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1993-2003 Treatment Episode Data Set (TEDS) Report of Substance Abuse Treatment Admissions |
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Chapter 2
Trends in Substance Abuse Treatment Admissions: 1993-2003
Trend data are invaluable in monitoring changing patterns in substance abuse treatment admissions. These patterns reflect underlying changes in substance abuse in the population, and have important implications for resource allocation and program planning.
Trends in Primary Substance Abuse
Table 2.1b and Figure 1. Between 1993 and 2003, TEDS treatment admissions were dominated by five substances: alcohol, opiates (primarily heroin), cocaine, marijuana, and stimulants (primarily methamphetamine). These substances together consistently accounted for between 95 and 96 percent of all TEDS admissions from 1993 to 2003.
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Figure 1 |
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SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
Alcohol accounted for just over two-fifths (42
percent) of all TEDS admissions in 2003, a decrease from 57 percent of all
admissions in 1993. However, 44 percent of these
admissions reported abuse of a secondary drug as well. The proportion of
admissions for abuse of alcohol alone declined from 35 percent in 1993 to 23
percent in 2003.
The proportion of TEDS admissions for primary opiate
abuse increased from 13 percent in 1993 to 18 percent in 2003. While
heroin represented 84 percent of all primary opiate admissions in 2003,
other opiates/synthetics3 represented an increasing
proportion of admissions for opiate abuse, from 7 percent in 1993 to 16
percent in 2003.
The proportion of admissions for primary cocaine
abuse declined from 17 percent in 1993 to 14 percent in 2003. Smoked cocaine
(crack) represented 72 percent of all primary cocaine admissions in 2003, down
from a high of 75 percent in 1995.
The proportion of admissions for primary marijuana
increased steadily from 7 percent in 1993 to 15 percent in 2003.
The proportion of admissions for abuse of stimulants
increased from 2 percent in 1993 to 7 percent in 2003. Ninety-nine percent
of all stimulant admissions were for methamphetamine or amphetamine abuse.
Admissions attributable to sedatives and tranquilizers
represented a small and stable proportion of TEDS admissions (each
less than one-half of 1 percent).
Admissions for abuse of hallucinogens, PCP, inhalants, and over-the-counter medications together remained fairly stable over the time period, each accounting for less than one-half of 1 percent of TEDS admissions in 2003.
Trends in the Co-Abuse of Alcohol and Drugs
Table 2.2 and Figure 2. The concurrent abuse of alcohol and drugs continues to be a significant problem. In 2003, approximately 41 percent of all admissions reported problems with both alcohol and drugs—22 percent reported primary drug abuse with secondary alcohol abuse, and 19 percent reported primary alcohol abuse with secondary drug abuse.
Primary alcohol abuse declined from 57 percent of TEDS admissions in 1993 to 42 percent in 2003. Primary drug abuse increased from 40 percent in 1993 to 56 percent in 2003. However, this may reflect changing priorities in the treatment/reporting system rather than a change in substance abuse patterns. Limited resources and targeted programs may result in a shift of State funds from treatment of alcohol abusers to treatment of drug abusers.
| Figure 2 Co-abuse of alcohol and drugs at admission: TEDS 1993-2003 |
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SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
Trends in Admission Rates by Primary Substance and State
Tables 2.3b-2.8b and Figures 3-8 show trends in State admission rates per 100,000 population aged 12 and over for selected substances from 1993 to 2003.
For the maps in Figures 3 to 8, the median, 75th, 90th, and 99th percentiles of the range of 1993 admission rates for each substance were used to establish the rate categories used in the legend. Therefore, for the 47 States (District of Columbia included) reporting in 1993, each 1993 map generally shows one State in purple (the 99th percentile and above), four States in red (the 90th to 98th percentiles), seven States in orange (the 75th to 89th percentiles), 12 States in gold (the 50th to 74th percentiles), and 23 States in cream (below the median 1993 U.S. rate). Crosshatching indicates States where no data were submitted, or where changes in reporting patterns made inclusion in trend calculations for a given year inappropriate.
Data were not submitted for one or more years in some States or jurisdictions because of changes to their data collection systems. These States were: Arizona (1993-1997), the District of Columbia (1993), Indiana (1997), Kentucky (1993-1996), Mississippi (1993-1994), West Virginia (1994, 1997-1998, 2000, and 2003), and Wyoming (1995-1996).
In five States and jurisdictions, significant changes in the clients or facilities reported to TEDS from 1993 to 2003 resulted in changes in the number of admissions large enough to influence trends. For these States, rates are not indicated on the maps for the years affected: the District of Columbia (1994-1996), Louisiana (1997), New Mexico (2002), Texas (1996), and Virginia (1997-1998). The actual data reported, however, are included in all tables.
