Results from the 2008
National Survey on Drug Use and Health:
National Findings
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Office of Applied Studies
Acknowledgments
This report was prepared by the Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), 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.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.
Recommended Citation
Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD.
Electronic Access and Copies of Publication
This publication may be downloaded from http://www.oas.samhsa.gov. Hard copies may be obtained from http://www.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
Substance Abuse and Mental Health Services Administration
Office of Applied Studies
Division of Population Surveys
1 Choke Cherry Road, Room 7-1044
Rockville, MD 20857
This report presents the first information from the 2008 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year. Unless otherwise noted, all comparisons in this report described using terms such as "increased," "decreased," or "more than" are statistically significant at the .05 level.
Illicit Drug Use
In 2008, an estimated 20.1 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.0 percent of the population aged 12 years old or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.
The rate of current illicit drug use among persons aged 12 or older in 2008 (8.0 percent) was the same as the rate in 2007 (8.0 percent).
Marijuana was the most commonly used illicit drug (15.2 million past month users). Among persons aged 12 or older, the rate of past month marijuana use in 2008 (6.1 percent) was similar to the rate in 2007 (5.8 percent).
In 2008, there were 1.9 million current cocaine users aged 12 or older, comprising 0.7 percent of the population. These estimates were similar to the number and rate in 2007 (2.1 million or 0.8 percent), but lower than the estimates in 2006 (2.4 million or 1.0 percent).
Hallucinogens were used in the past month by 1.1 million persons (0.4 percent) aged 12 or older in 2008, including 555,000 (0.2 percent) who had used Ecstasy. These estimates were similar to the corresponding estimates for 2007.
There were 6.2 million (2.5 percent) persons aged 12 or older who used prescription-type psychotherapeutic drugs nonmedically in the past month. These estimates were lower than in 2007 (6.9 million or 2.8 percent).
The number of past month methamphetamine users decreased by over half between 2006 and 2008. The numbers were 731,000 in 2006, 529,000 in 2007, and 314,000 in 2008.
Among youths aged 12 to 17, the current illicit drug use rate remained stable from 2007 (9.5 percent) to 2008 (9.3 percent). Between 2002 and 2008, youth rates declined significantly for illicit drugs in general (from 11.6 to 9.3 percent) and for marijuana (8.2 to 6.7 percent), cocaine (0.6 to 0.4 percent), prescription-type drugs used nonmedically (4.0 to 2.9 percent), pain relievers (3.2 to 2.3 percent), stimulants (0.8 to 0.5 percent), and methamphetamine (0.3 to 0.1 percent).
The rate of current marijuana use among youths aged 12 to 17 decreased from 8.2 percent in 2002 to 6.7 percent in 2006 and remained unchanged at 6.7 percent in 2007 and 2008.
The rate of current hallucinogen use among youths aged 12 to 17 increased from 0.7 percent in 2007 to 1.0 percent in 2008.
Rates of current use of illicit drugs in 2008 were higher among young adults aged 18 to 25 (19.6 percent) than for youths aged 12 to 17 (9.3 percent) and adults aged 26 or older (5.9 percent). Among young adults, there were no changes from 2007 to 2008 in the rate of current use of marijuana (16.5 percent in 2008), psychotherapeutics (5.9 percent), and hallucinogens (1.7 percent). The rate of cocaine use in this age group declined from 2.6 percent in 2005 to 1.5 percent in 2008.
From 2002 to 2008, there was an increase among young adults aged 18 to 25 in the rate of current nonmedical use of prescription pain relievers (from 4.1 to 4.6 percent) and in LSD (from 0.1 to 0.3 percent). There were decreases in the use of inhalants (from 0.5 to 0.3 percent) and methamphetamine (from 0.6 to 0.2 percent).
Among those aged 50 to 59, the rate of past month illicit drug use increased from 2.7 percent in 2002 to 4.6 percent in 2008. This trend may partially reflect the aging into this age group of the baby boom cohort, whose lifetime rate of illicit drug use is higher than those of older cohorts.
Among persons aged 12 or older in 2007-2008 who used pain relievers nonmedically in the past 12 months, 55.9 percent got the drug they most recently used from a friend or relative for free. Another 18.0 percent reported they got the drug from one doctor. Only 4.3 percent got pain relievers from a drug dealer or other stranger, and 0.4 percent bought them on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 81.7 percent reported in a follow-up question that the friend or relative had obtained the drugs from just one doctor.
Among unemployed adults aged 18 or older in 2008, 19.6 percent were current illicit drug users, which was higher than the 8.0 percent of those employed full time and 10.2 percent of those employed part time. However, most illicit drug users were employed. Of the 17.8 million current illicit drug users aged 18 or older in 2008, 12.9 million (72.7 percent) were employed either full or part time. The number of unemployed illicit drug users increased from 1.3 million in 2007 to 1.8 million in 2008, primarily because of an overall increase in the number of unemployed persons.
In 2008, 10.0 million persons aged 12 or older reported driving under the influence of illicit drugs during the past year. This corresponds to 4.0 percent of the population aged 12 or older, the same as the rate in 2007 (4.0 percent), but lower than the rate in 2002 (4.7 percent). In 2008, the rate was highest among young adults aged 18 to 25 (12.3 percent).
Alcohol Use
Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2008 survey (51.6 percent). This translates to an estimated 129.0 million people, which was similar to the 2007 estimate of 126.8 million people (51.1 percent).
In 2008, more than one fifth (23.3 percent) of persons aged 12 or older participated in binge drinking. This translates to about 58.1 million people, similar to the estimate in 2007. Binge drinking is defined as having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey.
In 2008, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.3 million people. This rate was the same as the rate of heavy drinking in 2007. Heavy drinking is defined as binge drinking on at least 5 days in the past 30 days.
Among young adults aged 18 to 25 in 2008, the rate of binge drinking was 41.0 percent, and the rate of heavy drinking was 14.5 percent. These rates were similar to the rates in 2007.
The rate of current alcohol use among youths aged 12 to 17 was 14.6 percent in 2008, which is lower than the 2007 rate (15.9 percent). Youth binge and heavy drinking rates in 2008 were 8.8 percent (lower than the 9.7 percent rate in 2007) and 2.0 percent, respectively.
Past month and binge drinking rates among underage persons (aged 12 to 20) declined between 2002 and 2008. The rate of past month underage drinking declined from 28.8 to 26.4 percent, and the rate of past month binge drinking declined from 19.3 to 17.4 percent.
Past month alcohol use rates declined between 2002 and 2008 for those aged 12 or 13 (4.3 to 3.4 percent), 14 or 15 (16.6 to 13.1 percent), 16 or 17 (32.6 to 26.2 percent), and 18 to 20 (51.0 to 48.7 percent).
Among persons aged 12 to 20, past month alcohol use rates in 2008 were 17.2 percent among Asians, 19.0 percent among blacks, 22.9 percent among those reporting two or more races, 23.1 percent among Hispanics, 26.4 percent among American Indians or Alaska Natives, and 30.1 percent among whites.
In 2008, 56.2 percent of current drinkers aged 12 to 20 reported that their last use of alcohol in the past month occurred in someone else's home, and 29.6 percent reported that it had occurred in their own home. About one third (30.8 percent) paid for the alcohol the last time they drank, including 8.3 percent who purchased the alcohol themselves and 22.3 percent who gave money to someone else to purchase it. Among those who did not pay for the alcohol they last drank, 37.4 percent got it from an unrelated person aged 21 or older, 21.1 percent from another person under 21 years of age, and 21.0 percent from a parent, guardian, or other adult family member.
In 2008, an estimated 12.4 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage has dropped since 2002, when it was 14.2 percent. The rate of driving under the influence of alcohol was highest among persons aged 21 to 25 (26.1 percent).
Tobacco Use
In 2008, an estimated 70.9 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 28.4 percent of the population in that age range. In addition, 59.8 million persons (23.9 percent of the population) were current cigarette smokers; 13.1 million (5.3 percent) smoked cigars; 8.7 million (3.5 percent) used smokeless tobacco; and 1.9 million (0.8 percent) smoked tobacco in pipes.
The rate of current use of any tobacco product among persons aged 12 or older remained steady from 2007 to 2008 (28.6 and 28.4 percent, respectively). Rates of current use of cigarettes, smokeless tobacco, cigars, and pipe tobacco also did not change significantly over that period. However, between 2002 and 2008, past month use of any tobacco product decreased from 30.4 to 28.4 percent, and past month cigarette use declined from 26.0 to 23.9 percent. Rates of past month use of cigars, smokeless tobacco, and pipe tobacco in 2008 were similar to corresponding rates in 2002.
The rate of past month cigarette use among 12 to 17 year olds declined from 9.8 percent in 2007 to 9.1 percent in 2008, continuing a decline since 2002 when the rate was 13.0 percent. However, past month smokeless tobacco use did not decline over this period (2.0 percent in 2002 and 2.2 percent in 2008).
Among pregnant women aged 15 to 44, combined data for 2007 and 2008 indicated that the rate of past month cigarette use was 16.4 percent. The rate was higher among women in that age group who were not pregnant (27.3 percent).
Initiation of Substance Use (Incidence, or First-Time Use) within the Past 12 Months
In 2008, an estimated 2.9 million persons aged 12 or older used an illicit drug for the first time within the past 12 months. This averages to almost 8,000 initiates per day and is similar to the estimate for 2007. A majority of these past year illicit drug initiates reported that their first drug was marijuana (56.6 percent). Nearly one third initiated with psychotherapeutics (29.6 percent, including 22.5 percent with pain relievers, 3.2 percent with tranquilizers, 3.0 percent with stimulants, and 0.8 percent with sedatives). A sizable proportion reported inhalants (9.7 percent) as their first illicit drug, and a small proportion used hallucinogens as their first drug (3.2 percent).
In 2008, the illicit drug categories with the largest number of past year initiates among persons aged 12 or older were marijuana use (2.2 million) and nonmedical use of pain relievers (2.2 million). These estimates were not significantly different from the numbers in 2007.
In 2008, there were 729,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 70.4 percent were under age 18 when they first used. There was no significant change in the number of inhalant initiates from 2007 to 2008, but the number in 2008 was significantly lower than the estimate in 2005 (877,000).
The number of past year initiates of methamphetamine among persons aged 12 or older was 95,000 in 2008. This estimate was significantly lower than the estimate in 2007 (157,000) and was less than one third of the number estimated in 2004 (318,000).
Following substantial drops in initiation between 2002 and 2003, estimates of initiation of Ecstasy and LSD among persons aged 12 or older have increased significantly. Between 2003 and 2008, the number of Ecstasy initiates increased from 642,000 to 894,000, and the number of LSD initiates increased from 200,000 to 394,000.
Most (84.6 percent) of the 4.5 million past year alcohol initiates were younger than age 21 at the time of initiation.
The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was 2.4 million in 2008, similar to the estimate in 2007 (2.2 million) but significantly higher than the estimate for 2002 (1.9 million). Most new smokers in 2008 were under age 18 when they first smoked cigarettes (58.8 percent); however, the number of persons initiating smoking at age 18 or older increased from about 600,000 in 2002 to 1 million in 2008.
Youth Prevention-Related Measures
Perceived risk is measured by NSDUH as the percentage reporting that there is great risk in the substance use behavior. The percentage of youths aged 12 to 17 perceiving great risk in smoking marijuana once or twice a week increased from 51.5 percent in 2002 to 55.0 percent in 2005, but dropped to 53.1 percent in 2008. A decline from 2005 to 2008 also was observed for using LSD once or twice a week (76.2 percent in 2002, 76.1 percent in 2005, and 73.9 percent in 2008). Between 2002 and 2008, the percentages who reported great risk in using alcohol and cigarettes increased. In 2002, 63.1 percent of youths reported great risk in smoking one or more packs of cigarettes per day, and in 2008 the percentage increased to 69.7 percent. In 2002, 38.2 percent reported great risk in binge drinking once or twice a week, and in 2008 the percentage increased to 40.5 percent.
Almost half (49.2 percent) of youths aged 12 to 17 reported in 2008 that it would be "fairly easy" or "very easy" for them to obtain marijuana if they wanted some. Around one quarter reported it would be easy to get cocaine (22.1 percent). About one in seven (13.8 percent) indicated that LSD would be "fairly" or "very" easily available, and 13.0 percent reported easy availability for heroin. Between 2002 and 2008, there were declines in the perceived availability for all four drugs.
A majority of youths aged 12 to 17 (90.8 percent) in 2008 reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice. Current marijuana use was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than for those who did not (4.3 vs. 29.8 percent).
In 2008, 11.1 percent of youths aged 12 to 17 reported that they had participated in substance use prevention programs outside of school within the past year. This was lower than the percentage reported in 2002 (12.7 percent). Almost four fifths (78.0 percent) reported having seen or heard drug or alcohol prevention messages from sources outside of school, lower than in 2002 when the percentage was 83.2 percent. The percentage of school-enrolled youths reporting that they had seen or heard prevention messages at school also declined during this period, from 78.8 to 75.9 percent.
Substance Dependence, Abuse, and Treatment
In 2008, an estimated 22.2 million persons (8.9 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Of these, 3.1 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.2 million were dependent on or abused alcohol but not illicit drugs.
Between 2002 and 2008, there was no change in the number of persons with substance dependence or abuse (22.0 million in 2002 and 22.2 million in 2008).
The specific illicit drugs that had the highest levels of past year dependence or abuse in 2008 were marijuana (4.2 million), followed by pain relievers (1.7 million) and cocaine (1.4 million).
In 2008, adults aged 21 or older who had first used alcohol at age 14 or younger were more than 5 times as likely to be classified with alcohol dependence or abuse than adults who had their first drink at age 21 or older (15.1 vs. 2.6 percent).
The rate of substance dependence or abuse for males aged 12 or older in 2008 was nearly twice as high as the rate for females (11.5 vs. 6.4 percent). Among youths aged 12 to 17, however, the rate of substance dependence or abuse was higher among females than males (8.2 vs. 7.0 percent).
Between 2002 and 2008, the percentage of youths aged 12 to 17 with substance dependence or abuse declined from 8.9 to 7.6 percent.
Treatment need is defined as having a substance use disorder or receiving treatment at a specialty facility (hospital inpatient, drug or alcohol rehabilitation, or mental health centers) within the past 12 months. In 2008, 23.1 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (9.2 percent of persons aged 12 or older). Of these, 2.3 million (0.9 percent of persons aged 12 or older and 9.9 percent of those who needed treatment) received treatment at a specialty facility. Thus, 20.8 million persons (8.3 percent of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty substance abuse facility in the past year.
Of the 20.8 million people in 2008 who were classified as needing substance use treatment but did not receive treatment at a specialty facility in the past year, 1.0 million persons (4.8 percent) reported that they felt they needed treatment for their illicit drug or alcohol use problem. Of these 1.0 million persons who felt they needed treatment, 233,000 (23.3 percent) reported that they made an effort to get treatment, and 766,000 (76.7 percent) reported making no effort to get treatment.
Mental Health
Serious mental illness (SMI) among adults is defined in Public Law 102-321 as persons aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within DSM-IV that has resulted in functional impairment, which substantially interferes with or limits one or more major life activities. In 2008, there were an estimated 9.8 million adults with SMI, representing 4.4 percent of adults.
Rates of SMI in 2008 were highest for adults aged 18 to 25 (7.4 percent) and lowest for adults aged 50 or older (2.3 percent).
The prevalence of SMI among women aged 18 or older (5.6 percent) was higher than that among men in that age group (3.0 percent).
The rate of SMI was higher among adults who were unemployed (8.0 percent) than among those who were employed full time (3.5 percent) or part time (4.8 percent).
SMI in the past year was associated with past year substance dependence or abuse. Among adults aged 18 or older with SMI in 2008, 25.2 percent (2.5 million) were dependent on or abused illicit drugs or alcohol. The rate among adults without SMI was 8.3 percent (17.9 million).
Among the 9.8 million adults with SMI in 2008, 5.7 million (58.7 percent) used mental health services in the past year. Among all adults with SMI, 52.6 percent received a prescription medication, 40.5 percent received outpatient services, and 7.5 percent received inpatient services for a mental health problem in the past year.
Among the 2.5 million adults with both SMI and substance dependence or abuse (i.e., a substance use disorder) in 2008, more than half (60.5 percent) received mental health care or substance use treatment at a specialty facility; 11.4 percent received both mental health care and specialty substance use treatment, 45.2 percent received only mental health care, and 3.7 percent received only specialty substance use treatment.
In 2008, an estimated 8.3 million adults (3.7 percent) had serious thoughts of suicide in the past year. The rate was 3.9 percent among women and 3.4 percent among men. The rate was highest among young adults aged 18 to 25 (6.7 percent) compared with adults 26 to 49 (3.9 percent) and adults aged 50 or older (2.3 percent).
Among adults aged 18 or older in 2008, 2.3 million (1.0 percent) made suicide plans in the past year, and 1.1 million (0.5 percent) reported attempting suicide. A half million adults reported staying overnight in a hospital as a result of their suicide attempt in the past year.
In 2008, 6.4 percent of persons aged 18 or older (14.3 million persons) had at least one major depressive episode (MDE) in the past year. Over 1 in 25 adults (4.2 percent or 9.5 million persons) had past year MDE with severe impairment.
In 2008, adults with past year MDE were more likely than those without MDE to be dependent on or abuse illicit drugs or alcohol (20.3 vs. 7.8 percent).
Among adults aged 18 or older who had MDE in the past year in 2008, 71.0 percent received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression in the same time period.
Among adults aged 18 or older with MDE in the past year in 2008, women were more likely than men to receive treatment for depression in the past year (74.2 vs. 65.0 percent).
In 2008, there were 2.0 million youths (8.3 percent of the population aged 12 to 17) who had MDE during the past year. An estimated 1.5 million (6.0 percent) had MDE with severe impairment in one or more role domains (chores at home; school or work; close relationships with family; or social life).
The rate of MDE in the past year was higher for adolescent females (12.4 percent) than for adolescent males (4.3 percent). The prevalence of MDE with severe impairment was 9.2 percent for females and 2.9 percent for males.
Among 12 to 17 year olds who had past year MDE in 2008, 37.4 percent had used illicit drugs during the same period. This was higher than the rate of 17.2 percent among youths who did not have past year MDE. Similarly, the rates of past month daily cigarette use and heavy alcohol use were higher for youths with MDE (3.6 and 3.4 percent, respectively) than for youths who did not have MDE (1.8 and 1.8 percent, respectively).
In 2008, 37.7 percent of youths aged 12 to 17 with past year MDE received treatment for depression (saw or talked to a medical doctor or other professional or used prescription medication). Among youths with past year MDE, 21.7 percent saw or talked to a medical doctor or other professional only, 2.9 percent used prescription medication only, and 13.1 percent received treatment from both sources for depression in the past year.
In 2008, 3.1 million youths aged 12 to 17 (12.7 percent) received treatment or counseling for problems with behavior or emotions in the specialty mental health setting (inpatient or outpatient care). Additionally, 11.8 percent of youths received services in the education setting, and 2.9 percent received mental health services in the general medical setting in the past 12 months. Mental health services were received in both the specialty setting and either the education or general medical settings (i.e., care from multiple settings) by 5.3 percent of youths.
