Highlights

This report presents the first information from the 2008 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 2008, an estimated 20.1 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 2008 (8.0 percent) was the same as the rate in 2007 (8.0 percent).
Marijuana was the most commonly used illicit drug (15.2 million past month users). Among persons aged 12 or older, the rate of past month marijuana use in 2008 (6.1 percent) was similar to the rate in 2007 (5.8 percent).
In 2008, there were 1.9 million current cocaine users aged 12 or older, comprising 0.7 percent of the population. These estimates were similar to the number and rate in 2007 (2.1 million or 0.8 percent), but lower than the estimates in 2006 (2.4 million or 1.0 percent).
Hallucinogens were used in the past month by 1.1 million persons (0.4 percent) aged 12 or older in 2008, including 555,000 (0.2 percent) who had used Ecstasy. These estimates were similar to the corresponding estimates for 2007.
There were 6.2 million (2.5 percent) persons aged 12 or older who used prescription-type psychotherapeutic drugs nonmedically in the past month. These estimates were lower than in 2007 (6.9 million or 2.8 percent).
The number of past month methamphetamine users decreased by over half between 2006 and 2008. The numbers were 731,000 in 2006, 529,000 in 2007, and 314,000 in 2008.
Among youths aged 12 to 17, the current illicit drug use rate remained stable from 2007 (9.5 percent) to 2008 (9.3 percent). Between 2002 and 2008, youth rates declined significantly for illicit drugs in general (from 11.6 to 9.3 percent) and for marijuana (8.2 to 6.7 percent), cocaine (0.6 to 0.4 percent), prescription-type drugs used nonmedically (4.0 to 2.9 percent), pain relievers (3.2 to 2.3 percent), stimulants (0.8 to 0.5 percent), and methamphetamine (0.3 to 0.1 percent).
The rate of current marijuana use among youths aged 12 to 17 decreased from 8.2 percent in 2002 to 6.7 percent in 2006 and remained unchanged at 6.7 percent in 2007 and 2008.
The rate of current hallucinogen use among youths aged 12 to 17 increased from 0.7 percent in 2007 to 1.0 percent in 2008.
Rates of current use of illicit drugs in 2008 were higher among young adults aged 18 to 25 (19.6 percent) than for youths aged 12 to 17 (9.3 percent) and adults aged 26 or older (5.9 percent). Among young adults, there were no changes from 2007 to 2008 in the rate of current use of marijuana (16.5 percent in 2008), psychotherapeutics (5.9 percent), and hallucinogens (1.7 percent). The rate of cocaine use in this age group declined from 2.6 percent in 2005 to 1.5 percent in 2008.
From 2002 to 2008, there was an increase among young adults aged 18 to 25 in the rate of current nonmedical use of prescription pain relievers (from 4.1 to 4.6 percent) and in LSD (from 0.1 to 0.3 percent). There were decreases in the use of inhalants (from 0.5 to 0.3 percent) and methamphetamine (from 0.6 to 0.2 percent).
Among those aged 50 to 59, the rate of past month illicit drug use increased from 2.7 percent in 2002 to 4.6 percent in 2008. This trend may partially reflect the aging into this age group of the baby boom cohort, whose lifetime rate of illicit drug use is higher than those of older cohorts.
Among persons aged 12 or older in 2007-2008 who used pain relievers nonmedically in the past 12 months, 55.9 percent got the drug they most recently used from a friend or relative for free. Another 18.0 percent reported they got the drug from one doctor. Only 4.3 percent got pain relievers from a drug dealer or other stranger, and 0.4 percent bought them on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 81.7 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 2008, 19.6 percent were current illicit drug users, which was higher than the 8.0 percent of those employed full time and 10.2 percent of those employed part time. However, most illicit drug users were employed. Of the 17.8 million current illicit drug users aged 18 or older in 2008, 12.9 million (72.7 percent) were employed either full or part time. The number of unemployed illicit drug users increased from 1.3 million in 2007 to 1.8 million in 2008, primarily because of an overall increase in the number of unemployed persons.
In 2008, 10.0 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 aged 12 or older, the same as the rate in 2007 (4.0 percent), but lower than the rate in 2002 (4.7 percent). In 2008, the rate was highest among young adults aged 18 to 25 (12.3 percent).

