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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.10 in Appendix A.

Nationally, 22.4 million persons aged 12 or older in 2008-2009 were classified with dependence on or abuse of illicit drugs or alcohol in the past year. Of these, 7.0 million were dependent on or had abused illicit drugs, and 18.5 million were dependent on or had abused alcohol (see Tables 16, 18, and 20 at http://www.samhsa.gov/data/2k9state/ageTabs.htm).

5.1 Alcohol Dependence or Abuse

In 2008-2009, 7.4 percent of the population aged 12 or older was classified with dependence on or abuse of alcohol nationwide in the past year (see Table B.16 in Appendix B). Persons aged 18 to 25 had the highest rate of alcohol dependence or abuse (16.6 percent) in the Nation. At the State level, Montana had the highest rate (9.9 percent) among persons aged 12 or older, and Kentucky and Utah had the lowest rates (6.0 percent). The District of Columbia had the highest rate of past year alcohol dependence or abuse among persons aged 26 or older (8.1 percent) and the lowest rate among persons aged 12 to 17 (3.0 percent). Six States (Colorado, Connecticut, Iowa, Minnesota, Montana, and South Dakota) ranked in the highest fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) and among persons 12 or older (Figures 5.1 to 5.4).

Nationally, past year dependence on or abuse of alcohol remained unchanged between 2007-2008 and 2008-2009 at 7.4 percent for persons aged 12 or older (see Table C.16 in Appendix C). Among 12 to 17 year olds, however, the national rate dropped from 5.1 to 4.7 percent. Among 12 to 17 year olds, seven States showed decreases (Illinois, Maine, Maryland, North Carolina, North Dakota, Pennsylvania, and Tennessee). For the 12 or older age group, New York had an increase from 7.1 to 7.9 percent, while decreases were observed in Illinois (from 8.2 to 7.6 percent) and Washington (from 8.0 to 7.1 percent). A decrease also was seen in the Midwest region (from 8.2 percent in 2007-2008 to 7.8 percent in 2008-2009).

In 2008-2009, 3.5 percent of persons aged 12 or older nationwide were estimated to be dependent on alcohol in the past year, representing about 47 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 3.0 percent in Kentucky and Pennsylvania to a high of 4.6 percent in the District of Columbia. The highest rates for alcohol dependence occurred in the 18 to 25 age group (6.9 percent nationally) compared with the rates for 12 to 17 year olds (1.9 percent nationally) and persons aged 26 or older (3.1 percent nationally). In 2008-2009 among young adults aged 18 to 25, these rates ranged from a low of 5.8 percent in Texas and Utah to a high of 10.8 percent in Montana.

Five 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, Minnesota, Montana, New Mexico, and Oregon) (Figures 5.1 and 5.5). Among young adults aged 18 to 25, there were decreases in alcohol dependence from 2007-2008 to 2008-2009 in three States—California (from 7.8 to 6.6 percent), Colorado (from 8.7 to 6.9 percent), and Pennsylvania (from 6.9 to 6.0 percent). A decrease in alcohol dependence also was seen in the West region among young adults from 7.8 percent in 2007-2008 to 6.9 percent in 2008-2009 (Table C.17). No increases in past year alcohol dependence were observed for any State or age group.

5.2 Illicit Drug Dependence or Abuse

Nationally in 2008-2009, 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 (4.4 percent) among persons aged 12 or older, and Iowa had the lowest rate (1.9 percent). The highest rates for past year illicit drug dependence or abuse occurred in the 18 to 25 age group (7.7 percent nationally), with the highest rate occurring in Rhode Island (10.8 percent) and the lowest rate in Iowa and Nebraska (5.4 percent). Among young adults aged 18 to 25, decreases in the rates of past year illicit drug dependence or abuse occurred in Minnesota (from 8.0 to 6.6 percent) and Tennessee (from 8.3 to 6.3 percent) between 2007-2008 and 2008-2009 (Table C.18). Among persons 12 or older, decreases were observed in Georgia, Minnesota, and Tennessee, but an increase was seen in Pennsylvania.

