1996 National Household Survey on Drug Abuse: Preliminary Results
A variety of other substance abuse surveys are useful in providing the context for the NHSDA, and are discussed below.
Monitoring the Future (MTF) is an annual school survey of 8th, 10th, and 12th graders with college and young adult followups, conducted by the University of Michigan, Institute for Social Research, under a grant from NIDA. The survey is conducted every spring. The 1996 results were released in a press release in December 1996 (U.S. DHHS 1996). For all three grades combined, there were about 435 public and private schools and about 50,000 students in the sample, for an average of approximately 140 schools and 17,000 students per grade.
Comparisons between the MTF and the students sampled in the NHSDA have generally shown NHSDA prevalences to be lower than MTF estimates, with the relative differences being largest for 8th graders. The direction of the estimates of change from year to year among 12th graders have generally been similar. Both surveys have shown significant increases in illicit drug use among adolescents between 1992 and 1996. The lower prevalences in the NHSDA may be due to more underreporting in the household setting than in the MTF school setting. MTF does not survey dropouts, a group shown (using the NHSDA) to have higher rates of use (Gfroerer, Wright, and Kopstein in press). For a single grade, the NHSDA sample sizes are much smaller than the MTF sample sizes.
The National Comorbidity Survey (National Survey of Health and Stress) was a 1991 household survey of persons aged 15-54 which collected data on drug abuse and mental health. The study was designed to provide nationally representative estimates of psychiatric disorders (including substance abuse), as defined by DSM-III-R criteria. It included about 8,000 households and was conducted by the Institute for Social Research under a grant from the National Institute for Mental Health with additional support from NIDA. Several papers have been published (Kessler et al 1994). Estimates of illicit drug use prevalence and the prevalence of drug dependence from the NCS were similar to estimates from the 1991 NHSDA. (Anthony et al 1993; Epstein and Gfroerer 1995).
Another recent study of illicit drug use is the Drug Supplement on the 1991 National Health Interview Survey (NHIS). This supplement was funded by the National Institute on Drug Abuse, and has the potential of providing important data on the relationship between drug use and health status. It also included questions designed to provide estimates of DSM-III-R abuse and dependence on marijuana and cocaine. The supplement covered adults aged 18-44. Comparisons with NHSDA estimates show significantly lower reported rates of use of marijuana and cocaine in the NHIS (Keer et al 1994).
In 1992, the NHIS was also used as sampling base for conducting the Youth Risk Behavior Survey (YRBS), a nationally representative sample of youth aged 12-21 years. The YRBS collects data on the prevalence of a variety of unhealthy behaviors, including alcohol, cigarette, marijuana, and cocaine use. This survey used a unique data collection method that allowed respondents to listen to tape recorded questions and record answers on an answer sheet that did not allow observers to match the answers with questions. This procedure was intended to maximize the privacy of youths responses and therefore improve the reporting of sensitive behaviors. In general, the survey found higher rates of alcohol, cigarette, marijuana, and cocaine use for youths than were found in the 1992 NHSDA (Adams et al 1995).
The National Pregnancy and Health Survey (NPHS) was conducted in 1992-1993 (NIDA 1996a). Sponsored by NIDA, it was the first probability survey specifically designed to provide extensive information on the nature and extent of substance abuse among women delivering live-born infants in the U.S. A random sample of 2,613 mothers delivering live borns at hospitals, selected to represent approximately 4 million women delivering live borns, was interviewed between 6 and 36 hours after delivery (while they were still in the hospital) about their use of substances during pregnancy. The survey estimated that 5.5 percent of all women delivering live borns had used illicit drugs at some time during their pregnancy. Alcohol was used by 18.8 percent and cigarettes were used by 20.4 percent. Consistent with the NHSDA, the NPHS found that while 4.6 percent of these women had used marijuana during the past 12 months (defined as use during pregnancy or use in the three months before their pregnancy), only about 1.5 percent used marijuana during the second and third trimesters of the pregnancy. The 1995 and 1996 NHSDAs found that while 9.0 percent of pregnant women reported use of marijuana in the past year, only 1.6 percent reported use in the past month.
Two recent surveys with information on the use of cigarettes and alcohol are the 1993 National Health Interview Survey Year 2000 Objectives Supplement (NHIS-2000) and the National Longitudinal Alcohol Epidemiologic Survey (NLAES).
