Chapter 3

Topics of Special Interest

Adolescent Admissions to Substance Abuse Treatment
Trends in Heroin Admissions and Medication-Assisted Opioid Therapy
Polydrug Abuse
Racial/Ethnic Subgroups

This chapter highlights topics that are of current or special interest. It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding.

TEDS data indicate that admissions to substance abuse treatment aged 12 to 17 increased by 9 percent (from 145,438 to 157,896) between 2001 and 2002, but declined by 13 percent (to 137,868) between 2002 and 2011 [Table 3.1a]. In 2011, 88 percent of adolescent treatment admissions involved marijuana as a primary or secondary substance, and 39 percent of these marijuana-involved admissions were referred to treatment through the criminal justice system [Table 3.4].

The number of TEDS admissions for primary heroin abuse decreased by 21 percent between 2001 and 2007 then increased by 32 percent between 2007 and 2011 [Table 3.1a].

The proportion of heroin admissions whose treatment plans included medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined from 36 percent in 2001 to 27 percent in 2011 [Table 3.7].1

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance [Table 3.8].

TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups; however, alcohol was the predominant substance for all racial/ethnic groups except persons of Puerto Rican origin, where the predominant substance was heroin [Table 2.2].


1 Comparisons between the TEDS heroin admissions whose treatment plans included medication-assisted opioid therapy and the N-SSATS clients that used methadone or buprenorphine in the treatment of opioids should be avoided for the following reasons: (i) private for-profit treatment facilities do not report to TEDS but do report to N-SSATS; (ii) TEDS data are calculated based on a full year’s data, while N-SSATS data are calculated based on a reference date (March 31); and (iii) both the data collection method and the manner in which the question is asked are different for both N-SSATS and TEDS data—in TEDS information is collected on planned treatment and in N-SSATS facilities report clients who received methadone or buprenorphine for detoxification or maintenance purposes.

Adolescent Admissions to Substance Abuse Treatment

Tables 3.1a and 3.1b and Figure 19. The number of adolescent admissions aged 12 to 17 increased by 9 percent from 2001 to 2002, then declined by 13 percent from 2002 to 2011.


2 These drugs include methadone, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

Figure 19. Adolescent admissions aged 12 to 17, by primary substance: 2001-2011

Figure 19. Line chart comparing Adolescent admissions, by primary substance: 1999-2009

Table 3.2. In 2011, overall 72 percent of adolescent admissions were male, a proportion heavily influenced by the 78 percent of marijuana admissions that were male. The proportion of female admissions was greater than 40 percent for most other substances. There were more female than male adolescent admissions for methamphetamine/amphetamines (56 percent vs. 44 percent).

Forty-five percent of adolescent admissions were non-Hispanic White, 24 percent were of Hispanic origin, 20 percent were non-Hispanic Black, and 10 percent were of other racial/ethnic groups.

Table 3.3. The number of adolescent admissions increased with age; 1 percent were 12 years old, increasing to 32 percent who were 17 years old. Among admissions for inhalants, 18 percent were aged 12 or 13. Among admissions for heroin and for opiates other than heroin, 60 percent and 52 percent, respectively, were age 17.

In 2011, 43 percent of adolescent admissions were referred to treatment through the criminal justice system, 17 percent were self- or individual referrals, and 14 percent were referred through schools.

Table 3.4 and Figure 20. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. In 2001, 44 percent of all adolescent admissions were marijuana involved and referred to treatment by the criminal justice system, and 38 percent were marijuana involved but referred by other sources. By 2011, the proportion referred by the criminal justice system decreased to 39 percent, while the proportion referred by other sources increased to 48 percent. The proportions nearly converged in 2007 and 2009.

Adolescent admissions not involving marijuana that were referred by the criminal justice system fell from 8 percent in 2001 to 4 percent in 2011. Admissions not involving marijuana that were referred from other sources were fairly stable, at between 8 and 11 percent of adolescent admissions.

