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5. Substance Dependence, Abuse, and
Treatment Need

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 drugs. These 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. For details, see Section A.8 in Appendix A.

Nationally, an estimated 22.5 million persons aged 12 or older in 2006-2007 were classified with dependence on or abuse of any illicit drug or alcohol in the past year. Of these, 6.9 million were dependent on or had abused illicit drugs, and 18.7 million were dependent on or had abused alcohol (see Tables 16, 18, and 20 at http://www.oas.samhsa.gov/2k7state/ageTabs.htm).

5.1 Alcohol Dependence or Abuse

In 2006-2007, 7.6 percent of the population aged 12 or older was classified with dependence on or abuse of alcohol nationwide in the past year (Table B.16). Persons aged 18 to 25 had the highest rate of alcohol dependence or abuse (17.2 percent) in the Nation. At the State level, the District of Columbia had the highest rate (10.1 percent) among persons aged 12 or older, and West Virginia had the lowest rate (6.1 percent). Six States (Colorado, Minnesota, Montana, North Dakota, South Dakota, and Wyoming) ranked in the highest fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) and among all persons 12 or older (Figures 5.1 to 5.4).

Nationally, past year dependence on or abuse of alcohol remained relatively unchanged between 2005-2006 and 2006-2007 at 7.7 percent and 7.6 percent, respectively, for all persons aged 12 or older (Table C.16). Rates of past year dependence on or abuse of alcohol for the 12 to 17, 18 to 25, and 26 or older age groups remained relatively constant during these years as well. Across all age groups (12 to 17, 18 to 25, and 26 or older), including the combined 12 or older age group, there were eight significant changes across six States. Five States exhibited decreases (Michigan, Missouri, Montana, Texas, and Utah). The only increases occurred in Hawaii.

In 2006-2007, 3.4 percent of persons aged 12 or older nationwide were estimated to be dependent on alcohol in the past year, representing about 45 percent of those who were dependent on or had abused alcohol in the past year (Tables B.16 and B.17). State estimates for alcohol dependence for persons aged 12 or older ranged from a low of 2.8 percent in North Carolina and Pennsylvania to a high of 4.7 percent in the District of Columbia. The highest rates for alcohol dependence occurred in the 18 to 25 age group (7.4 percent nationally). In 2006-2007 among young adults, these rates ranged from a low of 5.8 percent in Georgia to a high of 10.0 percent in Montana. Four States that ranked in the highest fifth in the 12 or older population for dependence on or abuse of alcohol in the past year also were ranked in the highest fifth for past year alcohol dependence (District of Columbia, Iowa, Montana, and Wyoming) (Figures 5.1 and 5.5). Wyoming's past year alcohol dependence rate increased from 2.7 percent in 2005-2006 to 3.4 percent in 2006-2007 among persons aged 26 or older. The rate for Wisconsin's 12 or older age group increased from 3.2 percent in 2005-2006 to 3.8 percent in 2006-2007. No other States experienced a change in the past year alcohol dependence rate between 2005-2006 and 2006-2007 (Table C.17).

5.2 Illicit Drug Dependence or Abuse

Nationally in 2006-2007, about 2.8 percent of persons aged 12 or older were dependent on or had abused illicit drugs in the past year (Table B.18). The District of Columbia had the highest rate of past year illicit drug dependence or abuse (4.5 percent) among persons aged 12 or older; Iowa and South Dakota had the lowest rate (2.1 percent). The highest rates for past year illicit drug dependence or abuse occurred in the 18 to 25 age group (7.9 percent nationally), with the highest rate in Rhode Island (13.0 percent) and the lowest rate in Iowa and North Dakota (5.9 percent). Among the 18 to 25 year old age group, decreases in the rates of past year illicit drug dependence or abuse occurred in Connecticut, Pennsylvania, and West Virginia between 2005-2006 and 2006-2007. Increases occurred in Kentucky and Ohio (Table C.18).

The percentage of persons aged 12 or older in 2006-2007 estimated to be dependent on illicit drugs in the past year was 1.9 percent (about two thirds of those who were estimated to be dependent on or had abused illicit drugs in the past year) (Tables B.18 and B.19). The District of Columbia had the highest percentage of persons aged 12 or older who were dependent on illicit drugs in the past year (3.1 percent). Hawaii and South Dakota had the lowest rate (1.4 percent). Among the 18 to 25 year old age group, declines in past year illicit drug dependence occurred in Connecticut, Michigan, and Vermont. There were no significant changes in the 12 to 17 or 26 or older age groups. Among the 12 or older population, Kansas had a significant decline in past year illicit drug dependence rates (Table C.19).

5.3 Alcohol or Illicit Drug Dependence or Abuse

The national rate in 2006-2007 for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older was 9.1 percent (Table B.20). When examining dependence on or abuse of alcohol or illicit drugs at the State level, the States with high rates for alcohol dependence or abuse tended to rank in the top fifth for alcohol and illicit drug dependence or abuse combined because alcohol accounts for most of the substance dependence or abuse. Nine of the 10 States that ranked in the highest fifth for past year alcohol dependence or abuse also ranked in the top fifth for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older (Colorado, District of Columbia, Massachusetts, Minnesota, Montana, North Dakota, South Dakota, Wisconsin, and Wyoming) (Figures 5.1 and 5.17).

State percentages for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older in 2006-2007 ranged from a low of 7.5 percent in New Jersey to a high of 12.6 percent in the District of Columbia (Table B.20). Only three States (Colorado, Minnesota, and Wyoming) were in the highest fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) and among all persons 12 or older (Figures 5.17 to 5.20).

