Chapter 2

Trends in Socioeconomic Status

Trend data are invaluable in monitoring changing patterns in substance abuse treatment admissions. These patterns reflect underlying changes in substance abuse in the population, and have important implications for resource allocation and program planning.

Trends in Primary Substance of Abuse

Table 2.1b and Figure 1. Between 1992 and 2001, TEDS treatment admissions were dominated by five substances: alcohol, opiates (primarily heroin), cocaine, marijuana/hashish, and stimulants (primarily methamphetamine). These substances together consistently accounted for 96 percent of all TEDS admissions from 1992-2001.

Figure 1
Primary substance of abuse at admission:
TEDS 1992-2001

• Alcohol accounted for nearly half (44 percent) of all TEDS admissions in 2001, a decrease from 59 percent of all admissions in 1992. However, 45 percent of these admissions reported abuse of a secondary drug as well. The proportion of admissions for abuse of alcohol alone declined from 37 percent in 1992 to 24 percent in 2001.
   
• The proportion of TEDS admissions for primary opiate abuse increased from 12 percent in 1992 to 18 percent in 2001.
   
• The proportion of admissions for primary cocaine abuse declined from 18 percent in 1992 to 13 percent in 2001. Smoked cocaine (crack) represented 72 percent of all primary cocaine admissions in 2001, a proportion that remained fairly stable over the time period.
   
• The proportion of admissions for primary marijuana/hashish increased steadily from 6 percent in 1992 to 15 percent in 2001.
   
• The proportion of admissions for abuse of stimulants increased from 1 percent in 1992 to 6 percent in 2001.
   
• Admissions attributable to sedatives and tranquilizers represented a small and stable proportion of TEDS admissions (each less than one-half of 1 percent).
   
• Admissions for abuse of hallucinogens, PCP, inhalants, and over-the-counter medications together remained fairly stable over the time period, accounting for one-half of 1 percent of TEDS admissions in 2001.

Trends in the Co-Abuse of Alcohol and Drugs

Table 2.2b and Figure 2. The concurrent abuse of alcohol and drugs is a significant problem. In 2001, approximately 42 percent of all admissions reported problems with both alcohol and drugs. Some 22 percent reported primary drug abuse with secondary alcohol abuse, and 20 percent reported primary alcohol abuse with secondary drug abuse.

Primary alcohol abuse declined from 59 percent of TEDS admissions in 1992 to 44 percent in 2001. Primary drug abuse increased from 38 percent in 1992 to 53 percent in 2001. However, this may reflect changing priorities in the treatment/reporting system rather than a change in substance abuse patterns. Limited resources and targeted programs may result in a shift of State funds from treatment of alcohol abusers to treatment of drug abusers.

Figure 2
Co-abuse of alcohol and drugs
at admission: TEDS 1992-2001

Trends in Admission Rates by Primary Substance and State

Tables 2.3b-2.7b and Figures 3-7 show trends in State admission rates per 100,000 population aged 12 and over for selected substances from 1992-2001.

For the maps in Figures 3-7, the median, 75th, and 90th percentiles of the range of 1992 admission rates for each substance were used to establish the rate categories used in the legend. Therefore, for the 46 States reporting in 1992, each 1992 map generally shows five States in red (the 90th percentile and above), seven States in orange (the 75th to 89th percentiles), 11 States in gold (the 50th to 74th percentiles), and 23 States in cream (below the median 1992 U.S. rate). Crosshatching indicates States where no data were submitted, or where changes in reporting patterns made inclusion in trend calculations for a given year inappropriate.

Data were not submitted for one or more years in some States because of changes to their data collection systems. These States were: Arizona (1992-1997), the District of Columbia (1992-1993), Indiana (1997 and 2001), Kentucky (1992-1996), Mississippi (1992-1994), West Virginia (1994, 1997-1998, 2000-2001), and Wyoming (1995-1996).

In four States, significant changes in the clients or facilities reporting to TEDS from 1992-2001 resulted in changes in the number of admissions large enough to influence trends. For these States, rates are not indicated on the maps for the years affected: Ohio (1999-2001), Texas (1992-1995), Virginia (1996-1999), and West Virginia (1996). The actual data reported, however, are included in all tables.

• Alcohol admission rates were generally highest in the Pacific Northwest, North Central, and Northeast. The rate for the United States as a whole declined by 23 percent between 1992 and 2001, from 443 per 100,000 population aged 12 and over to 342 per 100,000. This rate of decline was equaled or exceeded in 25 States.
   
• Heroin admission rates were highest in the Pacific, Northeast, and some Middle Atlantic States. The rate for the United States as a whole increased by 52 percent over the period 1992-2001, from 81 admissions per 100,000 population aged 12 and over in 1992 to 123 per 100,000 in 2001. Admission rates increased between 1992 and 2001 by 100 percent or more in 18 States. In 1992, no State had a rate higher than 250 per 100,000. By 2001, eight States had rates that high or higher.
   