Alcohol admission rates generally were highest in the New
England, Pacific, and West North Central States. For the United States as
a whole, the alcohol admission rate declined by 29 percent between 1993
and 2003, from 451 per 100,000 population aged 12 and over to 319 per 100,000.
Rates declined in 39 of the 46 States reporting in both years and increased
in 7 States [Table 2.3b and Figure
3].
Heroin admission rates were highest in the New England and
Middle Atlantic States. For the United States as a whole, the heroin admission
rate increased by 18 percent between 1993 and 2003, from 96 per 100,000
population aged 12 and over to 113 per 100,000. Heroin admission rates increased
in 29 of the 45 States reporting in both years,4 decreased
in 12, and were unchanged in 4 States. The highest heroin admission rate
in 1993 was 338 per 100,000 population aged 12 and over. By 2003, seven
States had rates that high or higher [Table
2.4b and Figure 4].
Admission rates for opiates other than heroin5
were generally highest in the New England and East South Central States.
For the United States as a whole, the admission rate for opiates other than
heroin increased by 233 percent between 1993 and 2003, from 6 per 100,000
population aged 12 and over to 20 per 100,000. Admission rates for opiates
other than heroin increased in 44 of the 45 States reporting in both years,4
and decreased in only 1 State. The highest admission rate in 1993 for opiates
other than heroin was 16 per 100,000 population aged 12 and over. By 2003,
29 States had rates that high or higher [Table
2.5b and Figure 5].
Cocaine admission rates were generally highest in the Middle
Atlantic and South Atlantic States. For the United States as a whole, the
cocaine admission rate declined by 25 percent between 1993 and 2003, from
138 per 100,000 population aged 12 and over to 104 per 100,000. Cocaine
admission rates decreased in 31 of the 46 States reporting in both years,
but increased in 14, and were unchanged in 1 State [Table
2.6b and Figure 6].
Marijuana treatment admission rates showed substantial increases
across a large number of States, and were generally highest in the West
North Central and Pacific States. For the United States as a whole, the
marijuana admission rate increased by 115 percent between 1993 and 2003,
from 55 per 100,000 population aged 12 and over to 118 per 100,000. Marijuana
admission rates increased in 39 of the 46 States reporting in both years,
decreased in 5, and were unchanged in 2 States. The highest marijuana admission
rate in 1993 was 144 per 100,000 population aged 12 and over. By 2003, 19
States had rates that high or higher [Table
2.7b and Figure 7].
Methamphetamine/amphetamine admission rates increased, spreading east from the Pacific States. Rates were generally highest in the Pacific, Mountain, and West North Central States. For the United States as a whole, the methamphetamine/amphetamine admission rate increased by 307 percent between 1993 and 2003, from 14 per 100,000 population aged 12 and over to 57 per 100,000. Methamphetamine/amphetamine admission rates increased in 40 of the 46 States reporting in both years, decreased in 4, and were unchanged in 2 States. The highest methamphetamine/amphetamine admission rate in 1993 was 98 per 100,000 population aged 12 and over. By 2003, 13 States had rates that high or higher [Table 2.8b and Figure 8].
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Figure 3 |
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| Continued. See notes at end of figure. |
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Figure 3 (continued) |
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| NOTES: See Chapter 2. SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
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Figure 4 |
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| Continued. See notes at end of figure. |
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Figure 4 (continued) |
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| NOTES: See Chapter 2. SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
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Figure 5 |
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| Continued. See notes at end of figure. |
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Figure 5 (continued) |
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| NOTES: See Chapter 2. SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
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Figure 6 |
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| Continued. See notes at end of figure. |
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Figure 6 (continued) |
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| NOTES: See Chapter 2. SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
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Figure 7 |
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| Continued. See notes at end of figure. |
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Figure 7 (continued) |
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| NOTES: See Chapter 2. SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
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Figure 8 |
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| Continued. See notes at end of figure. |
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Figure 8 (continued) |
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| NOTES: See Chapter 2. SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
Trends in Demographic Characteristics
Table 2.9b. Males represented
69 percent of TEDS admissions in 2003, a proportion that declined slightly from
72 percent in 1993. The distribution of TEDS admissions by sex was different
from that of the U.S. population, where approximately half (49 percent) of the
population was male.
