2007
National Survey on Drug Use & Health: National Results
|
Results from the 2007
National Survey on Drug Use and Health:
National Findings
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Office of Applied Studies
Acknowledgments
This report was prepared by the Division of Population Surveys, Office of Applied Studies, SAMHSA, and by RTI International, a trade name of Research Triangle Institute, Research Triangle Park, North Carolina. Work by RTI was performed under Contract No. 283-2004-00022. Contributors and reviewers at RTI listed alphabetically include Jeremy Aldworth, Kimberly Ault, Ellen Bishop, Lisa Carpenter, Patrick Chen, James R. Chromy, Elizabeth Copello, David B. Cunningham, Lanting Dai, Teresa R. Davis, Ralph E. Folsom, Jr., Misty Foster, Peter Frechtel, G. G. Frick, Julia Gable, Jody M. Greene, Wafa Handley, David C. Heller, Erica Hirsch, Ilona Johnson, Lauren Klein, Larry A. Kroutil, Bing Liu, Mary Ellen Marsden, Katherine B. Morton, Breda Munoz, Scott Novak, Lisa E. Packer, Lanny Piper, Jeremy Porter, Heather Ringeisen, Tania Robbins, Harley Rohloff, Kathryn Spagnola, Thomas G. Virag (Project Director), Michael Vorburger, and Jiantong Wang. Contributors at SAMHSA listed alphabetically, with chapter authorship noted, include Peggy Barker, Jonaki Bose, James Colliver (Chapters 2 and 4), Lisa Colpe (Chapter 8), Joseph Gfroerer (Chapters 1 and 9), Beth Han (Chapters 6 and 7), Arthur Hughes (Project Officer), Joel Kennet (Chapter 3), Pradip Muhuri (Chapter 5), and Dicy Painter. Also at RTI, report and web production staff listed alphabetically include Teresa G. Bass, Wendy Broome, Cassandra M. Carter, Joyce Clay-Brooks, Diane G. Eckard, Shari B. Lambert, Danny Occoquan, Brenda K. Porter, Pamela Couch Prevatt, and Richard S. Straw. Final report production was provided by Beatrice Rouse, Coleen Sanderson, and Jane Feldmann at SAMHSA.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration. However, this publication may not be reproduced or distributed for a fee without specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services. Citation of the source is appreciated. Suggested citation:
Substance Abuse and Mental Health Services Administration. (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD.
Electronic Access to Publication
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Or please call SAMHSA's Health Information Network at:
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Originating Office
SAMHSA, Office of Applied Studies
1 Choke Cherry Road, Room 7-1044
Rockville, MD 20857
September 2008
List of Figures
2.1 Past Month Illicit Drug Use among Persons Aged 12 or Older: 2007
2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2007
2.3 Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2007
2.4 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2007
2.5 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007
2.6 Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25: 2002-2007
2.7 Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2007
2.8 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2007
2.9 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2007
2.10 Past Month Illicit Drug Use among Persons Aged 18 or Older, by Employment Status: 2007
2.11 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2007
3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2007
3.2 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Race/Ethnicity: 2007
3.3 Heavy Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-2007
3.4 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 12 or Older: 2002-2007
3.5 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 16 or Older, by Age: 2007
3.6 Current Alcohol Use among Persons Aged 12 to 20, by Age: 2002-2007
3.7 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by Gender: 2007
4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2007
4.2 Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2007
4.3 Past Month Cigarette Use among Persons Aged 12 or Older, by Age: 2007
4.4 Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2007
4.5 Past Month Cigarette Use among Women Aged 15 to 44, by Pregnancy Status: Combined Years 2002-2003 to 2006-2007
4.6 Past Month Tobacco Use among Adults Aged 18 or Older, by Education: 2007
5.1 Specific Drug Used When Initiating Illicit Drug Use among Past Year Initiates of Illicit Drugs Aged 12 or Older: 2007
5.2 Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007
5.3 Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2007
5.4 Past Year Marijuana Initiates among Persons Aged 12 or Older and Mean Age at First Use of Marijuana among Past Year Marijuana Initiates Aged 12 to 49: 2002-2007
5.5 Past Year Ecstasy Initiates among Persons Aged 12 or Older and Mean Age at First Use of Ecstasy among Past Year Ecstasy Initiates Aged 12 to 49: 2002-2007
5.6 Past Year Methamphetamine Initiates among Persons Aged 12 or Older and Mean Age at First Use of Methamphetamine among Past Year Methamphetamine Initiates Aged 12 to 49: 2002-2007
5.7 Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First Use: 2002-2007
5.8 Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never Smoked, by Gender: 2002-2007
6.1 Past Month Binge Drinking and Marijuana Use among Youths Aged 12 to 17, by Perceptions of Risk: 2007
6.2 Perceived Great Risk of Cigarette and Alcohol Use among Youths Aged 12 to 17: 2002-2007
6.3 Perceived Great Risk of Marijuana Use among Youths Aged 12 to 17: 2002-2007
6.4 Perceived Great Risk of Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007
6.5 Perceived Availability of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007
6.6 Approached in the Past Month by Someone Selling Drugs among Youths Aged 12 to 17: 2002-2007
6.7 Exposure to Substance Use Prevention Messages and Programs among Youths Aged 12 to 17: 2002-2007
7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2007
7.2 Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2007
7.3 Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or Older, by Age at First Use of Alcohol: 2007
7.4 Substance Dependence or Abuse in the Past Year, by Age and Gender: 2007
7.5 Locations Where Past Year Substance Use Treatment Was Received among Persons Aged 12 or Older: 2007
7.6 Substances for Which Most Recent Treatment Was Received in the Past Year among Persons Aged 12 or Older: 2007
7.7 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2007
7.8 Reasons for Not Receiving Substance Use Treatment among Persons Aged 12 or Older Who Needed and Made an Effort to Get Treatment But Did Not Receive Treatment and Felt They Needed Treatment: 2004-2007 Combined
8.1 Serious Psychological Distress in the Past Year among Adults Aged 18 or Older, by Age: 2006-2007
8.2 Number of Types of Mental Health Services Received in the Past Year among Persons Aged 18 or Older with Past Year Serious Psychological Distress Who Received Mental Health Services in the Past Year: 2007
8.3 Past Year Mental Health Care among Adults Aged 18 or Older with Both Serious Psychological Distress and a Substance Use Disorder: 2007
8.4 Major Depressive Episode in the Past Year among Adults Aged 18 or Older, by Severe Impairment, Age, and Gender: 2007
8.5 Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2007
8.6 Past Year Mental Health Service Use among Adults Aged 18 or Older, by Type of Care: 2002-2007
8.7 Reasons for Not Receiving Mental Health Services in the Past Year among Adults Aged 18 or Older with an Unmet Need for Mental Health Care Who Did Not Receive Mental Health Services: 2007
8.8 Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Severe Impairment, Age, and Gender: 2007
8.9 Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2007
8.10 Past Year Mental Health Service Use among Youths Aged 12 to 17, by Gender: 2007
8.11 Number of Outpatient Visits in the Past Year among Youths Aged 12 to 17 Who Received Outpatient Specialty Mental Health Services: 2007
8.12 Number of Nights Stayed in an Inpatient Specialty Mental Health Facility in the Past Year among Youths Aged 12 to 17 Who Received Inpatient Specialty Mental Health Services: 2007
9.1 Past Month Marijuana Use among Youths in NSDUH, MTF, and YRBS: 1971-2007
B.1 Required Effective Sample as a Function of the Proportion Estimated
List of Tables
9.1 Comparison of NSDUH and MTF Prevalence Estimates among Youths: 2002-2007
9.2 Comparison of NSDUH and MTF Prevalence Estimates among Young Adults: 2002-2007
B.1 Demographic and Geographic Domains Forced to Match Their Respective U.S. Census Bureau Population Estimates through the Weight Calibration Process, 2007
B.2 Summary of 2007 NSDUH Suppression Rules
B.3 Weighted Percentages and Sample Sizes for 2006 and 2007 NSDUHs, by Screening Result Code
B.4 Weighted Percentages and Sample Sizes for 2006 and 2007 NSDUHs, by Final Interview Code
B.5 Response Rates and Sample Sizes for 2006 and 2007 NSDUHs, by Demographic Characteristics
B.6 Nonmedical Use of Methamphetamine in Lifetime, Past Year, and Past Month, by Demographic Characteristics: Percentages Based on Different Estimation Methods, 2002-2007
B.7 Nonmedical Use of Stimulants in Lifetime, Past Year, and Past Month, by Demographic Characteristics: Percentages Based on Different Estimation Methods, 2002-2007
B.8 Nonmedical Use of Psychotherapeutics in Lifetime, Past Year, and Past Month, by Demographic Characteristics: Percentages Based on Different Estimation Methods, 2002-2007
B.9 Nonmedical Use of Sedatives and Stimulants in the Lifetime, Past Year, and Past Month among Persons Aged 12 or Older Based on Different Estimation Methods, by Demographic Characteristics: Percentages, 2006 and 2007
B.10 Nonmedical Use of Prescription-Type Psychotherapeutics and Use of Hallucinogens in the Lifetime, Past Year, and Past Month among Persons Aged 12 or Older Based on Different Estimation Methods, by Demographic Characteristics: Percentages, 2006 and 2007
B.11 Illicit Drug Use and Illicit Drug Use Other Than Marijuana in the Lifetime, Past Year, and Past Month among Persons Aged 12 or Older Based on Different Estimation Methods, by Demographic Characteristics: Percentages, 2006 and 2007
D.1 Use of Specific Substances in Lifetime, Past Year, and Past Month among 8th, 10th, and 12th Graders in NSDUH and MTF: Percentages, 2006 and 2007
D.2 Lifetime and Past Month Substance Use among Students in Grades 9 to 12 in YRBS and NSDUH: 2005 and 2007
F.1 Survey Sample Size for Respondents Aged 12 or Older, by Gender and Detailed Age Category: 2006 and 2007
F.2 Numbers (in Thousands) of Persons Aged 12 or Older, by Gender and Detailed Age Category: 2006 and 2007
F.3 Survey Sample Size for Respondents Aged 12 or Older, by Age Group and Demographic Characteristics: 2006 and 2007
F.4 Numbers (in Thousands) of Persons Aged 12 or Older, by Age Group and Demographic Characteristics: 2006 and 2007
F.5 Survey Sample Size for Respondents Aged 12 or Older, by Age Group and Geographic Characteristics: 2006 and 2007
F.6 Numbers (in Thousands) of Persons Aged 12 or Older, by Age Group and Geographic Characteristics: 2006 and 2007
G.1 Types of Illicit Drug Use in Lifetime among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007
G.2 Types of Illicit Drug Use in Lifetime among Persons Aged 12 or Older: Percentages, 2002-2007
G.3 Types of Illicit Drug Use in the Past Year among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007
G.4 Types of Illicit Drug Use in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2007
G.5 Types of Illicit Drug Use in the Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007
G.6 Types of Illicit Drug Use in the Past Month among Persons Aged 12 or Older: Percentages, 2002-2007
G.7 Types of Illicit Drug Use in the Past Month among Persons Aged 12 to 17: Percentages, 2002-2007
G.8 Types of Illicit Drug Use in the Past Month among Persons Aged 18 to 25: Percentages, 2002-2007
G.9 Types of Illicit Drug Use in the Past Month among Persons Aged 26 or Older: Percentages, 2002-2007
G.10 Illicit Drug Use in Lifetime, Past Year, and Past Month, by Detailed Age Category: Percentages, 2006 and 2007
G.11 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2006 and 2007
G.12 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2006 and 2007
G.13 Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2006 and 2007
G.14 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 12 or Older, by Gender: Numbers in Thousands, 2002-2007
G.15 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 12 or Older, by Gender: Percentages, 2002-2007
G.16 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 12 to 17, by Gender: Percentages, 2002-2007
G.17 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 18 to 25, by Gender: Percentages, 2002-2007
G.18 Tobacco Product and Alcohol Use in the Past Month among Persons Aged 26 or Older, by Gender: Percentages, 2002-2007
G.19 Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 20, by Gender: Percentages, 2002-2007
G.20 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month, by Detailed Age Category: Percentages, 2006 and 2007
G.21 Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month among Persons Aged 12 to 20, by Demographic Characteristics: Percentages, 2006 and 2007
G.22 Cigarette Use in Lifetime, Past Year, and Past Month, by Detailed Age Category: Percentages, 2006 and 2007
G.23 Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2006 and 2007
G.24 Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2006 and 2007
G.25 Perceived Risk and Availability of Substances among Persons Aged 12 to 17: Percentages, 2002-2007
G.26 Past Year Initiation of Substance Use among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007
G.27 Substance Dependence or Abuse for Specific Substances in the Past Year among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007
G.28 Substance Dependence or Abuse for Specific Substances in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2007
G.29 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2006 and 2007
G.30 Received Substance Use Treatment at Any Treatment Location or at a Specialty Facility in the Past Year among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007
G.31 Received Substance Use Treatment at Any Treatment Location or at a Specialty Facility in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2007
G.32 Needed and Received Treatment for a Substance Use Problem in the Past Year among Persons Aged 12 or Older: Numbers in Thousands, 2002-2007
G.33 Needed and Received Treatment for a Substance Use Problem in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2007
G.34 Needed and Received Treatment for an Illicit Drug or Alcohol Problem in the Past Year among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2006 and 2007
G.35 Perceived Need for Illicit Drug or Alcohol Treatment and Whether Made an Effort to Get Treatment in the Past Year among Persons Aged 12 or Older Classified as Needing But Not Receiving Treatment for an Illicit Drug or Alcohol Problem, by Demographic Characteristics: Numbers in Thousands, 2006 and 2007
G.36 Perceived Need for Illicit Drug or Alcohol Treatment and Whether Made an Effort to Get Treatment in the Past Year among Persons Aged 12 or Older Classified as Needing But Not Receiving Treatment for an Illicit Drug or Alcohol Problem, by Demographic Characteristics: Percentages, 2006 and 2007
G.37 Serious Psychological Distress in the Past Year among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2004-2007
G.38 Received Mental Health Treatment/Counseling in the Past Year among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2002-2007
G.39 Had at Least One Major Depressive Episode (MDE) in the Past Year among Persons Aged 18 or Older, by Demographic Characteristics: Percentages, 2004-2007
G.40 Had at Least One Major Depressive Episode (MDE) in the Past Year among Persons Aged 12 to 17, by Demographic Characteristics: Percentages, 2004-2007
G.41 Source of Mental Health Service in the Past Year among Persons Aged 12 to 17: Percentages, 2002-2007
Highlights
This report presents the first information from the 2007 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year. Unless otherwise noted, all comparisons in this report described using terms such as "increased," "decreased," or "more than" are statistically significant at the .05 level.
Illicit Drug Use
- In 2007, an estimated 19.9 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.0 percent of the population aged 12 years old or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.
- The rate of current illicit drug use among persons aged 12 or older in 2007 (8.0 percent) was similar to the rate in 2006 (8.3 percent).
- Marijuana was the most commonly used illicit drug (14.4 million past month users). Among persons aged 12 or older, the rate of past month marijuana use in 2007 (5.8 percent) was similar to the rate in 2006 (6.0 percent).
- In 2007, there were 2.1 million current cocaine users aged 12 or older, comprising 0.8 percent of the population. These estimates were similar to the number and rate in 2006 (2.4 million or 1.0 percent).
- Hallucinogens were used in the past month by 1.0 million persons (0.4 percent) aged 12 or older in 2007, including 503,000 (0.2 percent) who had used Ecstasy. These estimates were similar to the corresponding estimates for 2006.
- There were 6.9 million (2.8 percent) persons aged 12 or older who used prescription-type psychotherapeutic drugs nonmedically in the past month. Of these, 5.2 million used pain relievers, the same as the number in 2006.
- In 2007, there were an estimated 529,000 current users of methamphetamine aged 12 or older (0.2 percent of the population). These estimates were not significantly different from the estimates for 2006 (731,000 or 0.3 percent).
- Among youths aged 12 to 17, the current illicit drug use rate remained stable from 2006 (9.8 percent) to 2007 (9.5 percent). Between 2002 and 2007, youth rates declined significantly for illicit drugs in general (from 11.6 to 9.5 percent) and for marijuana, cocaine, hallucinogens, LSD, Ecstasy, prescription-type drugs used nonmedically, pain relievers, stimulants, methamphetamine, and the use of illicit drugs other than marijuana.
- The rate of current marijuana use among youths aged 12 to 17 declined from 8.2 percent in 2002 to 6.7 percent in 2007. The rate decreased for both males (from 9.1 to 7.5 percent) and females (from 7.2 to 5.8 percent).
- Among young adults aged 18 to 25, there were decreases from 2006 to 2007 in the rate of current use of several drugs, including cocaine (from 2.2 to 1.7 percent), Ecstasy (from 1.0 to 0.7 percent), stimulants (from 1.4 to 1.1 percent), methamphetamine (from 0.6 to 0.4 percent), and illicit drugs other than marijuana (from 8.9 to 8.1 percent).
- From 2002 to 2007, there was an increase among young adults aged 18 to 25 in the rate of current use of prescription pain relievers, from 4.1 to 4.6 percent. There were decreases in the use of hallucinogens (from 1.9 to 1.5 percent), Ecstasy (from 1.1 to 0.7 percent), and methamphetamine (from 0.6 to 0.4 percent).
- Among those aged 50 to 54, the rate of past month illicit drug use increased from 3.4 percent in 2002 to 5.7 percent in 2007. Among those aged 55 to 59, current illicit drug use showed an increase from 1.9 percent in 2002 to 4.1 percent in 2007. These trends may partially reflect the aging into these age groups of the baby boom cohort, whose lifetime rates of illicit drug use are higher than those of older cohorts.
- Among persons aged 12 or older who used pain relievers nonmedically in the past 12 months, 56.5 percent reported that the source of the drug the most recent time they used was from a friend or relative for free. Another 18.1 percent reported they got the drug from just one doctor. Only 4.1 percent got the pain relievers from a drug dealer or other stranger, and 0.5 percent reported buying the drug on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 81.0 percent reported in a follow-up question that the friend or relative had obtained the drugs from just one doctor.
- Among unemployed adults aged 18 or older in 2007, 18.3 percent were current illicit drug users, which was higher than the 8.4 percent of those employed full time and 10.1 percent of those employed part time. However, most illicit drug users were employed. Of the 17.4 million current illicit drug users aged 18 or older in 2007, 13.1 million (75.3 percent) were employed either full or part time.
- In 2007, there were 9.9 million persons aged 12 or older who reported driving under the influence of illicit drugs during the past year. This corresponds to 4.0 percent of the population aged 12 or older, similar to the rate in 2006 (4.2 percent), but lower than the rate in 2002 (4.7 percent). In 2007, the rate was highest among young adults aged 18 to 25 (12.5 percent).
Alcohol Use
- Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2007 survey (51.1 percent). This translates to an estimated 126.8 million people, which was similar to the 2006 estimate of 125.3 million people (50.9 percent).
- More than one fifth (23.3 percent) of persons aged 12 or older participated in binge drinking (having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey) in 2007. This translates to about 57.8 million people, similar to the estimate in 2006.
- In 2007, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.0 million people. This rate was the same as the rate of heavy drinking in 2006. Heavy drinking is defined as binge drinking on at least 5 days in the past 30 days.
- In 2007, among young adults aged 18 to 25, the rate of binge drinking was 41.8 percent, and the rate of heavy drinking was 14.7 percent. These rates were similar to the rates in 2006.
- The rate of current alcohol use among youths aged 12 to 17 was 15.9 percent in 2007. Youth binge and heavy drinking rates were 9.7 and 2.3 percent, respectively. These rates were essentially the same as the 2006 rates.
- Past month and binge drinking rates among underage persons (aged 12 to 20) have remained essentially unchanged since 2002. In 2007, about 10.7 million persons aged 12 to 20 (27.9 percent of this age group) reported drinking alcohol in the past month. Approximately 7.2 million (18.6 percent) were binge drinkers, and 2.3 million (6.0 percent) were heavy drinkers.
- Among persons aged 12 to 20, past month alcohol use rates in 2007 were 16.8 percent among Asians, 18.3 percent among blacks, 24.7 percent among Hispanics, 26.2 percent among those reporting two or more races, 28.3 percent among American Indians or Alaska Natives, and 32.0 percent among whites.
- In 2007, 56.3 percent of current drinkers aged 12 to 20 reported that their last use of alcohol in the past month occurred in someone else's home, and 29.4 percent reported that it had occurred in their own home. About one third (30.2 percent) paid for the alcohol the last time they drank, including 8.2 percent who purchased the alcohol themselves and 21.8 percent who gave money to someone else to purchase it. Among those who did not pay for the alcohol they last drank, 37.2 percent got it from an unrelated person aged 21 or older, 20.7 percent from another person under 21 years of age, and 19.5 percent got it from a parent, guardian, or other adult family member.
- In 2007, an estimated 12.7 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage has decreased since 2002, when it was 14.2 percent. From 2006 to 2007, the rate of driving under the influence of alcohol among persons aged 18 to 25 decreased from 24.4 to 22.8 percent.
Tobacco Use
- In 2007, an estimated 70.9 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 28.6 percent of the population in that age range. In addition, 60.1 million persons (24.2 percent of the population) were current cigarette smokers; 13.3 million (5.4 percent) smoked cigars; 8.1 million (3.2 percent) used smokeless tobacco; and 2.0 million (0.8 percent) smoked tobacco in pipes.
- The rate of current use of any tobacco product among persons aged 12 or older decreased from 29.6 percent in 2006 to 28.6 percent in 2007, but the rates of current use of cigarettes, smokeless tobacco, cigars, and pipe tobacco did not change significantly over that period. Between 2002 and 2007, past month use of any tobacco product decreased from 30.4 to 28.6 percent, and past month cigarette use declined from 26.0 to 24.2 percent. Rates of past month use of cigars, smokeless tobacco, and pipe tobacco were similar in 2002 and 2007.
- The rate of past month cigarette use among 12 to 17 year olds declined from 13.0 percent in 2002 to 9.8 percent in 2007. However, past month smokeless tobacco use was higher in 2007 (2.4 percent) than in 2002 (2.0 percent).
- Among pregnant women aged 15 to 44, combined data for 2006 and 2007 indicated that the rate of past month cigarette use was 16.4 percent. The rate was higher among women in that age group who were not pregnant (28.4 percent).
