Skip To Content Table Of Contents
Click for DHHS Home Page
Click for the SAMHSA Home Page
Click for the OAS Drug Abuse Statistics Home Page
Click for What's New Click for Recent Reports and Highlights Click for Publications Click for Frequently Asked Questions Click for Short Reports and Facts Click for Data on Specific Drugs of Use Click for OAS Data Systems and more Pubs Click to send OAS Comments, Questions and Requests Click for OAS Home Page Click for Substance Abuse and Mental Health Services Administration Home Page Click to Search Our Site
National and State Estimates of Drug Abuse Treatment Gap 

Appendix A: Measurement of Dependence, Abuse, Treatment, and Treatment Need

The National Household Survey on Drug Abuse (NHSDA) has been used for many years to measure problematic substance use, including the need for and receipt of treatment. Different methods and definitions have been used, based on the particular focus of each analysis undertaken. This report presents estimates of the treatment gap and the need for and receipt of treatment for an illicit drug problem. Prior NHSDA reports and special analyses have included estimates of these measures. However, due to significant changes to the NHSDA questionnaire and the definitions and estimation methods used, the estimates of these measures from the 2000 NHSDA are not comparable with prior estimates. This appendix describes the changes and their impact on estimates.

A.1 Dependence

Since 1991, the NHSDA has included questions to estimate dependence. The questions have been based on criteria established by the American Psychiatric Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R, DSM-IV; APA, 1987, 1994). Questions in the 1991 to 1993 NHSDAs were based on the DSM-III-R definition of dependence, and questions in the 1994 to 2000 NHSDAs were based on the DSM-IV definition of dependence. DSM-IV defines a person as dependent if he or she met three out of seven dependence criteria (for substances with a withdrawal criterion) or three out of six criteria (for substances without a withdrawal criterion).

As part of an ongoing process to evaluate and improve the questions in the NHSDA, questions that were used in 1999 were cognitively tested to determine how well they were understood by respondents and to determine whether any particular phrases or words were problematic. The questions were also reviewed by an expert in the field to determine how well the questions captured the meaning of the DSM-IV criteria. Based on these assessments, the questions were revised for the 2000 NHSDA. Some individual questions were divided into several less complex questions, and revisions were made to improve question wording. Table A.1 at the end of this appendix indicates the questions used in 1999 and the revised questions used in 2000 to measure each DSM-IV criterion for each substance.

The revised dependence questions are generally more restrictive and less global than the ones used in 1999. Prevalence estimates for each criterion by substance are given in Table A.2 for the 1999 and 2000 NHSDAs. For most criteria, the 2000 estimate is smaller than the 1999estimate. This is probably due to the more restrictive nature of the questions covering the criteria in 2000. For example, criterion 3 was previously covered by a question asking whether the drug was used much more often or in larger amounts than intended. In 2000, criterion 3 was covered by two questions, one asking whether limits were set on the use of the substance and another asking if the limits were kept. To meet the criterion, a person must have a positive response to the first question and a negative response to the second question. For marijuana, the estimate for criterion 3 was 0.4 percent in 2000 and 1.4 percent in 1999.

The generally lower prevalences in 2000 for individual criteria resulted in a lower estimated prevalence for dependence. Estimates of dependence for 1999 and 2000 for any illicit drug and by specific substances (illicit drugs and alcohol) are given in Table A.3. Estimates of dependence for 1999 and 2000 for any illicit drug and for alcohol by demographic subgroups are given in Table A.4. The estimated percentage of persons aged 12 or older dependent on any illicit drug was 23 percent smaller in 2000 than in 1999 (1.6 percent in 1999 vs. 1.2 percent in 2000). The estimated percentage of persons dependent on alcohol was 38 percent smaller in 2000 than in 1999 (3.7 percent in 1999 vs. 2.3 percent in 2000). Estimates of dependence for any illicit drug were generally smaller in 2000 than in 1999 by most demographic subgroups. Although estimates of dependence were smaller in 2000 than in 1999, they followed similar patterns by demographic subgroups.

Estimates of dependence by State for 1999 are based on the 1999 dependence questions and not the revised dependence questions used in 2000. Thus, these dependence estimates are not comparable with estimates of dependence by State in 2000.