Table 2.9b and Figure 9. The age distribution of TEDS admissions changed between 1993 and 2003. The proportion of TEDS admissions aged 25 to 34 years declined from 39 percent in 1993 to 25 percent in 2003. This decline was offset by overall increases in the proportions of both older and younger admissions. The proportion of older admissions (aged 35 and older) increased from 40 percent in 1993 to 49 percent in 2003. The proportion of younger admissions (less than 25 years of age) increased from 21 percent in 1993 to 26 percent in 2003.
The age distribution of TEDS treatment admissions was different from that of the U.S. population. In 2003, some 88 percent of TEDS admissions aged 12 and over were between the ages of 18 and 54, compared to about 63 percent of the U.S. population aged 12 and over.
| Figure 9 Age at admission: TEDS 1993-2003 |
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SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
Table 2.9b and Figure 10. The racial/ethnic composition of TEDS admissions changed very little between 1993 and 2003. Non-Hispanic Whites made up 58 to 60 percent of admissions throughout the time period. The proportion of non-Hispanic Blacks declined slightly, from 27 percent of admissions in 1993 to 24 percent in 2003. This was offset by an increase in the proportion of admissions for Hispanics (from 11 percent in 1993 to 13 percent in 2003) and for other racial/ethnic groups (from 4 percent in 1993 to 5 percent in 2003).
The racial/ethnic composition of TEDS admissions differed from that of the U.S. population. Non-Hispanic Whites were the majority in both groups, but represented 59 percent of TEDS admissions in 2003, compared to 71 percent of the U.S. population. Non-Hispanic Blacks represented 24 percent of TEDS admissions in 2003 and 12 percent of the U.S. population. However, the proportion of Hispanic TEDS admissions (13 percent) was similar to the proportion of Hispanics in the U.S. population (12 percent). Other racial/ethnic groups made up 5 percent of TEDS admissions and 5 percent of the U.S. population.
| Figure 10 Race/ethnicity of admissions: TEDS 1993-2003 |
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SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
Trends in Socioeconomic Status
Table 2.10a, Table
2.10b, Figure 11 and Figure
12. TEDS admissions aged 16 and over were socioeconomically disadvantaged
compared to the U.S. population aged 16 and over. This is evident in the unadjusted
distributions of admissions by employment status and education shown in Table
2.10a. Because TEDS admissions differ demographically from the U.S. population,
Table 2.10b shows distributions that have been statistically adjusted to provide
a more valid comparison to the U.S. population.6 The
adjusted distributions indicate an even greater disparity in socioeconomic
status than do the unadjusted.
TEDS admissions aged 16 and over were less likely to be employed than the U.S. population aged 16 and over. Some 71 percent (75 percent adjusted) of 2003 TEDS admissions aged 16 and over were unemployed or not in the labor force, compared to 38 percent of the U.S. population aged 16 and over. Only 21 percent (18 percent adjusted) were employed full time, compared to 51 percent of the U.S. population aged 16 and over.
The proportion of TEDS admissions that were employed full time declined from 26 percent in 1993 to 21 percent in 2003.
The proportion of TEDS admissions that were unemployed declined from 28 percent in 1993 to a low of 24 percent in 1999, but had increased to 31 percent by 2003.
| Figure 11 Employment status at admission, aged 16 and over: TEDS 1993-2003 |
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SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
Table 2.10a, Table 2.10b, and Figure 12. TEDS admissions aged 18 and over had less education than the U.S. population aged 18 and over. Some 35 percent (31 percent adjusted) of TEDS admissions aged 18 and over had not completed high school, compared to 16 percent of the U.S. population aged 18 and over. TEDS admissions were also less likely to have received education beyond high school—21 percent (27 percent adjusted) of TEDS admissions aged 18 and over, compared to 52 percent of the U.S. population aged 18 and over. These proportions were relatively stable from 1993 to 2003.
| Figure 12 Education at admission, aged 18 and over: TEDS 1993-2003 |
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SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05. |
3 These drugs
include methadone (non-prescription use), codeine, hydrocodone, hydromorphone,
meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol,
and any other drug with morphine-like effects.
4 Tennessee included
Heroin admissions among admissions for Opiates other than heroin
beginning in 1998. Therefore Tennessee is excluded here from the tabulations
of the number of States reporting in 1993 and 2003.
5 These drugs include codeine, hydrocodone,
hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene,
tramadol, and any other drug with morphine-like effects. Non-prescription
use of methadone is not included.
6 The distributions have been adjusted for age, sex, and race/ethnicity
to the U.S. population. In essence, this technique compares the distributions
under the assumption that the TEDS population and the U.S. population had
the same age, sex, and racial/ethnic characteristics.
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