Chapter 5
Topics of Special Interest

Adolescent Substance Abuse (Aged 12-17)

Heroin Admissions by Route of Administration and Planned Use of Opioid Treatment

Polydrug Abuse

Racial/Ethnic Subgroups

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

Adolescent Substance Abuse (Aged 12-17)

TEDS data indicate an overall increase in adolescent admissions aged 12 to 17 for substance abuse treatment between 1993 and 2003, attributable primarily to increased admissions involving marijuana and increased referral to treatment through the criminal justice system.

Tables 5.1a and 5.1b and Figure 28. The number of adolescents aged 12 to 17 admitted to substance abuse treatment increased 61 percent between 1993 and 2003. This increase is largely accounted for by the increase in the number of adolescent primary marijuana admissions (222 percent between 1993 and 2003). The proportion of adolescent primary marijuana admissions grew from 32 percent of adolescent admissions in 1993 to 65 percent in 2003.

The number of adolescent primary stimulant and primary opiate admissions also increased (by 260 percent and 175 percent, respectively) from 1993 to 2003, but the proportion of adolescent admissions for stimulants represented only 4 percent of all adolescent admissions in 2003, while the proportion of adolescent primary opiate admissions was 2 percent.

Adolescent treatment admissions for primary alcohol and primary cocaine abuse decreased over this time period. The proportion of adolescent primary alcohol admissions decreased from 49 percent in 1993 to 19 percent in 2003, as the number of adolescent alcohol admissions fell 38 percent. Cocaine accounted for 2 percent of adolescent admissions in 2003, down from 3 percent in 1993; the number of adolescent primary cocaine admissions increased by 8 percent over this time period.

Figure 28
Adolescent admissions by primary substance: TEDS 1993-2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.

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 proportions of adolescent female admissions were greater than those for adolescent males for methamphetamine/amphetamines (58 percent female vs. 42 percent male) and for heroin (52 percent female vs. 48 percent male).

Table 5.3a. In 2003, more than half (53 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 29. The number of admissions referred by the criminal justice system increased every year from 1993 to 2002, but declined slightly in 2003. Admissions resulting from self- or individual referrals, schools, and other referral sources have been stable or declined slightly since 1995.

Figure 29
Adolescent admissions by source of referral to treatment: TEDS 1993-2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.

Table 5.4. In 2003, 46 percent of all adolescent admissions involved the use of both alcohol and marijuana. The number of admissions involving both alcohol and marijuana increased by 54 percent between 1993 and 2003. Admissions involving primary marijuana and no alcohol increased by 407 percent. Over the same period, admissions involving primary alcohol and no marijuana declined by 51 percent.

Table 5.5a and Figure 30. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. Between 1993 and 2003, the number of marijuana-involved adolescent admissions increased for both criminal justice and other referral sources. (The increases were 189 percent and 62 percent, respectively, yielding a net increase of 113 percent.) However, while the number of marijuana-involved adolescent admissions originating in the criminal justice system increased every year from 1993 to 2002, the number from other referral sources increased only through 1996, then stabilized. Beginning in 1998, marijuana-involved adolescent admissions referred through the criminal justice system outnumbered those entering treatment through other referral sources. Adolescent admissions not involving marijuana declined by 11 percent between 1993 and 2003; an increase of 8 percent in criminal justice referrals was more than offset by a decrease of 23 percent in referrals from other sources.

Figure 30
Adolescent admissions by marijuana involvement and criminal justice referral: TEDS 1993-2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.

Heroin Admissions by Route of Administration and Planned Use of Opioid Treatment

TEDS data indicate that heroin injection was a growing problem among young adults in the 1990s. Despite increases in the numbers of admissions for heroin abuse, the number where opioid treatment (medication-assisted therapy with methadone, LAAM, or buprenorphine) was planned declined.

Tables 5.6a and 5.6b. Heroin admissions increased by 39 percent between 1993 and 2003. Increases of 102 percent in admissions for heroin inhalation and 13 percent in admissions for heroin injection were largely responsible. The proportion of heroin admissions represented by injection declined from 74 percent in 1993 to 61 percent in 2003. Heroin inhalation made up 34 percent of all heroin admissions in 2003, an increase from 23 percent in 1993.

Tables 5.6a, 5.6b, and Figure 31. The planned use of opioid treatment did not keep pace with the increase in heroin admissions. While heroin admissions increased by 39 percent between 1993 and 2003, the planned use of opioid treatment decreased by 20 percent. In 2003, opioid treatment was more likely to be planned for heroin smokers and injectors (36 percent and 34 percent respectively) than inhalers (30 percent). Among admissions for heroin injection, the planned use of opioid treatment fell by 36 percent between 1993 and 2003. The proportion of admissions for heroin inhalation where opioid treatment was planned declined from a high of 42 percent in 1993 to a low of 23 percent in 1996 and 1997. Between 1998 and 2003 the level remained at about 30 percent.

Figure 31
Planned use of opioid treatment by route of heroin administration:
TEDS 1993-2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.