1. Introduction
This report presents a first look at results from the 2008 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. The report 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 serious mental illness, depression, and the co-occurrence of substance use and mental health problems. The report focuses on trends between 2007 and 2008 and from 2002 to 2008, as well as differences across population subgroups in 2008. Estimates from NSDUH for States and areas within States will be presented in separate reports.
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.
From 1971 through 1998, the survey employed paper and pencil data collection. 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 mode for responding to questions in order 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 2008 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 about half 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) and had a sample size of about 3,600 each. For the remaining 42 States and the District of Columbia, the sample size was about 900 per State. 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, screening was completed at 142,938 addresses, and 68,736 completed interviews were obtained. The survey was conducted from January through December 2008. Weighted response rates for household screening and for interviewing were 89.0 and 74.4 percent, respectively. See Appendix B for more information on NSDUH response rates.
1.2. Limitations on Trend Measurement
Because of the shift in interviewing method in 1999, the estimates from the pre-1999 surveys are not comparable with estimates from the current CAI-based surveys. Although the design of the 2002 through 2008 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are also important methodological differences that affect the comparability of the 2002 to 2008 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. Also, the name of the survey was changed in 2002, from the National Household Survey on Drug Abuse (NHSDA) to the current name. 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 the sample weights 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 in more detail (see OAS, 2005).
Because of changes in the questionnaire, estimates for methamphetamine, stimulants, and psychotherapeutics in this report should not be compared with corresponding estimates in OAS reports for data years prior to 2007. Estimates for 2002 to 2006 for these drug categories in this report, as well as in the 2007 report, incorporate statistical adjustments to enable year-to-year comparisons to be made over the period from 2002 to 2008.
The next section describes questionnaire changes that affect trend measurement for serious psychological distress and major depressive episode.
1.3. New Data on Mental Health
Several important changes were made to the adult mental health section in the 2008 NSDUH questionnaire. These changes provide valuable new data on mental health, but they also affect some of the measures that have been collected in NSDUH since 2004. A brief summary of the changes and their impact is provided below.
From 2004 to 2007, NSDUH collected data for adults aged 18 or older on lifetime and past year major depressive episode (MDE). The survey also included the K6 distress scale with a past 12 month time frame. SAMHSA used the K6 data to generate estimates of serious psychological distress (SPD) in the past 12 months. To address SAMHSA's need for estimates of serious mental illness (SMI), as well as data on suicidal ideation and behavior, OAS modified the NSDUH adult mental health module in 2008 to obtain these data. Scales were added that assessed impairment caused by mental problems. OAS also expanded the K6 questions to ask about the past 30 days (the time frame for which the K6 was originally designed). A Mental Health Surveillance Study (MHSS) was initiated in which a subsample of adults (about 1,500 in 2008) who had completed the NSDUH interview was administered a standard clinical interview by mental health clinicians via paper and pencil over the telephone to determine their SMI status. Using both clinical interview and computer-assisted interview data for the respondents who completed the clinical interview, statistical models were developed that then were applied to the full NSDUH adult sample to produce SMI estimates. See Section B.4.6 in Appendix B for a more complete discussion.
The first estimates from the expanded mental health module, including those for SMI, 30-day SPD, and suicidal thoughts and behavior, are included in Chapter 8 of this report. However, the questionnaire changes caused discontinuities in trends for MDE and 12-month SPD. Analyses of these data have determined that the 2008 data for MDE and 12-month SPD are not comparable with 2007 and earlier data (see Section B.4.4 in Appendix B). Thus, no 12-month SPD data are discussed in the report, and MDE data are presented only for 2008.
No questionnaire changes were made in 2008 that affected MDE items for youths aged 12 to 17 or for the youth and adult mental health service utilization questions. The discussion of estimates for these measures in this report includes comparisons with prior years' data.
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 (Appendix E), and present selected tabulations of estimates (Appendices F and G). A list of contributors to the production of this report also is provided (Appendix H).
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 2008 estimates are significantly different from 2007 or earlier estimates. In some tables and figures, estimates are presented based on data combined from two or more survey years to increase precision of the estimates; those estimates are annual averages based on multiple years of data.
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 in Appendix B). Estimates that do not meet these criteria are suppressed and do not appear in tables, figures, or text. 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 outside of 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 populations of fewer than 2,500 in urbanized areas.
1.5. Other NSDUH Reports and Data
Other reports focusing on specific topics of interest will be produced using the 2008 NSDUH data and made available on SAMHSA's website. A report on State-level estimates for 2007-2008 will be available in early 2010.
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. 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, 2009) at http://www.datafiles.samhsa.gov. Currently, files are available from the 1979 to 2007 surveys.2 The 2008 NSDUH public use file will be available by the end of 2009.
2. Illicit Drug Use
The National Survey on Drug Use and Health (NSDUH) obtains information on nine 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. They also include drugs within these groupings that originally were prescription medications but currently may be manufactured and distributed 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 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 beginning in 2005. Estimates for these drugs for earlier years when these items were not collected have been adjusted to be comparable with the current estimates. For further information, see Section B.4.6 of the 2007 NSDUH national findings report (Office of Applied Studies [OAS], 2008). The estimates for the nonmedical use of stimulants and psychotherapeutic drugs in this report are not comparable with corresponding estimates in NSDUH reports prior to the 2007 data year, and the methamphetamine use estimates in this report also are not comparable with those in NSDUH reports for survey years prior to 2006.
In 2008, an estimated 20.1 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview (Figure 2.1). This estimate represents 8.0 percent of the population aged 12 or older.
The overall rate of current illicit drug use among persons aged 12 or older in 2008 (8.0 percent) was the same as the rate in 2007 and has remained stable since 2002 (8.3 percent) (Figure 2.2).
Below is a bar graph. Click here for the text describing this graph.
Figure 2.1 Past Month Illicit Drug Use among Persons Aged 12 or Older: 2008
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: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Marijuana was the most commonly used illicit drug (15.2 million past month users). In 2008, marijuana was used by 75.7 percent of current illicit drug users and was the only drug used by 57.3 percent of them. Illicit drugs other than marijuana were used by 8.6 million persons or 42.7 percent of illicit drug users aged 12 or older. Current use of other drugs but not marijuana was reported by 24.3 percent of illicit drug users, and 18.4 percent used both marijuana and other drugs.
Among persons aged 12 or older, the overall rate of past month marijuana use in 2008 (6.1 percent) was similar to the rate in 2007 and the rates in earlier years going back to 2002 (Figure 2.2).
An estimated 8.6 million people aged 12 or older (3.4 percent) were current users of illicit drugs other than marijuana in 2008. The majority of these (6.2 million persons or 2.5 percent of the population) used psychotherapeutic drugs nonmedically. An estimated 4.7 million persons used pain relievers nonmedically in the past month in 2008, 1.8 million used tranquilizers, 904,000 used stimulants, and 234,000 used sedatives.
The number and percentage of current nonmedical users of psychotherapeutic drugs in 2008 (6.2 million or 2.5 percent) were lower than in 2007 (6.9 million or 2.8 percent) (Figure 2.2). A small decline in the percentage of pain reliever users between 2007 (2.1 percent) and 2008 (1.9 percent), although not statistically significant, partly contributed to the lower rate for current use of psychotherapeutic drugs (Figure 2.3).
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Figure 2.3 Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
The number of past month methamphetamine users decreased by over half between 2006 and 2008. The numbers were 731,000 in 2006, 529,000 in 2007, and 314,000 in 2008.
The estimated number and percentage of persons aged 12 or older who used cocaine in the past month in 2008 (1.9 million users or 0.7 percent of the population) were similar to those in 2007 (2.1 million or 0.8 percent) and 2002 (2.0 million or 0.9 percent). However, the number and percentage of past month crack users in 2008 (359,000 or 0.1 percent of the population) were lower than in 2007 (610,000 or 0.2 percent) and all other years going back to 2002 except for 2004.
Hallucinogens were used in the past month by 1.1 million persons aged 12 or older (0.4 percent) in 2008, including 555,000 (0.2 percent) who had used Ecstasy. These estimates are similar to the corresponding estimates for 2007. Current use of LSD remained stable from 2007 to 2008, but past year use of LSD increased from 620,000 to 802,000, a higher number than in 2003, 2004, 2005, and 2007, but lower than the 999,000 past year users in 2002.
Age
Rates of past month illicit drug use varied with age. Through the adolescent years from 12 to 17, the rates of current illicit drug use in 2008 increased from 3.3 percent at ages 12 or 13 to 8.6 percent at ages 14 or 15 to 15.2 percent at ages 16 or 17 (Figure 2.4). The highest rate was among persons aged 18 to 20 (21.5 percent). The rate was 18.4 percent among those aged 21 to 25, and it was 13.0 percent among those aged 26 to 29. Among persons aged 65 or older, the rate was 1.0 percent.
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Figure 2.4 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2008
In 2008, adults aged 26 or older were less likely to be current drug users than youths aged 12 to 17 or young adults aged 18 to 25 (5.9 vs. 9.3 and 19.6 percent, respectively). However, there were more drug users aged 26 or older (11.3 million) than users in the 12-to-17-year age group (2.3 million) and 18-to-25-year age group (6.5 million) combined.
Current illicit drug use remained stable from 2007 to 2008 among youths aged 12 to 17, young adults aged 18 to 25, and adults aged 26 or older. From 2002 to 2008, however, the rate of current illicit drug use among 12 to 17 year olds decreased from 11.6 to 9.3 percent (Figure 2.5).
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Figure 2.5 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Youths Aged 12 to 17
In 2008, 9.3 percent of youths aged 12 to 17 were current illicit drug users: 6.7 percent used marijuana, 2.9 percent engaged in nonmedical use of prescription-type psychotherapeutics, 1.1 percent used inhalants, 1.0 percent used hallucinogens, and 0.4 percent used cocaine.
Among youths aged 12 to 17, the types of drugs used in the past month varied by age group. Among 12 or 13 year olds, 1.5 percent used prescription-type drugs nonmedically, 1.2 percent used inhalants, and 1.0 percent used marijuana. Among 14 or 15 year olds, marijuana was the most commonly used drug (5.7 percent), followed by prescription-type drugs used nonmedically (3.0 percent), inhalants (1.3 percent), and hallucinogens (1.0 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (12.7 percent); it was followed by prescription-type drugs used nonmedically (4.0 percent), hallucinogens (1.6 percent), cocaine (0.7 percent), and inhalants (0.7 percent).
The overall rate of current illicit drug use remained stable from 2007 to 2008 among youths aged 12 to 17, as did the rates for most specific drugs, except for hallucinogens and the nonmedical use of psychotherapeutics. An increase was seen in the rate of past month hallucinogen use, which went from 0.7 percent in 2007 to 1.0 percent in 2008, driven in part by an increase in Ecstasy use from 0.3 to 0.4 percent. However, the rate of nonmedical use of prescription psychotherapeutic drugs among youths declined from 3.3 percent in 2007 to 2.9 percent in 2008, driven largely by a decrease in the misuse of pain relievers from 2.7 to 2.3 percent (Figure 2.5).
From 2002 to 2008, rates of current use among youths aged 12 to 17 declined significantly for illicit drugs overall and for several specific drugs, including marijuana (from 8.2 to 6.7 percent), cocaine (from 0.6 to 0.4 percent), prescription-type drugs used nonmedically (from 4.0 to 2.9 percent), pain relievers (from 3.2 to 2.3 percent), stimulants (from 0.8 to 0.5 percent), and methamphetamine (from 0.3 to 0.1 percent) (Figure 2.5). For illicit drug use overall, the rates were 11.6 percent in 2002, 11.2 percent in 2003, 10.6 percent in 2004, 9.9 percent in 2005, 9.8 percent in 2006, 9.5 percent in 2007, and 9.3 percent in 2008.
The rate of current marijuana use among youths aged 12 to 17 decreased from 8.2 percent in 2002 to 6.7 percent in 2006 and remained at that level in 2007 and 2008. Significant declines also occurred between 2002 and 2008 for past year marijuana use (from 15.8 to 13.0 percent) and lifetime marijuana use (from 20.6 to 16.5 percent).
Young Adults Aged 18 to 25
Rates of current use of illicit drugs in 2008 were higher for young adults aged 18 to 25 (19.6 percent) than for youths aged 12 to 17 (9.3 percent) and adults aged 26 or older (5.9 percent). Among young adults, 16.5 percent used marijuana in the past month, 5.9 percent used prescription-type drugs nonmedically, 1.7 percent used hallucinogens, and 1.5 percent used cocaine (Figure 2.6).
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Figure 2.6 Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
From 2007 to 2008, rates of current use among young adults aged 18 to 25 remained stable for illicit drugs overall and each specific drug.
From 2002 to 2008, there were declines in young adults' past month cocaine use (from 2.0 to 1.5 percent), inhalant use (from 0.5 to 0.3 percent), nonmedical use of stimulants (from 1.3 to 1.1 percent), and methamphetamine use (from 0.6 to 0.2 percent). Over the 7-year period, there were increases in the current use of pain relievers (from 4.1 to 4.6 percent) and LSD (from 0.1 to 0.3 percent).
Adults Aged 26 or Older
Among adults aged 26 or older, 5.9 percent were current illicit drug users in 2008. In this age group, 4.2 percent used marijuana, and 1.9 percent used prescription-type drugs nonmedically. Less than 1 percent used cocaine (0.7 percent), hallucinogens (0.1 percent), heroin (0.1 percent), and inhalants (0.1 percent). The only significant change between 2007 and 2008 in the rates of past month use among adults in this age group involved crack, which decreased from 0.3 to 0.2 percent. In addition, the rates of past year nonmedical use declined for psychotherapeutic drugs overall (from 4.9 percent in 2007 to 4.4 percent in 2008), sedatives (from 0.3 to 0.2 percent), and methamphetamine (from 0.4 to 0.3 percent). However, increases occurred in lifetime use of hallucinogens (from 14.2 percent in 2007 to 15.2 percent in 2008) and lifetime nonmedical use of pain relievers (from 11.8 to 12.7 percent).
Among adults aged 50 to 59, the rate of current illicit drug use increased from 2.7 to 4.6 percent between 2002 and 2008 (Figure 2.7). For those aged 50 to 54, the rate increased from 3.4 percent in 2002 to 6.0 percent in 2006, then dropped to 4.3 percent in 2008, not significantly different from the rate in either 2002 or 2006. Among those aged 55 to 59, current illicit drug use showed an increase from 1.9 percent in 2002 to 5.0 percent in 2008. These patterns and trends may partially reflect the aging into these age groups of members of the baby boom cohort, whose rates of illicit drug use have been higher than those of older cohorts.
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Figure 2.7 Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Gender
In 2008, as in prior years, the rate of current illicit drug use among persons aged 12 or older was higher for males than for females (9.9 vs. 6.3 percent, respectively). Males were more likely than females to be past month users of marijuana (7.9 vs. 4.4 percent). However, males and females had similar rates of past month nonmedical use of psychotherapeutic drugs (2.6 and 2.4 percent, respectively), pain relievers (2.0 and 1.8 percent), tranquilizers (0.7 and 0.8 percent), stimulants (0.4 percent for both), methamphetamine (0.1 percent for both), and sedatives (0.1 percent for both).
Although males were more likely than females to be current illicit drug users in 2008, the rate of current illicit drug use among females aged 12 or older increased from 5.8 percent in 2007 to 6.3 percent in 2008. However, the rate did not change significantly for males (10.4 and 9.9 percent for 2007 and 2008, respectively). Current marijuana use also increased from 3.8 to 4.4 percent among females, but for males there was no significant change (8.0 and 7.9 percent, respectively).
For males, current nonmedical use of psychotherapeutics declined from 3.2 percent in 2007 to 2.6 percent in 2008, driven in part by a decline in pain reliever misuse from 2.6 to 2.0 percent. Current use of crack by males also decreased in this time period from 0.4 to 0.2 percent. There were no significant changes in the use of these drugs among females.
Among youths aged 12 to 17 in 2008, males and females had similar rates of current use of illicit drugs (9.5 percent for males and 9.1 percent for females), cocaine (0.5 and 0.3 percent, respectively), hallucinogens (1.1 and 0.8 percent), and inhalants (1.1 percent for both). However, current marijuana use was more prevalent among male youths (7.3 percent) than female youths (6.0 percent) (Figure 2.8). Nonmedical use of psychotherapeutic drugs among 12 to 17 year olds, on the other hand, was more prevalent among females (3.3 percent) than males (2.5 percent), as was nonmedical use of pain relievers (2.6 and 2.0 percent, respectively).
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Figure 2.8 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Past month marijuana use among males aged 12 to 17 declined from 9.1 percent in 2002 to 6.8 percent in 2006 (Figure 2.8). In 2008, the rate was 7.3 percent, which was not significantly different from the rate in 2006 and was lower than the rate in 2002. Among female youths, little change in current marijuana use occurred from 2002 to 2004, but rates subsequently declined and the percentage in 2008 (6.0 percent) was lower than that in 2002 (7.2 percent).
Pregnant Women
Among pregnant women aged 15 to 44 years, 5.1 percent used illicit drugs in the past month based on data averaged for 2007 and 2008. This rate was significantly lower than the rate among women in this age group who were not pregnant (9.8 percent). Among pregnant women, the average rate of current illicit drug use in 2007-2008 (5.1 percent) did not change significantly from 2005-2006 (4.0 percent) and was similar to the rate observed in 2003-2004 (4.6 percent).
The rate of current illicit drug use in the combined 2007-2008 data was lower for pregnant women than for nonpregnant women among those aged 18 to 25 (7.1 vs. 16.2 percent, respectively) and among those aged 26 to 44 (3.0 vs. 6.7 percent). Among women aged 15 to 17, however, those who were pregnant had a higher rate of use than those who were not pregnant (21.6 vs. 12.9 percent).
Race/Ethnicity
Current illicit drug use among persons aged 12 or older varied by race/ethnicity in 2008, with the lowest rate among Asians (3.6 percent) (Figure 2.9). Rates were 14.7 percent for persons reporting two or more races, 10.1 percent for blacks, 9.5 percent for American Indians or Alaska Natives, 8.2 percent for whites, 7.3 percent of Native Hawaiians or Other Pacific Islanders, and 6.2 percent for Hispanics.
There were no statistically significant changes between 2007 and 2008 in the rate of current illicit drug use for any racial/ethnic group among persons aged 12 or older.
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Figure 2.9 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2008
Education
Illicit drug use in 2008 varied by educational status. Among adults aged 18 or older, the rate of current illicit drug use was lower for college graduates (5.7 percent) than for those who did not graduate from high school (8.1 percent), high school graduates (8.6 percent), and those with some college (9.4 percent). However, adults who had graduated from college were more likely to have tried illicit drugs in their lifetime when compared with adults who had not completed high school (51.8 vs. 37.7 percent). The rate of current illicit drug use declined from 9.3 percent in 2007 to 8.1 percent in 2008 among adults who had not completed high school.
College Students
Among persons aged 18 to 22 years old, the rate of current use of illicit drugs in 2008 among full-time college students (20.2 percent) was similar to the rate among other persons in that age group (21.9 percent), which includes part-time college students, students in other grades or types of institutions, and nonstudents. The rate of current use of illicit drugs overall among 18 to 22 year olds did not change significantly from 2007 to 2008 among either full-time college students or others in this age group.