A.2 Abuse

In 2000, questions to measure abuse based on the DSM-IV were introduced into the NHSDA for the first time. These questions were designed to cover the four abuse criteria defined in the DSM-IV. Table A.1 indicates the abuse questions in the 2000 NHSDA used to cover each abuse criterion. According to the DSM-IV, a person is defined with abuse if he or she meets one or more of the abuse criteria and does not meet the definition for dependence. The questions on abuse were cognitively tested and reviewed by experts in the field. Estimates of abuse are given in Table A.3 for individual substances and in Table A.4 by demographic characteristics. Estimates of abuse were smaller than estimates of dependence for any illicit drug and for specific illicit drugs. However, for alcohol the estimated percentage with abuse (3.1 percent) was larger than the estimated percentage with dependence (2.3 percent) in 2000.

A.3 Illicit Drug Treatment Need and Gap

In recent years, the Substance Abuse and Mental Health Services Administration (SAMHSA) produced estimates of illicit drug treatment need and the treatment gap (i.e., persons who needed but did not receive treatment) using two basic methods: adjusted and unadjusted. The adjusted estimates incorporated a ratio adjustment technique that inflated the NHSDA numbers based on separate counts of treatment and arrestee populations (Wright, Gfroerer, & Epstein, 1997). These ratio-adjusted treatment need and gap estimates were made only at the national level and were used by the Office of National Drug Control Policy (ONDCP) in its annual national drug control strategy. Unadjusted treatment need and gap estimates were used in most analyses of NHSDA data, including several SAMHSA publications. Although both the adjusted and unadjusted estimates employed the same definitions of need, the ratio adjustment produces estimates that are 20 to 30 percent higher than the unadjusted estimates. Starting with the 2000 NHSDA, a single new method for estimating treatment need and the gap has been employed. This new method was developed by an interagency work group chaired by ONDCP. The method uses a simpler and more widely accepted definition of treatment need than had been used previously, and it does not employ the ratio adjustment. There are two reasons that the ratio adjustment is no longer used: (a) to provide more accurate trend measurement, and (b) to allow the possibility of subgroup analysis. The ratio adjustment methodology is problematic because it depends on external data that are not available with the consistency over time or by geographic and demographic subpopulations.

The following discussion explains the change in the methodology for estimating treatment need and the gap and how the change affects the resulting estimates.

A.3.1 Definitions of Treatment Need

For the 1991 to 1999 NHSDAs, a respondent was classified as needing treatment (total treatment need) if he or she met at least one of four criteria during the past year: (1) dependent on any illicit drug; (2) used marijuana daily, or used some other illicit drug on at least 52 days; (3) was an injection drug user or used heroin at least once; and/or (4) received any treatment for drug abuse. Respondents needing treatment were further classified into "level 1" and "level 2" treatment need. Respondents needing treatment for a more severe drug problem were defined with level 2 treatment need. Respondents classified with needing treatment who did not meet the definition for level 2 treatment need were defined with level 1 treatment need. Respondents classified with level 2 drug abuse treatment need met at least one of the following five criteria in the past year: (1) dependent on any illicit drug other than marijuana; (2) used marijuana daily and were dependent on marijuana; (3) used cocaine on 52 or more days, or used some other illicitdrug daily; (4) were injection drug users or used heroin at least once; and/or (5) received treatment for drug abuse at a specialty facility (hospital [as an inpatient], mental health center, or drug treatment facility). Level 2 treatment need and specialty treatment are the measures used in calculating the "treatment gap" for the 1991 through 1999 NHSDAs (Office of Applied Studies [OAS], 1998).

The new definition of treatment need for 2000 classifies a respondent as needing treatment if he or she meets the criteria for dependence or abuse (DSM-IV) or received treatment at a specialty facility. Plans are to continue using this revised definition of treatment need in future years.

A.3.2 Comparison of Old Ratio-Adjusted Estimates with New Estimates

It is difficult to compare estimates of treatment need and the "treatment gap" used by ONDCP prior to 1999 with the new estimates for 2000 because several important changes to the NHSDA in 1999 and 2000 affected the estimates. Between 1998 and 1999, the NHSDA switched from a paper-and-pencil-interviewing (PAPI) mode to a computer-assisted interviewing (CAI) mode. All questions on drug use, dependence, and treatment need were administered using audio computer-assisted self-interviewing (ACASI) in 2000. There were also major changes to the sample design. The revision of the dependence questions in 2000 also affected the treatment need estimate. Besides these changes to the NHSDA, the change in the definition of treatment need in 2000 and the ratio adjustment used previously have had a significant impact on the estimates. As discussed below, estimates using the old definition (level 2) of treatment need on the 2000 file were 45 percent lower than estimates using the 2000 definition on the 2000 file. The ratio adjustment increased the old estimates by 20 to 30 percent, but it is not included in the new estimates of treatment need in 2000.

