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Results from the 2007
National Survey on Drug Use and Health:
National Findings

 

 

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

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, Kimberly Ault, Ellen Bishop, Lisa Carpenter, Patrick Chen, James R. Chromy, Elizabeth Copello, David B. Cunningham, Lanting Dai, Teresa R. Davis, Ralph E. Folsom, Jr., Misty Foster, Peter Frechtel, G. G. Frick, Julia Gable, Jody M. Greene, Wafa Handley, David C. Heller, Erica Hirsch, Ilona Johnson, Lauren Klein, Larry A. Kroutil, Bing Liu, Mary Ellen Marsden, Katherine B. Morton, Breda Munoz, Scott Novak, Lisa E. Packer, Lanny Piper, Jeremy Porter, Heather Ringeisen, Tania Robbins, Harley Rohloff, Kathryn Spagnola, Thomas G. Virag (Project Director), Michael Vorburger, and Jiantong Wang. Contributors at SAMHSA listed alphabetically, with chapter authorship noted, include Peggy Barker, Jonaki Bose, James Colliver (Chapters 2 and 4), Lisa Colpe (Chapter 8), Joseph Gfroerer (Chapters 1 and 9), Beth Han (Chapters 6 and 7), Arthur Hughes (Project Officer), Joel Kennet (Chapter 3), Pradip Muhuri (Chapter 5), and Dicy Painter. Also at RTI, report and web production staff listed alphabetically include Teresa G. Bass, Wendy Broome, Cassandra M. Carter, Joyce Clay-Brooks, Diane G. Eckard, Shari B. Lambert, Danny Occoquan, Brenda K. Porter, Pamela Couch Prevatt, and Richard S. Straw. Final report production was provided by Beatrice 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, Office of Applied Studies (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD.

Electronic Access to Publication

This publication may be downloaded from http://oas.samhsa.gov.
Hard copies may be obtained from http://oas.samhsa.gov/copies.cfm.

Or please call SAMHSA's Health Information Network at:
1-877-SAMHSA-7 (1-877-726-4727)
(English and Español).

Originating Office

SAMHSA, Office of Applied Studies
1 Choke Cherry Road, Room 7-1044
Rockville, MD 20857

September 2008

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2007 National Survey on Drug Use & Health:  National Results

Table of Contents

Citation:

Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD.

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Cover
Acknowledgements

List of Figures
List of Tables

Highlights

1. Introduction
1.1. Summary of NSDUH
1.2. Trend Measurement
1.3. Change in Estimates for Psychotherapeutic Drugs and Stimulants
1.4. Format of Report and Explanation of Tables
1.5. Other NSDUH Reports and Data

2. Illicit Drug Use
Age
Youths Aged 12 to 17
Young Adults Aged 18 to 25
Adults Aged 26 or Older
Gender
Pregnant Women
Race/Ethnicity
Education
College Students
Employment
Geographic Area
Criminal Justice Populations
Frequency of Use
Association with Cigarette and Alcohol Use
Driving Under the Influence of Illicit Drugs
Source of Prescription Drugs

3. Alcohol Use
3.1. Alcohol Use among Persons Aged 12 or Older
Age
Gender
Pregnant Women
Race/Ethnicity
Education
College Students
Employment
Geographic Area
Association with Illicit Drug and Tobacco Use
Driving Under the Influence of Alcohol
3.2. Underage Alcohol Use

4. Tobacco Use
Age
Gender
Pregnant Women
Race/Ethnicity
Education
College Students
Employment
Geographic Area
Association with Illicit Drug and Alcohol Use
Frequency of Cigarette Use

5. Initiation of Substance Use
Initiation of Illicit Drug Use
Comparison, by Drug
Marijuana
Cocaine
Heroin
Hallucinogens
Inhalants
Psychotherapeutics
Alcohol
Tobacco

6. Youth Prevention-Related Measures
Perceptions of Risk
Perceived Availability
Perceived Parental Disapproval of Substance Use
Feelings about Peer Substance Use
Fighting and Delinquent Behavior
Religious Beliefs and Participation in Activities
Exposure to Substance Use Prevention Messages and Programs
Parental Involvement

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

8. Mental Health
8.1. Adults Aged 18 or Older
Prevalence of Serious Psychological Distress among Adults
Mental Health Service Use among Adults with Serious Psychological Distress
Serious Psychological Distress and Substance Use and Dependence or Abuse among Adults
Mental Health Care among Adults with Co-Occurring Serious Psychological Distress and Substance Use Disorders
Prevalence of Major Depressive Episode among Adults
Major Depressive Episode and Substance Use and Dependence or Abuse among Adults
Treatment for Major Depressive Episode among Adults
Mental Health Service Use and Unmet Need for Mental Health Care among Adults
8.2. Youths Aged 12 to 17
Prevalence of Major Depressive Episode among Youths
Major Depressive Episode and Substance Use among Youths
Treatment for Major Depressive Episode among Youths
Mental Health Service Use among Youths

9. Discussion of Trends in Substance Use among Youths and Young Adults

Appendix

A. Description of the Survey
B. Statistical Methods and Measurement
C. Key Definitions, 2007
D. Other Sources of Data
E. References
F. Sample Size and Population Tables
G. Selected Prevalence Tables

List of Figures

2.1 Past Month Illicit Drug Use among Persons Aged 12 or Older: 2007

2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2007

2.3 Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2007

2.4 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2007

2.5 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007

2.6 Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25: 2002-2007

2.7 Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2007

2.8 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2007

2.9 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2007

2.10 Past Month Illicit Drug Use among Persons Aged 18 or Older, by Employment Status: 2007

2.11 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2007

3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2007

3.2 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Race/Ethnicity: 2007

3.3 Heavy Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-2007

3.4 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 12 or Older: 2002-2007

3.5 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 16 or Older, by Age: 2007

3.6 Current Alcohol Use among Persons Aged 12 to 20, by Age: 2002-2007

3.7 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by Gender: 2007

4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2007

4.2 Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2007

4.3 Past Month Cigarette Use among Persons Aged 12 or Older, by Age: 2007

4.4 Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2007

4.5 Past Month Cigarette Use among Women Aged 15 to 44, by Pregnancy Status: Combined Years 2002-2003 to 2006-2007

4.6 Past Month Tobacco Use among Adults Aged 18 or Older, by Education: 2007

5.1 Specific Drug Used When Initiating Illicit Drug Use among Past Year Initiates of Illicit Drugs Aged 12 or Older: 2007

5.2 Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007

5.3 Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2007

5.4 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: 2002-2007

5.5 Past Year Ecstasy Initiates among Persons Aged 12 or Older and Mean Age at First Use of Ecstasy among Past Year Ecstasy Initiates Aged 12 to 49: 2002-2007

5.6 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: 2002-2007

5.7 Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First Use: 2002-2007

5.8 Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never Smoked, by Gender: 2002-2007

