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2005
National Survey on Drug
Use & Health: National Results
Results from the 2005
National Survey on Drug Use and Health:
National Findings
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. 283-2004-00022. Contributors and reviewers at RTI listed alphabetically include Jeremy Aldworth, Ellen Bishop, Walter R. Boyle, Patrick Chen, James R. Chromy, Andrew Clarke, Elizabeth Copello, David B. Cunningham, Lanting Dai, - R. Davis, Steven L. Emrich, Ralph E. Folsom, Jr., Misty Foster, Peter Frechtel, G. G. Frick, Julia Gable, Jody M. Greene, David C. Heller, Erica Hirsch, Susan Hunter, B. Kathleen Jordan, Larry A. Kroutil, Bing Liu, Mary Ellen Marsden, Katherine B. Morton, Breda Munoz, Scott Novak, Lisa E. Packer, Lanny Piper, Jeremy Porter, Tania Robbins, Jill Ruppenkamp, Kathryn Spagnola, Paul Tillman, Thomas G. Virag (Project Director), Michael Vorburger, and Jiantong Wang. Contributors at SAMHSA listed alphabetically, with chapter authorship noted, include Peggy Barker (Chapter 8), James Colliver, Joan Epstein (Chapter 7), Joseph Gfroerer (Chapters 1, 2, 5, and 9), Joe Gustin, Arthur Hughes (Project Officer), Joel Kennet (Chapters 3 and 4), Sharon Larson (Chapter 8), Pradip Muhuri, Dicy Painter, and Doug Wright (Chapter 6). At RTI, Kathleen B. Mohar was the publication coordinator; Richard S. Straw edited the report; Diane G. Eckard and Danny Occoquan prepared the graphics; Brenda K. Porter formatted the tables; Joyce Clay-Brooks formatted and word processed the report; and Pamela Couch Prevatt, - F. Gurley, Kim Cone, 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. (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-30, DHHS Publication No. SMA 06-4194). Rockville, MD.
2005
National Survey on Drug
Use & Health: National Results
Highlights
This report presents the first information from the 2005 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year. Unless otherwise noted, all comparisons in this report described using terms such as "increased," "decreased," or "more than" are statistically significant at the .05 level.
Illicit Drug Use
In 2005, an estimated 19.7 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.1 percent of the population aged 12 years old or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.
The rate of current illicit drug use among persons aged 12 or older in 2005 (8.1 percent) was similar to the rate in 2004 (7.9 percent), 2003 (8.2 percent), and 2002 (8.3 percent).
Marijuana was the most commonly used illicit drug (14.6 million past month users). Among persons aged 12 or older, the rate of past month marijuana use was about the same in 2005 (6.0 percent) as in 2004 (6.1 percent), 2003 (6.2 percent), and 2002 (6.2 percent).
In 2005, there were 2.4 million current cocaine users aged 12 or older, which is more than in 2004 when the number was 2.0 million. However, the change in the rate of current use of cocaine between 2005 and 2004 (1.0 and 0.8 percent, respectively) was not statistically significant.
Hallucinogens were used in the past month by 1.1 million persons (0.4 percent) aged 12 or older in 2005, including 502,000 (0.2 percent) who had used Ecstasy. These estimates are similar to the corresponding estimates for 2004.
There were 6.4 million (2.6 percent) persons aged 12 or older who used prescription-type psychotherapeutic drugs nonmedically in the past month. Of these, 4.7 million used pain relievers, 1.8 million used tranquilizers, 1.1 million used stimulants (including 512,000 using methamphetamine), and 272,000 used sedatives. Each of these estimates is similar to the corresponding estimate for 2004.
The rates for past month and past year methamphetamine use did not change between 2004 and 2005, but the lifetime rate declined from 4.9 to 4.3 percent. From 2002 to 2005, decreases were seen in lifetime (5.3 to 4.3 percent) and past year (0.7 to 0.5 percent) use, but not past month use (0.3 percent in 2002 vs. 0.2 percent in 2005). Although the number of past month users has remained steady since 2002, the number of methamphetamine users who were dependent on or abused some illicit drug did rise significantly during this period, from 164,000 in 2002 to 257,000 in 2005.
The rate of current illicit drug use among youths aged 12 to 17 in 2005 was similar to the rate in 2004, but significantly lower than in 2002. The rates were 11.6 percent in 2002, 11.2 percent in 2003, 10.6 percent in 2004, and 9.9 percent in 2005.
The rate of current marijuana use among youths aged 12 to 17 declined from 7.6 percent in 2004 to 6.8 percent in 2005. The rate of current marijuana use has declined significantly from 8.2 percent in 2002.
There were no significant changes in past month use of any illicit drugs among young adults aged 18 to 25 between 2004 and 2005, except for cocaine use, which increased from 2.1 to 2.6 percent.
Past month nonmedical use of prescription-type drugs among young adults aged 18 to 25 increased from 5.4 percent in 2002 to 6.3 percent in 2005. This was primarily due to an increase in pain reliever use, which was 4.1 percent in 2002 and 4.7 percent in 2003, 2004, and 2005.
Among unemployed adults aged 18 or older in 2005, 17.1 percent were current illicit drug users, which was higher than the 8.2 percent of those employed full time and 10.4 percent of those employed part time. However, most drug users were employed. Of the 17.2 million current illicit drug users aged 18 or older in 2005, 12.9 million (74.8 percent) were employed either full or part time.
In 2005, there were 10.5 million persons aged 12 or older who reported driving under the influence of an illicit drug during the past year. This corresponds to 4.3 percent of the population aged 12 or older, similar to the rates in 2003 (4.6 percent) and 2004 (4.4 percent), but lower than the rate in 2002 (4.7 percent). In 2005, the rate was highest among young adults aged 18 to 25 (13.4 percent).
NSDUH includes questions for nonmedical users of prescription-type psychotherapeutic drugs regarding how they obtained the drugs they recently used nonmedically. In 2005, the most prevalent source from which recently used drugs were obtained among nonmedical users of prescription-type drugs was "from a friend or relative for free."
Among persons aged 12 or older who used pain relievers nonmedically in the past 12 months, 59.8 percent reported that the source of the drug the most recent time they used was from a friend or relative for free. Another 16.8 percent reported they got the drug from one doctor. Only 4.3 percent got the pain relievers from a drug dealer or other stranger, and only 0.8 percent reported buying the drug on the Internet.
Alcohol Use
Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2005 survey (51.8 percent). This translates to an estimated 126 million people, which is higher than the 2004 estimate of 121 million people (50.3 percent).
More than one fifth (22.7 percent) of persons aged 12 or older participated in binge drinking (having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey) in 2005. This translates to about 55 million people, comparable with the estimate in 2004.
In 2005, heavy drinking was reported by 6.6 percent of the population aged 12 or older, or 16 million people. This rate is similar to the rate of heavy drinking in 2004 (6.9 percent). Heavy drinking is defined as binge drinking on at least 5 days in the past 30 days.
In 2005, among young adults aged 18 to 25, the rate of binge drinking was 41.9 percent, and the rate of heavy drinking was 15.3 percent. These rates are similar to the rates in 2002, 2003, and 2004.
The rate of current alcohol use among youths aged 12 to 17 declined from 17.6 percent in 2004 to 16.5 percent in 2005. Youth binge drinking also declined during that period, from 11.1 to 9.9 percent, but heavy drinking did not change significantly (2.7 percent in 2004 and 2.4 percent in 2005).
Although there were declines in past month and binge alcohol use among youths aged 12 to 17 between 2004 and 2005, overall underage (persons aged 12 to 20) past month and binge drinking rates have remained essentially unchanged since 2002. In 2005, about 10.8 million persons aged 12 to 20 (28.2 percent of this age group) reported drinking alcohol in the past month. Nearly 7.2 million (18.8 percent) were binge drinkers, and 2.3 million (6.0 percent) were heavy drinkers.
Among persons aged 12 to 20, past month alcohol use rates were 12.0 percent among Native Hawaiians or Other Pacific Islanders, 15.5 percent among Asians, 19.0 percent among blacks, 21.7 percent among American Indians or Alaska Natives, 24.0 percent among those reporting two or more races, 25.9 percent among Hispanics, and 32.3 percent among whites.
In 2005, an estimated 13.0 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage has dropped since 2002, when it was 14.2 percent. The 2005 estimate corresponds to 31.7 million persons.
Tobacco Use
In 2005, an estimated 71.5 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 29.4 percent of the population in that age range. In addition, 60.5 million persons (24.9 percent of the population) were current cigarette smokers; 13.6 million (5.6 percent) smoked cigars; 7.7 million (3.2 percent) used smokeless tobacco; and 2.2 million (0.9 percent) smoked tobacco in pipes.
The rates of current use of cigarettes, smokeless tobacco, cigars, and pipe tobacco were unchanged between 2004 and 2005 among persons aged 12 or older. However, between 2002 and 2005, past month use of a tobacco product declined from 30.4 to 29.4 percent, and past month cigarette use decreased from 26.0 to 24.9 percent.
The rate of past month cigarette use among 12 to 17 year olds declined from 13.0 percent in 2002 to 10.8 percent in 2005. Cigar use in the past month declined to 4.2 percent of youths in 2005 from the 2004 estimate of 4.8 percent. Past month smokeless tobacco use was reported by 2.1 percent of youths in 2005, similar to estimates since 2002.
Among pregnant women aged 15 to 44, combined data for 2004 and 2005 indicated that the rate of past month cigarette use was 16.6 percent. The rate was higher among women in that age group who were not pregnant (29.6 percent).
Initiation of Substance Use (Incidence, or First-Time Use)
The illicit drug categories with the largest number of recent initiates among persons aged 12 or older were nonmedical use of pain relievers (2.2 million) and marijuana use (2.1 million). These estimates are not significantly different from the numbers in 2004.
In 2005, there were 877,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 72.3 percent were under age 18 when they first used. There was no significant change in the number of inhalant initiates from 2002 to 2005.
The number of recent new users of methamphetamine taken nonmedically among persons aged 12 or older was 192,000 in 2005. Between 2002 and 2004, the number of methamphetamine initiates remained steady at around 300,000 per year, but there was a decline from 2004 (318,000 initiates) to 2005.
Most (88.9 percent) of the 4.3 million recent alcohol initiates were younger than 21 at the time of initiation.
The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was 2.3 million in 2005, which was significantly greater than the estimate for 2002 (1.9 million). Most new smokers in 2005 were under age 18 when they first smoked cigarettes (63.4 percent).
Youth Prevention-Related Measures
Perceived risk is measured by NSDUH as the percentage reporting that there is great risk in the substance use behavior. Among youths aged 12 to 17, there were no changes in the perceived risk of marijuana, cocaine, heroin, or LSD use between 2004 and 2005. However, between 2002 and 2005, there were increases in the perceived risk of smoking marijuana once a month (from 32.4 to 34.0 percent) and smoking marijuana once or twice a week (from 51.5 to 55.0 percent). On the other hand, the percentage of youths who perceived that trying heroin once or twice is a great risk declined from 58.5 percent in 2002 to 56.5 percent in 2005, and those who perceived that using cocaine once a month is a great risk declined from 50.5 to 48.8 percent.
The proportion of youths aged 12 to 17 who reported perceiving great risk from smoking one or more packs of cigarettes per day increased from 63.1 percent in 2002 to 68.3 percent in 2005.
Over half (51.0 percent) of youths aged 12 to 17 reported in 2005 that it would be "fairly easy" or "very easy" for them to obtain marijuana if they wanted some. Around one quarter reported it would be easy to get cocaine (24.9 percent) or crack (25.3 percent). One in seven (14.0 percent) indicated that heroin would be "fairly" or "very" easily available, and about one in six (15.7 percent) said it would be easy for them to get LSD if they wanted some.
The perceived availability among youths decreased between 2002 and 2005 for marijuana (from 55.0 to 51.0 percent), crack (from 26.5 to 25.3 percent), heroin (from 15.8 to 14.0 percent), and LSD (from 19.4 to 15.7 percent). However, the percentage reporting that it would be easy to obtain cocaine showed no decline over this period (25.0 percent in 2002 and 24.9 percent in 2005).
A majority of youths (90.2 percent) reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice. Current marijuana use was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than for those who did not (4.6 vs. 27.0 percent).
Almost four fifths (77.9 percent) of youths aged 12 to 17 enrolled in school reported in 2005 they had seen or heard drug or alcohol prevention messages at school in the past year, a percentage similar to the 2004 estimate of 78.2 percent. Past month use of an illicit drug was lower for youths exposed to such messages in school (9.2 percent) than for youths not reporting such exposure (13.2 percent).
Substance Dependence, Abuse, and Treatment
In 2005, an estimated 22.2 million persons (9.1 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Of these, 3.3 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.6 million were dependent on or abused illicit drugs but not alcohol, and 15.4 million were dependent on or abused alcohol but not illicit drugs.
Between 2002 and 2005, there was no change in the number of persons with substance dependence or abuse (22.0 million in 2002, 21.6 million in 2003, 22.5 million in 2004, and 22.2 million in 2005).
The specific illicit drugs that had the highest levels of past year dependence or abuse in 2005 were marijuana (4.1 million), followed by cocaine (1.5 million) and pain relievers (1.5 million).
Adults aged 21 or older who had first used alcohol before age 21 were more likely than adults who had their first drink at age 21 or older to be classified with alcohol dependence or abuse (9.6 vs. 2.1 percent).
There were 3.9 million persons aged 12 or older (1.6 percent of the population) who received some kind of treatment for a problem related to the use of alcohol or illicit drugs in 2005. More than half (2.1 million) received treatment at a self-help group. There were 1.5 million persons who received treatment at a rehabilitation facility as an outpatient, 1.1 million at a rehabilitation facility as an inpatient, 1.0 million at a mental health center as an outpatient, 773,000 at a hospital as an inpatient, 460,000 at a private doctor's office, 399,000 at an emergency room, and 344,000 at a prison or jail. None of these estimates changed significantly between 2004 and 2005.
More than half (2.5 million) of the 3.9 million persons who received treatment for a substance use problem in the past year received treatment for alcohol use during their most recent treatment. There were 1.1 million persons who received treatment for marijuana use during their most recent treatment. Estimates for other drugs were 797,000 persons for cocaine, 466,000 for pain relievers, 358,000 for hallucinogens, 351,000 for stimulants, and 326,000 for heroin. (Note that respondents could indicate that they received treatment for more than one substance during their most recent treatment.)
In 2005, the number of persons aged 12 or older needing treatment for an illicit drug or alcohol use problem was 23.2 million (9.5 percent of the population aged 12 or older). Of these, 2.3 million (0.9 percent of persons aged 12 or older and 10.0 percent of those who needed treatment) received treatment at a specialty facility. Thus, there were 20.9 million persons (8.6 percent of the population aged 12 or older) who needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty substance abuse facility in the past year.
Of the 20.9 million people in 2005 who were classified as needing substance use treatment but did not receive treatment at a specialty facility in the past year, 1.2 million persons (5.6 percent) reported that they felt they needed treatment for their illicit drug or alcohol use problem. Of these 1.2 million persons who felt they needed treatment, 296,000 (25.5 percent) reported that they made an effort to get treatment, and 865,000 (74.5 percent) reported making no effort to get treatment.
The number of people who felt they needed treatment and made an effort to get it among those who needed but did not receive treatment was not statistically different in 2005 (296,000) from the number reported in 2004 (441,000).
Prevalence and Treatment of Mental Health Problems
Serious psychological distress (SPD) is an overall indicator of past year nonspecific psychological distress that is constructed from the K6 scale administered to adults aged 18 or older in NSDUH. The data related to SPD in this report are not comparable with data in previous reports due to changes in the survey administration of this instrument.
In 2005, there were an estimated 24.6 million adults aged 18 or older in the United States with SPD in the past year. This represents 11.3 percent of all adults in this country, a significantly lower rate than in 2004 (12.2 percent).
Rates of SPD in 2005 were highest for adults aged 18 to 25 (18.6 percent) and lowest for adults aged 50 or older (7.1 percent).
The prevalence of SPD among women aged 18 or older (14.0 percent) was higher than that among men in that age group (8.4 percent).
SPD in the past year was associated with past year substance dependence or abuse in 2005. Among adults with SPD in 2005, 21.3 percent (5.2 million) were dependent on or abused illicit drugs or alcohol. The rate among adults without SPD was 7.7 percent (14.9 million).
Among the 24.6 million adults with SPD in 2005, 11.1 million (45.3 percent) received treatment for a mental health problem in the past year. This was a higher proportion than in 2004 (41.6 percent). Among adults with SPD, 39.4 percent received a prescription medication, 28.5 percent received outpatient treatment, and 4.6 percent received inpatient treatment for a mental health problem in the past year.
Among the 5.2 million adults with both SPD and substance dependence or abuse (i.e., a substance use disorder) in 2005, about half (47.0 percent) received mental health treatment or substance use treatment at a specialty facility: 8.5 percent received both treatment for mental health problems and specialty substance use treatment, 34.3 percent received only treatment for mental health problems, and 4.1 percent received only specialty substance use treatment.