Table A.5 compares the old ratio-adjusted estimates of illicit drug treatment need and gap from 1991 to 1998 with the new estimates for 2000. The estimated numbers who needed treatment ranged from 4.6 million to 5.7 million from 1991 to 1998. The estimate for 2000 using the new methodology was 4.7 million. Although the new estimate is similar in size to the old estimates, this does not necessarily reflect stability in the numbers of persons in the population who need treatment. The methods upon which these estimates are based are quite different, as explained earlier. Furthermore, the estimated numbers of persons who received treatment were very different with the new and old methods. These estimates ranged from 1.6 million to 2.1 million from 1991 to 1998 and 0.8 million in 2000 using the new method. This probably reflects the fact that the 1991 to 1998 estimates incorporated the ratio adjustment, which essentially replaced the estimated numbers receiving treatment from the NHSDA (based on respondents' self-report) with an independent count of the numbers receiving treatment. The independent count used in this ratio adjustment was derived from a variety of sources, primarily the Uniform Facility Data Set (UFDS). The estimated treatment gap, which ranged from 2.5 million to 3.6 million for the 1991 to 1998 estimates, was somewhat higher with the new estimate for 2000 (3.9 million). Again, due to the major changes in estimation methodology, the data do not indicate any real increase in the treatment gap. The higher gap number is simply the result of the change in methodology. Furthermore, the difference in gap estimates is likely due more to the change in the definition of treatment need than it is to the change in the way treatment is estimated. This is because the ratio adjustment previously used inflates the treatment need estimate at least as much as it inflates the treatment estimate because the treatment need estimates (both old and new) include treated persons by definition.

To gain insight into the effects of the various changes, it is helpful to analyze estimates from the old and new definitions without the ratio adjustment. Some analyses are discussed below.

A.3.3 Comparison of Old Unadjusted Estimates with New Estimates

Estimates of total treatment need and level 2 treatment need that do not include the ratio adjustment for 1999 are compared with estimates of treatment need for 2000 in Table A.6 by demographic subgroups. The 2000 estimates of treatment need were generally larger than the 1999 estimates of level 2 treatment need and smaller than the 1999 estimates of total treatment need by demographic subgroups. The estimated percentage of the population needing treatment in 2000 (2.1 percent) was smaller than the estimated percentage of the population with total treatment need in 1999 (3.5 percent) and larger than the estimated percentage of the population with level 2 treatment need in 1999 without a ratio adjustment (1.5 percent). It is impossible to determine how much of the difference between the 1999 and 2000 estimates is due to a real change in the population needing treatment and how much is due to the change in the definitions.

To analyze the impact of the change in the treatment need definition, estimates were run based on both definitions using the same data file. Specifically, using the 2000 NHSDA file, estimates of treatment need were calculated using the 1999 definition (level 2) (and 2000 dependence questions) and compared with estimates of treatment need calculated using the 2000 definition on the same file. With the 1999 definition, 1.2 percent of the population needed treatment (2.7 million persons), while with the 2000 definition, 2.1 percent of the population needed treatment (4.7 million persons). Estimates by demographic subgroups are given in Table A.7. Estimates of treatment need with the 2000 definition were larger than estimates of treatment need with the 1999 (level 2) definition overall and for each demographic subgroup, indicating that the change in definition between 1999 and 2000 resulted in an increase in the estimates of treatment need.

The estimate of level 2 treatment need using the 1999 definition on the 2000 NHSDA file (1.2 percent) was slightly smaller than the estimate of treatment need using the same definition on the 1999 NHSDA file (1.5 percent), indicating that there was probably little change in the numbers of people needing treatment between 1999 and 2000. The slight decrease in the estimate on the 2000 file could be due to the fact that the dependence questions in 2000 were more restrictive, resulting in smaller estimates of dependence.

