Chapter 2
Trends in Substance Abuse Treatment Admissions: 1992-2002
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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 2002, TEDS
treatment admissions were dominated by five substances: alcohol, opiates
(primarily heroin), cocaine, marijuana, and stimulants (primarily
methamphetamine). These substances together consistently accounted for between
95 and 96 percent of all TEDS admissions from 1992 to 2002.
Figure 1
Primary substance of abuse at admission: TEDS 1992-2002
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SOURCE: Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Treatment Episode Data Set (TEDS) -
3.01.04.
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Alcohol accounted for just over two-fifths (43
percent) of all TEDS admissions in 2002, 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 2002.
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The proportion of TEDS admissions for primary opiate abuse increased from 12 percent in 1992 to 18 percent in 2002. While
heroin represented 86 percent of all primary opiate admissions in 2002,
other opiates/synthetics1 represented an
increasing proportion of admissions for opiate abuse, from 8 percent in 1992
to 14 percent in 2002.
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The proportion of admissions for primary cocaine
abuse declined from 17 percent in 1992 to 13 percent in 2002. Smoked cocaine
(crack) represented 73 percent of all primary cocaine admissions in 2002, a
proportion that remained fairly stable over the time period.
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The proportion of admissions for primary marijuana
increased steadily from 6 percent in 1992 to 15 percent in 2002.
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The proportion of admissions for abuse of stimulants increased from 1 percent in 1992 to 7 percent in 2002.
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Admissions attributable to sedatives and tranquilizers represented a small and stable proportion of TEDS admissions (each
less than one-half of 1 percent).
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Admissions for abuse of hallucinogens, PCP, inhalants,
and over-the-counter medications together remained fairly stable over the
time period, each accounting for less than one-half of 1 percent of TEDS
admissions in 2002.
1 These drugs include non-prescription use of codeine, hydrocodone, hydromorphone,
meperidine, methadone, morphine, opium, oxycodone, pentazocine, propoxyphene, and other drugs with morphine-like effects.
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 2002, approximately 41 percent of all admissions
reported problems with both alcohol and drugs. Some 22 percent reported primary
drug abuse with secondary alcohol abuse, and 19 percent reported primary alcohol
abuse with secondary drug abuse.
Primary alcohol abuse declined from 59 percent of TEDS admissions in 1992 to
43 percent in 2002. Primary drug abuse increased from 38 percent in 1992 to 54
percent in 2002. 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 1992-2002
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SOURCE: Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Treatment Episode Data Set (TEDS) -
3.01.04.
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Trends in Admission Rates by Primary Substance and State
Tables 2.3b-2.8b and Figures 3-8 show trends in State
admission rates per 100,000 population aged 12 and over for selected substances
from 1992-2002.
For the maps in Figures 3-8, 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
or jurisdictions because of changes to their data collection systems. These
States were: Arizona (1992-1997), the District of Columbia (1992-1993), Indiana
(1997), Kentucky (1992-1996), Mississippi (1992-1994), West Virginia (1994 and
1997-1998), and Wyoming (1995-1996).
In four States, significant changes in the clients or
facilities reported to TEDS from 1992-2002 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 (1999-2002), Texas
(1992-1995), Virginia (1996-1999), and West Virginia (1996, 2000, and 2002). The
actual data reported, however, are included in all tables.
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Alcohol admission rates generally were highest in the
Northeast and Midwest, particularly in the New England and West North Central
States. For the United States as a whole, the alcohol admission rate declined
by 26 percent between 1992 and 2002, from 457 per 100,000 population aged 12
and over to 337 per 100,000. This rate of decline was equaled or exceeded in
24 States [Table 2.3b and
Figure 3].
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Heroin admission rates were highest in the Northeast, in
both the Middle Atlantic and New England States. For the United States as a
whole, the heroin admission rate increased by 45 percent between 1992 and
2002, from 82 per 100,000 population aged 12 and over to 119 per 100,000.
Heroin admission rates increased by 100 percent or more in 21 States during this time period. In
1992, no State had a rate higher than 250 per 100,000. By 2002, eight States
had rates that high or higher [Table 2.4b and Figure 4].
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Admission rates for opiates other than heroin2
were generally highest in the Northeast, particularly in the New England
States. For the United States as a whole, the admission rate for opiates other
than heroin increased by 200 percent between 1992 and 2002, from 6 per 100,000
population aged 12 and over to 18 per 100,000. In 34 States, 2002 rates were
at least 100 percent higher than 1992 rates. In 1992, no State had a rate
higher than 17 per 100,000. By 2002, 24 States had rates that high or higher
[Table 2.5b and Figure 5].
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Cocaine admission rates were generally highest in the South
and Northeast, particularly in the South Atlantic and Middle Atlantic States.
For the United States as a whole, the cocaine admission rate declined by 24
percent between 1992 and 2002, from 133 per 100,000 population aged 12 and
over to 101 per 100,000. This rate of decline was equaled or exceeded in 23
States. In 1992, 14 States had rates of 150 or more per 100,000; by 2002, that
number had fallen to 8 per 100,000 [Table 2.6b and Figure 6].
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Marijuana treatment admission rates showed substantial
increases across a large number of States, and were generally highest in the
Midwest, particularly in the West North Central States. For the United States
as a whole, the marijuana admission rate increased by 162 percent between 1992
and 2002, from 45 per 100,000 population aged 12 and over to 118 per 100,000.
In 32 States, 2002 rates were at least 100 percent higher than 1992 rates. In
1992, no State reported a rate higher than 130 admissions per 100,000, and 43
States reported rates of 100 or fewer admissions per 100,000. By 2002, 24
States had rates of 130 or more admissions per 100,000, and the number of
States reporting 100 or fewer admissions per 100,000 had fallen to 19 [Table
2.7b and Figure 7].