• Cocaine admission rates were generally highest in the Northeast, Middle Atlantic, and some Southern States. Trends indicated stable or declining admission rates for primary cocaine abuse. The U.S. treatment admission rate for primary cocaine abuse declined by 24 percent between 1992 and 2001, from 132 admissions per 100,000 population aged 12 and over to 100 per 100,000. In 1992, eight States had rates of 175 or more per 100,000; in 2001, only five States had rates that high. Cocaine admission rates decreased between 1992 and 2001 by 25 percent or more in 17 States.
   
• Marijuana admission rates showed substantial increases across most States. In 29 States, 2001 rates were at least 100 percent higher than the rates reported in 1992. In another nine States, rates increased by 25-99 percent. In 1992, the U.S. treatment admission rate for primary marijuana abuse was 45 admissions per 100,000 population aged 12 and over. No State had a rate higher than 130 per 100,000, and 93 percent of reporting States had rates of fewer than 100 per 100,000. By 2001, the U.S. rate had increased by 151 percent, to 113 per 100,000 population aged 12 and over. Some 21 States had rates of 130 or more per 100,000, and the proportion of reporting States with fewer than 100 admissions per 100,000 had fallen to 44 percent.
   
• Methamphetamine/amphetamine admission rates increased, spreading east from the Pacific States into the Midwest and South. The treatment admission rate for primary amphetamine abuse rose from 10 admissions per 100,000 population aged 12 and over in 1992 to 44 per 100,000 in 2001. In 33 States, rates increased by 100 percent or more between 1992 and 2001. In 1992, one State had a rate higher than 50 per 100,000. Some 89 percent of reporting States had rates of 25 or fewer per 100,000. By 2001, 16 States had rates of 50 or more per 100,000; in 11 of these, rates were 100 or more per 100,000. The proportion of reporting States with fewer than 25 admissions per 100,000 had decreased to 58 percent.

Trends in Demographic Characteristics

Table 2.8b. Males represented 70 percent of TEDS admissions in 2001, a proportion that remained stable from 1992-2001. The distribution of TEDS admissions by sex was different from that of the U.S. population, where approximately half of the population was male.

Table 2.8b and Figure 8. The age distribution of TEDS admissions changed between 1992 and 2001. The proportion of TEDS admissions aged 25-34 declined from 40 percent in 1992 to 26 percent in 2001. Gradual increases in the proportions of admissions under age 18 and aged 35-54 continued over the time period. Admissions aged 18-24 and 55 and older remained stable over the time period.

The age distribution of TEDS treatment admissions was different from that of the U.S. population. Some 88 percent of TEDS admissions in 2001 were between the ages of 18 and 54, compared to about 53 percent of the U.S. population.

Figure 8
Age at admission: TEDS 1992-2001

Table 2.8b and Figure 9. The racial/ethnic composition of TEDS admissions shifted slightly between 1992 and 2001. Non-Hispanic Whites made up about 59 percent of admissions. Non-Hispanic Blacks declined slightly from 26 percent of admissions in 1992 to 24 percent in 2001. This was offset by an increase in the proportion of admissions for Hispanic and other racial/ethnic groups combined, from 14 percent in 1992 to 17 percent in 2001.

The racial/ethnic composition of TEDS admissions differed from that of the U.S. population. Non-Hispanic Whites were the majority in both groups, but represented 59 percent of TEDS admissions in 2001, compared to 71 percent of the U.S. population. Non-Hispanic Blacks represented 24 percent of TEDS admissions in 2001 and 12 percent of the U.S. population. However, the proportion of Hispanic TEDS admissions (12 percent) was similar to the proportion of Hispanics in the U.S. population (11 percent).

Figure 9
Race/ethnicity of admissions:
TEDS 1992-2001

Trends in Socioeconomic Status

Tables 2.9a, 2.9b, and Figures 10 and 11. TEDS admissions aged 18 and over were socioeconomically disadvantaged compared to the U.S. population. This is evident in the unadjusted distributions of admissions by employment status and education [Table 2.9a]. Because TEDS admissions differ demographically from the U.S. population, Table 2.9b shows distributions that have been statistically adjusted to provide a more valid comparison to the U.S. population.¹ The adjusted distributions indicate an even greater disparity in socioeconomic status than do the unadjusted.

TEDS admissions aged 16 and over were less likely to be employed than the U.S. population. Some 69 percent (73 percent adjusted) of 2001 TEDS admissions aged 16 and over were unemployed or not in the labor force, compared to 36 percent of the U.S. population. Only 24 percent (20 percent adjusted) were employed full time, compared to 51 percent of the U.S. population. These proportions were relatively stable from 1992-2001.

Figure 10
Employment status at admission, aged 16 and over: TEDS 1992-2001

Tables 2.9a, 2.9b, and Figure 11. TEDS admissions aged 18 and over had less education than the U.S. population. Some 36 percent (32 percent adjusted) of TEDS admissions aged 18 and over had not completed high school, compared to 17 percent of the U.S. population. TEDS admissions were also less likely to have received education beyond high school—21 percent (26 percent adjusted) of TEDS admissions aged 18 and over, compared to 51 percent of the U.S. population. These proportions were relatively stable from 1992-2001.

Figure 11
Educational attainment at admission, aged 18 and over: TEDS 1992-2001