Adolescent Admissions to Substance Abuse Treatment
Trends in Heroin Admissions and Medication-Assisted Opioid Therapy
Polydrug Abuse
Racial/Ethnic Subgroups

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

• Adolescent substance abuse 1998-2008

TEDS data indicate that admissions to substance abuse treatment aged 12 to 17 increased by 13 percent between 1998 and 2002, but declined by 10 percent between 2002 and 2008. Almost 80 percent of adolescent treatment admissions involved marijuana as a primary or secondary substance, and about 40 percent were referred to treatment through the criminal justice system.

• Heroin admissions and medication-assisted opioid therapy 1998-2008

The number of TEDS admissions for primary heroin abuse increased by 8 percent between 1998 and 2008. However, while the number of admissions aged 35 and older remained stable, the number younger than age 35 increased by 16 percent. Among non-Hispanic Whites under age 35, the number of admissions for primary heroin abuse increased by 65 percent; the number of admissions among non-Hispanic Blacks declined by by a similar percentage.

The proportion of heroin admissions receiving medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined from 40 percent in 1998 to 26 percent in 2008.

• Polydrug abuse

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

• Racial/ethnic subgroups

TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups; however, alcohol was the predominant substance for all racial/ethnic groups except persons of Puerto Rican origin, where the predominant substance was heroin.

Adolescent Admissions to Substance Abuse Treatment

Table 3.1 and Figure 19. The number of adolescent admissions aged 12 to 17 increased by 13 percent from 1998 to 2002, then declined by 10 percent from 2002 to 2008

• Two substances—marijuana and alcohol—accounted for between 83 and 87 percent of adolescent admissions from 1998 to 2008.
• Marijuana admissions increased from 59 percent of adolescent admissions in 1998 to 68 percent in 2008. The number of adolescent marijuana admissions increased by 18 percent between 1998 and 2008.
  
  
• Alcohol admissions declined from 26 percent of adolescent admissions in 1998 to 20 percent in 2008].
  
  
• Methamphetamine/amphetamine admissions (between 95 and 99 percent of these admissions were for methamphetamine or amphetamine abuse from 1998 through 2005; this proportion fell to 76 percent by 2008) increased from 3 percent in 1998 to 6 percent in 2005, but then decreased to 3 percent in 2008.
  
  
• Opiate admissions represented 1 to 2 percent of adolescent admissions from 1998 to 2008. Opiates other than heroin¹ represented 8 percent of adolescent opiate admissions in 1998 but rose to 63 percent in 2008.
  
  
• Cocaine and all other substances combined each accounted for 2 to 3 percent of adolescent admissions between 1998 and 2008.

¹ These drugs include methadone, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

Table 3.2. Overall, 70 percent of adolescent admissions were male, a proportion heavily influenced by the 76 percent of marijuana admissions that were male. The proportion of female admissions was greater than 40 percent for most other substances. There were more female than male adolescent admissions for methamphetamine/amphetamine (56 percent) and heroin (51 percent).

Half (50 percent) of adolescent admissions were non-Hispanic White, 21 percent were Hispanic, 19 percent were non-Hispanic Black, and 9 percent were of other racial/ethnic groups.

Table 3.3. The number of adolescent admissions increased with age; 1 percent were 12 years old, increasing to 32 percent who were age 17. Among admissions for inhalants, 20 percent were aged 12 or 13. Among admissions for heroin and for opiates other than heroin, 62 percent and 50 percent, respectively, were age 17.

In 2008, almost half (48 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.

Table 3.4 and Figure 20. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. In 1998, similar proportions (38 percent each) of marijuana-involved adolescent admissions were referred to treatment by the criminal justice system and by other sources. Between 1998 and 2002, the proportion referred by the criminal justice system increased to 42 percent while the proportion referred by other sources decreased to 34 percent. In 2007 and 2008, the proportions began to converge.

Adolescent admissions not involving marijuana and referred by the criminal justice system fell from 11 percent in 1998 to 8 percent in 2008. Admissions not involving marijuana referred from other sources were fairly stable, at between 12 and 14 percent of adolescent admissions.

