Introduction and Highlights

Substance abuse continues to be one of the foremost health and social problems faced by our Nation today. The use of illicit drugs, alcohol, and tobacco is responsible for a significant percentage of the preventable deaths each year, unmeasurable suffering, and economic costs of approximately $1,000 for every person in the United States (Horgan, Marsden, & Larson, 1993; Rouse, 1998). A creditable, national surveillance system for monitoring the levels of substance abuse in the United States is one of the essential tools for allowing researchers and policymakers to better understand and control this problem. The National Household Survey on Drug Abuse (NHSDA) was established in 1971 for this purpose.

This report presents the main findings of the 1997 NHSDA. The 1997 survey provides information on the use of illicit drugs, alcohol, and tobacco among the estimated 216 million members of the civilian, noninstitutionalized population aged 12 or older in the United States (hereinafter referred to as the "surveyed population"). Specifically, the Main Findings report provides four main types of information:
 

• prevalence data on the use of illicit drugs, alcohol, and tobacco for the surveyed population as a whole and specifically for four age groups: 12 to 17, 18 to 25, 26 to 34, and 35 or older;
  
  
• comparisons across survey years (i.e., "trend analyses") between 1979 and 1997 regarding the prevalence of use of illicit drugs, alcohol, and tobacco for the surveyed population;
  
  
• demographic correlates of the use of illicit drugs, alcohol, and tobacco among the surveyed population; and
  
  
• data on patterns of drug use among the surveyed population regarding problems arising from this use; perceptions of risk of using illicit drugs, alcohol, or cigarettes; treatment history of the population; and substance use among special populations.

The following pages provide highlights of the main findings from each chapter of this report.

Chapter 1 describes the NHSDA, including its history and purposes, survey methods, and guidelines for interpreting statistics presented in this report.

Rates of illicit drug use, alcohol, and tobacco for the total household population aged 12 or older did not change appreciably from 1996 to 1997 and, in general, were relatively stable from 1991 to 1997. None of the differences in lifetime, past year, and past month use for anysubstances between 1996 and 1997 were statistically significant. Among youths aged 12 to 17, however, rates of past year and past month use of marijuana, and lifetime and past year use of cocaine, increased significantly between 1996 and 1997. These increases appeared to be in line with a more general trend of increasing use among adolescents from 1992 to 1997, and the increases appeared to be pervasive across most of the major demographic subgroups. Although rates of alcohol use, including heavy use, and cigarette use among youths also tended to be higher in 1997, the differences from 1996 for these substances were less dramatic and not statistically significant.

Marijuana was the most commonly used illicit drug in 1997. About 33% of the 216 million persons represented in the 1997 NHSDA reported marijuana use in their lifetime, 9% reported recent use (in the past year), and 5% reported current use (in the past month). Marijuana use in the past year and past month was more common among males and young adults aged 18 to 25. Additionally, current marijuana use tended to be lowest in the Northeast and among college graduates and highest among the unemployed. The prevalence of marijuana use among adolescents aged 12 to 17 appeared to have generally increased since the early 1990s. Between 1996 and 1997, past year marijuana use increased from 13% to 16% and current use increased from 7% to 9%.

After marijuana, more people reported having used cocaine at some point in their lifetime than any other illicit drug. Around 11% of the persons represented in 1997 reported cocaine use in their lifetime, 2% reported recent use (in the past year), and nearly 1% reported current use (in the past 30 days). Recent and current cocaine use were more common among young adult males aged 18 to 25 than among all other age-gender groups. About 2% of the males in the 18 to 25 age group was a current cocaine user. Additionally, recent and current cocaine use tended to be higher among adults with less than a high school education and those who were unemployed. An estimated 2% of the surveyed population reported crack use in their lifetime, 0.6% reported past year crack use, and about 0.3% reported current crack use. Reported lifetime and past year crack use were relatively more common among males, blacks, adults who did not graduate from high school, and the unemployed.1

Approximately 10% of the NHSDA-surveyed population in 1997 reported ever having used hallucinogens, and roughly 6% reported lifetime use of inhalants. The lifetime prevalence of heroin use remained quite low (1%) compared with most other drugs. In general, use of inhalants and hallucinogens was more commonly reported among males, whites, and persons with at least some college education, and least reported in nonmetropolitan areas, among blacks, and among persons with a high school diploma or less education. Heroin use was more commonly reportedamong males and less commonly among college graduates. Persons in the "other" employment category were typically the least likely of any other group (full-time, part-time, and currently unemployed persons) to report use of inhalants, hallucinogens, or heroin.

