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Appendix C: Key Definitions, 2008

This appendix provides definitions for many of the measures and terms used in this report on the 2008 National Survey on Drug Use and Health (NSDUH). Where relevant, cross-references also are provided. For some key terms, specific question wording, including "feeder questions" that precede the question(s), is provided for clarity.

Abuse
Abuse of a substance was defined as meeting one or more of the four criteria for abuse included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994) and if the definition for dependence was not met for that substance. Additional criteria for alcohol and marijuana abuse include the use of these substances on 6 or more days in the past 12 months. These questions have been included in the survey since 2000. Responses to the dependence or abuse questions based only on the past year use of methamphetamine, Ambien®, Adderall®, or specific hallucinogens from the routing patterns added between 2005 and 2008 were not included in these measures. See Section B.4.3 of Appendix B for additional details.

SEE: "Dependence," "Need for Illicit Drug or Alcohol Use Treatment," and "Prevalence."

Adult Education
SEE: "Education."
Age
Age of the respondent was defined as "age at time of interview." The interview program calculated the respondent's age from the date of birth and interview date. The interview program prompts the interviewer to confirm the respondent's age after it has been calculated.

Alcohol Use
Measures of use of alcohol in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last drank an alcoholic beverage?"

Feeder question: "The next questions are about alcoholic beverages, such as, beer, wine, brandy, and mixed drinks. Listed on the next screen are examples of the types of beverages we are interested in. Please review this list carefully before you answer these questions. These questions are about drinks of alcoholic beverages. Throughout these questions, by a 'drink,' we mean a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. We are not asking about times when you only had a sip or two from a drink. Have you ever, even once, had a drink of any type of alcoholic beverage? Please do not include times when you only had a sip or two from a drink."

SEE: "Binge Use of Alcohol," "Current Use," "Heavy Use of Alcohol," "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

Alcohol Use in Combination with Illicit Drug Use
Respondents aged 12 to 20 who reported drinking at least one alcoholic beverage within the past 30 days were asked what other drugs were used while they were drinking or were used within a couple of hours of drinking. Respondents were presented a list of 10 possible drugs, depending on which drugs they previously reported using in the past month. The 10 possible drugs were marijuana or hashish, cocaine or crack, heroin, hallucinogens, inhalants, prescription pain relievers, prescription tranquilizers, prescription stimulants, methamphetamine, and prescription sedatives. A respondent was defined as having Alcohol Use in Combination with Illicit Drug Use if he or she reported using any 1 of the 10 drugs above with his or her last alcohol use or within a couple of hours of drinking.

NOTE: Respondents were defined as having used methamphetamine with their most recent use of alcohol in the past month if they reported use in the core stimulants module. They also were included if they reported use in the noncore special drugs module and said they had not reported methamphetamine use in the core module because they did not think of it as a prescription drug.

SEE: "Alcohol Use," "Core," "Illicit Drugs," and "Noncore."

American Indian or Alaska Native
American Indian or Alaska Native only, not of Hispanic, Latino, or Spanish origin (including North American, Central American, or South American Indian); does not include respondents reporting two or more races. (Respondents reporting that they were American Indians or Alaska Natives and of Hispanic, Latino, or Spanish origin were classified as Hispanic.)

SEE: "Hispanic" and "Race/Ethnicity."

Asian
Asian only, not of Hispanic, Latino, or Spanish origin; does not include respondents reporting two or more races. (Respondents reporting that they were Asian and of Hispanic, Latino, or Spanish origin were classified as Hispanic.) Specific Asian groups that were asked about were Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and "Other Asian."

SEE: "Hispanic" and "Race/Ethnicity."

Baby Boom Cohort
The baby boom cohort refers to persons born in the United States after World War II between 1946 and 1964 (Light, 1988).

SEE: "Age."

Binge Use of Alcohol
Binge use of alcohol was defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.

Feeder question: "How long has it been since you last drank an alcoholic beverage?"

SEE: "Alcohol Use" and "Heavy Use of Alcohol."

Black
Black/African American only, not of Hispanic, Latino, or Spanish origin; does not include respondents reporting two or more races. (Respondents reporting that they were black or African American and of Hispanic, Latino, or Spanish origin were classified as Hispanic.)

SEE: "Hispanic" and "Race/Ethnicity."

Blunts
Blunts were defined as cigars with marijuana in them. Measures of the use of blunts in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last smoked part or all of a cigar with marijuana in it?"

Feeder question: "Sometimes people take tobacco out of a cigar and replace it with marijuana. This is sometimes called a 'blunt.' Have you ever smoked part or all of a cigar with marijuana in it?"

SEE: "Cigar Use," "Current Use," "Lifetime Use," "Marijuana Use," "Past Month Use," "Past Year Use," "Prevalence," "Recency of Use," and "Tobacco Product Use."

Cash Assistance
Cash assistance was defined as receipt of direct monetary payments due to low income, such as Temporary Assistance for Needy Families (TANF), welfare, or other public assistance. In 2006 and 2007, a majority of respondents received two questions regarding cash assistance: (a) their personal receipt of cash assistance, and (b) whether another family member living in the household received cash assistance. The remaining respondents received a reduced set of income questions, including a single question about whether the respondent or another family member in the household received cash assistance. In 2008, all respondents received the reduced set of income questions, including a single question about cash assistance.

NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income.

SEE: "Welfare Assistance."

Cigar Use
Measures of use of cigars (including cigarillos and little cigars) in the respondent's lifetime, the past year, and the past month were developed from responses to the questions about cigar use in the past 30 days and the recency of use (if not in the past 30 days): "Now think about the past 30 days—that is, from [DATEFILL] up to and including today. During the past 30 days, have you smoked part or all of any type of cigar?" and "How long has it been since you last smoked part or all of any type of cigar?" Responses to questions about use of cigars with marijuana in them (blunts) were not included in these measures.

Feeder question: "The next questions are about smoking cigars. By cigars we mean any kind, including big cigars, cigarillos, and even little cigars that look like cigarettes. Have you ever smoked part or all of any type of cigar?"

SEE: "Blunts," "Cigarette Use," "Current Use," "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," "Recency of Use," "Smokeless Tobacco Use," and "Tobacco Product Use."

Cigarette Use
Measures of use of cigarettes in the respondent's lifetime, the past year, and the past month were developed from responses to the questions about cigarette use in the past 30 days and the recency of use (if not in the past 30 days): "Now think about the past 30 days—that is, from [DATEFILL] up to and including today. During the past 30 days, have you smoked part or all of a cigarette?" and "How long has it been since you last smoked part or all of a cigarette?"

Feeder question: "These questions are about your use of tobacco products. This includes cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco. The first questions are about cigarettes only. Have you ever smoked part or all of a cigarette?"

SEE: "Cigar Use," "Current Use," "Lifetime Daily Cigarette Use," "Lifetime Use," "Nicotine (Cigarette) Dependence," "Past Month Daily Cigarette Use," "Past Month Use," "Past Year Use," "Prevalence," "Recency of Use," "Smokeless Tobacco Use," and "Tobacco Product Use."

Cocaine Use
Measures of use of cocaine in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used any form of cocaine?"

Feeder question: "These questions are about cocaine, including all the different forms of cocaine such as powder, crack, free base, and coca paste. Have you ever, even once, used any form of cocaine?"

SEE: "Crack Use," "Current Use," "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

College Enrollment Status
This measure was computed only for college-aged respondents (i.e., respondents aged 18 to 22). Respondents in this age group were classified as full-time college students or as some other status (including part-time students, students in other grades, or nonstudents). Respondents were classified as full-time college students if they reported that they were attending (or will be attending) their first through fifth or higher year of college or university and that they were (or will be) a full-time student. Respondents whose current enrollment status was unknown were excluded from this variable.

Core
A core set of questions critical for basic trend measurement of prevalence estimates remains in the survey every year and comprises the first part of the interview. Supplemental or "noncore" questions, or modules, can be revised, dropped, or added from year to year and make up the latter part of the interview. The core consists of initial demographic items (which are interviewer-administered) and self-administered questions pertaining to the use of tobacco, alcohol, marijuana, cocaine, crack cocaine, heroin, hallucinogens, inhalants, pain relievers, tranquilizers, stimulants, and sedatives.

SEE: "Noncore."

County Type
Counties were grouped based on the "Rural/Urban Continuum Codes" developed by the U.S. Department of Agriculture (2003). Each county is in either a metropolitan statistical area (MSA) or outside of an MSA (also see Butler & Beale, 1994). Large metropolitan (large metro) areas have a population of 1 million or more. Small metropolitan (small metro) areas have a population of fewer than 1 million. Nonmetropolitan (nonmetro) areas are outside of MSAs and include urbanized counties with a population of 20,000 or more in urbanized areas, less urbanized counties with a population of at least 2,500 but fewer than 20,000 in urbanized areas, and completely rural counties with a population of fewer than 2,500 in urbanized areas. Estimates based on county-type information presented in this report use the 2003 revised definition of an MSA; estimates for 2002 in this report, therefore, are not directly comparable with those presented in the 2002 NSDUH report (Office of Applied Studies [OAS], 2003).