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

General measures of heroin abuse among treatment admissions were relatively consistent from 1998 through 2008. Primary heroin abuse accounted for 14 to 16 percent of TEDS admissions in every year from 1998 through 2008. Injection was the preferred route of administration for 60 to 65 percent of heroin admissions, inhalation by 30 to 34 percent, and smoking or other route by 4 to 5 percent. The majority of heroin admissions were 35 years of age or older (54 to 55 percent from 1998 through 2007 and 52 percent in 2008).

However, these measures conceal substantial changes in the age, race/ethnicity, and route of administration of heroin-using sub-populations.

Table 3.5 and Figure 21. TEDS data indicate that heroin abuse has been increasing among young non-Hispanic White adults. Among non-Hispanic Blacks, however, admissions have declined except among older admissions.

• In 1998, just over 1 in 5 heroin admissions (22 percent) was non-Hispanic White aged 20 to 34. By 2008, more than 1 in 3 heroin admissions (35 percent) belonged to this sub-group. The proportion of heroin admissions who were non-Hispanic White aged 35 to 44 fell from 17 percent to 10 percent in the same period. The proportions of non-Hispanic Whites younger than 20 and older than 45 remained constant, at 2 to 3 percent and 7 to 8 percent, respectively.
  
  
• In contrast, non-Hispanic Black heroin admissions aged 20 to 34 fell from 7 percent to 2 percent between 1998 and 2008. The proportion aged 35 to 44 fell from 10 percent to 8 percent. However, the proportion aged 45 and older increased from 7 percent in 1998 to 11 percent in 2008. Non-Hispanic Black admissions younger than age 20 accounted for about one-tenth of 1 percent of all heroin admissions.

Table 3.6 and Figure 22. Route of administration of heroin was closely linked to age and race/ ethnicity. Injection increased among young adults; inhalation increased among the those 45 and older.

• In 1998, about 1 in 4 heroin admissions (24 percent) were injectors aged 20 to 34 and a similar proportion (25 percent) were injectors aged 35 to 44. By 2008, more than 1 in 3 heroin admissions (34 percent) were injectors aged 20 to 34, while about 1 in 7 (14 percent) were injectors aged 35 to 44.
  
  
• The proportion of admissions who were heroin inhalers aged 20 to 34 fell from 14 percent in 1998 to 9 percent in 2008, while the proportion who were inhalers aged 45 and older rose from 4 percent to 10 percent.

Table 3.7 and Figures 23 and 24. Medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined among TEDS admissions for heroin abuse between 1998 and 2008.

• Figure 23. In 1998, about 40 percent of all heroin admissions received medication-assisted opioid therapy. The proportion varied by route of administration—48 percent of heroin smokers, 46 percent of heroin injectors, and 32 percent of heroin inhalers received it. By 2008, this proportion had declined to 30 percent of heroin admissions for all routes of administration.

• Figure 24. Older heroin admissions were most likely to receive medication-assisted opioid therapy. In 1998, opioid therapy was planned for 54 percent of admissions aged 45 and older, 44 percent of those aged 35 to 44, 30 percent of those aged 20-34, and 14 percent of those under age 20. The proportions fell for all age groups, and by 2008, 41 percent of heroin admissions aged 45 and older were receiving medication-assisted opioid therapy, 32 percent of those aged 35 to 44, 24 percent of those aged 20 to 34, and 12 percent of those younger than age 20.

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 3.8 and Figure 25. Polydrug abuse was reported by 55 percent of all TEDS admissions in 2008. Alcohol, marijuana, and cocaine were the most commonly reported secondary and tertiary substances.

• Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of most treatment admissions. Forty-one percent of all treatment admissions were for primary alcohol abuse, and 20 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, opiates, and methamphetamine/amphetamine were reported more often as primary substances than as secondary or tertiary substances. Twenty-seven percent of all admissions involved opiate abuse, with 20 percent reporting primary abuse and 7 percent reporting secondary or tertiary abuse. Ten percent of all admissions reported methamphetamine/amphetamine abuse, with 6 percent reporting primary abuse and 4 percent reporting secondary or tertiary abuse.
  