6.1 Past Month Binge Drinking and Marijuana Use among Youths Aged 12 to 17, by Perceptions of Risk: 2007

6.2 Perceived Great Risk of Cigarette and Alcohol Use among Youths Aged 12 to 17: 2002-2007

6.3 Perceived Great Risk of Marijuana Use among Youths Aged 12 to 17: 2002-2007

6.4 Perceived Great Risk of Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007

6.5 Perceived Availability of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007

6.6 Approached in the Past Month by Someone Selling Drugs among Youths Aged 12 to 17: 2002-2007

6.7 Exposure to Substance Use Prevention Messages and Programs among Youths Aged 12 to 17: 2002-2007

7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2007

7.2 Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2007

7.3 Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or Older, by Age at First Use of Alcohol: 2007

7.4 Substance Dependence or Abuse in the Past Year, by Age and Gender: 2007

7.5 Locations Where Past Year Substance Use Treatment Was Received among Persons Aged 12 or Older: 2007

7.6 Substances for Which Most Recent Treatment Was Received in the Past Year among Persons Aged 12 or Older: 2007

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: 2007

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: 2004-2007 Combined

8.1 Serious Psychological Distress in the Past Year among Adults Aged 18 or Older, by Age: 2006-2007

8.2 Number of Types of Mental Health Services Received in the Past Year among Persons Aged 18 or Older with Past Year Serious Psychological Distress Who Received Mental Health Services in the Past Year: 2007

8.3 Past Year Mental Health Care among Adults Aged 18 or Older with Both Serious Psychological Distress and a Substance Use Disorder: 2007

8.4 Major Depressive Episode in the Past Year among Adults Aged 18 or Older, by Severe Impairment, Age, and Gender: 2007

8.5 Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2007

8.6 Past Year Mental Health Service Use among Adults Aged 18 or Older, by Type of Care: 2002-2007

8.7 Reasons for Not Receiving Mental Health Services in the Past Year among Adults Aged 18 or Older with an Unmet Need for Mental Health Care Who Did Not Receive Mental Health Services: 2007

8.8 Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Severe Impairment, Age, and Gender: 2007

8.9 Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2007

8.10 Past Year Mental Health Service Use among Youths Aged 12 to 17, by Gender: 2007

8.11 Number of Outpatient Visits in the Past Year among Youths Aged 12 to 17 Who Received Outpatient Specialty Mental Health Services: 2007

8.12 Number of Nights Stayed in an Inpatient Specialty Mental Health Facility in the Past Year among Youths Aged 12 to 17 Who Received Inpatient Specialty Mental Health Services: 2007

9.1 Past Month Marijuana Use among Youths in NSDUH, MTF, and YRBS: 1971-2007

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

List of Tables

9.1 Comparison of NSDUH and MTF Prevalence Estimates among Youths: 2002-2007

9.2 Comparison of NSDUH and MTF Prevalence Estimates among Young Adults: 2002-2007

B.1 Demographic and Geographic Domains Forced to Match Their Respective U.S. Census Bureau Population Estimates through the Weight Calibration Process, 2007

B.2 Summary of 2007 NSDUH Suppression Rules

B.3 Weighted Percentages and Sample Sizes for 2006 and 2007 NSDUHs, by Screening Result Code

B.4 Weighted Percentages and Sample Sizes for 2006 and 2007 NSDUHs, by Final Interview Code

B.5 Response Rates and Sample Sizes for 2006 and 2007 NSDUHs, by Demographic Characteristics

B.6 Nonmedical Use of Methamphetamine in Lifetime, Past Year, and Past Month, by Demographic Characteristics: Percentages Based on Different Estimation Methods, 2002-2007

B.7 Nonmedical Use of Stimulants in Lifetime, Past Year, and Past Month, by Demographic Characteristics: Percentages Based on Different Estimation Methods, 2002-2007

B.8 Nonmedical Use of Psychotherapeutics in Lifetime, Past Year, and Past Month, by Demographic Characteristics: Percentages Based on Different Estimation Methods, 2002-2007

B.9 Nonmedical Use of Sedatives and Stimulants in the Lifetime, Past Year, and Past Month among Persons Aged 12 or Older Based on Different Estimation Methods, by Demographic Characteristics: Percentages, 2006 and 2007

B.10 Nonmedical Use of Prescription-Type Psychotherapeutics and Use of Hallucinogens in the Lifetime, Past Year, and Past Month among Persons Aged 12 or Older Based on Different Estimation Methods, by Demographic Characteristics: Percentages, 2006 and 2007

B.11 Illicit Drug Use and Illicit Drug Use Other Than Marijuana in the Lifetime, Past Year, and Past Month among Persons Aged 12 or Older Based on Different Estimation Methods, by Demographic Characteristics: Percentages, 2006 and 2007

D.1 Use of Specific Substances in Lifetime, Past Year, and Past Month among 8th, 10th, and 12th Graders in NSDUH and MTF: Percentages, 2006 and 2007

D.2 Lifetime and Past Month Substance Use among Students in Grades 9 to 12 in YRBS and NSDUH: 2005 and 2007

F.1 Survey Sample Size for Respondents Aged 12 or Older, by Gender and Detailed Age Category: 2006 and 2007

F.2 Numbers (in Thousands) of Persons Aged 12 or Older, by Gender and Detailed Age Category: 2006 and 2007

F.3 Survey Sample Size for Respondents Aged 12 or Older, by Age Group and Demographic Characteristics: 2006 and 2007

F.4 Numbers (in Thousands) of Persons Aged 12 or Older, by Age Group and Demographic Characteristics: 2006 and 2007

F.5 Survey Sample Size for Respondents Aged 12 or Older, by Age Group and Geographic Characteristics: 2006 and 2007

F.6 Numbers (in Thousands) of Persons Aged 12 or Older, by Age Group and Geographic Characteristics: 2006 and 2007

G.1 Types of Illicit Drug Use in Lifetime among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007

G.2 Types of Illicit Drug Use in Lifetime among Persons Aged 12 or Older: Percentages, 2002-2007

G.3 Types of Illicit Drug Use in the Past Year among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007

G.4 Types of Illicit Drug Use in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2007

G.5 Types of Illicit Drug Use in the Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007

G.6 Types of Illicit Drug Use in the Past Month among Persons Aged 12 or Older: Percentages, 2002-2007

G.7 Types of Illicit Drug Use in the Past Month among Persons Aged 12 to 17: Percentages, 2002-2007

G.8 Types of Illicit Drug Use in the Past Month among Persons Aged 18 to 25: Percentages, 2002-2007

G.9 Types of Illicit Drug Use in the Past Month among Persons Aged 26 or Older: Percentages, 2002-2007

G.10 Illicit Drug Use in Lifetime, Past Year, and Past Month, by Detailed Age Category: Percentages, 2006 and 2007

G.11 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2006 and 2007

G.12 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2006 and 2007

G.13 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2006 and 2007

G.14 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 12 or Older, by Gender: Numbers in Thousands, 2002-2007