Initiation of Substance Use (Incidence, or First-Time Use) within the Past 12 Months
- In 2007, an estimated 2.7 million persons aged 12 or older used an illicit drug for the first time within the past 12 months. A majority of these past year illicit drug initiates reported that their first drug was marijuana (56.2 percent). Nearly one third initiated with psychotherapeutics (30.6 percent, including 19.0 percent with pain relievers, 6.5 percent with tranquilizers, 4.1 percent with stimulants, and 1.1 percent with sedatives). A sizable proportion reported inhalants (10.7 percent) as their first illicit drug, and a small proportion used hallucinogens as their first drug (2.0 percent).
- The illicit drug categories with the largest number of past year initiates among persons aged 12 or older were nonmedical use of pain relievers (2.1 million) and marijuana use (2.1 million). These estimates were not significantly different from the numbers in 2006.
- In 2007, there were 775,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 66.3 percent were under age 18 when they first used. There was no significant change in the number of inhalant initiates from 2006 to 2007.
- The number of past year initiates of methamphetamine among persons aged 12 or older was 157,000 in 2007. This estimate was significantly lower than the estimate in 2002 (299,000), 2003 (260,000), 2004 (318,000), and 2006 (259,000).
- Ecstasy initiation remained essentially unchanged from 2006 (860,000) to 2007 (781,000), but was lower in 2007 than in 2002 (1.2 million).
- Most (85.9 percent) of the 4.6 million past year alcohol initiates were younger than age 21 at the time of initiation.
- The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was 2.2 million in 2007, which was significantly lower than the estimate in 2006 (2.4 million) but significantly higher than the estimate for 2002 (1.9 million). Most new smokers in 2007 were under age 18 when they first smoked cigarettes (59.7 percent).
Youth Prevention-Related Measures
- Perceived risk is measured by NSDUH as the percentage reporting that there is great risk in the substance use behavior. Among youths aged 12 to 17, there were no changes in the perceived risk of marijuana, cocaine, or heroin use between 2006 and 2007. However, between 2002 and 2007, there were increases in the perceived risk of smoking marijuana once a month (from 32.4 to 34.5 percent) and smoking marijuana once or twice a week (from 51.5 to 54.7 percent). On the other hand, the percentage of youths who perceived that trying heroin once or twice is a great risk declined from 58.5 percent in 2002 to 57.0 percent in 2007, and those who perceived that using LSD once or twice a week is a great risk declined from 76.2 to 74.2 percent.
- Almost half (49.1 percent) of youths aged 12 to 17 reported in 2007 that it would be "fairly easy" or "very easy" for them to obtain marijuana if they wanted some. Around one quarter reported it would be easy to get cocaine (24.5 percent). About one in seven (14.1 percent) indicated that heroin would be "fairly" or "very" easily available, and 14.4 percent reported easy availability for LSD.
- The percentage of youths aged 12 to 17 reporting that it would be easy to obtain cocaine declined from 25.9 percent in 2006 to 24.5 percent in 2007. In addition, the perceived availability decreased between 2002 and 2007 for marijuana (from 55.0 to 49.1 percent), heroin (from 15.8 to 14.1 percent), and LSD (from 19.4 to 14.4 percent).
- A majority of youths aged 12 to 17 (91.0 percent) in 2007 reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice. Current marijuana use was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than for those who did not (4.6 vs. 28.1 percent).
- In 2007, 11.3 percent of youths aged 12 to 17 reported that they had participated in substance use prevention programs outside of school within the past year. Almost four fifths (77.9 percent) reported having seen or heard drug or alcohol prevention messages from sources outside of school, lower than in 2002 when the percentage was 83.2 percent. Most (59.6 percent) youths reported in 2007 that they had talked with a parent in the past year about the dangers of drug, tobacco, or alcohol use.
Substance Dependence, Abuse, and Treatment
- In 2007, an estimated 22.3 million persons (9.0 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Of these, 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.7 million were dependent on or abused illicit drugs but not alcohol, and 15.5 million were dependent on or abused alcohol but not illicit drugs.
- Between 2002 and 2007, there was no change in the number of persons with substance dependence or abuse (22.0 million in 2002, 22.3 million in 2007).
- The specific illicit drugs that had the highest levels of past year dependence or abuse in 2007 were marijuana (3.9 million), followed by pain relievers (1.7 million) and cocaine (1.6 million).
- Adults aged 21 or older who had first used alcohol before age 21 were more likely than adults who had their first drink at age 21 or older to be classified with alcohol dependence or abuse (9.6 vs. 2.2 percent).
- The rate of substance dependence or abuse for males aged 12 or older in 2007 was about twice as high as the rate for females (12.5 vs. 5.7 percent). Among youths aged 12 to 17, however, the rate of substance dependence or abuse among males was the same as the rate among females (7.7 percent for both).
- Treatment need is defined as having a substance use disorder or receiving treatment at a specialty facility (hospital inpatient, drug or alcohol rehabilitation, or mental health centers) within the past 12 months. In 2007, 23.2 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (9.4 percent of persons aged 12 or older). Of these, 2.4 million (1.0 percent of persons aged 12 or older and 10.4 percent of those who needed treatment) received treatment at a specialty facility. Thus, 20.8 million persons (8.4 percent of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty substance abuse facility in the past year.
- Of the 20.8 million people in 2007 who were classified as needing substance use treatment but did not receive treatment at a specialty facility in the past year, 1.3 million persons (6.4 percent) reported that they felt they needed treatment for their illicit drug or alcohol use problem. Of these 1.3 million persons who felt they needed treatment, 380,000 (28.5 percent) reported that they made an effort to get treatment, and 955,000 (71.5 percent) reported making no effort to get treatment.
Mental Health
- Serious psychological distress (SPD) is an overall indicator of past year nonspecific psychological distress that is constructed from the K6 scale administered to adults aged 18 or older in NSDUH. In 2007, there were an estimated 24.3 million adults aged 18 or older in the United States with SPD in the past year. This represents 10.9 percent of all adults in this country, a rate similar to the SPD rate in 2006 (11.3 percent) but below the rate in 2004 (12.2 percent).
- Rates of SPD in 2007 were highest for adults aged 18 to 25 (17.9 percent) and lowest for adults aged 50 or older (7.0 percent).
- The prevalence of SPD among women aged 18 or older (13.4 percent) was higher than that among men in that age group (8.2 percent).
- SPD in the past year was associated with past year substance dependence or abuse in 2007. Among adults aged 18 or older with SPD in 2007, 22.1 percent (5.4 million) were dependent on or abused illicit drugs or alcohol. The rate among adults without SPD was 7.6 percent (15.0 million).
- Among the 24.3 million adults with SPD in 2007, 10.8 million (44.6 percent) used mental health services in the past year. Among all adults with SPD, 38.8 percent received a prescription medication, 27.3 percent received outpatient services, and 5.1 percent received inpatient services for a mental health problem in the past year.
- Among the 5.4 million adults with both SPD and substance dependence or abuse (i.e., a substance use disorder) in 2007, nearly half (46.5 percent) received mental health care or substance use treatment at a specialty facility; 10.4 percent received both mental health care and specialty substance use treatment, 33.3 percent received only mental health care, and 2.8 percent received only specialty substance use treatment.
- In 2007, 7.5 percent of persons aged 18 or older (16.5 million persons) had at least one major depressive episode (MDE) in the past year. Almost 1 in 20 adults (4.6 percent or 10.1 million persons) had a past year MDE with severe impairment.
- Having MDE in the past year was associated with past year substance dependence or abuse. In 2007, adults aged 18 or older with past year MDE had higher rates of past year illicit drug use than those without MDE (27.4 vs. 12.8 percent). Adults with past year MDE were more likely than those without MDE to be dependent on or abuse illicit drugs (8.8 vs. 2.1 percent) and alcohol (17.0 vs. 7.0 percent).
- Among adults aged 18 or older who had MDE in the past year, 64.5 percent received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression in the same time period, which was lower than in 2006 (69.1 percent).
- Among adults aged 18 or older with MDE in the past year in 2007, women were more likely than men to receive treatment for depression in the past year (68.0 vs. 57.8 percent), though the treatment rate for women was significantly lower than in 2006 (73.7 percent).
- In 2007, there were 2.0 million youths (8.2 percent of the population aged 12 to 17) who had MDE during the past year. An estimated 1.4 million (5.5 percent) had MDE with severe impairment in one or more role domains (chores at home; school or work; close relationships with family; or social life).
- The rate of MDE in the past year was higher for adolescent females (11.9 percent) than for adolescent males (4.6 percent). The prevalence of MDE with severe impairment was 8.2 percent for females and 3.0 percent for males.
- Among 12 to 17 year olds who had past year MDE in 2007, 35.5 percent had used illicit drugs during the same period. This was higher than the rate of 17.2 percent among youths who did not have past year MDE. Similarly, the rates of past month daily cigarette use and heavy alcohol use were higher for youths with MDE (4.8 and 3.8 percent, respectively) than for youths who did not have MDE (2.3 and 2.2 percent, respectively).
- In 2007, 38.9 percent of youths aged 12 to 17 with past year MDE received treatment for depression (saw or talked to a medical doctor or other professional or used prescription medication). Among youths with past year MDE, 20.5 percent saw or talked to a medical doctor or other professional only, 2.5 percent used prescription medication only, and 15.6 percent received treatment from both sources for depression in the past year.
- In 2007, 3.1 million youths aged 12 to 17 (12.5 percent) received treatment or counseling for problems with behavior or emotions in the specialty mental health setting (inpatient or outpatient care). Additionally, 11.5 percent of youths received services in the education setting, and 2.8 percent received mental health services in the general medical setting in the past 12 months. Mental health services were received in both the specialty setting and either the education or general medical settings (i.e., care from multiple settings) by 5.1 percent of youths.
1. Introduction
This report presents the first information from the 2007 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. This initial report on the 2007 data presents national estimates of rates of use, numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products. Measures related to mental health problems also are presented, including data on depression and on the co-occurrence of substance use and mental health problems. Estimates from NSDUH for States and areas within States will be presented in separate reports.
A major focus of this report is a comparison of substance use prevalence estimates between 2006 and 2007. Trends since 2002 also are discussed for some measures. Because of improvements to the survey in 2002, the 2002 data constitute a new baseline for tracking trends in substance use and other measures. Therefore, estimates from the 2002 through 2007 NSDUHs should not be compared with estimates from the 2001 and earlier surveys in the series to assess changes in substance use and mental health problems over time.
1.1. Summary of NSDUH
NSDUH is the primary source of statistical information on the use of illegal drugs by the U.S. population. Conducted by the Federal Government since 1971, the survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at the respondent's place of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, and is planned and managed by SAMHSA's Office of Applied Studies (OAS). Data collection and analysis are conducted under contract with RTI International, Research Triangle Park, North Carolina.1 This section briefly describes the survey methodology; a more complete description is provided in Appendix A.
NSDUH collects information from residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories) and from civilians living on military bases. The survey excludes homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails and hospitals. Appendix D describes surveys that cover populations outside the NSDUH target population.
Since 1999, the NSDUH interview has been carried out using computer-assisted interviewing (CAI). Most of the questions are administered with audio computer-assisted self-interviewing (ACASI). ACASI is designed to provide the respondent with a highly private and confidential means of responding to questions to increase the level of honest reporting of illicit drug use and other sensitive behaviors. Less sensitive items are administered by interviewers using computer-assisted personal interviewing (CAPI).
The 2007 NSDUH employed a State-based design with an independent, multistage area probability sample within each State and the District of Columbia. The eight States with the largest population (which together account for 48 percent of the total U.S. population aged 12 or older) were designated as large sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas). For these States, the design provided a sample sufficient to support direct State estimates. For the remaining 42 States and the District of Columbia, smaller, but adequate, samples support State estimates using small area estimation (SAE) techniques. The design oversampled youths and young adults, so that each State's sample was approximately equally distributed among three age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.
Nationally, 141,487 addresses were screened for the 2007 survey, and 67,870 completed interviews were obtained. The survey was conducted from January through December 2007. Weighted response rates for household screening and for interviewing were 89.5 and 73.9 percent, respectively. See Appendix B for more information on NSDUH response rates.
1.2. Trend Measurement
Although the design of the 2002 through 2007 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are important methodological differences that affect the comparability of the 2002-2007 estimates with estimates from prior surveys. The most important change was the incentive payment started in 2002 and continuing in subsequent surveys. Each NSDUH respondent completing the interview is given $30. The name of the survey was also changed in 2002, from the National Household Survey on Drug Abuse (NHSDA) to the current name. In addition, improved data collection quality control procedures were introduced in the survey starting in 2001, and updated population data from the 2000 decennial census were incorporated into NSDUH sample weighting procedures starting with the 2002 estimates. Analyses of the effects of these factors on NSDUH estimates have shown that 2002 and later data should not be compared with 2001 and earlier data from the survey series to assess changes over time. Appendix C of the 2004 NSDUH report on national findings discusses this issue in more detail (see OAS, 2005b).
1.3. Change in Estimates for Psychotherapeutic Drugs and Stimulants
This report includes revised estimates of nonmedical use of prescription psychotherapeutic drugs and prescription stimulants that take into account data on methamphetamine use based on information obtained from survey items added to NSDUH in 2005, 2006, and 2007. The 2006 NSDUH national findings report incorporated revised estimates for methamphetamine use based on these new items (OAS, 2007b), and this report extends the revisions to use of stimulants and any prescription psychotherapeutics. In a methodological study, these measures were found to be noticeably higher when the data from the new methamphetamine use items were taken into account. Estimates for use of illicit drugs overall and use of illicit drugs other than marijuana, however, were affected only minimally by these methamphetamine use items and were not revised. See Section B.4.6 in Appendix B for more information on the results of this study.
The 2006 estimates for nonmedical use of stimulants and prescription psychotherapeutics in this report have been revised based on the additional questions on methamphetamine use, and statistical adjustments have been applied to the estimates from 2002 to 2005. These modifications control for the potentially confounding effects of the questionnaire changes and enable year-to-year comparisons to be made over the period from 2002 to 2007. Section B.4.6 in Appendix B provides a discussion of the revised measures and the procedures used to generate estimates based on them. Because of these changes, estimates for nonmedical use of stimulants and psychotherapeutic drugs in this report are not comparable to corresponding estimates in previous NSDUH reports. Methamphetamine use estimates in this report also are not comparable with those in NSDUH reports for survey years prior to 2006.
1.4. Format of Report and Explanation of Tables
This report has separate chapters that discuss the national findings on seven topics: use of illicit drugs; use of alcohol; use of tobacco products; initiation of substance use; prevention-related issues; substance dependence, abuse, and treatment; and mental health problems and treatment. A final chapter summarizes the results and discusses key findings in relation to other research and survey results. Technical appendices describe the survey (Appendix A), provide technical details on the statistical methods and measurement (Appendix B), offer key NSDUH definitions (Appendix C), discuss other sources of related data (Appendix D), list the references cited in the report (as well as other relevant references) (Appendix E), and present selected tabulations of estimates (Appendices F and G).
Tables, text, and figures present prevalence measures for the population in terms of both the number of persons and the percentage of the population. Substance use tables show prevalence estimates by lifetime (i.e., ever used), past year, and past month use. Analyses focus primarily on past month use, which also is referred to as "current use." Tables and figures in which estimates are presented by year have footnotes indicating whether the 2007 estimates are significantly different from 2006 or earlier estimates.
Statistical tests have been conducted for all statements appearing in the text of the report that compare estimates between years or subgroups of the population. Unless explicitly stated that a difference is not statistically significant, all statements that describe differences are significant at the .05 level. Statistically significant differences are described using terms such as "higher," "lower," "increased," and "decreased." Statements that use terms such as "similar," "no difference," "same," or "remained steady" to describe the relationship between estimates denote that a difference is not statistically significant. In addition, a set of estimates for survey years or population subgroups may be presented without a statement of comparison, in which case a statistically significant difference between these estimates is not implied and testing was not conducted.
All estimates presented in the report have met the criteria for statistical reliability (see Section B.2.2 of Appendix B). Estimates that do not meet these criteria are suppressed and do not appear in tables, figures, or text. Also, subgroups with suppressed estimates are not included in statistical tests of comparisons. For example, a statement that "whites had the highest prevalence" means that the rate among whites was higher than the rate among all nonsuppressed racial/ethnic subgroups, but not necessarily higher than the rate among a subgroup for which the estimate was suppressed.
Data are presented for racial/ethnic groups based on current guidelines for collecting and reporting race and ethnicity data (Office of Management and Budget [OMB], 1997). Because respondents were allowed to choose more than one racial group, a "two or more races" category is presented that includes persons who reported more than one category among the basic groups listed in the survey question (white, black or African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, Other). Respondents choosing both Native Hawaiian and Other Pacific Islander but no other categories mentioned above are classified in the combined "Native Hawaiian or Other Pacific Islander" category instead of the "two or more race" category. It should be noted that, except for the "Hispanic or Latino" group, the racial/ethnic groups discussed in this report include only non-Hispanics. The category "Hispanic or Latino" includes Hispanics of any race.
Data also are presented for four U.S. geographic regions and nine geographic divisions within these regions. These regions and divisions, defined by the U.S. Census Bureau, consist of the following groups of States:
Northeast Region - New England Division: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont; Middle Atlantic Division: New Jersey, New York, Pennsylvania.
Midwest Region - East North Central Division: Illinois, Indiana, Michigan, Ohio, Wisconsin; West North Central Division: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota.
South Region - South Atlantic Division: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia; East South Central Division: Alabama, Kentucky, Mississippi, Tennessee; West South Central Division: Arkansas, Louisiana, Oklahoma, Texas.
West Region - Mountain Division: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming; Pacific Division: Alaska, California, Hawaii, Oregon, Washington.
Geographic comparisons also are made based on county type, a variable that reflects different levels of urbanicity and metropolitan area inclusion of counties, based on metropolitan area definitions issued by the OMB in June 2003 (OMB, 2003). For this purpose, counties are grouped based on the 2003 rural-urban continuum codes. These codes were originally developed by the U.S. Department of Agriculture (Butler & Beale, 1994). Each county is either inside or outside a metropolitan statistical area (MSA), as defined by the OMB.
Large metropolitan areas have a population of 1 million or more. Small metropolitan areas have a population of fewer than 1 million. Small metropolitan areas are further classified based on whether they have a population of 250,000 or more. Nonmetropolitan areas are areas outside MSAs. Counties in nonmetropolitan areas are further classified based on the number of people in the county who live in an urbanized area, as defined by the Census Bureau at the subcounty level. "Urbanized" counties have a population of 20,000 or more in urbanized areas, "less urbanized" counties have at least 2,500 but fewer than 20,000 population in urbanized areas, and "completely rural" counties have fewer than 2,500 population in urbanized areas.
1.5. Other NSDUH Reports and Data
Other reports focusing on specific topics of interest will be produced using the 2007 NSDUH data and made available on SAMHSA's website. A report on State-level estimates for 2006-2007 will be available in early 2009.
A comprehensive set of tables, referred to as "detailed tables," is available through the Internet at http://oas.samhsa.gov. The tables are organized into sections based primarily on the topic, and most tables are provided in several parts, showing population estimates (e.g., numbers of drug users), rates (e.g., percentages of population using drugs), and standard errors of all nonsuppressed estimates. A small subset of these detailed tables has been selected for inclusion in Appendices F and G of this report. The appendix tables can be mapped back to the detailed tables by using the table number in parentheses in the upper left corner of each table (e.g., Table G.1 in Appendix G is Table 8.1A in the detailed tables). Additional methodological information on NSDUH, including the questionnaire, is available electronically at the same web address.
Brief descriptive reports and in-depth analytic reports focusing on specific issues or population groups also are produced by OAS. A complete listing of previously published reports from NSDUH and other data sources is available from OAS. Most of these reports also are available through the Internet (http://oas.samhsa.gov). In addition, OAS makes public use data files available to researchers through the Substance Abuse and Mental Health Data Archive (SAMHDA, 2008) at http://www.icpsr.umich.edu/SAMHDA/index.html. Currently, files are available from the 1979 to 2006 surveys.2 The 2007 NSDUH public use file will be available by the end of 2008.
2. Illicit Drug Use
The National Survey on Drug Use and Health (NSDUH) obtains information on nine different categories of illicit drug use: use of marijuana, cocaine, heroin, hallucinogens, and inhalants; and the nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives. In these categories, hashish is included with marijuana, and crack is considered a form of cocaine. Several drugs are grouped under the hallucinogens category, including LSD, PCP, peyote, mescaline, psilocybin mushrooms, and "Ecstasy" (MDMA). Inhalants include a variety of substances, such as nitrous oxide, amyl nitrite, cleaning fluids, gasoline, spray paint, other aerosol sprays, and glue. The four categories of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives) cover numerous medications available by prescription and drugs within these groupings that may be manufactured illegally, such as methamphetamine, which is included under stimulants. Respondents are asked to report only "nonmedical" use of these drugs, defined as use without a prescription of the individual's own or simply for the experience or feeling the drugs caused. Use of over-the-counter drugs and legitimate use of prescription drugs are not included. NSDUH reports combine the four prescription-type drug groups into a category referred to as "psychotherapeutics."
Estimates of "illicit drug use" reported from NSDUH reflect the use of any of the nine drug categories listed above. Use of alcohol and tobacco products, while illegal for youths, is not included in these estimates, but is discussed in Chapters 3 and 4.
This chapter includes revised estimates of the nonmedical use of prescription psychotherapeutic drugs and prescription stimulants that take into account data on methamphetamine use based on information obtained from survey items added to NSDUH in 2005, 2006, and 2007. The 2006 NSDUH national findings report incorporated revised estimates for methamphetamine use based on these additional items (Office of Applied Studies [OAS], 2007b), and this report extends the revisions to use of stimulants and any prescription psychotherapeutics. In a methodological study, these measures were found to be noticeably higher when the data from the additional methamphetamine use items were taken into account. Estimates for use of illicit drugs overall and use of illicit drugs other than marijuana, however, were affected only minimally by these methamphetamine use items and were not revised. See Section B.4.6 in Appendix B for more information on the results of this study.
The 2006 estimates for nonmedical use of stimulants and prescription psychotherapeutics in this report have been revised based on the additional questions on methamphetamine use, and statistical adjustments have been applied to the estimates from 2002 to 2005. These modifications control for the potentially confounding effects of the questionnaire changes and enable year-to-year comparisons to be made over the period from 2002 to 2007. Section B.4.6 in Appendix B provides a discussion of the revised measures and the procedures used to generate estimates based on them. Because of these changes, estimates for the nonmedical use of stimulants and psychotherapeutic drugs in this report are not comparable with corresponding estimates in previous NSDUH reports. Methamphetamine use estimates in this report also are not comparable with those in NSDUH reports for survey years prior to 2006.