To compare the new and old definitions of treatment need in their coverage of various populations of drug users, several populations with various patterns and symptoms indicative of a drug use problem were identified. The proportions in each population who would be classified as needing treatment were compared under the old and new definitions. Table A.8 indicates for each of these populations the percentage of the population classified with level 2 treatment need using the 1999 definition, the percentage classified with treatment need using the 2000 definition, the percentage classified with dependence, and the percentage classified with abuse. Some of these populations were completely covered by level 2 treatment need because they were part of the definition of level 2 treatment need. This was true for heroin users, injection drug users, and weekly cocaine users. For these populations, the interest was in how well they would be covered by the new definition of treatment need and what proportion would be covered by abuse and dependence. More than 80 percent of the heroin users and the injection drug users were covered by the new definition of treatment need. Approximately 59 percent of weekly cocaine users were covered by the new definition of treatment need.

For some populations, the proportions covered by the old and new definitions of treatment need were not substantially different from each other. This was the case for weekly illicit drug users and daily marijuana users. The percentage classified with treatment need under the old definition among persons using an illicit drug weekly or more often was 41.2 percent, and the percentage classified as needing treatment under the new definition was 39.1 percent. Among daily marijuana users, 34.6 percent were classified as needing treatment under the old definition, and 35.6 percent were classified as needing treatment under the new definition.

Also compared were the percentages of persons meeting the old and new definitions of treatment need among each other. Among those who met the new definition of treatment need, 46.4 percent also met the old (level 2) definition of treatment need. Among those who met the old (level 2) definition of treatment need, 80.7 percent also met the new definition of treatmentneed. The estimated percentage of persons in the population meeting both the old and new definitions of treatment need was 0.9 percent.

A.3.4 Specialty Treatment

Persons who received specialty treatment in the past year but did not meet the criteria for dependence or abuse were included in the definition of treatment need because it was assumed that if a person received treatment, he or she probably needed it at some point in the past year. Keeping these people in the definition of treatment need does not affect the estimate of the number of people in the "treatment gap" because these people are included in the estimate of treatment need and the estimate of receiving treatment. Among the persons who received specialty treatment in the past year but did not meet the criteria for dependence or abuse, 53.2 percent were still in some kind of treatment at the time of interview, 27.9 percent had successfully completed treatment, 28.1 were arrested and booked in the past year, and 41.1 percent were on probation, parole, or other conditional release at some time in the past year.

In both 1999 and 2000, persons were defined as receiving specialty treatment if they received treatment in the past year at a hospital (as an inpatient), a mental health center, or a drug treatment facility. However, in the 2000 NHSDA, there were some changes from 1999 in the manner in which people were asked about treatment at specific locations. These changes resulted in a difference in the way specialty treatment was tabulated. In 1999, when a person was asked about treatment at a specific location, he or she was not asked whether the treatment was for alcohol or drugs. Thus, if a person reported receiving treatment for alcohol and drugs in the past year, it was assumed that he or she received treatment for alcohol and drugs at each location that he or she reported receiving treatment.

Because at a specific location a person may only receive treatment for alcohol or only receive treatment for drugs, a question was added to determine whether the treatment received at a specific location was for alcohol only, drugs only, or both. In 2000, if a person reported receiving treatment for alcohol and drugs in the past year, and reported specific locations where he or she received treatment, the person was further asked for each location reported whether the treatment at that location was for alcohol, drugs, or both. As a result, some people who might have been counted as receiving specialty treatment for illicit drugs in 1999 would not be counted in 2000. An estimated 0.8 million persons (0.3 percent of the population) received specialty treatment for illicit drugs in 2000. If the estimate for 2000 had been tabulated in the same manner as in 1999, the estimate of the numbers of persons receiving specialty treatment for illicit drugs would be 0.9 million persons (0.4 percent of the population).

 

Table A.1 Questions in the 1999 NHSDA and Corresponding Questions in the 2000 NHSDA for Each DSM-IV Criterion for Dependence and Abuse

DSM Criterion

Questions in the 1999 NHSDA Used to Cover the DSM-IV Criteria

Questions in the 2000 NHSDA Used to Cover the DSM-IV Criteria

 

Dependence

1.

During the past 12 months, have you built up a tolerance for the drug so that the same amount of the drug had less effect than before?

During the past 12 months, did you need to use more of the drug than you used to in order to get the effect you wanted?

During the past 12 months, did you notice that using the same amount of the drug had less effect on you than it used to?

2.