Psychotherapeutic drugs as defined here include prescription-type (as opposed to over-the-counter) stimulants, sedatives, tranquilizers, and analgesics. In 1997, approximately 9% of persons aged 12 or older (about 20 million persons) reported using at least one psychotherapeutic drug for nonmedical reasons in their lifetime; 3% (about 6 million persons) reported illicit psychotherapeutic use in the past year; and 1% (3 million persons) reported use in the past month. With a few exceptions, young and middle adults, males, and whites were more likely than persons in the other demographic subgroups to report the nonmedical use of psychotherapeutic drugs. With respect to metropolitan status and employment status, residents of nonmetropolitan areas and persons in the "other" employment category were the least likely to report the nonmedical use of psychotherapeutic drugs.

Since the inception of the NHSDA in 1971, alcohol has been reported as the most commonly used psychoactive drug in the United States. Approximately 177 million (82%) of the 216 million people aged 12 or older represented in 1997 reported alcohol use in their lifetime. An estimated 139 million persons (64%) reported use in the past year, and 111 million persons (51%) reported current use (in the previous month). Furthermore, about 11 million persons (5%) reported heavy alcohol use in the past month (five or more drinks on the same occasion on each of 5 or more days in the past 30 days), and 32 million persons (15%) reported "binge" alcohol use in that period (five or more drinks on the same occasion on at least 1 day in the past 30 days). Both the prevalence and intensity of alcohol use were greatest among males. In addition, respondents aged 18 to 34 tended to report higher rates of past year and current alcohol use than did those in younger or older age groups. Although the general prevalence estimates showed that adults with more education were more likely to have used alcohol in the past month, heavy use among adults was slightly more common among the less educated and significantly more common among the unemployed. Among adolescents aged 12 to 17, current alcohol use remained relatively stable between 1996 and 1997 (19% vs. 20%).

In 1997, approximately 71% of the population aged 12 or older had tried at least a few puffs of a cigarette at some point in their lifetime. Approximately 33% of the population aged 12 or older had smoked within the past year, and 30% were current smokers (i.e., they had smoked within the past 30 days). Rates of past year and current cigarette use among young adults aged 18 to 25 increased significantly from the mid-1990s, when they had reached a low point, to 1997. Use of smokeless tobacco products or cigars was less prevalent than cigarette use. An estimated 17% of the population aged 12 or older had ever tried smokeless tobacco, 5% had used it in the past year, and only 3% had used it in the past month. More than one-third of the population aged12 or older smoked at least a puff of a cigar in their lifetime, and about 6% reported that they smoked a cigar in the past month. The findings reported in this chapter make it clear that in 1997, tobacco products were more likely to be used currently by males than by females and by whites compared with blacks or Hispanics. In particular, current smokeless tobacco use occurred predominantly among white males in the young adult and middle adult age groups. Adults without a college education also were more likely than adults who had completed college to be current users of cigarettes or smokeless tobacco.

During 1997, about 650,000 cocaine users, 3 million marijuana users, 10 million drinkers of alcohol, and 23 million cigarette smokers reported three or more problems that are considered potential signs of dependence on each respective substance. Among those who reported heavy cigarette use (currently smoking about a pack or more a day), use of marijuana at least 12 days in the past year, or use of cocaine at least 12 days in the past year, 49%, 28%, and 36% reported three or more problems, respectively. Among heavy drinkers, 70% reported one or more problems and 33% reported three or more problems. The most frequently reported problems for past year users of marijuana and alcohol were spending a great deal of time getting or using the drug or getting over its effects, using the drug more often or in larger amounts than intended, and developing a tolerance for the substance. Among heavy cigarette smokers, the most frequently reported problem was wanting or trying to quit or cut down on using cigarettes but not being able to do so. Among past year users of cocaine aged 12 or older, the most prevalent problem was the occurrence of psychological problems associated with cocaine use.

