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 1996 and 2006, 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 5 percent net increase in the number of adolescents aged 12 to 17 admitted to substance abuse treatment between 1996 and 2006. However, this represented a 24 percent increase between 1996 and 2004, followed by a 15 percent decrease between 2004 and 2006. These changes were largely accounted for by changes in the number of adolescent primary marijuana admissions (a 43 percent increase from 1996 to 2004, followed by a 14 percent decrease between 2004 and 2006, for an overall increase of 23 percent between 1996 and 2006). In contrast, the proportion of adolescent primary marijuana admissions rose steadily, from 56 percent of adolescent admissions in 1996 to 66 percent in 2006.

Figure 27
Adolescent admissions by primary substance: TEDS 1996-2006

Line chart comparing Adolescent admissions by primary substance in TEDS 1996 to 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

The numbers of adolescent primary stimulant, opiate, and cocaine admissions also increased (by 95 percent, 65 percent, and 19 percent, respectively) from 1996 to 2006, but the proportion of adolescent admissions for primary stimulant abuse represented only 4 percent of all adolescent admissions in 2006. The proportions of adolescent admissions for primary cocaine abuse and primary opiate abuse were 3 percent and 2 percent, respectively.

Adolescent treatment admissions for primary alcohol abuse decreased over this time period. The proportion of adolescent primary alcohol admissions decreased from 29 percent in 1996 to 20 percent in 2006, as the number of adolescent alcohol admissions fell 27 percent.

Table 5.2a. Overall, 69 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 (59 percent were female) and for sedatives (53 percent were female). Females made up between 48 and 49 percent of admissions for smoked and non-smoked cocaine, tranquilizers, other stimulants, and heroin.

Table 5.3a. In 2006, half (51 percent) of adolescent admissions were referred to treatment through the criminal justice system. Seventeen percent were self- or individual referrals, and 11 percent were referred through schools.

Figure 28. The number of adolescent admissions referred by the criminal justice system increased every year from 1996 to 2002, but declined in 2003 to 2006. Admissions from schools declined slightly between 1996 and 2006, while those from self- or individual referrals and other referral sources increased slightly.

Figure 28
Adolescent admissions by source of referral to treatment: TEDS 1996-2006

Line chart comparing Adolescent admissions by source of referral to treatment in TEDS 1996 to 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

Table 5.4. In 2006, 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 11 percent between 1996 and 2006, while admissions involving primary marijuana and no alcohol increased by 69 percent. Over the same period, admissions involving primary alcohol and no marijuana declined by 14 percent.

Table 5.5a and Figure 29. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. Between 1996 and 2006, the number of marijuana-involved adolescent admissions increased by 30 percent for criminal justice referrals and declined by 4 percent for other referral sources. The net increase in all marijuana-involved adolescent treatment admissions was 11 percent. In 1996, the number of marijuana-involved adolescent treatment admissions referred by the criminal justice system was 19 percent lower than the number referred by other sources. The number of adolescent admissions involving marijuana increased every year from 1996 to 2002. Beginning in 1998, 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 5 percent between 1996 and 2006; there was also a decrease of 6 percent in criminal justice referrals and a decrease of 5 percent in referrals from other sources.

Figure 29
Adolescent admissions by marijuana involvement and criminal justice referral:
TEDS 1996-2006

Line chart comparing Adolescent admissions by marijuana involvement and criminal justice referral in TEDS 1996 to 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

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 10 percent between 1996 and 2006. Increases of 36 percent in admissions for heroin inhalation and 8 percent in admissions for heroin injection were largely responsible. The proportion of heroin admissions represented by injection declined from 69 percent in 1996 to 64 percent in 2006. Heroin inhalation made up 32 percent of all heroin admissions in 2006, an increase from 27 percent in 1996.

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 10 percent between 1996 and 2006, the number receiving medication-assisted opioid therapy decreased by 22 percent. In 2006, heroin smokers were more likely to receive medication-assisted opioid therapy (31 percent) than were the much larger groups of injectors and inhalers (29 percent and 28 percent, respectively). Among admissions for heroin injection, medication-assisted opioid therapy fell by 38 percent between 1996 and 2006. The proportion of admissions for heroin inhalation receiving medication-assisted opioid therapy increased to 32 percent in 1998 from 23 percent in 1996 and remained stable between 28 percent to 32 percent through 2006.

