Chapter 5
Topics of Special Interest

Adolescent Substance Abuse (Ages 12-17)
Heroin Admissions by Usual Route of Administration and Medication-Assisted Opioid Therapy
Polydrug Abuse
Racial/Ethnic Subgroups

This chapter highlights topics that are of current or special interest:

Adolescent Substance Abuse (Ages 12-17)

TEDS data indicate an overall increase in adolescent admissions aged 12 to 17 for substance abuse treatment between 1997 and 2007, attributable mainly to increased admissions involving marijuana and increased referral to treatment through the criminal justice system.

Tables 5.1a and 5.1b and Figure 27. There was a 1 percent net increase in the number of adolescents aged 12 to 17 admitted to substance abuse treatment between 1997 and 2007. However, this covers a 21 percent increase between 1997 and 2002, followed by a 17 percent decrease between 2002 and 2007. These changes were largely accounted for by changes in the number of adolescent primary marijuana admissions (a 35 percent increase from 1997 to 2003, followed by a 14 percent decrease between 2003 and 2007, for an overall increase of 16 percent between 1997 and 2007). In contrast, the proportion of adolescent primary marijuana admissions rose steadily, from 57 percent of adolescent admissions in 1997 to 66 percent in 2007.

The numbers of adolescent primary stimulant and cocaine admissions decreased slightly (2 percent and 1 percent, respectively) from 1997 to 2007. Opiate admissions increased by 26 percent from 1997 to 2007. The proportion of adolescent admissions for primary stimulant abuse represented only 3 percent of all adolescent admissions in 2007. The proportions of adolescent admissions for primary cocaine abuse and primary opiate abuse were 2 percent each.

Figure 27
Adolescent admissions by primary substance: TEDS 1997-2007

Line chart comparing Adolescent admissions by primary substance in TEDS from 1997 to 2007

Adolescent treatment admissions for primary alcohol abuse decreased over this time period. The proportion of adolescent primary alcohol admissions decreased from 27 percent in 1997 to 21 percent in 2007, as the number of adolescent alcohol admissions fell 24 percent.

Table 5.2a. Overall, 70 percent of adolescent admissions were male, a proportion heavily influenced by marijuana admissions, of which 76 percent were male. The proportions of adolescent female admissions were equal to or greater than those for adolescent males for methamphetamine/amphetamines (60 percent were female) and for sedatives (51 percent were female). Females made up between 45 to 51 percent of admissions for sedatives, smoked and non-smoked cocaine, heroin, and tranquilizers.

Table 5.3a. In 2007, almost half (49 percent) of adolescent admissions were referred to treatment through the criminal justice system. Sixteen percent were self- or individual referrals, and 12 percent were referred through schools.

Figure 28. The number of adolescent admissions referred by the criminal justice system increased every year from 1997 to 2002, but declined in 2003 to 2007. Admissions from schools and self- or individual referrals decreased slightly between 1997 and 2007, while those from other referral sources increased slightly.

Table 5.4. In 2007, 45 percent of all adolescent admissions involved the use of both alcohol and marijuana. The number of admissions involving both alcohol and marijuana declined by 13 percent between 1997 and 2007, while admissions involving primary marijuana and no alcohol increased by 60 percent. Over the same period, admissions involving primary alcohol and no marijuana declined by 4 percent.

Figure 28
Adolescent admissions by source of referral to treatment: TEDS 1997-2007

Line chart comparing Adolescent admissions by source of referral to treatment in TEDS from 1997 to 2007

Table 5.5a and Figure 29. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. Between 1997 and 2007, the number of marijuana-involved adolescent admissions increased by 18 percent for criminal justice referrals and declined by 1 percent for other referral sources. The net increase in all marijuana-involved adolescent treatment admissions was 8 percent. In 1997, the number of marijuana-involved adolescent treatment admissions referred by the criminal justice system was 13 percent lower than the number referred by other sources. The number of adolescent admissions involving marijuana increased every year from 1997 to 2002. Since1998, marijuana-involved adolescent treatment admissions referred by the criminal justice system have outnumbered admissions referred by other sources. Adolescent admissions not involving marijuana declined by 10 percent between 1997 and 2007; there was also a decrease of 11 percent in criminal justice referrals and a decrease of 9 percent in referrals from other sources.