Among full-time college students aged 18 to 22, there were increases from 2007 to 2008 in the current rate of use of hallucinogens (from 1.0 to 2.1 percent). Increases were seen for the specific hallucinogens Ecstasy (from 0.5 to 1.2 percent) and LSD (from 0.3 to 0.6 percent). There were no significant changes in the rates of current use for any drugs among persons aged 18 to 22 who were not full-time college students.
Employment
Current illicit drug use differed by employment status in 2008. Among adults aged 18 or older, the rate of illicit drug use was higher for unemployed persons (19.6 percent) than for those who were employed full time (8.0 percent) or part time (10.2 percent) (Figure 2.10). These rates were all similar to the corresponding rates in 2007.
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Figure 2.10 Past Month Illicit Drug Use among Persons Aged 18 or Older, by Employment Status: 2007 and 2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level. 1 The Other Employment category includes retired persons, disabled persons, homemakers, students, or other persons not in the labor force.
Although the rate of past month illicit drug use was higher among unemployed persons compared with those from other employment groups, most drug users in 2008 were employed. Of the estimated 17.8 million current illicit drug users aged 18 or older in 2008, 12.9 million (72.7 percent) were employed either full or part time. The number of unemployed illicit drug users increased from 1.3 million in 2007 to 1.8 million in 2008, primarily because of an overall increase in the number of unemployed persons between 2007 and 2008 (Figure 2.10).
Geographic Area
Among persons aged 12 or older, the rate of current illicit drug use in 2008 was 9.8 percent in the West, 7.6 percent in the Midwest, 8.2 percent in the Northeast, and 7.1 percent in the South.
In the South, current illicit drug use declined from 9.3 percent in 2007 to 8.0 percent in 2008 among youths aged 12 to 17, and use of crack decreased from 0.3 to 0.2 percent among persons aged 12 or older. Also in the South, current nonmedical use of prescription psychotherapeutics declined from 3.0 to 2.4 percent among persons aged 12 or older, from 3.8 to 2.8 percent among youths aged 12 to 17, and from 2.3 to 1.7 percent among adults aged 26 or older. These decreases were driven in part by decreases in the rates of nonmedical use of pain relievers for youths aged 12 to 17 and adults aged 26 or older, although the decrease among adults aged 26 or older was not significant. There were no significant changes in the rates of current use in any of the nine illicit drug categories for the Northeast, Midwest, and West between 2007 and 2008.
In 2008, the rate of current illicit drug use among persons aged 12 or older was higher in metropolitan areas than in nonmetropolitan areas. The rates were 8.5 percent in large metropolitan counties, 8.1 percent in small metropolitan counties, and 6.3 percent in nonmetropolitan counties as a group (Figure 2.11). Within nonmetropolitan areas, the rate was 7.2 percent in urbanized counties, 5.6 percent in less urbanized counties, and 6.1 percent in completely rural counties.
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Figure 2.11 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2008
Criminal Justice Populations
In 2008, an estimated 1.6 million adults aged 18 or older were on parole or other supervised release from prison at some time during the past year. Almost one fifth of these (18.3 percent) were current illicit drug users, which was higher than the rate of 7.8 percent among adults not on parole or supervised release.
Among the 5.2 million adults on probation at some time in the past year, 23.9 percent reported current illicit drug use in 2008. This was higher than the rate of 7.5 percent among adults not on probation in 2008.
Frequency of Use
In 2008, an estimated 15.0 percent of past year marijuana users aged 12 or older used marijuana on 300 or more days within the past 12 months. This translates into 3.9 million persons using marijuana on a daily or almost daily basis over a 12-month period. An estimated 35.7 percent (5.4 million) of past month marijuana users aged 12 or older used the drug on 20 or more days in the past month.
Association with Cigarette and Alcohol Use
In 2008, the rate of current illicit drug use was more than 9 times higher among youths aged 12 to 17 who smoked cigarettes in the past month (49.0 percent) than it was among youths who did not smoke cigarettes in the past month (5.3 percent).
Past month illicit drug use also was associated with the level of past month alcohol use. Among youths aged 12 to 17 in 2008 who were heavy drinkers (i.e., consumed five or more drinks on the same occasion on each of 5 or more days in the past 30 days), 68.5 percent also were current illicit drug users, which was higher than the rate among nondrinkers (4.3 percent). The rate of current illicit drug use among youths reporting heavy drinking in the past month increased from 60.1 percent in 2007 to 68.5 percent in 2008, and a similar increase in illicit drug use (from 37.9 to 42.6 percent) was seen among youths who engaged in binge drinking (i.e., consumption of five or more drinks on the same occasion on at least 1 day in the past month).
Driving Under the Influence of Illicit Drugs
In 2008, 10.0 million persons aged 12 or older reported driving under the influence of illicit drugs during the past year. This corresponds to 4.0 percent of the population aged 12 or older, the same as the rate in 2007, but lower than the rate in 2002 (4.7 percent). Across age groups, the rate of driving under the influence of illicit drugs in 2008 was highest among young adults aged 18 to 25 (12.3 percent).
Source of Prescription Drugs
Past year nonmedical users of prescription-type psychotherapeutic drugs are asked how they obtained the drugs they recently used nonmedically. Rates averaged for 2007 and 2008 show that over half of the nonmedical users of prescription-type pain relievers, tranquilizers, stimulants, and sedatives aged 12 or older said they got the drugs they used most recently "from a friend or relative for free." In a follow-up question, the majority of these respondents indicated that their friend or relative had obtained the drugs from one doctor.
Among persons aged 12 or older in 2007-2008 who used pain relievers nonmedically in the past 12 months, 55.9 percent got the pain relievers they most recently used from a friend or relative for free. Another 8.9 percent bought them from a friend or relative, and 5.4 percent took them from a friend or relative without asking. Nearly one fifth (18.0 percent) indicated that they got the drugs they most recently used through a prescription from one doctor. About 1 in 20 users (4.3 percent) got pain relievers from a drug dealer or other stranger, and 0.4 percent bought them on the Internet. These percentages are similar to those reported in 2006-2007.
In 81.7 percent of the instances in 2007-2008 where nonmedical users of prescription pain relievers aged 12 or older obtained the drugs from a friend or relative for free, the individuals indicated that their friend or relative had obtained the drugs from just one doctor. Only 1.6 percent reported that the friend or relative had bought the drugs from a drug dealer or other stranger.
In 2007-2008, 42.8 percent of past year methamphetamine users aged 12 or older reported that they obtained the methamphetamine they used most recently from a friend or relative for free, lower than the 49.7 percent reported in 2006-2007. In contrast, the percentage of past year methamphetamine users who bought it from a friend or relative increased from 25.1 percent in 2006-2007 to 30.1 percent in 2007-2008. About one in five users (21.7 percent) in 2007-2008 bought the methamphetamine they used most recently from a drug dealer or other stranger, which was comparable with the rate for 2006-2007 (20.5 percent).
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
Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2008 survey (51.6 percent). This translates to an estimated 129.0 million people, which is similar to the 2007 estimate of 126.8 million people (51.1 percent).
More than one fifth (23.3 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2008. This translates to about 58.1 million people. The rate in 2008 is the same as the rate in 2007 (23.3 percent).
In 2008, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.3 million people. This percentage is the same as the rate of heavy drinking in 2007 (6.9 percent).
Age
In 2008, rates of current alcohol use were 3.4 percent among persons aged 12 or 13, 13.1 percent of persons aged 14 or 15, 26.2 percent of 16 or 17 year olds, 48.7 percent of those aged 18 to 20, and 69.5 percent of 21 to 25 year olds (Figure 3.1). These estimates showed significant declines from 2007 for the 14 or 15 year olds (from 14.7 to 13.1 percent) and for the 16 or 17 year olds (from 29.0 to 26.2 percent).
Below is a bar graph. Click here for the text describing this graph.
Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2008
Among older age groups, the prevalence of current alcohol use decreased with increasing age, from 67.4 percent among 26 to 29 year olds to 50.3 percent among 60 to 64 year olds and 39.7 percent among people aged 65 or older.
Rates of binge alcohol use in 2008 were 1.5 percent among 12 or 13 year olds, 6.9 percent among 14 or 15 year olds, 17.2 percent among 16 or 17 year olds, 33.7 percent among persons aged 18 to 20, and peaked among those aged 21 to 25 at 46.0 percent. The 2008 binge drinking rate for 16 or 17 year olds showed a decrease from 2007, when it was 19.4 percent.
The binge drinking rate decreased beyond young adulthood from 36.4 percent of 26 to 34 year olds to 18.8 percent of persons aged 35 or older.
The rate of binge drinking was 41.0 percent for young adults aged 18 to 25. Heavy alcohol use was reported by 14.5 percent of persons aged 18 to 25. These rates are similar to the rates in 2007 (41.8 and 14.7 percent, respectively).
Persons aged 65 or older had lower rates of binge drinking (8.2 percent) than adults in other age groups. The rate of heavy drinking among persons aged 65 or older was 2.2 percent.
The rate of current alcohol use among youths aged 12 to 17 was 14.6 percent in 2008, which is lower than it was in 2007, when it was 15.9 percent. Youth binge and heavy drinking rates were 8.8 and 2.0 percent, respectively. The 2008 rate for youth binge drinking is also lower than the 2007 rate, which was 9.7 percent.
Gender
In 2008, 57.7 percent of males aged 12 or older were current drinkers, higher than the rate for females (45.9 percent). However, among youths aged 12 to 17, the percentage of males who were current drinkers (14.2 percent) was similar to the rate for females (15.0 percent).
Among adults aged 18 to 25, an estimated 58.0 percent of females and 64.3 percent of males reported current drinking in 2008. These rates are similar to those reported in 2007 (57.1 and 65.3 percent, respectively).
Pregnant Women
Among pregnant women aged 15 to 44, an estimated 10.6 percent reported current alcohol use, 4.5 percent reported binge drinking, and 0.8 percent reported heavy drinking. These rates were significantly lower than the rates for nonpregnant women in the same age group (54.0, 24.2, and 5.5 percent, respectively). Binge drinking during the first trimester of pregnancy was reported by 10.3 percent of pregnant women aged 15 to 44. All of these estimates by pregnancy status are based on data averaged over 2007 and 2008. The 2007-2008 estimate for first-trimester binge drinking is higher than in 2005-2006, when it was 4.6 percent.
Race/Ethnicity
Among persons aged 12 or older, whites in 2008 were more likely than other racial/ethnic groups to report current use of alcohol (56.2 percent) (Figure 3.2). The rates were 47.5 percent for persons reporting two or more races, 43.3 percent for American Indians or Alaska Natives, 43.2 percent for Hispanics, 41.9 percent for blacks, and 37.0 percent for Asians.
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Figure 3.2 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Race/Ethnicity: 2008
Note: Due to low precision, estimates for Native Hawaiians or Other Pacific Islanders are not shown.
The rate of binge alcohol use was lowest among Asians (11.9 percent). Rates for other racial/ethnic groups were 20.4 percent for blacks, 22.0 percent for persons reporting two or more races, 24.0 percent for whites, 24.4 percent for American Indians or Alaska Natives, and 25.6 percent for Hispanics.
Among youths aged 12 to 17 in 2008, Asians had lower rates of current alcohol use than any other racial/ethnic group (5.7 percent), while 10.1 percent of black youths, 13.6 percent of those reporting two or more races, 14.8 percent of Hispanic youths, and 16.3 percent of white youths were current drinkers.
Education
Among adults aged 18 or older, the rate of past month alcohol use increased with increasing levels of education. Among adults with less than a high school education, 36.8 percent were current drinkers in 2008, significantly lower than the 67.9 percent of college graduates who were current drinkers. However, among adults aged 26 or older, binge and heavy alcohol use rates were lower among college graduates (19.5 and 4.6 percent, respectively) than among those who had not completed college (23.2 vs. 7.0 percent, respectively).
College Students
Young adults aged 18 to 22 enrolled full time in college were more likely than their peers not enrolled full time (i.e., part-time college students and persons not currently enrolled in college) to use alcohol in the past month, binge drink, and drink heavily. Among full-time college students in 2008, 61.0 percent were current drinkers, 40.5 percent binge drank, and 16.3 percent were heavy drinkers. Among those not enrolled full time in college, these rates were 54.2, 38.1, and 13.0 percent, respectively. Rates of current alcohol use and binge use for full-time college students decreased from 2007, when they were 63.7 and 43.6 percent, respectively.
The pattern of higher rates of current alcohol use, binge alcohol use, and heavy alcohol use among full-time college students compared with rates for others aged 18 to 22 has remained consistent since 2002 (Figure 3.3).
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Figure 3.3 Heavy Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Employment
The rate of current alcohol use was 63.0 percent for full-time employed adults aged 18 or older in 2008, higher than the rate for unemployed adults (55.5 percent). However, the rate of heavy use for unemployed persons was 12.8 percent, which was higher than the rate of 8.8 percent for full-time employed persons. There was no significant difference in binge alcohol use rates between full-time employed adults (30.3 percent) and unemployed adults (33.4 percent).
Most binge and heavy alcohol users were employed in 2008. Among 55.9 million adult binge drinkers, 44.6 million (79.7 percent) were employed either full or part time. Among 16.8 million heavy drinkers, 13.1 million (78.0 percent) were employed.
Rates of binge and heavy alcohol use did not change significantly between 2007 and 2008 for full-time employed or unemployed adults. However, the number of unemployed binge and heavy drinkers did increase (from 2.3 million to 3.0 million for binge use and from 851,000 to 1.2 million for heavy use).
Geographic Area
The rate of past month alcohol use for people aged 12 or older in 2008 was lower in the South (47.3 percent) than in the Northeast (56.8 percent), Midwest (54.2 percent), or West (51.8 percent).
Among people aged 12 or older, the rate of past month alcohol use in large metropolitan areas (53.6 percent) was higher than the 51.3 percent in small metropolitan areas and 45.8 percent in nonmetropolitan areas. Binge drinking was equally prevalent in small metropolitan areas (22.5 percent), large metropolitan areas (23.9 percent), and nonmetropolitan areas (22.8 percent).
The rates of binge alcohol use among youths aged 12 to 17 were 9.8 percent in nonmetropolitan areas, 9.0 percent in small metropolitan areas, and 8.4 percent in large metropolitan areas.
Association with Illicit Drug and Tobacco Use
The level of alcohol use was associated with illicit drug use in 2008. Among the 17.3 million heavy drinkers aged 12 or older, 29.4 percent were current illicit drug users. Persons who were not current alcohol users were less likely to have used illicit drugs in the past month (3.3 percent) than those who reported (a) current use of alcohol but did not meet the criteria for binge or heavy use (6.1 percent), (b) binge use but did not meet the criteria for heavy use (16.4 percent), or (c) heavy use of alcohol (29.4 percent).
Alcohol consumption levels also were associated with tobacco use. Among heavy alcohol users aged 12 or older, 58.0 percent smoked cigarettes in the past month, while only 19.2 percent of non-binge current drinkers and 16.1 percent of persons who did not drink alcohol in the past month were current smokers. Smokeless tobacco use and cigar use also were more prevalent among heavy drinkers (12.5 and 17.8 percent, respectively) than among non-binge drinkers (2.2 and 4.6 percent) and nondrinkers (2.1 and 2.0 percent).
Driving Under the Influence of Alcohol
In 2008, an estimated 12.4 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year (Figure 3.4). This percentage has dropped since 2002, when it was 14.2 percent. The 2008 estimate corresponds to 30.9 million persons.
Driving under the influence of alcohol was associated with age in 2008. An estimated 7.2 percent of 16 or 17 year olds, 16.7 percent of 18 to 20 year olds, and 26.1 percent of 21 to 25 year olds reported driving under the influence of alcohol in the past year (Figure 3.5). Beyond age 25, these rates showed a general decline with increasing age.
Among persons aged 12 or older, males were more likely than females (16.0 vs. 9.0 percent) to drive under the influence of alcohol in the past year.
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Figure 3.4 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 12 or Older: 2002-2008
+ Difference between this estimate and the 2008 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: 2008
3.2. Underage Alcohol Use
In 2008, about 10.1 million persons aged 12 to 20 (26.4 percent of this age group) reported drinking alcohol in the past month. Approximately 6.6 million (17.4 percent) were binge drinkers, and 2.1 million (5.5 percent) were heavy drinkers. The rates for current and binge alcohol use are lower than they were in 2007, when they were 27.9 and 18.6 percent, respectively.
Rates of current, binge, and heavy alcohol use among underage persons declined between 2002 and 2008. Current use dropped from 28.8 to 26.4 percent; binge use declined from 19.3 to 17.4 percent; and heavy use declined from 6.2 to 5.5 percent.
Past month underage alcohol use rates declined between 2002 and 2008 for specific age categories (12 or 13, 14 or 15, 16 or 17, and 18 to 20) (Figure 3.6).
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Figure 3.6 Current Alcohol Use among Persons Aged 12 to 20, by Age: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Rates of current alcohol use increased with increasing age among underage persons. In 2008, 3.4 percent of persons aged 12 or 13, 13.1 percent of persons aged 14 or 15, 26.2 percent of 16 or 17 year olds, and 48.7 percent of 18 to 20 year olds drank alcohol during the 30 days before they were surveyed. This pattern has remained stable since 2002 (Figure 3.6).
More males than females aged 12 to 20 reported binge drinking (19.2 vs. 15.5 percent) and heavy drinking (7.0 vs. 4.0 percent) in 2008 (Figure 3.7). However, rates of current alcohol use were similar by gender (27.1 percent for males and 25.8 percent for females).
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Figure 3.7 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by Gender: 2008
Among persons aged 12 to 20, past month alcohol use rates in 2008 were 17.2 percent among Asians, 19.0 percent among blacks, 22.9 percent among those reporting two or more races, 23.1 percent among Hispanics, 26.4 percent among American Indians or Alaska Natives, and 30.1 percent among whites.
In 2008, among persons aged 12 to 20, binge drinking was reported by 20.8 percent of whites, followed by 15.1 percent of Hispanics and 15.0 percent of persons reporting two or more races, but only by 9.4 percent of Asians and 9.3 percent of blacks.
Across geographic regions in 2008, underage current alcohol use rates were higher in the Northeast (30.0 percent) than in the Midwest (27.1 percent), and both rates were higher than in the South (24.7 percent). The rate in the West (25.8 percent) was similar to rates in the South and Midwest regions, but was significantly lower than the rate in the Northeast.
In 2008, underage current alcohol use rates were higher in small metropolitan areas (27.9 percent) compared with large metropolitan areas (25.9 percent) and similar in large metropolitan areas and nonmetropolitan areas (25.3 percent). The rate in nonmetropolitan areas decreased from 2007, when it was 28.8 percent.
In 2008, 81.7 percent of current drinkers aged 12 to 20 were with two or more other people the last time they drank alcohol, 13.6 percent were with one other person the last time they drank, and 4.7 percent were alone.