Table 5.7b and Figure 32. Between 1993 and 2003, 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 1993, 41 percent of admissions for inhalation were under 30 years of age, compared to 19 percent of those injecting heroin. By 2003, the proportion of those admitted for inhaling heroin who were under age 30 had fallen to 21 percent. The proportion admitted for injecting heroin who were under age 30 had increased to 32 percent. Among heroin smokers, the proportion under age 30 was 37 percent.

Table 5.7a. Among heroin abusers experiencing a first treatment episode in 2003, the average duration of use was 12 years for both injection and smoking, and 13 years for inhalation.

Figure 32
Heroin admissions under age 30 by route of administration: TEDS 1993-2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.

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 5.8 and Figure 33. Polydrug abuse was reported by 54 percent of all TEDS admissions in 2003. Alcohol, marijuana, and cocaine were the most commonly reported secondary and tertiary substances.

Figure 33
Primary and secondary/tertiary substance abuse: TEDS 2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.

Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of most treatment admissions. Forty-two percent of all treatment admissions were for primary alcohol abuse, and 22 percent of admissions for other drugs reported that they also had an alcohol problem. Overall, 64 percent of all treatment admissions reported alcohol as a substance of abuse.

Alcohol and opiates were reported more often as primary substances than as secondary or tertiary substances. Twenty-three percent of all admissions involved opiate abuse, with 18 percent reporting primary abuse and 6 percent reporting secondary or tertiary abuse.

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 15 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 14 percent of admissions, but was a secondary or tertiary substance for an additional 17 percent. Thus nearly one-third (31 percent) of all treatment admissions involved cocaine abuse.

Table 5.9. This table details the most common substance combinations for selected primary substances. For example, for primary alcohol admissions, 56 percent reported abuse of alcohol alone, 14 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.

Racial/Ethnic Subgroups

TEDS permits analysis of racial/ethnic subgroups that are generally poorly represented in sample surveys. 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 34-39. Among non-Hispanic Whites [Figure 34], alcohol as the primary substance accounted for 50 percent of male admissions and 38 percent of female admissions. Marijuana and opiates were the most frequently reported illicit drugs for non-Hispanic White men (16 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 (19 percent), followed by stimulants (13 percent), marijuana (12 percent), and cocaine (11 percent).

Among non-Hispanic Blacks [Figure 35], 36 percent of male admissions used alcohol as the primary substance. Among non-Hispanic Black women, cocaine (35 percent) was more frequently reported as a primary substance than was alcohol (26 percent). Cocaine was the most commonly reported illicit substance for men (25 percent), followed by marijuana (20 percent) and opiates (15 percent). For women, other primary substances were opiates (19 percent) and marijuana (14 percent). Stimulants were reported by 1 percent each of non-Hispanic Black men and women.

Among persons of Mexican origin [Figure 36], alcohol was the primary substance involved in 43 percent of male admissions. Among women of Mexican origin, however, stimulants were more frequently reported as a primary substance than was alcohol (30 percent and 24 percent, respectively). Marijuana and opiates were the most commonly reported illicit substances for men (17 percent each), followed by stimulants (14 percent) and cocaine (7 percent). For women, other commonly reported primary substances were opiates (17 percent), marijuana (15 percent), and cocaine (11 percent).

Among persons of Puerto Rican origin [Figure 37], opiates were the main substances at treatment admission for both men and women (49 percent and 43 percent, respectively). Opiates were followed by alcohol for both men and women (30 percent and 24 percent, respectively). For men, other primary substances were marijuana (11 percent) and cocaine (9 percent). For women, other primary substances were cocaine (16 percent) and marijuana (12 percent). Admissions for stimulant use were 1 percent for women and less than 1 percent for men.

American Indians and Alaska Natives together accounted for 2 percent of all TEDS admissions [Table 3.1a]. Among American Indian/Alaska Native admissions, 67 percent of men and 53 percent of women entered treatment because of primary alcohol abuse [Figure 38]. Marijuana was the most frequently reported illicit substance for men (14 percent), followed by opiates and stimulants (6 percent each) and cocaine (4 percent). Stimulants were the most frequently reported illicit substances for women (13 percent), followed by marijuana (12 percent), opiates (10 percent), and cocaine (8 percent).

Asians and Pacific Islanders accounted for approximately 1 percent of all TEDS admissions [Table 3.1a]. Among this group [Figure 39], 36 percent of male admissions and 26 percent of female admissions used alcohol as the primary substance. Stimulants and marijuana were the most commonly reported illicit drugs for men (23 percent and 20 percent, respectively). Among women, however, 33 percent of admissions were for stimulants and 16 percent for marijuana. Opiates accounted for 8 percent of male admissions and 10 percent of female admissions, while cocaine was responsible for 11 percent of male admissions and 12 percent of female admissions.

Figure 34
White (non-Hispanic)

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.


Figure 35
Black (non-Hispanic)
Admissions by primary substance, sex, and age: TEDS 2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.


Figure 36
Mexican origin
Admissions by primary substance, sex, and age: TEDS 2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.


Figure 37
Puerto Rican origin
Admissions by primary substance, sex, and age: TEDS 2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.


Figure 38
American Indian/Alaska Native
Admissions by primary substance, sex, and age: TEDS 2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.


Figure 39
Asian/Pacific Islander
Admissions by primary substance, sex, and age: TEDS 2003

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 4.11.05.