For cigarettes, alcohol, heroin, analgesics, sedatives, stimulants:

(For cocaine or crack only:

During the past 12 months, have you felt kind of blue or down when the effect of the drug you were using was wearing off?)

During the past 12 months, have you had any of these symptoms as the effect of the drug was wearing off? Symptoms vary by drug (see next page)

During the past 12 months, did you use more of that drug to get over or avoid the bad aftereffects of using that drug?

Only for cigarettes, alcohol, cocaine, heroin, analgesics, sedatives, stimulants:

During the past 12 months did you cut down or stop using the drug at least one time?

(For cocaine or crack only:

During the past 12 months, have you felt kind of blue or down when you cut down or stopped using the drug?

During the past 12 months, did you have __ or more of these symptoms after you cut back or stopped using the drug? The symptoms and number needed to meet this criteria varies by drug. (See next page)

3.

During the past 12 months, have you used that kind of drug much more often or in larger amounts than you intended to?

During the past 12 months, did you try to set limits on how often or how much of the drug you would use?

If above was answered yes:

Were you able to keep to the limits you set or did you often use more than you intended to?

4.

During the past 12 months, did you want to try to stop or cut down on your use of that drug but found you couldn't?

During the past 12 months, did you want to or try to cut down or stop using the drug?

During the past 12 months, were you able to cut down or stop using the drug every time you wanted to or tried to?

5.

During the past 12 months, did you have a period of a month or more when you spent a great deal of time getting the drug, using the drug, or getting over its effects?

During the past 12 months, was there a month or more when you spent a lot of your time getting or using the drug?

During the past 12 months, was there a month or more when you spent a lot of your time getting over the effects of the drug?

6.

During the past 12 months, has your use of that drug often kept you from working, going to school, taking care of children, or engaging in recreational activities?

This question is about important activities such as working, going to school, taking care of children, doing fun things such as hobbies and sports, and spending time with friends and family.

During the past 12 months, did using the drug cause you to give up or spend less time doing these types of important activities?

7.

a. During the past 12 months, has your use of the drug caused you any health problems?

b. During the past 12 months, has your use of the drug caused you to have any emotional or psychological problems such as feeling uninterested in things, feeling depressed, feeling suspicious of people, feeling paranoid, or having strange ideas?

During the past 12 months, did you have any problems with your emotions, nerves or mental health that were probably caused or made worse by your use of the drug?

Did you continue to use the drug even though you thought it was causing you to have problems with your emotions, nerves or mental health?

During the past 12 months, did you have any physical health problems that were probably caused or made worse by your use of the drug?

Did you continue to use the drug even though you thought it was causing you to have physical problems?

 

Abuse

1.

Not asked in 1999 NHSDA.

Sometimes people who use this drug have serious problems at home, work or school—such as:

-neglecting their children
-missing work or school
-doing a poor job at work or school
-losing a job or dropping out of school

During the past 12 months, did using this drug cause you to have serious problems like this either at work, school or home?

2.

Not asked in 1999 NHSDA.

During the past 12 months did you regularly use the drug and then do something where using the drug might have put you in physical harm?

3.

Not asked in 1999 NHSDA.

During the past 12 months, did using the drug cause you to do things that repeatedly got you in trouble with the law?

4.

Not asked in 1999 NHSDA.

During the past 12 months, did you have any problems with family or friends that were probably caused by your use of the drug ?

Did you continue to use the drug even though you thought it caused problems with family or friends?

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999 and 2000.

 

Table A.2 Percentages Reporting Having Met DSM-IV Criteria, by Specific Substances: 1999 and 2000

Substance

DSM-IV Criteria

Criterion 1

 

Criterion 2

 

Criterion 3

 

Criterion 4

 

Criterion 5

 

Criterion 6

 

Criterion 7

1999

2000

 

1999

2000

 

1999

2000

 

1999

2000

 

1999

2000

 

1999

2000

 

1999

2000

Marijuana

0.8

1.5

 

--

--

 

1.4

0.4

 

1.6

0.4

 

1.5

2.2

 

0.5

0.6

 

1.1

0.6

Cocaine

0.3

0.3

 

0.4

0.1

 

0.4

0.1

 

0.3

0.1

 

0.4

0.3

 

0.2

0.2

 

0.4

0.2

Heroin

0.1

0.1

 

0.1

0.1

 

0.1

0.0

 

0.1

0.1

 