Crack Use
Measures of use of crack cocaine in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used crack?"

Feeder questions: "These questions are about cocaine, including all the different forms of cocaine such as powder, crack, free base, and coca paste. Have you ever, even once, used any form of cocaine?"

"The next questions are about crack, that is cocaine in rock or chunk form, and not the other forms of cocaine. Have you ever, even once, used crack?"

SEE: "Cocaine Use," "Current Use," "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

Current Use
Any reported use of a specific substance in the past 30 days.

SEE: "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

Delinquent Behavior
Youths aged 12 to 17 were asked a series of six questions: "During the past 12 months, how many times have you . . . stolen or tried to steal anything worth more than $50?" "sold illegal drugs?" "attacked someone with the intent to seriously hurt them?" "gotten into a serious fight at school or work?" "taken part in a fight where a group of your friends fought against another group?" and "carried a handgun?"

SEE: "Gang Fighting," "Prevalence," and "Stealing."

Dependence
Dependence on illicit drugs or alcohol was defined as meeting three out of seven dependence criteria (for substances that included questions to measure a withdrawal criterion) or three out of six dependence criteria (for substances that did not include withdrawal questions) for that substance, based on criteria included in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994). Additional criteria for alcohol and marijuana dependence since 2000 included the use of these substances on 6 or more days in the past 12 months. These criteria were not used to define Nicotine (Cigarette) Dependence, which used a different series of items. Responses to the dependence or abuse questions based only on the past year use of methamphetamine, Ambien®, Adderall®, or specific hallucinogens from the routing patterns added between 2005 and 2008 were not included in these measures. See Section B.4.3 in Appendix B for additional details.

SEE: "Abuse," "Need for Alcohol Use Treatment," "Need for Illicit Drug or Alcohol Use Treatment," "Need for Illicit Drug Use Treatment," "Nicotine (Cigarette) Dependence," and "Prevalence."

Depression
SEE: "Major Depressive Episode."

Driving Under the Influence
Respondents were asked whether in the past 12 months they had driven a vehicle while under the influence of alcohol and illegal drugs used together, alcohol only, or illegal drugs only.

SEE: "Prevalence."

Ecstasy Use
Measures of use of Ecstasy or MDMA (methylenedioxy-methamphetamine) in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used Ecstasy, also known as MDMA?"

SEE: "Current Use," "Hallucinogen Use," "Lifetime Use," "LSD Use," "Past Month Use," "Past Year Use," "PCP Use," "Prevalence," and "Recency of Use."

Education
This is the measure of educational attainment among respondents who are aged 18 or older. It is based on respondents' reports of their highest grade or year of school that they completed. Response alternatives were presented in terms of single years of education, ranging from 0 if respondents never attended school to 17 if respondents completed 5 or more years at the college or university level. Respondents were classified into four categories based on their answers: less than high school, high school graduate, some college, and college graduate. Persons indicating having completed the 12th grade were classified as high school graduates, and persons who indicated completing 4 or more years at the college or university level were defined as being college graduates.

Employment
Respondents were asked to report whether they worked in the week prior to the interview, and if not, whether they had a job despite not working in the past week. Respondents who worked in the past week or who reported having a job despite not working were asked whether they usually work 35 or more hours per week. Respondents who did not work in the past week but had a job were asked to look at a card that described why they did not work in the past week despite having a job. Respondents who did not have a job in the past week were asked to look at a different card that described why they did not have a job in the past week.

Full-time
"Full-time" in the tables includes respondents who usually work 35 or more hours per week and who worked in the past week or had a job despite not working in the past week.

Part-time
"Part-time" in the tables includes respondents who usually work fewer than 35 hours per week and who worked in the past week or had a job despite not working in the past week.

Unemployed
"Unemployed" in the tables refers to respondents who did not have a job, were on layoff, and were looking for work. For consistency with the Current Population Survey definition of unemployment, respondents who reported that they did not have a job but were looking for work needed to report making specific efforts to find work in the past 30 days, such as sending out resumes or applications, placing ads, or answering ads.

Other
"Other" includes all other responses, including being a student, keeping house or caring for children full time, retired, disabled, or other miscellaneous work statuses that were defined as not being in the labor force. Respondents who reported that they did not have a job or were on layoff, but were not looking for work, were classified as not being in the labor force. Similarly, respondents who reported not having a job and looking for work also were classified as not being in the labor force if they did not report making specific efforts to find work in the past 30 days.

Ethnicity
SEE: "Race/Ethnicity."

Ever Use
SEE: "Lifetime Use."

Exposure to Drug Education and Prevention
Youths aged 12 to 17 who reported they attended any type of school at any time in the past 12 months were asked: "During the past 12 months…. Have you had a special class about drugs or alcohol in school? Have you had films, lectures, discussions, or printed information about drugs or alcohol in one of your regular classes, such as health or physical education? Have you had films, lectures, discussions, or printed information about drugs or alcohol outside of one of your regular classes, such as in a special assembly?"

(Youths who reported that they were home schooled in the past 12 months also were asked these questions. Youths who reported that they were home schooled were instructed to think about their home schooling as "school.")

Youths also were asked: "During the past 12 months, have you seen or heard any alcohol or drug prevention messages from sources outside school, such as in posters, pamphlets, and radio or TV ads?"

Family Income
Family income was ascertained by asking respondents about their total personal income and total family income, based on the following questions: "Of these income groups, which category best represents (your /SAMPLE MEMBER's) total personal income during [the previous calendar year]?" and "Of these income groups, which category best represents (your/SAMPLE MEMBER's) total combined family income during [the previous calendar year]?" Family is defined as any related member in the household, including all foster relationships and unmarried partners (including same-sex partners.) It excludes roommates, boarders, and other nonrelatives.

NOTE: If no other family members were living with the respondent, total family income was based on information about the respondent's total personal income. For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income. In 2006 and 2007, respondents were subdivided into two groups. One group received the same version of the income questions as in 2005 (long version), and the second received a reduced set of questions (short version). Respondents in both groups were asked about total personal income and total combined family income, but the respondents who received the short version were asked fewer questions about specific sources of income. In addition, the introductions to these total income questions differed between the two versions. In 2008, all respondents received the reduced set of income questions.

SEE: "Poverty Level (% of U.S. Census Bureau Poverty Threshold)."

Food Stamps
Food stamps are government-issued coupons that can be used to purchase food. Instead of coupons, some States issue a special card that can be used like a credit card to purchase food in grocery stores. In 2006 and 2007, a majority of respondents received two questions regarding food stamps: (a) their personal receipt of food stamps, and (b) whether another family member living in the household received food stamps. The remaining respondents received a reduced set of income questions, including a single question about whether the respondent or another family member in the household received food stamps. In 2008, all respondents received the reduced set of income questions, including a single question about food stamps.

NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income.

SEE: "Welfare Assistance."

Gang Fighting
Youths aged 12 to 17 were asked how many times during the past 12 months they had taken part in a fight where a group of their friends fought against another group. Response alternatives were (1) 0 times, (2) 1 or 2 times, (3) 3 to 5 times, (4) 6 to 9 times, or (5) 10 or more times.

SEE: "Delinquent Behavior" and "Stealing."

Geographic Division
Data are presented for nine geographic divisions within the four geographic regions. Within the Northeast Region are the New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) and the Middle Atlantic Division (New Jersey, New York, Pennsylvania). Within the Midwest Region are the East North Central Division (Illinois, Indiana, Michigan, Ohio, Wisconsin) and the West North Central Division (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota). Within the South Region are the South Atlantic Division (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia), the East South Central Division (Alabama, Kentucky, Mississippi, Tennessee), and the West South Central Division (Arkansas, Louisiana, Oklahoma, Texas). Within the West Region are the Mountain Division (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming) and the Pacific Division (Alaska, California, Hawaii, Oregon, Washington).

SEE: "Region."

Hallucinogen Use
Measures of use of hallucinogens in the respondent's lifetime, the past year, and the past month were developed from responses to the core question about recency of use: "How long has it been since you last used any hallucinogen?" Responses to noncore questions about the use of the following drugs, which were added to the survey in 2006, were not included in these measures: ketamine, DMT (dimethyltryptamine), AMT (alpha-methyltryptamine), 5-MeO-DIPT (5-methoxy-diisopropyltryptamine, also known as "Foxy"), and Salvia divinorum.