A majority of underage current drinkers in 2008 reported that their last use of alcohol in the past month occurred either in someone else's home (56.2 percent) or their own home (29.6 percent). Underage males were more likely than females to have been at a concert or sports game on their last drinking occasion (2.5 vs. 1.1 percent), whereas females were more likely than males to have been in a restaurant, bar, or club on their last drinking occasion (10.3 vs. 7.0 percent).
Among underage current drinkers in 2008, 30.8 percent paid for the alcohol the last time they drank, including 8.3 percent who purchased the alcohol themselves and 22.3 percent who gave money to someone else to purchase it.
Among underage drinkers who did not pay for the alcohol the last time they drank, the most common source was an unrelated person aged 21 or older (37.4 percent). Other underage persons provided the alcohol on the last occasion 21.1 percent of the time. Parents, guardians, or other adult family members provided the alcohol 21.0 percent of the time. Other sources of alcohol for underage drinkers included (a) took the alcohol from home (5.8 percent), (b) took it from someone else's home (3.2 percent), and (c) got it some other way (6.9 percent).
Underage drinkers were more likely than persons aged 21 or older to use illicit drugs within 2 hours of alcohol use on their last reported drinking occasion (17.4 vs. 4.6 percent, respectively). The most commonly reported illicit drug used by underage drinkers in combination with alcohol was marijuana, which was used within 2 hours of alcohol use by 16.5 percent of current underage drinkers (1.6 million persons) on their last drinking occasion.
4. Tobacco Use
The National Survey on Drug Use and Health (NSDUH) includes a series of questions about the use of tobacco products, including cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco. Cigarette use is defined as smoking "part or all of a cigarette." For analytic purposes, data for chewing tobacco and snuff are combined as "smokeless tobacco."
In 2008, an estimated 70.9 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 28.4 percent of the population in that age range. In addition, 59.8 million persons (23.9 percent of the population) were current cigarette smokers; 13.1 million (5.3 percent) smoked cigars; 8.7 million (3.5 percent) used smokeless tobacco; and 1.9 million (0.8 percent) smoked tobacco in pipes (Figure 4.1).
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Figure 4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
The rate of current use of any tobacco product among persons aged 12 or older remained steady from 2007 to 2008 (28.6 and 28.4 percent, respectively). The rates of current use of cigarettes, smokeless tobacco, cigars, and pipe tobacco also did not change significantly over that period. Between 2002 and 2008, past month use of any tobacco product decreased from 30.4 to 28.4 percent, and past month cigarette use declined from 26.0 to 23.9 percent. Rates of past month use of cigars, smokeless tobacco, and pipe tobacco were similar in 2002 and 2008.
Age
In 2008, young adults aged 18 to 25 had the highest rate of current use of a tobacco product (41.4 percent) compared with youths aged 12 to 17 and adults aged 26 or older (11.4 and 28.3 percent, respectively). Young adults had the highest usage rates of each of the specific tobacco products as well. In 2008, the rates of past month use among young adults were 35.7 percent for cigarettes, 11.3 percent for cigars, 5.4 percent for smokeless tobacco, and 1.4 percent for pipe tobacco. The rate of current use of a tobacco product by young adults was similar in 2007 and 2008 (41.8 and 41.4 percent, respectively), as was the rate of cigarette use between 2007 and 2008 (36.2 and 35.7 percent, respectively). Between 2002 and 2008, there was a significant decrease in the rates for current use of tobacco products and cigarettes among young adults; in 2002, the rates were 45.3 and 40.8 percent, respectively.
The rate of past month tobacco use among youths aged 12 to 17 decreased from 12.4 percent in 2007 to 11.4 percent in 2008 (Figure 4.2). This decrease was driven by a decline in the rate of past month cigarette use that was statistically significant (9.8 to 9.1 percent) and a decline in past month cigar use that was not statistically significant (4.2 to 3.8 percent). The rate of past month cigarette use among 12 to 17 year olds declined from 13.0 percent in 2002 to 9.1 percent in 2008. One-half million or 2.2 percent of youths aged 12 to 17 used smokeless tobacco in 2008 compared with 2.0 percent in 2002; this slight increase was not statistically significant.
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Figure 4.2 Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
In 2008, 2.1 percent of 12 or 13 year olds and 7.6 percent of 14 or 15 year olds were current cigarette smokers (Figure 4.3). The percentage of current cigarette smokers among 16 or 17 year olds dropped from 18.9 percent in 2007 to 16.8 percent in 2008. Across age groups, current cigarette use peaked at 37.1 percent among persons aged 21 to 25 and those aged 26 to 29. About one third of 18 to 20 year olds and one third of 26 to 34 year olds (33.5 and 33.6 percent, respectively) smoked cigarettes in the past month. Less than a quarter (21.6 percent) of persons aged 35 or older in 2008 smoked cigarettes in the past month.
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Figure 4.3 Past Month Cigarette Use among Persons Aged 12 or Older, by Age: 2008
Gender
In 2008, current use of a tobacco product among persons aged 12 or older was reported by a higher percentage of males (34.5 percent) than females (22.5 percent). Males also had higher rates of past month use than females of each specific tobacco product: cigarettes (26.3 percent of males vs. 21.7 percent of females), cigars (9.0 vs. 1.7 percent), smokeless tobacco (6.8 vs. 0.4 percent), and pipe tobacco (1.2 vs. 0.3 percent).
Among youths aged 12 to 17, the rate of current cigarette smoking in 2008 did not differ significantly by gender (9.0 percent for males vs. 9.2 percent for females). The rate declined for both males and females between 2007 and 2008 (10.0 vs. 9.0 percent for males and 9.7 vs. 9.2 percent for females), although the decline for females was not statistically significant. From 2002 to 2008, the rate of current cigarette smoking among youths decreased for both males (from 12.3 to 9.0 percent) and females (from 13.6 to 9.2 percent) (Figure 4.4).
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Figure 4.4 Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
After dropping from 34.9 percent in 2006 to 31.8 percent in 2007, the rate of current cigarette smoking among female young adults aged 18 to 25 held steady at 31.8 percent in 2008. Between 2002 and 2008, the rate of cigarette use among young adults declined for both males (from 44.4 to 39.5 percent) and females (from 37.1 to 31.8 percent).
Pregnant Women
Among women aged 15 to 44, combined data for 2007 and 2008 indicated that the rate of past month cigarette use was lower among those who were pregnant (16.4 percent) than it was among those who were not pregnant (27.3 percent). This pattern was also evident among women aged 18 to 25 (22.1 vs. 32.3 percent for pregnant and nonpregnant women, respectively) and among women aged 26 to 44 (12.6 vs. 27.4 percent, respectively). However, among those aged 15 to 17, the rate of cigarette smoking was higher for pregnant women than nonpregnant women (20.6 vs. 14.7 percent), although the difference was not statistically significant.
Two-year moving average rates from 2002-2003 to 2007-2008 indicate that current cigarette use among women aged 15 to 44 decreased from 30.7 to 27.3 percent for those who were not pregnant and from 18.0 to 16.4 percent for those who were pregnant, although the latter difference was not statistically significant (Figure 4.5).
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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 2007-2008
+ Difference between this estimate and the 2007-2008 estimate is statistically significant at the .05 level.
Race/Ethnicity
In 2008, the prevalence of current use of a tobacco product among persons aged 12 or older was 13.9 percent for Asians, 21.3 percent for Hispanics, 28.6 percent for blacks, 30.4 percent for whites, 37.3 percent for persons who reported two or more races, and 48.7 percent for American Indians or Alaska Natives. There were no statistically significant changes in past month use of a tobacco product between 2007 and 2008 for any of these racial/ethnic groups. Among the specific tobacco products, smokeless tobacco use in the past month among blacks increased from 0.7 percent in 2007 to 1.4 percent in 2008.
In 2008, current cigarette smoking among youths aged 12 to 17 and young adults aged 18 to 25 was more prevalent among whites than blacks (10.6 vs. 5.0 percent for youths and 40.6 vs. 26.3 percent for young adults).
The current smoking rates for Hispanics were 7.9 percent among youths aged 12 to 17, 30.0 percent among young adults aged 18 to 25, and 19.1 percent among those aged 26 or older.
The smoking rate for Asian young adults aged 18 to 25 fell from 25.7 percent in 2007 to 18.0 percent in 2008. The rates for Asian youths aged 12 to 17 and adults aged 26 or older held steady between 2007 and 2008 (3.4 to 3.8 percent for youths and 13.5 to 11.8 percent for adults, respectively).
The smoking prevalence rate declined for white youths aged 12 to 17 from 12.2 percent in 2007 to 10.6 percent in 2008. This decrease occurred for both male and female youths: 11.7 to 10.1 percent for white males, and 12.7 to 11.2 percent for white females.
Education
As observed from 2002 onward, cigarette smoking in the past month was less prevalent among adults who were college graduates compared with those with less education. Among adults aged 18 or older, current cigarette use in 2008 was reported by 34.4 percent of those who had not completed high school, 30.6 percent of high school graduates who did not attend college, 26.6 percent of persons with some college, and 14.0 percent of college graduates (Figure 4.6).
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Figure 4.6 Past Month Tobacco Use among Adults Aged 18 or Older, by Education: 2008
In 2008, the use of smokeless tobacco in the past month was reported by 4.3 percent of persons aged 18 or older who had not completed high school, 4.6 percent of those who completed high school but did not attend college, and 3.2 percent of those who attended some college. The prevalence among college graduates, 2.5 percent, was lower than among those who had not completed high school and those who had completed high school but had not attended college. Among college graduates aged 18 to 25, the use of smokeless tobacco increased from 2.9 percent in 2007 to 4.3 percent in 2008.
College Students
Among young adults 18 to 22 years old, full-time college students were less likely to be current cigarette smokers than their peers who were not enrolled full time in college. Cigarette use in the past month in 2008 was reported by 27.2 percent of full-time college students, less than the rate of 40.6 percent for those not enrolled full time.
Among males aged 18 to 22 in 2008, full-time college students and those not enrolled full time in college did not differ significantly in their rates of past month cigar smoking (18.0 and 18.5 percent, respectively). However, cigar use by males in this age range who were not enrolled full time in college declined from 2007 (21.7 percent) to 2008 (18.5 percent).
Employment
In 2008, current cigarette smoking was more common among unemployed adults aged 18 or older than among adults who were working full time or part time (43.0 vs. 27.2 and 23.8 percent, respectively). Cigar smoking followed a similar pattern, with 9.8 percent of unemployed adults reporting past month use compared with 6.4 percent of full-time workers and 5.5 percent of part-time workers.
Current use of smokeless tobacco in 2008 was higher among adults aged 18 or older who were employed full time (4.8 percent) and those who were unemployed (4.9 percent) than among adults who were employed part time (1.8 percent) and those in the "other" employment category, which includes persons not in the labor force (2.0 percent).
Geographic Area
In 2008, current cigarette smoking among persons aged 12 or older was lower in the West (21.0 percent) and Northeast (22.2 percent) than in the South (25.5 percent) and Midwest (25.9 percent). Use of smokeless tobacco was also higher in the Midwest and South (3.9 and 4.4 percent, respectively) than in the West (2.8 percent), which in turn was higher than in the Northeast (2.1 percent).
Among persons aged 12 or older, the rate of current cigarette use was associated with county type in 2008. The rates of cigarette smoking were 22.6 percent in large metropolitan areas, 23.6 percent in small metropolitan areas, and 28.7 percent in nonmetropolitan areas.
Use of smokeless tobacco in the past month in 2008 among persons aged 12 or older was lowest in large metropolitan areas (2.1 percent). In small metropolitan areas, the rate was 4.0 percent; in nonmetropolitan areas, it was 6.9 percent.
Association with Illicit Drug and Alcohol Use
Use of illicit drugs and alcohol was more common among current cigarette smokers than among nonsmokers in 2008, as in prior years since 2002. Among persons aged 12 or older, 20.4 percent of past month cigarette smokers reported current use of an illicit drug compared with 4.2 percent of persons who were not current cigarette smokers. Past month alcohol use was reported by 67.4 percent of current cigarette smokers compared with 46.7 percent of those who did not use cigarettes in the past month. The association also was found with binge drinking (44.6 percent of current cigarette smokers vs. 16.5 percent of current nonsmokers) and heavy drinking (16.8 vs. 3.8 percent, respectively).
Frequency of Cigarette Use
Among the 59.8 million current cigarette smokers aged 12 or older in 2008, 36.9 million (61.7 percent) used cigarettes daily. The percentage of daily cigarette smokers increased with age, with 22.3 percent among past month cigarette users aged 12 to 17, 48.1 percent among those aged 18 to 25, and 67.1 percent among those aged 26 or older. Daily cigarette use among current smokers in the 12 to 17 year age group dropped from 26.3 percent in 2007 to 22.3 percent in 2008.
About half (49.1 percent) of daily smokers aged 12 or older reported smoking 16 or more cigarettes per day; this is approximately one pack or more. The percentage of daily smokers who smoked at least one pack of cigarettes per day increased with age from 18.4 percent among those aged 12 to 17 to 32.1 percent among those aged 18 to 25 to 52.8 percent among those aged 26 or older.
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 to assess the effectiveness of current prevention programs and to focus 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 (illicit drugs, cigarettes, and alcohol) initiation based on reported age and on year and month at first use. This chapter presents estimates of initiation occurring in the 12 months prior to the interview date. Individuals who initiated use within the past 12 months are referred to as recent or past year initiates. 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 the 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.
This chapter includes estimates of the number and rate of past year initiation of illicit drug, cigarette, and alcohol use among the total population aged 12 or older and by age and gender categories from the 2002 to 2008 NSDUHs. Also included are initiation estimates that pertain to persons at risk for initiation (i.e., those who had never used as of 12 months prior to the interview date). Some analyses are based on the ages at the time of interview, and others focus on the age at the time of first substance use. Readers need to be aware of these alternative estimation approaches when interpreting NSDUH incidence estimates and pay close attention to the approach used in each situation. Titles and notes on figures and associated detailed tables document which method applies.
For trend measurement, initiation estimates for each year (2002 to 2008) are produced independently based on the data from the survey conducted that year. It should be mentioned that trend estimates of incidence based on long recall periods have not been considered because of concerns about their validity (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004).
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.
Another important consideration in examining 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 past year initiation of specific illicit drugs cannot be added to obtain the overall number of illicit drug initiates because some of the initiates previously had used other drugs. The overall illicit drug initiation estimate only includes the past year initiation of specific drug use that was not preceded by use of other drugs. For example, a respondent who reported initiating marijuana use in the past 12 months is counted as a marijuana initiate. The same respondent also can be counted as an overall illicit drug initiate only if his or her marijuana use initiation was not preceded by use of any other drug (cocaine, heroin, hallucinogens, inhalants, pain relievers, tranquilizers, stimulants, or sedatives). To say it differently, the overall illicit drug initiation estimate only takes into account the first drug initiated. To help clarify this aspect of the incidence data, additional analyses have been generated to identify which specific illicit drug was used at the time of first use of any illicit drug. Furthermore, the overall illicit drug use initiation estimates in this chapter 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 beginning in 2007. See Section B.4.8 in Appendix B of this report for details.
Initiation of Illicit Drug Use
In 2008, an estimated 2.9 million persons aged 12 or older used an illicit drug for the first time within the past 12 months; this averages to almost 8,000 initiates per day. This estimate was not significantly different from the number in 2007 (2.7 million). About three fifths of initiates (56.7 percent) were younger than age 18 when they first used, and 54.9 percent of new users were female. The average age at initiation among persons aged 12 to 49 was 18.8 years.
In 2008, of the 2.9 million persons aged 12 or older who used illicit drugs for the first time within the past 12 months, a majority reported that their first drug was marijuana (56.6 percent) (Figure 5.1). Nearly one third initiated with psychotherapeutics (29.6 percent, including 22.5 percent with pain relievers, 3.2 percent with tranquilizers, 3.0 percent with stimulants, and 0.8 percent with sedatives). A sizable proportion reported inhalants (9.7 percent) as their first drug, and a small proportion used hallucinogens as their first illicit drug (3.2 percent). Between 2007 and 2008, the percentage of past year illicit drug initiates whose first drug was tranquilizers decreased from 6.5 to 3.2 percent, while the percentage whose first drug was inhalants decreased between 2003 and 2008 from 12.9 to 9.7 percent.
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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: 2008
Note: The percentages do not add to 100 percent due to rounding or because a small number of respondents initiated multiple drugs on the same day.
Comparison, by Drug
In 2008, the specific drug categories with the largest number of recent initiates among persons aged 12 or older were marijuana use (2.2 million) and nonmedical use of pain relievers (2.2 million), followed by nonmedical use of tranquilizers (1.1 million), Ecstasy (0.9 million), inhalants (0.7 million), cocaine (0.7 million), and stimulants (0.6 million) (Figure 5.2).
Among persons aged 12 to 49, the average age at first use of inhalants in 2008 was 15.9 years; it was 17.8 years for marijuana, 19.8 years for cocaine, 20.3 years for Ecstasy, 21.2 years for pain relievers, and 24.4 years for tranquilizers (Figure 5.3).
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Figure 5.2 Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2008
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Figure 5.3 Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2008
Marijuana
In 2008, there were 2.2 million persons aged 12 or older who had used marijuana for the first time within the past 12 months; this averages to about 6,000 initiates per day. This estimate was about the same as the estimate in 2007 (2.1 million) and 2002 (2.2 million) (Figure 5.4).
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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: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level. 1 Mean-age-at-first-use estimates are for recent initiates aged 12 to 49.
Most (61.8 percent) of the 2.2 million recent marijuana initiates were younger than age 18 when they first used. Among youths aged 12 to 17, an estimated 5.0 percent had used marijuana for the first time within the past year, similar to the rate in 2007 (4.6 percent).
As a percentage of those aged 12 to 17 who had not used marijuana prior to the past year, the youth marijuana initiation rate in 2008 (5.6 percent) was similar to the rate in 2007 (5.2 percent).
In 2008, the average age at first marijuana use among recent initiates aged 12 to 49 was 17.8 years, which was similar to the average in 2007 (17.6 years) (Figure 5.4). However, the average age at first marijuana use has increased since 2003, when it was 16.8 years. Among recent initiates aged 12 or older who initiated use prior to the age of 21, the mean age at first use was 16.1 years in 2008, which was not significantly different from the estimate (16.2 years) in 2007.
Cocaine
In 2008, there were 722,000 persons aged 12 or older who had used cocaine for the first time within the past 12 months; this averages to approximately 2,000 initiates per day. This estimate was significantly lower than the number in 2007 (906,000). The annual number of cocaine initiates declined from 1.0 million in 2002 to 722,000 in 2008.
Most (66.9 percent) of the 0.7 million recent cocaine initiates were 18 or older when they first used. The average age at first use among recent initiates aged 12 to 49 was 19.8 years, which was similar to the average age in 2007 (20.2 years).
Heroin
In 2008, there were 114,000 persons aged 12 or older who had used heroin for the first time within the past 12 months. The average age at first use among recent initiates aged 12 to 49 was 23.4 years in 2008. There were no significant changes in the number of initiates or in the average age at first use from 2007 to 2008. The number of heroin initiates was not significantly different from the number in 2002 (117,000).