G.15 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 12 or Older, by Gender: Percentages, 2002-2007

G.16 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 12 to 17, by Gender: Percentages, 2002-2007

G.17 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 18 to 25, by Gender: Percentages, 2002-2007

G.18 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 26 or Older, by Gender: Percentages, 2002-2007

G.19 Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 20, by Gender: Percentages, 2002-2007

G.20 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month, by Detailed Age Category: Percentages, 2006 and 2007

G.21 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month among Persons Aged 12 to 20, by Demographic Characteristics: Percentages, 2006 and 2007

G.22 Cigarette Use in Lifetime, Past Year, and Past Month, by Detailed Age Category: Percentages, 2006 and 2007

G.23 Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2006 and 2007

G.24 Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2006 and 2007

G.25 Perceived Risk and Availability of Substances among Persons Aged 12 to 17: Percentages, 2002-2007

G.26 Past Year Initiation of Substance Use among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007

G.27 Substance Dependence or Abuse for Specific Substances in the Past Year among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007

G.28 Substance Dependence or Abuse for Specific Substances in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2007

G.29 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2006 and 2007

G.30 Received Substance Use Treatment at Any Treatment Location or at a Specialty Facility in the Past Year among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007

G.31 Received Substance Use Treatment at Any Treatment Location or at a Specialty Facility in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2007

G.32 Needed and Received Treatment for a Substance Use Problem in the Past Year among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007

G.33 Needed and Received Treatment for a Substance Use Problem in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2007

G.34 Needed and Received Treatment for an Illicit Drug or Alcohol Problem in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2006 and 2007

G.35 Perceived Need for Illicit Drug or Alcohol Treatment and Whether Made an Effort to Get Treatment in the Past Year among Persons Aged 12 or Older Classified as Needing But Not Receiving Treatment for an Illicit Drug or Alcohol Problem, by Demographic Characteristics: Numbers in Thousands, 2006 and 2007

G.36 Perceived Need for Illicit Drug or Alcohol Treatment and Whether Made an Effort to Get Treatment in the Past Year among Persons Aged 12 or Older Classified as Needing But Not Receiving Treatment for an Illicit Drug or Alcohol Problem, by Demographic Characteristics: Percentages, 2006 and 2007

G.37 Serious Psychological Distress in the Past Year among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2004-2007

G.38 Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2002-2007

G.39 Had at Least One Major Depressive Episode (MDE) in the Past Year among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2004-2007

G.40 Had at Least One Major Depressive Episode (MDE) in the Past Year among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2004-2007

G.41 Source of Mental Health Service in the Past Year among Persons Aged 12 to 17: Percentages, 2002-2007

Highlights

This report presents the first information from the 2007 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

Alcohol Use

Tobacco Use

Initiation of Substance Use (Incidence, or First-Time Use) within the Past 12 Months

Youth Prevention-Related Measures

Substance Dependence, Abuse, and Treatment

Mental Health

1. Introduction

This report presents the first information from the 2007 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. This initial report on the 2007 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 2006 and 2007. 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 2007 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 and analysis are 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 2007 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, 141,487 addresses were screened for the 2007 survey, and 67,870 completed interviews were obtained. The survey was conducted from January through December 2007. Weighted response rates for household screening and for interviewing were 89.5 and 73.9 percent, respectively. See Appendix B for more information on NSDUH response rates.

1.2. Trend Measurement

Although the design of the 2002 through 2007 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are important methodological differences that affect the comparability of the 2002-2007 estimates with estimates from prior surveys. The most important change was the incentive payment started in 2002 and continuing in subsequent surveys. Each NSDUH respondent completing the interview is given $30. The name of the survey was also changed in 2002, from the National Household Survey on Drug Abuse (NHSDA) to the current name. In addition, improved data collection quality control procedures were introduced in the survey starting in 2001, and updated population data from the 2000 decennial census were incorporated into NSDUH sample weighting procedures starting with the 2002 estimates. 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, 2005b).

1.3. Change in Estimates for Psychotherapeutic Drugs and Stimulants

This report includes revised estimates of nonmedical use of prescription psychotherapeutic drugs and prescription stimulants that take into account data on methamphetamine use based on information obtained from survey items added to NSDUH in 2005, 2006, and 2007. The 2006 NSDUH national findings report incorporated revised estimates for methamphetamine use based on these new items (OAS, 2007b), and this report extends the revisions to use of stimulants and any prescription psychotherapeutics. In a methodological study, these measures were found to be noticeably higher when the data from the new methamphetamine use items were taken into account. Estimates for use of illicit drugs overall and use of illicit drugs other than marijuana, however, were affected only minimally by these methamphetamine use items and were not revised. See Section B.4.6 in Appendix B for more information on the results of this study.

The 2006 estimates for nonmedical use of stimulants and prescription psychotherapeutics in this report have been revised based on the additional questions on methamphetamine use, and statistical adjustments have been applied to the estimates from 2002 to 2005. These modifications control for the potentially confounding effects of the questionnaire changes and enable year-to-year comparisons to be made over the period from 2002 to 2007. Section B.4.6 in Appendix B provides a discussion of the revised measures and the procedures used to generate estimates based on them. Because of these changes, estimates for nonmedical use of stimulants and psychotherapeutic drugs in this report are not comparable to corresponding estimates in previous NSDUH reports. Methamphetamine use estimates in this report also are not comparable with those in NSDUH reports for survey years prior to 2006.

1.4. 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 2007 estimates are significantly different from 2006 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.

1.5. Other NSDUH Reports and Data

Other reports focusing on specific topics of interest will be produced using the 2007 NSDUH data and made available on SAMHSA's website. A report on State-level estimates for 2006-2007 will be available in early 2009.

A comprehensive set of tables, referred to as "detailed tables," is available through the Internet at http://oas.samhsa.gov. The tables are organized into sections based primarily on the topic, and most tables are provided in several parts, showing population estimates (e.g., numbers of drug users), rates (e.g., percentages of population using drugs), and standard errors of all nonsuppressed estimates. A small subset of these detailed tables has been selected for inclusion in Appendices F and G of this report. The appendix tables can be mapped back to the detailed tables by using the table number in parentheses in the upper left corner of each table (e.g., Table G.1 in Appendix G is Table 8.1A 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://oas.samhsa.gov). In addition, OAS makes public use data files available to researchers through the Substance Abuse and Mental Health Data Archive (SAMHDA, 2008) at http://www.icpsr.umich.edu/SAMHDA/index.html. Currently, files are available from the 1979 to 2006 surveys.2 The 2007 NSDUH public use file will be available by the end of 2008.