Figure 20. Adolescent admissions aged 12 to 17, by marijuana involvement and criminal justice referral: 2001-2011

Figure 20. Line chart comparing Adolescent admissions, by marijuana involvement and criminal justice referral: 1999-2009

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

General measures of heroin abuse among treatment admissions aged 12 and older were relatively consistent from 2001 through 2011. Primary heroin abuse accounted for 14 to 16 percent of TEDS admissions in every year from 2001 through 2011 [Table 1.1b]. In 2011, injection was the preferred route of administration for 70 percent of primary heroin admissions, inhalation for 25 percent, and smoking or other route for 4 percent [Table 2.4]. The majority of primary heroin admissions from 2001 to 2011 were 20 to 34 years of age or older (41 to 43 percent from 2001 through 2007 and 53 percent in 2011) [Table 3.5].

However, these measures conceal substantial changes in the age, race/ethnicity, and route of administration of some subpopulations among heroin-using admissions.

Table 3.5 and Figure 21. TEDS data show an increase in heroin admissions among young non-Hispanic White adults. Among non-Hispanic Blacks, however, admissions have declined except among older admissions.

Figure 21. Heroin admissions aged 12 and older, by age group and race/ethnicity: 2001-2011

Figure 21. Line chart comparing Heroin admissions aged 12 and older, by age group and race/ethnicity: 2000-2010

Table 3.6 and Figure 22. Route of administration of heroin was closely linked to age. Injection increased among young adults; inhalation increased among those 45 and older.

Figure 22. Heroin admissions aged 12 and older, by route of administration and age group: 2001-2011

Figure 22. Line chart comparing  Heroin admissions aged 12 and older, by route of administration and age group: 2000-2010

Table 3.7 and Figures 23 and 24. Planned use of medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined among TEDS admissions for heroin abuse between 2001 and 2011.

Figure 23. Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by route of heroin administration: 2001-2011

Figure 23. Line chart comparing Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by route of heroin administration: 2000-2010

Figure 24. Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by age group: 2001-2011

Figure 24. Line chart comparing Heroin admissions aged 12 and older receiving medication-assisted opioid therapy, by age group: 2000-2010

Polydrug Abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance.

Table 3.8 and Figure 25. Polydrug abuse was reported by 55 percent of TEDS admissions aged 12 or older in 2011. Marijuana, alcohol, and cocaine were the most commonly reported secondary and tertiary substances.

Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of most treatment admissions. Thirty-nine percent of all treatment admissions were for primary alcohol abuse, and 18 percent of admissions for primary drug abuse reported that they also had an alcohol problem. Overall, 57 percent of all treatment admissions reported alcohol as a substance of abuse.

Table 3.9.This table details the most common substance combinations for selected primary substances. For example, for primary alcohol admissions, 55 percent reported abuse of alcohol alone, 15 percent reported abuse of alcohol and marijuana but no other drugs, and 5 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.

Figure 25. Primary and secondary/tertiary substance of abuse: 2011

Figure 25. Stacked bar chart comparing Primary and secondary/tertiary substance of abuse: 2010

Racial/Ethnic Subgroups

Table 2.3b and Figures 26-31. TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups. Among admissions of Hispanic origin, substance abuse patterns differed accord­ing to country of origin. Patterns also differed between men and women within subgroups.

Figure 26. White (non-Hispanic) admissions, by gender, primary substance, and age: 2011

Figure 26. Line chart comparing White (non-Hispanic) admissions, by gender, primary substance, and age: 2009

Figure 27. Black (non-Hispanic) admissions, by gender, primary substance, and age: 2011

Figure 27. Line chart comparing Black (non-Hispanic) admissions, by gender, primary substance, and age: 2010

Figure 28. Mexican origin admissions, by gender, primary substance, and age: 2011

Figure 28. Line chart comparing Mexican origin admissions, by gender, primary substance, and age: 2010

Figure 29. Puerto Rican origin admissions, by gender, primary substance, and age: 2011

Figure 29. Line chart comparing Puerto Rican origin admissions, by gender, primary substance, and age: 2010

Figure 30. American Indian/Alaska Native admissions, by gender, primary substance, and age: 2011

Figure 30. Line chart comparing American Indian/Alaska Native admissions, by gender, primary substance, and age: 2010

Figure 31. Asian/Pacific Islander admissions, by gender, primary substance, and age: 2011

Figure 31. Line chart comparing Asian/Pacific Islander admissions, by gender, primary substance, and age: 2010

TO TABLES

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