit drug problem if they met at least one of three criteria during the past year: (1) dependent on any illicit drug; (2) abuse of any illicit drug; or (3) received treatment for an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use). Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000.

 

Table 4. Percentages of Persons Aged 12 to 17 Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Demographic Characteristics: 2000
Demographic Characteristic	Needed Treatment for an Illicit Drug Problem in the Past Year			Percentage Who Received Treatment at a Specialty Facility Among Persons Who Needed Treatment
	Total	Received Treatment at a Specialty Facility	Did Not Receive Treatment at a Specialty Facility
Total	4.6	0.5	4.1	11.4
Gender
Male	5.0	0.6	4.3	13.0
Female	4.2	0.4	3.8	9.4
Hispanic Origin and Race
Not Hispanic
White only	4.8	0.6	4.2	12.6
Black only	3.6	0.5	3.1	13.5
American Indian or Alaska Native only	10.7	*	8.7	*
Native Hawaiian or other Pacific Islander	*	*	*	*
Asian only	2.8	*	2.8	*
More than one race	2.5	*	2.5	*
Hispanic	5.2	0.3	4.9	6.1
Gender/Race/Hispanic Origin
Male - white	5.0	0.7	4.3	13.7
Female - white	4.5	0.5	4.0	11.4
Male - black	4.7	0.8	3.9	*
Female - black	2.4	0.2	2.3	*
Male - Hispanic	5.3	0.4	4.9	*
Female - Hispanic	5.0	0.2	4.8	*
*Low precision; no estimate reported. NOTE: Respondents were classified as needing treatment for an illicit drug problem if they met at least one of three criteria during the past year: (1) dependent on any illicit drug; (2) abuse of any illicit drug; or (3) received treatment for an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use). Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000.

 

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