Alcohol Use

Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2008 survey (51.6 percent). This translates to an estimated 129.0 million people, which was similar to the 2007 estimate of 126.8 million people (51.1 percent).
In 2008, more than one fifth (23.3 percent) of persons aged 12 or older participated in binge drinking. This translates to about 58.1 million people, similar to the estimate in 2007. Binge drinking is defined as having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey.
In 2008, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.3 million people. This rate was the same as the rate of heavy drinking in 2007. Heavy drinking is defined as binge drinking on at least 5 days in the past 30 days.
Among young adults aged 18 to 25 in 2008, the rate of binge drinking was 41.0 percent, and the rate of heavy drinking was 14.5 percent. These rates were similar to the rates in 2007.
The rate of current alcohol use among youths aged 12 to 17 was 14.6 percent in 2008, which is lower than the 2007 rate (15.9 percent). Youth binge and heavy drinking rates in 2008 were 8.8 percent (lower than the 9.7 percent rate in 2007) and 2.0 percent, respectively.
Past month and binge drinking rates among underage persons (aged 12 to 20) declined between 2002 and 2008. The rate of past month underage drinking declined from 28.8 to 26.4 percent, and the rate of past month binge drinking declined from 19.3 to 17.4 percent.
Past month alcohol use rates declined between 2002 and 2008 for those aged 12 or 13 (4.3 to 3.4 percent), 14 or 15 (16.6 to 13.1 percent), 16 or 17 (32.6 to 26.2 percent), and 18 to 20 (51.0 to 48.7 percent).
Among persons aged 12 to 20, past month alcohol use rates in 2008 were 17.2 percent among Asians, 19.0 percent among blacks, 22.9 percent among those reporting two or more races, 23.1 percent among Hispanics, 26.4 percent among American Indians or Alaska Natives, and 30.1 percent among whites.
In 2008, 56.2 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 29.6 percent reported that it had occurred in their own home. About one third (30.8 percent) paid for the alcohol the last time they drank, including 8.3 percent who purchased the alcohol themselves and 22.3 percent who gave money to someone else to purchase it. Among those who did not pay for the alcohol they last drank, 37.4 percent got it from an unrelated person aged 21 or older, 21.1 percent from another person under 21 years of age, and 21.0 percent from a parent, guardian, or other adult family member.
In 2008, an estimated 12.4 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage has dropped since 2002, when it was 14.2 percent. The rate of driving under the influence of alcohol was highest among persons aged 21 to 25 (26.1 percent).

Tobacco Use

In 2008, an estimated 70.9 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 28.4 percent of the population in that age range. In addition, 59.8 million persons (23.9 percent of the population) were current cigarette smokers; 13.1 million (5.3 percent) smoked cigars; 8.7 million (3.5 percent) used smokeless tobacco; and 1.9 million (0.8 percent) smoked tobacco in pipes.
The rate of current use of any tobacco product among persons aged 12 or older remained steady from 2007 to 2008 (28.6 and 28.4 percent, respectively). Rates of current use of cigarettes, smokeless tobacco, cigars, and pipe tobacco also did not change significantly over that period. However, between 2002 and 2008, past month use of any tobacco product decreased from 30.4 to 28.4 percent, and past month cigarette use declined from 26.0 to 23.9 percent. Rates of past month use of cigars, smokeless tobacco, and pipe tobacco in 2008 were similar to corresponding rates in 2002.
The rate of past month cigarette use among 12 to 17 year olds declined from 9.8 percent in 2007 to 9.1 percent in 2008, continuing a decline since 2002 when the rate was 13.0 percent. However, past month smokeless tobacco use did not decline over this period (2.0 percent in 2002 and 2.2 percent in 2008).
Among pregnant women aged 15 to 44, combined data for 2007 and 2008 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 (27.3 percent).

Initiation of Substance Use (Incidence, or First-Time Use) within the Past 12 Months

In 2008, an estimated 2.9 million persons aged 12 or older used an illicit drug for the first time within the past 12 months. This averages to almost 8,000 initiates per day and is similar to the estimate for 2007. A majority of these past year illicit drug initiates reported that their first drug was marijuana (56.6 percent). Nearly one third initiated with psychotherapeutics (29.6 percent, including 22.5 percent with pain relievers, 3.2 percent with tranquilizers, 3.0 percent with stimulants, and 0.8 percent with sedatives). A sizable proportion reported inhalants (9.7 percent) as their first illicit drug, and a small proportion used hallucinogens as their first drug (3.2 percent).
In 2008, the illicit drug categories with the largest number of past year initiates among persons aged 12 or older were marijuana use (2.2 million) and nonmedical use of pain relievers (2.2 million). These estimates were not significantly different from the numbers in 2007.
In 2008, there were 729,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 70.4 percent were under age 18 when they first used. There was no significant change in the number of inhalant initiates from 2007 to 2008, but the number in 2008 was significantly lower than the estimate in 2005 (877,000).
The number of past year initiates of methamphetamine among persons aged 12 or older was 95,000 in 2008. This estimate was significantly lower than the estimate in 2007 (157,000) and was less than one third of the number estimated in 2004 (318,000).
Following substantial drops in initiation between 2002 and 2003, estimates of initiation of Ecstasy and LSD among persons aged 12 or older have increased significantly. Between 2003 and 2008, the number of Ecstasy initiates increased from 642,000 to 894,000, and the number of LSD initiates increased from 200,000 to 394,000.
Most (84.6 percent) of the 4.5 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 2.4 million in 2008, similar to the estimate in 2007 (2.2 million) but significantly higher than the estimate for 2002 (1.9 million). Most new smokers in 2008 were under age 18 when they first smoked cigarettes (58.8 percent); however, the number of persons initiating smoking at age 18 or older increased from about 600,000 in 2002 to 1 million in 2008.