The percentage of persons aged 12 or older in 2008-2009 estimated to be dependent on illicit drugs in the past year was 1.9 percent (more than 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 and Rhode Island had the highest percentage of persons aged 12 or older who were dependent on illicit drugs in the past year (3.0 percent). Iowa had the lowest rate (1.3 percent). Among the 18 to 25 year old age group, a decline in past year illicit drug dependence occurred in Minnesota and Tennessee (similar to what was observed for past year illicit drug dependence or abuse) from 2007-2008 to 2008-2009 (Table C.19). Among persons 12 or older, decreases were observed in Georgia, Minnesota, and Tennessee, but increases were seen in New Jersey and Pennsylvania. Additionally, an increase in past year illicit drug dependence was seen in the Northeast region from 2.0 percent to 2.2 percent among persons 12 or older.

5.3 Alcohol or Illicit Drug Dependence or Abuse

The national rate in 2008-2009 for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older was 8.9 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. Of the 10 States that ranked in the highest fifth for past year alcohol dependence or abuse, 8 States 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, Connecticut, District of Columbia, Minnesota, Montana, New Mexico, Oregon, and South Dakota (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 2008-2009 ranged from a low of 7.5 percent in Mississippi to a high of 11.3 percent in the District of Columbia (Table B.20). Only three States (Colorado, Montana, and South Dakota) were in the highest fifth for three age groups (12 to 17, 18 to 25, and 26 or older) and among persons 12 or older (Figures 5.17 to 5.20). Five States (Mississippi, North Carolina, Pennsylvania, Tennessee, and Utah) were in the lowest fifth for all age groups.

Among persons aged 12 or older, the rate of past year dependence on or abuse of alcohol or illicit drugs nationwide remained nearly constant at 9.0 and 8.9 percent, respectively, in 2007-2008 and 2008-2009 (Table C.20). At the State level, across the three age groups (12 to 17, 18 to 25, and 26 or older) and among persons 12 or older, five significant changes in the rate of past year dependence on or abuse of alcohol or illicit drugs were observed across four States. Decreases were noted in Ohio, Tennessee, and Utah, whereas an increase was noted in New York (among persons 12 or older – from 8.8 to 9.5 percent).

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 2008-2009 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 2008-2009, Rhode Island had the highest percentage of persons aged 12 or older (3.5 percent) who were needing but not receiving treatment for an illicit drug use problem. Iowa had the lowest rate among persons 12 or older (1.8 percent) (Table B.21). Among persons 12 or older, decreases between 2007-2008 and 2008-2009 estimates were observed in Colorado (from 3.3 to 2.8 percent) and Georgia (from 2.8 to 2.4 percent). A decrease also was observed in Tennessee (from 7.4 to 5.8 percent) among young adults aged 18 to 25.

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 7.0 percent in 2008-2009, 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 2008-2009 were primarily Midwestern (Iowa, Minnesota, Nebraska, North Dakota, and South Dakota) or Western (Colorado, Montana, and New Mexico) (Figure 5.25). Connecticut and the District of Columbia rounded out the top 10. The District of Columbia and New Mexico 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). Montana had the highest rate of needing but not receiving treatment for an alcohol problem among persons aged 12 or older (9.2 percent), while Kentucky and Pennsylvania had the lowest rate (5.7 percent) (Table B.22). Although the District of Columbia ranked in the top fifth for needing but not receiving treatment for an alcohol problem among persons aged 26 or older (7.3 percent) and among persons 12 or older (8.6 percent), it ranked in the lowest quintile group among 12 to 17 year olds (3.3 percent).

At the State level, across two age groups (12 to 17 and 18 to 25) and among persons 12 or older, declines in the rate of needing but not receiving treatment for an alcohol problem from 2007-2008 to 2008-2009 were seen in Illinois, Maryland, North Dakota, Pennsylvania, Tennessee, Washington, and Wisconsin. Increases were observed in Montana and New York. No changes were noted in the 26 or older age group.

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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 2008 and 2009 NSDUHs

Figure 5.1

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 5.2 Alcohol Dependence or Abuse in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 5.2

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.3

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.4

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.5

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 5.6 Alcohol Dependence in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 5.6

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.7

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.8

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.9

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 5.10 Illicit Drug Dependence or Abuse in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 5.10

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.11

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.12

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.13

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 5.14 Illicit Drug Dependence in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 5.14

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.15

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.16

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.17

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 5.18 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 5.18

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.19

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.20

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.21

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 5.22 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 5.22

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.23

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.24

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.25

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 5.26 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 5.26

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.27

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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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 2008 and 2009 NSDUHs

Figure 5.28

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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