December 4, 2008

Trends in Substance Use, Dependence or Abuse, and Treatment among Adolescents: 2002 to 2007

Adolescents who use alcohol or drugs at an earlier age are more likely to develop substance dependence or abuse. Preventing or delaying substance use among this population is of utmost importance and has been an ongoing goal of the Federal Government's Healthy People initiative (see http://www.healthypeople.gov/). This issue of The NSDUH Report examines trends in substance use, dependence or abuse, and treatment among adolescents (i.e., youths aged 12 to 17). Data from the 2002 through 2007 National Surveys on Drug Use and Health (NSDUHs) are utilized.

In this report, substance dependence or abuse is defined using criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which includes symptoms such as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year. Respondents also are asked about the treatment they received for a substance use problem. For these analyses, an individual is defined as having received treatment only if he or she reported receiving specialty treatment for alcohol or illicit drug use in the past year. Specialty substance use treatment is defined as treatment received at drug or alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient services only), and mental health centers. Specialty substance use treatment excludes treatment in an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient.

Although there was little change in past month use of cigarettes, alcohol, and illicit drugs among adolescents between 2006 and 2007, the rates generally declined between 2002 and 2007 (Figure 1). For example, 9.8 percent of adolescents used cigarettes in the past month in 2007. This rate was similar to the 10.4 percent reported in 2006, but lower than the 13.0 percent reported in 2002.

Figure 1. Percentages of Adolescents Using Cigarettes, Alcohol, or Illicit Drugs in the Past Month: 2002 to 2007

The decline in past month illicit drug use can be attributed primarily to a decline in marijuana use—the illicit drug most commonly used (Figure 2)—with 8.2 percent of adolescents using marijuana in 2002 compared with 6.7 percent in 2007. The two other most commonly used illicit drugs among adolescents are inhalants and the nonmedical use of prescription-type drugs. Use of inhalants remained stable, while nonmedical use of prescription-type drugs declined from 4.0 to 3.3 percent over the 6-year period covered in this report.

Figure 2. Percentages of Adolescents Using Selected Illicit Drugs in the Past Month: 2002 to 2007

Past year dependence on or abuse of alcohol remained relatively stable among adolescents between 2002 and 2007 (5.9 and 5.4 percent, respectively) (Figure 3). However, past year dependence on or abuse of illicit drugs declined from 5.6 percent in 2002 to 4.3 percent in 2007.

Figure 3. Percentages of Adolescents Meeting the Criteria for Substance Dependence or Abuse in the Past Year: 2002 to 2007

Among adolescents who needed treatment for alcohol use in the past year, the percentage who received treatment at a specialty facility fluctuated between 5.9 and 8.1 percent from 2002 through 2007. The percentages for treatment for illicit drug use fluctuated between 8.5 and 11.3 percent. There were no statistically significant changes between 2002 and 2007 for either of these treatment indicators.

Taken together, the findings in this report present mixed results on trends in adolescent substance use, dependence and abuse, and treatment. On the positive side, past month use of cigarettes, alcohol, and illicit drugs declined among adolescents between 2002 and 2007, as did dependence on or abuse of illicit drugs. On the other hand, the rates of alcohol dependence or abuse remained fairly steady. In addition, given that the rate of adolescents receiving specialty treatment remained unchanged between 2002 and 2007, policymakers, treatment practitioners, local communities, and parents may need to look at strategies to expand the continuum of care to engage adolescent problem users who cannot or will not go to specialty substance use treatment programs.