Feeder questions: "The next questions are about substances called hallucinogens. These drugs often cause people to see or experience things that are not real... Have you ever, even once, used LSD, also called acid? Have you ever, even once, used PCP, also called angel dust or phencyclidine? Have you ever, even once, used peyote? Have you ever, even once, used mescaline? Have you ever, even once, used psilocybin, found in mushrooms? Have you ever, even once, used Ecstasy, also known as MDMA? Have you ever, even once used any other hallucinogen besides the ones that have been listed?"

SEE: "Core," "Current Use," "Ecstasy Use," "Lifetime Use," "LSD Use," "Noncore," "Past Month Use," "Past Year Use," "PCP Use," "Prevalence," and "Recency of Use."

Health Insurance Status
A series of questions was asked to identify whether respondents currently were covered by Medicare, Medicaid, the State Children's Health Insurance Program (SCHIP), military health care (such as TRICARE or CHAMPUS), private health insurance, or any kind of health insurance (if respondents reported not being covered by any of the above). If respondents did not currently have health insurance coverage, questions were asked to determine the length of time they were without coverage and the reasons for not being covered.

NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income.

SEE: "Medicaid" and "Medicare."

Heavy Use of Alcohol
Heavy use of alcohol was defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on each of 5 or more days in the past 30 days. Heavy alcohol users also were defined as binge users of alcohol.

Feeder question: "How long has it been since you last drank an alcoholic beverage?"

SEE: "Alcohol Use" and "Binge Use of Alcohol."

Heroin Use
Measures of use of heroin in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used heroin?"

Feeder question: "These next questions are about heroin. Have you ever, even once, used heroin?"

SEE: "Current Use," "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

Hispanic
Hispanic was defined as anyone of Hispanic, Latino, or Spanish origin. Respondents were classified as Hispanic in the race/ ethnicity measure regardless of race.

SEE: "American Indian or Alaska Native," "Asian," "Black," "Race/Ethnicity," "Two or More Races," and "White."

Illicit Drugs
Illicit drugs include marijuana or hashish, cocaine (including crack), inhalants, hallucinogens (including phencyclidine [PCP], lysergic acid diethylamide [LSD], and Ecstasy [MDMA]), heroin, or prescription-type psychotherapeutics used nonmedically, which include stimulants, sedatives, tranquilizers, and pain relievers. Illicit drug use refers to use of any of these drugs based on responses to questions only in the core sections and does not include data from the noncore methamphetamine items that were added in 2005 and 2006. Responses to questions about the use of the following drugs, which were added to the survey beginning in 2006, were not included in these measures: GHB (gamma hydroxybutyrate), Adderall®, Ambien®, nonprescription cough or cold medicines, ketamine, DMT (dimethyltryptamine), AMT (alpha-methyltryptamine), 5-MeO-DIPT (5-methoxy-diisopropyltryptamine, also known as "Foxy"), and Salvia divinorum.

SEE: "Core," "Current Use," "Lifetime Use," "Noncore," "Past Month Use," "Past Year Use," "Prevalence," "Psychotherapeutic Drugs," and "Recency of Use."

Illicit Drugs Other Than Marijuana
These drugs include cocaine (including crack), inhalants, hallucinogens (including phencyclidine [PCP], lysergic acid diethylamide [LSD], and Ecstasy [MDMA]), heroin, or prescription-type psychotherapeutics used nonmedically, which include stimulants, sedatives, tranquilizers, and pain relievers. This measure includes marijuana users who used any of the above drugs in addition to using marijuana, as well as users of those drugs who have not used marijuana. Illicit drugs other than marijuana is defined based on responses to questions only in the core sections and does not include responses based on the noncore methamphetamine items that were added in 2005 and 2006. Responses to questions about the use of the following drugs, which were added to the survey beginning in 2006, were not included in these measures: GHB (gamma hydroxybutyrate), Adderall®, Ambien®, nonprescription cough or cold medicines, ketamine, DMT (dimethyltryptamine), AMT (alpha-methyltryptamine), and 5-MeO-DIPT (5-methoxy-diisopropyltryptamine, also known as "Foxy"), and Salvia divinorum.

SEE: "Core," "Current Use," "Lifetime Use," "Noncore," "Past Month Use," "Past Year Use," "Prevalence," "Psychotherapeutic Drugs," and "Recency of Use."

Incidence
Substance use incidence refers to the use of a substance for the first time (new use). Incidence estimates are based on questions about age at first use of substances, year and month of first use for recent initiates, the respondent's date of birth, and the interview date.

Incidence statistics in this report reflect first use occurring within the 12 months prior to the interview. This is referred to as past year incidence. For these statistics, respondents who are immigrants are included regardless of whether their first use occurred inside or outside the United States. See Section B.4.1 in Appendix B for additional details.

Income
SEE: "Family Income."

Inhalant Use
Measures of use of inhalants in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used any inhalant for kicks or to get high?"

Feeder questions: "These next questions are about liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good... Have you ever, even once, inhaled [INHALANT NAME] for kicks or to get high?" Respondents were asked about the following inhalants: (a) amyl nitrite, "poppers," locker room odorizers, or "rush"; (b) correction fluid, degreaser, or cleaning fluid; (c) gasoline or lighter fluid; (d) glue, shoe polish, or toluene; (e) halothane, ether, or other anesthetics; (f) lacquer thinner or other paint solvents; (g) lighter gases, such as butane or propane; (h) nitrous oxide or whippits; (i) spray paints; (j) some other aerosol spray; and (k) any other inhalants besides the ones that have been listed.

SEE: "Current Use," "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

Large Metro
SEE: "County Type."

Lifetime Daily Cigarette Use
A respondent was defined as being a lifetime daily cigarette user if he or she ever had a period in his or her life of smoking part or all of a cigarette every day for at least 30 days.

SEE: "Cigarette Use" and "Past Month Daily Cigarette Use."

Lifetime Use
Lifetime use indicates use of a specific substance at least once in the respondent's lifetime. This measure includes respondents who also reported last using the substance in the past 30 days or past 12 months.

SEE: "Current Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

Location of Most Recent Underage Alcohol Use
Respondents aged 12 to 20 who reported drinking at least one alcoholic beverage within the past 30 days were asked to indicate where they drank alcoholic beverages the last time they drank. The possible locations were (1) in a car or other vehicle; (2) at the respondent's home; (3) at someone else's home; (4) at a park, on a beach, or in a parking lot; (5) in a restaurant, bar, or club; (6) at a concert or sports game; (7) at school; or (8) some other place. Those who reported "some other place" were asked to write in a response indicating the specific location.

SEE: "Alcohol Use."

Low Precision
Prevalence estimates based on only a few respondents or with relatively large standard errors were not shown in the tables, but have been replaced with an asterisk (*) and noted as "low precision." These estimates have been omitted because one cannot place a high degree of confidence in their accuracy. See Table B.2 in Appendix B for a complete list of the rules used to determine low precision.

LSD Use
Measures of use of lysergic acid diethylamide (LSD) in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used LSD?"

SEE: "Current Use," "Ecstasy Use," "Hallucinogen Use," "Lifetime Use," "Past Month Use," "Past Year Use," "PCP Use," "Prevalence," and "Recency of Use."

Major Depressive Episode
A person was defined as having had a lifetime major depressive episode (MDE) if he or she had at least five or more of the following nine symptoms in the same 2-week period in his or her lifetime, in which at least one of the symptoms was a depressed mood or loss of interest or pleasure in daily activities: (1) depressed mood most of the day, nearly every day; (2) markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day; (3) significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day; (4) insomnia or hypersomnia nearly every day; (5) psychomotor agitation or retardation nearly every day; (6) fatigue or loss of energy nearly every day; (7) feelings of worthlessness nearly every day; (8) diminished ability to think or concentrate or indecisiveness nearly every day; and (9) recurrent thoughts of death or recurrent suicide ideation. This definition is based on the definition found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994). A person was defined as having an MDE in the past year if he or she had a lifetime MDE and a period of time in the past 12 months when he or she felt depressed or lost interest or pleasure in daily activities for 2 weeks or longer, while also having at least four of the other symptoms defined above for a lifetime MDE. See Section B.4.7 of Appendix B for additional details regarding the changes in the measurement of MDE in 2008.

SEE: "Severe Impairment Due to Major Depressive Episode."

Marijuana Use
Measures of use of marijuana in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used marijuana or hashish?" Responses to questions about use of cigars with marijuana in them (blunts) were not included in these measures.

Feeder question: "The next questions are about marijuana and hashish. Marijuana is also called pot or grass. Marijuana is usually smoked, either in cigarettes called joints, or in a pipe. It is sometimes cooked in food. Hashish is a form of marijuana that is also called hash. It is usually smoked in a pipe. Another form of hashish is hash oil. Have you ever, even once, used marijuana or hashish?"

