September 29, 2011

Length of Time from First Use to Adult Treatment Admission

In Brief

Among adult first-time treatment admissions, an average of 15.6 years elapsed between first use of the primary substance of abuse and treatment entry The length of time between first use and treatment entry was longer for males than for females (16.5 vs. 13.8 years), and ranged from 13.3 years among Asian or Pacific Islander admissions to 17.4 years among American Indian/Alaska Native admissions Non-Hispanic Black admissions had a longer length of time between first use and treatment entry than other race/ethnicities for primary cocaine abuse (17.0 vs. 14.5 years or less) and primary heroin abuse (21.1 vs. 15.2 years or less) Male admissions had a longer time between first use and treatment entry than female admissions for primary cocaine abuse (15.7 vs. 12.6 years), primary heroin abuse (13.4 vs. 10.0 years), and stimulants (13.0 vs. 10.6 years)

To reduce the negative consequences of substance abuse, it is important for individuals who need treatment to receive services as soon as possible. However, the length of time between first use of a substance to treatment entry for abuse of that substance can be substantial. Research emphasizes the importance of early diagnosis and intervention, and indicates that the duration of use before starting treatment is related to the length of time it takes treatment admissions to achieve abstinence.¹ Duration of use prior to treatment entry may vary by a number of factors (e.g., substance of abuse and demographic characteristics) and may signal disparities in access to care.

Data from the Treatment Episode Data Set (TEDS) can be used to examine the duration of use prior to treatment entry and identify potential disparities in treatment access. This issue of The TEDS Report examines differences in the length of time between adult age at first admission to substance abuse treatment and age of first use of the primary substance of abuse—that is, duration of use.^2,3 In 2009, there were approximately 1.8 million admissions aged 18 or older. Of these, 36.9 percent (approximately 669,000) were first-time admissions.

Duration of Use

Among adult first-time substance abuse treatment admissions, the average age at first use of the primary substance of abuse was 18.4 years, and the average age at admission to treatment was 34.0 years. Taken together, these findings indicate that adult first-time admissions used their primary substance of abuse an average of 15.6 years before receiving treatment. Duration of use was longer among males than females (16.5 vs. 13.8 years), and ranged from 13.3 years among Asian or Pacific Islander admissions to 17.4 years among American Indian/Alaska Native admissions (Figure 1).

Duration of Use by Primary Substance of Abuse

The length of time between first use and entry into substance abuse treatment differed by primary substance of abuse. Adult first-time alcohol admissions had the longest duration of use with an average of 20.2 years between first use and treatment entry (Figure 2). The duration of use among first-time cocaine, heroin, marijuana, and stimulant admissions ranged from 12 to 14 years.⁴ The shortest duration of use was for first-time prescription drug admissions with an average of 7.8 years between first use and treatment entry.

Duration of Primary Substance Abuse by Race/Ethnicity and Gender

The duration of use of the various primary substances of abuse differed by race/ethnicity and gender. Among adult first-time admissions reporting alcohol as the primary substance of abuse, the average length of time between first use and treatment entry ranged from 22.0 years among non-Hispanic Blacks to 16.4 years among Asians/Pacific Islanders (Table 1). Non-Hispanic Black first-time admissions had longer average durations of use than admissions of other race/ethnicities for primary cocaine abuse (17.0 vs. 14.5 years or less) and primary heroin abuse (21.1 vs. 15.2 years or less). Among first-time admissions reporting primary stimulant abuse, the average duration of use was longer among non-Hispanic Whites and American Indians/Alaska Natives than other racial/ethnic groups (12.8 and 12.7 years vs. 11.5 years or less).

Male and female adult first-time admissions reporting primary abuse of alcohol, marijuana, or prescription drugs had similar durations of use. However, males had longer average durations of use than females for primary cocaine abuse (15.7 vs. 12.6 years), primary heroin abuse (13.4 vs. 10.0 years), and stimulants (13.0 vs. 10.6 years).

Discussion

The findings in this report indicate that, on average, adult first-time treatment admissions initiated use of their primary substance of abuse nearly two decades before entering treatment, and that there were significant differences in duration of use by race/ethnicity, substance of abuse, and gender.

The years between first use and treatment admission suggest that there may have been missed opportunities for intervention. Culturally appropriate outreach services that help individuals recognize the need for and potential benefits of treatment may help to ensure that individuals in need of treatment receive services sooner rather than later, thus giving them the best chances for successful recovery. Additionally, prevention and intervention programs that consider possible cultural and gender influences on drugs of choice and related patterns of use and abuse may help to prevent individuals from reaching the point where formal treatment would be needed.

Finally, there was a much shorter duration of use prior to first treatment for prescription drugs than for other substances. This may indicate a high potential for problematic substance use patterns to develop quickly. Therefore it is critical that physicians and other health professionals be vigilant in looking for signs of misuse of these drugs so that intervention can occur as soon as possible.

End Notes

¹ Scott, C. K., Dennis, M. L., & Foss, M. A. (2005). Utilizing recovery management checkups to shorten the cycle of relapse, treatment reentry, and recovery. Drug and Alcohol Dependence 78(3), 325-338.
² Age of first use is defined differently for alcohol than for drugs. For alcohol, age of first use signifies age of first intoxication. For drugs, age of first use identifies the age at which the respective drug was first used.
³ Analysis excludes adult first-time admissions with unknown durations of use.
⁴ Stimulants include methamphetamine, other amphetamines, and other non-amphetamine stimulants. Prescription drugs comprise opiates and synthetics other than heroin and methadone such as codeine, as well as tranquilizers, barbiturates, and other sedatives or hypnotics.

Suggested Citation

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (September 29, 2011). The TEDS Report: Length of Time from First Use to Adult Treatment Admission. Rockville, MD.

The TEDS Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, e-mail: shortreports@samhsa.hhs.gov.

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