About half of the surveyed population reported having used only alcohol and no other drug in their lifetime (47%), slightly more than one-third reported using both alcohol and some illicit drug (35%), and less than 1% reported using only some illicit drug (and no alcohol) in their lifetime. Lifetime needle use was relatively more common among males and adults aged 18 or older. Consistent with previous reports, cigarettes, alcohol, and inhalants tended to be first used at relatively early ages for the 1997 NHSDA population, while cocaine and heroin use usually began at later ages.

Most people perceived that one takes great risks of harming oneself with any use of cocaine or heroin and with heavy alcohol use nearly everyday. About two-thirds of the population assigned great risk to smoking a pack of cigarettes everyday. The prevalences of perceptions that great risks may be incurred with drug use were lowest among youths aged 12 to 17, but highest among all persons who had ever used any illicit drug. The majority of the total population reported that marijuana was easy to obtain. Between 28% and 50% thought that cocaine, crack, and LSD might be obtained easily. In general, those who had used at least one illicit drug weremore likely than nonusers to think that getting any of the drugs except heroin would be easy. About 7% of the population aged 12 or older reported being approached during the past month by someone offering to sell drugs. Past year illicit drug use and heavy alcohol use were highly related to other types of high-risk behaviors, such as driving while under the influence.

The number of individuals receiving treatment for alcohol or drug abuse was much smaller than the number who reported having problems resulting from their use of substances. Although an estimated 10 million people in the U.S. noninstitutionalized population aged 12 or older reported three or more problems related to their alcohol use in the past year (see Chapter 9), only about 3.1 million reported receiving treatment for that use. Similarly, 1.4% and 0.3% of the population reported three or more problems resulting from marijuana and cocaine use, respectively, while only 0.9% of the population reported receiving treatment for illicit drug use. Receipt of and perceived need for treatment were higher among young and middle adults (i.e., those aged 18 to 34) and among males; the higher rates of treatment among these age groups are probably related to the higher rates of substance use in these age groups. Past month use of illicit drugs among those aged 18 to 49 employed full-time decreased with business size, and access to drug and alcohol resources in the workplace tended to increase with business size.

Family income below $9,000, lack of health insurance, and having a family member in the same household receiving welfare were associated with any illicit drug use and marijuana use in the past year. Lack of health insurance and receipt of welfare assistance also were associated with past year cocaine use, especially among adults. Past year illicit drug use was consistently associated with being arrested and booked for criminal activities. Pregnant women were less likely than nonpregnant women to report past month illicit drug use, past month "binge" alcohol use, and past month cigarette use. These differences tended to be consistent irrespective of age, race/ethnicity, marital status, and educational attainment. Past year use of illicit drugs and being drunk on alcohol on 3 or more days in the past year were more common among those who had experienced major depressive episodes or panic attacks in the past year than among those who had not. Among youths, those who perceived that parents and close friends would not have strong negative reactions if they were to engage in various drug use behaviors consistently reported higher levels of use of illicit drugs, alcohol, and tobacco than did youths who perceived that their parents and friends would be very upset about their use of drugs. Friends were perceived as having substantially more favorable attitudes toward drug use than parents. For many of the relationships examined, the perceived attitudes of friends showed stronger associations with use than did the perceived attitudes of parents.

Appendix A presents key NHSDA definitions for the survey years from 1972 to 1997. Appendix B discusses data collection operations, response rates, and imputation and missing data in the 1997 NHSDA. Appendix C presents the statistical methods used in this report andinformation on the sampling variances and design effects of the 1997 NHSDA estimates. Appendix D discusses sampling and weighting procedures. Appendix E explains the adjustment procedure conducted on the 1979-1993 NHSDA estimates to account for the new survey methodology used in the 1994, 1995, 1996, and 1997 NHSDAs. Appendix F contains the drug answer sheets from the 1997 NHSDA questionnaire.

1 In the interest of readability for this report, "white" is used to indicate "white, non-Hispanic," and "black" to indicate "black, non-Hispanic."