Trends in Primary Substance of Abuse: 1999-2009
Trends in the Co-Abuse of Alcohol and Drugs
Trends in Demographic Characteristics
Trends in Employment Status

This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2009 and trend data for 1999 to 2009. It is a companion to the report Treatment Episode Data Set (TEDS): 1999-2009 State Admissions to Substance Abuse Treatment. These reports provide information on the demographic and substance abuse characteristics of admissions to treatment aged 12 and older for abuse of alcohol and/or drugs in facilities that report to individual State administrative data systems. Data include records for admissions during calendar years 1999 through 2009 that were received and processed through November 3, 2010.¹

TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, for example, an individual admitted to treatment twice within a calendar year would be counted as two admissions.

TEDS does not include all admissions to substance abuse treatment. It includes admissions at facilities that are licensed or certified by the State substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services. Additional information on the history and methodology of TEDS and this report as well as important issues related to State data collection systems are detailed in Appendix A.

This chapter details trends in the annual numbers and rates of admissions aged 12 and older in 2009 and trends for 1999 to 2009. Trend data are invaluable in monitoring changing patterns in substance abuse treatment admissions. These patterns reflect underlying changes in substance abuse in the population as well as changing priorities in the treatment/reporting system. (For example, limited resources and targeted programs may result in a shift of State funds from treatment of alcohol abusers to treatment to abusers of other drugs.) TEDS data thus have important implications for resource allocation and program planning.

Trends in Primary Substance of Abuse: 1999-2009

Admissions can report up to three substances of abuse. These represent the substances that led to the treatment episode and are not necessarily a complete enumeration of all substances used at the time of admission. Most of the information in this report is based on an admission's primary substance of abuse, although secondary and/or tertiary substances are mentioned in a couple of tables (see Appendix A for more details).

Table 1.1b and Figure 1. The number of admissions aged 12 and older increased by 14 percent from 1999 to 2009, commensurate with a similar increase in the U.S. population aged 12 and older.

• Between 1999 and 2009, five substance groups accounted for 96 percent of TEDS treat­ment admissions aged 12 and older: alcohol, opiates (primarily heroin), marijuana, cocaine, and methamphetamine/amphetamines. However, the proportions of admissions by primary substance changed considerably over that period:
  • Alcohol admissions declined steadily from 48 percent of admissions aged 12 and older in 1999 to 39 percent in 2005, but then increased steadily to 42 percent in 2009. In 2009, 44 percent of primary alcohol admissions aged 12 and older reported secondary drug abuse as well.
  • Opiate admissions increased from 16 percent of admissions aged 12 and older in 1999 to 21 percent in 2009.
    • Heroin admissions increased from 15 percent of admissions aged 12 and older in 1999 to 16 percent in 2001. They declined to 14 percent in 2005 and remained there through 2009. Heroin represented 92 percent of all opiate admissions in 1999 but declined steadily to 67 percent in 2009.
    • Opiates other than heroin² increased from 1 percent of admissions aged 12 and older in 1999 to 7 percent in 2009. Opiates other than heroin represented 8 percent of all opiate admissions in 1999 but rose to 33 percent in 2009.
  • Cocaine admissions declined from 14 percent in 1999 to 9 percent in 2009. Smoked cocaine (crack) represented 72 percent of all primary cocaine admissions in 2009, down from 73 percent in 1999.
  • Marijuana admissions increased from 13 percent in 1999 to 18 percent in 2009.
  • Stimulant admissions (98 to 99 percent of these admissions were for meth­amphetamine or amphetamine abuse) increased from 4 percent in 1999 to 9 percent in 2005, but then decreased to 6 percent in 2009.
  • Tranquilizers, sedatives and hypnotics, hallucinogens, PCP, inhalants, and over-the-counter medications each accounted for less than 1 percent of TEDS admissions between 1999 and 2009.