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, psilocybin mushrooms, and "Ecstasy" (MDMA). Inhalants include a variety of substances, such as nitrous oxide, amyl nitrite, cleaning fluids, gasoline, spray paint, other aerosol sprays, and glue. The four categories of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives) cover numerous medications available by prescription and drugs within these groupings that may be manufactured illegally, such as methamphetamine, which is included under stimulants. Respondents are asked to report only "nonmedical" use of these drugs, defined as use without a prescription of the individual's own or simply for the experience or feeling the drugs caused. Use of over-the-counter drugs and legitimate use of prescription drugs are not included. NSDUH reports combine the four prescription-type drug groups into a category referred to as "psychotherapeutics."

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.

This chapter includes revised estimates of the nonmedical use of prescription psychotherapeutic drugs and prescription stimulants that take into account data on methamphetamine use based on information obtained from survey items added to NSDUH in 2005, 2006, and 2007. The 2006 NSDUH national findings report incorporated revised estimates for methamphetamine use based on these additional items (Office of Applied Studies [OAS], 2007b), and this report extends the revisions to use of stimulants and any prescription psychotherapeutics. In a methodological study, these measures were found to be noticeably higher when the data from the additional methamphetamine use items were taken into account. Estimates for use of illicit drugs overall and use of illicit drugs other than marijuana, however, were affected only minimally by these methamphetamine use items and were not revised. See Section B.4.6 in Appendix B for more information on the results of this study.

The 2006 estimates for nonmedical use of stimulants and prescription psychotherapeutics in this report have been revised based on the additional questions on methamphetamine use, and statistical adjustments have been applied to the estimates from 2002 to 2005. These modifications control for the potentially confounding effects of the questionnaire changes and enable year-to-year comparisons to be made over the period from 2002 to 2007. Section B.4.6 in Appendix B provides a discussion of the revised measures and the procedures used to generate estimates based on them. Because of these changes, estimates for the nonmedical use of stimulants and psychotherapeutic drugs in this report are not comparable with corresponding estimates in previous NSDUH reports. Methamphetamine use estimates in this report also are not comparable with those in NSDUH reports for survey years prior to 2006.

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Figure 2.1 Past Month Illicit Drug Use among Persons Aged 12 or Older: 2007

Figure 2.1

1 Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.

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Figure 2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2007

Figure 2.2

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 2.3 Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2007

Figure 2.3

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Age

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Figure 2.4 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2007

Figure 2.4

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Figure 2.5 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007

Figure 2.5

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Youths Aged 12 to 17

Young Adults Aged 18 to 25

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Figure 2.6 Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25: 2002-2007

Figure 2.6

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Adults Aged 26 or Older

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Figure 2.7 Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2007

Figure 2.7

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Gender

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Figure 2.8 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2007

Figure 2.8

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Pregnant Women

Race/Ethnicity

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Figure 2.9 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2007

Figure 2.9

Note: Due to low precision, the estimate for Native Hawaiians or Other Pacific Islanders is not shown.

Education

College Students

Employment

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Figure 2.10 Past Month Illicit Drug Use among Persons Aged 18 or Older, by Employment Status: 2007

Figure 2.10

1 The Other Employment category includes retired persons, disabled persons, homemakers, students, or other persons not in the labor force.

Geographic Area

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Figure 2.11 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2007

Figure 2.11

Criminal Justice Populations

Frequency of Use

Association with Cigarette and Alcohol Use

Driving Under the Influence of Illicit Drugs

Source of Prescription Drugs

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.

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.

Heavy use - Five or more drinks on the same occasion on each of 5 or more days in the past 30 days.

These levels are not mutually exclusive categories of use; heavy use is included in estimates of binge and current use, and binge use is included in estimates of current use.

This chapter is divided into two main sections. Section 3.1 describes trends and patterns of alcohol use among the population aged 12 or older. Section 3.2 is particularly concerned with the use of alcohol by persons aged 12 to 20. These persons are under the legal drinking age in all 50 States and the District of Columbia.

3.1. Alcohol Use among Persons Aged 12 or Older

Age

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Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2007

Figure 3.1

Gender

Pregnant Women

Race/Ethnicity

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Figure 3.2 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Race/Ethnicity: 2007

Figure 3.2

Note: Due to low precision, estimates for Native Hawaiians or Other Pacific Islanders are not shown.

Education

College Students

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Figure 3.3 Heavy Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-2007

Figure 3.3

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Employment

Geographic Area

Association with Illicit Drug and Tobacco Use

Driving Under the Influence of Alcohol

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Figure 3.4 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 12 or Older: 2002-2007

Figure 3.4

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 3.5 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 16 or Older, by Age: 2007

Figure 3.5

3.2. Underage Alcohol Use

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Figure 3.6 Current Alcohol Use among Persons Aged 12 to 20, by Age: 2002-2007

Figure 3.6

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 3.7 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by Gender: 2007

Figure 3.7

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."

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Figure 4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2007

Figure 4.1

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Age

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Figure 4.2 Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2007

Figure 4.2

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 4.3 Past Month Cigarette Use among Persons Aged 12 or Older, by Age: 2007

Figure 4.3

Gender

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Figure 4.4 Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2007

Figure 4.4

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Pregnant Women

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Figure 4.5 Past Month Cigarette Use among Women Aged 15 to 44, by Pregnancy Status: Combined Years 2002-2003 to 2006-2007

Figure 4.5

+ Difference between this estimate and the 2006-2007 estimate is statistically significant at the .05 level.

Race/Ethnicity

Education

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Figure 4.6 Past Month Tobacco Use among Adults Aged 18 or Older, by Education: 2007

Figure 4.6

College Students

Employment

Geographic Area

Association with Illicit Drug and Alcohol Use

Frequency of Cigarette Use

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 focusing prevention efforts.

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, year, 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.

Because of concerns about the validity of trend estimates of incidence based on long recall periods (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004), this report only presents estimates of initiation occurring in the 12 months prior to the interview date. 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. One caveat of this approach is that because the survey interviews persons aged 12 or older and asks about the past 12 months, the initiation estimates will represent some, but not all of initiation at age 11, and no initiation occurring at age 10 or younger. This underestimation problem primarily affects estimates of initiation for cigarettes, alcohol, and inhalants because they tend to be initiated at a younger age than other substances. See Section B.4.1 in Appendix B for further discussion of the methods and bias in initiation estimates.

There are some important issues that readers need to be aware of when interpreting these NSDUH incidence estimates. First, note that some tables and analyses are based on the ages of initiates at the time of interview, while others focus on the age at the time of first substance use. This can have a large impact on estimates, so readers should pay close attention to the approach used in each situation. Titles and notes on tables document which method applies. Regarding the age at first use estimates, means, as measures of central tendency, are heavily influenced by the presence of extreme values in the data. Thus, for the purposes of this report and unless specified otherwise, the mean age at initiation pertains to 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. 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.

