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National and State Estimates of Drug Abuse Treatment Gap 

Chapter 2. National Estimates of Treatment Need and the Treatment Gap

2.1 Overview

The 2000 National Household Survey on Drug Abuse (NHSDA) included a series of questions to assess dependence on and abuse of substances, as well as questions that asked whether respondents had received treatment for a problem related to substance use. The dependence and abuse questions were designed to measure dependence and abuse based on the diagnostic criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994). Questions on dependence asked about health, emotional problems, attempts to cut down on use, tolerance, withdrawal, and other symptoms associated with the substances used. Questions on abuse asked about problems at work, home and school; problems with family or friends; physical danger; and trouble with the law due to substances used. Dependence reflects a more severe substance use problem than abuse; persons were classified with abuse of a particular substance only if they were not dependent on that substance.

This report provides estimates of the prevalence and patterns of the need for and receipt of treatment specifically for problems associated with illicit drug use. It presents estimates of the "treatment gap," defined as persons who needed treatment in the past year but did not receive that treatment. An individual was defined as needing treatment if he or she was dependent on or had abused an illicit drug or received treatment for an illicit drug problem at a "specialty" substance abuse facility in the past 12 months (i.e., during the 12 months before being interviewed). "Specialty" facilities include drug and alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient only), and mental health centers. It should be noted that respondents who were not dependent on or abusing drugs but who had received specialty treatment were counted as needing treatment under this definition. This was appropriate because it was assumed that a diagnostic assessment determining treatment need was done prior to entry into treatment.

This chapter presents estimates of the treatment gap at the national level, including estimates of the need for and receipt of treatment for an illicit drug problem by demographic characteristics (see Tables 1 to 5 at the end of the chapter). Due to changes to the NHSDA questionnaire and to the definitions and estimation methods used for measuring treatment need, the estimates in this report are not comparable with prior estimates. Based on cognitive testing, questions to measure dependence in 1999 were revised to improve how well the questions were understood by respondents. These questions were also revised based on a review by experts in the field to determine how well the questions capture the meaning of the DSM-IV criteria. In addition, starting with the 2000 NHSDA, questions to measure abuse based on the DSM-IV were added to the NHSDA and a new method for estimating treatment need and the gap was employed. This new method uses a simpler and more widely accepted definition of treatment need (abuse and dependence) and does not employ a ratio adjustment to inflate the NHSDA numbers based on separate counts of the treatment and arrestee populations (Wright, Gfroerer, & Epstein, 1997). This adjustment did not produce estimates as accurate as those generated by the new approach. Therefore, the treatment gap estimate of 3.9 million in 2000 cannot be compared with earlier estimates from 1991 to 1998 that ranged from 2.5 million to 3.6 million individuals. Additionally, the previous 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 (see ONDCP, 2000). A more detailed description of the changes to the NHSDA methods for generating these estimates is given in Appendix A.

2.2 Overall Estimates of Treatment Need

2.3 Treatment Need, by Age

2.4 Treatment Need, by Gender

 

Figure 1 Percentages of Persons with Past Year Illicit Drug Abuse Treatment Need and Receipt, by Age: 2000

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

 

Figure 2 Numbers of Persons with Past Year Illicit Drug Abuse Treatment Need and Receipt, by Age: 2000

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

2.5 Treatment Need, by Race/Ethnicity

2.6 Treatment Need, by Geographic Area

2.7 Treatment Need, by Education

2.8 Treatment Need, by Employment

 

Table 1. Estimated Numbers (in Thousands) of Persons Aged 12 or Older Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Demographic Characteristics: 2000

Demographic Characteristic

Needed Treatment for an Illicit Drug Problem in the Past Year

Percentage Who Received Treatment at a Specialty Facility Among Persons Who Needed Treatment

Total

Received Treatment at a Specialty Facility

Did Not Receive Treatment at a Specialty Facility

Total

4,655

774

3,881

16.6

Age in Years

       

    12-17

1,074

122

951

11.4

    18-25

1,645

142

1,503

8.6

    26 or older

1,937

510

1,427

26.3

Gender

       

    Male

2,749

411

2,337

15.0

    Female

1,907

363

1,544

19.0

Hispanic Origin and Race

       

    Not Hispanic

       

      White only

3,235

577

2,659

17.8

      Black only

632

118

514

*

      American Indian or Alaska Native only

46

4

42

*

      Native Hawaiian or other Pacific Islander

10

3

7

*

      Asian only

54

1

54

*

      More than one race

103

21

82

*

    Hispanic

574

51

523

9.0

*Low precision; no estimate reported.

Note: Respondents were classified as needing treatment for an illicit drug problem 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 an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use).

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

 

Table 2. Percentages of Persons Aged 12 or Older Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Demographic Characteristics: 2000

Demographic Characteristic

Needed Treatment for an Illicit Drug Problem in the Past Year

Percentage Who Received Treatment at a Specialty Facility Among Persons Who Needed Treatment

Total

Received Treatment at a Specialty Facility

Did Not Receive Treatment at a Specialty Facility

Total

2.1

0.3

1.7

16.6

Age in Years

       

    12-17

4.6

0.5

4.1

11.4

    18-25

5.7

0.5

5.2

8.6

    26 or older

1.1

0.3

0.8

26.3

Gender

       

    Male

2.6

0.4

2.2

15.0

    Female

1.6

0.3

1.3

19.0

Hispanic Origin and Race

       

    Not Hispanic

       

      White only

2.0

0.4

1.6

17.8

      Black only

2.5

0.5

2.0

*

      American Indian or Alaska Native only

4.3

0.4

3.9

*

      Native Hawaiian or other Pacific Islander

1.8

0.5

1.4

*

      Asian only

0.7

0.0

0.7

*

      More than one race

5.5

1.1

4.4

*

    Hispanic

2.4

0.2

2.2

9.0

*Low precision; no estimate reported.