SEE: "Blunts," "Current Use," "Illicit Drugs," "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," "Prior Year Marijuana Use," and "Recency of Use."

Medicaid
Medicaid is a public assistance program that pays for medical care for low-income and disabled persons. Respondents were asked specifically about the Medicaid program in the State where they lived. Respondents aged 12 to 19 were asked specifically about the State Children's Health Insurance Program (SCHIP) in their State. Respondents aged 12 to 19 who reported that they were covered by the SCHIP in their State also were classified as being covered by Medicaid. Respondents aged 65 or older who reported that they were covered by Medicaid were asked to verify that their answer was correct.

NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income.

SEE: "Health Insurance Status" and "Medicare."

Medicare
Medicare is a health insurance program for persons aged 65 or older and for certain disabled persons. Respondents under the age of 65 who reported that they were covered by Medicare were asked to verify that their answer was correct.

NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income.

SEE: "Health Insurance Status" and "Medicaid."

Mental Health Service Utilization
For adults aged 18 or older, mental health service utilization is defined as receiving treatment or counseling for any problem with emotions, nerves, or mental health in the 12 months prior to the interview in any inpatient or outpatient setting, or the use of prescription medication for treatment of any mental or emotional condition. Estimates for adults are based only on responses to items in the module on adult mental health service utilization.

For youths aged 12 to 17, mental health service utilization is defined as receiving within the 12 months prior to the interview treatment or counseling for any emotional or behavioral problem in the specialty mental health setting (inpatient or outpatient services); the education setting (school-based services); or the general medical setting (pediatrician or family physician services).

Treatment for only a substance use problem is not included for adults or youths.

SEE: "Prevalence" and "Unmet Need for Mental Health Services."

Mental Health Treatment
SEE: "Mental Health Service Utilization" and "Treatment for Major Depressive Episode."

Methamphetamine Use
Measures of use of methamphetamine (also known as crank, crystal, ice, or speed), Desoxyn®, or Methedrine® in the respondent's lifetime, the past year, and the past month were developed from responses to the core question about recency of use: "How long has it been since you last used methamphetamine, Desoxyn, or Methedrine?" In this report, estimates for the methamphetamine use measures from 2006 onward also include responses based on the noncore methamphetamine use items that were added in 2005 and 2006; estimates for 2002 through 2005 have been adjusted to make them comparable with estimates from 2006 onward that include responses to the noncore methamphetamine items. See Section B.4.8 of Appendix B for additional details.

SEE: "Core," "Current Use," "Lifetime Use," "Noncore," "Past Month Use," "Past Year Use," "Prevalence," "Recency of Use," "Source of Psychotherapeutic Drugs," and "Stimulant Use."

Midwest Region
The States included are those in the East North Central Division—Illinois, Indiana, Michigan, Ohio, and Wisconsin—and the West North Central Division—Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota.

SEE: "Geographic Division" and "Region."

Native Hawaiian or Other Pacific Islander
Native Hawaiian or Other Pacific Islander, not of Hispanic, Latino, or Spanish origin; does not include respondents reporting two or more races. (Respondents reporting that they were Native Hawaiian or Other Pacific Islander and of Hispanic, Latino, or Spanish origin were classified as Hispanic.)

SEE: "Hispanic" and "Race/Ethnicity."

Need for Alcohol Use Treatment
Respondents were classified as needing treatment for an alcohol use problem if they met at least one of three criteria during the past year: (1) dependence on alcohol; (2) abuse of alcohol; or (3) received treatment for alcohol use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient only], or mental health center).

SEE: "Abuse," "Dependence," "Prevalence," "Specialty Substance Use Treatment Facility," and "Treatment for a Substance Use Problem."

Need for Illicit Drug or Alcohol Use Treatment
Respondents were classified as needing treatment for an illicit drug or alcohol use problem if they met at least one of three criteria during the past year: (1) dependence on illicit drugs or alcohol; (2) abuse of illicit drugs or alcohol; or (3) received treatment for illicit drug or alcohol use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient only], or mental health center).

SEE: "Abuse," "Dependence," "Prevalence," "Specialty Substance Use Treatment Facility," and "Treatment for a Substance Use Problem."

Need for Illicit Drug Use Treatment
Respondents were classified as needing treatment for an illicit drug use problem if they met at least one of three criteria during the past year: (1) dependence on illicit drugs; (2) abuse of illicit drugs; or (3) received treatment for illicit drug use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient only], or mental health center).

SEE: "Abuse," "Dependence," "Prevalence," "Specialty Substance Use Treatment Facility," and "Treatment for a Substance Use Problem."

Nicotine (Cigarette) Dependence
A respondent was defined as having nicotine (cigarette) dependence if he or she met either the dependence criteria derived from the Nicotine Dependence Syndrome Scale (NDSS) or the Fagerstrom Test of Nicotine Dependence (FTND). See Section B.4.2 of Appendix B for additional details.

SEE: "Cigarette Use," "Dependence," and "Prevalence."

Noncash Assistance
Noncash assistance refers to assistance that is not in the form of direct monetary payments due to low income, such as help getting a job, placement in an education or job training program, or help with transportation, child care, or housing. In 2006 and 2007, a majority of respondents received two questions regarding noncash assistance: (a) their personal receipt of noncash assistance, and (b) whether another family member living in the household received noncash assistance. The remaining respondents received a reduced set of income questions where the latter question was excluded. In 2008, all respondents received the reduced set of income questions, including a single question about noncash assistance.

NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income.

SEE: "Cash Assistance" and "Welfare Assistance."

Noncore
A core set of unaltered questions (consisting of demographic items and modules on the use of tobacco, alcohol, marijuana, cocaine, crack cocaine, heroin, hallucinogens, inhalants, pain relievers, tranquilizers, stimulants, and sedatives) is critical for basic trend measurement of prevalence estimates. This core set remains in the survey every year and comprises the first part of the interview. Supplemental or "noncore" questions, or modules, can be revised, dropped, or added from year to year and make up the latter part of the interview. Supplemental topics in the remaining self-administered sections include (but are not limited to) injection drug use, perceived risks of substance use, substance dependence or abuse, arrests, treatment for substance use problems, pregnancy and health care issues, and mental health issues. Supplemental demographic questions (which are interviewer-administered and follow the audio computer-assisted self-interviewing [ACASI] questions) address such topics as immigration, current school enrollment, employment and workplace issues, health insurance coverage, and income. It should be noted that some of the supplemental portions of the interview have remained in the survey, relatively unchanged, from year to year (e.g., current health insurance coverage, employment).

SEE: "Core."

Nonmedical Use of Psychotherapeutics
A core section of the interview instrument deals with nonmedical use of four classes of prescription-type psychotherapeutics: pain relievers, sedatives, stimulants, and tranquilizers. Nonmedical use is defined as use of at least one of these medications without a prescription belonging to the respondent or use that occurred simply for the experience or feeling the drug caused. In this report, estimates for the measures of nonmedical use of psychotherapeutics from 2006 onward also include responses based on the noncore methamphetamine use items that were added in 2005 and 2006; estimates for 2002 through 2005 have been adjusted to make them comparable with estimates from 2006 onward that include responses to the noncore methamphetamine items. Responses to questions about the nonmedical use of Adderall® (a stimulant) and Ambien® (a sedative), which were added to the survey in 2006, were not included in these measures.

Measures of use of nonmedical psychotherapeutic agents in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used any prescription [pain reliever, sedative, stimulant, or tranquilizer] that was not prescribed for you or that you took only for the experience or feeling it caused?"

Feeder question: "Now we have some questions about drugs that people are supposed to take only if they have a prescription from a doctor. We are only interested in your use of a drug if the drug was not prescribed for you, or if you took the drug only for the experience or feeling it caused."

NOTE: The pill card contains pictures and names of specific drugs within each psychotherapeutic category. For example, pictures and the names of Valium®, Librium®, and other tranquilizers are shown when the section on tranquilizers is introduced.

SEE: "Core," "Current Use," "Lifetime Use," "Methamphetamine Use," "Noncore," "Pain Reliever Use," "Past Month Use," "Past Year Use," "Pill Cards," "Prevalence," "Psychotherapeutic Drugs," "Recency of Use," "Sedative Use," "Source of Psychotherapeutic Drugs," "Stimulant Use," and "Tranquilizer Use."

Nonmetro
SEE: "County Type."

Northeast Region
The States included are those in the New England Division—Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont—and the Middle Atlantic Division—New Jersey, New York, and Pennsylvania.

SEE: "Geographic Division" and "Region."