Figure 29
Adolescent admissions by marijuana involvement and criminal justice referral: TEDS 1997-2007

Line chart comparing Adolescent admissions by marijuana involvement and criminal justice referral in TEDS from 1997 to 2007

Heroin Admissions by Usual Route of Administration and Medication-Assisted Opioid Therapy

TEDS data indicate that heroin injection has been a growing problem among young adults since the 1990s. Despite increases in the numbers of admissions for heroin abuse, there was a decline in the number receiving medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine).

Tables 5.6a and 5.6b. Heroin admissions increased by 5 percent between 1997 and 2007. Increases of 23 percent in admissions for
heroin inhalation and 7 percent in admissions for heroin injection were largely responsible. However, the proportion of heroin admissions represented by injection declined from 66 percent in 1997 to 64 percent in 2007. Heroin inhalation made up 32 percent of all heroin admissions in 2007, an increase from 29 percent in 1997.

Tables 5.6a, 5.6b, and Figure 30. The number of admissions receiving medication-assisted opioid therapy did not keep pace with the increase in heroin admissions. While heroin admissions increased by 5 percent between 1997 and 2007, the number receiving medication-assisted opioid therapy decreased by 19 percent. In 2007, heroin smokers were more likely to receive medication-assisted opioid therapy (31 percent) than were the much larger groups of injectors and inhalers (28 percent each). Among admissions for heroin injection, medication-assisted opioid therapy fell by 34 percent between 1997 and 2007. The proportion of admissions for heroin inhalation receiving medication-assisted opioid therapy increased to 32 percent in 1998 from 23 percent in 1997, and remained between 28 percent to 32 percent through 2007.

Figure 30
Medication-assisted opioid therapy
by usual route of heroin administration: TEDS 1997-2007

Line chart comparing Medication-assisted opioid therapy by usual route of heroin administration in TEDS from 1997 to 2007

Table 5.7b and Figure 31. Between 1997 and 2007, the proportion of admissions under age 30 decreased among heroin inhalers and increased among heroin injectors. Until the year 2000, heroin inhalers admitted to treatment tended to be younger than heroin injectors admitted to treatment. In 1997, 32 percent of admissions for inhalation were under 30 years of age, compared to 22 percent of those injecting heroin. By 2007, the proportion of those admitted for inhaling heroin who were under age 30 had fallen to 20 percent. The proportion admitted for injecting heroin who were under age 30 had increased to 39 percent. Among heroin smokers, the proportion under age 30 was 37 percent in 1997 and had increased to 51 percent by 2007.

Table 5.7a. Among heroin abusers experiencing a first treatment episode in 2007, the average duration of use was 13 years for injection, 15 years for inhalation, and 9 years for smoking.

Figure 31
Other opiates
Admissions by gender, age, and race/ethnicity: TEDS 2007

Line charts comparing Other opiates Admissions by gender, age, and race/ethnicity in TEDS from 1997 to 2007

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 5.8 and Figure 32. Polydrug abuse was reported by 55 percent of all TEDS admissions in 2007. Alcohol, marijuana, 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. Forty percent of all treatment admissions were for primary alcohol abuse, and 20 percent of admissions for primary drug abuse reported that they also had an alcohol problem. Overall, 61 percent of all treatment admissions reported alcohol as a substance of abuse.1

Alcohol and opiates were reported more often as primary substances than as secondary or tertiary substances. Twenty-five percent of all admissions involved opiate abuse, with 19 percent reporting primary abuse and 7 percent reporting secondary or tertiary abuse.1

For marijuana and cocaine, more admissions reported these drugs as secondary or tertiary substances than as primary substances. Marijuana was reported as a primary substance by 16 percent of all admissions, but was a secondary or tertiary substance for another 20 percent, so that 36 percent of all treatment admissions reported marijuana as a substance of abuse. Cocaine was a primary substance for 13 percent of admissions, but was a secondary or tertiary substance for an additional 18 percent. Thus nearly one-third (30 percent) of all treatment admissions involved cocaine abuse.1

Table 5.9. 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 7 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.


Figure 32
Primary and secondary/tertiary substance abuse: TEDS 2007

Bar chart comparing Primary and secondary/tertiary substance abuse in TEDS 2007

Racial/Ethnic Subgroups
TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups. Among Hispanics, substance abuse patterns differed accord­ing to country of origin. Patterns also differed between men and women within subgroups.