  
• Marijuana and cocaine were reported more often as secondary or tertiary substances than as primary substances. Marijuana was reported as a primary substance by 17 percent of all admissions, but was a secondary or tertiary substance for another 20 percent, so that 37 percent of all treatment admissions reported marijuana as a substance of abuse. Cocaine was a primary substance for 11 percent of admissions, but was a secondary or tertiary substance for an additional 17 percent. Thus 28 percent of all treatment admissions involved cocaine abuse.

Table 3.9. 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, 15 percent reported abuse of alcohol and marijuana but no other drugs, and 6 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.

Racial/Ethnic Subgroups

Table 2.3b and Figures 26-31. TEDS data indicate that 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.

• Among non-Hispanic Whites [Figure 26], alcohol as the primary substance accounted for 49 percent of male admissions and 38 percent of female admissions.
  • Opiates and marijuana were the most frequently reported illicit drugs for non-Hispanic White men (20 percent and 15 percent, respectively), followed by cocaine (7 percent) and methamphetamine/amphetamines (6 percent).
    
    
  • For non-Hispanic White women, opiates were the primary illicit drug (26 percent), followed by marijuana (12 percent), cocaine (11 percent), and methamphetamine/amphetamines (10 percent).

• Among non-Hispanic Blacks [Figure 27], 35 percent of male admissions used alcohol as the primary substance. Among non-Hispanic Black women, cocaine (31 percent) was more frequently reported as a primary substance than was alcohol (26 percent).
  • Marijuana and cocaine were the most commonly reported illicit substances for men (26 percent and 20 percent, respectively), followed by opiates (14 percent).
    
    
  • For women, other primary substances were marijuana (19 percent) and opiates (18 percent).
    
    
  • Methamphetamine/amphetamines were reported by 1 percent each of non-Hispanic Black women and of non-Hispanic Black men.

• Among persons of Mexican origin [Figure 28], alcohol was the primary substance involved in 42 percent of male admissions. Among women of Mexican origin, however, methamphetamine/amphetamines were as frequently reported as a primary substance as was alcohol (27 percent each).
  • Marijuana (23 percent) was the most commonly reported illicit substance for men, followed by methamphetamine/amphetamines and opiates (15 percent and 13 percent, respectively) and cocaine (7 percent).
    
    
  • For women, other commonly reported primary substances were marijuana (18 percent), opiates (14 percent), and cocaine (11 percent).

• Among persons of Puerto Rican origin [Figure 29], opiates were the main primary substances at treatment admission for both men and women (45 percent and 38 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 (14 percent) and cocaine (10 percent).
    
    
  • For women, other primary substances were marijuana (17 percent) and cocaine (16 percent). Admissions for methamphetamine/amphetamine abuse were 1 percent each for women and men.

• American Indians and Alaska Natives1 together accounted for 2 percent of all TEDS admissions [Table 2.1a]. Among American Indian/Alaska Native admissions, 71 percent of men and 56 percent of women entered treatment because of primary alcohol abuse [Figure 30].
  • Marijuana was the most frequently reported illicit substance for men (14 percent), followed by opiates (6 percent), methamphetamine/amphetamines (5 percent), and cocaine (3 percent).
    
    
  • Marijuana and opiates were the most frequently reported illicit substances for women (12 percent each), followed by methamphetamine/amphetamines (10 percent) and cocaine (7 percent).

• Asians and Pacific Islanders accounted for 1 percent of all TEDS admissions [Table 2.1a]. Among this group [Figure 31], alcohol was the primary substance involved in 40 percent of male admissions and 35 percent of female admissions.
  • Marijuana and methamphetamine/amphetamines were the most commonly reported illicit drugs for men (22 percent and 20 percent, respectively), followed by opiates (10 percent) and cocaine (7 percent).
    
    
  • For women, methamphetamine/amphetamines were the most commonly reported illicit substance (25 percent), followed by were marijuana (18 percent), opiates (11 percent), and cocaine (8 percent).

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