OxyContin® Use
Measures of use of the prescription pain reliever OxyContin® in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used OxyContin that was not prescribed for you or that you took only for the experience or feeling it caused?" For additional details, see Section B.5.1 of Appendix B of the 2004 NSDUH's national results report (OAS, 2005).

SEE: "Current Use," "Lifetime Use," "Pain Reliever Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

Pain Reliever Use
Measures of the nonmedical use of prescription-type pain relievers in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used any prescription pain reliever that was not prescribed for you, or that you took only for the experience or feeling it caused?"

Feeder question: "These questions are about the use of pain relievers. We are not interested in your use of over-the-counter pain relievers such as aspirin, Tylenol, or Advil that can be bought in drug stores or grocery stores without a doctor's prescription. Card A shows pictures of some different types of prescription pain relievers and lists the names of some others. These pictures show only pills, but we are interested in your use of any form of prescription pain relievers that were not prescribed for you or that you took only for the experience or feeling they caused."

The following prescription pain relievers were listed on Pill Card A (Pain Relievers): (1) Darvocet®, Darvon®, or Tylenol® with Codeine; (2) Percocet®, Percodan®, or Tylox®; (3) Vicodin®, Lortab®, or Lorcet®/Lorcet Plus®; (4) Codeine; (5) Demerol®; (6) Dilaudid®; (7) Fioricet®; (8) Fiorinal®; (9) Hydrocodone; (10) Methadone; (11) Morphine; (12) OxyContin®; (13) Phenaphen® with Codeine; (14) Propoxyphene; (15) SK-65®; (16) Stadol® (no picture); (17) Talacen®; (18) Talwin®; (19) Talwin NX®; (20) Tramadol (no picture); and (21) Ultram®.

SEE: "Current Use," "Lifetime Use," "Nonmedical Use of Psychotherapeutics," "OxyContin® Use," "Past Month Use," "Past Year Use," "Pill Cards," "Prevalence," "Psychotherapeutic Drugs," "Recency of Use," "Sedative Use," "Source of Psychotherapeutic Drugs," "Stimulant Use," and "Tranquilizer Use."

Past Month Daily Cigarette Use
A respondent was defined as being a past month daily cigarette user if he or she smoked part or all of a cigarette on each of the past 30 days.

Feeder question: "Now think about the past 30 days – that is, from [DATEFILL] up to and including today. During the past 30 days, have you smoked part or all of a cigarette?"

SEE: "Cigarette Use" and "Lifetime Daily Cigarette Use."

Past Month Use
This measure indicates use of a specific substance in the 30 days prior to the interview. Respondents who indicated past month use of a specific substance also were classified as lifetime and past year users.

SEE: "Current Use," "Lifetime Use," "Past Year Use," "Prevalence," and "Recency of Use."

Past Year Incidence
SEE: "Incidence."

Past Year Use
This measure indicates use of a specific substance in the 12 months prior to the interview. This definition includes those respondents who last used the substance in the 30 days prior to the interview. Respondents who indicated past year use of a specific substance also were classified as lifetime users.

SEE: "Current Use," "Lifetime Use," "Past Month Use," "Prevalence," and "Recency of Use."

PCP Use
Measures of use of phencyclidine (PCP) in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used PCP?"

SEE: "Current Use," "Ecstasy Use," "Hallucinogen Use," "Lifetime Use," "LSD Use," "Past Month Use," "Past Year Use," "Prevalence," and "Recency of Use."

Perceived Availability
Respondents were asked to assess how difficult or easy it would be for them to get various illicit drugs if they wanted these drugs. Response alternatives were (1) probably impossible, (2) very difficult, (3) fairly difficult, (4) fairly easy, and (5) very easy.

Perceived Need for Alcohol Use Treatment
Respondents were classified as perceiving a need for alcohol use treatment if they reported feeling a need for alcohol use treatment when asked, "During the past 12 months, did you need treatment or counseling for your alcohol use?" or if they indicated feeling a need for additional treatment specifically for alcohol use when asked, "During the past 12 months, for which of the following drugs did you need additional treatment or counseling?"

SEE: "Prevalence" and "Treatment for a Substance Use Problem."

Perceived Need for Illicit Drug or Alcohol Use Treatment
Respondents were classified as perceiving a need for illicit drug or alcohol use treatment if they were classified as either perceiving a need for illicit drug use treatment or perceiving a need for alcohol use treatment.

SEE: "Perceived Need for Alcohol Use Treatment" and "Perceived Need for Illicit Drug Use Treatment."

Perceived Need for Illicit Drug Use Treatment
Respondents were classified as perceiving a need for illicit drug use treatment if they reported feeling a need for treatment for the use of one or more drugs when asked specifically about each of the individual drugs they had indicated using, "During the past 12 months, did you need treatment or counseling for your use of (drug)?" They also were classified as perceiving a need for illicit drug use treatment if they indicated feeling a need for additional treatment specifically for the use of one or more drugs when asked, "During the past 12 months, for which of the following drugs did you need additional treatment or counseling?" The response list of drugs included marijuana/hashish, cocaine or crack, heroin, hallucinogens, inhalants, pain relievers, tranquilizers, stimulants, sedatives, or some other drug.

SEE: "Prevalence" and "Treatment for a Substance Use Problem."

Perceived Risk/Harmfulness
Respondents were asked to assess the extent to which people risk harming themselves physically and in other ways when they use various illicit drugs, alcohol, and cigarettes, with various levels of frequency. Response alternatives were (1) no risk, (2) slight risk, (3) moderate risk, and (4) great risk.

Percentages
In this report, all of the tables contain percentages based on weighted data.

SEE: "Rounding."

Pill Cards
The pill cards contain pictures and names of specific drugs within each psychotherapeutic category. For example, pictures and the names of Valium®, Librium®, and other tranquilizers are shown when the questionnaire section on tranquilizers is introduced.

SEE: "Current Use," "Lifetime Use," "Nonmedical Use of Psychotherapeutics," "Pain Reliever Use," "Past Month Use," "Past Year Use," "Prevalence," "Psychotherapeutic Drugs," "Recency of Use," "Sedative Use," "Stimulant Use," and "Tranquilizer Use."

Poverty Level (% of U.S. Census Bureau Poverty Threshold)
This measure is a comparison of a respondent's total family income with the U.S. Census Bureau's poverty thresholds (both measured in dollar amounts) in order to determine the poverty status of the respondent and his or her family. Information on family income, size, and composition (i.e., number of children) and the respondent's age is used to determine the respondent's poverty level. The poverty level is calculated as a percentage of the poverty threshold by dividing the respondent's reported total family income by the appropriate poverty threshold amount. Thus, if a family's total income is less than the family's poverty threshold, then that family and every individual in it is considered to be in poverty (i.e., less than 100 percent of the U.S. census poverty threshold). Accordingly, if a family's total income is greater than the poverty threshold but less than twice the poverty threshold, then that family and every individual in it is classified as being 100 to 199 percent of the U.S. census poverty threshold. Because of changes in the creation of the poverty-level measure in 2006, estimates are not comparable with similar estimates published in NSDUH reports prior to 2006.

SEE: "Family Income."

Prevalence
Prevalence is a general term used to describe the estimates for lifetime, past year, and past month substance use, dependence or abuse, or other behaviors of interest within a given period (e.g., the past 12 months). Other behaviors of interest include delinquent behavior, driving under the influence of alcohol or drugs, mental health service utilization, perceived need for alcohol or illicit drug use treatment, serious psychological distress, treatment for a substance use problem, and unmet need for mental health services.

SEE: "Abuse," "Current Use," "Delinquent Behavior," "Dependence," "Driving Under the Influence," "Mental Health Service Utilization," "Need for Illicit Drug or Alcohol Use Treatment," "Nicotine (Cigarette) Dependence," "Perceived Need for Alcohol Use Treatment," "Perceived Need for Illicit Drug or Alcohol Use Treatment," "Perceived Need for Illicit Drug Use Treatment," "Recency of Use," "Serious Mental Illness," "Serious Psychological Distress," "Treatment for a Substance Use Problem," and "Unmet Need for Mental Health Services."

Prior Year Marijuana Use
A respondent was defined as engaging in prior year marijuana use if he or she used marijuana or hashish 12 to 23 months prior to the interview date. Prior Year Marijuana Use is different from Past Year Marijuana Use because Past Year Marijuana Use indicates use in the past 12 calendar months prior to the interview date, whereas Prior Year Marijuana Use is defined as using marijuana in the year prior to the past year (12 calendar months prior to the interview date) or within 12 to 23 months prior to the interview date.

SEE: "Marijuana Use."