Youth Prevention-Related Measures

Perceived risk is measured by NSDUH as the percentage reporting that there is great risk in the substance use behavior. The percentage of youths aged 12 to 17 perceiving great risk in smoking marijuana once or twice a week increased from 51.5 percent in 2002 to 55.0 percent in 2005, but dropped to 53.1 percent in 2008. A decline from 2005 to 2008 also was observed for using LSD once or twice a week (76.2 percent in 2002, 76.1 percent in 2005, and 73.9 percent in 2008). Between 2002 and 2008, the percentages who reported great risk in using alcohol and cigarettes increased. In 2002, 63.1 percent of youths reported great risk in smoking one or more packs of cigarettes per day, and in 2008 the percentage increased to 69.7 percent. In 2002, 38.2 percent reported great risk in binge drinking once or twice a week, and in 2008 the percentage increased to 40.5 percent.
Almost half (49.2 percent) of youths aged 12 to 17 reported in 2008 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 (22.1 percent). About one in seven (13.8 percent) indicated that LSD would be "fairly" or "very" easily available, and 13.0 percent reported easy availability for heroin. Between 2002 and 2008, there were declines in the perceived availability for all four drugs.
A majority of youths aged 12 to 17 (90.8 percent) in 2008 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 (4.3 vs. 29.8 percent).
In 2008, 11.1 percent of youths aged 12 to 17 reported that they had participated in substance use prevention programs outside of school within the past year. This was lower than the percentage reported in 2002 (12.7 percent). Almost four fifths (78.0 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. The percentage of school-enrolled youths reporting that they had seen or heard prevention messages at school also declined during this period, from 78.8 to 75.9 percent.

Substance Dependence, Abuse, and Treatment

In 2008, an estimated 22.2 million persons (8.9 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, 3.1 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.2 million were dependent on or abused alcohol but not illicit drugs.
Between 2002 and 2008, there was no change in the number of persons with substance dependence or abuse (22.0 million in 2002 and 22.2 million in 2008).
The specific illicit drugs that had the highest levels of past year dependence or abuse in 2008 were marijuana (4.2 million), followed by pain relievers (1.7 million) and cocaine (1.4 million).
In 2008, adults aged 21 or older who had first used alcohol at age 14 or younger were more than 5 times as likely to be classified with alcohol dependence or abuse than adults who had their first drink at age 21 or older (15.1 vs. 2.6 percent).
The rate of substance dependence or abuse for males aged 12 or older in 2008 was nearly twice as high as the rate for females (11.5 vs. 6.4 percent). Among youths aged 12 to 17, however, the rate of substance dependence or abuse was higher among females than males (8.2 vs. 7.0 percent).
Between 2002 and 2008, the percentage of youths aged 12 to 17 with substance dependence or abuse declined from 8.9 to 7.6 percent.
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 2008, 23.1 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (9.2 percent of persons aged 12 or older). Of these, 2.3 million (0.9 percent of persons aged 12 or older and 9.9 percent of those who needed treatment) received treatment at a specialty facility. Thus, 20.8 million persons (8.3 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 2008 who were classified as needing substance use treatment but did not receive treatment at a specialty facility in the past year, 1.0 million persons (4.8 percent) reported that they felt they needed treatment for their illicit drug or alcohol use problem. Of these 1.0 million persons who felt they needed treatment, 233,000 (23.3 percent) reported that they made an effort to get treatment, and 766,000 (76.7 percent) reported making no effort to get treatment.