Hallucinogens
In 2008, there were 1.1 million persons aged 12 or older who had used hallucinogens for the first time within the past 12 months (Figure 5.5). This estimate was not significantly different from the estimate in 2007, but was higher than the estimate for 2003 (886,000).
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Figure 5.5 Past Year Hallucinogen Initiates among Persons Aged 12 or Older: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Past year initiates of LSD aged 12 or older increased from 270,000 in 2007 to 394,000 in 2008, approximately doubling since 2003, when the estimate was 200,000. Past year initiates of PCP decreased from 123,000 in 2002 to 53,000 in 2008 (Figure 5.5).
There was no significant change in the number of past year initiates of Ecstasy between 2007 (781,000) and 2008 (894,000) (Figure 5.5). The number of past year Ecstasy initiates in 2008, however, was significantly higher than the estimates in 2003 (642,000), 2004 (607,000), and 2005 (615,000). The estimate had been 1.2 million in 2002, significantly higher than in 2008. Most (68.5 percent) of the recent Ecstasy initiates in 2008 were aged 18 or older at the time they first used Ecstasy. Among past year initiates aged 12 to 49, the average age at initiation of Ecstasy in 2008 was 20.3 years, similar to the average age in 2007 (20.2 years).
Inhalants
In 2008, there were 729,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 70.4 percent were under age 18 when they first used. There was no significant difference in the number of inhalant initiates between 2007 and 2008, but the 2008 estimate was significantly below the number in 2003 (871,000), 2004 (857,000), and 2005 (877,000). However, there was a significant decrease in the average age at first use among recent initiates aged 12 to 49 from 2007 (17.1 years) to 2008 (15.9 years).
Psychotherapeutics
Psychotherapeutics include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included. In 2008, there were 2.5 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year, which averages out to around 7,000 initiates per day. This annual estimate of the initiates of psychotherapeutics was significantly lower than the 2004 estimate (2.8 million). In 2008, the numbers of new users of specific classes of psychotherapeutics were 2.2 million for pain relievers, 1.1 million for tranquilizers, 599,000 for stimulants, and 181,000 for sedatives. There was a significant decrease in the number of past year initiates of stimulants from 2006 (845,000) to 2008 (599,000), but there were no significant changes in the estimates for the remaining psychotherapeutics between these years.
In 2008, the average age at first nonmedical use of any psychotherapeutics among recent initiates aged 12 to 49 was 22.0 years. More specifically, it was 21.2 years for pain relievers, 24.4 years for tranquilizers, 21.3 years for stimulants, and 21.6 years for sedatives.
In 2008, the number of new nonmedical users of OxyContin® aged 12 or older was 478,000, with an average age at first use of 21.8 years among those aged 12 to 49. These estimates are similar to those for 2007 (554,000 and 24.0 years, respectively). OxyContin® initiation declined between 2004 (615,000) and 2008.
The number of recent new users of methamphetamine among persons aged 12 or older was 95,000 in 2008 (Figure 5.6). This estimate was significantly lower than the estimate in 2002 (299,000), 2003 (260,000), 2004 (318,000), 2005 (192,000), 2006 (259,000), and 2007 (157,000). The average age of new methamphetamine users aged 12 to 49 in 2008 was 19.2 years, which was not significantly different from the average ages between 2002 and 2007.
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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: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level. 1 Mean-age-at-first-use estimates are for recent initiates aged 12 to 49.
Alcohol
In 2008, there were 4.5 million persons aged 12 or older who had used alcohol for the first time within the past 12 months; this averages to approximately 12,000 initiates per day.
Most (84.6 percent) of the 4.5 million recent alcohol initiates were younger than age 21 at the time of initiation.
In 2008, the average age at first alcohol use among recent initiates aged 12 to 49 was 17.0 years, similar to the corresponding 2007 estimate (16.8 years). The mean age at first use among recent initiates aged 12 or older who initiated use prior to the age of 21 was 15.9 years, which was similar to the 2007 estimate (15.8 years).
Tobacco
The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was 2.4 million in 2008, which was similar to the estimate in 2007 (2.2 million) but significantly higher than the estimate for 2002 (1.9 million), 2003 (2.0 million), and 2004 (2.1 million) (Figure 5.7). The 2008 estimate averages out to approximately 6,600 new cigarette smokers every day. Most new cigarette smokers in 2008 were under age 18 when they first smoked cigarettes (58.8 percent).
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Figure 5.7 Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First Use: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
The increase in cigarette initiation was due primarily to an increase among persons initiating at age 18 or older. Between 2002 and 2008, the number of initiates under age 18 remained stable (1.3 million in 2002 and 1.4 million in 2008), but the number of initiates aged 18 or older increased from about 600,000 to 1 million.
In 2008, among recent initiates aged 12 to 49, the average age of first cigarette use was 17.4 years, similar to the average in 2007 (16.9 years).
Of those aged 12 or older who had not smoked cigarettes prior to the past year, the past year initiation rate for cigarettes was 2.7 percent in 2008, similar to the rate in 2007 (2.5 percent). Among youths aged 12 to 17 years who had not smoked cigarettes prior to the past year, the incidence rate showed no significant difference between 2007 (5.9 percent) and 2008 (6.2 percent). Among males aged 12 to 17 who had never smoked prior to the past year, the decrease in the past year initiation rate from 6.1 percent in 2002 to 5.7 percent in 2008 was not statistically significant (Figure 5.8). Similarly for females, the decrease from 7.4 percent in 2002 to 6.7 percent in 2008 was not statistically significant.
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Figure 5.8 Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never Smoked Prior to the Past Year, by Gender: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
In 2008, the number of persons aged 12 or older who had started smoking cigarettes daily within the past 12 months was 0.9 million. This estimate was similar to the estimates for 2002 (1.0 million) and 2007 (1.0 million). Of the new daily smokers in 2008, 37.2 percent, or 350,000 persons, were younger than age 18 when they started smoking daily. This figure averages to approximately 1,000 initiates of daily smoking under age 18 every day.
The average age of first daily smoking among new daily smokers aged 12 to 49 in 2008 was 20.1 years. This was not significantly different from the average in 2007 (19.2 years).
In 2008, there were 2.9 million persons aged 12 or older who had used cigars for the first time in the past 12 months, which was similar to the 2007 estimate (3.1 million). However, the 2008 estimate reflects a significant decrease when compared with the 2005 estimate (3.3 million). Among past year cigar initiates aged 12 to 49, the average age at first use was 20.0 years in 2008, which was not significantly different from the estimate in 2007 (20.5 years).
The number of persons aged 12 or older initiating use of smokeless tobacco in the past year was 1.4 million in 2008, which was not significantly different from the estimate in 2006 (1.3 million) and 2007 (1.3 million). However, the estimated number of past year initiates of smokeless tobacco use in 2008 was 47 percent higher than the estimate in 2002 (951,000). About three quarters (72.5 percent) of new initiates in 2008 were male, and a little less than half (47.4 percent) were under age 18 when they first used.
The average age at first smokeless tobacco use among recent initiates aged 12 to 49 in 2008 was 18.9 years, which was not significantly different from the 2007 estimate (18.0 years). For males, the 2008 estimate of this average age (18.8 years) was significantly higher than the 2007 estimate (17.4 years). However, for females, the 2007 and 2008 age at first use estimates (19.7 and 19.0 years, respectively) did not significantly differ.
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 are associated with a reduction in 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; Robertson, David, & Rao, 2003). 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 2008 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, being approached by someone selling drugs, perceived parental disapproval of youth 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, cigarette, and alcohol use among youths aged 12 to 17 decreased between 2002 and 2008, 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."
The percentages of youths reporting binge alcohol use and use of cigarettes and marijuana in the past month were lower among those who perceived great risk in using these substances than among those who did not perceive great risk. For example, in 2008, 5.0 percent of youths aged 12 to 17 who perceived great risk from "having five or more drinks of an alcoholic beverage once or twice a week" reported binge drinking in the past month (consumption of five or more drinks of an alcoholic beverage on a single occasion on at least 1 day in the past 30 days); by contrast, past month binge drinking was reported by 11.5 percent of youths who saw moderate, slight, or no risk from having five or more drinks of an alcoholic beverage once or twice a week (Figure 6.1). Past month marijuana use was reported by 1.5 percent of youths who saw great risk in smoking marijuana once a month compared with 9.4 percent of youths who saw moderate, slight, 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: 2008
Decreases in the rate of current use of a substance often occur when there are increases in the level of perceived risk of using that substance. Looking over the 7-year period, the proportion of youths aged 12 to 17 who reported perceiving great risk from smoking one or more packs of cigarettes per day increased from 63.1 percent in 2002 to 69.7 percent in 2008 (Figure 6.2). During the same period, the rate of past month cigarette smoking among youths aged 12 to 17 dropped from 13.0 to 9.1 percent.
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Figure 6.2 Perceived Great Risk of Cigarette and Alcohol Use among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
The percentage of youths aged 12 to 17 indicating great risk in having four or five drinks of an alcoholic beverage nearly every day increased from 62.2 percent in 2002 to 65.9 percent in 2008 (Figure 6.2). The rate of past month heavy alcohol use among youths aged 12 to 17 decreased from 2.5 percent in 2002 to 2.0 percent in 2008.
The percentage of youths aged 12 to 17 perceiving great risk in having five or more drinks of an alcoholic beverage once or twice a week increased from 38.2 percent in 2002 to 40.5 percent in 2008 (Figure 6.2). The rate of past month binge alcohol use among youths decreased from 10.7 percent in 2002 to 8.8 percent in 2008.
The percentage of youths aged 12 to 17 indicating great risk in smoking marijuana once a month increased from 32.4 percent in 2002 to 34.9 percent in 2003, but the percentage remained unchanged between 2003 and 2008 (33.9 percent) (Figure 6.3). The rate of youths aged 12 to 17 perceiving great risk in smoking marijuana once or twice a week also increased from 51.5 percent in 2002 to 55.0 percent in 2005, but the rate declined between 2005 and 2008 (53.1 percent). Coincident with trends in perceived great risk of marijuana use, the prevalence of past month marijuana use among youths aged 12 to 17 decreased between 2002 (8.2 percent) and 2005 (6.8 percent), then remained stable between 2005 and 2008 (6.7 percent).
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Figure 6.3 Perceived Great Risk of Marijuana Use among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Between 2002 and 2008, the percentage of youths aged 12 to 17 perceiving great risk declined for the following substance use patterns: using heroin once or twice a week (from 82.5 to 81.3 percent), trying LSD once or twice (from 52.6 to 50.5 percent), and using LSD once or twice a week (from 76.2 to 73.9 percent) (Figure 6.4). Over the same period, however, there were no statistically significant changes in the percentages of youths aged 12 to 17 indicating great risk for trying heroin once or twice (from 58.5 to 57.7 percent), using cocaine once a month (50.5 percent in 2002 and 49.7 percent in 2008), and using cocaine once or twice a week (79.8 percent in 2002 and 79.2 percent in 2008). Moreover, percentages for all of these perceptions of risk measures remained stable between 2007 and 2008.
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Figure 6.4 Perceived Great Risk of Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Perceived Availability
In 2008, about half (49.2 percent) of the youths aged 12 to 17 reported that it would be "fairly easy" or "very easy" for them to obtain marijuana if they wanted some (Figure 6.5). One in seven (13.0 percent) indicated that heroin would be "fairly" or "very" easily available, and 13.8 percent reported so for LSD. Between 2002 and 2008, there were decreases in the perceived easy availability of marijuana (from 55.0 to 49.2 percent), cocaine (from 25.0 to 22.1 percent), crack (from 26.5 to 23.2 percent), LSD (from 19.4 to 13.8 percent), and heroin (from 15.8 to 13.0 percent). The perceived availability of the following illicit drugs declined between 2007 and 2008: cocaine from 24.5 to 22.1 percent; crack from 25.3 to 23.2 percent; and heroin from 14.1 to 13.0 percent. However, the perceived availability of marijuana and LSD did not change significantly during the 2-year period.
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Figure 6.5 Perceived Availability of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
The percentage of youths who reported that marijuana, cocaine, and LSD would be easy to obtain increased with age in 2008. For example, 20.5 percent of those aged 12 or 13 said it would be fairly or very easy to obtain marijuana compared with 52.2 percent of those aged 14 or 15 and 71.0 percent of those aged 16 or 17.
In 2008, 13.7 percent of youths aged 12 to 17 indicated that they had been approached by someone selling drugs in the past month, which was down from the 16.7 percent reported in 2002 (Figure 6.6). The rate remained stable between 2007 (14.5 percent) and 2008.
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Figure 6.6 Approached in the Past Month by Someone Selling Drugs among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Perceived Parental Disapproval of Substance Use
Most youths aged 12 to 17 believed their parents would "strongly disapprove" of their using substances. In 2008, 90.8 percent of youths reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice; this was similar to the 91.0 percent reported in 2007, but was higher than the 89.1 percent reported in 2002. Most (89.7 percent) reported that their parents would strongly disapprove of their having one or two drinks of an alcoholic beverage nearly every day, which was similar to the rates in 2007 (89.6 percent) and 2002 (89.0 percent). In 2008, 92.4 percent of youths reported that their parents would strongly disapprove of their smoking one or more packs of cigarettes per day, which was similar to the 92.1 percent reported in 2007, but was higher than the 89.5 percent reported in 2002.
Youths aged 12 to 17 who believed their parents would strongly disapprove of their using substances were less likely to use that substance than were youths who believed their parents would somewhat disapprove or neither approve nor disapprove. For example, in 2008, past month cigarette use was reported by 6.7 percent of youths who perceived strong parental disapproval of their smoking one or more packs of cigarettes per day compared with 37.3 percent of youths who believed their parents would not strongly disapprove. Current marijuana use also was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than among those who did not (4.3 vs. 29.8 percent, respectively).
Feelings about Peer Substance Use
A majority of youths aged 12 to 17 reported that they disapprove of their peers using substances. In 2008, 89.6 percent of youths "strongly" or "somewhat" disapproved of their peers smoking one or more packs of cigarettes per day, which was similar to the rate of 89.7 percent in 2007, but higher than the 87.1 percent in 2002. Also in 2008, 82.7 percent strongly or somewhat disapproved of peers using marijuana or hashish once a month or more, which was similar to the 82.9 percent reported in 2007, but was an increase from the 80.4 percent reported in 2002. In addition, 87.0 percent of youths strongly or somewhat disapproved of peers having one or two drinks of an alcoholic beverage nearly every day in 2008, which was similar to the 86.6 percent reported in 2007, but was higher than the 84.7 percent reported in 2002.
In 2008, past month marijuana use was reported by 2.3 percent of youths aged 12 to 17 who strongly or somewhat disapproved of their peers using marijuana once a month or more, lower than the 27.1 percent of youths who reported that they neither approve nor disapprove of such behavior from their peers.
Fighting and Delinquent Behavior
In 2008, 21.4 percent of youths aged 12 to 17 reported that, in the past year, they had gotten into a serious fight at school or at work; this was similar to the rates in 2007 (22.3 percent) and 2002 (20.6 percent). Almost one in six (14.5 percent) in 2008 had taken part in a group-against-group fight, which was lower than the rates in 2007 (15.4 percent) and 2002 (15.9 percent). About 1 in 30 (3.2 percent) had carried a handgun at least once, which was similar to the rates in 2007 and 2002 (both at 3.3 percent). An estimated 3.0 percent had sold illegal drugs, which was similar to the rate of 2.9 percent in 2007, but was lower than the 4.4 percent rate in 2002. In 2008, 4.6 percent had, at least once, stolen or tried to steal something worth more than $50; this was similar to the rates of 4.3 percent in 2007 and 4.9 percent in 2002. An estimated 7.3 percent had, in at least one instance, attacked others with the intent to harm or seriously hurt them in 2008, which was the same as the rate in 2007 and was similar to the 7.8 percent reported in 2002.
Youths aged 12 to 17 who had engaged in fighting or other delinquent behaviors were more likely than other youths to have used illicit drugs in the past month. For example, in 2008, past month illicit drug use was reported by 15.9 percent of youths who had gotten into a serious fight at school or work in the past year compared with 7.3 percent of those who had not engaged in fighting, and by 39.8 percent of those who had stolen or tried to steal something worth over $50 in the past year compared with 7.7 percent of those who had not engaged in such theft.
Religious Beliefs and Participation in Activities
In 2008, 31.7 percent of youths aged 12 to 17 reported that they had attended religious services 25 or more times in the past year, which was similar to the rates in 2007 (31.4 percent) and 2002 (33.0 percent). Also, 75.0 percent agreed or strongly agreed with the statement that religious beliefs are a very important part of their lives, which was similar to the 76.1 percent reported in 2007, but was lower than the 78.2 percent reported in 2002. In addition, 33.8 percent agreed or strongly agreed with the statement that it is important for their friends to share their religious beliefs, which was lower than the rates in 2007 (35.1 percent) and 2002 (35.8 percent).
The rates of past month use of illicit drugs, cigarettes, and alcohol (including binge alcohol) were lower among youths aged 12 to 17 who agreed with these statements about religious beliefs than among those who disagreed. For example, in 2008, past month illicit drug use was reported by 6.8 percent of those who agreed that religious beliefs are a very important part of life compared with 16.2 percent of those who disagreed with that statement.
Exposure to Substance Use Prevention Messages and Programs
In 2008, approximately one in nine youths aged 12 to 17 (11.1 percent) reported that they had participated in drug, tobacco, or alcohol prevention programs outside of school in the past year. This rate was similar to the 11.3 percent reported in 2007, but was lower than the rates reported in 2002 (12.7 percent) and 2003 (13.9 percent). The prevalence of past month use of illicit drugs, marijuana, cigarettes, or binge alcohol use among those who participated in these prevention programs outside of school was not significantly lower (8.9 percent, 5.6 percent, 8.0 percent, or 7.5 percent, respectively) than among those who did not (9.2 percent, 6.7 percent, 9.2 percent, or 8.9 percent, respectively).
In 2008, 78.0 percent of youths aged 12 to 17 reported having seen or heard drug or alcohol prevention messages in the past year from sources outside of school, which was similar to the 77.9 percent reported in 2007, but was lower than the 83.2 percent reported in 2002 (Figure 6.7). The prevalence of past month use of illicit drugs was lower among those who reported having such exposure (8.9 percent) than among those who reported having no such exposure (10.2 percent).
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Figure 6.7 Exposure to Substance Use Prevention Messages and Programs among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 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.
In 2008, 75.9 percent of youths aged 12 to 17 enrolled in school in the past year reported having seen or heard drug or alcohol prevention messages at school, which was similar to the 75.8 percent reported in 2007, but was lower than the 78.8 percent reported in 2002 (Figure 6.7). The prevalence of past month use of illicit drugs or marijuana was lower among those who reported having such exposure (8.5 percent and 6.1 percent for illicit drugs and marijuana, respectively) than among those who reported having no such exposure (12.1 percent and 9.0 percent, respectively).