- In 2007, an estimated 19.9 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview (Figure 2.1). This estimate represents 8.0 percent of the population aged 12 years old or older.
- The overall rate of current illicit drug use among persons aged 12 or older in 2007 (8.0 percent) was similar to the rate in 2006 (8.3 percent) and has remained stable since 2002 (8.3 percent) (Figure 2.2).
Below are two bar graphs. Click here for the text describing these graphs.
Figure 2.1 Past Month Illicit Drug Use among Persons Aged 12 or Older: 2007
1 Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.
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Figure 2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- Marijuana was the most commonly used illicit drug (14.4 million past month users). In 2007, marijuana was used by 72.8 percent of current illicit drug users and was the only drug used by 53.3 percent of them. Illicit drugs other than marijuana were used by 9.3 million persons or 46.7 percent of illicit drug users aged 12 or older. Current use of other drugs but not marijuana was reported by 27.2 percent of illicit drug users, and 19.4 percent used both marijuana and other drugs.
- Among persons aged 12 or older, the overall rate of past month marijuana use in 2007 (5.8 percent) was similar to the rate in 2006 and the rates in earlier years going back to 2002 (Figure 2.2).
- An estimated 9.3 million people aged 12 or older (3.7 percent) were current users of illicit drugs other than marijuana in 2007. Most (6.9 million persons, or 2.8 percent of the population) used psychotherapeutic drugs nonmedically. In addition to the estimated 5.2 million nonmedical users of pain relievers in 2007, 1.8 million used tranquilizers, 1.1 million used stimulants, and 346,000 used sedatives. The numbers of nonmedical users of pain relievers, tranquilizers, and sedatives in 2007 were similar to the corresponding numbers in 2006, and the percentage rates also remained stable (Figure 2.3). However, the number and percentage of nonmedical stimulant users decreased from 2006 to 2007.
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Figure 2.3 Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- The estimated number and percentage of persons aged 12 or older who used cocaine in the past month in 2007 (2.1 million users or 0.8 percent of the population) were similar to those in 2006 (2.4 million or 1.0 percent) and 2002 (2.0 million or 0.9 percent). The number of past month crack users was also similar over this period (610,000 in 2007 vs. 702,000 in 2006 and 567,000 in 2002).
- Hallucinogens were used in the past month by 1.0 million persons aged 12 or older (0.4 percent) in 2007, including 503,000 (0.2 percent) who had used Ecstasy. These estimates are similar to the corresponding estimates for 2006. However, lifetime use of Ecstasy increased from 10.2 million persons (4.3 percent) in 2002 to 12.4 million (5.0 percent) in 2007, while past year use of Ecstasy decreased from 3.2 million (1.3 percent) to 2.1 million (0.9 percent) over the same period.
- The number of current heroin users decreased from 338,000 in 2006 to 153,000 in 2007, and the corresponding prevalence rate decreased from 0.14 to 0.06 percent.
- In both 2006 and 2007, an estimated 5.2 million persons aged 12 or older (2.1 percent in each year) were current nonmedical users of prescription pain relievers (Figure 2.3). This number was higher than the estimated 4.4 million in 2002, but the difference between the rates in 2002 and 2007 (1.9 and 2.1 percent, respectively) was not statistically significant. However, the rate was higher in 2007 (2.1 percent) than in 2004 (1.8 percent).
- In 2007, the estimated number of past month nonmedical users of stimulants aged 12 or older, 1.1 million, was lower than it had been in 2006 (1.4 million); the corresponding rates also showed a decline (from 0.6 percent in 2006 to 0.4 percent in 2007). These numbers for stimulants included 529,000 persons (0.2 percent) who were current users of methamphetamine in 2007, similar to the number and rate in 2006 (731,000 persons or 0.3 percent of the population). However, the estimated number of past year methamphetamine users declined from 1.9 million in 2006 to 1.3 million in 2007, and the corresponding rate declined from 0.8 to 0.5 percent.
Age
- In 2007, rates of past month illicit drug use varied with age. Through the adolescent years from 12 to 17, the rates of current illicit drug use increased from 3.3 percent at ages 12 or 13 to 8.9 percent at ages 14 or 15 to 16.0 percent at ages 16 or 17 (Figure 2.4). The highest rate was among persons aged 18 to 20 (21.6 percent). The rate was 18.5 percent among those aged 21 to 25, 12.8 percent among those aged 26 to 29, and 0.7 percent among those aged 65 or older.
Below is a bar graph. Click here for the text describing this graph.
Figure 2.4 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2007
- Although adults aged 26 or older were less likely to be current drug users in 2007 than youths aged 12 to 17 or young adults aged 18 to 25 (5.8 vs. 9.5 and 19.7 percent, respectively), there were more drug users aged 26 or older (11.0 million) than in the 12-to-17-year age group (2.4 million) and 18-to-25-year age group (6.5 million) combined.
- Current illicit drug use remained stable from 2006 to 2007 among youths aged 12 to 17, young adults aged 18 to 25, and adults aged 26 or older. From 2002 to 2007, however, the rate of current illicit drug use among 12 to 17 year olds decreased from 11.6 to 9.5 percent (Figure 2.5).
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Figure 2.5 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
Youths Aged 12 to 17
- In 2007, 9.5 percent of youths aged 12 to 17 were current illicit drug users: 6.7 percent used marijuana, 3.3 percent engaged in nonmedical use of prescription-type psychotherapeutics, 1.2 percent used inhalants, 0.7 percent used hallucinogens, and 0.4 percent used cocaine.
- Among youths aged 12 to 17, the types of drugs used in the past month varied by age group. Among 12 or 13 year olds, 1.4 percent used prescription-type drugs nonmedically, 1.1 percent used inhalants, and 0.9 percent used marijuana. Among 14 or 15 year olds, marijuana was the most commonly used drug (5.7 percent), followed by prescription-type drugs used nonmedically (3.4 percent), and then inhalants (1.4 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (13.1 percent), followed by prescription-type drugs used nonmedically (4.9 percent), and then hallucinogens (1.2 percent), inhalants (1.0 percent), and cocaine (0.9 percent).
- Rates of current use remained stable from 2006 to 2007 among youths aged 12 to 17 for all drugs except use of heroin, which decreased from 0.06 to 0.01 percent, and nonmedical use of tranquilizers, which increased from 0.5 to 0.7 percent.
- From 2002 to 2007, rates of current use among youths aged 12 to 17 declined significantly for illicit drugs overall and for several specific drugs, including marijuana, cocaine, hallucinogens, LSD, Ecstasy, prescription-type drugs used nonmedically, pain relievers, stimulants, methamphetamine, and the use of illicit drugs other than marijuana (Figure 2.5). For illicit drug use overall, the rates were 11.6 percent in 2002, 11.2 percent in 2003, 10.6 percent in 2004, 9.9 percent in 2005, 9.8 percent in 2006, and 9.5 percent in 2007.
- The rate of current marijuana use among youths aged 12 to 17 decreased from 8.2 percent in 2002 to 6.7 percent in 2007. Significant declines were also evident between 2002 and 2007 for past year marijuana use (from 15.8 to 12.5 percent) and lifetime marijuana use (from 20.6 to 16.2 percent).
- Current use of illicit drugs other than marijuana among 12 to 17 year olds declined from 5.7 percent in 2002 to 4.7 percent in 2007. Over the same period, past month nonmedical use of psychotherapeutic drugs decreased from 4.0 to 3.3 percent, nonmedical use of pain relievers declined from 3.2 to 2.7 percent, nonmedical use of stimulants decreased from 0.8 to 0.5 percent, and methamphetamine use declined from 0.3 to 0.1 percent. Youths' current use of hallucinogens declined from 1.0 percent in 2002 to 0.7 percent in 2007, reflecting decreases in current use of Ecstasy (from 0.5 to 0.3 percent) and LSD (from 0.2 to 0.1 percent).
Young Adults Aged 18 to 25
- Rates of current use of illicit drugs in 2007 were higher for young adults aged 18 to 25 (19.7 percent) than for youths aged 12 to 17 (9.5 percent) and adults aged 26 or older (5.8 percent). Among young adults, 16.4 percent used marijuana, 6.0 percent used prescription-type drugs nonmedically, 1.7 percent used cocaine, and 1.5 percent used hallucinogens (Figure 2.6).
Below is a line graph. Click here for the text describing this graph.
Figure 2.6 Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- From 2006 to 2007, current use of several illicit drugs declined among young adults aged 18 to 25. Use of cocaine decreased from 2.2 to 1.7 percent, Ecstasy use declined from 1.0 to 0.7 percent, stimulant use went from 1.4 to 1.1 percent, methamphetamine use declined from 0.6 to 0.4 percent, and use of illicit drugs other than marijuana decreased from 8.9 to 8.1 percent.
- From 2002 to 2007, the rate of current use of prescription pain relievers among young adults aged 18 to 25 increased from 4.1 to 4.6 percent. Past month use of hallucinogens overall decreased from 1.9 to 1.5 percent, and use of Ecstasy decreased from 1.1 to 0.7 percent; however, use of LSD increased from 0.1 to 0.2 percent. A decline also was seen in current use of methamphetamine (0.6 percent in 2002 vs. 0.4 percent in 2007).
Adults Aged 26 or Older
- Among adults aged 26 or older, 5.8 percent reported current illicit drug use in 2007. In this age group, 3.9 percent used marijuana and 2.2 percent used prescription-type drugs nonmedically. Less than 1 percent used cocaine (0.7 percent), hallucinogens (0.2 percent), heroin (0.1 percent), and inhalants (0.1 percent). The only significant change between 2006 and 2007 in the rates of past month use among adults in this age group involved heroin, which decreased from 0.14 to 0.05 percent. Lifetime use of marijuana among adults aged 26 or older increased from 40.6 percent in 2006 to 42.0 percent in 2007, while past year nonmedical use of stimulants declined from 1.0 to 0.8 percent and past year use of methamphetamine decreased from 0.6 to 0.4 percent.
- Among adults aged 50 to 59, the rate of current illicit drug use showed an irregular increasing trend between 2002 and 2007 (Figure 2.7). For those aged 50 to 54, the rate increased from 3.4 in 2002 to 6.0 percent in 2006, then ended at 5.7 percent in 2007, not significantly different from the rate in 2006. Among those aged 55 to 59, current illicit drug use also showed an irregular trend with an overall increase from 1.9 percent in 2002 to 4.1 percent in 2007. These patterns and trends may partially reflect the aging into these age groups of the baby boom cohort, whose lifetime rates of illicit drug use are higher than those of older cohorts.
Below is a line graph. Click here for the text describing this graph.
Figure 2.7 Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
Gender
- In 2007, as in prior years, the rate of current illicit drug use among persons aged 12 or older was higher for males than for females (10.4 vs. 5.8 percent, respectively). Males were about twice as likely as females to be past month marijuana users (8.0 vs. 3.8 percent). However, males and females had similar rates of past month use of tranquilizers (0.8 and 0.7 percent for males and females, respectively), stimulants (0.4 percent for males and 0.5 percent for females), methamphetamine (0.2 percent for both males and females), sedatives (0.2 percent for males and 0.1 percent for females), and OxyContin® (0.2 percent for males and 0.1 percent for females).
- From 2006 to 2007, the rate of current heroin use decreased from 0.06 to 0.02 percent among females aged 12 or older, and the rate of current nonmedical use of stimulants declined from 0.6 to 0.4 percent among males in that age group.
- Among youths aged 12 to 17 in 2007, males and females had similar rates of current use of illicit drugs (10.0 percent for males and 9.1 percent for females), cocaine (0.4 and 0.5 percent, respectively), crack (0.03 and 0.09 percent), hallucinogens (0.8 and 0.6 percent), and inhalants (1.2 and 1.1 percent). Rates also were similar for nonmedical use of prescription psychotherapeutic drugs (3.0 and 3.5 percent for males and females, respectively) and prescription pain relievers (2.5 and 2.8 percent). Current marijuana use, however, was more common among male youths (7.5 percent) than female youths (5.8 percent).
- Past month marijuana use among male youths aged 12 to 17 declined from 9.1 percent in 2002 to 6.8 percent in 2006. In 2007, the rate was 7.5 percent, which was not significantly different from the rate in 2006, but was lower than the rate in 2002 (Figure 2.8). Among female youths, little change occurred from 2002 to 2004, but the rate in 2007 (5.8 percent) was lower than the rate in 2002 (7.2 percent).
Below is a line graph. Click here for the text describing this graph.
Figure 2.8 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
Pregnant Women
- Among pregnant women aged 15 to 44 years, an average of 5.2 percent used illicit drugs in the past month based on combined 2006 and 2007 NSDUH data. This rate was significantly lower than the rate among women in that age group who were not pregnant (9.7 percent). Among pregnant women, the average rate of current illicit drug use did not change significantly between 2004-2005 (3.9 percent) and 2006-2007 (5.2 percent).
- The rate of current illicit drug use in the combined 2006-2007 data was lower for pregnant women than for nonpregnant women among those aged 18 to 25 (7.2 vs. 16.0 percent, respectively) and among those aged 26 to 44 (3.0 vs. 6.5 percent). Among women aged 15 to 17, however, those who were pregnant had a higher rate of use (22.6 percent) than those who were not pregnant (13.3 percent). For nonpregnant women aged 15 to 17, current illicit drug use decreased from 14.7 to 13.3 percent between 2004-2005 and 2006-2007.
Race/Ethnicity
- Current illicit drug use varied by race/ethnicity in 2007 among persons aged 12 or older, with the lowest rate among Asians (4.2 percent) (Figure 2.9). Rates were 12.6 percent for American Indians or Alaska Natives, 11.8 percent for persons reporting two or more races, 9.5 percent for blacks, 8.2 percent for whites, and 6.6 percent for Hispanics.
- There were no statistically significant changes between 2006 and 2007 in the rate of current illicit drug use for any racial/ethnic group among persons aged 12 or older.
Below is a bar graph. Click here for the text describing this graph.
Figure 2.9 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2007
Note: Due to low precision, the estimate for Native Hawaiians or Other Pacific Islanders is not shown.
Education
- Illicit drug use in 2007 varied by educational status. Among adults aged 18 or older, the rate of current illicit drug use was lower for college graduates (5.1 percent) than for those who did not graduate from high school (9.3 percent), high school graduates (8.6 percent), and those with some college (8.9 percent). However, adults who had graduated from college were more likely to have tried illicit drugs in their lifetime when compared with adults who had not completed high school (51.8 vs. 36.0 percent). Rates of current illicit drug use remained stable from 2006 to 2007 for each category of education among adults.
College Students
- Among persons aged 18 to 22 years old, the rate of current use of illicit drugs in 2007 was lower among full-time college students (19.8 percent) than among other persons in that age group (22.8 percent), which includes part-time college students, students in other grades, and nonstudents. Current illicit drug use among college students and other 18 to 22 year olds did not change between 2006 and 2007.
- Among full-time college students aged 18 to 22, there were declines from 2006 to 2007 in the current rate of use of hallucinogens (from 1.9 to 1.0 percent), Ecstasy (1.2 to 0.5 percent), and methamphetamine (0.3 to 0.1 percent). Among persons aged 18 to 22 who were not full-time college students, there were decreases in the rate of cocaine use (from 2.7 to 2.1 percent) and nonmedical use of stimulants (from 1.5 to 0.9 percent).
Employment
- Current illicit drug use differed by employment status in 2007. Among adults aged 18 or older, the rate of drug use was higher for unemployed persons (18.3 percent) than for those who were employed full time (8.4 percent) or part time (10.1 percent) (Figure 2.10). These rates were all similar to the corresponding rates in 2006.
Below are two bar graphs. Click here for the text describing these graphs.
Figure 2.10 Past Month Illicit Drug Use among Persons Aged 18 or Older, by Employment Status: 2007
1 The Other Employment category includes retired persons, disabled persons, homemakers, students, or other persons not in the labor force.
- Although the rate of past month illicit drug use was higher among unemployed persons compared with those from other employment groups, most drug users were employed. Of the estimated 17.4 million current illicit drug users aged 18 or older in 2007, 13.1 million (75.3 percent) were employed either full or part time.
Geographic Area
- Among persons aged 12 or older, the rate of current illicit drug use in 2007 was 9.3 percent in the West, 7.9 percent in the Midwest, 7.8 percent in the Northeast, and 7.4 percent in the South.
- Among youths aged 12 to 17, current marijuana use declined from 2002 to 2007 in each region, although the difference was not significant in the West. In the Northeast, marijuana use rates declined from 9.5 percent in 2002 to 7.2 percent in 2007. In the Midwest, the rate declined from 8.1 percent in 2002 to 6.9 percent in 2005 and remained stable through 2007. In the South, the rate decreased from 2002 to 2004 and then remained reasonably stable through 2007. In the West, the rate did not change significantly from 2002 through 2004 (8.0 percent in 2002, 8.7 percent in 2003, and 9.3 percent in 2004), but then declined to 6.8 percent in 2005 and remained around that level through 2007.
- In 2007, the rate of current illicit drug use among persons aged 12 or older was higher in metropolitan areas than in nonmetropolitan areas. The rates were 8.3 percent in large metropolitan counties, 8.2 percent in small metropolitan counties, and 6.7 percent in nonmetropolitan counties as a group (Figure 2.11). Within nonmetropolitan areas, the rate was 7.5 percent in urbanized counties, 6.7 percent in less urbanized counties, and 4.1 percent in completely rural counties.
- The rate of current illicit drug use among the population aged 12 or older in completely rural counties in 2007 (4.1 percent) was lower than that observed in 2006 (7.8 percent).
Below is a bar graph. Click here for the text describing this graph.
Figure 2.11 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2007
Criminal Justice Populations
- In 2007, there were an estimated 1.6 million adults aged 18 or older on parole or other supervised release from prison during the past year. Almost one fourth of these (24.1 percent) were current illicit drug users, higher than the 7.7 percent among adults not on parole or supervised release.
- Among the 5.1 million adults on probation at some time in the past year, 28.4 percent reported current illicit drug use in 2007. This was higher than the rate of 7.4 percent among adults not on probation in 2007.
Frequency of Use
- In 2007, an estimated 14.2 percent of past year marijuana users aged 12 or older used marijuana on 300 or more days within the past 12 months. This translates into 3.6 million using marijuana on a daily or almost daily basis over a 12-month period, higher than the estimate of 3.1 million (12.3 percent of past year users) in 2006. Among past month marijuana users aged 12 or older, 35.3 percent (5.1 million) used the drug on 20 or more days in the past month.
Association with Cigarette and Alcohol Use
- In 2007, the rate of current illicit drug use was almost 9 times higher among youths aged 12 to 17 who smoked cigarettes in the past month (47.3 percent) than it was among youths who did not smoke cigarettes in the past month (5.4 percent).
- Past month illicit drug use also was associated with the level of past month alcohol use. Among youths aged 12 to 17 in 2007 who were heavy drinkers (i.e., consumed five or more drinks on the same occasion on each of 5 or more days in the past 30 days), 60.1 percent also were current illicit drug users, which was higher than the rate among nondrinkers (5.0 percent).
Driving Under the Influence of Illicit Drugs
- In 2007, 9.9 million persons aged 12 or older reported driving under the influence of illicit drugs during the past year. This corresponds to 4.0 percent of the population in that age group, similar to the rate in 2006 (4.2 percent), but lower than the rate in 2002 (4.7 percent). In 2007, the rate was highest among young adults aged 18 to 25 (12.5 percent).
Source of Prescription Drugs
- Past year nonmedical users of prescription-type psychotherapeutic drugs are asked how they obtained the drugs they recently used nonmedically. In both 2006 and 2007, over half of the nonmedical users of prescription-type pain relievers, tranquilizers, stimulants, and sedatives aged 12 or older said they got the drugs they used most recently "from a friend or relative for free." In a follow-up question, the majority of these respondents indicated that their friend or relative had obtained the drugs from one doctor.
- Among persons aged 12 or older in 2007 who used pain relievers nonmedically in the past 12 months, 56.5 percent said they got the pain relievers they most recently used from a friend or relative for free. Another 8.9 percent bought them from a friend or relative, and 5.2 percent reported stealing them from a friend or relative. Nearly one fifth (18.1 percent) indicated that they got the drugs from one doctor. Around 1 in 20 users (4.1 percent) got pain relievers from a drug dealer or other stranger, and 0.5 percent said they bought them on the Internet.
- In 81.0 percent of the cases in 2007 where nonmedical users of prescription pain relievers aged 12 or older obtained the drugs from a friend or relative for free, the individuals indicated that their friend or relative had obtained them from just one doctor. Only 1.8 percent reported that the friend or relative had bought the drugs from a drug dealer or other stranger.
- In 2007, 44.3 percent of past year methamphetamine users aged 12 or older reported that they obtained the methamphetamine they used most recently from a friend or relative for free. Another 30.4 percent bought it from a friend or relative. Around one in five users (19.8 percent) bought it from a drug dealer or other stranger.
3. Alcohol Use
The National Survey on Drug Use and Health (NSDUH) includes questions about the recency and frequency of consumption of alcoholic beverages, such as beer, wine, whiskey, brandy, and mixed drinks. An extensive list of examples of the kinds of beverages covered is given to respondents prior to the question administration. A "drink" is defined as 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. Times when the respondent only had a sip or two from a drink are not considered to be consumption. For this report, estimates for the prevalence of alcohol use are reported primarily at three levels defined for both males and females and for all ages as follows:
Current (past month) use - At least one drink in the past 30 days.
Binge use - 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.
Heavy use - Five or more drinks on the same occasion on each of 5 or more days in the past 30 days.
These levels are not mutually exclusive categories of use; heavy use is included in estimates of binge and current use, and binge use is included in estimates of current use.
This chapter is divided into two main sections. Section 3.1 describes trends and patterns of alcohol use among the population aged 12 or older. Section 3.2 is particularly concerned with the use of alcohol by persons aged 12 to 20. These persons are under the legal drinking age in all 50 States and the District of Columbia.
3.1. Alcohol Use among Persons Aged 12 or Older
- Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2007 survey (51.1 percent). This translates to an estimated 126.8 million people, which is similar to the 2006 estimate of 125.3 million people (50.9 percent).
- More than one fifth (23.3 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2007. This translates to about 57.8 million people. The rate in 2007 is similar to the rate in 2006 (23.0 percent).