Mental Health

Serious mental illness (SMI) among adults is defined in Public Law 102-321 as persons aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within DSM-IV that has resulted in functional impairment, which substantially interferes with or limits one or more major life activities. In 2008, there were an estimated 9.8 million adults with SMI, representing 4.4 percent of adults.
Rates of SMI in 2008 were highest for adults aged 18 to 25 (7.4 percent) and lowest for adults aged 50 or older (2.3 percent).
The prevalence of SMI among women aged 18 or older (5.6 percent) was higher than that among men in that age group (3.0 percent).
The rate of SMI was higher among adults who were unemployed (8.0 percent) than among those who were employed full time (3.5 percent) or part time (4.8 percent).
SMI in the past year was associated with past year substance dependence or abuse. Among adults aged 18 or older with SMI in 2008, 25.2 percent (2.5 million) were dependent on or abused illicit drugs or alcohol. The rate among adults without SMI was 8.3 percent (17.9 million).
Among the 9.8 million adults with SMI in 2008, 5.7 million (58.7 percent) used mental health services in the past year. Among all adults with SMI, 52.6 percent received a prescription medication, 40.5 percent received outpatient services, and 7.5 percent received inpatient services for a mental health problem in the past year.
Among the 2.5 million adults with both SMI and substance dependence or abuse (i.e., a substance use disorder) in 2008, more than half (60.5 percent) received mental health care or substance use treatment at a specialty facility; 11.4 percent received both mental health care and specialty substance use treatment, 45.2 percent received only mental health care, and 3.7 percent received only specialty substance use treatment.
In 2008, an estimated 8.3 million adults (3.7 percent) had serious thoughts of suicide in the past year. The rate was 3.9 percent among women and 3.4 percent among men. The rate was highest among young adults aged 18 to 25 (6.7 percent) compared with adults 26 to 49 (3.9 percent) and adults aged 50 or older (2.3 percent).
Among adults aged 18 or older in 2008, 2.3 million (1.0 percent) made suicide plans in the past year, and 1.1 million (0.5 percent) reported attempting suicide. A half million adults reported staying overnight in a hospital as a result of their suicide attempt in the past year.
In 2008, 6.4 percent of persons aged 18 or older (14.3 million persons) had at least one major depressive episode (MDE) in the past year. Over 1 in 25 adults (4.2 percent or 9.5 million persons) had past year MDE with severe impairment.
In 2008, adults with past year MDE were more likely than those without MDE to be dependent on or abuse illicit drugs or alcohol (20.3 vs. 7.8 percent).
Among adults aged 18 or older who had MDE in the past year in 2008, 71.0 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.
Among adults aged 18 or older with MDE in the past year in 2008, women were more likely than men to receive treatment for depression in the past year (74.2 vs. 65.0 percent).
In 2008, there were 2.0 million youths (8.3 percent of the population aged 12 to 17) who had MDE during the past year. An estimated 1.5 million (6.0 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 (12.4 percent) than for adolescent males (4.3 percent). The prevalence of MDE with severe impairment was 9.2 percent for females and 2.9 percent for males.
Among 12 to 17 year olds who had past year MDE in 2008, 37.4 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 (3.6 and 3.4 percent, respectively) than for youths who did not have MDE (1.8 and 1.8 percent, respectively).
In 2008, 37.7 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, 21.7 percent saw or talked to a medical doctor or other professional only, 2.9 percent used prescription medication only, and 13.1 percent received treatment from both sources for depression in the past year.
In 2008, 3.1 million youths aged 12 to 17 (12.7 percent) received treatment or counseling for problems with behavior or emotions in the specialty mental health setting (inpatient or outpatient care). Additionally, 11.8 percent of youths received services in the education setting, and 2.9 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 5.3 percent of youths.

1. Introduction

This report presents a first look at results from the 2008 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. The report 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 serious mental illness, depression, and the co-occurrence of substance use and mental health problems. The report focuses on trends between 2007 and 2008 and from 2002 to 2008, as well as differences across population subgroups in 2008. Estimates from NSDUH for States and areas within States will be presented in separate reports.

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.

From 1971 through 1998, the survey employed paper and pencil data collection. 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 mode for responding to questions in order 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 2008 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 about half 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) and had a sample size of about 3,600 each. For the remaining 42 States and the District of Columbia, the sample size was about 900 per State. 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, screening was completed at 142,938 addresses, and 68,736 completed interviews were obtained. The survey was conducted from January through December 2008. Weighted response rates for household screening and for interviewing were 89.0 and 74.4 percent, respectively. See Appendix B for more information on NSDUH response rates.

1.2. Limitations on Trend Measurement

Because of the shift in interviewing method in 1999, the estimates from the pre-1999 surveys are not comparable with estimates from the current CAI-based surveys. Although the design of the 2002 through 2008 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are also important methodological differences that affect the comparability of the 2002 to 2008 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. Also, the name of the survey was changed in 2002, from the National Household Survey on Drug Abuse (NHSDA) to the current name. 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 the sample weights 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 in more detail (see OAS, 2005).

Because of changes in the questionnaire, estimates for methamphetamine, stimulants, and psychotherapeutics in this report should not be compared with corresponding estimates in OAS reports for data years prior to 2007. Estimates for 2002 to 2006 for these drug categories in this report, as well as in the 2007 report, incorporate statistical adjustments to enable year-to-year comparisons to be made over the period from 2002 to 2008.

The next section describes questionnaire changes that affect trend measurement for serious psychological distress and major depressive episode.

1.3. New Data on Mental Health

Several important changes were made to the adult mental health section in the 2008 NSDUH questionnaire. These changes provide valuable new data on mental health, but they also affect some of the measures that have been collected in NSDUH since 2004. A brief summary of the changes and their impact is provided below.