In 2008, 58.7 percent of youths aged 12 to 17 reported that they had talked at least once in the past year with at least one of their parents about the dangers of drug, tobacco, or alcohol use, which was similar to rates reported in 2007 (59.6 percent) and 2002 (58.1 percent). The prevalence of past month use of illicit drugs or cigarettes among those who reported having had such conversations with their parents (8.6 percent and 8.5 percent, respectively) was lower than that among those who reported having no such conversations (10.0 percent and 9.8 percent, respectively). However, the prevalence of past month use of marijuana or binge alcohol among those who reported having had such conversations with their parents (6.5 percent and 8.7 percent, respectively) was similar to that among those who reported having no such conversations (6.8 percent and 8.9 percent, respectively).
Parental Involvement
Youths aged 12 to 17 were asked a number of questions related to the extent of support, oversight, and control that they perceived their parents exercised over them in the year prior to the survey. In 2008, among youths aged 12 to 17 enrolled in school in the past year, 79.3 percent reported that in the past year their parents always or sometimes checked on whether or not they had completed their homework, and 70.2 percent reported that their parents limited the amount of time that they spent out with friends on school nights. Both of these rates reported in 2008 were similar to those reported in 2007 and remained statistically unchanged from the rates reported in 2002. However, in 2008, 80.0 percent reported that their parents always or sometimes provided help with their homework, which was similar to the rate in 2007 (80.9 percent) but was lower than the rate in 2002 (81.4 percent).
In 2008, 87.9 percent of youths aged 12 to 17 reported that in the past year their parents made them always or sometimes do chores around the house, 86.1 percent reported that their parents always or sometimes let them know that they had done a good job, and 85.4 percent reported that their parents let them know they were proud of something they had done. All of these percentages in 2008 were similar to those reported in 2007 and remained statistically unchanged from the rates reported in 2002. In 2008, however, 39.9 percent of youths reported that their parents limited the amount of time that they watched television, which was similar to the rate in 2007 (39.7 percent), but was higher than the 36.9 percent reported in 2002.
In 2008, past month use of illicit drugs, cigarettes, and alcohol (including binge alcohol) was lower among youths aged 12 to 17 who reported that their parents always or sometimes engaged in monitoring behaviors than among youths whose parents "seldom" or "never" engaged in such behaviors. For example, the rate of past month use of any illicit drug was 7.7 percent for youths whose parents always or sometimes helped with homework compared with 15.6 percent among youths who indicated that their parents seldom or never helped. Rates of current cigarette smoking and past month binge alcohol use were also lower among youths whose parents always or sometimes helped with homework (7.7 and 7.3 percent, respectively) than among youths whose parents did not (15.3 and 15.9 percent, respectively).
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 2008 NSDUH and compares these estimates against the results from the 2002 through 2007 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
In 2008, an estimated 22.2 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8.9 percent of the population aged 12 or older) (Figure 7.1). Of these, 3.1 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.2 million were dependent on or abused alcohol but not illicit drugs.
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Figure 7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
The number of persons with substance dependence or abuse was stable between 2002 and 2008 (22.0 million in 2002, 21.6 million in 2003, 22.5 million in 2004, 22.2 million in 2005, 22.6 million in 2006, 22.3 million in 2007, and 22.2 million in 2008).
In 2008, 18.3 million persons aged 12 or older were classified with dependence on or abuse of alcohol. This represents 7.3 percent of the population. The number and percentage have remained similar since 2002.
Marijuana was the illicit drug with the highest rate of past year dependence or abuse in 2008, followed by pain relievers and cocaine. Of the 7.0 million persons aged 12 or older classified with dependence on or abuse of illicit drugs in 2008, 4.2 million were dependent on or abused marijuana or hashish (representing 1.7 percent of the total population aged 12 or older, and 60.1 percent of all those classified with illicit drug dependence or abuse), 1.7 million persons were classified with dependence on or abuse of pain relievers, and 1.4 million persons were classified with dependence on or abuse of cocaine (Figure 7.2). None of these estimates changed significantly between 2007 and 2008 or between 2002 and 2008 (Figure 7.3).
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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: 2008
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Figure 7.3 Dependence on or Abuse of Illicit Drugs, Marijuana, Cocaine, and Pain Relievers in the Past Year among Persons Aged 12 or Older: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
The rate for use of marijuana in the past year decreased from 2002 to 2008 but was stable between 2007 and 2008, while the number of persons who were dependent on or were abusing marijuana did not change significantly between 2002 and 2008 and between 2007 and 2008. However, between 2004 and 2008, the percentage and the number of persons dependent on or abusing pain relievers increased (from 0.6 to 0.7 percent and from 1.4 million to 1.7 million).
The percentages of persons aged 12 or older with dependence on or abuse of illicit drugs remained the same between 2007 (2.8 percent) and 2008 (2.8 percent) and were stable between 2002 (3.0 percent) and 2008. During the 7-year period, the percentages of persons with dependence on or abuse of alcohol remained stable as well (7.7 percent in 2002, 7.5 percent in 2007, and 7.3 percent in 2008).
Age at First Use
In 2008, among adults aged 18 or older, age at first use of marijuana was associated with dependence on or abuse of marijuana. Among those who first tried marijuana at age 14 or younger, 13.5 percent were classified with illicit drug dependence or abuse, higher than the 2.2 percent of adults who had first used marijuana at age 18 or older.
Among adults, age at first use of alcohol was associated with dependence on or abuse of alcohol. Among adults aged 18 or older who first tried alcohol at age 14 or younger, 16.5 percent were classified with alcohol dependence or abuse compared with only 3.9 percent of adults who had first used alcohol at age 18 or older. Adults aged 21 or older who had first used alcohol before age 21 were more likely than adults who had their first drink at age 21 or older to be classified with alcohol dependence or abuse (15.1, 9.3, and 4.7 percent for adults who first used alcohol at age 14 or younger, age 15 to 17, and age 18 to 20, respectively, vs. 2.6 percent for first use at age 21 or older) (Figure 7.4).
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Figure 7.4 Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or Older, by Age at First Use of Alcohol: 2008
Age
Rates of substance dependence or abuse were associated with age. In 2008, the rate of substance dependence or abuse among adults aged 18 to 25 (20.8 percent) was higher than that among youths aged 12 to 17 (7.6 percent) and among adults aged 26 or older (7.0 percent). None of these rates changed significantly between 2007 and 2008. For youths aged 12 to 17, the rate decreased from 8.9 percent in 2002 to 7.6 percent in 2008. For young adults aged 18 to 25 and adults aged 26 or older, these rates remained stable from 2002 to 2008.
In 2008, among persons with substance dependence or abuse, the proportion with dependence on or abuse of illicit drugs also was associated with age: 60.6 percent of youths aged 12 to 17 were dependent on or abused illicit drugs compared with 37.4 percent of young adults aged 18 to 25 and 24.3 percent of adults aged 26 or older.
The rate of alcohol dependence or abuse among youths aged 12 to 17 was 4.9 percent in 2008, which was down from 5.4 percent in 2007 and from 5.9 percent in 2002 (Figure 7.5). Among adults aged 26 or older, the rate remained stable between 2007 (6.2 percent) and 2008 (6.0 percent) and between 2002 (6.2 percent) and 2008. Among young adults aged 18 to 25, the rate of alcohol dependence or abuse remained similar between 2007 (16.8 percent) and 2008 (17.2 percent) and between 2002 (17.7 percent) and 2008.
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Figure 7.5 Dependence on or Abuse of Alcohol and Illicit Drugs among Youths Aged 12 to 17: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Gender
As was the case from 2002 through 2007, the rate of substance dependence or abuse for males aged 12 or older in 2008 was about twice as high as the rate for females. For males in 2008, the rate was 11.5 percent, which was down from the 12.5 percent in 2007, while for females, it was 6.4 percent, which was higher than the 5.7 percent in 2007 (Figure 7.6). Among youths aged 12 to 17, however, the rate of substance dependence or abuse among males was lower than the rate among females in 2008 (7.0 vs. 8.2 percent).
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Figure 7.6 Substance Dependence or Abuse in the Past Year, by Age and Gender: 2008
Race/Ethnicity
In 2008, among persons aged 12 or older, the rate of substance dependence or abuse was the lowest among Asians (4.2 percent). Racial/ethnic groups with similar rates included American Indians or Alaska Natives (11.1 percent), persons reporting two or more races (9.8 percent), whites (9.0 percent), blacks (8.8 percent), and Hispanics (9.5 percent). These rates in 2008 were similar to the rates in 2002 through 2007.
Education/Employment
Rates of substance dependence or abuse were associated with level of education in 2008. Among adults aged 18 or older, those who graduated from a college or university had a lower rate of dependence or abuse (7.0 percent) than those who graduated from high school (9.4 percent), those who did not graduate from high school (9.5 percent), and those with some college (10.5 percent).
Rates of substance dependence or abuse were associated with current employment status in 2008. A higher percentage of unemployed adults aged 18 or older were classified with dependence or abuse (19.0 percent) than were full-time employed adults (10.2 percent) or part-time employed adults (11.0 percent).
Most adults aged 18 or older with substance dependence or abuse were employed full time in 2008. Of the 20.3 million adults classified with dependence or abuse, 12.5 million (61.5 percent) were employed full time.
Criminal Justice Populations
In 2008, adults aged 18 or older who were on parole or a supervised release from jail during the past year had higher rates of dependence on or abuse of a substance (27.8 percent) than their counterparts who were not on parole or supervised release during the past year (8.9 percent).
In 2008, probation status was associated with substance dependence or abuse. The rate of substance dependence or abuse was 34.0 percent among adults who were on probation during the past year, which was significantly higher than the rate among adults who were not on probation during the past year (8.4 percent).
Geographic Area
In 2008, rates of substance dependence or abuse for persons aged 12 or older showed evidence of differences by region, with the West (9.6 percent) having a higher rate than the South (8.2 percent), but a similar rate to the Midwest (9.4 percent) and the Northeast (8.9 percent). Rates for substance dependence or abuse among persons aged 12 or older in 2008 also varied by county type, with large metropolitan counties (9.3 percent) having a significantly higher rate than nonmetropolitan counties (8.0 percent), but a similar rate when compared with small metropolitan counties (8.6 percent).
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 either illicit drug use treatment or in estimates of alcohol use treatment; however, they were counted in estimates for "drug or alcohol use" treatment.
In 2008, 4.0 million persons aged 12 or older (1.6 percent of the population) received treatment for a problem related to the use of alcohol or illicit drugs. Of these, 1.3 million received treatment for the use of both alcohol and illicit drugs, 0.8 million received treatment for the use of illicit drugs but not alcohol, and 1.6 million received treatment for the use of alcohol but not illicit drugs. (Note that estimates by substance do not sum to the total number of persons receiving treatment because the total includes persons who reported receiving treatment but did not report for which substance the treatment was received.)
The percentage of the population aged 12 or older receiving substance use treatment within the past year remained stable between 2007 and 2008 and between 2002 and 2008 (1.6 percent in 2008, 1.6 percent in 2007, and 1.5 percent in 2002). Although the number of persons receiving substance use treatment within the past year remained stable between 2007 and 2008, the number increased between 2002 (3.5 million) and 2008 (4.0 million).
In 2008, among the 4.0 million persons aged 12 or older who received treatment for alcohol or illicit drug use in the past year, 2.2 million persons received treatment at a self-help group, and 1.5 million received treatment at a rehabilitation facility as an outpatient (Figure 7.7). There were 1.1 million persons who received treatment at a mental health center as an outpatient, 743,000 persons who received treatment at a rehabilitation facility as an inpatient, 675,000 at a hospital as an inpatient, 672,000 at a private doctor's office, 374,000 at an emergency room, and 343,000 at a prison or jail. None of these estimates changed significantly between 2007 and 2008 or between 2002 and 2008, except that the number of persons who received treatment at a rehabilitation facility as an inpatient in 2008 was lower than that in 2007 (1.0 million) and 2002 (1.1 million).
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Figure 7.7 Locations Where Past Year Substance Use Treatment Was Received among Persons Aged 12 or Older: 2008
In 2008, during their most recent treatment in the past year, 2.7 million persons aged 12 or older reported receiving treatment for alcohol use, and 947,000 persons reported receiving treatment for marijuana use (Figure 7.8). Accordingly, estimates on receiving treatment for the use of other drugs were 663,000 persons for cocaine, 601,000 for pain relievers, 341,000 for heroin, 336,000 for stimulants, 326,000 for tranquilizers, and 287,000 for hallucinogens. None of these estimates changed significantly between 2007 and 2008. Also, none of these estimates changed significantly between 2002 and 2008, except that the numbers who received treatment for the use of pain relievers and tranquilizers in 2008 were higher than the numbers in 2002 (360,000 and 197,000 persons, respectively) (Figure 7.9). (Note that respondents could indicate that they received treatment for more than one substance during their most recent treatment.)
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Figure 7.8 Substances for Which Most Recent Treatment Was Received in the Past Year among Persons Aged 12 or Older: 2008
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Figure 7.9 Received Most Recent Treatment in the Past Year for the Use of Pain Relievers among Persons Aged 12 or Older: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
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
In 2008, 23.1 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (9.2 percent of the persons aged 12 or older). Of these, 2.3 million (0.9 percent of persons aged 12 or older and 9.9 percent of those who needed treatment) received treatment at a specialty facility. Thus, 20.8 million persons (8.3 percent of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty substance abuse facility in the past year. These estimates are similar to the estimates for 2007 and for 2002.
Of the 2.3 million people aged 12 or older who received specialty substance use treatment in 2008, 983,000 received treatment for alcohol use only, 632,000 received treatment for illicit drug use only, and 577,000 received treatment for both alcohol and illicit drug use. These estimates are similar to the estimates for 2007 and for 2002.
In 2008, among persons who received their most recent substance use treatment at a specialty facility in the past year, 49.5 percent reported using their "own savings or earnings" as a source of payment for their most recent specialty treatment, 36.1 percent reported using private health insurance, 24.7 percent reported using Medicaid, 22.3 percent reported using public assistance other than Medicaid, 17.5 percent reported using Medicare, and 16.5 percent reported using funds from family members. None of these estimates changed significantly between 2007 and 2008 and between 2002 and 2008. (Note that persons could report more than one source of payment.)
Of the 20.8 million persons in 2008 who were classified as needing substance use treatment but not receiving treatment at a specialty facility in the past year, 1.0 million persons (4.8 percent) reported that they perceived a need for treatment for their illicit drug or alcohol use problem (Figure 7.10). Of these 1.0 million persons who felt they needed treatment but did not receive treatment in 2008, 233,000 (23.3 percent) reported that they made an effort to get treatment, and 766,000 (76.7 percent) reported making no effort to get treatment. These estimates remained stable between 2007 and 2008, except that the number of persons who felt they needed treatment, made an effort to get treatment, but did not receive treatment in 2008 decreased from 380,000 persons in 2007 to 233,000 persons in 2008, and the percentage of persons who felt they needed treatment among those who were classified as needing substance use treatment declined from 6.4 percent in 2007 to 4.8 percent in 2008.
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Figure 7.10 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: 2008
The number and the percentage of youths aged 12 to 17 who needed treatment for an illicit drug or alcohol use problem remained unchanged between 2007 (2.0 million, 7.9 percent) and 2008 (1.9 million, 7.8 percent); however, there was a significant decrease between 2002 (2.3 million, 9.1 percent) and 2008. Of the 1.9 million youths who needed treatment in 2008, 143,000 received treatment at a specialty facility (about 7.4 percent of the youths who needed treatment), leaving 1.8 million who needed treatment for a substance use problem but did not receive it at a specialty facility.
Based on 2005-2008 combined data, the five most often reported reasons for not receiving illicit drug or alcohol use treatment among persons aged 12 or older who needed but did not receive treatment at a specialty facility and perceived a need for treatment included (a) not ready to stop using (38.8 percent), (b) no health coverage and could not afford cost (32.1 percent), (c) possible negative effect on job (12.3 percent), (d) not knowing where to go for treatment (12.0 percent), and (e) concern that receiving treatment might cause neighbors/community to have negative opinion (11.8 percent).
Based on 2005-2008 combined data, among persons aged 12 or older who needed but did not receive illicit drug or alcohol use treatment, felt a need for treatment, and made an effort to receive treatment, the most often reported reasons for not receiving treatment were (a) no health coverage and could not afford cost (37.4 percent), (b) not ready to stop using (29.3 percent), (c) able to handle the problem without treatment (13.0 percent), (d) no transportation/inconvenient (10.6 percent), (e) no program having type of treatment (8.3 percent), (f) did not feel need for treatment at the time (8.2 percent), (g) did not know where to go for treatment (8.1 percent), (h) might cause neighbors/community to have negative opinion (7.7 percent), and (i) might have negative effect on job (7.4 percent) (Figure 7.11).
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Figure 7.11 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: 2005-2008 Combined
Illicit Drug Use Treatment and Treatment Need
In 2008, the number of persons aged 12 or older needing treatment for an illicit drug use problem was 7.6 million (3.0 percent of the total population). Of these, 1.2 million (0.5 percent of the total population and 16.0 percent of the persons who needed treatment) received treatment at a specialty facility for an illicit drug use problem in the past year. Thus, there were 6.4 million persons (2.5 percent of the total population) who needed but did not receive treatment at a specialty facility for an illicit drug use problem in 2008. None of these estimates changed significantly between 2007 and 2008. The percentage of persons needing treatment for an illicit drug use problem decreased between 2002 (3.3 percent) and 2008 (3.0 percent).
Of the 6.4 million people aged 12 or older who needed but did not receive specialty treatment for illicit drug use in 2008, 400,000 (6.3 percent) reported that they perceived a need for treatment for their illicit drug use problem. Of the 400,000 persons who felt a need for treatment in 2008, 99,000 (24.7 percent) reported that they made an effort (the number and percentage decreased from 205,000 persons and 37.5 percent in 2007), and 301,000 (75.3 percent) reported making no effort to get treatment (the number and percentage remained similar to those reported in 2007).
Among youths aged 12 to 17, there were 1.2 million (4.8 percent) who needed treatment for an illicit drug use problem in 2008. Of this group, only 111,000 received treatment at a specialty facility (9.3 percent of youths aged 12 to 17 who needed treatment), leaving 1.1 million youths who needed treatment but did not receive it at a specialty facility.
Among people aged 12 or older who needed but did not receive illicit drug use treatment and felt they needed treatment (based on 2005-2008 combined data), the most often reported reasons for not receiving treatment were (a) no health coverage and could not afford cost (37.2 percent), (b) not ready to stop using (29.5 percent), (c) concern that receiving treatment might cause neighbors/community to have negative opinion (15.4 percent), (d) not knowing where to go for treatment (15.3 percent), (e) possible negative effect on job (13.0 percent), and (f) being able to handle the problem without treatment (12.0 percent).
Alcohol Use Treatment and Treatment Need
In 2008, the number of persons aged 12 or older needing treatment for an alcohol use problem was 19.0 million (7.6 percent of the population aged 12 or older). Of these, 1.6 million (0.6 percent of the total population and 8.2 percent of the people who needed treatment for an alcohol use problem) received alcohol use treatment at a specialty facility. Thus, there were 17.4 million people who needed but did not receive treatment at a specialty facility for an alcohol use problem. None of these estimates changed significantly between 2007 and 2008 and between 2002 and 2008.