An important consideration in looking at incidence estimates across different drug categories is that substance users typically initiate use of different substances at different times in their lives. Thus, the estimates for specific illicit drugs cannot be added to obtain the number of illicit drug initiates, because, for example, most of the cocaine initiates had previously used marijuana or other drugs and therefore would be represented in the illicit drug initiate estimates for a prior year. Similarly, the estimates of crack initiation are not a subset of the estimates of cocaine initiation, as some persons would have used powder cocaine prior to using crack. To help clarify this aspect of the incidence data, additional tables have been generated to identify which specific illicit drug was used at the time of first use of any illicit drug. These new estimates are discussed below in the first section of this chapter.

The prevalence estimates for nonmedical use of psychotherapeutic drugs, stimulants, and methamphetamine discussed in Chapter 2 take account of data from new items on methamphetamine use that were added to the noncore section of the survey in 2005 and 2006 to capture information on methamphetamine users who failed to recognize the drug when it was presented in the context of prescription drugs in the core stimulants module. The drug use initiation estimates in this chapter, however, are based on data only from the core section of the questionnaire and do not take account of data from new items on the initiation of methamphetamine use that were added to the noncore section in 2007 following up on the additional methamphetamine users identified in the questions introduced in 2005 and 2006. See Section B.4.6 in Appendix B of this report for details.

Initiation of Illicit Drug Use

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Figure 5.1 Specific Drug Used When Initiating Illicit Drug Use among Past Year Initiates of Illicit Drugs Aged 12 or Older: 2007

Figure 5.1

Note: The percentages add to greater than 100 percent because of a small number of respondents initiating multiple drugs on the same day.

Comparison, by Drug

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Figure 5.2 Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007

Figure 5.2

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Figure 5.3 Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2007

Figure 5.3

Marijuana

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Figure 5.4 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: 2002-2007

Figure 5.4

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
1 Mean-age-at-first-use estimates are for recent initiates aged 12 to 49.

Cocaine

Heroin

Hallucinogens

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Figure 5.5 Past Year Ecstasy Initiates among Persons Aged 12 or Older and Mean Age at First Use of Ecstasy among Past Year Ecstasy Initiates Aged 12 to 49: 2002-2007

Figure 5.5

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
1 Mean-age-at-first-use estimates are for recent initiates aged 12 to 49.

Inhalants

Psychotherapeutics

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Figure 5.6 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: 2002-2007

Figure 5.6

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
1 Mean-age-at-first-use estimates are for recent initiates aged 12 to 49.

Alcohol

Tobacco

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Figure 5.7 Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First Use: 2002-2007

Figure 5.7

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 5.8 Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never Smoked, by Gender: 2002-2007

Figure 5.8

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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 2007 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). This report shows that marijuana use, cigarette use, and alcohol use among youths aged 12 to 17 decreased between 2002 and 2007, 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 a weak causal connection, a lagged relationship between the occurrence of a risk factor and the change in drug use 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 in certain amounts or frequencies. Response choices for these items were "great risk," "moderate risk," "slight risk," or "no risk."

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Figure 6.1 Past Month Binge Drinking and Marijuana Use among Youths Aged 12 to 17, by Perceptions of Risk: 2007

Figure 6.1

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Figure 6.2 Perceived Great Risk of Cigarette and Alcohol Use among Youths Aged 12 to 17: 2002-2007

Figure 6.2

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 6.3 Perceived Great Risk of Marijuana Use among Youths Aged 12 to 17: 2002-2007

Figure 6.3

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 6.4 Perceived Great Risk of Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007

Figure 6.4

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Perceived Availability

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Figure 6.5 Perceived Availability of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007

Figure 6.5

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 6.6 Approached in the Past Month by Someone Selling Drugs among Youths Aged 12 to 17: 2002-2007

Figure 6.6

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Perceived Parental Disapproval of Substance Use

Feelings about Peer Substance Use

Fighting and Delinquent Behavior

Religious Beliefs and Participation in Activities

Exposure to Substance Use Prevention Messages and Programs

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Figure 6.7 Exposure to Substance Use Prevention Messages and Programs among Youths Aged 12 to 17: 2002-2007

Figure 6.7

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
1 Estimates are from youths aged 12 to 17 who were enrolled in school in the past year.

Parental Involvement

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, 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 related to 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 here for both dependence and abuse, persons meeting the criteria for both are classified as having dependence, but not abuse. Persons defined with abuse in this report 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 2007 NSDUH and compares these estimates against the results from the 2002, 2003, 2004, 2005, and 2006 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. This chapter concludes with a discussion of the need for and the receipt of treatment at specialty facilities for problems associated with substance use.

7.1. Substance Dependence or Abuse

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Figure 7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2007

Figure 7.1

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

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Figure 7.2 Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2007

Figure 7.2

Age at First Use

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Figure 7.3 Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or Older, by Age at First Use of Alcohol: 2007

FIgure 7.3

Age

Gender

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Figure 7.4 Substance Dependence or Abuse in the Past Year, by Age and Gender: 2007

Figure 7.4

Race/Ethnicity

Education/Employment

Criminal Justice Populations

Geographic Area

7.2. Past Year Treatment for a Substance Use Problem

Estimates described in this section refer to treatment received for 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.

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Figure 7.5 Locations Where Past Year Substance Use Treatment Was Received among Persons Aged 12 or Older: 2007

Figure 7.5

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Figure 7.6 Substances for Which Most Recent Treatment Was Received in the Past Year among Persons Aged 12 or Older: 2007

Figure 7.6

7.3. Need for 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, 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 perceived 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

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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: 2007

Figure 7.7

Below is a bar graph. Click here for the text describing this graph.

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: 2004-2007 Combined

Figure 7.8

Illicit Drug Use Treatment and Treatment Need

Alcohol Use Treatment and Treatment Need

8. Mental Health

This chapter presents findings on mental health problems in the United States, including the prevalence 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). Also reported here are the rates of treatment for depression (among those with MDE) in the past year, the percentages of adults aged 18 or older and youths aged 12 to 17 who received mental health care in the past year, and the percentage of adults who had an unmet need for mental health care in the past year.

SPD is an overall indicator of past year psychological distress that is derived from the K6 scale administered to adults aged 18 or older in the National Survey on Drug Use and Health (NSDUH). Numerical scores derived from responses to these six questions range from 0 to 24. For this report, a score of 13 or higher is considered SPD. It is notable that the data related to SPD assessed from 2004 to 2007 are not directly comparable with data from earlier years because of study design changes. Further information on the measurement of SPD, the scoring algorithm, and the study design changes is provided in Section B.4.4 of Appendix B.

A module of questions designed to obtain measures of lifetime and past year prevalence of MDE, the level of functional impairment caused by MDE in the past year, and treatment for depression has been administered to adults aged 18 or older and youths aged 12 to 17 since 2004. Some questions in the adolescent depression module were modified slightly from the adult depression module to make them more appropriate for youths. Given these differences, adult and youth depression estimates are presented separately in this chapter.