Among all persons aged 12 or older, the rate of past year dependence on or abuse of alcohol or illicit drugs nationwide remained nearly constant at 9.2 and 9.1 percent, respectively, in 2005-2006 and 2006-2007 (Table C.20). The only significant national change occurred among young adults aged 18 to 25, where there was a decrease from 21.6 to 21.0 percent. At the State level, decreases were noted among this age group in Connecticut, Michigan, Nebraska, and Texas.

5.4 Needing But Not Receiving Treatment for Illicit Drug Problems

The definition of a person needing but not receiving treatment for an illicit drug problem is that the person meets the criteria for abuse of or dependence on illicit drugs in the past year according to the DSM-IV, but did not receive 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. It does not include treatment at an emergency room, private doctor's office, self-help group, prison, or jail, or hospital as an outpatient. The national rate in 2006-2007 for needing but not receiving treatment for an illicit drug problem among persons aged 12 or older was 2.5 percent (Table B.21).

In 2006-2007, Rhode Island had the highest percentage of persons aged 12 or older (3.7 percent), 12 to 17 (5.2 percent), and 18 to 25 (12.1 percent) needing but not receiving treatment for an illicit drug use problem. Iowa, Kansas, New Jersey, and North Dakota shared the lowest rate among persons 12 or older (1.9 percent). North Dakota had the lowest rate among youths aged 12 to 17 (3.4 percent), among young adults aged 18 to 25 (5.3 percent), and among persons 26 or older (0.9 percent) (Table B.21). The States in the top fifth for needing but not receiving treatment for an illicit drug use problem among persons 12 or older were distributed across the West (three States), Northeast (two States), and the South (four States and the District of Columbia) (Figure 5.21).

Among the three age groups, statistically significant declines in the percentage needing but not receiving treatment for illicit drug use between 2005-2006 and 2006-2007 occurred among 12 to 17 year olds in Arkansas, Florida, Maine, and Montana. Among 18 to 25 year olds, decreases were noted in Connecticut and West Virginia; increases were noted in Kentucky and Ohio (Table C.21).

5.5 Needing But Not Receiving Treatment for Alcohol Problems

The definition of a person needing but not receiving treatment for an alcohol problem is that the person meets the criteria for abuse of or dependence on alcohol in the past year according to the DSM-IV, but did not receive specialty treatment for an alcohol problem in the past year. The percentage of persons aged 12 or older needing but not receiving treatment for alcohol problems was 7.2 percent in 2006-2007, which was almost 3 times larger than the corresponding percentage of persons needing but not receiving treatment for illicit drug problems (2.5 percent) (Tables B.21 and B.22).

States in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older in 2006-2007 were primarily Midwestern (Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin) or Western (Colorado, Montana, and Wyoming) (Figure 5.25). The District of Columbia and Massachusetts rounded out the top 10. Colorado, the District of Columbia, and Montana were ranked in the highest quintile for both needing but not receiving treatment for an alcohol problem and needing but not receiving treatment for an illicit drug problem among persons aged 12 or older (Figures 5.21 and 5.25). Five States were ranked in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older and in each of the three age categories (12 to 17, 18 to 25, and 26 or older): Colorado, Minnesota, North Dakota, South Dakota, and Wyoming (Figures 5.25 to 5.28). The District of Columbia had the highest rate of needing but not receiving treatment for an alcohol problem among persons aged 12 or older (9.7 percent), while Kentucky had the lowest rate (5.8 percent) (Table B.22). Although the District of Columbia also had highest rate of needing but not receiving treatment for an alcohol problem among persons aged 26 or older (8.3 percent), it had the lowest rate among 12 to 17 year olds (3.5 percent).

Among persons aged 12 or older needing but not receiving treatment for an alcohol problem, there was no significant change between 2005-2006 (7.3 percent) and 2006-2007 (7.2 percent) for the Nation; however, there was a significant decrease in Texas and a significant increase in Hawaii (Table C.22). Among 12 to 17 year olds, significant decreases occurred in Kentucky and Montana. Among 18 to 25 year olds, decreases occurred in Michigan and Missouri. Among persons 26 years or older, an increase occurred in Hawaii.

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Figure 5.1 Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.1

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.2 Alcohol Dependence or Abuse in Past Year among Persons Aged 12 to 17, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.2

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.3 Alcohol Dependence or Abuse in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.3

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.4 Alcohol Dependence or Abuse in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.4

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.5 Alcohol Dependence in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.5

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.6 Alcohol Dependence in Past Year among Persons Aged 12 to 17, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.6

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.7 Alcohol Dependence in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.7

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.8 Alcohol Dependence in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.8

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.9 Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.9

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.10 Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 to 17, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.10

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.11 Illicit Drug Dependence or Abuse in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.11

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.12 Illicit Drug Dependence or Abuse in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.12

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.13 Illicit Drug Dependence in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.13

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.14 Illicit Drug Dependence in Past Year among Persons Aged 12 to 17, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.14

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.15 Illicit Drug Dependence in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.15

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.16 Illicit Drug Dependence in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.16

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.17 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.17

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.18 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 12 to 17, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.18

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.19 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.19

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.20 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.20

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.21 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.21

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.22 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 12 to 17, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.22

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.23 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.23

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.24 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.24

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.25 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.25

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.26 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 12 to 17, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.26

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.27 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.27

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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Figure 5.28 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

Figure 5.28

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

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