From 2004 to 2007, NSDUH collected data for adults aged 18 or older on lifetime and past year major depressive episode (MDE). The survey also included the K6 distress scale with a past 12 month time frame. SAMHSA used the K6 data to generate estimates of serious psychological distress (SPD) in the past 12 months. To address SAMHSA's need for estimates of serious mental illness (SMI), as well as data on suicidal ideation and behavior, OAS modified the NSDUH adult mental health module in 2008 to obtain these data. Scales were added that assessed impairment caused by mental problems. OAS also expanded the K6 questions to ask about the past 30 days (the time frame for which the K6 was originally designed). A Mental Health Surveillance Study (MHSS) was initiated in which a subsample of adults (about 1,500 in 2008) who had completed the NSDUH interview was administered a standard clinical interview by mental health clinicians via paper and pencil over the telephone to determine their SMI status. Using both clinical interview and computer-assisted interview data for the respondents who completed the clinical interview, statistical models were developed that then were applied to the full NSDUH adult sample to produce SMI estimates. See Section B.4.6 in Appendix B for a more complete discussion.

The first estimates from the expanded mental health module, including those for SMI, 30-day SPD, and suicidal thoughts and behavior, are included in Chapter 8 of this report. However, the questionnaire changes caused discontinuities in trends for MDE and 12-month SPD. Analyses of these data have determined that the 2008 data for MDE and 12-month SPD are not comparable with 2007 and earlier data (see Section B.4.4 in Appendix B). Thus, no 12-month SPD data are discussed in the report, and MDE data are presented only for 2008.

No questionnaire changes were made in 2008 that affected MDE items for youths aged 12 to 17 or for the youth and adult mental health service utilization questions. The discussion of estimates for these measures in this report includes comparisons with prior years' data.

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 (Appendix E), and present selected tabulations of estimates (Appendices F and G). A list of contributors to the production of this report also is provided (Appendix H).

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 2008 estimates are significantly different from 2007 or earlier estimates. In some tables and figures, estimates are presented based on data combined from two or more survey years to increase precision of the estimates; those estimates are annual averages based on multiple years of data.

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 in Appendix B). Estimates that do not meet these criteria are suppressed and do not appear in tables, figures, or text. 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 outside of 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 populations of fewer than 2,500 in urbanized areas.

1.5. Other NSDUH Reports and Data

Other reports focusing on specific topics of interest will be produced using the 2008 NSDUH data and made available on SAMHSA's website. A report on State-level estimates for 2007-2008 will be available in early 2010.

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. 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, 2009) at http://www.datafiles.samhsa.gov. Currently, files are available from the 1979 to 2007 surveys.² The 2008 NSDUH public use file will be available by the end of 2009.

2. Illicit Drug Use

The National Survey on Drug Use and Health (NSDUH) obtains information on nine 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. They also include drugs within these groupings that originally were prescription medications but currently may be manufactured and distributed 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 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 beginning in 2005. Estimates for these drugs for earlier years when these items were not collected have been adjusted to be comparable with the current estimates. For further information, see Section B.4.6 of the 2007 NSDUH national findings report (Office of Applied Studies [OAS], 2008). The estimates for the nonmedical use of stimulants and psychotherapeutic drugs in this report are not comparable with corresponding estimates in NSDUH reports prior to the 2007 data year, and the methamphetamine use estimates in this report also are not comparable with those in NSDUH reports for survey years prior to 2006.

In 2008, an estimated 20.1 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 or older.
The overall rate of current illicit drug use among persons aged 12 or older in 2008 (8.0 percent) was the same as the rate in 2007 and has remained stable since 2002 (8.3 percent) (Figure 2.2).

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Figure 2.1 Past Month Illicit Drug Use among Persons Aged 12 or Older: 2008

Figure 2.1

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: 2002-2008

Figure 2.2

⁺ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.

Marijuana was the most commonly used illicit drug (15.2 million past month users). In 2008, marijuana was used by 75.7 percent of current illicit drug users and was the only drug used by 57.3 percent of them. Illicit drugs other than marijuana were used by 8.6 million persons or 42.7 percent of illicit drug users aged 12 or older. Current use of other drugs but not marijuana was reported by 24.3 percent of illicit drug users, and 18.4 percent used both marijuana and other drugs.
Among persons aged 12 or older, the overall rate of past month marijuana use in 2008 (6.1 percent) was similar to the rate in 2007 and the rates in earlier years going back to 2002 (Figure 2.2).
An estimated 8.6 million people aged 12 or older (3.4 percent) were current users of illicit drugs other than marijuana in 2008. The majority of these (6.2 million persons or 2.5 percent of the population) used psychotherapeutic drugs nonmedically. An estimated 4.7 million persons used pain relievers nonmedically in the past month in 2008, 1.8 million used tranquilizers, 904,000 used stimulants, and 234,000 used sedatives.
The number and percentage of current nonmedical users of psychotherapeutic drugs in 2008 (6.2 million or 2.5 percent) were lower than in 2007 (6.9 million or 2.8 percent) (Figure 2.2). A small decline in the percentage of pain reliever users between 2007 (2.1 percent) and 2008 (1.9 percent), although not statistically significant, partly contributed to the lower rate for current use of psychotherapeutic drugs (Figure 2.3).