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 at least four of the seven additional symptoms reflecting 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. Impairment is defined by the level of role interference reported to be caused by MDE in the past 12 months. For adults, the Sheehan Disability Scale (SDS) role domains are (1) home management, (2) work/school, (3) close relationships with others, and (4) social life. The role domains are assessed on a 0 to 10 scale with impairment categories of none (0), mild (1-3), moderate (4-6), severe (7-9), and very severe (10). The role domains for youths are slightly modified to be made age appropriate, but are assessed on the same 0 to 10 scale described for adults. The specific 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.

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 endorsed having symptoms at a level known to be indicative of having a mental disorder (i.e., any disorder such as an anxiety or mood disorder). Meeting the criteria for past year MDE indicates that the respondent had the specific physical and emotional symptom profile indicative of MDE in the past 12 months. MDE is known to be a fairly common disorder that often has a significant impact on a person's work, home, and social life.

This chapter also presents data on mental health care among adults aged 18 or older and youths aged 12 to 17 for any type of mental health problem. Initiated in 2000, the mental health service utilization modules are asked of respondents regardless of MDE or SPD status. In the adult module, respondents are asked whether they received treatment or counseling for any problem with emotions, "nerves," or mental health in the past year in any inpatient or outpatient setting or used prescription medication for a mental or emotional condition. The treatment questions in this module are generic in that they do not ask specifically about treatment for a particular disorder, as do the questions in the MDE module. As such, subsequent references to treatment or counseling for any problem with emotions, nerves, or mental health are described broadly as "mental health service use" or receiving/needing "mental health care." It is possible for a respondent to have indicated receipt of treatment for depression without having indicated that he or she received services for any problems with emotions, nerves, or mental health.

In NSDUH, questions in the youth mental health service utilization module differ from those asked of adults. Youths aged 12 to 17 are asked whether they received any treatment or counseling within the 12 months prior to the interview for problems with behavior or emotions in the specialty mental health setting (outpatient or inpatient care), the general medical setting (pediatrician or family physician care for emotional or behavior problems), or the education setting (talked with a counselor, psychologist, or teacher, or received special education services while in a regular classroom or placed in a special classroom, special program, or special school). They also are asked for the number of nights spent in overnight facilities, the number of visits they had to outpatient mental health providers, and the reason(s) for the most recent stay or visit. Both the youth and the adult mental health questions specifically exclude treatment for problems with substance use, a topic asked about in other interview modules.

Estimates of unmet need for mental health care are reported for adults. Unmet need is established using a question that asks whether the respondent perceived a need for, but did not receive mental health treatment or counseling at any time in the 12 months prior to the NSDUH interview. This measure also includes persons who received some type of mental health service in the past 12 months, but reported a perceived need for additional services they did not receive.

It is important to note that because the survey covers the U.S. civilian, noninstitutionalized population, persons residing in long-term psychiatric or other institutions continuously throughout the year were not included in the NSDUH sampling frame. Persons who were hospitalized or institutionalized for a period of time during 2007, but who resided in households during the rest of the year, were included in the sample.

8.1. Adults Aged 18 or Older

Prevalence of Serious Psychological Distress among Adults

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Figure 8.1 Serious Psychological Distress in the Past Year among Adults Aged 18 or Older, by Age: 2006-2007

Figure 8.1

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Mental Health Service Use among Adults with Serious Psychological Distress

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Figure 8.2 Number of Types of Mental Health Services Received in the Past Year among Persons Aged 18 or Older with Past Year Serious Psychological Distress Who Received Mental Health Services in the Past Year: 2007

Figure 8.2

Note: The three types of mental health care are receiving inpatient care, outpatient care, or prescription medication.

Serious Psychological Distress and Substance Use and Dependence or Abuse among Adults

Mental Health Care among Adults with Co-Occurring Serious Psychological Distress and Substance Use Disorders

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Figure 8.3 Past Year Mental Health Care among Adults Aged 18 or Older with Both Serious Psychological Distress and a Substance Use Disorder: 2007

Figure 8.3

Prevalence of Major Depressive Episode among Adults

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Figure 8.4 Major Depressive Episode in the Past Year among Adults Aged 18 or Older, by Severe Impairment, Age, and Gender: 2007

Figure 8.4

Note: Respondents with an unknown level of impairment were included in the estimates for Major Depressive Episode without Severe Impairment.

Major Depressive Episode and Substance Use and Dependence or Abuse among Adults

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Figure 8.5 Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2007

Figure 8.5

Treatment for Major Depressive Episode among Adults

Mental Health Service Use and Unmet Need for Mental Health Care among Adults

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Figure 8.6 Past Year Mental Health Service Use among Adults Aged 18 or Older, by Type of Care: 2002-2007

Figure 8.6

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

Below is a bar graph. Click here for the text describing this graph.

Figure 8.7 Reasons for Not Receiving Mental Health Services in the Past Year among Adults Aged 18 or Older with an Unmet Need for Mental Health Care Who Did Not Receive Mental Health Services: 2007

Figure 8.7

8.2. Youths Aged 12 to 17

Prevalence of Major Depressive Episode among Youths

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Figure 8.8 Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Severe Impairment, Age, and Gender: 2007

Figure 8.8

Note: Respondents with an unknown level of impairment were included in the estimates for Major Depressive Episode without Severe Impairment.

Major Depressive Episode and Substance Use among Youths

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Figure 8.9 Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2007

Figure 8.9

Treatment for Major Depressive Episode among Youths

Mental Health Service Use among Youths

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Figure 8.10 Past Year Mental Health Service Use among Youths Aged 12 to 17, by Gender: 2007

Figure 8.10

Below is a pie chart. Click here for the text describing this chart.

Figure 8.11 Number of Outpatient Visits in the Past Year among Youths Aged 12 to 17 Who Received Outpatient Specialty Mental Health Services: 2007

Figure 8.11

Below is a pie chart. Click here for the text describing this chart.

Figure 8.12 Number of Nights Stayed in an Inpatient Specialty Mental Health Facility in the Past Year among Youths Aged 12 to 17 Who Received Inpatient Specialty Mental Health Services: 2007

Figure 8.12

9. Discussion of Trends in Substance Use among Youths and Young Adults

This report presents findings from the 2007 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 2007 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 2007 and changes between 2006 and 2007, as well as between 2002 and 2007. This chapter provides an additional discussion of the findings concerning a topic of great interest—trends in substance use among youths and young adults.

An important step in the analysis and interpretation of NSDUH or any other survey data is to compare the results with 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 confirm or support 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, 2007c, 2008a, 2008b). Historically, NSDUH rates of substance use among youths have been lower than those of MTF, and occasionally the two surveys have shown different trends over a short time period. Nevertheless, the two sources have shown very similar long-term trends in prevalence. 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 2007 is shown in Tables 9.1 and 9.2 at the end of this chapter 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 estimates for NSDUH youths aged 12 to 17, while MTF follow-up data on persons aged 19 to 24 provide the closest match on age to estimates for NSDUH young adults aged 18 to 25. The NSDUH results are remarkably consistent with MTF trends for both youths and young adults, as discussed below.

