Highlights

This report on substance use is the first presenting State estimates from the 2001 National Household Survey on Drug Abuse (NHSDA). The report presents State estimates for 19 different measures related to substance use or mental health. Of those measures, 18 are based on an average for the combined years 2000 and 2001, while the remaining measure on mental health status only uses 2001 data. For each measure, States have been ranked and categorized into quintiles, or fifths, in order to simplify the discussion. In addition to State estimates of prevalence rates, the report also includes estimates of change between 1999–2000 and 2000–2001 for 12 measures that have consistent definitions for the years from 1999 through 2001. Combining 2 years of data to make comparisons improves precision in situations where changes are relatively small.

Illicit Drug Use (1999–2001)

Reflecting the significant increase at the national level between 2000 and 2001 in past month use of any illicit drug among all persons age 12 or older, 38 States had prevalence rates of any illicit drug use that were somewhat higher in 2000–2001 than in 1999–2000. Only six of those States displayed increases that were statistically significant. In order to measure change for the purpose of this report, statistical significance is assumed to be 0.10 or less. Arkansas increased from 5.4 to 6.7 percent; Illinois, from 6.3 to 7.2 percent; Maine, from 6.9 to 8.4 percent; New Hampshire, from 6.6 to 8.0 percent; New York, from 5.8 to 6.8 percent; and Vermont, from 8.5 to 10.5 percent. Most of these increases were driven by increases in the 18 to 25 age group. (Figure 2.1; Table s A.1 and B.1)
Massachusetts had the highest estimated rate (10.7 percent) of past month use of any illicit drug among persons age 12 or older. As was the case in 1999–2000, the highest rates occurred in the West and Northeast. The Northeastern States were all in New England: Massachusetts, Vermont, Maine, Rhode Island, and New Hampshire. The Western States included Colorado, Alaska, Oregon, and California. (Figure 2.1; Table B.1)
Marijuana is the most commonly used illicit substance by the population age 12 years or older. Eight States (Vermont, Massachusetts, Colorado, Alaska, Oregon, Maine, New Hampshire, and Rhode Island) ranked in the top fifth, meaning the highest rates, for past month marijuana use. These States also were in the top fifth for use of any illicit drug. Eight States showed significant increases when the 1999–2000 estimate is compared with the 2000–2001 estimate for past month use of marijuana among persons age 12 or older. Five of these States are the same States that had significant increases in current use of any illicit drug. Across all age groups, Delaware was the only State that displayed a significant decrease in marijuana use; the prevalence rate among youths age 12 to 17 dropped from 11.9 to 9.6 percent. (Figures 2.1, 2.5, and 2.6; Table s A.2, B.1, and B.2)
Vermont had the lowest rate of "perceived great risk" for monthly use of marijuana among the population 12 or older, both in 1999–2000 and in 2000–2001. Of the States with the lowest rates of perceived risk, 9 out of 10 ranked in the highest fifth for past month use of marijuana. Among all States, only Alaska showed any significant increase in perceived risk-from 32.4 to 35.8 percent among persons age 12 or older, and from 35.0 to 39.7 percent in the 26 or older age group. (Figures 2.5 and 2.9; Table s A.3, B.2, and B.3)
The highest rates of past year cocaine use among persons age 12 or older were found in New Mexico and Colorado (2.8 percent). Four Western States (New Mexico, Colorado, Arizona, and Nevada) ranked in the top fifth for past year use of cocaine for all three age groups: 12 to 17, 18 to 25, and 26 or older. Only Hawaii showed a significant change in any of the age groups-a decline from 1.5 to 0.8 percent among persons age 26 or older. (Figure 2.20; Table s A.6 and B.6)

Alcohol Use (1999–2001)

Nine States had significant increases in the percentage that used alcohol in the past month among persons age 12 or older between 1999–2000 and 2000–2001. Connecticut increased from 56.0 to 59.6 percent; the District of Columbia, from 44.9 to 50.2 percent; Maine, from 49.9 to 54.3 percent; Michigan, from 47.0 to 50.2 percent; Minnesota, from 53.8 to 58.4 percent; Rhode Island, from 53.1 to 58.0 percent; South Carolina, from 35.9 to 40.5 percent; Vermont, from 56.5 to 61.6 percent; and West Virginia, from 32.7 to 36.5 percent. Only Alaska had a significant decrease in alcohol use during the period for the 12 or older age group: from 52.9 to 49.4 percent. (Figure 3.1; Table s A.7 and B.7)
Vermont had the highest rate of all States for past month alcohol use (61.6 percent) among persons age 12 or older. With the exception of Delaware, most of the States that ranked in the top fifth for alcohol use were Northern States: Vermont, New Hampshire, Massachusetts, Wisconsin, Connecticut, Minnesota, Rhode Island, Colorado, and North Dakota. Also, Vermont, New Hampshire, Massachusetts, Wisconsin, Connecticut, and North Dakota were ranked in the top fifth for alcohol use for all three age groups (12 to 17, 18 to 25, and 26 or older). (Figures 3.1 to 3.4; Table B.7)
Utah reported the lowest prevalence of past month alcohol use among persons age 12 or older—28.9 percent. (Figure 3.1; Table B.7)
Prevalence rates of binge alcohol use ranged from a low of 14.2 percent in Utah to a high of 29.0 percent in North Dakota for persons age 12 or older. The District of Columbia was the only area that showed a significant increase in binge use of alcohol, from 18.9 to 22.0 percent for persons age 12 or older between 1999–2000 and 2000–2001. The District of Columbia, Idaho, and Maryland also displayed increases in the 18 to 25 age group, but there were no other significant increases among any of the States or the District of Columbia for any of the component age groups. Virginia was the only State to show a decrease in binge drinking (from 38.2 to 33.3 percent), this occurring in the 18 to 25 age group. (Figures 3.1, 3.5, and 3.6; Table s A.8, B.7, and B.8)
The District of Columbia's increase in past month binge use of alcohol was consistent with its significant decreases in the perceived risk of binge use of alcohol in the 18 to 25 age group, 26 or older age group, and the 12 or older age group. However, the District of Columbia still ranked among the States having the highest rates of perceived risk of binge use of alcohol in the Nation. (Figures 3.5, 3.9, and 3.10; Table s A.9, B.8, and B.9)