Trends in the Co-Abuse of Alcohol and Drugs

Table 1.2. The concurrent abuse of alcohol and drugs continues to be a significant problem. Because TEDS collects a maximum of three substances of abuse and not all substances abused, alcohol use among polydrug abusers may be underreported.

• The proportion of admissions aged 12 and older reporting abuse of both alcohol and drugs declined from 43 percent in 1999 to 37 percent in 2009.
• The proportion reporting abuse of drugs only increased from 27 percent in 1999 to 38 percent in 2009, while the proportion reporting abuse of alcohol only fell slightly, from 27 percent in 1999 to 23 percent in 2009.
  

Trends in Demographic Characteristics

Table 1.3b. Males represented 68 percent of TEDS admissions aged 12 and older in 2009, a proportion that declined slightly but steadily from 71 percent in 1999.

• The distribution of TEDS admissions aged 12 and older differed markedly by gender from that of the U.S. population, where 49 percent of the population was male.
  

Table 1.3b and Figure 2. The age distribution of TEDS admissions aged 12 and older changed between 1999 and 2009.

• Admissions aged 30 to 44 years made up 49 percent of TEDS admissions in 1999 but only 34 percent in 2009.
• The proportion of admissions aged 45 and older increased from 16 percent in 1999 to 24 percent in 2009.
• The proportion of admissions aged 18 to 29 years increased from 28 percent in 1999 to 34 percent in 2009. The proportion of admissions aged 12 to 17 was stable at about 8 percent.
• The age distribution of TEDS treatment admissions aged 12 and older differed considerably from that of the U.S. population. In 2009, some 68 percent of TEDS admissions were aged 18 to 44 years compared to 44 percent of the U.S. population. Adolescents aged 12 to 17 years made up 8 percent of TEDS admissions but 10 percent of the U.S. population. Admissions aged 45 and older made up 24 percent of TEDS admissions but 46 percent of the U.S. population.
  

Table 1.4 and Figure 3. The racial/ethnic composition of TEDS admissions aged 12 and older changed very little between 1999 and 2009.

• Non-Hispanic Whites made up 58 to 60 percent of admissions throughout the time period.
• The proportion of non-Hispanic Blacks declined slightly, from 24 percent of admissions in 1999 to 21 percent in 2009.
• This was offset by increases in the proportions of admissions of Hispanic origin (from 12 percent in 1999 to 14 percent in 2009) and for other racial/ethnic groups combined (from 5 percent in 1999 to 6 percent in 2009).
• 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 they represented 60 percent of TEDS admissions in 2009 compared to 67 percent of the U.S. population. Non-Hispanic Blacks represented 21 percent of TEDS admissions in 2009 and 12 percent of the U.S. population. However, the proportion of TEDS admissions of Hispanic origin (14 percent) was the same as the proportion of Hispanics in the U.S. population (14 percent). Other racial/ethnic groups made up 6 percent of TEDS admissions and 7 percent of the U.S. population.

Trends in Employment Status

Table 1.5 and Figure 4. TEDS admissions aged 16 and older were less likely to be employed than the U.S. population aged 16 and older. This is evident in the unadjusted distributions of admissions by employment status (employed, unemployed, and not in labor force) shown in Table 1.5. Because TEDS admissions differ demographically from the U.S. population, Table 1.5 also 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.

• Unemployment as a proportion of TEDS admissions aged 16 and older rose sharply from a low of 24 percent in 1999 and 2000 to 39 percent in 2009. Between 1999 and 2009, unemployment grew from the least common employment status reported by treatment admissions aged 16 and older to the most common status.
• The most common employment status reported by TEDS admissions aged 16 and older between 1999 and 2008 was "not in the labor force." However, this proportion declined from a peak of 43 percent in 2000 to 37 percent in 2009.
• Among the U.S. population aged 16 and older in 2009, 34 percent were not in the labor force, 9 percent were unemployed, and 59 percent were employed.

³The distributions have been adjusted for age, gender, 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, gender, and racial/ethnic characteristics.

TO TABLES

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