Psychotherapeutic Drugs
Psychotherapeutic drugs are prescription-type medications with legitimate medical uses as pain relievers, tranquilizers, stimulants, and sedatives. The interview instrument covers nonmedical use of these drugs, which involves use without a prescription belonging to the respondent or use that occurred simply for the experience or feeling the drug caused. In this report, estimates for psychotherapeutic drug measures from 2006 onward include responses based on the core questions about nonmedical use of psychotherapeutics and the noncore methamphetamine use items that were added in 2005 and 2006; estimates for 2002 through 2005 have been adjusted to make them comparable with estimates from 2006 onward that include responses to the noncore methamphetamine items.

SEE: "Core," "Current Use," "Lifetime Use," "Methamphetamine Use," "Noncore," "Nonmedical Use of Psychotherapeutics," "Pain Reliever Use," "Past Month Use," "Past Year Use," "Pill Cards," "Prevalence," "Recency of Use," "Sedative Use," "Source of Psychotherapeutic Drugs," "Stimulant Use," and "Tranquilizer Use."

Race/Ethnicity
Race/ethnicity is used to refer to the respondent's self-classification of racial and ethnic origin and identification. For Hispanic origin, respondents were asked, "Are you of Hispanic, Latino, or Spanish origin or descent?" For race, respondents were asked, "Which of these groups best describes you?" Response alternatives were (1) white, (2) black/African American, (3) American Indian or Alaska Native, (4) Native Hawaiian, (5) Other Pacific Islander, (6) Asian, and (7) Other. Categories for a combined race/ethnicity variable included Hispanic; non-Hispanic groups where respondents indicated only one race (white, black, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, Asian); and non-Hispanic groups where respondents reported two or more races. These categories are based on classifications developed by the U.S. Census Bureau.

SEE: "American Indian or Alaska Native," "Asian," "Black," "Hispanic," "Native Hawaiian or Other Pacific Islander," "Two or More Races," and "White."

Recency of Use
The recency question for each substance was the source for the lifetime, past year, and past month prevalence estimates.

The question was essentially the same for all classes of substances. The question was: "How long has it been since you last used [substance name]?" For the four classes of psychotherapeutics, the phrase "that was not prescribed for you or only for the experience or feeling it caused" was added after the name of the drug.

For tobacco products (cigarettes, snuff, chewing tobacco, or cigars), a question first was asked about use in the past 30 days. If the respondent did not use the product in the past 30 days, the recency question was asked as above, with the response alternatives (1) more than 30 days ago but within the past 12 months; (2) more than 12 months ago but within the past 3 years; and (3) more than 3 years ago. For the remaining substances, the response alternatives were (1) within the past 30 days; (2) more than 30 days ago but within the past 12 months; and (3) more than 12 months ago.

SEE: "Current Use," "Lifetime Use," "Past Month Use," "Past Year Use," and "Prevalence."

Region
Four regions, Northeast, Midwest, South, and West, are based on classifications developed by the U.S. Census Bureau.

SEE: "Geographic Division," "Midwest Region," "Northeast Region," "South Region," and "West Region."

Rounding
The decision rules for the rounding of percentages were as follows. If the second number to the right of the decimal point was greater than or equal to 5, the first number to the right of the decimal point was rounded up to the next higher number. If the second number to the right of the decimal point was less than 5, the first number to the right of the decimal point remained the same. Thus, a prevalence estimate of 16.55 percent would be rounded to 16.6 percent, while an estimate of 16.44 percent would be rounded to 16.4 percent. Although the percentages in the tables generally total 100 percent, the use of rounding sometimes produces a total of slightly less than or more than 100 percent.

SEE: "Percentages."

Sedative Use
Measures of the nonmedical use of prescription-type sedatives in the respondent's lifetime, the past year, and the past month were developed from responses to the core question about recency of use: "How long has it been since you last used any prescription sedative that was not prescribed for you, or that you took only for the experience or feeling it caused?" Responses to noncore questions about use of the prescription sedative Ambien®, which were added to the survey in 2006, were not included in these measures.

Feeder question: "These next questions ask about the use of sedatives or barbiturates. These drugs are also called downers or sleeping pills. People take these drugs to help them relax or to help them sleep. We are not interested in the use of over-the-counter sedatives such as Sominex, Unisom, Nytol, or Benadryl that can be bought in drug stores or grocery stores without a doctor's prescription. Card D shows pictures of different kinds of prescription sedatives and lists the names of some others. These pictures show only pills, but we are interested in your use of any form of prescription sedatives that were not prescribed for you or that you took only for the experience or feeling they caused."

The following prescription sedatives were listed on Pill Card D (Sedatives): (1) Methaqualone (includes Sopor®, Quaalude®) (no picture); (2) Nembutal®, Pentobarbital (no picture), Seconal®, Secobarbital (no picture), or Butalbital (no picture); (3) Restoril® or Temazepam; (4) Amytal®; (5) Butisol®; (6) Chloral Hydrate (no picture); (7) Dalmane®; (8) Halcion®; (9) Phenobarbital; (10) Placidyl®; and (11) Tuinal®.

SEE: "Core," "Current Use," "Lifetime Use," "Noncore," "Nonmedical Use of Psychotherapeutics," "Pain Reliever Use," "Past Month Use," "Past Year Use," "Pill Cards," "Prevalence," "Psychotherapeutic Drugs," "Recency of Use," "Source of Psychotherapeutic Drugs," "Stimulant Use," and "Tranquilizer Use."

Self-Help Group
NSDUH has collected data on self-help groups because they may be potential locations of treatment for a substance use problem. Respondents who reported that they received treatment for their use of alcohol or drugs in the past 12 months were asked whether they received treatment in a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous; these groups were not considered specialty substance use treatment facilities. Beginning with the 2006 survey, respondents also were asked whether they attended self-help groups in the past 12 months to receive help for their alcohol or drug use, regardless of whether they previously reported receiving any treatment in the past 12 months.

SEE: "Specialty Substance Use Treatment Facility" and "Treatment for a Substance Use Problem."

Serious Mental Illness
SMI among adults is defined in Public Law 102-321 as persons aged 18 or older who currently or at any time in the past year have had diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within DSM-IV that has resulted in functional impairment, which substantially interferes with or limits one or more major life activities. NSDUH respondents' SMI status was determined based on modeling their responses to questions on distress (K6 scale) and impairment (truncated version of the World Health Organization Disability Assessment Schedule [WHODAS] for half the sample and the Sheehan Disability Scale [SDS] for the other half). See Section B.4.6 in Appendix B for additional details on model specification and how this variable was defined.

SEE: "Prevalence," "Serious Psychological Distress," "Severe Impairment Due to Major Depressive Episode," "Sheehan Disability Scale (SDS)," and "World Health Organization Disability Assessment Schedule (WHODAS)."

Serious Psychological Distress
Serious psychological distress (SPD) is defined as having a score of 13 or higher on the 30-day K6 scale. Starting in 2008, respondents aged 18 or older were first asked six questions about how they have been feeling during the past 30 days. Following the 30-day distress questions, respondents were asked whether there was a month in the past 12 months when they felt worse emotionally than they felt in the past 30 days. If there was such a month, the K6 items were asked about that worst month. With the availability of the new 30-day questions, past month SPD is being reported instead of past year SPD. Because of this difference, SPD estimates presented in this report are not comparable with SPD estimates in earlier reports. See Section B.4.5 of Appendix B for additional details.

SEE: "Prevalence" and "Serious Mental Illness."

Severe Impairment Due to Major Depressive Episode
Severe impairment in adults is defined by the level of role interference reported to be caused by major depressive episode (MDE) in the past 12 months. The Sheehan Disability Scale (SDS) role domains are assessed on a 0 to 10 visual analog scale with impairment categories of "none" (0), "mild" (1-3), "moderate" (4-6), "severe" (7-9), and "very severe" (10). For adults aged 18 or older, the SDS role domains are (1) home management, (2) work, (3) close relationships with others, and (4) social life. For youths aged 12 to 17, the SDS role domains are (1) chores at home, (2) school or work, (3) close relationships with family, and (4) social life. Ratings of 7 or greater in one or more role domains are classified as severe impairment. See Section B.4.7 of Appendix B for additional details.

SEE: "Major Depressive Episode," "Sheehan Disability Scale (SDS)," and "Serious Mental Illness."

Sheehan Disability Scale (SDS)
The Sheehan Disability Scale (SDS) consists of a series of four questions that are used to measure impairment in a person's daily functioning. The SDS role domains are assessed on a 0 to 10 visual analog scale with impairment categories of "none" (0), "mild" (1-3), "moderate" (4-6), "severe" (7-9), and "very severe" (10). For adults aged 18 or older, the SDS role domains are (1) home management, (2) work, (3) close relationships with others, and (4) social life. For youths aged 12 to 17, the SDS role domains are (1) chores at home, (2) school or work, (3) close relationships with family, and (4) social life. Ratings of 7 or greater are classified as severe impairment. Adult respondents were asked about interference caused by major depressive episode (MDE) and also about interference due to their emotions, nerves, or mental health. Respondents aged 12 to 17 were asked about interference caused by MDE. Summing across the four responses resulted in a total score with a range from 0 to 40.