Figure 30
Medication-assisted opioid therapy, by usual route of heroin administration: TEDS 1996-2006

Line chart comparing Opioid replacement therapy by usual route of heroin administration in TEDS 1996 to 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

Table 5.7b and Figure 31. Between 1996 and 2006, 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 1996, 33 percent of admissions for inhalation were under 30 years of age, compared to 20 percent of those injecting heroin. By 2006, 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 38 percent. Among heroin smokers, the proportion under age 30 was 38 percent in 1996 and had increased to 48 percent by 2006.

Figure 31
Heroin admissions under age 30 by usual route of administration: TEDS 1996-2006

Line chart comparing Heroin admissions under age 30 by usual route of administration in TEDS 1996 to 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

Table 5.7a. Among heroin abusers experiencing a first treatment episode in 2006, the average duration of use was 13 years for injection, 13 years for inhalation, and 9 years for smoking.

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 56 percent of all TEDS admissions in 2006. Alcohol, marijuana, and cocaine were the most commonly reported secondary and tertiary substances.

Figure 32
Primary and secondary/tertiary substance abuse: TEDS 2006

Line chart comparing Primary and secondary/tertiary substance abuse in TEDS 1996 to 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

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 21 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.

Alcohol and opiates were reported more often as primary substances than as secon­dary or tertiary substances. Twenty-four 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 16 percent of all admissions, but was a secondary or tertiary substance for another 21 percent, so that 37 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 18 percent. Thus nearly one-third (32 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, 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.

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 33-38. Among non-Hispanic Whites [Figure 33], alcohol as the primary substance accounted for 48 percent of male admissions and 35 percent of female admissions. Opiates and marijuana were the most frequently reported illicit drugs for non-Hispanic White men (17 per­cent and 15 percent, respectively), followed by cocaine and stimulants (9 percent and 8 percent, respectively). For non-Hispanic White women, opiates were the primary illicit drug (21 percent), followed by stimulants and cocaine (13 percent each), and marijuana (12 percent).

Figure 33
White (non-Hispanic)
Admissions by primary substance, gender, and age: TEDS 2006

Line chart comparing White (non-Hispanic) Admissions by primary substance, gender, and age in TEDS 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

Among non-Hispanic Blacks [Figure 34], 34 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 (25 percent). Cocaine and marijuana were the most commonly reported illicit substances for men (24 percent each), followed by opiates (14 percent). For women, other primary substances were opiates (18 percent) and marijuana (17 percent). Stimulants were reported by 2 percent of non-Hispanic Black women and 1 percent of non-Hispanic Black men.

Figure 34
Black (non-Hispanic)
Admissions by primary substance, gender, and age: TEDS 2006

Line chart comparing Black (non-Hispanic) Admissions by primary substance, gender, and age in TEDS 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

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 23 percent, respectively). Marijuana (19 percent) was the most commonly reported illicit substance for men, followed by stimulants and opiates (18 percent and 14 percent, respectively) and cocaine (8 percent). For women, other commonly reported primary substances were marijuana (16 percent), opiates (14 percent), and cocaine (12 percent).

Figure 35
Mexican origin
Admissions by primary substance, gender, and age: TEDS 2006

Line chart comparing Mexican origin Admissions by primary substance, gender, and age in TEDS 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

Among persons of Puerto Rican origin [Figure 36], opiates were the main primary subst­ances at treatment admission for both men and women (48 percent and 41 percent, respectively). Opiates were followed by alcohol for both men and women (26 percent and 20 percent, respectively). For men, other primary substances were marijuana (13 percent) and cocaine (11 percent). For women, other primary substances were cocaine (18 percent) and marijuana (15 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 2006

Line chart comparing Puerto Rican origin Admissions by primary substance, gender, and age in TEDS 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

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 52 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 (7 percent), opiates (5 percent), and cocaine (4 percent). Stimulants were the most frequently reported illicit substances for women (15 percent), followed by marijuana (12 percent), opiates (10 percent), and cocaine (7 percent).

Figure 37
American Indian/Alaska Native
Admissions by primary substance, gender, and age: TEDS 2006

Line chart comparing American Indian/Alaska Native Admissions by primary substance, gender, and age in TEDS 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

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 35 percent of male admissions. Among women, however, stimulants were more frequently reported as a primary substance than was alcohol (35 percent and 28 percent, respectively). Stimulants and marijuana were the most commonly reported illicit drugs for men (24 percent and 21 percent, respectively), followed by cocaine (9 percent) and opiates (8 percent). For women, other commonly reported primary substances were marijuana (16 percent), opiates (10 percent), and cocaine (9 percent).

Figure 38
Asian/Pacific Islander
Admissions by primary substance, gender, and age: TEDS 2006

Line chart comparing Asian/Pacific Islander Admissions by primary substance, gender, and age in TEDS 2006

SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.9.07.

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