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Figure 2.3 Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2008

Figure 2.3

⁺ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.

The number of past month methamphetamine users decreased by over half between 2006 and 2008. The numbers were 731,000 in 2006, 529,000 in 2007, and 314,000 in 2008.
The estimated number and percentage of persons aged 12 or older who used cocaine in the past month in 2008 (1.9 million users or 0.7 percent of the population) were similar to those in 2007 (2.1 million or 0.8 percent) and 2002 (2.0 million or 0.9 percent). However, the number and percentage of past month crack users in 2008 (359,000 or 0.1 percent of the population) were lower than in 2007 (610,000 or 0.2 percent) and all other years going back to 2002 except for 2004.
Hallucinogens were used in the past month by 1.1 million persons aged 12 or older (0.4 percent) in 2008, including 555,000 (0.2 percent) who had used Ecstasy. These estimates are similar to the corresponding estimates for 2007. Current use of LSD remained stable from 2007 to 2008, but past year use of LSD increased from 620,000 to 802,000, a higher number than in 2003, 2004, 2005, and 2007, but lower than the 999,000 past year users in 2002.

Age

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 in 2008 increased from 3.3 percent at ages 12 or 13 to 8.6 percent at ages 14 or 15 to 15.2 percent at ages 16 or 17 (Figure 2.4). The highest rate was among persons aged 18 to 20 (21.5 percent). The rate was 18.4 percent among those aged 21 to 25, and it was 13.0 percent among those aged 26 to 29. Among persons aged 65 or older, the rate was 1.0 percent.

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Figure 2.4 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2008

Figure 2.4

In 2008, adults aged 26 or older were less likely to be current drug users than youths aged 12 to 17 or young adults aged 18 to 25 (5.9 vs. 9.3 and 19.6 percent, respectively). However, there were more drug users aged 26 or older (11.3 million) than users in the 12-to-17-year age group (2.3 million) and 18-to-25-year age group (6.5 million) combined.
Current illicit drug use remained stable from 2007 to 2008 among youths aged 12 to 17, young adults aged 18 to 25, and adults aged 26 or older. From 2002 to 2008, however, the rate of current illicit drug use among 12 to 17 year olds decreased from 11.6 to 9.3 percent (Figure 2.5).

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Figure 2.5 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2008

Figure 2.5

⁺ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.

Youths Aged 12 to 17

In 2008, 9.3 percent of youths aged 12 to 17 were current illicit drug users: 6.7 percent used marijuana, 2.9 percent engaged in nonmedical use of prescription-type psychotherapeutics, 1.1 percent used inhalants, 1.0 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, 1.5 percent used prescription-type drugs nonmedically, 1.2 percent used inhalants, and 1.0 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 (3.0 percent), inhalants (1.3 percent), and hallucinogens (1.0 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (12.7 percent); it was followed by prescription-type drugs used nonmedically (4.0 percent), hallucinogens (1.6 percent), cocaine (0.7 percent), and inhalants (0.7 percent).
The overall rate of current illicit drug use remained stable from 2007 to 2008 among youths aged 12 to 17, as did the rates for most specific drugs, except for hallucinogens and the nonmedical use of psychotherapeutics. An increase was seen in the rate of past month hallucinogen use, which went from 0.7 percent in 2007 to 1.0 percent in 2008, driven in part by an increase in Ecstasy use from 0.3 to 0.4 percent. However, the rate of nonmedical use of prescription psychotherapeutic drugs among youths declined from 3.3 percent in 2007 to 2.9 percent in 2008, driven largely by a decrease in the misuse of pain relievers from 2.7 to 2.3 percent (Figure 2.5).
From 2002 to 2008, rates of current use among youths aged 12 to 17 declined significantly for illicit drugs overall and for several specific drugs, including marijuana (from 8.2 to 6.7 percent), cocaine (from 0.6 to 0.4 percent), prescription-type drugs used nonmedically (from 4.0 to 2.9 percent), pain relievers (from 3.2 to 2.3 percent), stimulants (from 0.8 to 0.5 percent), and methamphetamine (from 0.3 to 0.1 percent) (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, 9.5 percent in 2007, and 9.3 percent in 2008.
The rate of current marijuana use among youths aged 12 to 17 decreased from 8.2 percent in 2002 to 6.7 percent in 2006 and remained at that level in 2007 and 2008. Significant declines also occurred between 2002 and 2008 for past year marijuana use (from 15.8 to 13.0 percent) and lifetime marijuana use (from 20.6 to 16.5 percent).