In 2005, there were 30.8 million adults (14.2 percent of persons aged 18 or older) who had at least one major depressive episode (MDE) in their lifetime, and 15.8 million adults (7.3 percent of persons aged 18 or older) had at least one MDE in the past year. In 2004, there were 17.1 million adults (8.0 percent) who had MDE during the past year. This represents a statistically significant decline in the rate of past year MDE between 2004 and 2005.
Having MDE in the past year was associated with past year substance dependence or abuse in 2005. Among adults who had MDE in 2005, 19.9 percent were dependent on or abused alcohol or illicit drugs, while among persons without MDE only 8.4 percent were dependent on or abused alcohol or illicit drugs. Persons with MDE were more likely than those without MDE to be dependent on or abuse illicit drugs (8.3 vs. 2.1 percent) and alcohol (14.8 vs. 7.4 percent).
Among adults aged 18 or older who had MDE in the past year, 65.6 percent received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression in the same time period.
Among adults aged 18 or older with MDE in the past year in 2005, women were more likely than men to receive treatment for depression in the past year (70.9 vs. 55.6 percent).
In 2005, there were 3.4 million youths aged 12 to 17 years (13.7 percent of the population aged 12 to 17 years old) who had at least one MDE in their lifetime and 2.2 million youths (8.8 percent) who had MDE during the past year.
The rate of MDE in the past year was higher for adolescent females (13.3 percent) than for adolescent males (4.5 percent).
The occurrence of MDE in the past year among youths aged 12 to 17 was associated with a higher prevalence of illicit drug or alcohol dependence or abuse (19.8 percent). Among youths who did not report past year MDE, 6.9 percent had illicit drug or alcohol dependence or abuse during the same period.
In 2005, 37.8 percent of youths aged 12 to 17 with past year MDE received treatment for depression (saw or talked to a medical doctor or other professional or used prescription medication).
2005
National Survey on Drug
Use & Health: National Results
1. Introduction
This report presents the first information from the 2005 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 name was the National Household Survey on Drug Abuse (NHSDA). This initial report on the 2005 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 presented, including data on depression and on the co-occurrence of substance use and mental health problems. Estimates from NSDUH for States and areas within States will be presented in separate reports.
A major focus of this report is a comparison of substance use prevalence estimates between 2004 and 2005. Trends since 2002 also are discussed for some measures. 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 through 2005 NSDUHs should not be compared with estimates from the 2001 and earlier surveys in the series to assess changes in substance use and mental health problems 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 the respondent's place of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), 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 and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories) and from civilians living on military bases. The survey excludes 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 target population.
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).
The 2005 NSDUH employed a State-based design with an independent, multistage area probability sample within each State 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 support State estimates using small area estimation (SAE) techniques. The design oversampled youths and young adults, so that each State's sample was approximately equally distributed among three age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.
Nationally, 134,055 addresses were screened for the 2005 survey, and 68,308 completed interviews were obtained. The survey was conducted from January through December 2005. Weighted response rates for household screening and for interviewing were 91.3 and 76.2 percent, respectively. See Appendix B for more information on NSDUH response rates.
1.2. Trend Measurement
Although the design of the 2002 through 2005 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are important methodological differences that affect the comparability of the 2002-2005 estimates with estimates from prior surveys. In addition to the name change, each NSDUH respondent completing the interview is now given an incentive payment of $30. These changes, implemented in 2002 and continued subsequently, resulted in an improvement in the response rate, but also affected respondents' reporting of items that are the basis of prevalence measures produced each year. Comparability also may be affected by improved data collection quality control procedures that were introduced beginning in 2001 and by the incorporation of new population data from the 2000 decennial census into NSDUH sample weighting procedures. Analyses of the effects of these factors on NSDUH estimates have shown that 2002 and later data should not be compared with 2001 and earlier data from the survey series to assess changes over time. Appendix C of the 2004 NSDUH report on national findings discusses this issue in more detail (see OAS, 2005).
1.3. Format of Report and Explanation of Tables
This report has separate chapters that discuss the national findings on seven topics: use of illicit drugs; use of alcohol; use of tobacco products; initiation of substance use; prevention-related issues; substance dependence, abuse, and treatment; and mental health problems and treatment. 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 persons and the percentage of the population. Substance use tables show prevalence estimates 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 in which estimates are presented by year have footnotes indicating whether the 2005 estimates are significantly different from 2004 or earlier estimates.
Statistical tests have been conducted for all statements appearing in the text of the report that compare estimates between years or subgroups of the population. Unless explicitly stated that a difference is not statistically significant, all statements that describe differences are significant at the .05 level. Statistically significant differences are described using terms such as "higher," "lower," "increased," and "decreased." Statements that use terms such as "similar," "no difference," "same," or "remained steady" to describe the relationship between estimates denote that a difference is not statistically significant. In addition, a set of estimates for survey years or population subgroups may be presented without a statement of comparison, in which case a statistically significant difference between these estimates is not implied and testing was not conducted.
All estimates presented in the report have met the criteria for statistical reliability (see Section B.2.2 of Appendix B). Estimates that do not meet these criteria are suppressed and do not appear in tables, figures, or text. Also, subgroups with suppressed estimates are not included in statistical tests of comparisons. For example, a statement that "whites had the highest prevalence" means that the rate among whites was higher than the rate among all nonsuppressed racial/ethnic subgroups, but not necessarily higher than the rate among a subgroup for which the estimate was suppressed.
Data are presented for racial/ethnic groups based on current guidelines for collecting and reporting race and ethnicity data (Office of Management and Budget [OMB], 1997). 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 basic groups listed in the survey question (white, black or African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, Other). Respondents choosing both Native Hawaiian and Other Pacific Islander but no other categories mentioned above are classified in the combined "Native Hawaiian or Other Pacific Islander" category instead of the "two or more race" category. 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.
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. Census Bureau, 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 also are made based on county type, a variable that reflects different levels of urbanicity and metropolitan area inclusion of counties, based on metropolitan area definitions issued by the OMB in June 2003 (OMB, 2003). 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. Small metropolitan areas are further classified based on whether they have a population of 250,000 or more. Nonmetropolitan areas are areas outside MSAs. Counties in nonmetropolitan areas are further 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 a population of 20,000 or more 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.
1.4. Other NSDUH Reports and Data
Other reports focusing on specific topics of interest will be produced using the 2005 NSDUH data and made available on SAMHSA's website. A report on State-level estimates for 2004-2005 will be available in early 2007.
In addition to the tables in Appendices F and G, 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. Tables in Appendices F and G can be mapped back to these detailed tables by using the table number in parentheses in the upper left corner of each table (e.g., Table F.1 in Appendix F is Table 9.1N in the detailed tables). 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, 2006) at http://www.icpsr.umich.edu/SAMHDA/index.html. Currently, files are available from the 1979 to 2004 surveys. The 2005 NSDUH public use file will be available by the end of 2006.
2005
National Survey on Drug
Use & Health: National Results
2. Illicit Drug Use
The National Survey on Drug Use and Health (NSDUH) obtains information on nine different categories of illicit drug use: use of marijuana, cocaine, heroin, hallucinogens, and inhalants; and the 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 as well as drugs within these groupings that may be manufactured illegally, such as methamphetamine, which is included under stimulants. 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; therefore, over-the-counter drugs and legitimate uses of prescription drugs are not included. NSDUH reports combine the four prescription-type drug groups into a category referred to as "psychotherapeutics."
Because of concerns that methamphetamine use is underestimated in NSDUH due to its inclusion within the prescription-type drug questions, new questions regarding methamphetamine use were added to NSDUH in 2005. Preliminary analysis of these new data showed that underestimation is occurring, and additional questions may be needed to make it possible to estimate correctly the actual prevalence rate for methamphetamine use. Additional questions were included in the 2006 NSDUH. A discussion of these analyses, including preliminary data from the new 2006 questions, is provided in Section B.4.6 in Appendix B. Estimates of methamphetamine use in this chapter and in the tables in Appendix G are based on the same "core" NSDUH questions that were used in the 2004 survey and are therefore comparable with estimates from previous years.
Estimates of "illicit drug use" reported from NSDUH reflect the use of any of the nine drug categories listed above. Use of alcohol and tobacco products, while illegal for youths, is not included in these estimates, but is discussed in Chapters 3 and 4.
In 2005, an estimated 19.7 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.1 percent of the population aged 12 years old or older.
The overall rate of current illicit drug use among persons aged 12 or older in 2005 (8.1 percent) was similar to the rate in 2004 (7.9 percent), 2003 (8.2 percent), and 2002 (8.3 percent).
Marijuana was the most commonly used illicit drug (14.6 million past month users). In 2005, it was used by 74.2 percent of current illicit drug users. Among current illicit drug users, 54.5 percent used only marijuana, 19.6 percent used marijuana and another illicit drug, and the remaining 25.8 percent used only an illicit drug other than marijuana in the past month (Figure 2.1).
Figure 2.1 Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2005
Among persons aged 12 or older, the overall rate of past month marijuana use was about the same in 2005 (6.0 percent) as it was in 2004 (6.1 percent), 2003 (6.2 percent), and 2002 (6.2 percent) (Figure 2.2).
Figure 2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
In 2005, there were 2.4 million persons who were current cocaine users, which is more than in 2004 when the number was 2.0 million. However, the change in the rate of current use of cocaine between 2005 and 2004 (1.0 and 0.8 percent, respectively) was not statistically significant.
Similarly, the number of current crack users increased from 467,000 in 2004 to 682,000 in 2005. However, the change in the rate of current use of crack between 2004 and 2005 (0.2 and 0.3 percent, respectively) was not statistically significant.
Hallucinogens were used in the past month by 1.1 million persons (0.4 percent) in 2005, including 502,000 (0.2 percent) who had used Ecstasy. These estimates are similar to the corresponding estimates for 2004.
There was no significant change in the number of current heroin users in 2005 (136,000), nor in the rate of heroin use (0.1 percent), compared with estimates from 2004.
There were 9.0 million people aged 12 or older (3.7 percent) who were current users of illicit drugs other than marijuana in 2005. Most (6.4 million, 2.6 percent) used psychotherapeutic drugs nonmedically. Of these, 4.7 million used pain relievers, 1.8 million used tranquilizers, 1.1 million used stimulants (including 512,000 using methamphetamine), and 272,000 used sedatives. Each of these estimates is similar to the corresponding estimate for 2004.
The rate of current use of sedatives declined from 0.2 percent in 2002 to 0.1 percent in 2005, but there were no significant changes in current nonmedical use of other categories of psychotherapeutics during that period.
The rates for past month and past year methamphetamine use did not change between 2004 and 2005, but the lifetime rate declined from 4.9 to 4.3 percent. From 2002 to 2005, decreases were seen in lifetime (5.3 to 4.3 percent) and past year (0.7 to 0.5 percent) use, but not past month use (0.3 percent in 2002 vs. 0.2 percent in 2005). Although the number of past month users has remained steady since 2002, the number of methamphetamine users who were dependent on or abused some illicit drug did rise significantly during this period, from 164,000 in 2002 to 257,000 in 2005 (Figure 2.3).
Figure 2.3 Past Month Methamphetamine Use and Illicit Drug or Stimulant Dependence or Abuse in the Past Year among Persons Aged 12 or Older, by Year: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Age
Rates of drug use are associated with age. Among youths aged 12 to 17, the rates of current illicit drug use increased with age: 3.8 percent at ages 12 or 13, 8.9 percent at ages 14 or 15, and 17.0 percent at ages 16 or 17 (Figure 2.4). The highest rate was among persons aged 18 to 20 (22.3 percent). The rate was 18.7 percent among those aged 21 to 25 and declined with increasing age among older adults.
Figure 2.4 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2005
Among youths, different age groups engaged in the use of different types of illicit drugs in the past month. Among 12 or 13 year olds, 1.7 percent used prescription-type drugs nonmedically, 1.5 percent used inhalants, and 0.9 percent used marijuana. Among 14 or 15 year olds, marijuana was the dominant drug used (5.9 percent), followed by prescription-type drugs used nonmedically (2.8 percent) and inhalants (1.2 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (13.6 percent), followed by prescription-type drugs used nonmedically (5.4 percent), hallucinogens (1.7 percent), cocaine (1.2 percent), and inhalants (1.0 percent).
In 2005, 9.9 percent of youths aged 12 to 17 were current illicit drug users: 6.8 percent used marijuana, 3.3 percent used prescription-type drugs nonmedically, 1.2 percent used inhalants, 0.8 percent used hallucinogens, and 0.6 percent used cocaine (Figure 2.5).
Figure 2.5 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
The rate of current illicit drug use among youths aged 12 to 17 in 2005 was significantly lower than in 2002 (Figure 2.6). The rates were 11.6 percent in 2002, 11.2 percent in 2003, 10.6 percent in 2004, and 9.9 percent in 2005.
Figure 2.6 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
The rate of current marijuana use among youths aged 12 to 17 declined from 7.6 percent in 2004 to 6.8 percent in 2005. There were also significant declines in past year use (14.5 to 13.3 percent) and lifetime use (19.0 to 17.4 percent). The rate of current marijuana use has declined significantly from 8.2 in 2002 to 6.8 percent in 2005. Significant declines were also evident between 2002 and 2005 for past year use (from 15.8 to 13.3 percent) and lifetime use (from 20.6 to 17.4 percent).
Young Adults Aged 18 to 25
Rates of current use of illicit drugs were higher for young adults aged 18 to 25 (20.1 percent) than for youths aged 12 to 17 and adults aged 26 or older, with 16.6 percent using marijuana, 6.3 percent using prescription-type drugs nonmedically, 2.6 percent using cocaine, and 1.5 percent using hallucinogens (Figure 2.7).
Figure 2.7 Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
There were no significant changes in past month use of any drugs among young adults between 2004 and 2005, except for cocaine use, which increased from 2.1 to 2.6 percent.
Past year use of Ecstasy among young adults declined from 5.8 percent in 2002 to 3.7 percent in 2003 and to 3.1 percent in both 2004 and 2005.
Past month nonmedical use of prescription-type drugs among young adults increased from 5.4 percent in 2002 to 6.3 percent in 2005. This was primarily due to an increase in pain reliever use, which was 4.1 percent in 2002 and 4.7 percent in 2003, 2004, and 2005.
Adults Aged 26 or Older
Among adults aged 26 or older, 5.8 percent reported current illicit drug use in 2005. In this age group, 4.1 percent used marijuana, and 1.9 percent used prescription-type drugs. Moreover, fewer than 1 percent used cocaine (0.8 percent), hallucinogens (0.2 percent), and inhalants (0.1 percent). Rates of lifetime, past year, and past month illicit drug use among adults aged 26 or older were unchanged between 2004 and 2005.
Among adults aged 50 to 59, the rate of current illicit drug use increased between 2002 and 2005 (Figure 2.8). For those aged 50 to 54, the rate increased from 3.4 to 5.2 percent, but this increase was not statistically significant. Among those aged 55 to 59, the rate increased significantly from 1.9 to 3.4 percent. This may reflect the aging into these age groups of the baby boom cohort, which has a relatively higher rate of lifetime illicit drug use than older cohorts have.
Figure 2.8 Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Gender
As in prior years, males were more likely in 2005 to report current illicit drug use than females (10.2 vs. 6.1 percent, respectively). Males were about twice as likely to use marijuana as females (8.2 vs. 4.0 percent). However, the rates of nonmedical use of prescription-type psychotherapeutics were similar for both males (2.8 percent) and females (2.5 percent).
Among youths aged 12 to 17, the rate of current illicit drug use was similar for boys (10.1 percent) and girls (9.7 percent). While boys aged 12 to 17 had a higher rate of marijuana use than girls (7.5 vs. 6.2 percent), the rate for nonmedical use of prescription-type psychotherapeutics was similar for boys and girls (3.1 and 3.6 percent, respectively).
Past month marijuana use declined from 2002 to 2005 for both male youths (9.1 to 7.5 percent) and female youths (7.2 to 6.2 percent) (Figure 2.9).
Figure 2.9 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Pregnant Women
Among pregnant women aged 15 to 44 years, 3.9 percent reported using illicit drugs in the past month based on combined 2004 and 2005 NSDUH data. This rate was significantly lower than the rate among women aged 15 to 44 who were not pregnant (9.9 percent). The 2002-2003 combined rate of current illicit drug use among pregnant women (4.3 percent) was not significantly different from the 2004-2005 combined rate.
Race/Ethnicity
Current illicit drug use was associated with race/ethnicity in 2005. The rate was lowest among Asians (3.1 percent). Rates were 12.8 percent for American Indians or Alaska Natives, 12.2 percent for persons reporting two or more races, 9.7 percent for blacks, 8.7 percent for Native Hawaiians or Other Pacific Islanders, 8.1 percent for whites, and 7.6 percent for Hispanics.
Among youths aged 12 to 17 in 2005, the rate of current illicit drug use was highest among American Indians or Alaska Natives, about twice the overall rate among youths (19.2 vs. 9.9 percent, respectively). The rates for other groups were 11.0 percent among blacks, 10.1 percent among whites, 9.7 percent among those reporting two or more races, 9.4 percent among Hispanics, and 3.3 percent among Asians.
There were no statistically significant changes between 2004 and 2005 in the rate of current illicit drug use for any racial/ethnic subgroup among persons aged 12 or older. For youths aged 12 to 17, there was a decline among whites from 11.1 to 10.1 percent.