SEE: "Prevalence," "Serious Mental Illness," "Serious Psychological Distress," "Severe Impairment Due to Major Depressive Episode," and "World Health Organization Disability Assessment Schedule (WHODAS)."

Significance
For tables in which trends over time were shown, statistically significant differences between estimates from two different time points (e.g., 2007 and 2008) were identified at two levels: 0.05 and 0.01. Thus, estimates with different values that did not meet the criteria for statistical significance were not considered to be different from one another. In the text of this report, a significance level of 0.05 was used to determine whether estimates from different demographic subgroups were statistically different.

Small Metro
SEE: "County Type."

Smokeless Tobacco Use
Measures of use of smokeless tobacco in the respondent's lifetime, the past year, and the past month were developed from responses to the questions about snuff and chewing tobacco use in the past 30 days and the recency of use (if not in the past 30 days): "Now think about the past 30 days—that is, from [DATEFILL] up to and including today. During the past 30 days, have you used snuff, even once?" "How long has it been since you last used snuff?" "Now think about the past 30 days—that is, from [DATEFILL] up to and including today. During the past 30 days, have you used chewing tobacco, even once?" and "How long has it been since you last used chewing tobacco?"

Feeder questions: "These next questions are about your use of snuff, sometimes called dip... Have you ever used snuff, even once?" and "These next questions are only about chewing tobacco... Have you ever used chewing tobacco, even once?"

SEE: "Cigar Use," "Cigarette Use," "Current Use," "Lifetime Use," "Past Month Use," "Past Year Use," "Prevalence," "Recency of Use," and "Tobacco Product Use."

Social Context of Most Recent Alcohol Use
Respondents aged 12 to 20 who reported drinking at least one alcoholic beverage within the past 30 days were asked if they were alone, with one other person, or with more than one person the last time they drank.

SEE: "Alcohol Use."

Source of Alcohol for Most Recent Underage Alcohol Use
Respondents aged 12 to 20 who reported drinking at least one alcoholic beverage within the past 30 days were asked questions pertaining to the source of the alcohol for their most recent alcohol use. The sources were (1) purchased it himself or herself; (2) it was purchased by someone else; (3) received it from a parent or guardian; (4) received it from another family member aged 21 or older; (5) received it from an unrelated person aged 21 or older; (6) received it from someone under age 21; (7) took it from own home; (8) took it from someone else's home; or (9) got it some other way.

The questions on the source of last alcohol use are presented in two categories: (a) respondent paid (he or she purchased the alcohol or gave someone else money to purchase the alcohol), and (b) respondent did not pay (he or she received the alcohol for free from someone or took the alcohol from his or her own or someone else's home).

SEE: "Alcohol Use."

Source of Psychotherapeutic Drugs
There are two measures of the source of psychotherapeutic drugs (prescription pain relievers, prescription tranquilizers, prescription stimulants, methamphetamine, and prescription sedatives) used nonmedically: (a) how respondents obtained these drugs the last time they used them nonmedically and (b) how respondents obtained these drugs for any nonmedical use in the past month. Beginning in 2006, respondents who reported that they obtained these drugs from a friend or relative for free were asked how the friend or relative obtained them. For all of these drugs except methamphetamine, response options for the source of the medications were as follows: (a) got a prescription from just one doctor; (b) got prescriptions from more than one doctor; (c) wrote a fake prescription; (d) stole from a doctor's office, clinic, hospital, or pharmacy; (e) got from a friend or relative for free; (f) bought from a friend or relative; (g) took from a friend or relative without asking; (h) bought from a drug dealer or other stranger; (i) bought on the Internet; and (j) got in some other way (includes other sources specified by respondents). Methamphetamine users were presented with options (e) through (j) only.

If respondents last used a psychotherapeutic drug nonmedically in the past 30 days and reported getting that drug from only one source, the source of the psychotherapeutic drug for the most recent use measure was based on that answer. For respondents who reported getting a psychotherapeutic drug from multiple sources in the past 30 days or who last misused that drug more than 30 days ago but in the past 12 months, the source of the psychotherapeutic drug for the most recent use measure was based on their answer to a question about how they got that drug the last time they used it nonmedically. The source of the psychotherapeutic drug for any use in the past month was based only on the answer to the question about sources in the past 30 days.

Measures of the source of methamphetamine differ from all other measures regarding the source of psychotherapeutic drugs in that they include respondents who reported methamphetamine use in the stimulants module and respondents who reported methamphetamine use in the special drugs module who did not initially report methamphetamine use in the stimulants module because they did not consider it to be a prescription drug. All other measures of the source of psychotherapeutic drugs only include respondents who reported psychotherapeutic drug use in their respective core drug modules.

Feeder questions from the drug modules: "Earlier, the computer recorded that, during the past 30 days, you used [prescription pain relievers, prescription tranquilizers, prescription stimulants, methamphetamine, prescription sedatives] that were not prescribed for you or that you took only for the experience or feeling it caused. How did you get these [fill in relevant drug name from above]? Please enter all the ways that you got the [fill in relevant drug name from above] you used in the past 30 days."

"Now think about the last time you used [a prescription pain reliever, a prescription tranquilizer, a prescription stimulant, methamphetamine, a prescription sedative] that was not prescribed for you or that you took only for the experience or feeling it caused. How did you get this [fill in relevant drug name from above]?"

Feeder questions from the special drugs module: "Earlier, the computer recorded that you have never used Methamphetamine, Desoxyn, or Methedrine."

"Why did you report earlier that you had never used Methamphetamine?"

SEE: "Core," "Methamphetamine Use," "Noncore," "Nonmedical Use of Psychotherapeutics," "Pain Reliever Use," "Psychotherapeutic Drugs," "Sedative Use," "Stimulant Use," and "Tranquilizer Use."

South Region
The States included are those in the South Atlantic Division—Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia; the East South Central Division—Alabama, Kentucky, Mississippi, and Tennessee; and the West South Central Division—Arkansas, Louisiana, Oklahoma, and Texas.

SEE: "Geographic Division" and "Region."

Specialty Substance Use Treatment Facility
Defined as a drug or alcohol rehabilitation facility (inpatient or outpatient), a hospital (inpatient services only), and a mental health center.

SEE: "Need for Illicit Drug or Alcohol Use Treatment," "Self-Help Group," and "Treatment for a Substance Use Problem."

Stealing
Respondents were asked how many times during the past 12 months they had stolen or tried to steal anything worth more than $50. Response alternatives were (1) 0 times, (2) 1 or 2 times, (3) 3 to 5 times, (4) 6 to 9 times, or (5) 10 or more times.

This item was asked of the 12 to 17 age group and of those aged 18 or older.

SEE: "Delinquent Behavior" and "Gang Fighting."

Stimulant Use
Measures of nonmedical use of prescription-type stimulants in the respondent's lifetime, the past year, and the past month were developed from responses to the core questions about recency of use: "How long has it been since you last used any prescription stimulant that was not prescribed for you or that you took only for the experience or feeling it caused?" and "How long has it been since you last used Methamphetamine, Desoxyn, or Methedrine?" In this report, estimates for the stimulant use measures from 2006 onward included responses based on the noncore methamphetamine use items that were added in 2005 and 2006; estimates for 2002 through 2005 have been adjusted to make them comparable with estimates from 2006 onward that include responses to the noncore methamphetamine items. However, measures of stimulant use do not include data from noncore questions added to the survey in 2006 about the use of the prescription stimulant Adderall®.

Feeder question: "These next questions are about the use of drugs such as amphetamines that are known as stimulants, uppers, or speed. People sometimes take these drugs to lose weight, to stay awake, or for attention deficit disorders. We are not interested in the use of over-the-counter stimulants such as Dexatrim or No-Doz that can be bought in drug stores or grocery stores without a doctor's prescription. Card C shows pictures of some different kinds of prescription stimulants and lists the names of some others. These pictures show only pills, but we are interested in your use of any form of prescription stimulants that were not prescribed for you or that you took only for the experience or feeling it caused."

The following prescription stimulants were listed on Pill Card C (Stimulants): (1) Methamphetamine (crank, crystal, ice, or speed) (no picture), Desoxyn®, or Methedrine® (no picture); (2) Amphetamines (no picture), Benzedrine®, Biphetamine®, Fastin®, or Phentermine; (3) Ritalin® or Methylphenidate; (4) Cylert®; (5) Dexedrine®; (6) Dextroamphetamine (no picture); (7) Didrex®; (8) Eskatrol®; (9) Ionamin®; (10); Mazanor®; (11) Obedrin-LA® (no picture); (12) Plegine®; (13) Preludin®; (14) Sanorex®; and (15) Tenuate®.