0.1

0.1

 

0.0

0.1

 

0.1

0.1

Hallucinogens

0.1

0.2

 

--

--

 

0.1

0.0

 

0.1

0.0

 

0.2

0.2

 

0.1

0.1

 

0.2

0.1

Inhalants

0.1

0.1

 

--

--

 

0.1

0.0

 

0.1

0.0

 

0.1

0.1

 

0.0

0.0

 

0.1

0.0

Pain Relievers

0.1

0.4

 

0.2

0.2

 

0.3

0.1

 

0.2

0.1

 

0.3

0.4

 

0.2

0.2

 

0.2

0.1

Tranquilizers

0.1

0.2

 

--

--

 

0.1

0.0

 

0.1

0.1

 

0.1

0.1

 

0.0

0.1

 

0.1

0.1

Stimulants

0.1

0.2

 

0.1

0.1

 

0.1

0.1

 

0.1

0.1

 

0.1

0.1

 

0.1

0.1

 

0.1

0.1

Sedatives

0.0

0.0

 

0.1

0.0

 

0.0

0.0

 

0.0

0.0

 

0.0

0.1

 

0.0

0.0

 

0.0

0.0

Alcohol

3.0

6.5

 

3.4

1.1

 

7.2

1.6

 

6.2

1.6

 

4.4

6.4

 

1.5

1.9

 

2.9

1.9

-- Not available.

NOTE: Criterion 1: Needed to use substance more than before to get desired effects or noticed that the same amount of substance use had less effect than before. Criterion 2: Reported experiencing two or more additional substance withdrawal symptoms at the same time that lasted longer than a day after substance use was cut back or stopped. Also, for cocaine and stimulants, respondent must have reported feeling blue or down when trying to stop or cut down using substance (not a necessary criterion for dependence of marijuana, hallucinogens, inhalants, or tranquilizers). Criterion 3: Used substance more often than intended and was unable to keep set limits on substance use. Criterion 4: Inability to cut down or stop using substance every time tried or wanted to. Criterion 5: Spent a great deal of time over a period of a month getting, using, or getting over the effects of substance. Criterion 6: Substance use reduced or eliminated involvement or participation in important activities. Criterion 7: Continued to use substance even though it was causing problems with emotions, nerves, mental health, or physical problems.

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999 and 2000.

 

Table A.3 Total Population and Percentages of Persons Aged 12 or Older Classified with Dependence on Specific Substances in 1999 and 2000 and Classified with Abuse of Specific Substances in 2000

 

Dependence 1999

 

Dependence 2000

 

Abuse 2000

Substance

Number
(in Thousands)

Percent

 

Number
(in Thousands)

Percent

 

Number
(in Thousands)

Percent

Any Illicit Drug1

3,554

1.6

 

2,771

1.2

 

1,538

0.7

Marijuana

2,319

1.0

 

1,676

0.8

 

1,164

0.5

Cocaine

770

0.3

 

557

0.2

 

190

0.1

Heroin

141

0.1

 

164

0.1

 

20

0.0

Hallucinogens

256

0.1

 

151

0.1

 

251

0.1

Inhalants

103

0.0

 

101

0.0

 

77

0.0

Any Psychotherapeutic

718

0.3

 

698

0.3

 

386

0.2

Pain Reliever

447

0.2

 

443

0.2

 

279

0.1

Tranquilizers

148

0.1

 

149

0.1

 

115

0.1

Stimulants

278

0.1

 

238

0.1

 

83

0.0

Sedatives

86

0.0

 

81

0.0

 

39

0.0

Alcohol

8,201

3.7

 

5,089

2.3

 

7,021

3.1

NOTE: Dependence and abuse are based on the definition found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994).

1Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens (including LSD and PCP), inhalants, or any prescription-type psychotherapeutic used nonmedically.

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999 and 2000.