Education
Illicit drug use in 2005 was associated with educational status. Among adults aged 18 or older, the rate of current illicit drug use was lower among college graduates (5.0 percent) compared with those who did not graduate from high school (9.8 percent), high school graduates (8.6 percent), and those with some college (8.9 percent). However, adults who had graduated from college were more likely to have tried illicit drugs in their lifetime when compared with adults who had not completed high school (51.7 vs. 37.7 percent).
College Students
In the college-aged population (persons aged 18 to 22 years old), the rate of current illicit drug use was similar among full-time college students (21.2 percent) and among other persons aged 18 to 22 years, which includes part-time college students, students in other grades, and nonstudents (21.8 percent). Current illicit drug use among college students and other 18 to 22 year olds did not change between 2004 and 2005.
There was a significant increase in methamphetamine use among full-time college students aged 18 to 22 from 0.2 percent in 2004 to 0.5 percent in 2005. The rate was unchanged among other persons in that age group (1.0 percent in 2004 vs. 0.8 percent in 2005).
Employment
Current employment status was associated with illicit drug use in 2005. Among unemployed adults aged 18 or older, 17.1 percent were current illicit drug users, which was higher than the 8.2 percent of those employed full time and 10.4 percent of those employed part time. These rates were all similar to the corresponding rates in 2004.
Although the rate of past month illicit drug use was higher among unemployed persons compared with those from other employment groups, most drug users were employed. Of the 17.2 million current illicit drug users aged 18 or older in 2005, 12.9 million (74.8 percent) were employed either full or part time.
Geographic Area
Among persons aged 12 or older, the rate of current illicit drug use in 2005 was 9.0 percent in the West, 8.9 percent in the Northeast, 7.5 percent in the South, and 7.5 percent in the Midwest.
The rate of current illicit drug use in metropolitan areas was higher than the rate in nonmetropolitan areas in 2005. The rates were 8.4 percent in large metropolitan counties, 8.4 percent in small metropolitan counties, and 6.9 percent in nonmetropolitan counties as a group. Within nonmetropolitan areas, counties that were urbanized had a rate of 7.8 percent, less urbanized counties had a rate of 6.5 percent, while completely rural counties had a rate of 5.1 percent.
The rate of current illicit drug use in completely rural counties had declined between 2002 and 2003, from 6.7 to 3.1 percent, but then increased to 5.1 percent in 2005. The rate in 2005 was not significantly different from the rate in 2004 (4.6 percent).
Among youths aged 12 to 17, there was evidence of regional differences in trends of marijuana use between 2002 and 2005. Current marijuana use rates declined in the Northeast, Midwest, and South between 2002 and 2005. In the West, the rates were steady between 2002 and 2004 (8.0 percent in 2002, 8.7 percent in 2003, and 9.3 percent in 2004) and then declined to 6.8 percent in 2005 (Figure 2.10).
Figure 2.10 Past Month Marijuana Use among Youths Aged 12 to 17, by Geographic Region: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Criminal Justice Populations
In 2005, among the 1.6 million adults aged 18 or older on parole or other supervised release from prison during the past year, 26.3 percent were current illicit drug users, higher than the 7.7 percent among adults not on parole or supervised release.
Among the 4.7 million adults on probation at some time in the past year, 29.2 percent reported current illicit drug use in 2005. This is higher than the rate of 7.4 percent among adults not on probation in 2005.
Frequency of Use
In 2005, among past year marijuana users aged 12 or older, 13.3 percent used marijuana on 300 or more days within the past 12 months. This translates into 3.4 million persons using marijuana on a daily or almost daily basis over a 12-month period, similar to the estimate in 2004.
Among past month marijuana users aged 12 or older, 34.8 percent (5.1 million) used the drug on 20 or more days in the past month. The percentage of past month marijuana users aged 12 to 17 who used on 20 or more days in the past month declined from 28.1 percent (536,000) in 2004 to 23.1 percent (400,000) in 2005.
Association with Cigarette and Alcohol Use
In 2005, the rate of current illicit drug use was approximately 8 times higher among youths aged 12 to 17 who smoked cigarettes in the past month (46.7 percent) than it was among youths who did not smoke cigarettes in the past month (5.5 percent).
Past month illicit drug use also was associated with the level of past month alcohol use. Among youths aged 12 to 17 in 2005 who were heavy drinkers (i.e., drank five or more drinks on the same occasion [i.e., at the same time or within a couple of hours of each other] on each of 5 or more days in the past 30 days), 59.9 percent also were current illicit drug users, which was higher than among nondrinkers (5.0 percent).
Among youths aged 12 to 17 who were both smokers and heavy drinkers in the past month in 2005, 70.9 percent used illicit drugs in the past month, higher than the 3.5 percent among youths who did not drink or smoke in the past month.
Driving Under the Influence of Illicit Drugs
In 2005, there were 10.5 million persons aged 12 or older who reported driving under the influence of an illicit drug during the past year. This corresponds to 4.3 percent of the population aged 12 or older, similar to the rates in 2003 (4.6 percent) and 2004 (4.4 percent), but lower than the rate in 2002 (4.7 percent). In 2005, the rate was highest among young adults aged 18 to 25 (13.4 percent).
Source of Prescription Drugs
NSDUH includes questions for nonmedical users of prescription-type psychotherapeutic drugs regarding how they obtained the drugs they recently used nonmedically. In 2005, the most prevalent source from which recently used drugs were obtained among nonmedical users of prescription-type drugs was "from a friend or relative for free."
Among persons aged 12 or older who used pain relievers nonmedically in the past 12 months, 59.8 percent reported that the source of the drug the most recent time they used was from a friend or relative for free. Another 16.8 percent reported they got the drug from one doctor. Only 4.3 percent got the pain relievers from a drug dealer or other stranger, and only 0.8 percent reported buying the drug on the Internet.
Over half (57.6 percent) of past year nonmedical users of stimulants aged 12 or older reported getting the drug from a friend or relative for free. Also, 6.5 percent bought the drug from a drug dealer or other stranger, and 7.2 percent bought it on the Internet. However, compared with overall stimulant users, methamphetamine users were less likely to purchase this stimulant on the Internet (1.5 percent) and more likely to purchase it from a drug dealer or other stranger (17.1 percent). Nearly half (47.7 percent) of past year methamphetamine users reported obtaining the drug from a friend or relative for free.
2005
National Survey on Drug
Use & Health: National Results
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 to be 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 (past month) 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 (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days (includes heavy use).
Heavy use - Five or more drinks on the same occasion on each of 5 or more days in the past 30 days.
Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2005 survey (51.8 percent). This translates to an estimated 126 million people, which is higher than the 2004 estimate of 121 million people (50.3 percent).
More than one fifth (22.7 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2005. This translates to about 55 million people, comparable with the estimates reported since 2002.
In 2005, heavy drinking was reported by 6.6 percent of the population aged 12 or older, or 16 million people. This percentage is similar to the rates of heavy drinking in 2002 (6.7 percent), 2003 (6.8 percent), and 2004 (6.9 percent).
Age
In 2005, rates of current alcohol use were 4.2 percent among persons aged 12 or 13, 15.1 percent of persons aged 14 or 15, 30.1 percent of 16 or 17 year olds, 51.1 percent of those aged 18 to 20, and 67.4 percent of 21 to 25 year olds (Figure 3.1). Among older age groups, the prevalence of alcohol use decreased with increasing age, from 63.7 percent among 26 to 29 year olds to 47.5 percent among 60 to 64 year olds and 40.0 percent among people aged 65 or older.
Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2005
Rates of binge alcohol use in 2005 were 2.0 percent among 12 or 13 year olds, 8.0 percent among 14 or 15 year olds, 19.7 percent among 16 or 17 year olds, 36.1 percent among persons aged 18 to 20, and 45.7 percent among those aged 21 to 25. The rate peaked at ages 21 to 23 (49.9 percent at age 21, 46.6 percent at age 22, and 47.7 percent at age 23), then decreased beyond young adulthood from 32.9 percent of 26 to 34 year olds to 18.3 percent of persons aged 35 or older.
The rate of binge drinking was 41.9 percent for young adults aged 18 to 25. Heavy alcohol use was reported by 15.3 percent of persons aged 18 to 25. These rates are similar to the rates in 2002, 2003, and 2004.
Persons aged 65 or older had lower rates of binge drinking (8.3 percent) than adults in other age groups. The rate of heavy drinking among persons aged 65 or older was 1.7 percent.
The rate of current alcohol use among youths aged 12 to 17 declined from 17.6 percent in 2004 to 16.5 percent in 2005. Youth binge drinking also declined during that period, from 11.1 to 9.9 percent, but heavy drinking did not change significantly (2.7 percent in 2004 and 2.4 percent in 2005).
Underage Alcohol Use
In 2005, about 10.8 million persons aged 12 to 20 (28.2 percent of this age group) reported drinking alcohol in the past month. Nearly 7.2 million (18.8 percent) were binge drinkers, and 2.3 million (6.0 percent) were heavy drinkers. These figures have remained essentially the same since the 2002 survey.
More males than females aged 12 to 20 reported current alcohol use (28.9 vs. 27.5 percent, respectively), binge drinking (21.3 vs. 16.1 percent), and heavy drinking (7.6 vs. 4.3 percent) in 2005 (Figure 3.2).
Figure 3.2 Current Alcohol Use among Persons Aged 12 to 20, by Gender: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Underage Alcohol Use by Race/Ethnicity, Region, and Size of Metropolitan
Area
Among persons aged 12 to 20, past month alcohol use rates were 12.0 percent among Native Hawaiians or Other Pacific Islanders, 15.5 percent among Asians, 19.0 percent among blacks, 21.7 percent among American Indians or Alaska Natives, 24.0 percent among those reporting two or more races, 25.9 percent among Hispanics, and 32.3 percent among whites.
Among persons aged 12 to 20, binge drinking was reported by 22.3 percent of whites, 18.1 percent of American Indians or Alaska Natives, 17.9 percent of Hispanics, and 16.6 percent of persons reporting two or more races, but only by 7.4 percent of Asians, 8.4 percent of Native Hawaiians or Other Pacific Islanders, and 9.1 percent of blacks.
Across geographic regions in 2005, underage current alcohol use rates were higher in the Northeast (31.4 percent) and Midwest (31.0 percent) than in the South (26.4 percent) and the West (26.0 percent). This pattern has remained essentially the same since 2002.
In 2005, underage current alcohol use rates were similar in small metropolitan areas (29.5 percent), large metropolitan areas (27.6 percent), and nonmetropolitan areas (27.9 percent). The rate in nonmetropolitan rural areas was 23.1 percent.
Gender
In 2005, 58.1 percent of males aged 12 or older were current drinkers, higher than the rate for females (45.9 percent). However, among youths aged 12 to 17, the percentage of females who were current drinkers (17.2 percent) was higher than that for males (15.9 percent).
Among adults aged 18 to 25, an estimated 55.4 percent of females and 66.3 percent of males reported current drinking in 2005. These percentages are similar to 2004.
Pregnant Women
Among pregnant women aged 15 to 44, an estimated 12.1 percent reported current alcohol use and 3.9 percent reported binge drinking. These rates were significantly lower than the rates for nonpregnant women in the same age group (53.1 and 23.3 percent, respectively). Heavy alcohol use was relatively rare (0.7 percent) among pregnant women. All of these estimates are based on data averaged over 2004 and 2005.
Race/Ethnicity
Among persons aged 12 or older, whites in 2005 were more likely than other racial/ethnic groups to report current use of alcohol (56.5 percent) (Figure 3.3). The rates were 47.3 percent for persons reporting two or more races, 42.6 percent for Hispanics, 42.4 percent for American Indians or Alaska Natives, 40.8 percent for blacks, 38.1 percent for Asians, and 37.3 percent for Native Hawaiians or Other Pacific Islanders.
Figure 3.3 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Race/Ethnicity: 2005
The rate of binge alcohol use was lowest among Asians (12.7 percent). Rates for other racial/ethnic groups were 20.3 percent for blacks, 20.8 percent for persons reporting two or more races, 23.4 percent for whites, 23.7 percent for Hispanics, 25.7 percent for Native Hawaiians or Other Pacific Islanders, and 32.8 percent for American Indians or Alaska Natives.
Among youths aged 12 to 17 in 2005, Asians had the lowest rate of past month alcohol use. Only 7.0 percent of Asian youths were current drinkers, while 11.6 percent of blacks, 12.2 percent of American Indians or Alaska Natives, 13.0 percent of those reporting two or more races, 16.7 percent of Hispanics, and 18.5 percent of white youths were current drinkers.
Education
Among adults aged 18 or older, the rate of past month alcohol use increased with increasing levels of education. Among adults with less than a high school education, 36.7 percent were current drinkers in 2005, significantly lower than the 69.4 percent of college graduates who were current drinkers. However, among adults aged 26 or older, binge and heavy alcohol use rates were lower among college graduates (18.9 and 4.9 percent, respectively) than among adults who had not completed college (21.9 vs. 6.0 percent, respectively).
College Students
Young adults aged 18 to 22 enrolled full time in college were more likely than their peers not enrolled full time (i.e., part-time college students and persons not currently enrolled in college) to use alcohol in the past month, binge drink, and drink heavily. Past month alcohol use was reported by 64.4 percent of full-time college students compared with 53.2 percent of persons aged 18 to 22 who were not enrolled full time. Binge and heavy use rates for college students were 44.8 and 19.5 percent, respectively, compared with 38.3 and 13.0 percent, respectively, for 18 to 22 year olds not enrolled full time in college.
The pattern of higher rates of current alcohol use, binge alcohol use, and heavy alcohol use among full-time college students than the rates for others aged 18 to 22 has remained consistent since 2002 (Figure 3.4).
Figure 3.4 Heavy Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Employment
Rates of current alcohol use were 63.2 percent for full-time employed adults aged 18 or older in 2005, higher than the rate for unemployed adults (56.5 percent). However, the pattern was different for heavy alcohol use; the rate of heavy alcohol use was higher for unemployed persons (10.4 percent) than for full-time employed persons (8.4 percent). There was no significant difference in the rates of binge alcohol use between unemployed adults and adults employed full time.
Most binge and heavy alcohol users were employed in 2005. Among 52.6 million adult binge drinkers, 42.1 million (80.0 percent) were employed either full or part time. Among 15.4 million heavy drinkers, 12.5 million (80.8 percent) were employed.
Geographic Area
The rate of past month alcohol use for people aged 12 or older in 2005 was lower in the South (47.8 percent) than in the Northeast (55.0 percent), Midwest (55.0 percent), or West (52.5 percent). This pattern has remained unchanged since 2002, but the gap between the South and the other regions may be closing because the South was the only region to show a significant increase in its current alcohol use rate between 2004 and 2005. The rate of past month alcohol use in the South in 2004 was 45.1 percent.
Among people aged 12 or older, the rate of past month alcohol use in large metropolitan areas (54.4 percent) was higher than the 51.4 percent in small metropolitan areas and 44.2 percent in nonmetropolitan areas. Binge drinking was more prevalent in small metropolitan areas (23.7 percent) than in large metropolitan areas (22.3 percent) and nonmetropolitan areas (21.9 percent). The rate of heavy alcohol use was 6.1 percent in large metropolitan areas, 7.4 percent in small metropolitan areas, and 6.7 percent in nonmetropolitan areas.
Among youths aged 12 to 17, the rate of binge alcohol was associated with county type. The rates of binge alcohol use were 11.5 percent in nonmetropolitan areas, 10.2 percent in small metropolitan areas, and 9.3 percent in large metropolitan areas. In completely rural counties of nonmetropolitan areas, 11.9 percent of youths reported binge drinking.
Association with Illicit Drug and Tobacco Use
The level of alcohol use was associated with illicit drug use in 2005. Among the 16.0 million heavy drinkers aged 12 or older, 32.0 percent were current illicit drug users. Persons who were not current alcohol users were less likely to have used illicit drugs in the past month (3.5 percent) than those who reported (a) current use of alcohol but did not meet the criteria for binge or heavy use (5.9 percent), (b) binge use but did not meet the criteria for heavy use (16.1 percent), or (c) heavy use of alcohol (32.0 percent).
Alcohol consumption levels also were associated with tobacco use. Among heavy alcohol users aged 12 or older, 60.6 percent smoked cigarettes in the past month, while only 20.4 percent of non-binge current drinkers and 16.7 percent of persons who did not drink alcohol in the past month were current smokers. Smokeless tobacco use and cigar use also were more prevalent among heavy drinkers (11.9 and 19.2 percent, respectively) than among non-binge drinkers (1.9 and 5.0 percent) and nondrinkers (1.9 and 2.2 percent).
Driving Under the Influence of Alcohol
In 2005, an estimated 13.0 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year (Figure 3.5). This percentage has dropped since 2002, when it was 14.2 percent. The 2005 estimate corresponds to 31.7 million persons.
Figure 3.5 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 12 or Older: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Driving under the influence of alcohol was associated with age in 2005. An estimated 8.3 percent of 16 or 17 year olds, 19.8 percent of 18 to 20 year olds, and 27.9 percent of 21 to 25 year olds reported driving under the influence of alcohol in the past year (Figure 3.6). Beyond age 25, these rates showed a general decline with increasing age.