The results of the NHIS-2000 were published in December 1994 (CDC 1994). This survey of approximately 21,000 adults was conducted by the Bureau of the Census for the National Center for Health Statistics. The survey estimated that, in 1993, 25.0 percent of the population age 18 and over were current smokers. Current smokers are defined as those who have smoked at least 100 cigarettes in their lifetime and answer that they currently smoke, including those who smoke only on some days. This definition is somewhat different from the NHSDA definition of current smoking (any use in the past month) which resulted in a prevalence of 30.9 percent (adjusted for the effect of the new NHSDA questionnaire) for adults in 1993. The 1996 estimate for adults was 30.1 percent.
School-based surveys have shown increases in smoking rates among students from 1991 to 1996. Past-month smoking rates found in the Monitoring the Future Study (MTF) were 14.3percent in 1991 and 21.0 percent in 1996 for 8th graders. For tenth graders, rates were 20.8 percent in 1991 and 30.4 percent in 1996. For 12th graders, rates were 28.3 percent in 1991 and 34.0 percent in 1996. Small but statistically significant increases were found for all three grades between 1995 and 1996 (U.S. DHHS 1996). The Youth Risk Behavior Survey also found increases in current cigarette use among students in grades 9-12 from 27.5 percent in 1991 to 34.8 percent in 1995 (CDC 1996). While the NHSDA trend for youth (age 12-17) smoking has not shown these increases, the NHSDA estimates for years prior to 1994 were apparently substantial underestimates because the data were collected without private self-administered answer sheets. When the NHSDA converted to the use of these answer sheets in 1994, the smoking rate for adolescents approximately doubled. This raises questions about the accuracy of the NHSDA measurement of the trend prior to 1994, even after adjustments are made to account for the effect of the new questionnaire.
The Surgeon General's Report on Smoking and Health (US DHHS 1994) included smoking prevalence data from a number of sources, including the NHSDA. Comparisons between the various sources were made and methodological differences were assessed. These comparisons were based on NHSDA data prior to 1994, which were based on the interviewer-administered smoking questions, and thus show low rates of smoking in the NHSDA, particularly among youth.
Alcohol supplements sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and included on the NHIS have also provided estimates of alcohol use, including DSM-III-R abuse and dependence (Grant et al 1991).
NLAES was conducted by the Bureau of the Census for the NIAAA in 1992. Face-to-face interviews were conducted with 42,862 respondents age 18 and older in the contiguous U.S. It was designed to study the drinking practices, behaviors, and related problems in the general public. The survey included an extensive set of questions designed to assess the presence of symptoms of alcohol abuse and dependence during the prior 12 months, based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994). NLAES estimated that 4.4 percent of adults were alcohol dependent and another 3.0 percent were classified as abusing alcohol, but not dependent, within the past year (Grant et al 1995).
The Washington, D.C. Metropolitan Area Drug Study (DC*MADS) was designed to (1) estimate the prevalence, correlates, and consequences of drug abuse among all types of people residing in one metropolitan area of the country during one period of time and (2) to develop a methodological model for similar types of research in other metropolitan areas of the country. Sponsored by the National Institute on Drug Abuse and conducted in 1991 and 1992, the project focused on hard-to-reach populations, such as adult and juvenile offenders, new mothers, and school dropouts. DC*MADS provided a replicable methodological approach for developingrepresentative estimates of the prevalence of drug abuse among all population subgroups, regardless of their residential setting, in a metropolitan area. The key domains in DC*MADS were the homeless, the institutionalized, and the household. A major finding of DC*MADS was that, when data are aggregated for populations from each of the three domains, the overall prevalence estimates for use of drugs differ only marginally from those that would be obtained from the household population alone (i.e., from the NHSDA). However, for some categories of drug users, the nonhousehold population was found to include a substantial proportion of users. About 20 percent of past month crack users, 20 percent of past year heroin users, and one-third of past year needle users were found in the nonhousehold population (NIDA 1992; NIDA 1993; NIDA 1994a; NIDA 1994b).
The 1992 Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel was sponsored by the Department of Defense and conducted by Research Triangle Institute. The survey interviewed 25,000 Armed Forces personnel worldwide. Military personnel exhibited lower rates of illicit drug use than the civilian population after controlling for sociodemographic composition of the two populations, but higher rates of cigarette smoking and heavy alcohol drinking (Research Triangle Institute 1992).
The Survey of Inmates of Local Jails (1989) is a sample survey of approximately 6000 inmates in 400 jails, conducted by the Bureau of the Census for the Bureau of Justice Statistics (BJS). BJS also sponsors a Survey of Inmates in State Correctional Facilities. Among other items, these surveys collect information on the use of drugs in the month before the offense for convicted inmates. The survey results indicate substantially higher rates of use among convicted inmates (BJS 1991; BJS 1993) than in the household population.
This page was last updated on February 05, 2009.