- In 2007, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.0 million people. This percentage is the same as the rate of heavy drinking in 2006 (6.9 percent).
Age
- In 2007, rates of current alcohol use were 3.5 percent among persons aged 12 or 13, 14.7 percent of persons aged 14 or 15, 29.0 percent of 16 or 17 year olds, 50.7 percent of those aged 18 to 20, and 68.3 percent of 21 to 25 year olds (Figure 3.1). Among older age groups, the prevalence of current alcohol use decreased with increasing age, from 63.2 percent among 26 to 29 year olds to 47.6 percent among 60 to 64 year olds and 38.1 percent among people aged 65 or older.
Below is a bar graph. Click here for the text describing this graph.
Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2007
- Rates of binge alcohol use in 2007 were 1.5 percent among 12 or 13 year olds, 7.8 percent among 14 or 15 year olds, 19.4 percent among 16 or 17 year olds, 35.7 percent among persons aged 18 to 20, and peaked among those aged 21 to 25 at 45.9 percent. The rate decreased beyond young adulthood from 35.1 percent of 26 to 34 year olds to 18.9 percent of persons aged 35 or older.
- The rate of binge drinking was 41.8 percent for young adults aged 18 to 25. Heavy alcohol use was reported by 14.7 percent of persons aged 18 to 25. These rates are similar to the rates in 2006 (42.2 and 15.6 percent, respectively).
- Persons aged 65 or older had lower rates of binge drinking (7.6 percent) than adults in other age groups. The rate of heavy drinking among persons aged 65 or older was 1.4 percent.
- The rate of current alcohol use among youths aged 12 to 17 was 15.9 percent in 2007. Youth binge and heavy drinking rates were 9.7 and 2.3 percent, respectively. These rates are essentially the same as the 2006 rates (16.6, 10.3, and 2.4 percent, respectively).
Gender
- In 2007, 56.6 percent of males aged 12 or older were current drinkers, higher than the rate for females (46.0 percent). However, among youths aged 12 to 17, the percentage of males who were current drinkers (15.9 percent) was similar to the rate for females (16.0 percent).
- Among adults aged 18 to 25, an estimated 57.1 percent of females and 65.3 percent of males reported current drinking in 2007. These rates are similar to those reported in 2006 (57.9 and 65.9 percent, respectively).
Pregnant Women
- Among pregnant women aged 15 to 44, an estimated 11.6 percent reported current alcohol use, 3.7 percent reported binge drinking, and 0.7 percent reported heavy drinking. These rates were significantly lower than the rates for nonpregnant women in the same age group (53.2, 24.1, and 5.5 percent, respectively). Binge drinking during the first trimester of pregnancy was reported by 6.6 percent of pregnant women aged 15 to 44. All of these estimates by pregnancy status are based on data averaged over 2006 and 2007.
Race/Ethnicity
- Among persons aged 12 or older, whites in 2007 were more likely than other racial/ethnic groups to report current use of alcohol (56.1 percent) (Figure 3.2). The rates were 47.5 percent for persons reporting two or more races, 44.7 percent for American Indians or Alaska Natives, 42.1 percent for Hispanics, 39.3 percent for blacks, and 35.2 percent for Asians.
Below is a bar graph. Click here for the text describing this graph.
Figure 3.2 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Race/Ethnicity: 2007
Note: Due to low precision, estimates for Native Hawaiians or Other Pacific Islanders are not shown.
- The rate of binge alcohol use was lowest among Asians (12.6 percent). Rates for other racial/ethnic groups were 19.1 percent for blacks, 23.2 percent for persons reporting two or more races, 23.4 percent for Hispanics, 24.6 percent for whites, and 28.2 percent for American Indians or Alaska Natives.
- Among youths aged 12 to 17 in 2007, whites had higher rates of current alcohol use than any other racial/ethnic group. In 2007, 18.2 percent of white youths were current drinkers, while 8.1 percent of Asian youths, 10.1 percent of black youths, 12.5 percent of those reporting two or more races, and 15.2 percent of Hispanic youths used alcohol in the past month.
Education
- Among adults aged 18 or older, the rate of past month alcohol use increased with increasing levels of education. Among adults with less than a high school education, 36.5 percent were current drinkers in 2007, significantly lower than the 68.5 percent of college graduates who were current drinkers. However, among adults aged 26 or older, binge and heavy alcohol use rates were lower among college graduates (20.1 and 4.8 percent, respectively) than among those who had not completed college (22.7 vs. 6.7 percent, respectively).
College Students
- Young adults aged 18 to 22 enrolled full time in college were more likely than their peers not enrolled full time (i.e., part-time college students and persons not currently enrolled in college) to use alcohol in the past month, binge drink, and drink heavily. Past month alcohol use was reported by 63.7 percent of full-time college students compared with 53.5 percent of persons aged 18 to 22 who were not enrolled full time. Binge and heavy use rates for college students were 43.6 and 17.2 percent, respectively, compared with 38.4 and 12.9 percent, respectively, for 18 to 22 year olds not enrolled full time in college.
- The pattern of higher rates of current alcohol use, binge alcohol use, and heavy alcohol use among full-time college students compared with rates for others aged 18 to 22 has remained consistent since 2002 (Figure 3.3).
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Figure 3.3 Heavy Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
Employment
- Rates of current alcohol use were 62.8 percent for full-time employed adults aged 18 or older in 2007, higher than the rate for unemployed adults (56.9 percent). However, the rate of heavy use for unemployed persons was 12.0 percent, which was higher than the rate of 8.8 percent for full-time employed persons. There was no significant difference in binge alcohol use rates between full-time employed adults (30.2 percent) and unemployed adults (32.2 percent).
- Most binge and heavy alcohol users were employed in 2007. Among 55.3 million adult binge drinkers, 44.0 million (79.4 percent) were employed either full or part time. Among 16.4 million heavy drinkers, 13.1 million (79.6 percent) were employed.
Geographic Area
- The rate of past month alcohol use for people aged 12 or older in 2007 was lower in the South (46.8 percent) than in the Northeast (56.0 percent), Midwest (54.6 percent), or West (50.8 percent).
- Among people aged 12 or older, the rate of past month alcohol use in large metropolitan areas (53.5 percent) was higher than the 50.9 percent in small metropolitan areas and 44.0 percent in nonmetropolitan areas. Binge drinking was equally prevalent in small metropolitan areas (23.4 percent), large metropolitan areas (23.3 percent), and nonmetropolitan areas (23.0 percent). The rate of binge alcohol use in nonmetropolitan urbanized areas increased from 21.9 percent in 2006 to 25.7 percent in 2007.
- The rates of binge alcohol use among youths aged 12 to 17 were 11.6 percent in nonmetropolitan areas, 9.4 percent in small metropolitan areas, and 9.3 percent in large metropolitan areas.
Association with Illicit Drug and Tobacco Use
- The level of alcohol use was associated with illicit drug use in 2007. Among the 17.0 million heavy drinkers aged 12 or older, 31.3 percent were current illicit drug users. Persons who were not current alcohol users were less likely to have used illicit drugs in the past month (3.4 percent) than those who reported (a) current use of alcohol but did not meet the criteria for binge or heavy use (5.5 percent), (b) binge use but did not meet the criteria for heavy use (16.1 percent), or (c) heavy use of alcohol (31.3 percent).
- Alcohol consumption levels also were associated with tobacco use. Among heavy alcohol users aged 12 or older, 58.1 percent smoked cigarettes in the past month, while only 19.0 percent of non-binge current drinkers and 16.4 percent of persons who did not drink alcohol in the past month were current smokers. Smokeless tobacco use and cigar use also were more prevalent among heavy drinkers (12.3 and 17.5 percent, respectively) than among non-binge drinkers (2.0 and 4.3 percent) and nondrinkers (1.9 and 2.2 percent).
Driving Under the Influence of Alcohol
- In 2007, an estimated 12.7 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year (Figure 3.4). This percentage has dropped slightly since 2002, when it was 14.2 percent. The 2007 estimate corresponds to 31.4 million persons. From 2006 to 2007, the rate of driving under the influence of alcohol among young adults aged 18 to 25 decreased from 24.4 to 22.8 percent.
- Driving under the influence of alcohol was associated with age in 2007. An estimated 7.8 percent of 16 or 17 year olds, 18.3 percent of 18 to 20 year olds, and 25.8 percent of 21 to 25 year olds reported driving under the influence of alcohol in the past year (Figure 3.5). Beyond age 25, these rates showed a general decline with increasing age.
- Among persons aged 12 or older, males were nearly twice as likely as females (16.6 vs. 9.0 percent) to drive under the influence of alcohol in the past year.
Below is a bar graph. Click here for the text describing this graph.
Figure 3.4 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 12 or Older: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
Below is a bar graph. Click here for the text describing this graph.
Figure 3.5 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 16 or Older, by Age: 2007
3.2. Underage Alcohol Use
- In 2007, about 10.7 million persons aged 12 to 20 (27.9 percent of this age group) reported drinking alcohol in the past month. Approximately 7.2 million (18.6 percent) were binge drinkers, and 2.3 million (6.0 percent) were heavy drinkers. These figures have remained essentially the same since the 2002 survey.
- Rates of current alcohol use increased with increasing age among underage persons. In 2007, 3.5 percent of persons aged 12 or 13, 14.7 percent of persons aged 14 or 15, 29.0 percent of 16 or 17 year olds, and 50.7 percent of 18 to 20 year olds drank alcohol during the 30 days before they were surveyed. This pattern has remained stable since 2002 (Figure 3.6).
Below is a line graph. Click here for the text describing this graph.
Figure 3.6 Current Alcohol Use among Persons Aged 12 to 20, by Age: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- More males than females aged 12 to 20 reported binge drinking (21.1 vs. 16.1 percent) and heavy drinking (7.8 vs. 4.2 percent) in 2007 (Figure 3.7). However, rates of current alcohol use were similar by gender (28.4 percent for males and 27.3 percent for females).
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Figure 3.7 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by Gender: 2007
- Among persons aged 12 to 20, past month alcohol use rates in 2007 were 16.8 percent among Asians, 18.3 percent among blacks, 24.7 percent among Hispanics, 26.2 percent among those reporting two or more races, 28.3 percent among American Indians or Alaska Natives, and 32.0 percent among whites.
- In 2007, among persons aged 12 to 20, binge drinking was reported by 22.4 percent of whites, 16.7 percent of Hispanics, and 16.4 percent of persons reporting two or more races, but only by 9.6 percent of Asians and 8.4 percent of blacks.
- Across geographic regions in 2007, underage current alcohol use rates were higher in the Northeast (31.4 percent) and Midwest (29.1 percent) than in the South (25.7 percent). The rate in the West (27.3 percent) was similar to rates in the South and Midwest regions, but was significantly lower than the rate in the Northeast.
- In 2007, underage current alcohol use rates were higher in small metropolitan areas (29.2 percent) compared with large metropolitan areas (26.9 percent) and similar in small metropolitan areas and nonmetropolitan areas (28.8 percent). The rate in completely rural nonmetropolitan areas was 24.6 percent.
- In 2007, 80.9 percent of current drinkers aged 12 to 20 were with two or more other people the last time they drank alcohol, 14.1 percent were with one other person the last time they drank, and 4.9 percent were alone.
- A majority of underage current drinkers in 2007 reported that their last use of alcohol in the past month occurred either in someone else's home (56.3 percent) or their own home (29.4 percent). Underage males were more likely than females to have been in their own home on their last drinking occasion (31.3 vs. 27.3 percent), whereas females were more likely than males to have been in a restaurant, bar, or club on their last drinking occasion (12.8 vs. 6.1 percent).
- Among underage current drinkers in 2007, 30.2 percent paid for the alcohol the last time they drank, including 8.2 percent who purchased the alcohol themselves and 21.8 percent who gave money to someone else to purchase it.
- Among underage drinkers who did not pay for the alcohol the last time they drank, the most common source was an unrelated person aged 21 or older (37.2 percent). Other underage persons provided the alcohol on the last occasion 20.7 percent of the time. Parents, guardians, or other adult family members provided the alcohol 19.5 percent of the time. Other sources of alcohol for underage drinkers included (a) took the alcohol from home (5.5 percent), (b) took it from someone else's home (3.4 percent), and (c) got it some other way (8.5 percent).
- Underage drinkers were more likely than persons aged 21 or older to use illicit drugs within 2 hours of alcohol use on their last reported drinking occasion (16.3 vs. 4.5 percent, respectively). The most commonly reported illicit drug used by underage drinkers in combination with alcohol was marijuana, which was used within 2 hours of alcohol use by 15.3 percent of current underage drinkers (1.6 million persons) on their last drinking occasion.
4. Tobacco Use
The National Survey on Drug Use and Health (NSDUH) includes a series of questions about the use of tobacco products, including cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco. Cigarette use is defined as smoking "part or all of a cigarette." For analytic purposes, data for chewing tobacco and snuff are combined as "smokeless tobacco."
- In 2007, an estimated 70.9 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 28.6 percent of the population in that age range. In addition, 60.1 million persons (24.2 percent of the population) were current cigarette smokers; 13.3 million (5.4 percent) smoked cigars; 8.1 million (3.2 percent) used smokeless tobacco; and 2.0 million (0.8 percent) smoked tobacco in pipes (Figure 4.1).
- The rate of current use of any tobacco product among persons aged 12 or older decreased from 29.6 percent in 2006 to 28.6 percent in 2007, but the rates of current use of cigarettes, smokeless tobacco, cigars, and pipe tobacco did not change significantly over that period. Between 2002 and 2007, past month use of any tobacco product decreased from 30.4 to 28.6 percent, and past month cigarette use declined from 26.0 to 24.2 percent. Rates of past month use of cigars, smokeless tobacco, and pipe tobacco were similar in 2002 and 2007.
Below is a line graph. Click here for the text describing this graph.
Figure 4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
Age
- Young adults aged 18 to 25 had the highest rate of current use of a tobacco product (41.8 percent) and of each specific product compared with youths aged 12 to 17 and adults aged 26 or older. In 2007, the rates of past month use among young adults were 36.2 percent for cigarettes, 11.8 percent for cigars, 5.3 percent for smokeless tobacco, and 1.2 percent for pipe tobacco. The rate of current use of a tobacco product by young adults decreased from 2006 to 2007 (43.9 vs. 41.8 percent), as did the rate of cigarette use (38.4 vs. 36.2 percent). These decreases from 2006 to 2007 in current use of any tobacco product and cigarettes continue declines seen from 2002 to 2006 among young adults; in 2002, the rates were 45.3 and 40.8 percent, respectively. However, the rate of current use of cigars by young adults was higher in 2007 than in 2002 (11.8 vs. 11.0 percent).
- Among youths aged 12 to 17 in 2007, 3.1 million (12.4 percent) used a tobacco product in the past month, 2.5 million (9.8 percent) used cigarettes, and 1.1 million (4.2 percent) used cigars (Figure 4.2). The rate of past month cigarette use among 12 to 17 year olds declined from 13.0 percent in 2002 to 9.8 percent in 2007. Past month use of smokeless tobacco, however, was higher in 2007 (2.4 percent) than in 2002 (2.0 percent).
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Figure 4.2 Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- In 2007, 1.8 percent of 12 or 13 year olds, 8.4 percent of 14 or 15 year olds, and 18.9 percent of 16 or 17 year olds were current cigarette smokers (Figure 4.3). Across age groups, current cigarette use peaked at 38.5 percent among persons aged 21 to 25. Less than a quarter (22.0 percent) of persons aged 35 or older in 2007 smoked cigarettes in the past month. From 2006 to 2007, the rate of current cigarette use decreased among persons aged 18 to 20 (from 35.6 to 32.7 percent) and among persons aged 21 to 25 (from 40.2 to 38.5 percent).
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Figure 4.3 Past Month Cigarette Use among Persons Aged 12 or Older, by Age: 2007
Gender
- In 2007, current use of a tobacco product among persons aged 12 or older was reported by a higher percentage of males (35.2 percent) than females (22.4 percent). Males also had higher rates of past month use than females of each specific tobacco product: cigarette smoking (27.1 percent of males vs. 21.5 percent of females), cigar smoking (9.1 vs. 1.8 percent), use of smokeless tobacco (6.3 vs. 0.4 percent), and use of pipe tobacco (1.5 vs. 0.2 percent).
- Among youths aged 12 to 17, the rate of current cigarette smoking in 2007 did not differ significantly for males (10.0 percent) and females (9.7 percent). The rate declined for females between 2006 and 2007 (10.7 vs. 9.7 percent), but remained unchanged for males (10.0 percent in each year). From 2002 to 2007, the rate of current cigarette smoking among youths decreased for both males (from 12.3 to 10.0 percent) and females (from 13.6 to 9.7 percent) (Figure 4.4).
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Figure 4.4 Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- Among female young adults aged 18 to 25, current cigarette smoking decreased from 34.9 percent in 2006 to 31.8 percent in 2007. Between 2002 and 2007, the rate of cigarette use among young adults declined for both males (from 44.4 to 40.5 percent) and females (from 37.1 to 31.8 percent). Among male young adults, however, there was an increase in the rate of current cigar smoking over that period (from 16.8 percent in 2002 to 18.4 percent in 2007).
Pregnant Women
- Among women aged 15 to 44, combined data for 2006 and 2007 indicated that the rate of past month cigarette use was lower among those who were pregnant (16.4 percent) than it was among those who were not pregnant (28.4 percent). This pattern was evident among women aged 18 to 25 (23.3 vs. 33.9 percent for pregnant and nonpregnant women, respectively) and among women aged 26 to 44 (11.6 vs. 28.3 percent, respectively). However, among those aged 15 to 17, the rate of cigarette smoking for pregnant women was higher than for nonpregnant women (24.3 vs. 16.0 percent). A similar pattern in cigarette smoking was observed in the combined 2004-2005 data, although the difference among those aged 15 to 17 was not statistically significant in the data for those years.
- Two-year moving average rates from 2002-2003 to 2006-2007 indicate that current cigarette use among women aged 15 to 44 decreased from 30.7 to 28.4 percent for those who were not pregnant and from 18.0 to 16.4 percent for those who were pregnant, although the latter difference was not statistically significant (Figure 4.5).
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Figure 4.5 Past Month Cigarette Use among Women Aged 15 to 44, by Pregnancy Status: Combined Years 2002-2003 to 2006-2007
+ Difference between this estimate and the 2006-2007 estimate is statistically significant at the .05 level.
Race/Ethnicity
- In 2007, the prevalence of current use of a tobacco product among persons aged 12 or older was 15.4 percent for Asians, 22.7 percent for Hispanics, 26.8 percent for blacks, 30.7 percent for whites, 35.2 percent for persons who reported two or more races, and 41.8 percent for American Indians or Alaska Natives. There were no statistically significant changes in past month use of a tobacco product between 2006 and 2007 for any of these racial/ethnic groups. Among the specific tobacco products, smokeless tobacco use in the past month among blacks decreased from 1.7 percent in 2006 to 0.7 percent in 2007.
- In 2007, current cigarette smoking among youths aged 12 to 17 and young adults aged 18 to 25 was more prevalent among whites than blacks (12.2 vs. 6.1 percent for youths and 40.8 vs. 26.2 percent for young adults). Among adults aged 26 or older, however, whites and blacks used cigarettes at about the same rate (24.8 and 25.7 percent, respectively). The rates for Hispanics were 6.7 percent among youths, 29.5 percent among young adults, and 21.0 percent among those aged 26 or older.
- From 2006 to 2007, current cigarette use among whites aged 18 to 25 decreased from 44.4 to 40.8 percent, and current use of smokeless tobacco among blacks aged 26 or older decreased from 2.2 to 0.8 percent.
Education
- Cigarette smoking in the past month was less prevalent among adults who were college graduates compared with those with less education. Among adults aged 18 or older, current cigarette use in 2007 was reported by 32.9 percent of those who had not completed high school, 31.9 percent of high school graduates who did not attend college, 26.8 percent of persons with some college, and 14.0 percent of college graduates (Figure 4.6). Past month cigarette smoking among adults who had not completed high school decreased from 35.6 percent in 2006 to 32.9 percent in 2007.
- In 2007, the use of smokeless tobacco in the past month was reported by 3.5 percent of persons aged 18 or older who had not completed high school, 4.4 percent of those who completed high school but did not attend college, and 3.3 percent of those who attended some college. The prevalence among college graduates, 2.1 percent, was lower than among the other groups.
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Figure 4.6 Past Month Tobacco Use among Adults Aged 18 or Older, by Education: 2007
College Students
- Among young adults 18 to 22 years old, full-time college students were less likely to be current cigarette smokers than their peers who were not enrolled full time in college. Cigarette use in the past month in 2007 was reported by 25.6 percent of full-time college students, less than the rate of 41.2 percent for those not enrolled full time.
- Among males aged 18 to 22 in 2007, full-time college students and those not enrolled full time in college did not differ significantly in their rates of past month cigar smoking (19.1 and 21.7 percent, respectively) or past month smokeless tobacco use (9.8 and 10.7 percent). A similar pattern was seen among females aged 18 to 22.
Employment
- In 2007, current cigarette smoking was more common among unemployed adults aged 18 or older than among adults who were working full time or part time (44.6 vs. 27.6 and 24.5 percent, respectively). Cigar smoking followed a similar pattern, with 11.2 percent of unemployed adults reporting past month use compared with 6.4 percent of full-time workers and 5.3 percent of part-time workers.
- Current use of smokeless tobacco in 2007 was higher among adults aged 18 or older who were employed full time (4.4 percent) and those who were unemployed (4.9 percent) than among adults who were employed part time (2.0 percent) and those in the "other" employment category, which includes persons not in the labor force (1.9 percent).
Geographic Area
- In 2007, current cigarette smoking among persons aged 12 or older was lowest in the West (21.1 percent) and Northeast (22.1 percent), higher in the South (25.5 percent), and highest in the Midwest (27.2 percent). Use of smokeless tobacco was higher in the Midwest and South (4.0 and 3.8 percent, respectively) than in the West (2.8 percent); the lowest rate was in the Northeast (1.8 percent).
- Among persons aged 12 or older, the rate of current cigarette use was associated with county type in 2007. The rates of cigarette smoking were 22.7 percent in large metropolitan areas, 24.8 percent in small metropolitan areas, 28.0 percent in urbanized nonmetropolitan areas, and 29.5 percent in less urbanized nonmetropolitan areas. In completely rural counties, 23.6 percent of persons aged 12 or older were current cigarette smokers in 2007, which is lower than the rate in 2006 (30.1 percent) and similar to the rate in 2005 (23.3 percent).