Tobacco Use (1999–2001)

Seven Southern States were ranked among the top fifth in past month tobacco use by persons age 12 or older. In this age group, Kentucky, one of the largest tobacco-producing States, ranked the highest at 38.7 percent; West Virginia was second at 37.5 percent. Utah had the lowest rate in the Nation for this age group—18.8 percent. (Figures 4.1 and 4.3; Table B.10)
Kentucky, Louisiana, West Virginia, Ohio, Tennessee, and Arkansas ranked in the top fifth both for past month use of tobacco and for past month use of cigarettes among persons age 12 or older. Three States had decreases in past month use of cigarettes between 1999–2000 and 2000–2001 among youths age 12 to 17: Arkansas, from 18.6 to 14.6 percent; Oregon, from 15.0 to 11.8 percent; and Pennsylvania, from 16.4 to 14.8 percent. The only other significant change was an increase in cigarette use in Rhode Island among those age 18 to 25 (from 37.3 to 42.7 percent). (Figures 4.1, 4.5, and 4.6; Table s A.11, B.10, and B.11)

Dependence on, or Abuse of, Alcohol or Illicit Drugs and Receipt of Treatment (2000–2001)

North Dakota had the highest rate (8.5 percent) of alcohol dependence or abuse in the 12 or older age group. Other high prevalence rates were found in Montana, District of Columbia, Massachusetts, Nebraska, New Mexico, South Dakota, Alaska, Rhode Island, and Colorado. North Carolina had the lowest rate at 4.2 percent. (Figure 5.1; Table B.13)
The highest rate of dependence on or abuse of illicit drugs among persons age 12 or older was found in Nevada and California (2.9 percent) and the lowest in Iowa (1.4 percent). The States with the highest rates for dependence on or abuse of alcohol were different from those with the highest rates of dependence on or abuse of illicit drugs. Only three States were in the top fifth for both measures: Massachusetts, New Mexico, and Colorado. (Figures 5.1 and 5.9; Table s B.13 and B.15)
California had the largest treatment gap (defined as the number of persons who needed treatment in the past year but did not receive treatment in a specialty substance abuse treatment facility) for the 12 or older population—2.7 percent. Iowa had the lowest treatment gap in this group—1.4 percent. Included in the top fifth were four Western States, three Northeastern States, and one Southern State. The lowest fifth included five Midwestern States, four Southern States, and two Northeastern States. (Figure 5.21; Table B.18)
California also had the greatest number of persons in need of but not receiving treatment in the Nation, approximately 708,000 persons age 12 or older, which was almost 16 percent of the total treatment gap for the Nation. Other States with a large number of persons in need of but not receiving treatment included New York (337,000), Texas (297,000), Florida (216,000), Illinois (206,000), Pennsylvania (163,000), Ohio (157,000), Massachusetts (131,000), Washington (115,000), and Georgia (113,000). Although the 12 to 25 age group represented only about 23 percent of the total population age 12 or older, nationally it included about 60 percent of all persons in the gap. (Table B.19)

Serious Mental Illness (SMI) (2001)

Questions relating to serious mental illness (SMI) were included for the first time in the 2001 NHSDA for adults age 18 or older. These questions focus on functional impairment and diagnosable mental, behavioral, or emotional disorders that meet criteria from the Diagnostic and Statistical Manual of Mental Disorders (4^th edition). This report is the first time that it has been possible to provide State estimates of this problem. Oklahoma had the highest rate of SMI in the Nation, 10.4 percent, and Hawaii had the lowest rate, 5.1 percent. The majority of States with the highest rates of SMI in the 18 or older population were in the South: Oklahoma, Kentucky, Georgia, West Virginia, Arkansas, and Louisiana. (Figure 6.1; Table B.20)
Although SMI is correlated at the individual level with the use of illicit drugs and cigarettes, the correlation of SMI and past month illicit drug use at the State level was small and negative, -0.18. Correlation at the State level of SMI and past month use of cigarettes was positive and larger, 0.31. The largest correlation of SMI with demographic information, at the State level, was the correlation of SMI and the 1999 per capita income (in 1,000s) obtained from the Bureau of Health Professions' 2002 Area Resource File, -0.53.