drug addiction recovery news | National Survey on Drug Use and Health (NSDUH)
A.5.4. Substance Dependence, Abuse, and Treatment Need
Several 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 are included in NSDUH each year. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, and inhalants, and the nonmedical use of prescription-type psychotherapeutic drugs. These series of questions are used to classify persons as being dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994). The questions on dependence ask about health and emotional problems, attempts to cut down on use, tolerance, withdrawal, and other symptoms associated with substances used. 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 reflects a more severe substance problem than abuse, and persons are classified with abuse of a particular substance only if they are not dependent on that substance.
Nationally, 7.7 percent of the population aged 12 or older was classified with being dependent on or having abused alcohol in the past year in 2004-2006. Past year alcohol dependence or abuse varied from a low of 5.6 percent in Delaware (Sussex County), in Georgia (Region 5), in Mississippi (Region 5), and in southern Utah (Central, Four Corners, San Juan, and Southwest) to a high of 14.0 percent in the District of Columbia (Ward 2). The District of Columbia, Montana, North Dakota, South Dakota, and Wisconsin all had more than one of its substate regions in the highest 15.
In 2004-2006, 2.9 percent of persons aged 12 or older were dependent on or had abused illicit drugs in the past year. The rates among substate regions ranged from a low of 1.8 percent in Pennsylvania's Regions 5, 18, 23, 24, and 46 to 5.9 percent in the District of Columbia's Ward 5. The District of Columbia accounted for 5 of the top 15 substate regions with dependence on or abuse of illicit drugs in the past year. Only 3 of the top 15 substate regions for alcohol dependence or abuse were also in the top 15 for illicit drug dependence or abuse: the District of Columbia's Ward 1, Circuit 2 in Florida, and Region 5 in Montana.
The national rate in 2004-2006 for past year dependence on or abuse of illicit drugs or alcohol among persons aged 12 or older was 9.2 percent. Substate regions that were ranked high for past year dependence on or abuse of alcohol also tended to be ranked high for dependence on or abuse of illicit drugs or alcohol because alcohol accounts for most of the substance dependence or abuse. For example, 10 of the top 15 substate regions for alcohol dependence or abuse were in the top 15 for illicit drug or alcohol dependence or abuse. The substate region with the highest rate of illicit drug or alcohol dependence or abuse (15.4 percent) was Ward 2 in the District of Columbia, and Regions 5, 18, 23, 24, and 46 in Pennsylvania had the lowest rate in the Nation (6.5 percent).
The definition of a person needing but not receiving treatment for an illicit drug use problem is that the person meets the criteria for abuse of or dependence on illicit drugs according to the DSM-IV, but has not received specialty treatment for an illicit drug problem in the past year. Specialty treatment is treatment received at a drug or alcohol rehabilitation facility (inpatient or outpatient), hospital (inpatient only), or mental health center. In 2004-2006, 2.6 percent of persons aged 12 or older needed treatment for an illicit drug use problem in the past year, but did not receive it. The lowest rate in the Nation (1.5 percent) occurred in Pennsylvania's Regions 5, 18, 23, 24, and 46. The region with the highest rate in the Nation (4.8 percent) was Detroit City in Michigan.
Arkansas, California, the District of Columbia, Florida, and Rhode Island each had more than one substate region among those with the highest rates of needing but not receiving treatment for illicit drug use problems. The top 15 substate regions were not very clustered and represented 10 different States.
In 2004-2006, the percentage of persons aged 12 or older who needed but did not receive treatment for alcohol use problems was more than twice as large (7.3 percent) as the percentage for illicit drug use problems. Generally, the substate regions with the highest rates of untreated alcohol use problems were not the same as those regions with the highest rates of untreated illicit drug use problems. Only Circuit 2 of Florida and Region 5 of Montana were among the top 15 for both measures. The District of Columbia's Ward 2 had a rate of 13.8 percent, the highest in the Nation, and Sussex County in Delaware had the lowest rate (5.1 percent).
A.5.5. Serious Psychological Distress and Major Depressive Episode among Adults
In 2004-2006, past year serious psychological distress (SPD) was present in 11.5 percent of adults aged 18 or older in the Nation. The 15 substate regions with the highest rates of SPD included 6 in West Virginia and 2 each in Kentucky, Missouri, and Utah. Southern II region in West Virginia had the highest rate of past year SPD (16.5 percent). Montgomery County, Maryland, had the lowest rate (8.7 percent). Of the 15 substate regions with the lowest rates of SPD, Florida and Maryland each had 4 regions and Hawaii had 2 regions.
This report marks the first time that estimates of the prevalence of a major depressive episode (MDE) are being reported at the substate level. Nationally, 7.6 percent of adults aged 18 or older experienced having MDE in the past year. Salt Lake County, Utah, had the highest rate (11.1 percent), while Circuits 11 and 16 in Florida had the lowest rate (5.7 percent). Of the 15 substate regions with the highest rates, the District of Columbia and Wyoming each had 3 regions, and Nevada and Utah each had 2 regions. Regions with the lowest estimates of MDE included California and Florida (3 regions each) and Hawaii and Texas (2 regions each).
For details on how SPD and MDE were measured, refer to Section B.7 of this report and Sections A.8 and A.9 in Appendix A of the 2005-2006 NSDUH State report (Hughes et al., 2008).
A.6. Caveats
In Section A.5, a discussion covering most of the 23 substance use measures shown in Section C was presented. This discussion was primarily limited to providing the range of rates from lowest to highest in the Nation and any State-level clustering of substate regions in the lowest 15 or the highest 15 group of substate regions. It is important to note that these estimates are based on a sample, and that different samples could result in slightly different high and low regions. For example, Montana's Region 5 had the highest rate of past month illicit drug use (13.8 percent) of any substate region in the Nation. It can be stated with 95 percent confidence that the true value for Region 5 falls between 11.4 and 16.8 percent (see Table C1). Estimates in the highest group ranged from 11.7 in Providence, Rhode Island, to 13.8 in Montana's Region 5; therefore, Montana's Region 5 estimate of past month illicit drug use may not be any different from estimates shown in the other regions in the highest group.
The tables presented in Section C contain estimates for 363 substate regions, 21 aggregated substate regions, 50 States and the District of Columbia, 4 census regions, and the total United States. The national maps included in that section display 345 substate regions (a combination of substate regions and aggregate substate regions) to satisfy requests made by some States to only show aggregate substate regions (see Section D). The discussion in Section A.5 above is based only on these 345 substate or aggregate substate regions.
End Notes
1 RTI International is a trade name of Research Triangle Institute.
2 These regions were defined by officials from each State, typically based on the substance abuse treatment planning regions specified by States in their applications for a SAPT Block Grant administered by SAMHSA. There is extensive variation in treatment planning regions across States. In some States, the planning regions are used more for administrative purposes rather than for planning purposes. Because the estimation method required a minimum NSDUH sample size of approximately 200 to provide adequate precision, planning regions with sample sizes that were much smaller than that were collapsed with adjacent regions until an adequate sample size was obtained.