 

Table A.4 Percentages of Persons Aged 12 or Older Reporting Past Year Illicit Drug or Alcohol Dependence, by Demographic Characteristics: 1999 and 2000

Demographic Characteristic

Type of Past Year Dependence

 

Type of Past Year Abuse

Any Illicit Drug

 

Alcohol

 

Any Illicit Drug

 

Alcohol

1999

2000

 

1999

2000

 

2000

 

2000

Total

1.6

1.2

 

3.7

2.3

 

0.7

 

3.1

Age in Years

                 

    12-17

3.3

2.4

 

3.6

1.8

 

2.0

 

3.3

    18-25

4.7

3.5

 

9.2

4.6

 

2.0

 

8.1

    26 or older

0.9

0.7

 

2.8

2.0

 

0.3

 

2.3

Gender

                 

    Male

2.0

1.5

 

4.9

3.1

 

0.9

 

4.5

    Female

1.3

1.0

 

2.6

1.5

 

0.5

 

1.9

Hispanic Origin and Race

                 

Not Hispanic

                 

    White only

1.5

1.2

 

3.8

2.2

 

0.6

 

3.3

    Black only

2.3

1.6

 

3.1

2.4

 

0.7

 

2.2

    American Indian or Alaska Native only

4.7

1.6

 

5.1

3.4

 

2.5

 

4.4

    Native Hawaiian or other Pacific Islander

*

1.4

 

*

1.3

 

0.1

 

1.5

    Asian only

0.8

0.5

 

2.2

2.0

 

0.3

 

1.3

    More than one race

2.6

2.5

 

7.7

2.8

 

*

 

3.6

Hispanic

1.9

1.2

 

3.9

2.4

 

1.1

 

3.5

*Low precision; no estimate reported.

NOTE: Dependence is based on the definition found in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994).

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999 and 2000.

 

Table A.5 Treatment Gap for Persons Aged 12 or Older: 1991 to 1998 and 2000

 

Old Method

 

New Method1

 

1991

1992

1993

1994

1995

1996

1997

1998

 

2000

Needs Treatment (in Thousands)

5,148

4,716

4,741

4,610

4,646

5,303

5,726

5,031

 

4,655

Received Treatment (in Thousands)

1,649

1,814

1,848

1,984

2,121

1,973

2,137

2,137

 

774

% Treated2

32%

38%

39%

43%

46%

37%

37%

43%

 

16.6%

% Not Treated2

68%

62%

61%

57%

54%

63%

63%

57%

 

83.4%

Treatment Gap (in Thousands)

3,499

2,904

2,893

2,626

2,525

3,330

3,589

2,894

 

3,881

NOTE: Because of changes in the NHSDA and in the methodology, no treatment gap numbers are included for 1999. The "treatment gap" consists of those persons who needed treatment for an illicit drug problem but did not receive treatment. "Needs treatment" refers to level 2 treatment need. "Received treatment" refers to treatment received for drug abuse at a specialty facility (hospital [as an inpatient], mental health center, or drug treatment facility).

1 Corresponds to the 2000 definition of "treatment need," not the definition of level 2 treatment need.
2 "% treated" and the "% not treated" are among those persons who need treatment in the past year.

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1991-1998 and 2000.

 

Table A.6 Comparison of Treatment Need Estimates from the 1999 and 2000 NHSDAs for Percentages of Persons Aged 12 or Older

 

1999 NHSDA (Without Ratio Adjustment)

 

2000 NHSDA

Demographic Characteristic

Total Treatment Need1

Level 2 Treatment Need1

 

Treatment Need2

Total

3.5

1.5

 

2.1

Age in Years

       

    12-17

6.6

2.1

 

4.6

    18-25

8.5

3.5

 

5.7

    26 or older

2.2

1.1

 

1.1

Gender

       

    Male

4.4

2.0

 

2.6

    Female

2.6

1.1

 

1.6

Hispanic Origin and Race

       

Not Hispanic

       

    White only

3.1

1.4

 

2.0

    Black only

4.9

2.1

 

2.5

    American Indian or Alaska Native only

9.2

3.9

 

4.3

    Native Hawaiian or other Pacific Islander

0.8

*

 

1.8

    Asian only

2.2

0.5

 

0.7

    More than one race

6.3

3.0

 

5.5

Hispanic

4.2

1.8

 

2.4

*Low precision; no estimate reported.