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Methamphetamine/amphetamine admission rates increased,
spreading east from the Pacific States into the Midwest and South. Rates were
generally highest in the West, particularly in the Pacific States. For the
United States as a whole, the methamphetamine/amphetamine admission rate
increased by 420 percent between 1992 and 2002, from 10 per 100,000 population
aged 12 and over to 52 per 100,000. Since 1992, methamphetamine/amphetamine
admission rates increased by 100 percent or more in 35 States. In 1992, one
State reported a rate higher than 50 admissions per 100,000, and 41 States
reported rates of 25 or fewer admissions per 100,000. By 2002, 19 States
reported rates of 50 or more admissions per 100,000; in 13 of these, rates
were 100 or more admissions per 100,000. The number of States reporting fewer
than 25 admissions per 100,000 had decreased to 29 [Table 2.8b and Figure 8].
2 These drugs include non-prescription
use of codeine, hydrocodone, hydromorphone, meperidine, methadone, morphine,
opium, oxycodone, pentazocine, propoxyphene, and other drugs with
morphine-like effects.
Figure 3
Primary alcohol admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 3 (continued)
Primary alcohol admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 4
Primary heroin admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 4 (continued)
Primary heroin admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 5
Primary non-heroin opiates/synthetics admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 5 (continued)
Primary non-heroin opiates/synthetics admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 6
Primary non-heroin opiates/synthetics admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 6 (continued)
Primary non-heroin opiates/synthetics admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 7
Primary marijuana admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 7 (continued)
Primary marijuana admission rates by State: TEDS 1992-2002
(per 100,000 population aged 12 and over)
Figure 8
Primary methamphetamine/amphetamine admission rates by State:
TEDS 1992-2002 (per 100,000 population aged 12 and over)
Figure 8 (continued)
Primary methamphetamine/amphetamine admission rates by State:
TEDS 1992-2002 (per 100,000 population aged 12 and over)
Trends in Demographic Characteristics
Table 2.9b. Males represented 70 percent of TEDS
admissions in 2002, a proportion that remained stable from 1992 to 2002. 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 2.9b and Figure 9. The age distribution of TEDS
admissions changed between 1992 and 2002. The proportion of TEDS admissions aged
25 to 34 years declined from 40 percent in 1992 to 25 percent in 2002. This
decline was offset by overall increases in the proportions of both older and
younger admissions.
The age distribution of TEDS treatment admissions was different from that of
the U.S. population. In 2002, some 88 percent of TEDS admissions aged 12 and
over were between the ages of 18 and 54, compared to about 63 percent of the
U.S. population aged 12 and over.
Figure 9
Age at admission: TEDS 1992-2002
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SOURCE: Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Treatment Episode Data Set (TEDS) -
3.01.04.
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Table 2.9b and Figure 10. The racial/ethnic composition of TEDS admissions
changed very little between 1992 and 2002. Non-Hispanic Whites made up 59-60
percent of admissions throughout the time period. The proportion of non-Hispanic
Blacks declined slightly, from 26 percent of admissions in 1992 to 24 percent in
2002. This was offset by an increase in the proportion of admissions for
Hispanics, from 10 percent in 1992 to 13 percent in 2002.
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 2002, compared to 71 percent of the
U.S. population. Non-Hispanic Blacks represented 24 percent of TEDS admissions
in 2002 and 12 percent of the U.S. population. However, the proportion of
Hispanic TEDS admissions (13 percent) was similar to the proportion of Hispanics
in the U.S. population (12 percent).
Figure 10
Race/ethnicity of admissions: TEDS 1992-2002
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SOURCE: Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Treatment Episode Data Set (TEDS) -
3.01.04.
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Trends in Socioeconomic Status
Tables 2.10a, 2.10b, and Figures 11 and 12. TEDS
admissions aged 16 and over were socioeconomically disadvantaged compared to the
U.S. population aged 16 and over. This is evident in the unadjusted
distributions of admissions by employment status and education [Table 2.10a].
Because TEDS admissions differ demographically from the U.S. population, Table
2.10b shows distributions that have been statistically adjusted to provide a
more valid comparison to the U.S. population.3 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 aged 16 and over. Some 71 percent (74 percent
adjusted) of 2002 TEDS admissions aged 16 and over were unemployed or not in the
labor force, compared to 37 percent of the U.S. population aged 16 and over.
Only 22 percent (19 percent adjusted) were employed full time, compared to 52
percent of the U.S. population aged 16 and over.
The proportion of TEDS admissions that were unemployed
declined from 29 percent in 1992 to a low of 24 percent in 1999, but had
increased to 29 percent by 2002.
Figure 11
Employment status at admission, aged 16 and over: TEDS 1992-2002
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SOURCE: Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Treatment Episode Data Set (TEDS) -
3.01.04.
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3 The distributions have been adjusted for age, sex,
and race/ethnicity to the U.S. population. In essence, this technique compares
the distributions under the assumption that the TEDS population and the U.S.
population had the same age, sex, and racial/ethnic characteristics.
Tables 2.10a, 2.10b, and Figure 12. TEDS admissions aged 18 and over had
less education than the U.S. population aged 18 and over. Some 35 percent (31
percent adjusted) of TEDS admissions aged 18 and over had not completed high
school, compared to 17 percent of the U.S. population aged 18 and over. 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 aged 18 and over. These
proportions were relatively stable from 1992 to 2002.
Figure 12
Educational attainment at admission, aged 18 and over: TEDS 1992-2002
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SOURCE: Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Treatment Episode Data Set (TEDS) -
3.01.04.
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