Among the 17.4 million people aged 12 or older who needed but did not receive treatment for an alcohol use problem in 2008, there were 651,000 (3.7 percent) who felt they needed treatment for their alcohol use problem. The number and the percentage were similar to those reported in 2007 (859,000 persons and 4.8 percent, respectively) and 2002 (761,000 persons and 4.5 percent, respectively). Of these, 512,000 (78.6 percent) did not make an effort to get treatment, and 139,000 (21.4 percent) made an effort but were unable to get treatment in 2008.
In 2008, there were 1.2 million youths (5.0 percent) aged 12 to 17 who needed treatment for an alcohol use problem. Of this group, only 77,000 received treatment at a specialty facility (0.3 percent of all youths and 6.2 percent of youths who needed treatment), leaving almost 1.2 million youths who needed but did not receive treatment.
8. Mental Health
This chapter presents findings on mental health problems in the United States, including the prevalence of serious mental illness (SMI), serious psychological distress (SPD), suicidal thoughts and behavior, and major depressive episode (MDE). The association of these problems with substance use and substance dependence or abuse (i.e., substance use disorder) is discussed. Also reported here are the rates of treatment for depression (among those with MDE) in the past year among adults aged 18 or older and youths aged 12 to 17, the percentages of adults and youths 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.
Serious Mental Illness
Public Law No. 102-321, the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992, established a block grant for U.S. States to fund community mental health services for adults with SMI. The law required States to include prevalence estimates in their annual applications for block grant funds. This legislation also required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop an operational definition of SMI. SAMHSA defined SMI as persons aged 18 or older who currently or at any time in the past year have had diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994) that has resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities.
To establish the means to generate estimates of SMI in the United States, SAMHSA conducted a methodological study—the Mental Health Surveillance Study (MHSS)—to calibrate mental health questionnaire items in the National Survey on Drug Use and Health (NSDUH) with a "gold standard" clinical psychiatric interview and assessment of functioning. A split-sample design was used to administer the 12-month K6 distress scale and either an abbreviated World Health Organization Disability Assessment Schedule (WHODAS) or the Sheehan Disability Scale (SDS) to each respondent aged 18 or older. A subsample of 1,502 adults selected from the main study participated in the calibration study by agreeing to undergo additional mental health assessment via a telephone interview. An analysis was conducted to determine the statistical models (using K6 plus WHODAS items or K6 plus SDS) that accurately predict SMI status as determined by the clinical interview and assessment of function. The analyses found that the WHODAS impairment measure performed slightly better than the SDS, so the WHODAS has been retained as the only impairment scale in the survey instrument for 2009 going forward. A description of the MHSS design and results may be found in Section B.4.6 in Appendix B.
Serious Psychological Distress
As a direct outcome of the MHSS, this report focuses on a past 30 day indicator of SPD rather than a past year reference period as has been reported in previous national findings reports. SPD is defined as having a score of 13 or higher on the 30-day K6 scale. Based on responses about symptoms (on the K6) in the past 30 days, this measure of SPD now more closely corresponds with SPD reference periods reported in other surveys, such as the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS). Although the differing modes and contexts of the other surveys prevent direct comparisons of SPD prevalence, there is utility in examining health and behavior correlates of SPD within each survey. Further description of the SPD measure may be found in Section B.4.5 in Appendix B.
Suicidal Thoughts and Behavior
Responding to a need for national data on the prevalence of suicidal thoughts and behavior, a brief module was added to the 2008 NSDUH questionnaire. Suicidality data have been (and continue to be) collected within the context of the MDE module; however, that approach did not capture respondents who screened out of the depression module before they were asked about suicide and did not specifically assess suicidal thoughts and behaviors in the past 12 months. The current module asks all adult respondents if they had serious thoughts of suicide, and if they had thoughts of suicide, whether they made suicide plans or attempts in the past year and further, if an attempt was made, whether the respondent received medical attention or hospitalization as a result of attempted suicide.
Major Depressive Episode (Depression)
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 differ 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 seven additional symptoms reflecting the criteria as described in the DSM-IV. It should be noted that unlike the DSM-IV criteria for MDE, no exclusions were made in NSDUH for depressive symptoms 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 aged 18 or older, the SDS role domains are (1) home management, (2) work, (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 aged 12 to 17 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.4.7 in Appendix B.
One consequence of the MHSS is that the measures inserted to accommodate it (i.e., the past 30 day K6 scale, the functional impairment scale[s], and the suicidal thoughts and behavior items) are suspected of having some impact on respondents' reporting of symptoms in the adult MDE module. As a result, direct comparison with previous years of data is compromised, requiring that a new MDE trend begin with the 2008 data. To facilitate comparison with the 2009 MDE estimates, only data from the sample of respondents receiving the WHODAS items are presented in this report.
Comparing the Measures
Although the populations classified with SMI, MDE, and SPD substantially overlap, the definitions used for the three measures differ distinctly. Meeting the criteria for SMI indicates that a respondent endorsed having symptoms and related functional impairment at a level that is predictive of having a clinically significant mental disorder and functional impairment as measured by a "gold standard" clinical interview. Meeting the criteria for past year MDE indicates that a respondent had the specific physical and emotional symptom profile indicative of MDE for 2 weeks or more in the past 12 months as described in the DSM-IV. (MDE is known to be a fairly common disorder that often includes significant impairment in a person's functioning at work, at home, and in his or her social life.) Meeting the criteria for past 30 day SPD indicates a respondent recently experienced heightened distress symptomatology that may be affecting health and behavior. This distress may be part of a chronic psychological disturbance (even SMI) or may represent a temporary disturbance (e.g., in reaction to an acute stressor) that could subside after a brief period of adjustment.
Mental Health Service Utilization
This chapter also presents data on mental health care among adults aged 18 or older and youths aged 12 to 17. Initiated in 2000, the mental health service utilization modules are asked of respondents regardless of SMI, 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. Consequently, 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." Of note, 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 designed to assess mental health service utilization asked of youths 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). Youths 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 because substance use treatment is assessed 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 a 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 2008, 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 Mental Illness among Adults
In 2008, there were an estimated 9.8 million adults aged 18 or older in the United States with SMI in the past year. This represents 4.4 percent of all adults in this country (Figure 8.1).
Rates of SMI in 2008 were highest for adults aged 18 to 25 (7.4 percent) and lowest for adults aged 50 or older (2.3 percent).
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Figure 8.1 Serious Mental Illness in the Past Year among Adults Aged 18 or Older, by Age and Gender: 2008
The prevalence of SMI in 2008 among women aged 18 or older (5.6 percent) was significantly higher than among men in that age group (3.0 percent).
In 2008, the rate of past year SMI was lowest among Asians (2.9 percent) and blacks (3.5 percent). Rates for other racial/ethnic groups were 4.0 percent among Hispanics, 4.2 percent among American Indians or Alaska Natives, 4.7 percent among whites, and 5.6 percent among persons reporting two or more races. Estimates of SMI among Native Hawaiians or Other Pacific Islanders could not be reported due to low precision.
The rate of SMI in 2008 was higher among adults who were unemployed (8.0 percent) than those who were employed full time (3.5 percent) or part time (4.8 percent).
Mental Health Service Use among Adults with Serious Mental Illness
Among the 9.8 million adults aged 18 or older with SMI in 2008, 5.7 million (58.7 percent) used mental health services in the past year. Service use was higher among adults with SMI who were aged 50 or older (70.9 percent) and aged 26 to 49 (62.2 percent) than among adults aged 18 to 25 (40.4 percent).
Among all adults aged 18 or older with SMI, 52.6 percent received prescription medication, 40.5 percent received outpatient services, and 7.5 percent received inpatient services for a mental health problem in the past year. Respondents could report more than one type of service used.
Among adults aged 18 or older with SMI who reported receiving mental health services in the past year, 38.5 percent received one type of care (inpatient, outpatient, or prescription medication), 51.2 percent received two types of care, and 10.3 percent received all three types of care (Figure 8.2).
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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 Mental Illness Who Received Mental Health Services in the Past Year: 2008
Note: The three types of mental health care are receiving inpatient care, outpatient care, or prescription medication.
Serious Mental Illness and Substance Use and Dependence or Abuse among Adults
Past year illicit drug use in 2008 was higher among adults aged 18 or older with past year SMI (30.3 percent) than among adults without SMI (12.9 percent). Similarly, the rate of past year cigarette use was higher among adults with SMI (50.5 percent) than among adults without SMI (28.5 percent).
Among adults aged 18 or older with past year SMI in 2008, the rate of binge alcohol use (drinking five or more drinks on the same occasion [i.e., at the same time or within a couple of hours of each other] on at least 1 day in the past 30 days) was 29.4 percent, which was higher than the 24.6 percent among adults who did not meet the criteria for SMI. Similarly, the rate of heavy alcohol use (drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days) among adults with SMI in the past year (11.6 percent) was higher than the rate reported among adults without SMI in the past year (7.3 percent).
SMI in the past year was associated with past year substance dependence or abuse in 2008. Among adults aged 18 or older with SMI, 25.2 percent (2.5 million) were dependent on or abused illicit drugs or alcohol. The rate among adults without SMI was 8.3 percent (17.9 million).
Mental Health Care among Adults with Co-Occurring Serious Mental Illness and Substance Use Disorders
Among the 2.5 million adults aged 18 or older with both SMI and substance dependence or abuse (i.e., a substance use disorder) in 2008, 60.5 percent received mental health care or substance use treatment at a specialty facility; 11.4 percent received both mental health care and specialty substance use treatment, 45.2 percent received only mental health care, and 3.7 percent received only specialty substance use treatment (Figure 8.3).
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Figure 8.3 Past Year Mental Health Care and Treatment for Substance Use Problems among Adults Aged 18 or Older with Both Serious Mental Illness and a Substance Use Disorder: 2008
Note: The percentages add to less than 100 percent because of rounding.
Note: Mental health care is defined as having received inpatient care or outpatient care or having used prescription medication for problems with emotions, nerves, or mental health. Treatment for substance use problems refers to treatment at a hospital (inpatient), rehabilitation facility (inpatient or outpatient), or mental health center in order to reduce or stop drug or alcohol use, or for medical problems associated with drug or alcohol use.
Prevalence of Suicidal Thoughts and Behavior among Adults
In 2008, an estimated 8.3 million adults (3.7 percent) aged 18 or older had serious thoughts of suicide in the past year (Figure 8.4). The rate was 3.9 percent among women and 3.4 percent among men. Rates of serious thoughts of suicide were highest among young adults aged 18 to 25 (6.7 percent) compared with adults aged 26 to 49 (3.9 percent) and adults aged 50 or older (2.3 percent).
Among adults 18 or older, 2.3 million (1.0 percent) made suicide plans in the past year (Figure 8.5). The rate was 1.1 percent among women and 0.9 percent among men. Rates of adults who made suicide plans were also highest among 18 to 25 year olds (1.9 percent), followed by 26 to 49 year olds (1.1 percent) and adults 50 years or older (0.7 percent).
In 2008, 1.1 million adults (0.5 percent) aged 18 or older attempted suicide (Figure 8.5). Among those 1.1 million adults who attempted suicide, 0.9 million reported having made plans for suicide, while 0.2 million had not made suicide plans. Among adults, 678,000 (0.3 percent) received medical attention for their suicide attempt, and 500,000 (0.2 percent) stayed overnight or longer in a hospital as a result of their suicide attempt in the past year.
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Figure 8.4 Suicidal Thoughts in the Past Year among Adults Aged 18 or Older, by Age and Gender: 2008
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Figure 8.5 Suicidal Thoughts and Behavior in the Past Year among Adults Aged 18 or Older: 2008
Prevalence of Major Depressive Episode among Adults
In 2008, 6.4 percent of adults aged 18 or older (14.3 million people) had at least one MDE in the past year (Figure 8.6). Over 1 in 25 adults (4.2 percent or 9.5 million people) had past year MDE with severe impairment.
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Figure 8.6 Major Depressive Episode in the Past Year among Adults Aged 18 or Older, by Severe Impairment, Age, and Gender: 2008
Note: Respondents with an unknown level of impairment were included in the estimates for Major Depressive Episode without Severe Impairment.
The past year prevalence of MDE in 2008 was lower for those aged 50 or older (4.5 percent) compared with rates among persons aged 18 to 25 (8.7 percent) and those aged 26 to 49 (7.4 percent).
The past year prevalence of MDE was higher among adult females than among adult males (8.1 vs. 4.6 percent). Among women, past year MDE rates were higher in the younger age groups (12.1 percent for 18 to 25 year olds, 8.8 percent for 26 to 49 year olds) compared with those 50 or older (6.0 percent).
Among adults aged 18 or older, past year prevalence of MDE varied by race/ethnicity in 2008. The rate of MDE was highest among persons reporting two or more races (12.7 percent), while rates for single race groups were 7.0 percent among whites, 5.2 percent among Hispanics, 4.9 percent among American Indians or Alaska Natives, 4.9 percent among blacks, and 3.6 percent among Asians. Estimates of past year MDE among Native Hawaiians or Other Pacific Islanders could not be reported due to low precision.
Among adults aged 18 or older in 2008, past year prevalence of MDE with severe impairment was higher among unemployed persons (6.6 percent) than among persons employed full time (3.2 percent). Past year prevalence of MDE was 4.8 percent among persons employed part time and 5.7 percent among persons retired or otherwise not in the labor force.
Major Depressive Episode and Substance Use and Dependence or Abuse among Adults
In 2008, adults aged 18 or older with past year MDE had higher rates of past year illicit drug use than those without MDE (27.2 vs. 13.0 percent). A similar pattern was observed for specific types of past year illicit drug use, such as the use of marijuana, cocaine, heroin, or hallucinogens and the nonmedical use of prescription-type psychotherapeutics.
Among adults aged 18 or older with MDE in the past year, 9.6 percent were heavy alcohol users in the past month, higher than the 7.1 percent of heavy alcohol users without MDE in the past year. Similarly, among adults with past year MDE, the rate of daily cigarette use in the past month was 29.1 percent, while the rate was 15.2 percent among adults without past year MDE.
Having MDE in the past year was associated with past year substance dependence or abuse. Among adults aged 18 or older who had MDE in 2008, 20.3 percent were dependent on or abused alcohol or illicit drugs, while among adults without MDE, 7.8 percent were dependent on or abused alcohol or illicit drugs (Figure 8.7).
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Figure 8.7 Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2008
Treatment for Major Depressive Episode among Adults
Among adults aged 18 or older who had past year MDE in 2008, 71.0 percent received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression in the same time period. The past year MDE treatment rate was highest among persons aged 50 or older (86.3 percent), followed by adults aged 26 to 49 (72.6 percent) and adults aged 18 to 25 (44.7 percent). Of all adults aged 18 or older who had past year MDE with severe impairment in 2008, 75.0 percent received treatment.
In 2008, women aged 18 or older who had MDE in the past year were more likely than their male counterparts to have received treatment for depression in the past year (74.2 vs. 65.0 percent).
Among adults aged 18 or older with past year MDE in 2008, about two thirds of those with no insurance (64.1 percent) and private insurance (69.8 percent) received treatment for depression in the past year compared with higher rates for those with Medicaid or CHIP (83.1 percent) and 83.5 percent of adults with other health insurance (including Medicare, CHAMPUS, TRICARE, CHAMPVA, VA, and other sources of health care or insurance).
Prevalence of Past 30 Day Serious Psychological Distress among Adults
In 2008, there were an estimated 10.2 million adults aged 18 or older in the United States with SPD in the past month. This represents 4.5 percent of all U.S. adults.
Rates of SPD were highest for adults aged 18 to 25 (7.5 percent) and lowest for adults aged 50 or older (2.9 percent).
In 2008, rates of past 30 day SPD were higher among unemployed adults (10.2 percent) than among adults employed full time (3.3 percent), part time (4.4 percent), or other persons not in the labor force (6.1 percent).
Serious Psychological Distress and Substance Use among Adults
Past 30 day illicit drug use in 2008 was higher among adults aged 18 or older with SPD (19.6 percent) than among adults without SPD (7.3 percent). Past 30 day use of illicit drugs other than marijuana in 2008 was higher among adults with SPD (12.3 percent) than among adults without SPD (2.9 percent).
Among adults aged 18 or older with past month SPD in 2008, the rate of binge alcohol use (drinking five or more drinks on the same occasion [i.e., at the same time or within a couple of hours of each other] on at least 1 day in the past 30 days) was 30.9 percent, which was higher than the 24.6 percent rate among adults who did not meet the criteria for SPD. The rate of heavy alcohol use (drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days) among adults with SPD in the past month was higher (12.1 percent) than the rate reported among adults without SPD in the past month (7.3 percent). Similarly, the rate of past month use of cigarettes was higher among adults with SPD (47.6 percent) than among adults without SPD (24.5 percent).
Mental Health Service Use and Unmet Need for Mental Health Care among Adults
In 2008, 30 million adults (13.4 percent of the population 18 years or older) received mental health services during the past 12 months (Figure 8.8). This was similar to the rate in 2007 (13.2 percent).
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Figure 8.8 Past Year Mental Health Service Use among Adults Aged 18 or Older, by Type of Care: 2002-2008
+ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
In 2008, the type of mental health services most often received by adults aged 18 or older was prescription medication (11.3 percent), followed by outpatient services (6.8 percent). Rates of prescription medication and outpatient service use in 2008 were similar to the rates in 2007 (11.1 and 6.9 percent, respectively). Note that respondents could report receiving more than one type of mental health care. Between 2002 and 2008, the percentage of adults receiving outpatient services declined from 7.4 to 6.8 percent, while the percentage receiving prescription medication increased from 10.5 to 11.3 percent.
About 2.0 million adults (0.9 percent of the population aged 18 years or older) received inpatient care for mental health problems during the past year. This estimate was similar to the rate reported in 2007 (1.0 percent or 2.1 million adults).
Rates of mental health service use varied by age for adults aged 18 or older. Adults aged 18 to 25 had a lower rate of mental health service use (10.8 percent) than both adults aged 26 to 49 (14.0 percent) and adults aged 50 or older (13.6 percent).
Men were less likely than women to receive outpatient mental health services (5.0 vs. 8.5 percent) and prescription medication (7.5 vs. 14.8 percent) for mental health problems in the past year.
Among racial/ethnic groups, the rates of mental health service use for adults aged 18 or older in 2008 were 18.8 percent for persons reporting two or more races, 16.0 percent for whites, 13.2 percent for American Indians or Alaska Natives, 8.7 percent for blacks (up from 6.8 percent in 2007), 6.8 percent for Hispanics, and 4.5 percent for Asians. Estimates of mental health service use among Native Hawaiians or Other Pacific Islanders could not be reported due to low precision.
In 2008, there were 10.6 million adults aged 18 or older (4.7 percent) who reported an unmet need for mental health care in the past year. This included 5.1 million adults who did not receive any mental health services in the past year. Among adults who did receive some type of mental health service in the past year, 17.9 percent (5.4 million) reported an unmet need for mental health care. (Unmet need among adults who received mental health services may reflect a delay in care or a perception of insufficient care.)
Among the 5.1 million adults who reported an unmet need for mental health care and did not receive mental health services in the past year, several barriers to care were reported. These included an inability to afford care (42.7 percent), believing at the time that the problem could be handled without care (28.6 percent), not knowing where to go for care (19.8 percent), and not having the time to go for care (13.9 percent) (Figure 8.9).