Young Adults Aged 18 to 25

Rates of current use of illicit drugs in 2008 were higher for young adults aged 18 to 25 (19.6 percent) than for youths aged 12 to 17 (9.3 percent) and adults aged 26 or older (5.9 percent). Among young adults, 16.5 percent used marijuana in the past month, 5.9 percent used prescription-type drugs nonmedically, 1.7 percent used hallucinogens, and 1.5 percent used cocaine (Figure 2.6).

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Figure 2.6 Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25: 2002-2008

Figure 2.6

⁺ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.

From 2007 to 2008, rates of current use among young adults aged 18 to 25 remained stable for illicit drugs overall and each specific drug.
From 2002 to 2008, there were declines in young adults' past month cocaine use (from 2.0 to 1.5 percent), inhalant use (from 0.5 to 0.3 percent), nonmedical use of stimulants (from 1.3 to 1.1 percent), and methamphetamine use (from 0.6 to 0.2 percent). Over the 7-year period, there were increases in the current use of pain relievers (from 4.1 to 4.6 percent) and LSD (from 0.1 to 0.3 percent).

Adults Aged 26 or Older

Among adults aged 26 or older, 5.9 percent were current illicit drug users in 2008. In this age group, 4.2 percent used marijuana, and 1.9 percent used prescription-type drugs nonmedically. Less than 1 percent used cocaine (0.7 percent), hallucinogens (0.1 percent), heroin (0.1 percent), and inhalants (0.1 percent). The only significant change between 2007 and 2008 in the rates of past month use among adults in this age group involved crack, which decreased from 0.3 to 0.2 percent. In addition, the rates of past year nonmedical use declined for psychotherapeutic drugs overall (from 4.9 percent in 2007 to 4.4 percent in 2008), sedatives (from 0.3 to 0.2 percent), and methamphetamine (from 0.4 to 0.3 percent). However, increases occurred in lifetime use of hallucinogens (from 14.2 percent in 2007 to 15.2 percent in 2008) and lifetime nonmedical use of pain relievers (from 11.8 to 12.7 percent).
Among adults aged 50 to 59, the rate of current illicit drug use increased from 2.7 to 4.6 percent between 2002 and 2008 (Figure 2.7). For those aged 50 to 54, the rate increased from 3.4 percent in 2002 to 6.0 percent in 2006, then dropped to 4.3 percent in 2008, not significantly different from the rate in either 2002 or 2006. Among those aged 55 to 59, current illicit drug use showed an increase from 1.9 percent in 2002 to 5.0 percent in 2008. These patterns and trends may partially reflect the aging into these age groups of members of the baby boom cohort, whose rates of illicit drug use have been higher than those of older cohorts.

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Figure 2.7 Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2008

Figure 2.7

⁺ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.

Gender

In 2008, as in prior years, the rate of current illicit drug use among persons aged 12 or older was higher for males than for females (9.9 vs. 6.3 percent, respectively). Males were more likely than females to be past month users of marijuana (7.9 vs. 4.4 percent). However, males and females had similar rates of past month nonmedical use of psychotherapeutic drugs (2.6 and 2.4 percent, respectively), pain relievers (2.0 and 1.8 percent), tranquilizers (0.7 and 0.8 percent), stimulants (0.4 percent for both), methamphetamine (0.1 percent for both), and sedatives (0.1 percent for both).
Although males were more likely than females to be current illicit drug users in 2008, the rate of current illicit drug use among females aged 12 or older increased from 5.8 percent in 2007 to 6.3 percent in 2008. However, the rate did not change significantly for males (10.4 and 9.9 percent for 2007 and 2008, respectively). Current marijuana use also increased from 3.8 to 4.4 percent among females, but for males there was no significant change (8.0 and 7.9 percent, respectively).
For males, current nonmedical use of psychotherapeutics declined from 3.2 percent in 2007 to 2.6 percent in 2008, driven in part by a decline in pain reliever misuse from 2.6 to 2.0 percent. Current use of crack by males also decreased in this time period from 0.4 to 0.2 percent. There were no significant changes in the use of these drugs among females.
Among youths aged 12 to 17 in 2008, males and females had similar rates of current use of illicit drugs (9.5 percent for males and 9.1 percent for females), cocaine (0.5 and 0.3 percent, respectively), hallucinogens (1.1 and 0.8 percent), and inhalants (1.1 percent for both). However, current marijuana use was more prevalent among male youths (7.3 percent) than female youths (6.0 percent) (Figure 2.8). Nonmedical use of psychotherapeutic drugs among 12 to 17 year olds, on the other hand, was more prevalent among females (3.3 percent) than males (2.5 percent), as was nonmedical use of pain relievers (2.6 and 2.0 percent, respectively).

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Figure 2.8 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2008

Figure 2.8

⁺ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.