Among persons aged 12 or older, males were nearly twice as likely as females (17.1 vs. 9.2 percent) to drive under the influence of alcohol in the past year.
Figure 3.6 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 16 or Older, by Age: 2005
2005
National Survey on Drug
Use & Health: National Results
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. Cigarette use is defined as smoking "part or all of a cigarette." For analytic purposes, data for chewing tobacco and snuff are combined as "smokeless tobacco."
In 2005, an estimated 71.5 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 29.4 percent of the population in that age range. In addition, 60.5 million persons (24.9 percent of the population) were current cigarette smokers; 13.6 million (5.6 percent) smoked cigars; 7.7 million (3.2 percent) used smokeless tobacco; and 2.2 million (0.9 percent) smoked tobacco in pipes (Figure 4.1).
Figure 4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
The rates of current use of cigarettes, smokeless tobacco, cigars, and pipe tobacco were unchanged between 2004 and 2005. However, between 2002 and 2005, past month use of a tobacco product declined from 30.4 to 29.4 percent, and past month cigarette use decreased from 26.0 to 24.9 percent.
Age
Young adults aged 18 to 25 had the highest rate of current use of a tobacco product (44.3 percent) and of each specific product compared with youths aged 12 to 17 and adults aged 26 or older. In 2005, the rates of past month use among young adults were 39.0 percent for cigarettes, 12.0 percent for cigars, 5.1 percent for smokeless tobacco, and 1.5 percent for pipe tobacco. The rate of current use of smokeless tobacco by young adults did not change significantly between 2002 and 2005, but the rates of current use of cigars and pipe tobacco were higher in 2005 than they were in 2002, and the rate of current cigarette use was lower in 2005 than in 2002.
Among youths aged 12 to 17 in 2005, 3.3 million (13.1 percent) used a tobacco product in the past month, and 2.7 million (10.8 percent) used cigarettes (Figure 4.2). The rate of past month cigarette use among 12 to 17 year olds declined from 13.0 percent in 2002 to 10.8 percent in 2005. Cigar use in the past month declined to 4.2 percent of youths in 2005 from the 2004 estimate of 4.8 percent. Past month smokeless tobacco use was reported by 2.1 percent of youths in 2005, similar to estimates since 2002.
Figure 4.2 Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
In 2005, 2.4 percent of 12 or 13 year olds, 9.2 percent of 14 or 15 year olds, and 20.6 percent of 16 or 17 year olds were current cigarette smokers (Figure 4.3). Current cigarette use peaked at 41.2 percent among young adults aged 21 to 25. Less than a quarter (22.3 percent) of persons in the 35 or older age group in 2005 smoked cigarettes in the past month.
Cigar smoking in the past month remained stable from 2002 to 2005 among adults aged 18 or older. Rates were 5.5 percent in both 2002 and 2003, and they were 5.8 percent in both 2004 and 2005. Among youths aged 12 to 17, current cigar smoking was similar in 2002 (4.5 percent), 2003 (4.5 percent), and 2004 (4.8 percent), then declined to 4.2 percent in 2005.
Among adults aged 26 or older in 2005, 3.0 percent used smokeless tobacco in the past month. Among youths aged 12 to 17, the rate was 2.1 percent, and among young adults aged 18 to 25, the rate was 5.1 percent. For all three of these age groups, estimates of smokeless tobacco use in 2005 were essentially the same as those obtained in 2002.
Gender
In 2005, the current use of a tobacco product among persons aged 12 or older was reported by a higher percentage of males (35.8 percent) than females (23.4 percent). Males also had higher rates of past month use than females of each specific tobacco product: cigarette smoking (27.4 percent of males vs. 22.5 percent of females), cigar smoking (9.6 vs. 1.8 percent), and use of smokeless tobacco (6.1 vs. 0.4 percent).
Among youths aged 12 to 17, current cigarette smoking in 2005 was equally prevalent among females (10.8 percent) and males (10.7 percent). The rate for females in this age group declined from 13.6 percent in 2002 to 12.5 percent in 2003, remained unchanged from 2003 to 2004 (12.5 percent), then declined again between 2004 and 2005 (10.8 percent). Among 12- to 17-year-old males, the rate of current cigarette use was 12.3 percent in 2002, 11.9 percent in 2003, 11.3 percent in 2004, and 10.7 percent in 2005 (Figure 4.4).
Figure 4.4 Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Pregnant Women
Among women aged 15 to 44, combined data for 2004 and 2005 indicated that the rate of past month cigarette use was lower among those who were pregnant (16.6 percent) than it was among those who were not pregnant (29.6 percent).
Looking at combined 2004-2005 data, rates of past month cigarette smoking were lower for pregnant women than nonpregnant women among those aged 26 to 44 (10.4 vs. 28.8 percent) and among those aged 18 to 25 (26.4 vs. 35.8 percent) (Figure 4.5). However, among those aged 15 to 17, the rate of cigarette smoking for pregnant women was higher than for nonpregnant women (22.3 vs. 18.5 percent), although the difference was not significant. Similar patterns were observed in the combined 2002-2003 data.
Figure 4.5 Past Month Cigarette Use among Women Aged 15 to 44, by Age and Pregnancy Status, 2004-2005 Combined
In 2005, among persons aged 12 or older, 14.6 percent of Asians, 24.5 percent of Hispanics, 28.4 percent of blacks, 30.3 percent of Native Hawaiians or Other Pacific Islanders, 31.2 percent of whites, 33.9 percent of persons who reported two or more races, and 41.7 percent of American Indians or Alaska Natives reported that they had used a tobacco product in the past month. There were no statistically significant changes in past month tobacco use between 2004 and 2005 among any of these groups.
In 2005, current cigarette smoking among youths aged 12 to 17 and young adults aged 18 to 25 was more prevalent among whites than blacks (12.8 vs. 6.5 percent for 12 to 17 year olds and 44.2 vs. 28.7 percent for 18 to 25 year olds). Among adults aged 26 or older, however, whites and blacks used cigarettes at about the same rate (24.8 and 27.0 percent, respectively). The rates for Hispanics were 9.1 percent among youths, 31.9 percent among young adults, and 22.2 percent among those aged 26 or older.
Current use of smokeless tobacco increased from 3.6 percent in 2004 to 8.6 percent in 2005 among American Indians or Alaska Natives aged 18 or older. In the same age group, past month smokeless tobacco use remained stable among persons in all other racial/ethnic groups.
Education
Cigarette smoking in the past month tended to be less prevalent among adults with more education. Among adults aged 18 or older, current cigarette use in 2005 was reported by 34.8 percent of those who had not completed high school, 31.8 percent of high school graduates who did not attend college, 28.1 percent of persons with some college, and 13.8 percent of college graduates.
In 2005, the use of smokeless tobacco in the past month was reported by 3.5 percent of persons aged 18 or older who had not completed high school, 4.3 percent of those who completed high school but did not attend college, and 3.4 percent of those who attended some college. The prevalence among college graduates (1.9 percent) was lower than among the other groups.
College Students
Among young adults 18 to 22 years old, full-time college students were less likely to be current cigarette smokers than their peers who were not enrolled full time in college. Cigarette use in the past month in 2005 was reported by 30.6 percent of full-time college students compared with 42.7 percent of those not enrolled full time.
In 2005, past month cigar smoking was equally common among male full-time college students aged 18 to 22 (20.8 percent) as among males in the same age group who were not enrolled full time in college (19.8 percent).
Past month cigar smoking among males aged 18 to 22 not enrolled full time in college declined from 22.3 percent in 2004 to 19.8 percent in 2005.
Employment
In 2005, current cigarette smoking was more common among unemployed adults aged 18 or older than among adults who were working full time or part time (43.8 vs. 28.3 and 25.2 percent, respectively). Cigar smoking followed a similar pattern, with 10.4 percent of unemployed adults reporting past month use compared with 6.8 percent of full-time workers and 5.6 percent of part-time workers.
Rates of current cigarette use among adults aged 18 or older decreased among unemployed persons between 2002 and 2005; rates were 49.8 percent in 2002, 42.7 percent in 2003, 44.1 percent in 2004, and 43.8 percent in 2005. Among adults who were employed full time, current use of smokeless tobacco increased from 3.7 percent in 2004 to 4.2 percent in 2005.
Geographic Area and County Type
Current cigarette smoking among persons aged 12 or older was lowest in the West (21.0 percent) and highest in the Midwest (28.1 percent). Use of smokeless tobacco was higher in the South and Midwest (4.1 and 3.8 percent, respectively) than in the West and Northeast (2.0 and 1.9 percent, respectively). Cigar smoking, like cigarette use, was highest in the Midwest (6.7 percent).
In the Midwest, the prevalence of current cigar smoking increased from 5.6 percent in 2002 and 5.8 percent in 2003 to 6.9 percent in 2004, leveling off at 6.7 percent in 2005.
Among persons aged 12 or older, the rate of current cigarette use was associated with county type in 2005. The rates of cigarette smoking were 29.4 percent in less urbanized nonmetropolitan areas, 29.2 percent in urbanized nonmetropolitan areas, 25.7 percent in small metropolitan areas, and 23.3 percent in large metropolitan areas. The rate for completely rural nonmetropolitan counties in 2005 was also 23.3 percent.
In completely rural nonmetropolitan counties, current cigarette use among persons aged 12 or older declined from 31.8 percent in 2002 and 28.0 percent in 2003 to 22.8 percent in 2004, leveling off at 23.3 percent in 2005 (Figure 4.6).
Figure 4.6 Past Month Cigarette Use among Persons in Completely Rural Counties, by Age: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Use of smokeless tobacco in the past month among persons aged 12 or older was lowest in large metropolitan areas (1.7 percent). In small metropolitan areas, the rate was 3.7 percent; in nonmetropolitan areas, it was 6.8 percent; and in completely rural nonmetropolitan counties, the rate was 7.8 percent.
Association with Illicit Drug and Alcohol Use
Use of illicit drugs and alcohol was more common among current cigarette smokers than among nonsmokers in 2005, as in 2002 through 2004. Among persons aged 12 or older, 20.2 percent of past month cigarette smokers reported current use of an illicit drug compared with 4.1 percent of persons who were not current cigarette smokers. Past month alcohol use was reported by 67.6 percent of current cigarette smokers compared with 46.6 percent of those who did not use cigarettes in the past month. The association also was found with binge drinking (43.8 percent of current cigarette users vs. 15.7 percent of current nonusers) and heavy drinking (16.1 vs. 3.5 percent, respectively).
Use of tobacco products other than cigarettes was higher among current cigarette smokers than among current nonsmokers. Approximately 1 in 20 current cigarette users (5.0 percent) reported using smokeless tobacco in the past month compared with 2.6 percent of nonsmokers. Moreover, 12.6 percent of current cigarette smokers also smoked cigars in the past month compared with 3.3 percent of those who did not smoke cigarettes.
2005
National Survey on Drug
Use & Health: National Results
5. Initiation of Substance Use
Information on substance use initiation, also known as incidence or first-time use, is important for policymakers and researchers. Measures of initiation are often leading indicators of emerging patterns of substance use. They provide valuable information that can be used in the assessment of the effectiveness of current prevention programs and in determining where prevention efforts need to focus.
With its large sample size and oversampling of youths aged 12 to 17 and young adults aged 18 to 25, the National Survey on Drug Use and Health (NSDUH) provides a variety of estimates related to substance use initiation based on questions on age and month at first use. Using this information, along with the interview date and the respondent's date of birth, a date of first use is determined for each substance used by a respondent. Estimates of the number of initiates, rates of initiation, and average age at first use can be constructed for specific time periods. For example, estimates for calendar years as far back as 1965 have been tabulated from 2002-2004 NSDUH data to show long-term trends in initiation. However, recent methodological assessments of these long-term trend estimates of initiation have suggested that they are biased, due to suspected recall errors that seem to increase with the length of recall (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004). Evidence of forward and backward telescoping, where respondents shift their reported age at first use either closer to their current age or further from the interview date, also has been found (Golub, Johnson, & Labouvie, 2000; Johnson & Schultz, 2005).
Because of concerns about the validity of trend estimates of incidence based on long recall periods, an alternative approach to estimating incidence was developed and presented for the first time in the 2004 NSDUH national findings report (Office of Applied Studies [OAS], 2005b) and is continued in this 2005 NSDUH report. The new estimates describe initiation of substance use in the 12 months prior to the interview date, and individuals who initiated use within the past 12 months are defined as recent or past year initiates. Estimates for each year are produced independently based on the data from the survey conducted that year. This approach should improve the comparability of estimates across years. Although it will not eliminate reporting biases, the approach should minimize recall bias because the estimates are based on a more recent time period than the previously produced calendar year estimates. The more recent time period also provides more timely information on incidence. Finally, an advantage of this approach is that initiation estimates can be analyzed in conjunction with past year prevalence estimates because they reflect the same time period. For example, this approach allows the estimation of initiates as a proportion of past year users. For specific substances, initiation prior to age 12 is not well covered, and initiation prior to age 11 is not included at all. This problem primarily affects estimates of initiation for cigarettes, alcohol, and inhalants because they tend to be initiated at a younger age than other substances.
As a measure of central tendency, means are heavily influenced by the presence of extreme values in the data. Thus, for the purposes of this report, mean age at initiation will refer specifically to the mean age at initiation among persons aged 12 to 49. This constraint was implemented so that the mean age estimates reported would not be influenced by those few respondents who were past year initiates at age 50 or older. This should increase the utility of these results to health researchers and analysts by providing a better picture of the substance use initiation behaviors among the civilian, noninstitutionalized population in the United States. Note that this constraint only affects estimates of mean age at initiation; other estimates in this chapter, including the number and prevalence of past year initiates, are among all persons aged 12 or older.
See Section B.4.1 in Appendix B for further discussion of the methods and bias in initiation estimates. The Substance Abuse and Mental Health Services Administration (SAMHSA) continues to study the advantages and disadvantages of alternative methods of estimating incidence.
Illicit Drugs
In 2005, an estimated 2.9 million persons aged 12 or older used an illicit drug for the first time within the past 12 months; this averages to nearly 8,000 initiates per day. This estimate was not significantly different from the number in 2004 (2.8 million). Most initiates (56.1 percent) were younger than age 18 when they first used, and the majority of new users (56.2 percent) were female. The average age at initiation among persons aged 12 to 49 was 18.7 years.
The specific drug categories with the largest number of recent initiates among persons aged 12 or older were nonmedical use of pain relievers (2.2 million) and marijuana use (2.1 million), followed by nonmedical use of tranquilizers (1.3 million), then by use of inhalants (0.9 million) and cocaine (0.9 million) (Figure 5.1).
Figure 5.1 Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2005
Among persons aged 12 to 49, the average age at first use of inhalants in 2005 was 16.1 years; it was 17.4 years for marijuana, 19.7 years for cocaine, 21.2 years for pain relievers, and 25.7 years for tranquilizers (Figure 5.2).
Figure 5.2 Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2005
In 2005, there were 2.1 million persons who had used marijuana for the first time within the past 12 months; this averages to approximately 6,000 initiates per day. This estimate was not significantly different from the numbers in 2004 (2.1 million), 2003 (2.0 million), and 2002 (2.2 million) (Figure 5.3).
Figure 5.3 Past Year Marijuana Initiates among Persons Aged 12 or Older and Mean Age at First Use of Marijuana among Past Year Marijuana Initiates Aged 12 to 49: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level. 1 Mean age at first use estimates are among recent initiates aged 12 to 49.
Most (59.1 percent) of the 2.1 million recent marijuana initiates were younger than age 18 when they first used. Among youths aged 12 to 17, an estimated 4.5 percent had used marijuana for the first time within the past year, which was lower than the rate in 2004 (5.0 percent), but this difference was not statistically significant.
As a percentage of those who had not used marijuana prior to the past year, youth marijuana initiation declined significantly from 5.8 percent in 2004 to 5.2 percent in 2005.
In 2005, the average age at first marijuana use among recent initiates aged 12 to 49 was 17.4 years. This average increased from 17.0 years in 2002, 16.8 years in 2003, and 17.1 years in 2004, although only the difference between the 2005 and 2003 mean ages was significant (Figure 5.3). Excluding initiation at age 21 or older, the mean ages of initiation were 15.9 years in 2002, 15.9 years in 2003, 16.0 years in 2004, and 16.0 years in 2005.
Cocaine
In 2005, there were 872,000 persons aged 12 or older who had used cocaine for the first time within the past 12 months; this averages to approximately 2,400 initiates per day. This estimate was lower than the number in 2002 (1.0 million).
Most (62.3 percent) of the 0.9 million recent cocaine initiates were 18 or older when they first used. The average age at first use among recent initiates aged 12 to 49 was 19.7 years, which was similar to the average age in 2002 (19.8 years).
Heroin
In 2005, there were 108,000 persons aged 12 or older who had used heroin for the first time within the past 12 months. The average age at first use among recent initiates aged 12 to 49 was 22.2 years in 2005. There were no significant changes in the number of initiates or in the average age at first use from 2002 to 2005.
Hallucinogens
In 2005, there were 953,000 persons aged 12 or older who had used hallucinogens for the first time within the past 12 months. This estimate was not significantly different from the estimates in 2004 (934,000) or 2003 (886,000), but it was lower than the estimate in 2002 (1.2 million).