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Figure 8.9 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: 2008
8.2. Youths Aged 12 to 17
Prevalence of Major Depressive Episode among Youths
In 2008, there were 2.0 million youths (8.3 percent of the population aged 12 to 17) who had major depressive episode (MDE) during the past year. An estimated 1.5 million (6.0 percent) had MDE with severe impairment in one or more role domains (chores at home; school or work; close relationships with family; or social life).
Among youths aged 12 to 17 in 2008, the past year prevalence of MDE ranged from 3.9 percent among 12 year olds to 11.6 percent among those aged 16 and 10.6 percent among those aged 17 (Figure 8.10). Similarly, rates of past year MDE with severe impairment ranged from 2.5 percent among 12 years olds to 8.8 percent among 16 year olds and 7.9 percent among 17 year olds.
Among youths aged 12 to 17 in 2008, the prevalence rates of MDE and MDE with severe impairment among females were higher than those of their male counterparts. Female youths had an MDE prevalence rate of 12.4 percent in 2008, almost 3 times the rate for males in the same age range (4.3 percent). The prevalence of MDE with severe impairment was 9.2 percent for females, which was over 3 times the rate for males (2.9 percent).
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Figure 8.10 Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Severe Impairment, Age, and Gender: 2008
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
Among 12 to 17 year olds who had past year MDE in 2008, 37.4 percent had used illicit drugs during the same period (Figure 8.11), which was higher than the rate of 17.2 percent among youths who did not have past year MDE. This pattern was similar for most specific types of illicit drug use, including the use of marijuana, cocaine, hallucinogens, or inhalants and the nonmedical use of prescription-type psychotherapeutics.
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Figure 8.11 Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2008
In 2008, youths aged 12 to 17 who had MDE during the past year were more likely to report daily cigarette use in comparison with those who did not have MDE during the past year (3.6 vs. 1.8 percent). Similarly, youths who had past year MDE were more likely to report heavy use of alcohol than those who did not have MDE (3.4 vs. 1.8 percent).
The occurrence of MDE in the past year among youths aged 12 to 17 was associated with a higher prevalence of illicit drug or alcohol dependence or abuse (21.3 percent). Among youths who did not report past year MDE, 6.4 percent had illicit drug or alcohol dependence or abuse during the same period.
Treatment for Major Depressive Episode among Youths
In 2008, 37.7 percent of youths aged 12 to 17 with past year MDE received treatment for depression (i.e., saw or talked to a medical doctor or other professional or used prescription medication).
In 2008, among youths with past year MDE, 21.7 percent saw or talked to a medical doctor or other professional only, 2.9 percent used prescription medication only, and 13.1 percent received treatment from both sources for depression in the past year.
Mental Health Service Use among Youths
In 2008, 3.1 million youths aged 12 to 17 (12.7 percent) received treatment or counseling for problems with behavior or emotions in a specialty mental health setting (inpatient or outpatient care). Additionally, 11.8 percent of youths received services in an education setting, and 2.9 percent received mental health services in a general medical setting in the past 12 months. Mental health services were received in both a specialty setting and either an education or a general medical setting (i.e., care from multiple settings) by 5.3 percent of youths.
Female youths were more likely than male youths to report using outpatient specialty mental health services (13.6 vs. 9.3 percent), education services (13.0 vs. 10.5 percent), or general medical-based services (3.2 vs. 2.6 percent), but there was no significant gender difference in the use of inpatient specialty mental health services (Figure 8.12).
Of the 2.8 million youths who received outpatient specialty mental health services in the past 12 months, 18.3 percent reported having 1 visit, 15.8 percent reported having 2 visits, 29.1 percent reported having 3 to 6 visits, 25.1 percent reported having 7 to 24 visits, and 11.8 percent reported having 25 or more visits (Figure 8.13).
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Figure 8.12 Past Year Mental Health Service Use among Youths Aged 12 to 17, by Gender: 2008
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Figure 8.13 Number of Outpatient Visits in the Past Year among Youths Aged 12 to 17 Who Received Outpatient Specialty Mental Health Services: 2008
Of the 598,000 youths who received inpatient or residential specialty mental health services in the past 12 months, about one third (36.0 percent) reported staying overnight 1 night, 31.4 percent reported staying 2 to 6 nights, 19.6 percent reported staying 7 to 24 nights, and 13.0 percent reported staying 25 or more nights.
9. Discussion of Trends in Substance Use among Youths and Young Adults
This report presents findings from the 2008 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 2008 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 2008, changes between 2007 and 2008, and changes between 2002 and 2008. 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, 2008a, 2008b, 2009). 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 2008 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. For comparison purposes, MTF data on 8th and 10th graders are combined to give an age range close to 12 to 17 years, the standard youth age group for NSDUH. Appendix D provides comparisons according to MTF definitions (8th, 10th, and 12th grades). 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 2008 in the percentages of youths who used marijuana, cocaine, Ecstasy, LSD, alcohol, and cigarettes in the lifetime, past year, and past month (Table 9.1). Exceptions were for the past month use of LSD in both NSDUH and MTF data and the past month use of Ecstasy in the NSDUH data. The hallucinogen trends are discussed in more detail below. Both surveys show no decrease in the rates of past year and past month inhalant use among youths between 2002 and 2008, and 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 2008, the rate of current alcohol use among youths declined 17 percent according to NSDUH and 19 percent according to MTF, and between 2007 and 2008 the declines were 8 and 9 percent, respectively. Current cigarette use prevalence rates in 2008 were 30 percent lower in NSDUH and 32 percent lower in MTF compared with 2002 rates. For past month marijuana use, the NSDUH decline from 2002 to 2008 was 18 percent, and the MTF decline was 25 percent.
In both surveys, the decline in marijuana use among youths between 2002 and 2008 was driven by decreases early in the 7-year period, while in the most recent years, little change has occurred in the rate of use. Between 2006 and 2008, there was no significant change in rates of lifetime, past year, or past month marijuana use for youths in NSDUH (aged 12 to 17) or MTF (8th and 10th graders).
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 from the data for youths 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 between 2002 and 2008 for past year and past month cigarette and marijuana use among young adults, although the decline in past month marijuana use in NSDUH was not significant. In addition, the extent of the declines in current cigarette and marijuana use for young adults in NSDUH from 2002 through 2008 were less than the corresponding declines for young adults in MTF. Past month marijuana prevalence among young adults declined 5 percent according to NSDUH and by 13 percent according to MTF. Similarly, the prevalence of past month cigarette use among young adults in NSDUH declined by 13 percent over this period and by 23 percent in MTF. Both surveys show no significant change between 2002 and 2008 in the rate of current alcohol use among young adults. A significant decline in past month cocaine use between 2006 and 2008 is seen in the NSDUH data. The MTF data show a similar drop in use between 2006 and 2008 (although not statistically significant).
Both NSDUH and MTF generally show 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, 2007, and 2008 data from NSDUH show evidence of a possible resurgence in the use of these two hallucinogens among both youths and young adults. Between 2005 and 2008, there were increases in the use of Ecstasy in the lifetime among youths according to NSDUH (from 1.6 to 2.1 percent) and past year (from 1.0 to 1.4 percent); past month use among youths increased from 0.3 to 0.4 percent between 2007 and 2008. LSD use among youths also increased between 2007 and 2008 in the lifetime (0.8 to 1.1 percent) and in the past year (0.5 to 0.7 percent). Past year Ecstasy and LSD estimates among youths in MTF were higher in 2008 than in 2006, but these differences were not statistically significant (Figure 9.1). For young adults in NSDUH, past year Ecstasy use increased from 3.1 percent in 2005 to 3.9 percent in 2008, and LSD use increased from 1.0 to 1.5 percent during that same period. No significant changes were observed in the MTF data on past year Ecstasy use for young adults between 2004 and 2008. However, past year LSD use among young adults in MTF in 2008 was significantly greater than in 2004 and 2005.
Below is a line graph. Click here for the text describing this graph.
Figure 9.1 Past Year Ecstasy and LSD Use among Youths in NSDUH and MTF: 2002-2008
MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health. + Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
Data on availability and perceived risk from NSDUH and MTF provide important context for these emerging trends. Both surveys indicate diminishing availability of these drugs in early years of the decade, but a plateau in recent years. In NSDUH, the percentage of youths aged 12 to 17 reporting that LSD is easy to get declined from 19.4 percent in 2002 to 14.0 percent in 2006, but the rate has not changed since then (13.8 percent in 2008). MTF (8th and 10th graders combined) has shown the same trend for perceived availability of LSD (21.0 percent in 2002, 15.0 percent in 2006, and 15.1 percent in 2008). Although NSDUH does not ask about availability of Ecstasy, MTF showed similar trends for perceived availability of Ecstasy (31.9 percent in 2002, 21.0 percent in 2006, and 20.4 percent in 2008). Measures of youths' perceptions of risk in using these hallucinogens declined during the period from 2002 to 2008 in both surveys. Declining perceived risk could lead to more young people initiating use of these drugs and could be contributing to the increase from 2005 to 2008 in the number of past year initiates of Ecstasy (from 615,000 to 894,000) and LSD (from 243,000 to 394,000) among persons aged 12 or older.
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 the 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 current alcohol use (47.1 percent in 2001 and 44.7 percent in 2007), but decreases in cigarette use (28.5 percent in 2001, 20.0 percent in 2007), marijuana use (23.9 percent in 2001, 19.7 percent in 2007), and cocaine use (4.2 percent in 2001, 3.3 percent in 2007).
Although changes in NSDUH survey methodology 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, although not as high as in the late 1970s, followed by declines in use after the turn of the 21st century and a leveling in the most recent years (Figure 9.2).
Below is a line graph. Click here for the text describing this graph.
Figure 9.2 Past Month Marijuana Use among Youths in NSDUH, MTF, and YRBS: 1971-2008
MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health; YRBS = Youth Risk Behavior Survey.
Note: NSDUH data for youths aged 12 to 17 are not presented for 1999 to 2001 because of design changes in the survey. These design changes preclude direct comparisons of estimates from 2002 to 2008 with estimates prior to 1999.
Table 9.1 – Comparison of NSDUH and MTF Prevalence Estimates among Youths: Percentages, 2002-2008
Substance/ Time Period
NSDUH (2002)
NSDUH (2003)
NSDUH (2004)
NSDUH (2005)
NSDUH (2006)
NSDUH (2007)
NSDUH (2008)
MTF (2002)
MTF (2003)
MTF (2004)
MTF (2005)
MTF (2006)
MTF (2007)
MTF (2008)
-- Not available.
NOTE: NSDUH data are for youths aged 12 to 17, and MTF data are simple averages of estimates for 8th and 10th graders. MTF data for 8th and 10th graders are reported in Johnston, O'Malley, Bachman, and Schulenberg (2009a). MTF design effects used for variance estimation are reported in Johnston, O'Malley, Bachman, and Schulenberg (2008b). a Difference between this estimate and 2008 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, 2007, and 2008. University of Michigan, The Monitoring the Future Study, 2002, 2003, 2004, 2005, 2006, 2007, and 2008.
Marijuana
Lifetime
20.6a
19.6a
19.0a
17.4
17.3
16.2
16.5
29.0a
27.0a
25.7a
25.3a
23.8
22.6
22.3
Past Year
15.8a
15.0a
14.5a
13.3
13.2
12.5
13.0
22.5a
20.5a
19.7a
19.4a
18.5
17.5
17.4
Past Month
8.2a
7.9a
7.6a
6.8
6.7
6.7
6.7
13.1a
12.3a
11.2a
10.9a
10.4
10.0
9.8
Cocaine
Lifetime
2.7a
2.6a
2.4a
2.3a
2.2a
2.1
1.9
4.9a
4.4
4.4
4.5
4.1
4.2
3.8
Past Year
2.1a
1.8a
1.6a
1.7a
1.6a
1.5a
1.2
3.2a
2.8
2.9
2.9
2.6
2.7
2.4
Past Month
0.6a
0.6a
0.5
0.6a
0.4
0.4
0.4
1.4a
1.1
1.3a
1.3
1.3
1.1
1.0
Ecstasy
Lifetime
3.3a
2.4
2.1
1.6a
1.9
1.8a
2.1
5.5a
4.3a
3.6
3.4
3.5
3.8
3.4
Past Year
2.2a
1.3
1.2
1.0a
1.2
1.3
1.4
3.9a
2.6
2.1
2.2
2.1
2.5
2.3
Past Month
0.5
0.4
0.3
0.3
0.3
0.3a
0.4
1.6a
0.9
0.8
0.8
1.0
0.9
1.0
LSD
Lifetime
2.7a
1.6a
1.2
1.1
0.9
0.8a
1.1
3.8a
2.8
2.3
2.2
2.2
2.3
2.3
Past Year
1.3a
0.6
0.6
0.6
0.4a
0.5a
0.7
2.1a
1.5
1.4
1.4
1.3
1.5
1.6
Past Month
0.2
0.2
0.2
0.1
0.1
0.1
0.2
0.7
0.6
0.6
0.6
0.6
0.6
0.6
Inhalants
Lifetime
10.5a
10.7a
11.0a
10.5a
10.1a
9.6
9.3
14.4
14.3
14.9
15.1
14.7
14.6
14.3
Past Year
4.4
4.5a
4.6a
4.5a
4.4
3.9
3.9
6.8
7.1
7.8
7.8
7.8
7.5
7.4
Past Month
1.2
1.3
1.2
1.2
1.3
1.2
1.1
3.1
3.2
3.5
3.2
3.2
3.2
3.1
Alcohol
Lifetime
43.4a
42.9a
42.0a
40.6a
40.4a
39.4
38.3
57.0a
55.8a
54.1a
52.1a
51.0a
50.3a
48.6
Past Year
34.6a
34.3a
33.9a
33.3a
32.9a
31.8
30.8
49.4a
48.3a
47.5a
45.3a
44.7a
44.1a
42.3
Past Month
17.6a
17.7a
17.6a
16.5a
16.6a
15.9a
14.6
27.5a
27.6a
26.9a
25.2a
25.5a
24.7a
22.4
Cigarettes
Lifetime
33.3a
31.0a
29.2a
26.7a
25.8a
23.7
22.9
39.4a
35.7a
34.3a
32.4a
30.4a
28.4a
26.1
Past Year
20.3a
19.0a
18.4a
17.3a
17.0a
15.7
15.0
--
--
--
--
--
--
--
Past Month
13.0a
12.2a
11.9a
10.8a
10.4a
9.8a
9.1
14.2a
13.5a
12.6a
12.1a
11.6a
10.6a
9.6
Table 9.2 – Comparison of NSDUH and MTF Prevalence Estimates among Young Adults: Percentages, 2002-2008
Substance/ Time Period
NSDUH (2002)
NSDUH (2003)
NSDUH (2004)
NSDUH (2005)
NSDUH (2006)
NSDUH (2007)
NSDUH (2008)
MTF (2002)
MTF (2003)
MTF (2004)
MTF (2005)
MTF (2006)
MTF (2007)
MTF (2008)
-- Not available.
NOTE: NSDUH data shown in this table are for persons aged 18 to 25.
NOTE: MTF data shown in this table are for persons aged 19 to 24. These estimates are simple averages of modal age groups 19-20, 21-22, and 23-24 as reported in Johnston, O'Malley, and Bachman (2003) and in Johnston, O'Malley, Bachman, and Schulenberg (2004, 2005, 2006, 2007, 2008a, 2009b).
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 2003, 2005, and 2007 estimates with 2008 estimates, this assumption results in conservative tests for comparisons of 2002, 2004, and 2006 estimates with 2008 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 2008 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, 2007, and 2008. University of Michigan, The Monitoring the Future Study, 2002, 2003, 2004, 2005, 2006, 2007, and 2008.
Marijuana
Lifetime
53.8a
53.9a
52.8a
52.4a
52.4a
50.8
50.4
56.1a
56.4a
55.6a
54.4
53.8
53.9
53.0
Past Year
29.8a
28.5
27.8
28.0
28.0
27.5
27.6
34.2a
33.0
31.6
31.4
30.9
31.0
30.9
Past Month
17.3
17.0
16.1
16.6
16.3
16.4
16.5
19.8a
19.9a
18.2
17.0
17.0
17.5
17.3
Cocaine
Lifetime
15.4a
15.0
15.2
15.1
15.7a
15.0
14.4
12.9
14.5a
14.3a
12.6
13.6
12.4
12.2
Past Year
6.7a
6.6a
6.6a
6.9a
6.9a
6.4a
5.5
6.5
7.3a
7.8a
6.9
7.0
6.3
6.0
Past Month
2.0a
2.2a
2.1a
2.6a
2.2a
1.7
1.5
2.5
2.6
2.4
2.1
2.4
1.9
1.9
Ecstasy
Lifetime
15.1a
14.8a
13.8a
13.7a
13.4a
12.8
12.1
16.0a
16.6a
14.9a
12.4a
11.5
9.5
10.1
Past Year
5.8a
3.7
3.1a
3.1a
3.8
3.5
3.9
8.0a
5.3a
3.3
3.4
3.6
2.8
3.8
Past Month
1.1
0.7
0.7
0.8
1.0a
0.7
0.9
1.6
1.0
0.8
0.6
0.9
0.3
0.9
LSD
Lifetime
15.9a
14.0a
12.1a
10.5a
8.9a
7.3a
6.5
13.9b
13.8b
10.4b
7.9b
6.7
5.9
5.6
Past Year
1.8
1.1a
1.0a
1.0a
1.2a
1.1a
1.5
2.4b
1.5
1.2
1.1
1.5
1.4
1.9
Past Month
0.1a
0.2
0.3
0.2
0.2a
0.2
0.3
0.4
0.2
0.2
0.2
0.3
0.3
0.5
Inhalants
Lifetime
15.7a
14.9a
14.0a
13.3a
12.5a
11.3a
10.4
11.7b
11.4b
10.6b
9.3
9.7
7.5
8.4
Past Year
2.2a
2.1a
2.1a
2.1a
1.8
1.6
1.6
2.2b
1.5
2.3b
1.6
1.8
1.1
1.7
Past Month
0.5a
0.4
0.4
0.5
0.4
0.4
0.3
0.8
0.3
0.4
0.3
0.4
0.3
0.6
Alcohol
Lifetime
86.7a
87.1a
86.2
85.7
86.5
85.2
85.6
88.4b
87.6
87.2
87.1
87.0
86.0
86.4
Past Year
77.9
78.1
78.0
77.9
78.8
77.9
78.0
83.9
82.3
83.1
82.8
83.2
82.8
82.5
Past Month
60.5
61.4
60.5
60.9
61.9
61.2
61.2
67.7
66.3
67.3
66.8
67.0
67.4
67.4
Cigarettes
Lifetime
71.2a
70.2a
68.7a
67.3a
66.6a
64.7
64.2
--
--
--
--
--
--
--
Past Year
49.0a
47.6a
47.5a
47.2a
47.0a
45.1
45.0
41.8b
40.8b
41.4b
40.2b
37.1
36.2
35.4
Past Month
40.8a
40.2a
39.5a
39.0a
38.4a
36.2
35.7
31.4b
29.5b
30.2b
28.7b
26.7
25.7
24.3
End Notes
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