- Use of smokeless tobacco in the past month in 2007 among persons aged 12 or older was lowest in large metropolitan areas (2.0 percent). In small metropolitan areas, the rate was 3.5 percent; in nonmetropolitan areas, it was 6.7 percent; and in completely rural nonmetropolitan counties, the rate was 7.0 percent.
Association with Illicit Drug and Alcohol Use
- Use of illicit drugs and alcohol was more common among current cigarette smokers than among nonsmokers in 2007, as in 2002 through 2006. Among persons aged 12 or older, 20.1 percent of past month cigarette smokers reported current use of an illicit drug compared with 4.1 percent of persons who were not current cigarette smokers. Past month alcohol use was reported by 66.9 percent of current cigarette smokers compared with 46.1 percent of those who did not use cigarettes in the past month. The association also was found with binge drinking (45.0 percent of current cigarette users vs. 16.4 percent of current nonusers) and heavy drinking (16.4 vs. 3.8 percent, respectively).
Frequency of Cigarette Use
- Among the 60.1 million current cigarette smokers aged 12 or older in 2007, 36.8 million (61.3 percent) used cigarettes daily. The percentage of daily cigarette smokers increased with age, with 26.3 percent among past month cigarette users aged 12 to 17, 49.3 percent among those aged 18 to 25, and 66.3 percent among those aged 26 or older. In addition, over half (50.9 percent) of daily smokers aged 12 or older reported smoking 16 or more cigarettes per day; this is approximately one pack or more. The percentage of daily smokers who used a pack of cigarettes or more per day was steadily higher with age from 18.5 percent among those aged 12 to 17 to 33.1 percent among those aged 18 to 25 to 55.0 percent among those aged 26 or older.
5. Initiation of Substance Use
Information on substance use initiation, also known as incidence or first-time use, is important for policymakers and researchers. Measures of initiation are often leading indicators of emerging patterns of substance use. They provide valuable information that can be used in the assessment of the effectiveness of current prevention programs and in focusing prevention efforts.
With its large sample size and oversampling of youths aged 12 to 17 and young adults aged 18 to 25, the National Survey on Drug Use and Health (NSDUH) provides a variety of estimates related to substance use initiation based on questions on age, year, and month at first use. Using this information, along with the interview date and the respondent's date of birth, a date of first use is determined for each substance used by a respondent. Estimates of the number of initiates, rates of initiation, and average age at first use can be constructed for specific time periods.
Because of concerns about the validity of trend estimates of incidence based on long recall periods (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004), this report only presents estimates of initiation occurring in the 12 months prior to the interview date. Individuals who initiated use within the past 12 months are defined as recent or past year initiates. Estimates for each year are produced independently based on the data from the survey conducted that year. One caveat of this approach is that because the survey interviews persons aged 12 or older and asks about the past 12 months, the initiation estimates will represent some, but not all of initiation at age 11, and no initiation occurring at age 10 or younger. This underestimation problem primarily affects estimates of initiation for cigarettes, alcohol, and inhalants because they tend to be initiated at a younger age than other substances. See Section B.4.1 in Appendix B for further discussion of the methods and bias in initiation estimates.
There are some important issues that readers need to be aware of when interpreting these NSDUH incidence estimates. First, note that some tables and analyses are based on the ages of initiates at the time of interview, while others focus on the age at the time of first substance use. This can have a large impact on estimates, so readers should pay close attention to the approach used in each situation. Titles and notes on tables document which method applies. Regarding the age at first use estimates, means, as measures of central tendency, are heavily influenced by the presence of extreme values in the data. Thus, for the purposes of this report and unless specified otherwise, the mean age at initiation pertains to persons aged 12 to 49. This constraint was implemented so that the mean age estimates reported would not be influenced by those few respondents who were past year initiates at age 50 or older. Note that this constraint only affects estimates of mean age at initiation; other estimates in this chapter, including the number and prevalence of past year initiates, are among all persons aged 12 or older.
An important consideration in looking at incidence estimates across different drug categories is that substance users typically initiate use of different substances at different times in their lives. Thus, the estimates for specific illicit drugs cannot be added to obtain the number of illicit drug initiates, because, for example, most of the cocaine initiates had previously used marijuana or other drugs and therefore would be represented in the illicit drug initiate estimates for a prior year. Similarly, the estimates of crack initiation are not a subset of the estimates of cocaine initiation, as some persons would have used powder cocaine prior to using crack. To help clarify this aspect of the incidence data, additional tables have been generated to identify which specific illicit drug was used at the time of first use of any illicit drug. These new estimates are discussed below in the first section of this chapter.
The prevalence estimates for nonmedical use of psychotherapeutic drugs, stimulants, and methamphetamine discussed in Chapter 2 take account of data from new items on methamphetamine use that were added to the noncore section of the survey in 2005 and 2006 to capture information on methamphetamine users who failed to recognize the drug when it was presented in the context of prescription drugs in the core stimulants module. The drug use initiation estimates in this chapter, however, are based on data only from the core section of the questionnaire and do not take account of data from new items on the initiation of methamphetamine use that were added to the noncore section in 2007 following up on the additional methamphetamine users identified in the questions introduced in 2005 and 2006. See Section B.4.6 in Appendix B of this report for details.
Initiation of Illicit Drug Use
- In 2007, an estimated 2.7 million persons aged 12 or older used an illicit drug for the first time within the past 12 months; this averages to more than 7,000 initiates per day. This estimate was not significantly different from the number in 2006 (2.8 million). Three fifths of initiates (60.1 percent) were younger than age 18 when they first used, and 54.1 percent of new users were female. The average age at initiation among persons aged 12 to 49 was 18.0 years.
- In 2007, of the 2.7 million persons aged 12 or older who used illicit drugs for the first time within the past 12 months, a majority reported that their first drug was marijuana (56.2 percent) (Figure 5.1). Nearly one third initiated with psychotherapeutics (30.6 percent, including 19.0 percent with pain relievers, 6.5 percent with tranquilizers, 4.1 percent with stimulants, and 1.1 percent with sedatives). A sizable proportion reported inhalants (10.7 percent) as their first drug, and a small proportion used hallucinogens as their first illicit drug (2.0 percent). The percentage of past year illicit drug initiates whose first drug was tranquilizers increased from 2.4 percent in 2002 to 6.5 percent in 2007, while the percentage whose first drug was Ecstasy decreased from 1.9 percent in 2002 to 0.6 percent in 2007.
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Figure 5.1 Specific Drug Used When Initiating Illicit Drug Use among Past Year Initiates of Illicit Drugs Aged 12 or Older: 2007
Note: The percentages add to greater than 100 percent because of a small number of respondents initiating multiple drugs on the same day.
Comparison, by Drug
- The specific drug categories with the largest number of recent initiates among persons aged 12 or older were nonmedical use of pain relievers (2.1 million) and marijuana use (2.1 million), followed by nonmedical use of tranquilizers (1.2 million), cocaine (0.9 million), Ecstasy (0.8 million), inhalants (0.8 million), and stimulants (0.6 million) (Figure 5.2).
- Among persons aged 12 to 49, the average age at first use of inhalants in 2007 was 17.1 years; it was 17.6 years for marijuana, 20.2 years for cocaine, 20.2 years for Ecstasy, 21.2 years for pain relievers, and 24.5 years for tranquilizers (Figure 5.3).
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Figure 5.2 Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007
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Figure 5.3 Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2007
Marijuana
- In 2007, there were 2.1 million persons who had used marijuana for the first time within the past 12 months; this averages to approximately 6,000 initiates per day. This estimate of past year initiates in 2007 was about the same as the number in 2006 (2.1 million), 2005 (2.1 million), 2004 (2.1 million), 2003 (2.0 million), and 2002 (2.2 million) (Figure 5.4).
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Figure 5.4 Past Year Marijuana Initiates among Persons Aged 12 or Older and Mean Age at First Use of Marijuana among Past Year Marijuana Initiates Aged 12 to 49: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
1 Mean-age-at-first-use estimates are for recent initiates aged 12 to 49.
- Most (62.2 percent) of the 2.1 million recent marijuana initiates were younger than age 18 when they first used. Among youths aged 12 to 17, an estimated 4.6 percent had used marijuana for the first time within the past year, similar to the rate in 2006 (4.7 percent).
- As a percentage of those aged 12 to 17 who had not used marijuana prior to the past year, the youth marijuana initiation rate in 2007 (5.2 percent) was similar to the rate in 2006 (5.4 percent).
- In 2007, the average age at first marijuana use among recent initiates aged 12 to 49 was 17.6 years, which was similar to the average in 2006 (17.4 years) (Figure 5.4). Among recent initiates aged 12 or older who initiated use prior to the age of 21, the mean age at first use was 16.2 years in 2007, which was not significantly different from the estimate (16.1 years) in 2006.
Cocaine
- In 2007, there were 906,000 persons aged 12 or older who had used cocaine for the first time within the past 12 months; this averages to approximately 2,500 initiates per day. This estimate was not significantly different from the number in 2006 (977,000).
- Most (66.5 percent) of the 0.9 million recent cocaine initiates were 18 or older when they first used. The average age at first use among recent initiates aged 12 to 49 was 20.2 years, which was similar to the average age in 2006 (20.3 years).
Heroin
- In 2007, there were 106,000 persons aged 12 or older who had used heroin for the first time within the past 12 months. The average age at first use among recent initiates aged 12 to 49 was 21.8 years in 2007. There were no significant changes in the number of initiates or in the average age at first use from 2006 to 2007.
Hallucinogens
- In 2007, there were 1.1 million persons aged 12 or older who had used hallucinogens for the first time within the past 12 months. This estimate was not significantly different from the estimate in 2002, 2004, 2005, and 2006. However, the estimate was significantly higher than the estimate in 2003 (886,000).
- There was no significant change between 2006 and 2007 in the number of past year initiates of LSD (264,000 and 270,000, respectively).
- There was no significant change in the past year initiates of Ecstasy between 2006 (860,000) and 2007 (781,000). The number of past year Ecstasy initiates in 2007, however, was significantly lower than the estimate in 2002 (1.2 million), but higher than the estimate in 2003 (642,000), 2004 (607,000), and 2005 (615,000) (Figure 5.5). Most (61.2 percent) of the recent Ecstasy initiates in 2007 were aged 18 or older at the time they first used Ecstasy. The corresponding figure was 70.1 percent in 2006. Among past year initiates aged 12 to 49, the average age at initiation of Ecstasy in 2007 was 20.2 years, similar to the average age in 2006 (20.6 years).
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Figure 5.5 Past Year Ecstasy Initiates among Persons Aged 12 or Older and Mean Age at First Use of Ecstasy among Past Year Ecstasy Initiates Aged 12 to 49: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
1 Mean-age-at-first-use estimates are for recent initiates aged 12 to 49.
Inhalants
- In 2007, there were 775,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 66.3 percent were under age 18 when they first used. There was no significant difference in the number of inhalant initiates between 2006 and 2007. However, there was a significant increase in the average age at first use among recent initiates aged 12 to 49 from 2006 (15.7 years) to 2007 (17.1 years).
Psychotherapeutics
- Psychotherapeutics include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included. In 2007, there were 2.5 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year, which averages out to around 7,000 initiates per day. The numbers of new users of specific classes of psychotherapeutics in 2007 were 2.1 million for pain relievers, 1.2 million for tranquilizers, 642,000 for stimulants, and 198,000 for sedatives. There was a significant decrease in the number of past year initiates of stimulants from 2006 (845,000) to 2007 (642,000), but there were no significant changes in the estimates for the remaining psychotherapeutics between these years. The estimated number of past year initiates of nonmedical pain reliever use declined from 2.5 million in 2003 to 2.1 million in 2007.
- The average age at first nonmedical use of any psychotherapeutics among recent initiates aged 12 to 49 was 21.8 years. More specifically, it was 21.2 years for pain relievers, 21.9 years for stimulants, 24.5 years for tranquilizers, and 24.2 years for sedatives.
- In 2007, the number of new nonmedical users of OxyContin® aged 12 or older was 554,000, with an average age at first use of 24.0 years among those aged 12 to 49. These estimates are similar to those for 2006 (533,000 and 22.6 years, respectively).
- The number of recent new users of methamphetamine among persons aged 12 or older was 157,000 in 2007 (Figure 5.6). This estimate was significantly lower than the estimate in 2002 (299,000), 2003 (260,000), 2004 (318,000), and 2006 (259,000). The average age of new methamphetamine users aged 12 to 49 in 2007 was 19.1 years, not significantly different from the average ages in 2002 through 2006.
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Figure 5.6 Past Year Methamphetamine Initiates among Persons Aged 12 or Older and Mean Age at First Use of Methamphetamine among Past Year Methamphetamine Initiates Aged 12 to 49: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
1 Mean-age-at-first-use estimates are for recent initiates aged 12 to 49.
Alcohol
- In 2007, there were 4.6 million persons aged 12 or older who had used alcohol for the first time within the past 12 months; this averages to approximately 12,500 initiates per day. The number of past year alcohol initiates in 2007 was significantly greater than the estimate in 2002 (3.9 million) and 2003 (4.1 million), but similar to the numbers in 2004 (4.4 million), 2005 (4.3 million), and 2006 (4.4 million).
- Most (85.9 percent) of the 4.6 million recent alcohol initiates were younger than age 21 at the time of initiation.
- In 2007, the average age at first alcohol use among recent initiates aged 12 to 49 was 16.8 years, similar to the corresponding 2006 estimate (16.6 years). The mean age at first use among recent initiates aged 12 or older who initiated use prior to the age of 21 was 15.8 years, which was the same as the 2006 estimate.
Tobacco
- The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was 2.2 million in 2007, which was significantly lower than the estimate in 2006 (2.4 million) but significantly higher than the estimate for 2002 (1.9 million) and 2003 (2.0 million) (Figure 5.7). The 2007 estimate averages out to approximately 6,100 new cigarette smokers every day. Most new smokers in 2007 were under age 18 when they first smoked cigarettes (59.7 percent).
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Figure 5.7 Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First Use: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- In 2007, among recent initiates aged 12 to 49, the average age of first cigarette use was 16.9 years, similar to the average in 2006 (17.1 years).
- Of those aged 12 or older who had not smoked cigarettes prior to the past year, the past year initiation rate for cigarettes was 2.5 percent in 2007, significantly lower than the rate in 2006 (2.9 percent). Among youths aged 12 to 17 years who had not smoked cigarettes prior to the past year, incidence showed a significant decrease between 2006 (6.6 percent) and 2007 (5.9 percent). Among males aged 12 to 17, the decrease in the past year initiation rate from 6.1 percent in 2002 to 5.7 percent in 2007 was not statistically significant, but among females, the decrease from 7.4 percent in 2002 to 6.0 percent in 2007 was statistically significant (Figure 5.8).
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Figure 5.8 Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never Smoked, by Gender: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- In 2007, the number of persons who had started smoking cigarettes daily within the past 12 months was 1.0 million. This estimate is similar to the estimates for 2002 (1.0 million), 2003 (1.1 million), 2004 (1.1 million), 2005 (1.0 million), and 2006 (1.1 million). Of these new daily smokers in 2007, 40.7 percent, or 400,000, were younger than age 18 when they started smoking daily. This figure averages to approximately 1,100 initiates of daily smoking under age 18 every day.
- The average age of first daily smoking among new daily smokers aged 12 to 49 in 2007 was 19.2 years. This was not significantly different from the average in 2006 (18.9 years).
- In 2007, there were 3.1 million persons aged 12 or older who had used cigars for the first time in the past 12 months, the same as the number in 2006. However, this estimate reflects a significant increase in the number of initiates from 2003 (2.7 million). Among past year cigar initiates aged 12 to 49, the average age at first use was 20.5 years in 2007, which was not significantly different from the estimate in 2006 (19.9 years).
- The number of persons aged 12 or older initiating use of smokeless tobacco in the past year was 1.3 million in 2007, which was the same as the estimate in 2006 and not significantly different from the estimate in 2005 (1.1 million). However, the estimated number of past year initiates of smokeless tobacco use in 2007 was at least 30 percent higher than the estimate in 2002 (951,000), 2003 (928,000), and 2004 (999,000). About three quarters (74.2 percent) of new initiates in 2007 were male, and a little more than half (52.5 percent) were under age 18 when they first used.
- The average age at first smokeless tobacco use among recent initiates aged 12 to 49 in 2007 was 18.0 years. Averages were 17.4 years for males and 19.7 years for females.
6. Youth Prevention-Related Measures
The National Survey on Drug Use and Health (NSDUH) includes questions for youths aged 12 to 17 about a number of risk and protective factors that may affect the likelihood that they will engage in substance use. Risk factors are individual characteristics and environmental influences associated with an increased vulnerability to the initiation, continuation, or escalation of substance use. Protective factors include individual resilience and other circumstances that appear to reduce the likelihood of substance use. Risk and protective factors include variables that operate at different stages of development and reflect different domains of influence, including the individual, family, peer, school, community, and societal levels (Hawkins, Catalano, & Miller, 1992). Interventions to prevent substance use generally are designed to ameliorate the influence of risk factors and enhance the effectiveness of protective factors.
This chapter presents findings for youth prevention-related measures collected in the 2007 NSDUH and compares these with findings from previous years. Included are measures of perceived risk from substance use (cigarettes, alcohol, and illicit drugs), perceived availability of substances, perceived parental disapproval of substance use, feelings about peer substance use, involvement in fighting and delinquent behavior, participation in religious and other activities, exposure to substance use prevention messages and programs, and parental involvement.
In this chapter, rates of substance use are compared for persons responding differently to questions reflecting risk or protective factors, such as the perceived risk of harm from using a substance. Because the NSDUH data for an individual are collected at only one point in time, it is not possible to determine causal connections from these data. However, a number of research studies of youths have shown that reducing risk factors and increasing protective factors can reduce rates of substance use (Botvin, Botvin, & Ruchlin, 1998). This report shows that marijuana use, cigarette use, and alcohol use among youths aged 12 to 17 decreased between 2002 and 2007, yet corresponding changes in individual risk and protective factors for the same period may or may not have occurred. There can be many reasons for this, such as the lack of or a weak causal connection, a lagged relationship between the occurrence of a risk factor and the change in drug use behavior, or that individual use is typically the result of multiple simultaneous risk factors rather than a single factor (Newcomb, Maddahian, & Bentler, 1986).
Perceptions of Risk
One factor that can influence whether youths will use tobacco, alcohol, or illicit drugs is the extent to which youths believe these substances might cause them harm. NSDUH respondents were asked how much they thought people risk harming themselves physically and in other ways when they use various substances in certain amounts or frequencies. Response choices for these items were "great risk," "moderate risk," "slight risk," or "no risk."
- The percentages of youths reporting binge alcohol use and use of cigarettes and marijuana in the past month were lower among those who perceived great risk in using these substances than among those who did not perceive great risk. For example, in 2007, 5.0 percent of youths aged 12 to 17 who perceived great risk from "having 5 or more drinks of an alcoholic beverage once or twice a week" reported binge drinking in the past month (consumption of five or more drinks of an alcoholic beverage on a single occasion on at least 1 day in the past 30 days); by contrast, past month binge drinking was reported by 12.9 percent of youths who saw moderate, slight, or no risk from having five or more drinks of an alcoholic beverage once or twice a week (Figure 6.1). Past month marijuana use was reported by 1.4 percent of youths who saw great risk in smoking marijuana once a month compared with 9.5 percent of youths who saw moderate, slight, or no risk.
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Figure 6.1 Past Month Binge Drinking and Marijuana Use among Youths Aged 12 to 17, by Perceptions of Risk: 2007
- Increases in the perceived risk of using a substance often are associated with decreases in the rate of current use of that substance. Looking over the 6-year period, the proportion of youths aged 12 to 17 who reported perceiving great risk from smoking one or more packs of cigarettes per day increased from 63.1 percent in 2002 to 68.8 percent in 2007 (Figure 6.2). The rate of past month cigarette smoking among youths aged 12 to 17 dropped from 13.0 to 9.8 percent during the same period. Percentages for both perceived risk of smoking one or more packs of cigarettes per day and smoking in the past month were similar in 2006 and 2007.
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Figure 6.2 Perceived Great Risk of Cigarette and Alcohol Use among Youths Aged 12 to 17: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- The percentage of youths aged 12 to 17 indicating great risk in having four or five drinks nearly every day increased from 62.2 percent in 2002 to 65.2 percent in 2007, but the percentage remained unchanged between 2006 (64.6 percent) and 2007 (Figure 6.2). The rates of past month heavy alcohol use among youths aged 12 to 17 were about the same throughout the period from 2002 to 2007 (e.g., 2.5 percent in 2002, 2.4 percent in 2006, and 2.3 percent in 2007).
- The percentage of youths aged 12 to 17 perceiving great risk in having five or more drinks of an alcoholic beverage once or twice a week increased from 38.2 percent in 2002 to 39.4 percent in 2007, but remained stable between 2006 (39.4 percent) and 2007. Accordingly, the rate of past month binge alcohol use among youths decreased from 10.7 percent in 2002 to 9.7 percent in 2007, but the rate remained stable between 2006 (10.3 percent) and 2007.
- The percentage of youths aged 12 to 17 indicating great risk in smoking marijuana once a month increased from 32.4 percent in 2002 to 34.5 percent in 2007 (Figure 6.3). The percentage of youths aged 12 to 17 perceiving great risk in smoking marijuana once or twice a week also increased from 51.5 percent in 2002 to 54.7 percent in 2007. Both of these percentages of perceived great risk of use were similar between 2006 and 2007.
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Figure 6.3 Perceived Great Risk of Marijuana Use among Youths Aged 12 to 17: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- Coincident with the increase in the percentage of youths who perceived great risk of marijuana use, the prevalence of lifetime, past year, and past month marijuana use among youths aged 12 to 17 decreased between 2002 and 2007. During the 6-year period, lifetime use of marijuana dropped from 20.6 to 16.2 percent, past year use declined from 15.8 to 12.5 percent, and past month use fell from 8.2 to 6.7 percent. Although lifetime use of marijuana decreased from 17.3 percent in 2006 to 16.2 percent in 2007, past year and past month marijuana use rates remained stable during the 2-year period.