Although there was no significant change between 2004 and 2005 in the number of past year initiates of LSD or Ecstasy, there were declines between 2002 and 2003. The number of past year LSD initiates among persons aged 12 or older was 338,000 in 2002, 200,000 in 2003, 235,000 in 2004, and 243,000 in 2005. The number of Ecstasy initiates in the past year was 1.2 million in 2002, 642,000 in 2003, 607,000 in 2004, and 615,000 in 2005. Most (65.9 percent) of the recent Ecstasy initiates in 2005 were aged 18 or older at the time they first used Ecstasy. Among past year initiates aged 12 to 49, the average age at initiation of Ecstasy in 2005 was 20.7 years.
Inhalants
In 2005, there were 877,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 72.3 percent were under age 18 when they first used. The average age at first use among recent initiates aged 12 to 49 was 16.1 years in 2005. There were no significant changes in the number of inhalant initiates or the average age at first use from 2002 to 2005.
Psychotherapeutics
Psychotherapeutics include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included. In 2005, there were 2.5 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year. The numbers of new users of specific psychotherapeutics in 2005 were 2.2 million for pain relievers, 1.3 million for tranquilizers, 647,000 for stimulants, and 247,000 for sedatives. These estimates are similar to the corresponding estimates for 2004.
The average age at first nonmedical use of psychotherapeutics among recent initiates aged 12 to 49 was 22.2 years. For specific drug classes, the average ages were 20.1 years for stimulants, 21.2 years for pain relievers, 22.9 years for sedatives, and 25.7 years for tranquilizers.
In 2005, the number of new nonmedical users of OxyContin® aged 12 or older was 526,000, with an average age at first use of 23.2 years among those aged 12 to 49. These estimates are similar to estimates for 2004 (615,000 and 22.9 years, respectively).
The number of recent new users of methamphetamine taken nonmedically among persons aged 12 or older was 192,000 in 2005 (Figure 5.4). Between 2002 and 2004, the number of methamphetamine initiates remained steady at around 300,000 per year, but there was a decline from 2004 (318,000 initiates) to 2005. The average age of new methamphetamine users aged 12 to 49 was 18.9 years in 2002, 20.4 years in 2003, 20.6 years in 2004, and 18.6 years in 2005.
Figure 5.4 Past Year Methamphetamine Initiates among Persons Aged 12 or Older and Mean Age at First Use of Methamphetamine among Past Year Methamphetamine Initiates Aged 12 to 49: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level. 1 Mean age at first use estimates are among recent initiates aged 12 to 49.
Alcohol
In 2005, there were 4.3 million persons aged 12 or older who had used alcohol for the first time within the past 12 months; this averages to approximately 12,000 initiates per day. The number of alcohol initiates was significantly greater than in 2002 (3.9 million), but similar to the numbers in 2003 (4.1 million) and 2004 (4.4 million).
Most (88.9 percent) of the 4.3 million recent alcohol initiates were younger than 21 at the time of initiation.
In 2005, the average age at first alcohol use among recent initiates aged 12 to 49 was 16.4 years. This average age was 16.6 years in 2002 and 16.4 years in both 2003 and 2004, but these are not statistically different from the average age at first use in 2005. Excluding initiation at age 21 or older, the mean ages were 15.5 years in 2002 and 15.6 years in 2003, 2004, and 2005.
Tobacco
The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was 2.3 million in 2005, which was significantly greater than the estimate for 2002 (1.9 million) (Figure 5.5). Most new smokers in 2005 were under age 18 when they first smoked cigarettes (63.4 percent).
Figure 5.5 Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First Use: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
In 2005, the average age of first cigarette use among recent initiates aged 12 to 49 was 17.3 years. This average was similar to the averages in 2002 (16.9 years), 2003 (16.9 years), and 2004 (16.7 years).
The initiation rate (i.e., the percentage of nonsmokers who initiated cigarette use within the past 12 months) was 2.6 percent in 2002, 2003, and 2004, and it was 2.7 percent in 2005. Among youths aged 12 to 17 years, the incidence showed no significant changes during this period in that it was 6.7 percent in 2002, 6.6 percent in 2003, 6.8 percent in 2004, and 6.6 percent in 2005. This pattern was observed for both male and female youths (Figure 5.6).
Figure 5.6 Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never Smoked, by Gender: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
In 2005, the number of persons who had started smoking cigarettes daily within the past 12 months was 1.0 million. This estimate is similar to the estimates for 2002 (1.0 million), 2003 (1.1 million), and 2004 (1.1 million). Of these new daily smokers, 43.1 percent, or 0.4 million (an average of about 1,140 initiates per day), were younger than age 18 when they started smoking daily.
The average age of first daily smoking among new daily smokers aged 12 to 49 in 2005 was 19.7 years. This was not significantly different from the average in 2002 (19.9 years), 2003 (19.8 years), or 2004 (18.8 years).
In 2005, there were 3.3 million persons aged 12 or older who had used cigars for the first time in the past 12 months, a significant increase in the number of initiates from 2002 (2.9 million) and 2003 (2.7 million). The average age at first cigar use was 21.2 years among past year cigar initiates aged 12 or 49 in 2005.
The number of persons aged 12 or older initiating use of smokeless tobacco in the past year was higher in 2005 (1.1 million) than in 2002 (951,000) and 2003 (928,000), but it was similar to the number in 2004 (999,000). Three quarters (74.6 percent) of new initiates in 2005 were male, and more than half (53.9 percent) were under age 18 when they first used.
The average age at first smokeless tobacco use among recent initiates aged 12 to 49 in 2005 was 18.3 years. Averages were 18.2 years for males and 18.9 years for females.
2005
National Survey on Drug
Use & Health: National Results
6. Youth Prevention-Related Measures
The National Survey on Drug Use and Health (NSDUH) includes questions for youths aged 12 to 17 about a number of risk and protective factors that may affect the likelihood that they will engage in substance use. Risk factors are individual characteristics and environmental influences associated with an increased vulnerability to the initiation, continuation, or escalation of substance use. Protective factors include individual resilience and other circumstances that appear to reduce the likelihood of substance use. Risk and protective factors include variables that operate at different stages of development and reflect different domains of influence, including the individual, family, peer, school, community, and societal levels (Hawkins, Catalano, & Miller, 1992). Interventions to prevent substance use generally are designed to ameliorate the influence of risk factors and enhance the effectiveness of protective factors.
This chapter presents findings for youth prevention-related measures collected in the 2005 NSDUH and compares these with findings from previous years. Included are measures of perceived risk from substance use (cigarettes, alcohol, and illicit drugs), perceived availability of substances, perceived parental disapproval of substance use, feelings about peer substance use, involvement in fighting and delinquent behavior, participation in religious and other activities, exposure to substance use prevention messages and programs, and parental involvement.
In this chapter, rates of substance use are compared for persons responding differently to questions reflecting risk or protective factors, such as the perceived risk of harm from using a substance. Because the NSDUH data for an individual are collected at only one point in time, it is not possible to determine causal connections from these data. However, a number of research studies of youths have shown that reducing risk factors and increasing protective factors can reduce rates of substance use (Botvin, Botvin, & Ruchlin, 1998). Earlier chapters of this report show that marijuana use, cigarette use, and binge use of alcohol among youths decreased between 2004 and 2005, yet corresponding changes in individual risk and protective factors for the same period may or may not have occurred. There can be many reasons for this, such as the lack of or weak causal connection, a lagged relationship between the occurrence of a risk factor and the change in drug behavior, or that individual use is typically the result of multiple simultaneous risk factors rather than a single factor (Newcomb, Maddahian, & Bentler, 1986).
Perceptions of Risk
One factor that can influence whether youths will use tobacco, alcohol, or illicit drugs is the extent to which youths believe these substances might cause them harm. NSDUH respondents were asked how much they thought people risk harming themselves physically and in other ways when they use various substances. Response choices for these items were "great risk," "moderate risk," "slight risk," or "no risk."
The percentages of youths reporting binge alcohol use and use of cigarettes and marijuana in the past month were lower among those who perceived great risk in using these substances than among those who did not perceive great risk. For example, 5.2 percent of youths aged 12 to 17 in 2005 who perceived great risk from "having 5 or more drinks of an alcoholic beverage once or twice a week" reported binge drinking in the past month (consumption of five or more drinks of an alcoholic beverage on a single occasion on at least 1 day in the past 30 days); by contrast, past month binge drinking was reported by 13.0 percent of youths who saw moderate, slight, or no risk from having five or more drinks of an alcoholic beverage once or twice a week (Figure 6.1). Past month marijuana use was reported by 1.5 percent of youths who saw great risk in smoking marijuana once a month compared with 9.7 percent of youths who saw moderate, slight, or no risk.
Figure 6.1 Past Month Binge Drinking and Marijuana Use among Youths Aged 12 to 17, by Perceptions of Risk: 2005
Increases in the perceived risk of using a substance often are associated with decreases in the rate of use of that substance. Looking over 4 years, the proportion of youths aged 12 to 17 who reported perceiving great risk from smoking one or more packs of cigarettes per day increased from 63.1 percent in 2002 to 68.3 percent in 2005 (Figure 6.2). Over the same period, the rate of past month cigarette smoking among youths decreased from 13.0 to 10.8 percent, and the rate of lifetime cigarette smoking declined from 33.3 to 26.7 percent (Figure 6.3). There was no change between 2004 and 2005 in the percentage of youths who perceived a great risk of smoking one or more packs of cigarettes per day (67.5 percent in 2004 and 68.3 percent in 2005).
Figure 6.2 Perceived Great Risk of Cigarette and Alcohol Use among Youths Aged 12 to 17: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
The perceived risk of having five or more drinks of an alcoholic beverage once or twice a week was stable between 2002 and 2005, while the perceived risk of having four or five drinks nearly every day changed during the period (Figure 6.2). The percentages of youths aged 12 to 17 who reported that they perceived great risk in having five or more drinks of an alcoholic beverage once or twice a week were 38.2 percent in 2002, 38.5 percent in 2003, 38.1 percent in 2004, and 38.4 percent in 2005. The percentage of youths indicating a great risk in having four or five drinks nearly every day had been stable between 2002 and 2004, but rose from 61.8 percent in 2004 to 63.8 percent in 2005. Past month binge use of alcohol decreased among youths from 11.1 percent in 2004 to 9.9 percent in 2005, and heavy use remained unchanged, 2.7 percent in 2004 and 2.4 percent in 2005.
In 2005, 55.0 percent of youths indicated a great risk in smoking marijuana once or twice a week, and 34.0 percent perceived a great risk in smoking marijuana once a month (Figure 6.4). There was no change in the perceived risk of using marijuana in either of these frequencies among youths between 2004 and 2005. Looking over a 4-year period, the perceived risk of marijuana use increased for these two measures between 2002 and 2003 and remained stable from 2003 through 2005. Between 2002 and 2005, marijuana use among youths decreased overall, although not all decreases between years were statistically significant. The prevalence of lifetime marijuana use decreased between 2002 and 2003, while the prevalence of lifetime, past year, and past month marijuana use decreased between 2004 and 2005 (Figure 6.5). From 2002 to 2005, lifetime use of marijuana dropped from 20.6 to 17.4 percent, past year use declined from 15.8 to 13.3 percent, and past month use fell from 8.2 to 6.8 percent.
Figure 6.4 Perceived Great Risk of Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Between 2004 and 2005, the perception of great risk of smoking marijuana once a month among both male and female youths aged 12 to 17 remained unchanged (Figure 6.6). For males, 32.6 percent indicated a great risk in 2004, and 31.1 percent indicated that in 2005. Among females, 37.4 percent reported a great risk in 2004, and 36.9 percent indicated great risk in 2005.
Figure 6.6 Perceived Great Risk of Smoking Marijuana Once a Month among Youths Aged 12 to 17, by Gender: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Between 2004 and 2005, there were no changes in the perceived risk of marijuana, cocaine, heroin, or LSD use. However, since 2002, there have been increases in the perceived risk of smoking marijuana once a month (from 32.4 to 34.0 percent) and smoking marijuana once or twice a week (from 51.5 to 55.0 percent). On the other hand, the percentage of youths aged 12 to 17 who perceived that trying heroin once or twice is a great risk declined from 58.5 percent in 2002 to 56.5 percent in 2005, and those who perceived that using cocaine once a month is a great risk declined from 50.5 to 48.8 percent.
Perceived Availability
Over half (51.0 percent) of youths aged 12 to 17 reported in 2005 that it would be "fairly easy" or "very easy" for them to obtain marijuana if they wanted some (Figure 6.7). Around one quarter reported it would be easy to get cocaine (24.9 percent) or crack (25.3 percent). One in seven (14.0 percent) indicated that heroin would be "fairly" or "very" easily available, and about one in six (15.7 percent) said it would be easy for them to get LSD if they wanted some.
Figure 6.7 Perceived Availability of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
The perceived availability of marijuana declined from 52.2 percent in 2004 to 51.0 percent in 2005, and the perceived availability of LSD declined during the same period from 16.9 to 15.7 percent. The perceived availability of cocaine, crack, and heroin remained unchanged between 2004 and 2005.
The perceived availability decreased between 2002 and 2005 for marijuana (from 55.0 to 51.0 percent), crack (from 26.5 to 25.3 percent), heroin (from 15.8 to 14.0 percent), and LSD (from 19.4 to 15.7 percent). However, the percentage reporting that it would be easy to obtain cocaine showed no decline over this period (25.0 percent in 2002 and 24.9 percent in 2005).
The percentage of youths who reported that drugs would be easy to obtain if they wanted some was associated with age, with perceived availability increasing with age. For example, in 2005, 22.0 percent of those aged 12 or 13 said it would be fairly or very easy to obtain marijuana compared with 53.8 percent of those aged 14 or 15 and 75.5 percent of those aged 16 or 17.
In 2005, 15.5 percent of youths aged 12 to 17 indicated that they had been approached by someone selling drugs in the past month, similar to the 16.3 percent reported in 2004. Youths who reported being approached by someone selling drugs, compared with those who reported no such approaches, were much more likely to have used an illicit drug in their lifetime (61.3 vs. 21.5 percent), in the past year (51.2 vs. 14.1 percent), and in the past month (32.6 vs. 5.8 percent).
Perceived Parental Disapproval of Substance Use
Most youths aged 12 to 17 believed their parents would "strongly disapprove" of their using substances. In 2005, 91.1 percent of youths aged 12 to 17 reported that their parents would strongly disapprove of their smoking one or more packs of cigarettes per day, while the remaining 8.9 percent believed their parents would "somewhat disapprove" or "neither approve nor disapprove." A majority of youths (90.2 percent) reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice, and 88.9 percent reported their parents would strongly disapprove of their having one or two drinks of an alcoholic beverage nearly every day. These rates of perceived parental disapproval in 2005 were similar to those seen in 2004.
Youths aged 12 to 17 who believed their parents would strongly disapprove of their using a particular substance were less likely to use that substance than were youths who believed their parents would somewhat disapprove or neither approve nor disapprove. For example, past month cigarette use was reported by 7.9 percent of youths who perceived strong parental disapproval of their smoking one or more packs of cigarettes per day compared with 40.5 percent of youths who believed their parents would not strongly disapprove. Current marijuana use also was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than for those who did not (4.6 vs. 27.0 percent).
Feelings about Peer Substance Use
A majority of youths aged 12 to 17 reported that they disapprove of their peers using substances. In 2005, 88.2 percent of youths "strongly" or "somewhat" disapproved of their peers smoking one or more packs of cigarettes per day; 80.8 percent reported similar feelings about their peers trying marijuana or hashish once or twice; and 85.6 percent strongly or somewhat disapproved of peers having one or two drinks of an alcoholic beverage nearly every day. These rates are similar to those observed in 2004.
The percentage disapproving of peers' substance use generally decreased with age. In 2005, disapproval of peers using marijuana once a month or more, for example, was reported by 92.0 percent of youths aged 12 or 13, 81.6 percent of those aged 14 or 15, and 70.9 percent of those aged 16 or 17 (Figure 6.8).
Figure 6.8 Disapproval of Peer Substance Use among Youths Aged 12 to 17, by Age: 2005
Past month marijuana use was reported by 2.4 percent of youths aged 12 to 17 who disapproved of their peers using marijuana once a month or more compared with 26.0 percent of youths who reported that they neither approve nor disapprove of such behavior from their peers.
Fighting and Delinquent Behavior
In 2005, 23.4 percent of youths aged 12 to 17 reported that, in the past year, they had gotten into a serious fight at school or at work; 16.8 percent had taken part in a group-against-group fight; 3.2 percent had carried a handgun at least once; 3.3 percent had sold illegal drugs (down from 3.8 percent in 2004); 4.2 percent had, at least once, stolen or tried to steal something worth more than $50; and 7.4 percent had, in at least one instance, attacked others with intent to seriously hurt them (down from 8.2 percent in 2004).
Youths who had engaged in fighting or other delinquent behaviors were more likely than other youths to have used illicit drugs. For example, past month illicit drug use was reported by 17.3 percent of youths who had gotten into serious fights at school or work in the past year compared with 7.6 percent of those who had not, and by 38.9 percent of those who had stolen or tried to steal something worth over $50 in the past year compared with 8.5 percent of those who had not (Figure 6.9).