Both surveys generally show decreases between 2002 and 2007 in the percentages of youths who used marijuana, Ecstasy, LSD, alcohol, and cigarettes in the lifetime, past year, and past month (Table 9.1). One exception was for LSD in the past month for MTF, and information on cigarettes in the past year was not available for MTF. Estimates from both surveys indicate a decline in cocaine use between 2002 and 2007, although the trend was statistically significant in NSDUH data but not in MTF data. Both surveys show no decrease in the rates of past year and past month inhalant use among youths between 2002 and 2007, although only NSDUH shows a significant decrease in lifetime use. The consistency between NSDUH and MTF trend data is found not only in terms of the specific drugs showing decreases, but also in terms of the magnitude of the decreases. Despite the higher levels of prevalence estimated from MTF, the two surveys show very similar rates of change in past month prevalence, especially for the three substances used most commonly by youths: alcohol, cigarettes, and marijuana. Between 2002 and 2007, the rate of current alcohol use among youths declined 10 percent according to both NSDUH and MTF. Current cigarette use prevalence rates in 2007 were 25 percent lower in both NSDUH and MTF compared with 2002 rates. For past month marijuana use, the NSDUH decline from 2002 to 2007 was 18 percent, and the MTF decline was 24 percent.

Data on young adults also show similar trends in the two surveys, although not as consistent as for the youth data (Table 9.2). Potential reasons for differences are the relatively smaller MTF sample size for young adults and possible bias in the MTF sample due to noncoverage of school dropouts and a low overall response rate, considering nonresponse by schools, by students in the 12th grade survey, and in the follow-up mail survey. Both surveys show declines from 2002 to 2007 in past year and past month cigarette and marijuana use among young adults, although the decline in past month marijuana use in NSDUH was not statistically significant. However, the NSDUH rates of decline in current cigarette and marijuana use for young adults were less than the declines in NSDUH for youths and for young adults in MTF. Past month marijuana prevalence among young adults declined 5 percent according to NSDUH and 12 percent according to MTF. For past month cigarette use, declines were 11 percent in NSDUH and 18 percent in MTF. Both surveys show no significant change from 2002 and 2007 in the rate of current alcohol use among young adults. A significant decline between 2006 and 2007 in past month cocaine use is seen in the NSDUH data, and the MTF data show a similar drop in use (although not statistically significant).

Both NSDUH and MTF generally show substantial decreases for both youths and young adults in the past year use of Ecstasy and LSD between 2002 and 2004, then a leveling in 2005. The 2006 data from both surveys had suggested the start of a possible resurgence in the past year use of Ecstasy among youths and young adults, but the 2007 data do not indicate any major increase or decrease since 2005, in general. The only statistically significant change in past year Ecstasy use between 2005 and 2007 was for use among youths in NSDUH (from 1.0 to 1.3 percent). NSDUH also showed a statistically significant increase between 2005 and 2006 in past year initiation of Ecstasy use for young adults (from 322,000 initiates in 2005 to 494,000 initiates in 2006), but the increase did not continue in 2007 (414,000 initiates).

Another source of data on trends in the use of drugs among youths is the Youth Risk Behavior Survey (YRBS), sponsored by the Centers for Disease Control and Prevention. YRBS surveys students in 9th through 12th grades in classrooms every other year during the spring (Eaton et al., 2008). The most recent survey was completed in 2007. YRBS has generally shown higher prevalence rates but similar long-term trends when compared with NSDUH and MTF. However, comparisons between YRBS and NSDUH or MTF are less straightforward because of the different periodicity (i.e., biennially instead of annually) and ages covered, the limited number of drug use questions, and smaller sample size in the YRBS. For the substances for which information on current use is collected in the YRBS, including alcohol, cigarettes, marijuana, and cocaine, the YRBS trend results between 2001 and 2007 are consistent with NSDUH and MTF (Eaton et al., 2008; Grunbaum et al., 2002). YRBS data for the combined grades 9 through 12 showed no significant change in alcohol use (47.1 percent in 2001 and 44.7 percent in 2007), a decrease in cigarette use (28.5 percent in 2001, 20.0 percent in 2007), a decrease in marijuana use (23.9 percent in 2001, 19.7 percent in 2007), and a decline in cocaine use (4.2 percent in 2001, 3.3 percent in 2007).

Although changes in NSDUH preclude direct comparisons of recent estimates with estimates from before 2002, it is important to put the recent trends in context by reviewing longer term trends in use. NSDUH data (prior to the design changes in 1999 and 2002) on youths aged 12 to 17 and MTF data on high school seniors have shown substantial increases in youth illicit drug use during the 1970s, reaching a peak in the late 1970s. Both surveys then showed significant declines throughout the 1980s until about 1992, when rates reached a low point. These trends were driven by the trend in marijuana use. With the start of annual data collection in NSDUH in 1991, along with the biennial YRBS and the annual 8th and 10th grade samples in MTF, trends among youths are well documented since the low point that occurred in the early 1990s. Although they employ different survey designs and cover different age groups, the three surveys are consistent in showing increasing rates of marijuana use during the early to mid-1990s, reaching a peak in the late 1990s, followed by consistent declines in use since the turn of the 21st century (Figure 9.1).

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Figure 9.1 Past Month Marijuana Use among Youths in NSDUH, MTF, and YRBS: 1971-2007

Figure 9.1

MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health; YRBS = Youth Risk Behavior Survey.