SEE: "Core," "Current Use," "Lifetime Use," "Methamphetamine Use," "Noncore," "Nonmedical Use of Psychotherapeutics," "Pain Reliever Use," "Past Month Use," "Past Year Use," "Pill Cards," "Prevalence," "Psychotherapeutic Drugs," "Recency of Use," "Sedative Use," "Source of Psychotherapeutic Drugs," and "Tranquilizer Use."

Substance Use Treatment
SEE: "Treatment for a Substance Use Problem."

Suicide
Adults aged 18 or older were asked whether they had seriously thought about, made any plans, or attempted to kill themselves at any time during the past 12 months, or if they had received medical attention from a health professional or stayed overnight in a hospital in the past 12 months because of a suicide attempt.

SEE: "Prevalence."

Supplemental Security Income (SSI)
Supplemental Security Income (SSI) is a governmental program that makes assistance payments to low-income, aged, blind, and disabled persons. In 2006 and 2007, a majority of respondents received two questions regarding SSI: (a) their personal receipt of SSI, and (b) whether another family member living in the household received cash assistance. The remaining respondents received a reduced set of income questions, including a single question about whether the respondent or another family member in the household received SSI. In 2008, all respondents received the reduced set of income questions, including a single question about SSI.

NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income.

SEE: "Welfare Assistance."

Tobacco Product Use
This measure indicates use of any tobacco product: cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco. Tobacco product use in the past year includes past month pipe tobacco use. Tobacco product use in the past year does not include use of pipe tobacco more than 30 days ago but within 12 months of the interview because the survey did not capture this information. Measures of tobacco product use in the respondent's lifetime, the past year, or the past month also do not include use of cigars with marijuana in them (blunts).

SEE: "Blunts," "Cigar Use," "Cigarette Use," and "Smokeless Tobacco Use."

Total Family Income
SEE: "Family Income."

Tranquilizer Use
Measures of the nonmedical use of prescription-type tranquilizers in the respondent's lifetime, the past year, and the past month were developed from responses to the question about recency of use: "How long has it been since you last used any prescription tranquilizer that was not prescribed for you, or that you took only for the experience or feeling it caused?"

Feeder question: "These next questions ask about the use of tranquilizers. Tranquilizers are usually prescribed to relax people, to calm people down, to relieve anxiety, or to relax muscle spasms. Some people call tranquilizers nerve pills. Card B shows pictures of some different kinds of prescription tranquilizers. These pictures show only pills, but we are interested in your use of any form of prescription tranquilizers that were not prescribed for you, or that you took only for the experience or feeling they caused."

The following prescription tranquilizers were listed on Pill Card B (Tranquilizers): (1) Klonopin® or Clonazepam; (2) Xanax®, Alprazolam, Ativan®, or Lorazepam; (3) Valium® or Diazepam; (4) Atarax®; (5) BuSpar®; (6) Equanil®; (7) Flexeril®; (8) Librium®; (9) Limbitrol®; (10) Meprobamate; (11) Miltown®; (12) Rohypnol®; (13) Serax®; (14) Soma®; (15) Tranxene®; and (16) Vistaril®.

SEE: "Current Use," "Lifetime Use," "Nonmedical Use of Psychotherapeutics," "Pain Reliever Use," "Past Month Use," "Past Year Use," "Pill Cards," "Prevalence," "Psychotherapeutic Drugs," "Recency of Use," "Sedative Use," "Source of Psychotherapeutic Drugs," and "Stimulant Use."

Treatment for Depression
Treatment for depression is defined as seeing or talking to a medical doctor or other professional or using prescription medication in the past year for depression.

Treatment for Major Depressive Episode
Treatment for major depressive episode (MDE) is the same as treatment for depression. In this report, treatment for depression refers to treatment among those classified with past year MDE.

SEE: "Major Depressive Episode" and "Treatment for Depression."

Treatment for a Substance Use Problem
Respondents were asked whether they had received treatment for illicit drug use, alcohol use, or both illicit drug and alcohol use in the past 12 months in any of the following locations: a hospital overnight as an inpatient, a residential drug or alcohol rehabilitation facility where they stayed overnight, a drug or alcohol rehabilitation facility as an outpatient, a mental health facility as an outpatient, an emergency room, a private doctor's office, a prison or jail, a self-help group, or some other place.

SEE: "Alcohol Use," "Illicit Drugs," "Need for Illicit Drug or Alcohol Use Treatment," "Prevalence," "Self-Help Group," and "Specialty Substance Use Treatment Facility."

Two or More Races
Respondents were asked to report which racial group describes them. Response alternatives were (1) white, (2) black or African American, (3) American Indian or Alaska Native, (4) Native Hawaiian, (5) Other Pacific Islander, (6) Asian, and (7) Other. Respondents were allowed to choose more than one of these groups. Persons who chose both the "Native Hawaiian" and "Other Pacific Islander" categories (and no additional categories) were classified in a single category: Native Hawaiian or Other Pacific Islander. Otherwise, persons reporting two or more of the above groups and that they were not of Hispanic, Latino, or Spanish origin were included in a "Two or More Races" category. This category does not include respondents who reported more than one Asian subgroup but who reported "Asian" as their only race. Respondents reporting two or more races and reporting that they were of Hispanic, Latino, or Spanish origin were classified as Hispanic.

SEE: "Hispanic" and "Race/Ethnicity."

Unmet Need for Mental Health Services
Unmet need for mental health services is defined as a perceived need for mental health treatment in the past 12 months that was not received. This measure also includes persons who received some type of mental health service in the past 12 months, but reported a perceived need for additional services they did not receive.

Feeder question: "During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn't get it?"

SEE: "Mental Health Service Utilization" and "Prevalence."

Welfare Assistance
Household participation in one or more government (welfare) assistance programs during the prior calendar year was defined as one or more family members receiving Supplemental Security Income (SSI), food stamps, cash, or noncash assistance. SSI provides payments to low-income, aged, blind, and disabled persons. Food stamps are government-issued coupons used to purchase food. Cash assistance refers to cash payments through Temporary Assistance for Needy Families (TANF), welfare, or other public assistance. Noncash assistance refers to services, such as help getting a job, placement in an education or job-training program, or help with transportation, child care, or housing.

In 2006 and 2007, a majority of respondents received multiple questions for each of these forms of government assistance: (a) their personal receipt of these forms of assistance, and (b) whether another family member living in the household received these forms of assistance. The remaining respondents received a reduced set of income questions, including single questions for each of these forms of assistance that applied to the respondent or any other family members in the household. In 2008, all respondents received the reduced set of income questions, including the single version of the welfare assistance questions.

NOTE: For youths aged 12 to 17 and those respondents who were unable to respond to the insurance or income questions, proxy responses were accepted from a household member identified as being better able to give the correct information about insurance and income.

SEE: "Cash Assistance," "Food Stamps," "Noncash Assistance," and "Supplemental Security Income (SSI)."

West Region
The States included are those in the Mountain Division—Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming; and the Pacific Division—Alaska, California, Hawaii, Oregon, and Washington.

SEE: "Geographic Division" and "Region."

White
White, not of Hispanic, Spanish, or Latino origin; does not include respondents reporting two or more races. (Respondents reporting that they were white and of Hispanic, Latino, or Spanish origin were classified as Hispanic.)

SEE: "Hispanic" and "Race/Ethnicity."

World Health Organization Disability Assessment Schedule (WHODAS)
The World Health Organization Disability Assessment Schedule (WHODAS) consists of a series of questions that are used for assessing disturbances in social adjustment and behavior. A reduced set of WHODAS items was used in NSDUH (Rehm et al., 1999). Respondents were asked if they had difficulty doing any of the following eight activities during the 1 month when their emotions, nerves, or mental health interfered most with their daily activities: (1) remembering to do things they needed to do; (2) concentrating on doing something important when other things were going on around them; (3) going out of the house and getting around on their own; (4) dealing with people they did not know well; (5) participating in social activities; (6) taking care of household responsibilities; (7) taking care of daily responsibilities at work or school; and (8) getting daily work done as quickly as needed. These eight items were assessed on a 0 to 3 scale with categories of "no difficulty," "don't know," and "refuse" (0); "mild difficulty" (1); "moderate difficulty" (2); and "severe difficulty" (3). Some items had a fifth category to deal with “not applicable” responses. Summing across the eight responses resulted in a total score with a range from 0 to 24.

SEE: "Prevalence," "Serious Mental Illness," "Serious Psychological Distress," "Severe Impairment Due to Major Depressive Episode," and "Sheehan Disability Scale (SDS)."

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