Figure 6.9 Past Month Illicit Drug Use among Youths Aged 12 to 17, by Participation in Fighting and Delinquent Behavior in the Past Year: 2005
In 2005, 32.8 percent of youths aged 12 to 17 reported that they had attended religious services 25 or more times in the past year; 76.9 percent expressed agreement with the statement that religious beliefs are a very important part of their lives; 67.9 percent agreed with the statement that religious beliefs influence how they make decisions in life; and 34.9 percent agreed with the statement that it is important for their friends to share their religious beliefs. Findings for these measures remained stable from 2004 to 2005. Illicit drug, alcohol, and cigarette use were lower among youths who agreed with these statements than among those who disagreed. For example, past month illicit drug use was reported by 7.7 percent of those who agreed that religious beliefs are a very important part of life compared with 17.2 percent of those who disagreed with that statement.
Exposure to Substance Use Prevention Messages and Programs
Approximately one in eight youths aged 12 to 17 (11.7 percent) reported in 2005 that they had participated in drug, tobacco, or alcohol prevention programs outside of school in the past year. The prevalence of past month alcohol use was lower among youths who reported participating in these programs, 14.0 percent, than among youths who did not, 16.9 percent. However, for past month use of marijuana, there was no statistically significant difference between those who participated (5.8 percent used marijuana) and those who did not (6.9 percent used marijuana). Similarly, there was no difference between the two groups in current cigarette use (10.4 percent among participants and 10.8 percent among nonparticipants).
In 2005, 59.8 percent of youths aged 12 to 17 reported that they had talked at least once in the past year with at least one of their parents about the dangers of drug, tobacco, or alcohol use—similar to the 60.3 percent in 2004. Among youths who reported having had such conversations with their parents, rates of current alcohol, cigarette, and illicit drug use were lower than among youths who did not talk about substance abuse. For example, past month binge drinking was reported by 9.2 percent of youths who had talked with their parents about drug, tobacco, or alcohol use compared with 11.0 percent of those who had not. Past month use of marijuana was lower among youths who had talked with their parents (6.4 percent) than among those who had not (7.4 percent).
Almost four fifths (77.9 percent) of youths aged 12 to 17 enrolled in school reported in 2005 they had seen or heard drug or alcohol prevention messages at school in the past year, a percentage similar to the 2004 estimate of 78.2 percent. Past month use of an illicit drug was lower for youths exposed to such messages in school (9.2 percent) than for youths not reporting such exposure (13.2 percent).
Out-of-school exposure to drug or alcohol prevention messages in the past year was reported by 81.1 percent of youths aged 12 to 17 in 2005, a decline from 83.0 percent in 2004. Past month rates of use of any illicit drug, marijuana, any illicit drug other than marijuana, alcohol, and binge alcohol among those reporting no exposure to drug or alcohol prevention messages outside of school were all similar to rates among those who reported that they had seen prevention messages outside of school. Past month cigarette use showed a significant difference (12.6 percent among those who had not been exposed vs. 10.3 percent among those who had).
Parental Involvement
Youths aged 12 to 17 were asked a number of questions related to the extent of support, oversight, and control that they perceived their parents exercised over them in the year prior to the survey. In 2005, among youths aged 12 to 17 enrolled in school in the past year, 79.2 percent reported that in the past year their parents always or sometimes checked on whether or not they had completed their homework, 79.5 percent reported that their parents always or sometimes provided help with their homework, and 68.7 percent reported that their parents limited the amount of time that they spent out with friends on school nights. Also in 2005, among all youths aged 12 to 17, 87.5 percent reported that in the past year their parents made them always or sometimes do chores around the house, 38.6 percent reported that their parents limited the amount of time that they watched television, and 85.9 percent reported that their parents always or sometimes let them know that they had done a good job. All of these percentages were similar to those for 2004 with the exception of the percentage reporting that their parents provided help with homework, which had declined from the 80.8 percent that had been reported in 2004.
In 2005, past month use of any illicit drug, cigarettes, and alcohol was lower among youths aged 12 to 17 who reported that their parents always or sometimes engaged in monitoring behaviors than among youths whose parents "seldom" or "never" engaged in such behaviors. For example, the rate of past month use of any illicit drug was 8.1 percent for youths whose parents always or sometimes helped with homework compared with 17.4 percent among youths who indicated that their parents seldom or never helped. Rates for current cigarette smoking were 9.3 and 17.7 percent for the two groups of youths, respectively, and rates of past month alcohol use were 14.5 versus 27.2 percent.
2005
National Survey on Drug
Use & Health: National Results
7. Substance Dependence, Abuse, and Treatment
The National Survey on Drug Use and Health (NSDUH) includes a series of questions to assess the prevalence of substance use disorders (i.e., dependence on or abuse of a substance) in the past 12 months. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, and inhalants, and the nonmedical use of prescription-type psychotherapeutic drugs. These questions are used to classify persons as 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 associated with substance use, unsuccessful attempts to cut down on use, tolerance, withdrawal, reducing other activities to use substances, spending a lot of time engaging in activities related to substance use, or using the substance in greater quantities or for a longer time than intended. 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 is considered to be a more severe substance use problem than abuse because it involves the psychological and physiological effects of tolerance and withdrawal. Although individuals may meet the criteria specified for both dependence and abuse, persons meeting the criteria for both are classified as having dependence, but not abuse. Persons defined with abuse do not meet the criteria for dependence.
This chapter provides estimates of the prevalence and patterns of substance use disorders occurring in the past year from the 2005 NSDUH and compares these estimates against the results from the 2002, 2003, and 2004 surveys. It also provides estimates of the prevalence and patterns of the receipt of treatment in the past year 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 or Abuse
In 2005, an estimated 22.2 million persons aged 12 or older were classified with substance dependence or abuse in the past year (9.1 percent of the population aged 12 or older) (Figure 7.1). Of these, 3.3 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.6 million were dependent on or abused illicit drugs but not alcohol, and 15.4 million were dependent on or abused alcohol but not illicit drugs.
Figure 7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Between 2002 and 2005, there was no change in the number of persons with substance dependence or abuse (22.0 million in 2002, 21.6 million in 2003, 22.5 million in 2004, and 22.2 million in 2005).
There were 18.7 million persons aged 12 or older classified with dependence on or abuse of alcohol in 2005 (7.7 percent). This estimate has remained stable since 2002.
The specific illicit drugs that had the highest levels of past year dependence or abuse in 2005 were marijuana, followed by cocaine and pain relievers. Of the 6.8 million persons aged 12 or older classified with dependence on or abuse of illicit drugs, 4.1 million were dependent on or abused marijuana in 2005 (Figure 7.2). This number represents 1.7 percent of the total population aged 12 or older and 59.9 percent of all those classified with illicit drug dependence or abuse. There were 1.5 million persons who were classified with dependence on or abuse of cocaine, about the same as the number classified with dependence on or abuse of pain relievers.
Figure 7.2 Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2005
There were no changes between 2002 and 2005 in the percentages of persons with dependence on or abuse of illicit drugs (3.0 percent in 2002, 2.9 percent in 2003, 3.0 percent in 2004, and 2.8 percent in 2005) and dependence on or abuse of alcohol (7.7 percent in 2002, 7.5 percent in 2003, 7.8 percent in 2004, and 7.7 percent in 2005). However, there was a decrease in the rate of dependence on or abuse of marijuana from 2004 to 2005 (1.9 to 1.7 percent).
Age at First Use
In 2005, among adults aged 18 or older who first tried marijuana at age 14 or younger, 13.3 percent were classified with illicit drug dependence or abuse, higher than the 2.4 percent of adults who had first used marijuana at age 18 or older.
Among adults, there was an association between age at first use of alcohol and dependence on or abuse of alcohol in 2005. Among adults aged 18 or older who first tried alcohol at age 14 or younger, 17.8 percent were classified with alcohol dependence or abuse compared with only 3.9 percent of adults who had first used alcohol at age 18 or older. Adults aged 21 or older who had first used alcohol before age 21 also were more likely than adults who had their first drink at age 21 or older to be classified with alcohol dependence or abuse (9.6 vs. 2.1 percent) (Figure 7.3).
Figure 7.3 Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or Older, by Age at First Use of Alcohol: 2005
Rates of substance dependence or abuse were associated with age. In 2005, young adults aged 18 to 25 had higher rates of substance dependence or abuse (21.8 percent) than youths aged 12 to 17 (8.0 percent) and adults aged 26 or older (7.1 percent). Among persons with substance dependence or abuse, the proportion dependent on or abusing illicit drugs was associated with age in 2005: 58.2 percent of youths aged 12 to 17, 38.6 percent of young adults aged 18 to 25, and 22.3 percent of adults aged 26 or older with substance dependence or abuse were dependent on or abused illicit drugs.
Among youths aged 12 to 17, the rate of substance dependence or abuse decreased between 2004 and 2005 from 8.8 to 8.0 percent. This decline was driven by a decrease in the rate of illicit drug dependence or abuse among youths aged 12 to 17 (5.3 to 4.7 percent). The rates of alcohol dependence or abuse were 6.0 percent in 2004 and 5.5 percent in 2005, but this was not a statistically significant change.
Gender
As was the case from 2002 through 2004, males aged 12 or older in 2005 were about twice as likely to be classified with substance dependence or abuse as females (12.0 vs. 6.4 percent) (Figure 7.4). Among youths aged 12 to 17, however, the rate of substance dependence or abuse among males was similar to the rate among females (7.8 vs. 8.3 percent).
Figure 7.4 Substance Dependence or Abuse in the Past Year, by Age and Gender: 2005
There was a decrease in the rate of illicit drug dependence or abuse among males aged 12 or older from 3.9 percent in 2004 to 3.5 percent in 2005. The rate for females did not change between 2004 and 2005 (2.2 vs. 2.1 percent).
Race/Ethnicity
In 2005, among persons aged 12 or older, the rate of substance dependence or abuse was highest among American Indians or Alaska Natives (21.0 percent) and lowest among Asians (4.5 percent). Other racial/ethnic groups reported generally similar rates: Native Hawaiians or Other Pacific Islanders (11.0 percent), persons reporting two or more races (10.9 percent), whites (9.4 percent), Hispanics (9.3 percent), and blacks (8.5 percent). These rates were all similar to the rates seen in 2004.
Education/Employment
Rates of substance dependence or abuse were associated with level of education in 2005. Among adults aged 18 or older, those who graduated from high school but did not attend any college and those who graduated from college had lower rates of dependence or abuse (9.0 and 8.0 percent, respectively) than those who were not high school graduates and those with some college (10.2 and 10.3 percent, respectively).
Rates of substance dependence or abuse were associated with current employment status in 2005. A higher percentage of unemployed adults aged 18 or older were classified with dependence or abuse (17.6 percent) than were full-time employed adults (10.2 percent) and part-time employed adults (11.2 percent).
Most adults aged 18 or older with substance dependence or abuse in 2005 were employed either full or part time. Of the 20.2 million adults classified with dependence or abuse, 15.5 million (76.7 percent) were employed.
Criminal Justice Populations
In 2005, adults aged 18 or older who were on parole or a supervised release from jail during the past year were more likely to be classified with dependence on or abuse of a substance (33.7 percent) than those who were not on parole or supervised release during the past year (9.1 percent).
In 2005, probation status was associated with substance dependence or abuse. The rate of substance dependence or abuse was 37.2 percent among adults who were on probation during the past year, which is significantly higher than the rate among adults who were not on probation during the past year (8.7 percent).
Geographic Area
Rates of substance dependence or abuse in 2005 for persons aged 12 or older showed evidence of differences by region. The rates were 9.7 percent in the West, 9.6 percent in the Midwest, 8.8 percent in the South, and 8.5 percent in the Northeast.
In 2005, among persons aged 12 or older, the rate for substance dependence or abuse was 9.0 percent in large metropolitan counties, 9.9 percent in small metropolitan counties, and 8.2 percent in nonmetropolitan counties.
7.2. Past Year Treatment for a Substance Use Problem
Estimates described in this section refer to treatment received to reduce or stop illicit 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 a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous. Persons could report receiving treatment at more than one location. Note that the definition of treatment in this section is different from the definition of specialty treatment described in Section 7.3. Specialty treatment only includes treatment at a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or a mental health center.
Individuals who reported receiving substance use treatment but were missing information on whether the treatment was specifically for alcohol use or illicit drug use were not counted in estimates of illicit drug use treatment or in estimates of alcohol use treatment; however, they were counted in estimates for "drug or alcohol use" treatment.
There were 3.9 million persons aged 12 or older (1.6 percent of the population) who received some kind of treatment for a problem related to the use of alcohol or illicit drugs in 2005. Of these, 1.5 million received treatment for the use of both alcohol and illicit drugs, 0.7 million received treatment for the use of illicit drugs but not alcohol, and 1.3 million received treatment for the use of alcohol but not illicit drugs. (Note that estimates by substance do not add to the total number of persons receiving treatment because the total includes persons who reported receiving treatment but did not report for which substance the treatment was received.)
Between 2004 and 2005, there was no statistically significant change in the number or percentage of the population receiving substance use treatment within the past year (3.8 million, 1.6 percent in 2004; 3.9 million, 1.6 percent in 2005).
Location of Treatment and Substance Treated
In 2005, among the 3.9 million persons aged 12 or older who received treatment for alcohol or illicit drug use in the past year, more than half (2.1 million) received treatment at a self-help group (Figure 7.5). There were 1.5 million persons who received treatment at a rehabilitation facility as an outpatient, 1.1 million at a rehabilitation facility as an inpatient, 1.0 million at a mental health center as an outpatient, 773,000 at a hospital as an inpatient, 460,000 at a private doctor's office, 399,000 at an emergency room, and 344,000 at a prison or jail. None of these estimates changed significantly between 2004 and 2005.
Figure 7.5 Locations Where Past Year Substance Use Treatment Was Received among Persons Aged 12 or Older: 2005
More than half (2.5 million) of the 3.9 million persons who received treatment for a substance use problem in the past year received treatment for alcohol use during their most recent treatment. There were 1.1 million persons who received treatment for marijuana use during their most recent treatment. Estimates for other drugs were 797,000 persons for cocaine, 466,000 for pain relievers, 358,000 for hallucinogens, 351,000 for stimulants, and 326,000 for heroin. (Note that respondents could indicate that they received treatment for more than one substance during their most recent treatment.)
7.3. Need and Receipt of Specialty Treatment
This section discusses the need for and receipt of treatment for a substance use problem at a "specialty" treatment facility. Specialty treatment is defined as treatment received at any of the following types of facilities: hospitals (inpatient only), drug or alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers. It does not include 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 use problem if he or she met the DSM-IV (APA, 1994) diagnostic criteria for dependence on or abuse of alcohol or illicit drugs in the past 12 months or if he or she received specialty treatment for alcohol use or illicit drug use in the past 12 months.
In this section (7.3), an individual needing treatment for an illicit drug use problem is defined as receiving treatment for his or her drug use problem only if he or she reported receiving specialty treatment for drug use in the past year. Thus, an individual who needed treatment for illicit drug use but only received specialty treatment for alcohol use in the past year or who received treatment for illicit drug use only at a facility not classified as a specialty facility was not counted as receiving treatment for drug use. Similarly, an individual who needed treatment for an alcohol use problem was only counted as receiving alcohol use treatment if the treatment was received for alcohol use at a specialty treatment facility. Individuals who reported receiving specialty substance use treatment but were missing information on whether the treatment was specifically for alcohol use or drug use were not counted in estimates of specialty drug use treatment or in estimates of specialty alcohol use treatment; however, they were counted in estimates for "drug or alcohol use" treatment.
In addition to questions about symptoms of substance use problems that are used to classify respondents' need for treatment based on DSM-IV criteria, NSDUH includes questions asking respondents about their perceived need for treatment (i.e., whether they felt they needed treatment or counseling for illicit drug use or alcohol use). In this report, estimates for felt need for treatment are only discussed for persons who were classified as needing treatment (based on DSM-IV criteria) but did not receive treatment at a specialty facility. Similarly, estimates for whether a person made an effort to get treatment are only discussed for persons who felt the need for treatment.
Illicit Drug or Alcohol Use Treatment and Treatment Need
In 2005, the number of persons aged 12 or older needing treatment for an illicit drug or alcohol use problem was 23.2 million (9.5 percent of the population aged 12 or older) (Figure 7.6). Of these, 2.3 million (0.9 percent of persons aged 12 or older and 10.0 percent of those who needed treatment) received treatment at a specialty facility. Thus, there were 20.9 million persons (8.6 percent of the population aged 12 or older) who needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty substance abuse facility in the past year.
Figure 7.6 Need for and Receipt of Specialty Treatment in the Past Year for Illicit Drug or Alcohol Use among Persons Aged 12 or Older: 2005
The number of persons needing treatment for a substance use problem in 2005 (23.2 million) was not statistically different from the numbers reported since 2002. Similarly, the number of persons needing but not receiving treatment in 2005 (20.9 million) was similar to the numbers since 2002. The number of persons receiving specialty treatment in 2005 was essentially the same as the estimates in 2004 and 2002 (2.3 million in these 3 years), but it was higher than the number in 2003 (1.9 million).