- Between 2002 and 2007, the percentage of youths aged 12 to 17 perceiving great risk declined for the following substance use patterns: trying heroin once or twice (from 58.5 to 57.0 percent), using heroin once or twice a week (from 82.5 to 81.0 percent), trying LSD once or twice (from 52.6 to 51.2 percent), and using LSD once or twice a week (from 76.2 to 74.2 percent) (Figure 6.4). Over the same period, however, the percentage of youths aged 12 to 17 indicating great risk for using cocaine once a month (50.5 percent in 2002 and 49.6 percent in 2007) and using cocaine once or twice a week (79.8 percent in 2002 and 78.9 percent in 2007) remained statistically unchanged. Moreover, percentages for all of these perception of risk measures remained stable between 2006 and 2007.
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Figure 6.4 Perceived Great Risk of Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
Perceived Availability
- In 2007, about half (49.1 percent) of the youths aged 12 to 17 reported that it would be "fairly easy" or "very easy" for them to obtain marijuana if they wanted some (Figure 6.5). One in seven (14.1 percent) indicated that heroin would be "fairly" or "very" easily available, and 14.4 percent reported so for LSD. Between 2002 and 2007, there were decreases in the perceived availability of marijuana (from 55.0 to 49.1 percent), crack (from 26.5 to 25.3 percent), LSD (from 19.4 to 14.4 percent), and heroin (from 15.8 to 14.1 percent). The perceived availability of cocaine declined from 25.9 percent in 2006 to 24.5 percent in 2007, but the perceived availability of marijuana, crack, LSD, and heroin did not change significantly during the 2-year period.
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Figure 6.5 Perceived Availability of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- The percentage of youths who reported that illicit drugs would be easy to obtain increased with age in 2007. For example, 20.6 percent of those aged 12 or 13 said it would be fairly or very easy to obtain marijuana compared with 50.9 percent of those aged 14 or 15 and 73.4 percent of those aged 16 or 17.
- In 2007, 14.5 percent of youths aged 12 to 17 indicated that they had been approached by someone selling drugs in the past month, which was down from the 16.7 percent reported in 2002 (Figure 6.6). The rate remained stable between 2006 (15.3 percent) and 2007.
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Figure 6.6 Approached in the Past Month by Someone Selling Drugs among Youths Aged 12 to 17: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
Perceived Parental Disapproval of Substance Use
- Most youths aged 12 to 17 believed their parents would "strongly disapprove" of their using substances. In 2007, 91.0 percent of youths reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice; this was similar to the rate in 2006 (90.4 percent), but was higher than the rate in 2002 (89.1 percent). Most (89.6 percent) reported that their parents would strongly disapprove of their having one or two drinks of an alcoholic beverage nearly every day, which was the same as the rate in 2006 and similar to the 89.0 percent reported in 2002. In 2007, however, 92.1 percent of youths reported that their parents would strongly disapprove of their smoking one or more packs of cigarettes per day, which was higher than the 91.4 percent reported in 2006 and the 89.5 percent reported in 2002.
- Youths aged 12 to 17 who believed their parents would strongly disapprove of their using substances in certain amounts or frequencies were less likely to use that substance than were youths who believed their parents would somewhat disapprove or neither approve nor disapprove. For example, in 2007, past month cigarette use was reported by 7.2 percent of youths who perceived strong parental disapproval of their smoking one or more packs of cigarettes per day compared with 41.5 percent of youths who believed their parents would not strongly disapprove. Current marijuana use also was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than among those who did not (4.6 vs. 28.1 percent, respectively).
Feelings about Peer Substance Use
- A majority of youths aged 12 to 17 reported that they disapprove of their peers using substances. In 2007, 89.7 percent of youths "strongly" or "somewhat" disapproved of their peers smoking one or more packs of cigarettes per day, which was similar to the rate of 89.1 percent in 2006, but higher than the 87.1 percent in 2002. In addition, 82.9 percent strongly or somewhat disapproved of peers using marijuana or hashish once a month or more, which was similar to the 82.8 percent reported in 2006, but was an increase from the 80.4 percent in 2002. Also, 86.6 percent of youths strongly or somewhat disapproved of peers having one or two drinks of an alcoholic beverage nearly every day, which was similar to the rate of 86.4 percent in 2006, but was higher than the 84.7 percent reported in 2002.
- In 2007, past month marijuana use was reported by 2.3 percent of youths aged 12 to 17 who strongly or somewhat disapproved of their peers using marijuana once a month or more compared with 27.7 percent of youths who reported that they neither approve nor disapprove of such behavior from their peers.
Fighting and Delinquent Behavior
- In 2007, 22.3 percent of youths aged 12 to 17 reported that, in the past year, they had gotten into a serious fight at school or at work; this was similar to the rate in 2006 (22.6 percent), but was higher than that in 2002 (20.6 percent). Almost one in six (15.4 percent) had taken part in a group-against-group fight, which was lower than the rate in 2006 (17.0 percent), but was similar to the rate in 2002 (15.9 percent). One in thirty (3.3 percent) had carried a handgun at least once, which was similar to the rates in 2006 (3.2 percent) and 2002 (3.3 percent). An estimated 2.9 percent had sold illegal drugs, which was similar to the rate of 3.3 percent in 2006, but was lower than the 4.4 percent rate in 2002. In 2007, 4.3 percent had, at least once, stolen or tried to steal something worth more than $50; this was similar to the rate in 2006 (4.8 percent), but lower than the rate in 2002 (4.9 percent). An estimated 7.3 percent had, in at least one instance, attacked others with the intent to harm or seriously hurt them, which was similar to the rates of 7.9 percent in 2006 and 7.8 percent in 2002.
- Youths aged 12 to 17 who had engaged in fighting or other delinquent behaviors were more likely than other youths to have used illicit drugs in the past month. For example, in 2007, past month illicit drug use was reported by 16.5 percent of youths who had gotten into a serious fight at school or work in the past year compared with 7.5 percent of those who had not engaged in fighting, and by 36.6 percent of those who had stolen or tried to steal something worth over $50 in the past year compared with 8.2 percent of those who had not engaged in such theft.
Religious Beliefs and Participation in Activities
- In 2007, 31.4 percent of youths aged 12 to 17 reported that they had attended religious services 25 or more times in the past year, which was similar to the rate in 2006 (31.7 percent) and the rate in 2002 (33.0 percent). In addition, 76.1 percent agreed or strongly agreed with the statement that religious beliefs are a very important part of their lives, which was similar to the 77.0 percent reported in 2006, but was lower than the 78.2 percent reported in 2002. Also, 35.1 percent agreed with the statement that it is important for their friends to share their religious beliefs, which was the same as the rate in 2006 and similar to the rate in 2002 (35.8 percent).
- Rates of past month use of illicit drugs, cigarettes, and alcohol (including binge alcohol) were lower among youths aged 12 to 17 who agreed with these statements than among those who disagreed. For example, in 2007, past month illicit drug use was reported by 7.4 percent of those who agreed that religious beliefs are a very important part of life compared with 16.3 percent of those who disagreed with that statement.
Exposure to Substance Use Prevention Messages and Programs
- In 2007, approximately one in eight youths aged 12 to 17 (11.3 percent) reported that they had participated in drug, tobacco, or alcohol prevention programs outside of school in the past year. This rate was similar to the 11.4 percent reported in 2006, but was lower than the rates reported in 2002 (12.7 percent) and 2003 (13.9 percent). The prevalence of past month binge alcohol use was lower among those who participated in these prevention programs outside of school (7.9 percent) than among those who did not (9.9 percent). However, the prevalence of past month use of illicit drugs, marijuana, or cigarettes was not significantly lower among those who participated in these prevention programs outside of school (9.4 percent, 6.2 percent, and 9.0 percent, respectively) than among those who did not (9.5 percent, 6.7 percent, and 9.9 percent, respectively).
- In 2007, 77.9 percent of youths aged 12 to 17 reported having seen or heard drug or alcohol prevention messages in the past year from sources outside of school, which was lower than the 79.4 percent reported in 2006 and the 83.2 percent reported in 2002 (Figure 6.7). The prevalence of past month use of illicit drugs was lower among those who reported having such exposure (9.2 percent) than among those who reported having no such exposure (10.6 percent).
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Figure 6.7 Exposure to Substance Use Prevention Messages and Programs among Youths Aged 12 to 17: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
1 Estimates are from youths aged 12 to 17 who were enrolled in school in the past year.
- In 2007, 75.8 percent of youths aged 12 to 17 enrolled in school in the past year reported having seen or heard drug or alcohol prevention messages at school, which was lower than the 76.9 percent reported in 2006 and the 78.8 percent reported in 2002 (Figure 6.7). The prevalence of past month use of illicit drugs or marijuana was lower among those who reported having such exposure (8.7 percent and 6.0 percent for illicit drugs and marijuana, respectively) than among those who reported having no such exposure (12.0 percent and 9.1 percent, respectively).
- In 2007, 59.6 percent of youths aged 12 to 17 reported that they had talked at least once in the past year with at least one of their parents about the dangers of drug, tobacco, or alcohol use. This was similar to the 59.8 percent reported in 2006, but was higher than the 58.1 percent reported in 2002. The prevalence of past month use of illicit drugs, marijuana, cigarettes, or binge alcohol among those who reported having had such conversations with their parents (8.6 percent, 6.2 percent, 9.0 percent, and 9.3 percent, respectively) was lower than that among those who reported having no such conversations (10.9 percent, 7.3 percent, 11.0 percent, and 10.4 percent, respectively).
Parental Involvement
- Youths aged 12 to 17 were asked a number of questions related to the extent of support, oversight, and control that they perceived their parents exercised over them in the year prior to the survey. In 2007, among youths aged 12 to 17 enrolled in school in the past year, 79.5 percent reported that in the past year their parents always or sometimes checked on whether or not they had completed their homework, which was the same as the rate in 2006 and similar to the 78.4 percent reported in 2002. In addition, 80.9 percent reported that their parents always or sometimes provided help with their homework, which was similar to the rates of 79.8 percent in 2006 and 81.4 percent in 2002. Also, 70.4 percent reported that their parents limited the amount of time that they spent out with friends on school nights, which was higher than the 69.1 percent reported in 2006, but was similar to the 70.7 percent reported in 2002.
- In 2007, 87.8 percent of youths aged 12 to 17 reported that in the past year their parents made them always or sometimes do chores around the house, 86.2 percent reported that their parents always or sometimes let them know that they had done a good job, and 85.7 percent reported that their parents let them know they were proud of something they had done. All of these percentages in 2007 were similar to those reported in 2006 and remained statistically unchanged from the rates reported in 2002. In 2007, however, 39.7 percent of youths reported that their parents limited the amount of time that they watched television, which was similar to the rate in 2006 (39.4 percent), but was higher than the 36.9 percent reported in 2002.
- In 2007, past month use of illicit drugs, cigarettes, and alcohol (including binge alcohol) was lower among youths aged 12 to 17 who reported that their parents always or sometimes engaged in monitoring behaviors than among youths whose parents "seldom" or "never" engaged in such behaviors. For example, the rate of past month use of any illicit drug was 8.1 percent for youths whose parents always or sometimes helped with homework compared with 16.0 percent among youths who indicated that their parents seldom or never helped. Rates for current cigarette smoking were 8.5 and 16.3 percent for the two groups of youths, respectively, and rates of past month binge alcohol use were 7.9 versus 18.3 percent correspondingly.
7. Substance Dependence, Abuse, and Treatment
The National Survey on Drug Use and Health (NSDUH) includes a series of questions to assess the prevalence of substance use disorders (i.e., dependence on or abuse of a substance) in the past 12 months. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutic drugs. These questions are used to classify persons as dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994).
The questions related to dependence ask about health and emotional problems associated with substance use, unsuccessful attempts to cut down on use, tolerance, withdrawal, reducing other activities to use substances, spending a lot of time engaging in activities related to substance use, or using the substance in greater quantities or for a longer time than intended. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use. Dependence is considered to be a more severe substance use problem than abuse because it involves the psychological and physiological effects of tolerance and withdrawal. Although individuals may meet the criteria specified here for both dependence and abuse, persons meeting the criteria for both are classified as having dependence, but not abuse. Persons defined with abuse in this report do not meet the criteria for dependence.
This chapter provides estimates of the prevalence and patterns of substance use disorders occurring in the past year from the 2007 NSDUH and compares these estimates against the results from the 2002, 2003, 2004, 2005, and 2006 surveys. It also provides estimates of the prevalence and patterns of the receipt of treatment in the past year for problems related to substance use. This chapter concludes with a discussion of the need for and the receipt of treatment at specialty facilities for problems associated with substance use.
7.1. Substance Dependence or Abuse
- In 2007, an estimated 22.3 million persons aged 12 or older were classified with substance dependence or abuse in the past year (9.0 percent of the population aged 12 or older) (Figure 7.1). Of these, 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.7 million were dependent on or abused illicit drugs but not alcohol, and 15.5 million were dependent on or abused alcohol but not illicit drugs.
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Figure 7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- The number of persons with substance dependence or abuse was stable between 2002 and 2007 (22.0 million in 2002, 21.6 million in 2003, 22.5 million in 2004, 22.2 million in 2005, 22.6 million in 2006, and 22.3 million in 2007).
- In 2007, 18.6 million persons aged 12 or older were classified with dependence on or abuse of alcohol. This represents 7.5 percent of the population. The number and the percentage have remained similar since 2002.
- Marijuana was the illicit drug that had the highest rate of past year dependence or abuse in 2007, followed by pain relievers and cocaine. Of the 6.9 million persons aged 12 or older classified with dependence on or abuse of illicit drugs in 2007, 3.9 million were dependent on or abused marijuana or hashish (representing 1.6 percent of the total population aged 12 or older, and 57.4 percent of all those classified with illicit drug dependence or abuse), 1.7 million persons were classified with dependence on or abuse of pain relievers, and 1.6 million persons were classified with dependence on or abuse of cocaine (Figure 7.2). These estimates for pain relievers and cocaine did not change significantly between 2006 and 2007 and between 2002 and 2007. The rate for marijuana decreased from 2002 to 2007 but was stable from 2006 to 2007, while the number of people dependent on or abusing marijuana did not change significantly between 2006 and 2007 and between 2002 and 2007.
- The percentages of persons with dependence on or abuse of illicit drugs remained stable between 2006 (2.9 percent) and 2007 (2.8 percent). Between 2002 and 2007, the rate declined from 3.0 to 2.8 percent. During the 6-year period, the percentages of persons with dependence on or abuse of alcohol remained stable (7.7 percent in 2002, 7.6 percent in 2006, and 7.5 percent in 2007).
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Figure 7.2 Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2007
Age at First Use
- In 2007, among adults aged 18 or older who first tried marijuana at age 14 or younger, 12.9 percent were classified with illicit drug dependence or abuse, higher than the 2.7 percent of adults who had first used marijuana at age 18 or older.
- Among adults, age at first use of alcohol was associated with dependence on or abuse of alcohol. In 2007, among adults aged 18 or older who first tried alcohol at age 14 or younger, 15.9 percent were classified with alcohol dependence or abuse compared with only 3.9 percent of adults who had first used alcohol at age 18 or older. Adults aged 21 or older who had first used alcohol before age 21 were more likely than adults who had their first drink at age 21 or older to be classified with alcohol dependence or abuse (9.6 vs. 2.2 percent) (Figure 7.3).
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Figure 7.3 Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or Older, by Age at First Use of Alcohol: 2007
Age
- Rates of substance dependence or abuse were associated with age. In 2007, the rate of substance dependence or abuse among adults aged 18 to 25 (20.7 percent) was higher than that among youths aged 12 to 17 (7.7 percent) and among adults aged 26 or older (7.2 percent). None of these estimates changed significantly between 2006 and 2007. For youths aged 12 to 17, the rate decreased from 8.9 percent in 2002 to 7.7 percent in 2007. There were no changes from 2002 to 2007 for adults aged 18 to 25 and those 26 or older.
- In 2007, among persons with substance dependence or abuse, the proportion with dependence on or abuse of illicit drugs also was associated with age: 56.3 percent of youths aged 12 to 17, 38.3 percent of young adults aged 18 to 25, and 23.3 percent of adults aged 26 or older. For young adults aged 18 to 25 and adults aged 26 or older, these estimates did not change significantly between 2006 and 2007 and between 2002 and 2007. For youths aged 12 to 17, the rate decreased between 2002 and 2007, but did not change significantly between 2006 and 2007.
- The rate of substance dependence or abuse among youths aged 12 to 17 remained stable between 2006 and 2007 (7.7 percent in 2007 and 8.0 percent in 2006), but the rate in 2007 was lower than the rate in 2002 (8.9 percent). The rate of alcohol dependence or abuse among youths aged 12 to 17 remained stable between 2006 and 2007 and between 2002 and 2007 (5.4 percent in 2007, 5.4 percent in 2006, and 5.9 percent in 2002).
Gender
- As was the case from 2002 through 2006, the rate of substance dependence or abuse for males aged 12 or older in 2007 was about twice as high as the rate for females. For males in 2007, the rate was 12.5 percent, which was similar to the 12.3 percent in 2006, while for females, it was 5.7 percent, which was lower than the 6.3 percent in 2006 (Figure 7.4). Among youths aged 12 to 17, however, the rate of substance dependence or abuse among males was similar to the rate among females during the 6-year period (7.7 vs. 7.7 percent in 2007; 8.0 vs. 8.1 percent in 2006; and 9.3 vs. 8.6 percent in 2002).
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Figure 7.4 Substance Dependence or Abuse in the Past Year, by Age and Gender: 2007
- The rate of illicit drug dependence or abuse among males aged 12 or older was similar between 2006 and 2007 and between 2002 and 2007 (3.8 percent in 2007, 3.7 percent in 2006, and 4.0 percent in 2002). The rate for females remained stable between 2006 and 2007, but decreased between 2002 and 2007 (1.8 percent in 2007, 2.0 percent in 2006, and 2.1 percent in 2002).
Race/Ethnicity
- In 2007, among persons aged 12 or older, the rate of substance dependence or abuse was the lowest among Asians (4.7 percent). Racial/ethnic groups with similar rates included American Indians or Alaska Natives (13.4 percent), persons reporting two or more races (10.8 percent), Native Hawaiians or Other Pacific Islanders (9.9 percent), whites (9.4 percent), blacks (8.5 percent), and Hispanics (8.3 percent). These rates in 2007 were similar to the rates in 2002 and 2006, except that the rate of substance dependence or abuse among Hispanics in 2007 was lower than the rate in 2002 (10.4 percent) and 2006 (10.0 percent).
Education/Employment
- Rates of substance dependence or abuse were associated with level of education in 2007. Among adults aged 18 or older, those who graduated from a college or university had a lower rate of dependence or abuse (7.5 percent) than those who graduated from high school (9.3 percent), those who did not graduate from high school (9.8 percent), and those with some college (10.3 percent).
- Rates of substance dependence or abuse were associated with current employment status in 2007. A higher percentage of unemployed adults aged 18 or older were classified with dependence or abuse (20.0 percent) than were full-time employed adults (10.1 percent) or part-time employed adults (10.6 percent).
- Most adults aged 18 or older with substance dependence or abuse were employed full time in 2007. Of the 20.4 million adults classified with dependence or abuse, 12.3 million (60.4 percent) were employed full time.
Criminal Justice Populations
- In 2007, adults aged 18 or older who were on parole or a supervised release from jail during the past year had higher rates of dependence on or abuse of a substance (37.2 percent) than their counterparts who were not on parole or supervised release during the past year (8.9 percent).
- In 2007, probation status was associated with substance dependence or abuse. The rate of substance dependence or abuse was 37.4 percent among adults who were on probation during the past year, which was significantly higher than the rate among adults who were not on probation during the past year (8.5 percent).
Geographic Area
- In 2007, rates of substance dependence or abuse for persons aged 12 or older showed evidence of differences by region, with the Midwest (10.0 percent) having a higher rate than the South (8.7 percent) and the Northeast (8.1 percent), but a similar rate to the West (9.2 percent). Rates for substance dependence or abuse among persons aged 12 or older in 2007 also varied by county type, with small metropolitan counties (9.4 percent) having a significantly higher rate than nonmetropolitan counties (8.3 percent), but a similar rate when compared with large metropolitan counties (9.0 percent).
7.2. Past Year Treatment for a Substance Use Problem
Estimates described in this section refer to treatment received for illicit drug or alcohol use, or for medical problems associated with the use of illicit drugs or alcohol. This includes treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous. Persons could report receiving treatment at more than one location. Note that the definition of treatment in this section is different from the definition of specialty treatment described in Section 7.3. Specialty treatment only includes treatment at a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or a mental health center.
Individuals who reported receiving substance use treatment but were missing information on whether the treatment was specifically for alcohol use or illicit drug use were not counted in estimates of illicit drug use treatment or in estimates of alcohol use treatment; however, they were counted in estimates for "drug or alcohol use" treatment.
- In 2007, 3.9 million persons aged 12 or older (1.6 percent of the population) received some kind of treatment for a problem related to the use of alcohol or illicit drugs. Of these, 1.4 million received treatment for the use of both alcohol and illicit drugs, 0.8 million received treatment for the use of illicit drugs but not alcohol, and 1.3 million received treatment for the use of alcohol but not illicit drugs. (Note that estimates by substance do not sum to the total number of persons receiving treatment because the total includes persons who reported receiving treatment but did not report for which substance the treatment was received.)
- The number and the percentage of the population aged 12 or older receiving substance use treatment within the past year remained stable between 2006 and 2007 and between 2002 and 2007 (3.9 million, 1.6 percent in 2007; 4.0 million, 1.6 percent in 2006; and 3.5 million, 1.5 percent in 2002).
- In 2007, among the 3.9 million persons aged 12 or older who received treatment for alcohol or illicit drug use in the past year, 2.2 million persons received treatment at a self-help group, and 1.7 million received treatment at a rehabilitation facility as an outpatient (Figure 7.5). There were 1.0 million persons who received treatment at a rehabilitation facility as an inpatient, 889,000 persons who received treatment at a mental health center as an outpatient, 779,000 at a hospital as an inpatient, 593,000 at a private doctor's office, 523,000 at an emergency room, and 302,000 at a prison or jail. None of these estimates changed significantly between 2006 and 2007 or between 2002 and 2007.
