Chapter 5

Topics of Special Interest

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Adolescent Substance Abuse (Ages 12-17)

Heroin Admissions by Route of Administration and Planned Use of Methadone

Polydrug Abuse

Population 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 12-17 for substance abuse treatment between 1992 and 2001, attributable primarily to increased admissions involving marijuana and increased referral to treatment through the criminal justice system. However, the total number of adolescent admissions peaked in 1998.

Tables 5.1a and 5.1b and Figure 27. The number of adolescents aged 12-17 admitted to substance abuse treatment showed a net increase of 49 percent between 1992 and 2001. Admissions for marijuana abuse grew steadily from 23 percent of adolescent admissions in 1992 to 62 percent in 2001, and largely accounted for the overall increase in adolescent admissions from 1992 to 2001.

Table 5.2a. Overall, 70 percent of adolescent admissions were male. However, this proportion was heavily influenced by marijuana admissions, where 76 percent were male. The male:female ratio was much closer for most other substances. For heroin and cocaine, male adolescent admissions outnumbered female only slightly.

Figure 27
Adolescent admissions by primary substance: TEDS 1992-2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Table 5.2a. In 2001, more than half (52 percent) of adolescent admissions were referred to treatment through the criminal justice system. Seventeen percent were self- or individual referrals, and 12 percent were referred through schools. These referral sources together accounted for 81 percent of all youth admissions.

Figure 28. The number of admissions from the criminal justice system increased every year but one from 1992 to 2001. Admissions resulting from self- or individual referrals, schools, and other referral sources have been stable or declined slightly since 1995.

Figure 28
Adolescent admissions by referral source: TEDS 1992-2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Table 5.3a. In 2001, 48 percent of all adolescent admissions involved the use of both alcohol and marijuana. Admissions involving both alcohol and marijuana increased by 77 percent between 1992 and 2001. Admissions involving primary marijuana and no alcohol increased by 520 percent. Over the same period, admissions involving primary alcohol and no marijuana declined by 61 percent. For admissions involving both marijuana and alcohol, or marijuana and no alcohol, the majority of increase was from criminal justice referrals.

Figure 29 summarizes the data in Table 5.3a according to whether marijuana was involved in the admission. Adolescent admissions increased between 1992 and 2001 only for marijuana-involved admissions. The number of marijuana-involved admissions originating in the criminal justice system increased every year but one from 1992 to 2001. However, marijuana-involved admissions from other referral sources increased only through 1996, then stabilized. Beginning in 1999, marijuana-involved adolescent admissions referred through the criminal justice system outnumbered those entering treatment through other referral sources. Adolescent admissions not involving marijuana declined between 1992 and 2001, regardless of referral source.

Figure 29
Adolescent admissions by marijuana involvement and criminal justice referral:
TEDS 1992-2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Heroin Admissions by Route of Administration and Planned Use of Methadone

TEDS data indicate that heroin inhalation and, to a lesser extent, heroin smoking were growing problems among young adults in the 1990s. Despite increases in the numbers of admissions for heroin abuse, the number where methadone use was planned as a part of treatment declined.

Tables 5.4a and 5.4b. Heroin admissions increased by 64 percent between 1992 and 2001. Increases of 171 percent in admissions for heroin inhalation and 28 percent in admissions for heroin injection were largely responsible. The proportion of heroin admissions represented by injection declined from 77 percent in 1992 to 62 percent in 2001. Heroin inhalation made up 33 percent of all heroin admissions in 2001, an increase from 20 percent in 1992.

Tables 5.4a and 5.4b and Figure 30. The planned use of methadone as part of treatment did not keep pace with the increase in heroin admissions. While heroin admissions increased by 64 percent between 1992 and 2001, the planned use of methadone decreased by 2 percent. Methadone use was more likely to be planned for heroin injectors and smokers than inhalers. Among admissions for heroin injection (the majority of heroin admissions), planned use of methadone fell by 19 percent between 1992 and 2001. The proportion of admissions for heroin inhalation that included planned use of methadone rose from a low of 23 percent in 1997 to about 30 percent between 1998 and 2001, a level below the 47 percent reported in 1992.

Figure 30
Planned use of methadone by route of heroin administration: TEDS 1992-2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Table 5.5b and Figure 31. Between 1992 and 1999, heroin inhalers admitted to treatment tended to be younger than heroin injectors admitted to treatment. However, the proportion of admissions under age 30 decreased among heroin inhalers and increased among heroin injectors. In 1992, 45 percent of admissions for inhalation were under 30 years of age, compared to 21 percent of those injecting heroin. By 2001, the proportion of those admitted for inhaling heroin who were under age 30 had fallen to 24 percent. The proportion admitted for injecting heroin who were under age 30 had increased to 30 percent. Among heroin smokers, the proportion under age 30 remained at about 40 percent.

Table 5.5a. Among heroin abusers experiencing a first treatment episode in 2001, the average duration of use was similar regardless of route of administration, at 12 years for injection and inhalation and 11 years for smoking.