Of the 2.3 million people aged 12 or older who received specialty substance use treatment, 748,000 persons received treatment for both alcohol and illicit drug use, 878,000 received treatment for alcohol use only, and 532,000 received treatment for illicit drug use only.
In 2005, among persons who received their last or current substance use treatment at a specialty facility in the past year, 45.3 percent reported using their "own savings or earnings" as a source of payment for their most recent specialty treatment. In addition, 31.9 percent reported using private health insurance, 27.9 percent reported using public assistance other than Medicaid, 24.3 percent reported using Medicaid, 23.4 percent reported relying on family members, and 20.8 percent reported using Medicare. (Note that persons could report more than one source of payment.)
In 2005, more than half of the 2.3 million persons aged 12 or older who received specialty substance use treatment in the past year also received treatment at a self-help group (1.4 million persons). In addition, among those who received specialty substance use treatment, 361,000 persons received treatment at an emergency room, 254,000 received treatment at a private doctor's office, and 229,000 received treatment at a prison or jail.
Of the 20.9 million people in 2005 who were classified as needing substance use treatment but did not receive treatment at a specialty facility in the past year, 1.2 million persons (5.6 percent) reported that they felt they needed treatment for their illicit drug or alcohol use problem (Figure 7.7). Of these 1.2 million persons who felt they needed treatment, 296,000 (25.5 percent) reported that they made an effort to get treatment, and 865,000 (74.5 percent) reported making no effort to get treatment.
Figure 7.7 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2005
Note: Due to rounding, these percentages do not add to 100 percent.
The number of people who felt they needed treatment and made an effort to get it among those who needed but did not receive treatment was not statistically different in 2005 (296,000) from the number reported in 2004 (441,000).
In 2005, there were 2.1 million youths aged 12 to 17 (8.3 percent of this population) who needed treatment for an illicit drug or alcohol use problem. Of this group, only 181,000 youths received treatment at a specialty facility (8.6 percent of youths who needed treatment), leaving 1.9 million youths who needed treatment for a substance use problem but did not receive it at a specialty facility.
Between 2004 and 2005, there was a decrease in the number and percentage of youths aged 12 to 17 who needed treatment for an alcohol or illicit drug use problem: 2.3 million in 2004 (9.1 percent) compared with 2.1 million in 2005 (8.3 percent).
Based on 2004-2005 combined data, the five most often reported reasons for not receiving illicit drug or alcohol use treatment among persons who needed but did not receive treatment at a specialty facility and felt they needed treatment were (a) not ready to stop using (37.9 percent), (b) cost or insurance barriers (35.1 percent), (c) stigma (e.g., negative opinions from neighbors and community, negative effect on job) (23.9 percent), (d) did not know where to go for treatment (14.3 percent), and (e) other access barriers (e.g., no transportation, no openings in programs) (13.4 percent).
Based on 2004-2005 combined data, among persons who needed but did not receive illicit drug or alcohol use treatment, felt they needed treatment, and made an effort to receive treatment, the four most often reported reasons for not receiving treatment were (a) cost or insurance barriers (44.4 percent), (b) other access barriers (21.2 percent), (c) not ready to stop using (21.1 percent), and (d) stigma (18.5 percent) (Figure 7.8).
Figure 7.8 Reasons for Not Receiving Substance Use Treatment among Persons Aged 12 or Older Who Needed and Made an Effort to Get Treatment But Did Not Receive Treatment and Felt They Needed Treatment: 2004-2005 Combined
Persons who made no effort to receive treatment were more likely to report that they were not ready to stop using (45.3 percent) as a reason for not receiving treatment than persons who made an effort to receive treatment (21.1 percent) (2004-2005 combined data). Among those who made no effort to receive treatment, 26.3 percent reported stigma and 31.0 percent reported cost and insurance barriers as reasons for not receiving treatment.
Illicit Drug Use Treatment and Treatment Need
In 2005, the number of persons aged 12 or older needing treatment for an illicit drug use problem was 7.6 million (3.1 percent of the total population). Of these, 1.3 million (0.5 percent of the total population and 17.0 percent of the people who needed treatment) received treatment at a specialty facility for an illicit drug use problem in the past year. Thus, there were 6.3 million persons (2.6 percent of the total population) who needed treatment but did not receive treatment at a specialty facility for an illicit drug use problem in 2005 (Figure 7.6).
The number of persons needing but not receiving specialty treatment in the past year for an illicit drug use problem in 2005 (6.3 million) was essentially the same as the estimates in 2002 (6.3 million) and 2003 (6.2 million) and also was not statistically different from the estimate in 2004 (6.6 million). The number of persons needing treatment for illicit drug use in 2005 (7.6 million) was similar to the number needing treatment in 2004 (8.1 million), 2003 (7.3 million), and 2002 (7.7 million).
Of the 6.3 million people who needed but did not receive specialty treatment for illicit drug use in 2005, there were 601,000 (9.6 percent) who reported that they felt they needed treatment for their illicit drug use problem. Of the 601,000 persons who felt they needed treatment, 175,000 (29.1 percent) reported that they made an effort, and 426,000 (70.9 percent) reported making no effort to get treatment.
Among persons needing but not receiving treatment for an illicit drug use problem, the number who felt they needed treatment in 2005 (601,000) was similar to the number reported in 2004 (598,000), but it was higher than the numbers in 2003 (426,000) and 2002 (362,000) (Figure 7.9).
Figure 7.9 Number of Persons Aged 12 or Older Who Felt the Need for Illicit Drug Use Treatment among Those Needing But Not Receiving Specialty Treatment for an Illicit Drug Use Problem in the Past Year: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Among youths aged 12 to 17, there were 1.3 million (4.9 percent) who needed treatment for an illicit drug use problem in 2005. Of this group, only 142,000 received treatment at a specialty facility (11.3 percent of youths aged 12 to 17 who needed treatment), leaving 1.1 million youths who needed treatment but did not receive it at a specialty facility.
Among people who needed but did not receive illicit drug use treatment and felt they needed treatment (based on 2004-2005 combined data), the six most often reported reasons for not receiving treatment were (a) cost or insurance barriers (36.7 percent), (b) not ready to stop using (34.7 percent), (c) stigma (24.4 percent), (d) did not feel the need for treatment at the time or could handle the problem without treatment (16.3 percent), (e) did not know where to go for treatment (16.3 percent), and (f) other access barriers (16.1 percent).
Alcohol Use Treatment and Treatment Need
In 2005, the number of persons aged 12 or older needing treatment for an alcohol use problem was 19.4 million (8.0 percent of the population aged 12 or older). Of these, 1.6 million (0.7 percent of the total population and 8.4 percent of the people who needed treatment for an alcohol use problem) received alcohol use treatment at a specialty facility. Thus, there were 17.8 million people who needed treatment but did not receive treatment at a specialty facility for an alcohol use problem (Figure 7.6).
Between 2004 and 2005, there were no statistically significant changes in the number of persons needing or receiving treatment for an alcohol use problem.
Among the 17.8 million people who needed but did not receive treatment for an alcohol use problem in 2005, there were 641,000 (3.6 percent) who felt they needed treatment for their alcohol use problem. Of these, 154,000 (24.0 percent) made an effort but were unable to get treatment, and 487,000 (76.0 percent) did not make an effort to get treatment.
In 2005, there were 1.5 million youths (5.8 percent) aged 12 to 17 who needed treatment for an alcohol use problem. Of this group, only 119,000 received treatment at a specialty facility (0.5 percent of all youths and 8.1 percent of youths who needed treatment), leaving 1.3 million youths who needed but did not receive treatment.
2005
National Survey on Drug
Use & Health: National Results
8. Prevalence and Treatment of Mental Health Problems
This chapter presents findings on mental health problems in the United States, including the prevalence and treatment of serious psychological distress (SPD) and major depressive episode (MDE) and the association of these problems with substance use and substance dependence or abuse (substance use disorder).
SPD is an overall indicator of past year nonspecific psychological distress that is constructed from the K6 scale administered to adults aged 18 or older in the National Survey on Drug Use and Health (NSDUH). The K6 scale consists of six questions that gather information on 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. Responses to these six questions are combined to produce a score ranging from 0 to 24, where a score of 13 or greater is considered SPD. This cutoff is based on research suggesting that scores above this threshold indicate a high probability of having serious mental illness. The questions used to measure SPD and the scoring algorithm are included in Section B.4.4 of Appendix B.
The data related to SPD in this report are not comparable with data in previous reports due to changes in the survey administration of this instrument. In the 2001-2003 NSDUHs, the K6 was embedded in a module that had survey questions addressing a variety of mental health-related symptoms. The 2004 NSDUH employed a split-sample design in which approximately half of the adult respondents (sample A) were administered the K6 questions as it was administered in prior years of the survey. The other half of the adult respondents (sample B) were administered only the K6 questions without other mental health symptom questions in the module. Analyses comparing sample A and sample B data found significant differences in the reporting of the K6 items. In 2005, the full sample of adults were surveyed using the K6 as a stand-alone instrument (i.e., as in sample B in 2004). The 2004 NSDUH report showed trends in SPD from 2002 to 2004 using the A sample for 2004 estimates. In this report, 2005 SPD data are compared only with the 2004 sample B data, for which the questions were administered similarly.
In 2005, adults also were administered a module of questions to measure lifetime and past year prevalence of MDE, the severity of MDE as measured by role impairment, and treatment received specifically for depression. A similar set of questions on MDE also was administered to the full sample of youths aged 12 to 17. Some questions in the adolescent depression module were slightly modified to make them more appropriate for youths. For example, "lost interest" in the adult module was changed to "lost interest and became bored." Adult and youth depression estimates are presented separately in this chapter because of differences in the modules.
MDE is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had symptoms that met the criteria for major depressive disorder as described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994). It should be noted that no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders.
Although there is substantial overlap in the populations classified with SPD and MDE, there are important distinctions between the definitions of the two. Meeting the criteria for SPD indicates that the respondent exhibited a high level of distress due to any type of mental problem, which may include general symptoms related to phobia, anxiety, or depression. However, meeting the criteria for MDE indicates that the respondent had the specific physical and emotional symptom profile indicative of major depression. The questions used to measure MDE and role impairment and the scoring algorithm for these responses are included in Section B.4.5 of Appendix B.
This chapter also presents data on the receipt of treatment for any type of mental health problem among adults and adolescents. This may be different from the treatment received specifically for MDE, and it is possible for a respondent to have indicated receipt of treatment for depression without having indicated that he or she received treatment for any mental health problems. Different questions and definitions of treatment and counseling are used for adults and youths. Treatment for adults is defined as the receipt of treatment or counseling for any problem with emotions, "nerves," or mental health in the past year in any inpatient or outpatient setting or the use of prescription medication for a mental or emotional condition. 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, or from other outpatient or inpatient settings within the past year. Both the youth and the adult questions specifically exclude treatment for problems with substance use, which is asked about elsewhere in the interview. Estimates of unmet need for treatment are reported separately for all adults and for adults with SPD. Unmet need is defined using a question in the 2005 NSDUH that asks whether the respondent perceived a need for mental health treatment or counseling at any time in the 12 months prior to the interview but did not receive it.
It is important to note that because the survey covers only the U.S. civilian, noninstitutionalized population, persons who were residing in long-term psychiatric or other institutions at the time of interview were excluded from the NSDUH sample.
8.1 Adults Aged 18 or Older
Prevalence of Serious Psychological Distress
In 2005, there were an estimated 24.6 million adults aged 18 or older in the United States with SPD in the past year. This represents 11.3 percent of all adults in this country, a significantly lower rate compared with the rate of 12.2 percent in 2004 (Figure 8.1).
Figure 8.1 Rates of Serious Psychological Distress in the Past Year among Adults Aged 18 or Older, by Age: 2004-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Rates of SPD in 2005 were highest for adults aged 18 to 25 (18.6 percent) and lowest for adults aged 50 or older (7.1 percent).
The prevalence of SPD among women aged 18 or older (14.0 percent) was higher than that among men in that age group (8.4 percent).
In 2005, rates of past year SPD were lowest among Asians at 7.2 percent. Rates for other racial/ethnic groups were 10.7 percent among blacks, 11.4 percent among whites, 11.7 percent among Hispanics, 16.8 percent among persons reporting two or more races, and 21.1 percent among American Indians or Alaska Natives.
Serious Psychological Distress and Substance Use and Dependence or Abuse
In 2005, adults who used illicit drugs in the past year were significantly more likely to have SPD compared with adults who did not use an illicit drug (22.0 vs. 9.6 percent).
Past year illicit drug use was higher among adults with SPD (26.9 percent) than among adults without SPD (12.1 percent). Similarly, the rate of past month cigarette use was higher among adults with SPD (42.8 percent) than among adults without SPD (24.5 percent).
The rate of heavy alcohol use (drinking five or more drinks on the same occasion [i.e., at the same time or within a couple of hours of each other] on each of 5 or more days in the past 30 days) among adults with SPD in the past year was higher (9.4 percent) than the rate reported among adults without SPD in the past year (6.8 percent). Similarly, among adults with SPD, the rate of binge alcohol use (drinking five or more drinks on the same occasion on at least 1 day in the past 30 days) was 28.9 percent, higher than the 23.5 percent among adults who did not meet the criteria for SPD.
SPD in the past year was associated with past year substance dependence or abuse in 2005. Among adults with SPD in 2005, 21.3 percent (5.2 million) were dependent on or abused illicit drugs or alcohol. The rate among adults without SPD was 7.7 percent (14.9 million).
In 2005, fewer men who were dependent on or abused illicit drugs met the criteria for SPD than women who were dependent on or abused illicit drugs (28.1 vs. 54.0 percent).
Treatment and Unmet Need for Treatment among Adults with Serious Psychological Distress
Among the 24.6 million adults with SPD in 2005, 11.1 million (45.3 percent) received treatment for a mental health problem in the past year. This was a higher proportion than in 2004 (41.6 percent). Among adults with SPD, 39.4 percent received a prescription medication, 28.5 percent received outpatient treatment, and 4.6 percent received inpatient treatment for a mental health problem in the past year.
In 2005, among adults with SPD in the past year who did not receive treatment and reported an unmet need for treatment, cost or insurance issues were the most frequently reported reason for not obtaining treatment (53.5 percent). Other reasons for not receiving treatment included not feeling a need for treatment at the time or believing that the problem could be handled without treatment (32.3 percent), stigma associated with treatment (26.2 percent), not knowing where to go for services (21.8 percent), and not having time (16.6 percent).
Treatment among Adults with Co-Occurring Serious Psychological Distress and Substance Use Disorders
Among the 5.2 million adults with both SPD and substance dependence or abuse (i.e., a substance use disorder) in 2005, about half (47.0 percent) received mental health treatment or substance use treatment at a specialty facility: 8.5 percent received both treatment for mental health problems and specialty substance use treatment, 34.3 percent received only treatment for mental health problems, and 4.1 percent received only specialty substance use treatment (Figure 8.2).
Figure 8.2 Past Year Treatment among Adults Aged 18 or Older with Both Serious Psychological Distress and a Substance Use Disorder: 2005
Note: Due to rounding, these percentages do not add to 100 percent.
Prevalence of Major Depressive Episode
In 2005, there were 30.8 million adults (14.2 percent of persons aged 18 or older) who had at least one MDE in their lifetime, and 15.8 million adults (7.3 percent of persons aged 18 or older) had at least one MDE in the past year. In 2004, there were 17.1 million adults (8.0 percent) who had at least one MDE during the past year. This represents a statistically significant decline in the rate of past year MDE between 2004 and 2005.
The lifetime prevalence of MDE was 15.7 percent among persons aged 18 to 25, 16.0 percent among persons aged 26 to 49 and, 11.6 percent among persons aged 50 or older.
The past year prevalence of MDE was highest for adults aged 18 to 25 (9.7 percent) and lowest for those aged 50 or older (5.1 percent).
The past year prevalence of MDE was higher among adult females than among adult males (9.3 vs. 5.2 percent).
Among adults, past year prevalence of MDE was associated with race/ethnicity in 2005. The rate of MDE among persons aged 18 or older was lowest among Asians (3.6 percent). Rates for other groups were 10.1 percent among persons reporting two or more races, 9.4 percent among American Indians or Alaska Natives, 7.6 percent among whites, 7.0 percent among Hispanics, and 6.5 percent among blacks (Figure 8.3).
Figure 8.3 Major Depressive Episode in the Past Year among Adults Aged 18 or Older, by Race/Ethnicity: 2004-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Note: Due to low precision, estimates for Native Hawaiians or Other Pacific Islanders are not shown.
Among adults aged 18 or older, past year prevalence of MDE was higher among unemployed persons (14.4 percent) than among persons employed full time (6.3 percent), persons not in the labor force (8.0 percent), and persons employed part time (8.2 percent).
Major Depressive Episode and Substance Use and Dependence or Abuse
In 2005, adults with MDE in the past year were more likely than those without MDE to have used an illicit drug in the past year (26.8 vs. 12.7 percent) (Figure 8.4). A similar pattern was observed for specific types of past year illicit drug use, such as marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutics.
Figure 8.4 Substance Use among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2005
Past month heavy alcohol use also was associated with MDE in the past year in 2005. Among persons with MDE in the past year, 8.4 percent were heavy alcohol users, higher than the 7.0 percent of persons without MDE in the past year. Similarly, among persons with MDE, the rate of daily cigarette use was 28.0 percent, while the rate was 16.3 percent among persons without MDE.