Table 9.1 – Comparison of NSDUH and MTF Prevalence Estimates among Youths: 2002-2007
Substance/Time Period NSDUH MTF
Ages 12-17 8th and 10th Grades
2002 2003 2004 2005 2006 2007 2002 2003 2004 2005 2006 2007
-- 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 (2008a). Design effects used for variance estimation are reported in Johnston, O'Malley, Bachman, and Schulenberg (2007c).
a Difference between this estimate and 2007 estimate is statistically significant at the .05 level.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, 2004, 2005, 2006, and 2007. University of Michigan, The Monitoring the Future Study, 2002, 2003, 2004, 2005, 2006, and 2007.
Marijuana                        
Lifetime 20.6a 19.6a 19.0a 17.4a 17.3a 16.2 29.0a 27.0a 25.7a 25.3a 23.8 22.6
Past Year 15.8a 15.0a 14.5a 13.3a 13.2 12.5 22.5a 20.5a 19.7a 19.4a 18.5 17.5
Past Month 8.2a 7.9a 7.6a 6.8 6.7 6.7 13.1a 12.3a 11.2a 10.9 10.4 10.0
Cocaine                        
Lifetime 2.7a 2.6a 2.4 2.3 2.2 2.1 4.9 4.4 4.4 4.5 4.1 4.2
Past Year 2.1a 1.8 1.6 1.7 1.6 1.5 3.2 2.8 2.9 2.9 2.6 2.7
Past Month 0.6a 0.6a 0.5 0.6 0.4 0.4 1.4 1.1 1.3 1.3 1.3 1.1
Ecstasy                        
Lifetime 3.3a 2.4a 2.1 1.6 1.9 1.8 5.5a 4.3 3.6 3.4 3.5 3.8
Past Year 2.2a 1.3 1.2 1.0a 1.2 1.3 3.9a 2.6 2.1 2.2 2.1 2.5
Past Month 0.5a 0.4 0.3 0.3 0.3 0.3 1.6a 0.9 0.8 0.8 1.0 0.9
LSD                        
Lifetime 2.7a 1.6a 1.2a 1.1a 0.9 0.8 3.8a 2.8 2.3 2.2 2.2 2.3
Past Year 1.3a 0.6 0.6 0.6 0.4 0.5 2.1a 1.5 1.4 1.4 1.3 1.5
Past Month 0.2a 0.2 0.2 0.1 0.1 0.1 0.7 0.6 0.6 0.6 0.6 0.6
Inhalants                        
Lifetime 10.5a 10.7a 11.0a 10.5a 10.1 9.6 14.4 14.3 14.9 15.1 14.7 14.6
Past Year 4.4 4.5a 4.6a 4.5a 4.4 3.9 6.8 7.1 7.8 7.8 7.8 7.5
Past Month 1.2 1.3 1.2 1.2 1.3 1.2 3.1 3.2 3.5 3.2 3.2 3.2
Alcohol                        
Lifetime 43.4a 42.9a 42.0a 40.6a 40.4 39.4 57.0a 55.8a 54.1a 52.1a 51.0 50.3
Past Year 34.6a 34.3a 33.9a 33.3a 32.9a 31.8 49.4a 48.3a 47.5a 45.3 44.7 44.1
Past Month 17.6a 17.7a 17.6a 16.5 16.6 15.9 27.5a 27.6a 26.9a 25.2 25.5 24.7
Cigarettes                        
Lifetime 33.3a 31.0a 29.2a 26.7a 25.8a 23.7 39.4a 35.7a 34.3a 32.4a 30.4a 28.4
Past Year 20.3a 19.0a 18.4a 17.3a 17.0a 15.7 -- -- -- -- -- --
Past Month 13.0a 12.2a 11.9a 10.8a 10.4 9.8 14.2a 13.5a 12.6a 12.1a 11.6a 10.6
Table 9.2 – Comparison of NSDUH and MTF Prevalence Estimates among Young Adults: 2002-2007
Substance/
Time Period
NSDUH MTF
Ages 18-25 Ages 19-24
2002 2003 2004 2005 2006 2007 2002 2003 2004 2005 2006 2007
-- 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 (2003b) and in Johnston, O'Malley, Bachman, and Schulenberg (2004b, 2005b, 2006b, 2007b, 2008b).
NOTE: For the 19 to 24 age group in the MTF data, significance tests were performed assuming independent samples between years an odd number of years apart because two distinct cohorts a year apart were monitored longitudinally at 2-year intervals. Although appropriate for comparisons of 2002, 2004, and 2006 estimates with 2007 estimates, this assumption results in conservative tests for comparisons of 2003 and 2005 estimates with 2007 estimates because it does not take into account covariances that are associated with repeated observations from the longitudinal samples. Estimates of covariances were not available.
a Difference between this estimate and 2007 estimate is statistically significant at the .05 level.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, 2004, 2005, 2006, and 2007. University of Michigan, The Monitoring the Future Study, 2002, 2003, 2004, 2005, 2006, and 2007.
Marijuana                        
Lifetime 53.8a 53.9a 52.8a 52.4a 52.4a 50.8 56.1 56.4a 55.6 54.4 53.8 53.9
Past Year 29.8a 28.5 27.8 28.0 28.0 27.5 34.2a 33.0 31.6 31.4 30.9 31.0
Past Month 17.3 17.0 16.1 16.6 16.3 16.4 19.8a 19.9a 18.2 17.0 17.0 17.5
Cocaine                        
Lifetime 15.4 15.0 15.2 15.1 15.7 15.0 12.9 14.5a 14.3a 12.6 13.6 12.4
Past Year 6.7 6.6 6.6 6.9 6.9 6.4 6.5 7.3 7.8a 6.9 7.0 6.3
Past Month 2.0 2.2a 2.1a 2.6a 2.2a 1.7 2.5 2.6 2.4 2.1 2.4 1.9
Ecstasy                        
Lifetime 15.1a 14.8a 13.8a 13.7 13.4 12.8 16.0a 16.6a 14.9a 12.4a 11.5 9.5
Past Year 5.8a 3.7 3.1 3.1 3.8 3.5 8.0a 5.3a 3.3 3.4 3.6 2.8
Past Month 1.1a 0.7 0.7 0.8 1.0a 0.7 1.6a 1.0a 0.8 0.6 0.9 0.3
LSD                        
Lifetime 15.9a 14.0a 12.1a 10.5a 8.9a 7.3 13.9a 13.8a 10.4a 7.9a 6.7 5.9
Past Year 1.8a 1.1 1.0 1.0 1.2 1.1 2.4a 1.5 1.2 1.1 1.5 1.4
Past Month 0.1a 0.2 0.3 0.2 0.2 0.2 0.4 0.2 0.2 0.2 0.3 0.3
Inhalants                        
Lifetime 15.7a 14.9a 14.0a 13.3a 12.5a 11.3 11.7a 11.4a 10.6a 9.3 9.7 7.5
Past Year 2.2a 2.1a 2.1 2.1a 1.8 1.6 2.2a 1.5 2.3a 1.6 1.8 1.1
Past Month 0.5 0.4 0.4 0.5 0.4 0.4 0.8 0.3 0.4 0.3 0.4 0.3
Alcohol                        
Lifetime 86.7a 87.1a 86.2 85.7 86.5a 85.2 88.4a 87.6 87.2 87.1 87.0 86.0
Past Year 77.9 78.1 78.0 77.9 78.8 77.9 83.9 82.3 83.1 82.8 83.2 82.8
Past Month 60.5 61.4 60.5 60.9 61.9 61.2 67.7 66.3 67.3 66.8 67.0 67.4
Cigarettes                        
Lifetime 71.2a 70.2a 68.7a 67.3a 66.6a 64.7 -- -- -- -- -- --
Past Year 49.0a 47.6a 47.5a 47.2a 47.0a 45.1 41.8a 40.8a 41.4a 40.2a 37.1 36.2
Past Month 40.8a 40.2a 39.5a 39.0a 38.4a 36.2 31.4a 29.5a 30.2a 28.7a 26.7 25.7

End Notes

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

2See http://webapp.icpsr.umich.edu/cocoon/SAMHDA/DAS3/00064.xml.

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