Figure 31
Heroin admissions under age 30 by route of administration: TEDS 1992-2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Polydrug Abuse

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

Table 5.6 and Figure 32. Polydrug abuse was reported by 55 percent of all TEDS admissions in 2001. Alcohol, marijuana/hashish, and cocaine were the most commonly reported secondary substances.

Abuse of alcohol as either a primary or secondary substance was characteristic of most treatment admissions. Nearly half (44 percent) of all treatment admissions were for primary alcohol abuse, and 22 percent of persons admitted for other drugs reported that they also had an alcohol problem. Overall, 66 percent of all persons admitted to treatment reported alcohol as a substance of abuse.

Alcohol and opiates were reported more often as primary substances than as secondary substances. Twenty-three percent of all admissions involved opiate abuse, with 18 percent reporting primary abuse and 5 percent reporting secondary abuse.

For marijuana/hashish and cocaine, more admissions reported these drugs as secondary substances than as primary substances. Marijuana/hashish was reported as a primary substance by 15 percent of all admissions, but was a secondary substance for another 20 percent, so that 35 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 substance for an additional 18 percent. Thus nearly one-third of all treatment admissions involved cocaine abuse.

Table 5.7. 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 secondary abuse of both cocaine and marijuana.

Figure 32
Primary and secondary substance abuse: TEDS 2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Population Racial/Ethnic Subgroups

TEDS permits analysis of racial/ethnic subgroups that are generally poorly represented in sample surveys.

Tables 3.1a, 3.1b, 3.2a, and 3.2b and Figures 33-38. Substance abuse patterns differed widely among racial/ethnic subgroups in 2001. However, alcohol was the predominant substance for all racial/ethnic groups except persons of Puerto Rican origin. The proportion of admissions with alcohol as the primary substance ranged from 27 percent for persons of Puerto Rican origin to 64 percent for American Indians [Table 3.1b].

Among non-Hispanic Whites [Figure 33 and Table 3.2b], alcohol as the primary substance accounted for 54 percent of admissions among males and 42 percent of female admissions. Marijuana was the most frequently reported illicit drug for non-Hispanic White men (15 percent), followed by opiates (14 percent), cocaine (7 percent), and stimulants (6 percent). For non-Hispanic White women, opiates were the primary illicit drug (19 percent), followed by marijuana (12 percent), cocaine, and stimulants (11 percent each).

Among non-Hispanic Blacks [Figure 34 and Table 3.2b], 38 percent of male admissions and 28 percent of female admissions involved alcohol as the primary substance. Cocaine was the most commonly reported illicit substance for both men and women (25 percent and 36 percent, respectively). This was followed by marijuana (19 percent) and opiates (15 percent) for men and opiates (19 percent) and marijuana (12 percent) for women.

Among Hispanics, substance abuse patterns differed according to country of origin. Among persons of Mexican origin [Figure 35 and Table 3.2b], alcohol was the primary substance involved in 45 percent of male admissions, but only 25 percent of female admissions. Opiates were the most commonly reported illicit substances for both men and women (23 percent and 25 percent, respectively). For men, this was followed by marijuana (15 percent), stimulants (8 percent), and cocaine (7 percent). For women, it was followed by stimulants (22 percent), marijuana (14 percent), and cocaine (11 percent).

Among persons of Puerto Rican origin [Figure 36 and Table 3.2b], opiates were the main substances at treatment admission for both men and women (52 percent and 49 percent, respectively). Opiates were followed by alcohol (28 percent), marijuana (10 percent), and cocaine (8 percent) for men. For women, alcohol (24 percent), cocaine (14 percent), and marijuana (10 percent) were the next most common primary substances.

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 54 percent of women entered treatment because of primary alcohol abuse [Figure 37 and Table 3.2b]. Marijuana was the most frequently reported illicit substance, responsible for 13 percent of both male and female admissions. This was followed by opiates (7 percent), stimulants (5 percent), and cocaine (4 percent) for men. For women, stimulants and opiates accounted for 11 percent and 10 percent of admissions, respectively, while cocaine accounted for 7 percent.

Asians and Pacific Islanders accounted for approximately 1 percent of all TEDS admissions [Table 3.1a]. Among this group [Figure 38 and Table 3.2b], 35 percent of male admissions and 27 percent of female admissions involved alcohol as the primary substance. Marijuana and stimulants were the most commonly reported illicit drugs for men (22 percent and 19 percent, respectively). Among women, however, 30 percent of admissions were for stimulants and 18 percent for marijuana. For both men and women, opiates (13 percent and 12 percent, respectively) and cocaine (8 percent and 10 percent, respectively) followed.

Figure 33
White (non-Hispanic)
Admissions by primary substance, sex, and age: TEDS 2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Figure 34
Black (non-Hispanic)
Admissions by primary substance, sex, and age: TEDS 2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Figure 35
Mexican origin
Admissions by primary substance, sex, and age: TEDS 2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Figure 36
Puerto Rican origin
Admissions by primary substance, sex, and age: TEDS 2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Figure 37
American Indian/Alaska Native
Admissions by primary substance, sex, and age: TEDS 2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.

 

Figure 38
Asian/Pacific Islander
Admissions by primary substance, sex, and age: TEDS 2001

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 5.31.03.