Having MDE in the past year was associated with past year substance dependence or abuse in 2005. Among adults who had MDE in 2005, 19.9 percent were dependent on or abused alcohol or illicit drugs, while among persons without MDE only 8.4 percent were dependent on or abused alcohol or illicit drugs. Adults with MDE were more likely than those without MDE to be dependent on or abuse illicit drugs (8.3 vs. 2.1 percent) and alcohol (14.8 vs. 7.4 percent).
Among adults aged 18 or older with substance dependence or abuse in the past year, 15.6 percent had at least one MDE in the past year, higher than the 6.4 percent who had at least one MDE in the past year among those who did not have substance dependence or abuse.
Treatment for Major Depressive Episode
Among adults aged 18 or older who had MDE in the past year, 65.6 percent received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression in the same time period.
In 2005, women who had MDE in the past year were more likely than men to receive treatment for depression in the past year (70.9 vs. 55.6 percent).
Among adults aged 18 or older with MDE in the past year, approximately half of those with no insurance (47.9 percent) received treatment for depression in the past year compared with higher rates for those with insurance: 67.4 percent of adults with MDE in the past year who had private insurance, 76.5 percent of adults with Medicaid or CHIP, and 79.6 percent of adults with other health insurance (including Medicare, CHAMPUS, TRICARE, CHAMPVA, VA, and other sources of health care or insurance) received treatment for depression in the past year.
Among adults with MDE in the past year who saw or talked to a health care professional in the past year for depression, 39.8 percent believed this treatment helped "a lot" or "extremely," and 32.0 percent believed this care helped "not at all" or "a little."
Among adults aged 18 or older with MDE in the past year, 53.1 percent who received prescription medication for depression in the past year believed that the medication had helped "a lot" or "extremely." This is significantly higher than the percentage of those who saw or talked to a medical doctor or other professional who believed that this treatment helped "a lot" or "extremely" (39.8 percent).
Treatment for Mental Health Problems and Unmet Treatment Need among All Adults
In 2005, there were 28.2 million adults who received treatment for mental health problems during the past 12 months. This represents 13.0 percent of the population 18 years or older and is similar to the rate in 2004 (12.8 percent).
The treatment type most often reported by the adult population in 2005 was prescription medication (10.7 percent), followed by outpatient treatment (6.8 percent) (Figure 8.5). About 2.1 million adults (1.0 percent) received inpatient care for mental health problems during the past year. These patterns of utilization were not significantly different from those seen in 2004.
Figure 8.5 Past Year Treatment for Mental Health Problems among Adults Aged 18 or Older, by Type of Treatment: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Rates of treatment for mental health problems were associated with age for adults aged 18 or older: 11.2 percent for adults aged 18 to 25, 13.9 percent for adults aged 26 to 49, and 12.5 percent for adults aged 50 or older.
Men were less likely than women to receive outpatient treatment (4.6 vs. 8.9 percent) and prescription medication (7.0 vs. 14.1 percent) for mental health problems in the past year. There was no gender difference in the rates of inpatient treatment (0.9 vs. 1.1 percent) in 2005.
Among racial/ethnic groups, the rates of treatment for adults in 2005 were 15.4 percent for American Indians or Alaska Natives, 15.1 percent for whites, 14.4 percent for persons reporting two or more races, 8.9 percent for blacks, 7.8 percent for Hispanics, and 4.0 percent for Asians.
In 2005, there were 11.2 million adults aged 18 or older (5.1 percent) who reported an unmet need for treatment or counseling for mental health problems in the past year. This included 5.7 million adults who did not receive mental health treatment. Among the 5.5 million adults who did receive treatment or counseling for a mental health problem in the past year, 19.4 percent reported an unmet need. (Unmet need among adults who received treatment may reflect a delay in treatment or a perception of insufficient treatment.)
Among the 5.7 million adults who reported an unmet need for treatment or counseling for mental health problems and did not receive treatment in the past year, several barriers to treatment were reported. These included cost or insurance issues (46.8 percent), not feeling a need for treatment at the time or believing that the problem could be handled without treatment (36.7 percent), stigma associated with treatment (23.4 percent), and not knowing where to go for services (18.5 percent) (Figure 8.6).
Figure 8.6 Reasons for Not Receiving Treatment in the Past Year among Adults Aged 18 or Older with an Unmet Need for Treatment Who Did Not Receive Treatment: 2005
In 2005, there were 3.4 million youths aged 12 to 17 years (13.7 percent of the population aged 12 to 17 years old) who had at least one MDE in their lifetime and 2.2 million youths (8.8 percent) who had MDE during the past year.
Among youths, the past year prevalence of MDE ranged from 4.3 percent among 12 year olds to 11.2 percent among those aged 16 and 11.9 percent among those aged 17.
The rate of MDE in the past year was higher for adolescent females (13.3 percent) than for adolescent males (4.5 percent).
Among youths, 9.1 percent of Hispanics had MDE in the past year, similar to the rate for non-Hispanic youths (8.7 percent) (Figure 8.7). Among 12 to 17 year olds, youths who reported two or more races had the highest prevalence of lifetime MDE (19.0 percent) in 2005.
Figure 8.7 Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Race/Ethnicity: 2004-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
Note: Due to low precision, estimates for Native Hawaiians or Other Pacific Islanders are not shown.
Major Depressive Episode and Substance Use
Among 12 to 17 year olds who had past year MDE, 38.0 percent had used illicit drugs during the same period (Figure 8.8). This was significantly more than the 18.0 percent of youths who did not have past year MDE who used illicit drugs during the past year. This pattern was similar for specific types of illicit drug use, including marijuana, cocaine, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutics.
Figure 8.8 Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2005
In 2005, youths who had MDE during the past year were more likely to report daily cigarette use in comparison with those who did not have MDE during the past year (5.3 vs. 2.5 percent).
The occurrence of MDE in the past year among youths aged 12 to 17 was associated with a higher prevalence of illicit drug or alcohol dependence or abuse (19.8 percent). Among youths who did not report past year MDE, 6.9 percent had illicit drug or alcohol dependence or abuse during the same period.
Among youths with past year dependence on or abuse of illicit drugs or alcohol, 21.7 percent had at least one MDE in the past year, higher than the 7.7 percent with MDE in the past year among adolescents with no past year dependence or abuse.
Treatment for Major Depressive Episode
In 2005, 37.8 percent of youths aged 12 to 17 with past year MDE received treatment for depression (saw or talked to a medical doctor or other professional or used prescription medication). Among youths with past year MDE, 20.5 percent saw or talked to a medical doctor or other professional only, 2.6 percent used prescription medication only, and 14.4 percent received treatment from both sources for depression in the past year.
Among persons aged 12 to 17 who received specialty treatment for illicit drug or alcohol use in the past year, 19.1 percent had MDE during the year. This is significantly higher than the percentage of youths with MDE in the past year who did not receive specialty treatment (8.7 percent).
Among youths aged 12 to 17 in 2005 with MDE during the past year who saw or talked to a medical doctor or other professional for depression, 41.6 percent believed that this treatment helped "not at all" or "a little." In addition, 34.0 percent believed that this treatment was "a lot of help" or "extremely helpful."
In 2005, among youths aged 12 to 17 with MDE in the past year who received prescription medication for depression, 28.7 percent believed that the prescription medication helped "not at all" or "a little." Nearly half of youths with MDE in the past year (47.2 percent) who received prescription medication for depression in the past year reported the medication was "a lot of help" or "extremely helpful."
Mental Health Treatment among Youths
In 2005, there were 5.5 million youths aged 12 to 17 (21.8 percent) who received treatment or counseling for emotional or behavior problems in the year prior to the interview. Adolescent females were more likely than adolescent males to report past year treatment for mental health problems (23.6 vs. 20.0 percent) (Figure 8.9).
Figure 8.9 Past Year Treatment for Mental Health Problems among Youths Aged 12 to 17, by Gender: 2002-2005
+ Difference between estimate and the 2005 estimate is statistically significant at the .05 level.
The rate of treatment for mental health problems among youths aged 12 to 17 who used illicit drugs in the past year (32.0 percent) was higher than the rate among youths who did not use illicit drugs (19.3 percent).
The rate of illicit drug use in the past year was higher among youths who received mental health treatment or counseling in the past year than among those who did not (29.1 vs. 17.2 percent). This pattern also was observed for marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutics.
Youths aged 12 to 17 who received mental health treatment or counseling in the past year were more likely to use alcohol in the past year than those who did not receive treatment or counseling (39.7 vs. 31.5 percent). Youths receiving mental health treatment or counseling in the past year also were more likely to have smoked cigarettes in the past year (25.8 vs. 14.9 percent).
In 2005, among youths who received mental health treatment or counseling in the past year, 14.2 percent were dependent on or abused illicit drugs or alcohol in the past year, higher than the 6.3 percent who did not receive treatment or counseling.
2005
National Survey on Drug
Use & Health: National Results
9. Discussion of Trends in Substance Use among Youths and Young Adults
This report presents findings from the 2005 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 through 2005 estimates are not comparable with estimates from 2001 and earlier surveys. Therefore, the primary focus of the report is on comparisons of measures of substance use and mental health problems across subgroups of the U.S. population in 2005 and changes between 2004 and 2005, as well as between 2002 and 2005. This chapter provides an additional discussion of the findings concerning a topic of great interest—trends in substance use among youths and young adults.
NSDUH shows declines from 2002 to 2005 among youths aged 12 to 17 for past month rates of use (i.e., current use) of alcohol, cigarettes, marijuana, hallucinogens (such as Ecstasy and LSD), and the nonmedical use of prescription-type psychotherapeutic drugs. The past month use of cocaine and inhalants, however, showed no change among youths during that time period. Among young adults aged 18 to 25, the rates of current use of alcohol and marijuana were similar in 2002 and 2005. Cigarette use and Ecstasy use declined among young adults, but cocaine use and nonmedical use of prescription drugs increased.
An important step in the analysis and interpretation of NSDUH or any other survey data is to compare the results with those from other data sources. This can be difficult sometimes because the other surveys typically have different purposes, definitions, and designs. 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 about trends and patterns of use, 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 sources of substance use and mental health data.
Unfortunately, few additional data sources 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). MTF surveys students in the 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 participated earlier in the study as 12th graders (Johnston, O'Malley, Bachman, & Schulenberg, 2006a). Historically, NSDUH rates of substance use among youths have been lower than those of MTF, but the two sources usually have shown similar trends. NSDUH and MTF rates of substance use generally have been similar among young adults, and the two sources also have shown similar trends.
A comparison of NSDUH and MTF estimates for 2002 to 2005 is shown in Tables 9.1 and 9.2 for several substances that are defined similarly in the two surveys. MTF data on 8th and 10th graders combined give the closest match on age to NSDUH youth estimates, while MTF follow-up data on persons aged 19 to 24 provide the closest match on age to NSDUH young adult estimates. The NSDUH results are consistent with MTF trends. Both surveys show decreases between 2002 and 2005 in the percentages of youths using marijuana, Ecstasy, LSD, alcohol, and cigarettes in the lifetime, past year, and past month, with the exception of LSD in the past month for MTF and cigarettes in the past year for MTF for which an estimate is not available. Both surveys show no difference in the rates of past month cocaine and inhalant use among youths between 2002 and 2005. Data on young adults also show generally consistent trends in the two surveys for use of specific illicit drugs, as well as alcohol and cigarettes.
Table 9.1 Comparison of NSDUH and MTF Prevalence Estimates among Youths: 2002-2005
Substance/Time Period
NSDUH Ages 12-17
MTF 8th and 10th Grades
2002
2003
2004
2005
2002
2003
2004
2005
Marijuana
Lifetime
20.6a
19.6a
19.0a
17.4
29.0a
27.0
25.7
25.3
Past Year
15.8a
15.0a
14.5a
13.3
22.5a
20.5
19.7
19.4
Past Month
8.2a
7.9a
7.6a
6.8
13.1a
12.3a
11.2
10.9
Cocaine
Lifetime
2.7a
2.6
2.4
2.3
4.9
4.4
4.4
4.5
Past Year
2.1a
1.8
1.6
1.7
3.2
2.8
2.9
2.9
Past Month
0.6
0.6
0.5
0.6
1.4
1.1
1.3
1.3
Ecstasy
Lifetime
3.3a
2.4a
2.1a
1.6
5.5a
4.3a
3.6
3.4
Past Year
2.2a
1.3a
1.2
1.0
3.9a
2.6
2.1
2.2
Past Month
0.5a
0.4
0.3
0.3
1.6a
0.9
0.8
0.8
LSD
Lifetime
2.7a
1.6a
1.2
1.1
3.8a
2.8a
2.3
2.2
Past Year
1.3a
0.6
0.6
0.6
2.1a
1.5
1.4
1.4
Past Month
0.2a
0.2
0.2
0.1
0.7
0.6
0.6
0.6
Inhalants
Lifetime
10.5
10.7
11.0
10.5
14.4
14.3
14.9
15.1
Past Year
4.4
4.5
4.6
4.5
6.8a
7.1
7.8
7.8
Past Month
1.2
1.3
1.2
1.2
3.1
3.2
3.5
3.2
Alcohol
Lifetime
43.4a
42.9a
42.0a
40.6
57.0a
55.8a
54.1a
52.1
Past Year
34.6a
34.3
33.9
33.3
49.4a
48.3a
47.5a
45.3
Past Month
17.6a
17.7a
17.6a
16.5
27.5a
27.6a
26.9a
25.2
Cigarettes
Lifetime
33.3a
31.0a
29.2a
26.7
39.4a
35.7a
34.3a
32.4
Past Year
20.3a
19.0a
18.4a
17.3
--
--
--
--
Past Month
13.0a
12.2a
11.9a
10.8
14.2a
13.5a
12.6
12.1
-- Not available.
Note: MTF data for 8th and 10th graders are simple averages of estimates for those two grades. Data for 8th and 10th graders are reported in Johnston, O'Malley, Bachman, and Schulenberg (2006a). Design effects used for variance estimation are reported in Johnston, O'Malley, Bachman, and Schulenberg (2005c). a Difference between estimate and 2005 estimate is statistically significant at the .05 level.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, 2004, and 2005. University of Michigan, The Monitoring the Future Study, 2002, 2003, 2004, and 2005.
Table 9.2 Comparison of NSDUH and MTF Prevalence Estimates among Young Adults: 2002-2005
Substance/Time Period
NSDUH Ages 18-25
MTF Ages 19-24
2002
2003
2004
2005
2002
2003
2004
2005
Marijuana
Lifetime
53.8
53.9a
52.8
52.4
56.1
56.4
55.6
54.4
Past Year
29.8a
28.5
27.8
28.0
34.2a
33.0
31.6
31.4
Past Month
17.3
17.0
16.1
16.6
19.8a
19.9
18.2
17.0
Cocaine
Lifetime
15.4
15.0
15.2
15.1
12.9
14.5
14.3a
12.6
Past Year
6.7
6.6
6.6
6.9
6.5
7.3
7.8
6.9
Past Month
2.0a
2.2
2.1a
2.6
2.5
2.6
2.4
2.1
Ecstasy
Lifetime
15.1a
14.8a
13.8
13.7
16.0a
16.6
14.9a
12.4
Past Year
5.8a
3.7a
3.1
3.1
8.0a
5.3
3.3
3.4
Past Month
1.1a
0.7
0.7
0.8
1.6a
1.0
0.8
0.6
LSD
Lifetime
15.9a
14.0a
12.1a
10.5
13.9a
13.8
10.4a
7.9
Past Year
1.8a
1.1
1.0
1.0
2.4a
1.5
1.2
1.1
Past Month
0.1
0.2
0.3
0.2
0.4
0.2
0.2
0.2
Inhalants
Lifetime
15.7a
14.9a
14.0
13.3
11.7a
11.4
10.6
9.3
Past Year
2.2
2.1
2.1
2.1
2.2
1.5
2.3
1.6
Past Month
0.5
0.4
0.4
0.5
0.8a
0.3
0.4
0.3
Alcohol
Lifetime
86.7a
87.1a
86.2
85.7
88.4
87.6
87.2
87.1
Past Year
77.9
78.1
78.0
77.9
83.9
82.3
83.1
82.8
Past Month
60.5
61.4
60.5
60.9
67.7
66.3
67.3
66.8
Cigarettes
Lifetime
71.2a
70.2a
68.7a
67.3
--
--
--
--
Past Year
49.0a
47.6
47.5
47.2
41.8
40.8
41.4
40.2
Past Month
40.8a
40.2
39.5
39.0
31.4a
29.5
30.2
28.7
-- Not available.
Note: MTF data for persons aged 19 to 24 are simple averages of modal age groups 19-20, 21-22, and 23-24 as reported in Johnston, O'Malley, and Bachman (2003c) and Johnston, O'Malley, Bachman, and Schulenberg (2004a, 2005a,2006b).
Note: Significance testing was not performed between 2003 and 2005 MTF data. a Difference between estimate and 2005 estimate is statistically significant at the .05 level.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, 2004, and 2005.
University of Michigan, The Monitoring the Future Study, 2002, 2003, 2004, and 2005.
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