- In 2007, during their most recent treatment in the past year, 2.5 million persons aged 12 or older reported receiving treatment for alcohol use, and 936,000 persons reported receiving treatment for marijuana use (Figure 7.6). Accordingly, estimates on receiving treatment for the use of other drugs were 809,000 persons for cocaine, 558,000 for pain relievers, 335,000 for heroin, 311,000 for stimulants, and 303,000 for hallucinogens. None of these estimates changed significantly between 2006 and 2007, except that the numbers who received treatment for marijuana use and for nonmedical use of stimulants in 2007 were lower than the numbers in 2006 (1.2 million and 535,000 persons, respectively). None of these estimates changed significantly between 2002 and 2007, except that the number who received treatment for the use of pain relievers in 2007 was higher than the number in 2002 (360,000 persons). (Note that respondents could indicate that they received treatment for more than one substance during their most recent treatment.)
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Figure 7.5 Locations Where Past Year Substance Use Treatment Was Received among Persons Aged 12 or Older: 2007
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Figure 7.6 Substances for Which Most Recent Treatment Was Received in the Past Year among Persons Aged 12 or Older: 2007
7.3. Need for and Receipt of Specialty Treatment
This section discusses the need for and receipt of treatment for a substance use problem at a "specialty" treatment facility. Specialty treatment is defined as treatment received at any of the following types of facilities: hospitals (inpatient only), drug or alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers. It does not include treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient. An individual is defined as needing treatment for an alcohol or drug use problem if he or she met the DSM-IV (APA, 1994) diagnostic criteria for dependence on or abuse of alcohol or illicit drugs in the past 12 months or if he or she received specialty treatment for alcohol use or illicit drug use in the past 12 months.
In this section, an individual needing treatment for an illicit drug use problem is defined as receiving treatment for his or her drug use problem only if he or she reported receiving specialty treatment for drug use in the past year. Thus, an individual who needed treatment for illicit drug use but only received specialty treatment for alcohol use in the past year or who received treatment for illicit drug use only at a facility not classified as a specialty facility was not counted as receiving treatment for drug use. Similarly, an individual who needed treatment for an alcohol use problem was only counted as receiving alcohol use treatment if the treatment was received for alcohol use at a specialty treatment facility. Individuals who reported receiving specialty substance use treatment but were missing information on whether the treatment was specifically for alcohol use or drug use were not counted in estimates of specialty drug use treatment or in estimates of specialty alcohol use treatment; however, they were counted in estimates for "drug or alcohol use" treatment.
In addition to questions about symptoms of substance use problems that are used to classify respondents' need for treatment based on DSM-IV criteria, NSDUH includes questions asking respondents about their perceived need for treatment (i.e., whether they felt they needed treatment or counseling for illicit drug use or alcohol use). In this report, estimates for perceived need for treatment are only discussed for persons who were classified as needing treatment (based on DSM-IV criteria) but did not receive treatment at a specialty facility. Similarly, estimates for whether a person made an effort to get treatment are only discussed for persons who felt the need for treatment.
Illicit Drug or Alcohol Use Treatment and Treatment Need
- In 2007, 23.2 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (9.4 percent of the persons aged 12 or older). Of these, 2.4 million (1.0 percent of persons aged 12 or older and 10.4 percent of those who needed treatment) received treatment at a specialty facility. Thus, 20.8 million persons (8.4 percent of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty substance abuse facility in the past year. These estimates are similar to the estimates for 2006 and for 2002.
- Of the 2.4 million people aged 12 or older who received specialty substance use treatment in 2007, 952,000 received treatment for alcohol use only, 728,000 received treatment for illicit drug use only, and 615,000 persons received treatment for both alcohol and illicit drug use. These estimates are similar to the estimates for 2006 and for 2002.
- In 2007, among persons who received their last or current substance use treatment at a specialty facility in the past year, 53.3 percent reported using their "own savings or earnings" as a source of payment for their most recent specialty treatment, 34.9 percent reported using private health insurance, 26.3 percent reported using public assistance other than Medicaid, 19.7 percent reported using Medicare, 19.6 percent reported using funds from family members, and 18.2 percent reported using Medicaid. None of these estimates changed significantly between 2006 and 2007 and between 2002 and 2007, except that the 53.3 percent reported using their "own savings or earnings" as a source of payment in 2007 was higher than the 42.1 percent reported in 2006. (Note that persons could report more than one source of payment.)
- Of the 20.8 million persons in 2007 who were classified as needing substance use treatment but not receiving treatment at a specialty facility in the past year, 1.3 million persons (6.4 percent) reported that they perceived a need for treatment for their illicit drug or alcohol use problem (Figure 7.7). Of these 1.3 million persons who felt they needed treatment but did not receive treatment in 2007, 380,000 (28.5 percent) reported that they made an effort to get treatment, and 955,000 (71.5 percent) reported making no effort to get treatment.
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Figure 7.7 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2007
- The number and the percentage of youths aged 12 to 17 who needed treatment for an illicit drug or alcohol use problem remained unchanged between 2006 and 2007; however, there was a significant decrease between 2002 and 2007 (2.0 million youths and 7.9 percent of the population in 2007; 2.1 million and 8.2 percent in 2006; and 2.3 million and 9.1 percent in 2002). Of the 2.0 million youths who needed treatment in 2007, 150,000 received treatment at a specialty facility (about 7.6 percent of the youths who needed treatment), leaving 1.8 million who needed treatment for a substance use problem but did not receive it at a specialty facility.
- Based on 2004-2007 combined data, five of the most often reported reasons for not receiving illicit drug or alcohol use treatment among persons who needed but did not receive treatment at a specialty facility and perceived a need for treatment included (a) not ready to stop using (38.7 percent), (b) no health coverage and could not afford cost (31.1 percent), (c) possible negative effect on job (11.6 percent), (d) not knowing where to go for treatment (11.6 percent), and (e) concern that receiving treatment might cause neighbors/community to have negative opinion (11.1 percent).
- Based on 2004-2007 combined data, among persons who needed but did not receive illicit drug or alcohol use treatment, made an effort to receive treatment, and felt a need for treatment, some of the most often reported reasons for not receiving treatment were (a) no health coverage and could not afford cost (35.9 percent), (b) not ready to stop using (26.6 percent), (c) able to handle the problem without treatment (12.5 percent), (d) no transportation/inconvenient (10.5 percent), (e) might cause neighbors/community to have negative opinion (8.9 percent), (f) no program having type of treatment (8.1 percent), (g) might have negative effect on job (7.0 percent), and (h) did not know where to go for treatment (6.9 percent) (Figure 7.8).
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Figure 7.8 Reasons for Not Receiving Substance Use Treatment among Persons Aged 12 or Older Who Needed and Made an Effort to Get Treatment But Did Not Receive Treatment and Felt They Needed Treatment: 2004-2007 Combined
Illicit Drug Use Treatment and Treatment Need
- In 2007, the number of persons aged 12 or older needing treatment for an illicit drug use problem was 7.5 million (3.0 percent of the total population). Of these, 1.3 million (0.5 percent of the total population and 17.8 percent of the persons who needed treatment) received treatment at a specialty facility for an illicit drug use problem in the past year. Thus, there were 6.2 million persons (2.5 percent of the total population) who needed treatment but did not receive treatment at a specialty facility for an illicit drug use problem in 2007. None of these estimates changed significantly between 2006 and 2007 and between 2002 and 2007.
- The number of persons needing treatment for illicit drug use in 2007 (7.5 million) was similar to the number needing treatment in 2002 (7.7 million), 2003 (7.3 million), 2004 (8.1 million), 2005 (7.6 million), and 2006 (7.8 million). Also, the number of persons needing but not receiving specialty treatment in the past year for an illicit drug use problem in 2007 (6.2 million) was similar to the estimates in 2002 (6.3 million), 2003 (6.2 million), 2004 (6.6 million), 2005 (6.3 million), and 2006 (6.2 million).
- Of the 6.2 million people aged 12 or older who needed but did not receive specialty treatment for illicit drug use in 2007, 548,000 (8.9 percent) reported that they perceived a need for treatment for their illicit drug use problem. Of the 548,000 persons who felt a need for treatment in 2007, 205,000 (37.5 percent) reported that they made an effort and 343,000 (62.5 percent) reported making no effort to get treatment.
- Among youths aged 12 to 17, there were 1.1 million (4.5 percent) who needed treatment for an illicit drug use problem in 2007. Of this group, only 111,000 received treatment at a specialty facility (9.9 percent of youths aged 12 to 17 who needed treatment), leaving 1.0 million youths who needed treatment but did not receive it at a specialty facility.
- Among people aged 12 or older who needed but did not receive illicit drug use treatment and felt they needed treatment (based on 2004-2007 combined data), six of the most often reported reasons for not receiving treatment were (a) no health coverage and could not afford cost (34.3 percent), (b) not ready to stop using (31.8 percent), (c) concern that getting treatment might cause neighbors/community to have negative opinion (14.4 percent), (d) not knowing where to go for treatment (13.5 percent), (e) being able to handle the problem without treatment (12.7 percent), and (f) possible negative effect on job (11.7 percent).
Alcohol Use Treatment and Treatment Need
- In 2007, the number of persons aged 12 or older needing treatment for an alcohol use problem was 19.3 million (7.8 percent of the population aged 12 or older). Of these, 1.6 million (0.6 percent of the total population and 8.1 percent of the people who needed treatment for an alcohol use problem) received alcohol use treatment at a specialty facility. Thus, there were 17.7 million people who needed treatment but did not receive treatment at a specialty facility for an alcohol use problem. None of these estimates changed significantly between 2006 and 2007 and between 2002 and 2007.
- Among the 17.7 million people aged 12 or older who needed but did not receive treatment for an alcohol use problem in 2007, there were 859,000 (4.8 percent) who felt they needed treatment for their alcohol use problem. The number and the percentage were higher than those reported in 2006 (541,000 persons and 3.0 percent, respectively), but were similar to those reported in 2002 (761,000 persons and 4.5 percent, respectively). Of these, 619,000 (72.1 percent) did not make an effort to get treatment, and 240,000 (27.9 percent) made an effort but were unable to get treatment in 2007.
- In 2007, there were 1.4 million youths (5.5 percent) aged 12 to 17 who needed treatment for an alcohol use problem. Of this group, only 82,000 received treatment at a specialty facility (0.3 percent of all youths and 5.9 percent of youths who needed treatment), leaving 1.3 million youths who needed but did not receive treatment.
8. Mental Health
This chapter presents findings on mental health problems in the United States, including the prevalence of serious psychological distress (SPD) and major depressive episode (MDE) and the association of these problems with substance use and substance dependence or abuse (substance use disorder). Also reported here are the rates of treatment for depression (among those with MDE) in the past year, the percentages of adults aged 18 or older and youths aged 12 to 17 who received mental health care in the past year, and the percentage of adults who had an unmet need for mental health care in the past year.
SPD is an overall indicator of past year psychological distress that is derived from the K6 scale administered to adults aged 18 or older in the National Survey on Drug Use and Health (NSDUH). Numerical scores derived from responses to these six questions range from 0 to 24. For this report, a score of 13 or higher is considered SPD. It is notable that the data related to SPD assessed from 2004 to 2007 are not directly comparable with data from earlier years because of study design changes. Further information on the measurement of SPD, the scoring algorithm, and the study design changes is provided in Section B.4.4 of Appendix B.
A module of questions designed to obtain measures of lifetime and past year prevalence of MDE, the level of functional impairment caused by MDE in the past year, and treatment for depression has been administered to adults aged 18 or older and youths aged 12 to 17 since 2004. Some questions in the adolescent depression module were modified slightly from the adult depression module to make them more appropriate for youths. Given these differences, adult and youth depression estimates are presented separately in this chapter.
MDE is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least four of the seven additional symptoms reflecting the criteria for major depressive disorder as described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994). It should be noted that no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders. Impairment is defined by the level of role interference reported to be caused by MDE in the past 12 months. For adults, the Sheehan Disability Scale (SDS) role domains are (1) home management, (2) work/school, (3) close relationships with others, and (4) social life. The role domains are assessed on a 0 to 10 scale with impairment categories of none (0), mild (1-3), moderate (4-6), severe (7-9), and very severe (10). The role domains for youths are slightly modified to be made age appropriate, but are assessed on the same 0 to 10 scale described for adults. The specific questions used to measure MDE and role impairment and the scoring algorithm for these responses are included in Section B.4.5 of Appendix B.
Although there is substantial overlap in the populations classified with SPD and MDE, there are important distinctions between the definitions of the two. Meeting the criteria for SPD indicates that the respondent endorsed having symptoms at a level known to be indicative of having a mental disorder (i.e., any disorder such as an anxiety or mood disorder). Meeting the criteria for past year MDE indicates that the respondent had the specific physical and emotional symptom profile indicative of MDE in the past 12 months. MDE is known to be a fairly common disorder that often has a significant impact on a person's work, home, and social life.
This chapter also presents data on mental health care among adults aged 18 or older and youths aged 12 to 17 for any type of mental health problem. Initiated in 2000, the mental health service utilization modules are asked of respondents regardless of MDE or SPD status. In the adult module, respondents are asked whether they received treatment or counseling for any problem with emotions, "nerves," or mental health in the past year in any inpatient or outpatient setting or used prescription medication for a mental or emotional condition. The treatment questions in this module are generic in that they do not ask specifically about treatment for a particular disorder, as do the questions in the MDE module. As such, subsequent references to treatment or counseling for any problem with emotions, nerves, or mental health are described broadly as "mental health service use" or receiving/needing "mental health care." It is possible for a respondent to have indicated receipt of treatment for depression without having indicated that he or she received services for any problems with emotions, nerves, or mental health.
In NSDUH, questions in the youth mental health service utilization module differ from those asked of adults. Youths aged 12 to 17 are asked whether they received any treatment or counseling within the 12 months prior to the interview for problems with behavior or emotions in the specialty mental health setting (outpatient or inpatient care), the general medical setting (pediatrician or family physician care for emotional or behavior problems), or the education setting (talked with a counselor, psychologist, or teacher, or received special education services while in a regular classroom or placed in a special classroom, special program, or special school). They also are asked for the number of nights spent in overnight facilities, the number of visits they had to outpatient mental health providers, and the reason(s) for the most recent stay or visit. Both the youth and the adult mental health questions specifically exclude treatment for problems with substance use, a topic asked about in other interview modules.
Estimates of unmet need for mental health care are reported for adults. Unmet need is established using a question that asks whether the respondent perceived a need for, but did not receive mental health treatment or counseling at any time in the 12 months prior to the NSDUH interview. 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.
It is important to note that because the survey covers the U.S. civilian, noninstitutionalized population, persons residing in long-term psychiatric or other institutions continuously throughout the year were not included in the NSDUH sampling frame. Persons who were hospitalized or institutionalized for a period of time during 2007, but who resided in households during the rest of the year, were included in the sample.
8.1. Adults Aged 18 or Older
Prevalence of Serious Psychological Distress among Adults
- In 2007, there were an estimated 24.3 million adults aged 18 or older in the United States with SPD in the past year. This represents 10.9 percent of all adults in this country, a rate similar to the SPD rate in 2006 (11.3 percent) (Figure 8.1), but below the rate in 2004 (12.2 percent).
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Figure 8.1 Serious Psychological Distress in the Past Year among Adults Aged 18 or Older, by Age: 2006-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- Rates of SPD in 2007 were highest for adults aged 18 to 25 (17.9 percent) and lowest for adults aged 50 or older (7.0 percent).
- The prevalence of SPD in 2007 among women aged 18 or older (13.4 percent) was significantly higher than among men in that age group (8.2 percent).
- In 2007, rates of past year SPD were lowest among Asians at 6.4 percent. Rates for other racial/ethnic groups were 10.2 percent among Hispanics, 10.5 percent among blacks, 11.3 percent among whites, 11.9 percent among Native Hawaiians or Other Pacific Islanders, 13.7 percent among American Indians or Alaska Natives, and 14.0 percent among persons reporting two or more races.
Mental Health Service Use among Adults with Serious Psychological Distress
- Among the 24.3 million adults aged 18 or older with SPD in 2007, 10.8 million (44.6 percent) used mental health services in the past year. Among all adults with SPD, 38.8 percent received prescription medication, 27.3 percent received outpatient services, and 5.1 percent received inpatient services for a mental health problem in the past year. Respondents could report more than one type of service used.
- Among those with SPD who reported receiving mental health services in the past year, 47.2 percent received one type of care (inpatient, outpatient, or prescription medication), 45.9 percent received two types of care, and 6.9 percent received all three types of care (Figure 8.2).
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Figure 8.2 Number of Types of Mental Health Services Received in the Past Year among Persons Aged 18 or Older with Past Year Serious Psychological Distress Who Received Mental Health Services in the Past Year: 2007
Note: The three types of mental health care are receiving inpatient care, outpatient care, or prescription medication.
Serious Psychological Distress and Substance Use and Dependence or Abuse among Adults
- Past year illicit drug use in 2007 was higher among adults aged 18 or older with SPD (28.0 percent) than among adults without SPD (12.2 percent). Similarly, the rate of past month cigarette use was higher among adults with SPD (42.1 percent) than among adults without SPD (23.9 percent).
- Among adults aged 18 or older with past year SPD in 2007, the rate of binge alcohol use (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) was 32.2 percent, which was higher than the 24.0 percent among adults who did not meet the criteria for SPD. Similarly, the rate of heavy alcohol use (drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days) among adults with SPD in the past year was higher (10.9 percent) than the rate reported among adults without SPD in the past year (6.9 percent).
- SPD in the past year was associated with past year substance dependence or abuse in 2007. Among adults aged 18 or older with SPD, 22.1 percent were dependent on or abused illicit drugs or alcohol. The rate among adults without SPD was 7.6 percent.
Mental Health Care among Adults with Co-Occurring Serious Psychological Distress and Substance Use Disorders
- Among the 5.4 million adults aged 18 or older with both SPD and substance dependence or abuse (i.e., a substance use disorder) in 2007, 46.5 percent received mental health care or substance use treatment at a specialty facility; 10.4 percent received both mental health care and specialty substance use treatment, 33.3 percent received only mental health care, and 2.8 percent received only specialty substance use treatment (Figure 8.3).
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Figure 8.3 Past Year Mental Health Care among Adults Aged 18 or Older with Both Serious Psychological Distress and a Substance Use Disorder: 2007
Prevalence of Major Depressive Episode among Adults
- In 2007, 7.5 percent of adults aged 18 or older (16.5 million people) had at least one MDE in the past year (Figure 8.4). Almost 1 in 20 adults (4.6 percent or 10.1 million people) had a past year MDE with severe impairment. The rates of past year MDE and MDE with severe impairment were stable between 2006 and 2007.
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Figure 8.4 Major Depressive Episode in the Past Year among Adults Aged 18 or Older, by Severe Impairment, Age, and Gender: 2007
Note: Respondents with an unknown level of impairment were included in the estimates for Major Depressive Episode without Severe Impairment.
- The past year prevalence of MDE in 2007 was lowest for those aged 50 or older (5.8 percent). The rates were similar among persons aged 18 to 25 (8.9 percent) and those aged 26 to 49 (8.5 percent).
- The past year prevalence of MDE was higher among adult females than among adult males (9.5 vs. 5.3 percent). Among women, past year MDE rates were higher in the younger age groups (11.9 percent for 18 to 25 year olds, 11.0 percent for 26 to 49 year olds) compared with those 50 or older (7.2 percent).
- Among adults aged 18 or older, past year prevalence of MDE varied by race/ethnicity in 2007. The rate of MDE was lowest among Asians (2.9 percent), while rates for other groups were 12.1 percent among persons reporting two or more races, 9.2 percent among American Indians or Alaska Natives, 8.1 percent among whites, 6.3 percent among Hispanics, and 6.1 percent among blacks.
- Among adults aged 18 or older in 2007, past year prevalence of MDE with severe impairment was higher among unemployed persons (10.2 percent) than among persons employed full time (3.6 percent), persons employed part time (5.2 percent), and persons not in the labor force (5.7 percent).
Major Depressive Episode and Substance Use and Dependence or Abuse among Adults
- In 2007, adults aged 18 or older with past year MDE had higher rates of past year illicit drug use than those without MDE (27.4 vs. 12.8 percent). A similar pattern was observed for specific types of past year illicit drug use, such as marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutics.
- Among adults aged 18 or older with MDE in the past year, 10.4 percent were heavy alcohol users in the past month, higher than the 7.1 percent of heavy alcohol users without MDE in the past year. Similarly, among adults with past year MDE, the rate of daily cigarette use in the past month was 28.7 percent, while the rate was 15.2 percent among adults without past year MDE.
- Having MDE in the past year was associated with past year substance dependence or abuse. Among adults aged 18 or older who had MDE in 2007, 21.5 percent were dependent on or abused alcohol or illicit drugs, while among adults without MDE 8.2 percent were dependent on or abused alcohol or illicit drugs (Figure 8.5). Adults with past year MDE were more likely than those without MDE to be dependent on or abuse illicit drugs (8.8 vs. 2.1 percent) and alcohol (17.0 vs. 7.0 percent).
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Figure 8.5 Substance Dependence or Abuse among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2007
Treatment for Major Depressive Episode among Adults
- Among adults aged 18 or older who had past year MDE in 2007, 64.5 percent received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression in the same time period, which was lower than in 2006 (69.1 percent). Among persons aged 50 or older who had MDE in the past year, the treatment rate decreased from 85.4 percent in 2006 to 74.2 percent in 2007. Of adults aged 18 or older who had past year MDE with severe impairment in 2007, 72.2 percent received treatment, similar to the rate in 2006 (74.1 percent).
- In 2007, women aged 18 or older who had MDE in the past year were more likely than men to receive treatment for depression in the past year (68.0 vs. 57.8 percent), though the treatment rate for women was significantly lower than in 2006 (73.7 percent).
- Among adults aged 18 or older with past year MDE in 2007, approximately half of those with no insurance (49.3 percent) received treatment for depression in the past year compared with higher rates for those with insurance: 64.4 percent of adults with private insurance, 76.7 percent of adults covered by Medicaid or CHIP, and 77.6 percent of adults with other health insurance (including Medicare, CHAMPUS, TRICARE, CHAMPVA, VA, and other sources of health care or insurance). The rates of treatment for adults with private health insurance and other health insurance decreased from 2006 (71.1 and 86.8 percent, respectively).
Mental Health Service Use and Unmet Need for Mental Health Care among Adults
- In 2007, 29.4 million adults (13.2 percent of the population 18 years or older) received mental health services during the past 12 months (Figure 8.6). This was similar to the rate in 2006 (12.9 percent).