1 Respondents were classified as needing treatment for illicit drug abuse if they met at least one of four criteria during the past year: (1) dependent on any illicit drug; (2) used marijuana daily, or used some other illicit drug on at least 52 days; (3) were injection drug users or used heroin; or (4) received any treatment for drug abuse. Respondents were classified with level 2 drug abuse treatment need if they met at least one of the following five criteria in the past year: (1) used marijuana daily and were dependent on marijuana; (2) were dependent on an illicit drug other than marijuana; (3) used cocaine on 52 or more days, or used inhalants, hallucinogens, pain relievers, tranquilizers, sedatives, or stimulants daily; (4) were injection drug users or used heroin; or (5) received treatment for drug abuse at a specialty facility (i.e., a hospital as an inpatient, a mental health center, or a drug abuse facility).
2 For the 2000 definition of "needing treatment," respondents were classified as needing treatment for illicit drug abuse if they met at least one of three criteria during the past year: (1) dependent on any illicit drug; (2) abuse of any illicit drug; or (3) received treatment for drug abuse at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers).

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999 and 2000.

 

Table A.7 Comparison of Treatment Need Estimates Using the 1999 Definition of Level 2 Treatment Need and the 2000 Definition of Treatment Need on the 2000 NHSDA's Estimated Numbers of Persons Aged 12 or Older

 

1999 Definition of Treatment
Need (Level 2)1

 

2000 Definition of Treatment
Need2

Demographic Characteristic

Number
(in
Thousands)

Percent

 

Number
(in
Thousands)

Percent

Total

2,677

1.2

 

4,655

2.1

Age in Years

         

    12-17

424

1.8

 

1,074

4.6

    18-25

769

2.7

 

1,645

5.7

    26-34

504

1.5

 

730

2.2

    35 or older

981

0.7

 

1,207

0.9

Gender

         

    Male

1,554

1.4

 

2,749

2.6

    Female

1,123

1.0

 

1,907

1.6

Hispanic Origin and Race

         

Not Hispanic

         

    White only

1,907

1.2

 

3,235

2.0

    Black only

353

1.4

 

632

2.5

    American Indian or Alaska Native only

37

3.4

 

46

4.3

    Native Hawaiian or other Pacific Islander

10

1.8

 

10

1.8

    Asian only

28

0.4

 

54

0.7

    More than one race

43

2.3

 

103

5.5

Hispanic

299

1.3

 

574

2.4

1 Respondents were classified with level 2 drug abuse treatment need if they met at least one of the following five criteria in the past year: (1) used marijuana daily and were dependent on marijuana; (2) were dependent on an illicit drug other than marijuana; (3) used cocaine on 52 or more days, or used inhalants, hallucinogens, pain relievers, tranquilizers, sedatives, or stimulants daily; (4) were injection drug users or used heroin; or (5) received treatment for drug abuse at a specialty facility (i.e., a hospital as an inpatient, a mental health center, or a drug abuse facility).

2 For the 2000 Definition of "needing treatment," respondents were classified as needing treatment for illicit drug abuse if they met at least one of three criteria during the past year: (1) dependent on any illicit drug; (2) abuse of any illicit drug; or (3) received treatment for drug abuse at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers).

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000.

 

Table A.8 Percentages Reporting Needing Treatment (1999 Definition - Level 2), Needing Treatment (2000 Definition), Abuse Only, and Dependence Only for Any Illicit Drug in the Past Year among Persons Aged 12 or Older: 2000

   

Treatment Need

   

Drug Use-Related Activities

Size of Population
(in Thousands)

1999 Definition (Level 2)

2000 Definition

Abuse Only (2000)

Dependence Only

Used an illicit drug weekly or more often

3,644

41.2

39.1

9.6

28.3

Used heroin at least once

308

100.0

80.4

6.9

68.6

Used a needle to inject heroin, cocaine or stimulants

322

100.0

81.4

3.2

77.6

Used marijuana daily

998

34.6

35.6

9.2

26.0

Used cocaine weekly or more often

792

100.0

58.5

8.9

48.8

Met two or more DSM-IV dependence criteria

6,903

28.1

52.4

12.5

39.0

Used cocaine weekly with two or more dependence criteria

525

100.0

84.0

10.1

73.6

Had treatment for a drug problem at a hospital, treatment center, or mental health center

774

100.0

100.0

9.5

45.7

Had any type of treatment

1,268

67.2

73.0

9.5

36.2

Used inhalants weekly

354

36.7

50.5

12.3

37.7

Used psychotherapeutic weekly

2,642

31.9

37.0

10.2

25.6

With dependence or abuse

4,308

42.1

100.0

35.7

64.3

1999 definition (level 2)

2,677

100.0

80.7

5.9

61.8

NOTE: Dependence is based on the definition found in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994).

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000.

Table Of Contents

This page was last updated on May 16, 2008.