Table 3.3b and Figures 33-38. Among non-Hispanic Whites [Figure 33], alcohol as the primary substance accounted for 48 percent of male admissions and 36 percent of female admissions. Opiates and marijuana were the most frequently reported illicit drugs for non-Hispanic White men (18 per­cent and 15 percent, respectively), followed by cocaine (8 percent) and stimulants (7 percent). For non-Hispanic White women, opiates were the primary illicit drug (22 percent), followed by cocaine and stimulants (12 percent each), and marijuana (11 percent).

Figure 33
White (non-Hispanic)
Admissions by primary substance, gender, and age: TEDS 2007

Line charts comparing White (non-Hispanic)
Admissions by primary substance, gender, and age in TEDS 2007

Among non-Hispanic Blacks [Figure 34], 35 percent of male admissions used alcohol as the primary substance. Among non-Hispanic Black women, cocaine (33 percent) was more frequently reported as a primary substance than was alcohol (25 percent). Marijuana and
cocaine were the most commonly reported illicit substances for men (24 percent and 23 percent, respectively), followed by opiates (14 percent). For women, other primary substances were opiates and marijuana (18 percent each) . Stimulants were reported by 1 percent of non-Hispanic Black women and non-Hispanic Black men.

Figure 34
Black (non-Hispanic)
Admissions by primary substance, gender, and age: TEDS 2007

Line charts comparing Black (non-Hispanic)
Admissions by primary substance, gender, and age in TEDS 2007

Among persons of Mexican origin [Figure 35], alcohol was the primary substance involved in 41 percent of male admissions. Among women of Mexican origin, however, stimulants were more frequently reported as a primary substance than was alcohol (33 percent and 24 percent, respectively). Marijuana (20 percent) was the most commonly reported illicit substance for men, followed by stimulants and opiates (18 percent and 14 percent, respectively) and cocaine (7 percent). For women, other commonly reported primary substances were marijuana (16 percent), opiates (14 percent), and cocaine (11 percent).

Figure 35
Mexican origin
Admissions by primary substance, gender, and age: TEDS 2007

Line charts comparing Figure 35
Mexican origin Admissions by primary substance, gender, and age in TEDS 2007

Among persons of Puerto Rican origin [Figure 36], opiates were the main primary substances at treatment admission for both men and women (45 percent and 38 percent, respectively). Opiates were followed by alcohol for both men and women (28 percent and 24 percent, respectively). For men, other primary substances were marijuana (14 percent) and cocaine (11 percent). For women, other primary substances were cocaine (18 percent) and marijuana (16 percent). Admissions for stimulant use were 2 percent for women and 1 percent for men.

Figure 36
Puerto Rican origin
Admissions by primary substance, gender, and age: TEDS 2007

Line charts comparing Puerto Rican origin
Admissions by primary substance, gender, and age in TEDS 2007

American Indians and Alaska Natives together accounted for 2 percent of all TEDS admissions [Table 3.1a]. Among American Indian/Alaska Native admissions, 69 percent of men and 53 percent of women entered treatment because of primary alcohol abuse [Figure 37]. Marijuana was the most frequently reported illicit substance for men (13 percent), followed by stimulants (6 percent), opiates (5 percent), and cocaine (4 percent). Stimulants were the most frequently reported illicit substances for women (13 percent), followed by marijuana (11 percent), opiates (10 percent), and cocaine (7 percent).

Figure 37
American Indian/Alaska Native
Admissions by primary substance, gender, and age: TEDS 2007

Line charts comparing American Indian/Alaska Native Admissions by primary substance, gender, and age in TEDS 2007

Asians and Pacific Islanders accounted for 1 percent of all TEDS admissions [Table 3.1a]. Among this group [Figure 38], alcohol was the primary substance involved in 37 percent of male admissions. Among women, however, stimulants and alcohol were more frequently reported as a primary substance (31 percent each). Stimulants and marijuana were the most commonly reported illicit drugs for men (24 percent and 21 percent, respectively), followed by opiates (9 percent) and cocaine (7 percent). For women, other commonly reported primary substances were marijuana (18 percent), opiates (9 percent), and cocaine (7 percent).

Figure 38
Asian/Pacific Islander
Admissions by primary substance, gender, and age: TEDS 2007

Line charts comparing Asian/Pacific Islander
Admissions by primary substance, gender, and age in TEDS 2007

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