NOTE: Respondents were classified as needing treatment for an illicit drug problem 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 an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use).

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

 

 

 

Table 3. Percentages of Persons Aged 12 or Older Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Geographic Characteristics: 2000

Geographic Characteristic

Needed Treatment for an Illicit Drug Problem in the Past Year

Percentage Who Received Treatment at a Specialty Facility Among Persons Who Needed Treatment

Total

Received Treatment at a Specialty Facility

Did Not Receive Treatment at a Specialty Facility

Total

2.1

0.3

1.7

16.6

Geographic Division

       

    Northeast

2.4

0.4

2.0

17.2

      New England

3.2

0.7

2.6

*

      Middle Atlantic

2.1

0.3

1.8

15.3

    Midwest

1.8

0.3

1.5

17.8

      East North Central

1.9

0.3

1.6

16.1

      West North Central

1.7

0.4

1.4

*

    South

1.7

0.3

1.4

17.3

      South Atlantic

1.7

0.3

1.4

20.0

      East South Central

1.6

0.2

1.4

10.1

      West South Central

1.8

0.3

1.5

16.6

    West

2.7

0.4

2.3

14.7

      Mountain

2.8

0.4

2.4

13.9

      Pacific

2.7

0.4

2.3

*

County Type

       

    Large metro

2.3

0.4

1.9

16.2

    Small metro

2.0

0.3

1.7

15.5

      250K - 1 mil. pop.

2.0

0.3

1.7

15.1

      <250K pop
    .

2.0

0.3

1.7

16.7

    Nonmetro

1.7

0.3

1.4

20.0

      Urbanized

2.0

0.5

1.5

*

      Less urbanized

1.7

0.3

1.4

*

      Completely rural

1.2

0.2

1.0

*

*Low precision; no estimate reported.

NOTE: Respondents were classified as needing treatment for an illicit drug problem 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 an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use).

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

 

 

 

Table 4. Percentages of Persons Aged 12 to 17 Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Demographic Characteristics: 2000

Demographic Characteristic

Needed Treatment for an Illicit Drug Problem in the Past Year

Percentage Who Received Treatment at a Specialty Facility Among Persons Who Needed Treatment

Total

Received Treatment at a Specialty Facility

Did Not Receive Treatment at a Specialty Facility

Total

4.6

0.5

4.1

11.4

Gender

       

    Male

5.0

0.6

4.3

13.0

    Female

4.2

0.4

3.8

9.4

Hispanic Origin and Race

       

    Not Hispanic

       

    White only

4.8

0.6

4.2

12.6

    Black only

3.6

0.5

3.1

13.5

    American Indian or Alaska Native only

10.7

*

8.7

*

    Native Hawaiian or other Pacific Islander

*

*

*

*

    Asian only

2.8

*

2.8

*

    More than one race

2.5

*

2.5

*

    Hispanic

5.2

0.3

4.9

6.1

Gender/Race/Hispanic Origin

       

    Male - white

5.0

0.7

4.3

13.7

    Female - white

4.5

0.5

4.0

11.4

    Male - black

4.7

0.8

3.9

*

    Female - black

2.4

0.2

2.3

*

    Male - Hispanic

5.3

0.4

4.9

*

    Female - Hispanic

5.0

0.2

4.8

*

*Low precision; no estimate reported.

NOTE: Respondents were classified as needing treatment for an illicit drug problem 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 an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use).

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

 

 

 

Table 5. Percentages of Persons Aged 18 or Older Who Needed and Received Treatment for an Illicit Drug Problem in the Past Year, by Demographic Characteristics: 2000

Demographic Characteristic

Needed Treatment for an Illicit Drug Problem in the Past Year

Percentage Who
Received Treatment at
a Specialty Facility
Among Persons Who
Needed Treatment

Total

Received Treatment at a Specialty Facility

Did Not Receive Treatment at a Specialty Facility

Total

1.8

0.3

1.5

18.2

Gender

       

    Male

2.3

0.4

1.9

15.5

    Female

1.4

0.3

1.1

22.3

Hispanic Origin and Race

       

    Not Hispanic

       

    White only

1.7

0.3

1.4

19.3

    Black only

2.3

0.5

1.9

*

    American Indian or Alaska Native only

3.3

0.1

3.1

*

    Native Hawaiian or other Pacific Islander

1.7

0.5

1.2

*

    Asian only

0.5

0.0

0.4

*

    More than one race

6.3

1.4

4.9

*

    Hispanic

2.0

0.2

1.8

10.2

Adult Education

       

    < High school

2.9

0.7

2.2

25.4

    High school graduate

1.7

0.3

1.4

18.9

    Some college

1.9

0.3

1.6

15.8

    College graduate

1.1

0.1

1.0

*

Current Employment

       

    Full-time

1.6

0.2

1.4

14.1

    Part-time

2.7

0.5

2.2

*

    Unemployed

7.7

1.5

6.2

*

    Other1

1.3

0.4

0.9

28.8

* Low precision; no estimate reported.

NOTE: Respondents were classified as needing treatment for an illicit drug problem 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 an illicit drug problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers). Illicit Drugs include marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type psychotherapeutic (nonmedical use).

1 Retired, disabled, homemaker, student, or "other."

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

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This page was last updated on June 03, 2008.