- In 2007, the type of mental health services most often received by adults aged 18 or older was prescription medication (11.1 percent), followed by outpatient services (6.9 percent). Rates of prescription medication and outpatient service use in 2007 were similar to the rates in 2006 (10.9 and 6.7 percent, respectively). Respondents could report receiving more than one type of mental health care.
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Figure 8.6 Past Year Mental Health Service Use among Adults Aged 18 or Older, by Type of Care: 2002-2007
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
- About 2.1 million adults (1.0 percent of the population aged 18 years or older) received inpatient care for mental health problems during the past year. This estimate was the same as the rate reported in 2005 after a significant decline in inpatient care noted in 2006 (0.7 percent or 1.6 million adults).
- Rates of mental health service use varied by age for adults aged 18 or older: 10.3 percent for adults aged 18 to 25, 14.3 percent for adults aged 26 to 49, and 13.2 percent for adults aged 50 or older.
- Men were less likely than women to receive outpatient mental health services (4.7 vs. 9.0 percent) and prescription medication (7.5 vs. 14.5 percent) for mental health problems in the past year. There was no significant gender difference in inpatient care (1.0 vs. 0.9 percent).
- Among racial/ethnic groups, the rates of mental health service use for adults aged 18 or older in 2007 were 16.0 percent for whites, 15.6 percent for persons reporting two or more races, 11.6 percent for American Indians or Alaska Natives, 7.3 percent for Hispanics, 6.8 percent for blacks, and 3.9 percent for Asians.
- In 2007, there were 10.9 million adults aged 18 or older (4.9 percent) who reported an unmet need for mental health care in the past year. This included 5.4 million adults who did not receive any mental health services in the past year. Among the 5.5 million adults with an unmet need who did receive some type of mental health service in the past year, 18.7 percent reported an unmet need for mental health care. (Unmet need among adults who received mental health services may reflect a delay in care or a perception of insufficient care.)
- Among the 5.4 million adults who reported an unmet need for mental health care and did not receive mental health services in the past year, several barriers to care were reported. These included an inability to afford care (43.2 percent), believing at the time that the problem could be handled without care (29.3 percent), not knowing where to go for care (18.1 percent), and not having the time to go for care (16.7 percent) (Figure 8.7).
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Figure 8.7 Reasons for Not Receiving Mental Health Services in the Past Year among Adults Aged 18 or Older with an Unmet Need for Mental Health Care Who Did Not Receive Mental Health Services: 2007
8.2. Youths Aged 12 to 17
Prevalence of Major Depressive Episode among Youths
- In 2007, there were 2.0 million youths (8.2 percent of the population aged 12 to 17) who had major depressive episode (MDE) during the past year. An estimated 1.4 million (5.5 percent) had MDE with severe impairment in one or more role domains (chores at home; school or work; close relationships with family; or social life).
- Among youths aged 12 to 17 in 2007, the past year prevalence of MDE ranged from 2.8 percent among 12 year olds to 11.8 percent among those aged 16 and 11.1 percent among those aged 17. Similarly, rates of past year MDE with severe impairment ranged from 1.8 percent among 12 years olds to 7.9 percent among 16 and 17 year olds.
- Among youths aged 12 to 17 in 2007, the prevalence rates of MDE and MDE with severe impairment among females were more than twice those among males. Female youths had an MDE prevalence rate of 11.9 percent in 2007, while the rate for males in the same age range was 4.6 percent. The prevalence of MDE with severe impairment was 8.2 percent for females and 3.0 percent for males (Figure 8.8).
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Figure 8.8 Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Severe Impairment, Age, and Gender: 2007
Note: Respondents with an unknown level of impairment were included in the estimates for Major Depressive Episode without Severe Impairment.
Major Depressive Episode and Substance Use among Youths
- Among 12 to 17 year olds who had past year MDE in 2007, 35.5 percent had used illicit drugs during the same period (Figure 8.9). This was higher than the rate of 17.2 percent among youths who did not have past year MDE. This pattern was similar for most specific types of illicit drug use, including marijuana, cocaine, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutics.
- In 2007, youths aged 12 to 17 who had MDE during the past year were more likely to report daily cigarette use in comparison with those who did not have MDE during the past year (4.8 vs. 2.3 percent). Similarly, youths who had past year MDE were more likely to report heavy use of alcohol than those who did not have MDE (3.8 vs. 2.2 percent).
- The occurrence of MDE in the past year among youths aged 12 to 17 was associated with a higher prevalence of illicit drug or alcohol dependence or abuse (18.9 percent). Among youths who did not report past year MDE, 6.7 percent had illicit drug or alcohol dependence or abuse during the same period.
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Figure 8.9 Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2007
Treatment for Major Depressive Episode among Youths
- In 2007, 38.9 percent of youths aged 12 to 17 with past year MDE received treatment for depression (i.e., saw or talked to a medical doctor or other professional or used prescription medication), which was unchanged from the 2006 rate. Among youths with past year MDE in 2007, 20.5 percent saw or talked to a medical doctor or other professional only, 2.5 percent used prescription medication only, and 15.6 percent received treatment from both sources for depression in the past year.
Mental Health Service Use among Youths
- In 2007, 3.1 million youths aged 12 to 17 (12.5 percent) received treatment or counseling for problems with behavior or emotions in the specialty mental health setting (inpatient or outpatient care). Additionally, 11.5 percent of youths received services in the education setting, and 2.8 percent received mental health services from the general medical setting in the past 12 months. Mental health services were received from both the specialty setting and either the education or general medical settings (i.e., care from multiple settings) by 5.1 percent of youths.
- Female youths were more likely than male youths to report using outpatient specialty mental health services (13.3 vs. 9.1 percent), education services (13.2 vs. 9.9 percent), or general medical-based services (3.2 vs. 2.3 percent), but there was no significant gender difference in the use of inpatient specialty mental health services (Figure 8.10).
- Of the 2.8 million youths who received outpatient specialty mental health services in the past 12 months, 19.7 percent reported having 1 visit, 17.4 percent reported having 2 visits, 27.1 percent reported having 3 to 6 visits, 22.9 percent reported having 7 to 24 visits, and 12.9 percent reported having 25 or more visits (Figure 8.11).
- Of the 628,000 youths who received inpatient or residential specialty mental health services in the past 12 months, over half (52.4 percent) reported staying overnight 1 to 2 nights, 18.4 percent reported staying 3 to 6 nights, 14.4 percent reported staying 7 to 24 nights, and 14.8 reported staying 25 or more nights (Figure 8.12).
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Figure 8.10 Past Year Mental Health Service Use among Youths Aged 12 to 17, by Gender: 2007
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Figure 8.11 Number of Outpatient Visits in the Past Year among Youths Aged 12 to 17 Who Received Outpatient Specialty Mental Health Services: 2007
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Figure 8.12 Number of Nights Stayed in an Inpatient Specialty Mental Health Facility in the Past Year among Youths Aged 12 to 17 Who Received Inpatient Specialty Mental Health Services: 2007
9. Discussion of Trends in Substance Use among Youths and Young Adults
This report presents findings from the 2007 National Survey on Drug Use and Health (NSDUH). Conducted since 1971 and previously named the National Household Survey on Drug Abuse (NHSDA), the survey underwent several methodological improvements in 2002 that have affected prevalence estimates. As a result, the 2002 through 2007 estimates are not comparable with estimates from 2001 and earlier surveys. Therefore, the primary focus of the report is on comparisons of measures of substance use and mental health problems across subgroups of the U.S. population in 2007 and changes between 2006 and 2007, as well as between 2002 and 2007. This chapter provides an additional discussion of the findings concerning a topic of great interest—trends in substance use among youths and young adults.
An important step in the analysis and interpretation of NSDUH or any other survey data is to compare the results with those from other data sources. This can be difficult sometimes because the other surveys typically have different purposes, definitions, and designs. Research has established that surveys of substance use and other sensitive topics often produce inconsistent results because of different methods used. Thus, it is important to understand that conflicting results often reflect differing methodologies, not incorrect results. Despite this limitation, comparisons can be very useful. Consistency across surveys can confirm or support conclusions about trends and patterns of use, and inconsistent results can point to areas for further study. Further discussion of this issue is included in Appendix D, along with descriptions of methods and results from other sources of substance use and mental health data.
Unfortunately, few additional data sources are available at this time to compare with NSDUH results. One established source is Monitoring the Future (MTF), a study sponsored by the National Institute on Drug Abuse (NIDA). MTF surveys students in the 8th, 10th, and 12th grades in classrooms during the spring of each year, and it also collects data by mail from a subsample of adults who had participated earlier in the study as 12th graders (Johnston, O'Malley, Bachman, & Schulenberg, 2007c, 2008a, 2008b). Historically, NSDUH rates of substance use among youths have been lower than those of MTF, and occasionally the two surveys have shown different trends over a short time period. Nevertheless, the two sources have shown very similar long-term trends in prevalence. NSDUH and MTF rates of substance use generally have been similar among young adults, and the two sources also have shown similar trends.
A comparison of NSDUH and MTF estimates for 2002 to 2007 is shown in Tables 9.1 and 9.2 at the end of this chapter for several substances that are defined similarly in the two surveys. MTF data on 8th and 10th graders combined give the closest match on age to estimates for NSDUH youths aged 12 to 17, while MTF follow-up data on persons aged 19 to 24 provide the closest match on age to estimates for NSDUH young adults aged 18 to 25. The NSDUH results are remarkably consistent with MTF trends for both youths and young adults, as discussed below.
Both surveys generally show decreases between 2002 and 2007 in the percentages of youths who used marijuana, Ecstasy, LSD, alcohol, and cigarettes in the lifetime, past year, and past month (Table 9.1). One exception was for LSD in the past month for MTF, and information on cigarettes in the past year was not available for MTF. Estimates from both surveys indicate a decline in cocaine use between 2002 and 2007, although the trend was statistically significant in NSDUH data but not in MTF data. Both surveys show no decrease in the rates of past year and past month inhalant use among youths between 2002 and 2007, although only NSDUH shows a significant decrease in lifetime use. The consistency between NSDUH and MTF trend data is found not only in terms of the specific drugs showing decreases, but also in terms of the magnitude of the decreases. Despite the higher levels of prevalence estimated from MTF, the two surveys show very similar rates of change in past month prevalence, especially for the three substances used most commonly by youths: alcohol, cigarettes, and marijuana. Between 2002 and 2007, the rate of current alcohol use among youths declined 10 percent according to both NSDUH and MTF. Current cigarette use prevalence rates in 2007 were 25 percent lower in both NSDUH and MTF compared with 2002 rates. For past month marijuana use, the NSDUH decline from 2002 to 2007 was 18 percent, and the MTF decline was 24 percent.
Data on young adults also show similar trends in the two surveys, although not as consistent as for the youth data (Table 9.2). Potential reasons for differences are the relatively smaller MTF sample size for young adults and possible bias in the MTF sample due to noncoverage of school dropouts and a low overall response rate, considering nonresponse by schools, by students in the 12th grade survey, and in the follow-up mail survey. Both surveys show declines from 2002 to 2007 in past year and past month cigarette and marijuana use among young adults, although the decline in past month marijuana use in NSDUH was not statistically significant. However, the NSDUH rates of decline in current cigarette and marijuana use for young adults were less than the declines in NSDUH for youths and for young adults in MTF. Past month marijuana prevalence among young adults declined 5 percent according to NSDUH and 12 percent according to MTF. For past month cigarette use, declines were 11 percent in NSDUH and 18 percent in MTF. Both surveys show no significant change from 2002 and 2007 in the rate of current alcohol use among young adults. A significant decline between 2006 and 2007 in past month cocaine use is seen in the NSDUH data, and the MTF data show a similar drop in use (although not statistically significant).
Both NSDUH and MTF generally show substantial decreases for both youths and young adults in the past year use of Ecstasy and LSD between 2002 and 2004, then a leveling in 2005. The 2006 data from both surveys had suggested the start of a possible resurgence in the past year use of Ecstasy among youths and young adults, but the 2007 data do not indicate any major increase or decrease since 2005, in general. The only statistically significant change in past year Ecstasy use between 2005 and 2007 was for use among youths in NSDUH (from 1.0 to 1.3 percent). NSDUH also showed a statistically significant increase between 2005 and 2006 in past year initiation of Ecstasy use for young adults (from 322,000 initiates in 2005 to 494,000 initiates in 2006), but the increase did not continue in 2007 (414,000 initiates).
Another source of data on trends in the use of drugs among youths is the Youth Risk Behavior Survey (YRBS), sponsored by the Centers for Disease Control and Prevention. YRBS surveys students in 9th through 12th grades in classrooms every other year during the spring (Eaton et al., 2008). The most recent survey was completed in 2007. YRBS has generally shown higher prevalence rates but similar long-term trends when compared with NSDUH and MTF. However, comparisons between YRBS and NSDUH or MTF are less straightforward because of the different periodicity (i.e., biennially instead of annually) and ages covered, the limited number of drug use questions, and smaller sample size in the YRBS. For the substances for which information on current use is collected in the YRBS, including alcohol, cigarettes, marijuana, and cocaine, the YRBS trend results between 2001 and 2007 are consistent with NSDUH and MTF (Eaton et al., 2008; Grunbaum et al., 2002). YRBS data for the combined grades 9 through 12 showed no significant change in alcohol use (47.1 percent in 2001 and 44.7 percent in 2007), a decrease in cigarette use (28.5 percent in 2001, 20.0 percent in 2007), a decrease in marijuana use (23.9 percent in 2001, 19.7 percent in 2007), and a decline in cocaine use (4.2 percent in 2001, 3.3 percent in 2007).
Although changes in NSDUH preclude direct comparisons of recent estimates with estimates from before 2002, it is important to put the recent trends in context by reviewing longer term trends in use. NSDUH data (prior to the design changes in 1999 and 2002) on youths aged 12 to 17 and MTF data on high school seniors have shown substantial increases in youth illicit drug use during the 1970s, reaching a peak in the late 1970s. Both surveys then showed significant declines throughout the 1980s until about 1992, when rates reached a low point. These trends were driven by the trend in marijuana use. With the start of annual data collection in NSDUH in 1991, along with the biennial YRBS and the annual 8th and 10th grade samples in MTF, trends among youths are well documented since the low point that occurred in the early 1990s. Although they employ different survey designs and cover different age groups, the three surveys are consistent in showing increasing rates of marijuana use during the early to mid-1990s, reaching a peak in the late 1990s, followed by consistent declines in use since the turn of the 21st century (Figure 9.1).
Below is a line graph. Click here for the text describing this graph.
Figure 9.1 Past Month Marijuana Use among Youths in NSDUH, MTF, and YRBS: 1971-2007
MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health; YRBS = Youth Risk Behavior Survey.
Table 9.1 – Comparison of NSDUH and MTF Prevalence Estimates among Youths: 2002-2007
Substance/Time Period |
NSDUH |
MTF |
Ages 12-17 |
8th and 10th Grades |
2002 |
2003 |
2004 |
2005 |
2006 |
2007 |
2002 |
2003 |
2004 |
2005 |
2006 |
2007 |
-- Not available.
NOTE: MTF data for 8th and 10th graders are simple averages of estimates for those two grades. Data for 8th and 10th graders are reported in Johnston, O'Malley, Bachman, and Schulenberg (2008a). Design effects used for variance estimation are reported in Johnston, O'Malley, Bachman, and Schulenberg (2007c).
a Difference between this estimate and 2007 estimate is statistically significant at the .05 level.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, 2004, 2005, 2006, and 2007. University of Michigan, The Monitoring the Future Study, 2002, 2003, 2004, 2005, 2006, and 2007. |
Marijuana |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
16.2 |
23.8 |
22.6 |
Past Year |
13.2 |
12.5 |
18.5 |
17.5 |
Past Month |
6.8 |
6.7 |
6.7 |
10.9 |
10.4 |
10.0 |
Cocaine |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
2.4 |
2.3 |
2.2 |
2.1 |
4.9 |
4.4 |
4.4 |
4.5 |
4.1 |
4.2 |
Past Year |
1.8 |
1.6 |
1.7 |
1.6 |
1.5 |
3.2 |
2.8 |
2.9 |
2.9 |
2.6 |
2.7 |
Past Month |
0.5 |
0.6 |
0.4 |
0.4 |
1.4 |
1.1 |
1.3 |
1.3 |
1.3 |
1.1 |
Ecstasy |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
2.1 |
1.6 |
1.9 |
1.8 |
4.3 |
3.6 |
3.4 |
3.5 |
3.8 |
Past Year |
1.3 |
1.2 |
1.2 |
1.3 |
2.6 |
2.1 |
2.2 |
2.1 |
2.5 |
Past Month |
0.4 |
0.3 |
0.3 |
0.3 |
0.3 |
0.9 |
0.8 |
0.8 |
1.0 |
0.9 |
LSD |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
0.9 |
0.8 |
2.8 |
2.3 |
2.2 |
2.2 |
2.3 |
Past Year |
0.6 |
0.6 |
0.6 |
0.4 |
0.5 |
1.5 |
1.4 |
1.4 |
1.3 |
1.5 |
Past Month |
0.2 |
0.2 |
0.1 |
0.1 |
0.1 |
0.7 |
0.6 |
0.6 |
0.6 |
0.6 |
0.6 |
Inhalants |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
10.1 |
9.6 |
14.4 |
14.3 |
14.9 |
15.1 |
14.7 |
14.6 |
Past Year |
4.4 |
4.4 |
3.9 |
6.8 |
7.1 |
7.8 |
7.8 |
7.8 |
7.5 |
Past Month |
1.2 |
1.3 |
1.2 |
1.2 |
1.3 |
1.2 |
3.1 |
3.2 |
3.5 |
3.2 |
3.2 |
3.2 |
Alcohol |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
40.4 |
39.4 |
51.0 |
50.3 |
Past Year |
31.8 |
45.3 |
44.7 |
44.1 |
Past Month |
16.5 |
16.6 |
15.9 |
25.2 |
25.5 |
24.7 |
Cigarettes |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
23.7 |
28.4 |
Past Year |
15.7 |
-- |
-- |
-- |
-- |
-- |
-- |
Past Month |
10.4 |
9.8 |
10.6 |
Table 9.2 – Comparison of NSDUH and MTF Prevalence Estimates among Young Adults: 2002-2007
Substance/
Time Period |
NSDUH |
MTF |
Ages 18-25 |
Ages 19-24 |
2002 |
2003 |
2004 |
2005 |
2006 |
2007 |
2002 |
2003 |
2004 |
2005 |
2006 |
2007 |
-- Not available.
NOTE: MTF data for persons aged 19 to 24 are simple averages of modal age groups 19-20, 21-22, and 23-24 as reported in Johnston, O'Malley, and Bachman (2003b) and in Johnston, O'Malley, Bachman, and Schulenberg (2004b, 2005b, 2006b, 2007b, 2008b).
NOTE: For the 19 to 24 age group in the MTF data, significance tests were performed assuming independent samples between years an odd number of years apart because two distinct cohorts a year apart were monitored longitudinally at 2-year intervals. Although appropriate for comparisons of 2002, 2004, and 2006 estimates with 2007 estimates, this assumption results in conservative tests for comparisons of 2003 and 2005 estimates with 2007 estimates because it does not take into account covariances that are associated with repeated observations from the longitudinal samples. Estimates of covariances were not available.
a Difference between this estimate and 2007 estimate is statistically significant at the .05 level.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, 2004, 2005, 2006, and 2007. University of Michigan, The Monitoring the Future Study, 2002, 2003, 2004, 2005, 2006, and 2007. |
Marijuana |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
50.8 |
56.1 |
55.6 |
54.4 |
53.8 |
53.9 |
Past Year |
28.5 |
27.8 |
28.0 |
28.0 |
27.5 |
33.0 |
31.6 |
31.4 |
30.9 |
31.0 |
Past Month |
17.3 |
17.0 |
16.1 |
16.6 |
16.3 |
16.4 |
18.2 |
17.0 |
17.0 |
17.5 |
Cocaine |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
15.4 |
15.0 |
15.2 |
15.1 |
15.7 |
15.0 |
12.9 |
12.6 |
13.6 |
12.4 |
Past Year |
6.7 |
6.6 |
6.6 |
6.9 |
6.9 |
6.4 |
6.5 |
7.3 |
6.9 |
7.0 |
6.3 |
Past Month |
2.0 |
1.7 |
2.5 |
2.6 |
2.4 |
2.1 |
2.4 |
1.9 |
Ecstasy |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
13.7 |
13.4 |
12.8 |
11.5 |
9.5 |
Past Year |
3.7 |
3.1 |
3.1 |
3.8 |
3.5 |
3.3 |
3.4 |
3.6 |
2.8 |
Past Month |
0.7 |
0.7 |
0.8 |
0.7 |
0.8 |
0.6 |
0.9 |
0.3 |
LSD |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
7.3 |
6.7 |
5.9 |
Past Year |
1.1 |
1.0 |
1.0 |
1.2 |
1.1 |
1.5 |
1.2 |
1.1 |
1.5 |
1.4 |
Past Month |
0.2 |
0.3 |
0.2 |
0.2 |
0.2 |
0.4 |
0.2 |
0.2 |
0.2 |
0.3 |
0.3 |
Inhalants |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
11.3 |
9.3 |
9.7 |
7.5 |
Past Year |
2.1 |
1.8 |
1.6 |
1.5 |
1.6 |
1.8 |
1.1 |
Past Month |
0.5 |
0.4 |
0.4 |
0.5 |
0.4 |
0.4 |
0.8 |
0.3 |
0.4 |
0.3 |
0.4 |
0.3 |
Alcohol |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
86.2 |
85.7 |
85.2 |
87.6 |
87.2 |
87.1 |
87.0 |
86.0 |
Past Year |
77.9 |
78.1 |
78.0 |
77.9 |
78.8 |
77.9 |
83.9 |
82.3 |
83.1 |
82.8 |
83.2 |
82.8 |
Past Month |
60.5 |
61.4 |
60.5 |
60.9 |
61.9 |
61.2 |
67.7 |
66.3 |
67.3 |
66.8 |
67.0 |
67.4 |
Cigarettes |
|
|
|
|
|
|
|
|
|
|
|
|
Lifetime |
64.7 |
-- |
-- |
-- |
-- |
-- |
-- |
Past Year |
45.1 |
37.1 |
36.2 |
Past Month |
36.2 |
26.7 |
25.7 |
End Notes
1 RTI International is a trade name of Research Triangle Institute.
2See http://webapp.icpsr.umich.edu/cocoon/SAMHDA/DAS3/00064.xml.
This page was last updated on September 4, 2008.
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