Past month marijuana use among males aged 12 to 17 declined from 9.1 percent in 2002 to 6.8 percent in 2006 (Figure 2.8). In 2008, the rate was 7.3 percent, which was not significantly different from the rate in 2006 and was lower than the rate in 2002. Among female youths, little change in current marijuana use occurred from 2002 to 2004, but rates subsequently declined and the percentage in 2008 (6.0 percent) was lower than that in 2002 (7.2 percent).

Pregnant Women

Among pregnant women aged 15 to 44 years, 5.1 percent used illicit drugs in the past month based on data averaged for 2007 and 2008. This rate was significantly lower than the rate among women in this age group who were not pregnant (9.8 percent). Among pregnant women, the average rate of current illicit drug use in 2007-2008 (5.1 percent) did not change significantly from 2005-2006 (4.0 percent) and was similar to the rate observed in 2003-2004 (4.6 percent).
The rate of current illicit drug use in the combined 2007-2008 data was lower for pregnant women than for nonpregnant women among those aged 18 to 25 (7.1 vs. 16.2 percent, respectively) and among those aged 26 to 44 (3.0 vs. 6.7 percent). Among women aged 15 to 17, however, those who were pregnant had a higher rate of use than those who were not pregnant (21.6 vs. 12.9 percent).

Race/Ethnicity

Current illicit drug use among persons aged 12 or older varied by race/ethnicity in 2008, with the lowest rate among Asians (3.6 percent) (Figure 2.9). Rates were 14.7 percent for persons reporting two or more races, 10.1 percent for blacks, 9.5 percent for American Indians or Alaska Natives, 8.2 percent for whites, 7.3 percent of Native Hawaiians or Other Pacific Islanders, and 6.2 percent for Hispanics.
There were no statistically significant changes between 2007 and 2008 in the rate of current illicit drug use for any racial/ethnic group among persons aged 12 or older.

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Figure 2.9 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2008

Figure 2.9

Education

Illicit drug use in 2008 varied by educational status. Among adults aged 18 or older, the rate of current illicit drug use was lower for college graduates (5.7 percent) than for those who did not graduate from high school (8.1 percent), high school graduates (8.6 percent), and those with some college (9.4 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. 37.7 percent). The rate of current illicit drug use declined from 9.3 percent in 2007 to 8.1 percent in 2008 among adults who had not completed high school.

College Students

Among persons aged 18 to 22 years old, the rate of current use of illicit drugs in 2008 among full-time college students (20.2 percent) was similar to the rate among other persons in that age group (21.9 percent), which includes part-time college students, students in other grades or types of institutions, and nonstudents. The rate of current use of illicit drugs overall among 18 to 22 year olds did not change significantly from 2007 to 2008 among either full-time college students or others in this age group.
Among full-time college students aged 18 to 22, there were increases from 2007 to 2008 in the current rate of use of hallucinogens (from 1.0 to 2.1 percent). Increases were seen for the specific hallucinogens Ecstasy (from 0.5 to 1.2 percent) and LSD (from 0.3 to 0.6 percent). There were no significant changes in the rates of current use for any drugs among persons aged 18 to 22 who were not full-time college students.

Employment

Current illicit drug use differed by employment status in 2008. Among adults aged 18 or older, the rate of illicit drug use was higher for unemployed persons (19.6 percent) than for those who were employed full time (8.0 percent) or part time (10.2 percent) (Figure 2.10). These rates were all similar to the corresponding rates in 2007.

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Figure 2.10 Past Month Illicit Drug Use among Persons Aged 18 or Older, by Employment Status: 2007 and 2008

Figure 2.10

⁺ Difference between this estimate and the 2008 estimate is statistically significant at the .05 level.
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 in 2008 were employed. Of the estimated 17.8 million current illicit drug users aged 18 or older in 2008, 12.9 million (72.7 percent) were employed either full or part time. The number of unemployed illicit drug users increased from 1.3 million in 2007 to 1.8 million in 2008, primarily because of an overall increase in the number of unemployed persons between 2007 and 2008 (Figure 2.10).

Geographic Area

Among persons aged 12 or older, the rate of current illicit drug use in 2008 was 9.8 percent in the West, 7.6 percent in the Midwest, 8.2 percent in the Northeast, and 7.1 percent in the South.
In the South, current illicit drug use declined from 9.3 percent in 2007 to 8.0 percent in 2008 among youths aged 12 to 17, and use of crack decreased from 0.3 to 0.2 percent among persons aged 12 or older. Also in the South, current nonmedical use of prescription psychotherapeutics declined from 3.0 to 2.4 percent among persons aged 12 or older, from 3.8 to 2.8 percent among youths aged 12 to 17, and from 2.3 to 1.7 percent among adults aged 26 or older. These decreases were driven in part by decreases in the rates of nonmedical use of pain relievers for youths aged 12 to 17 and adults aged 26 or older, although the decrease among adults aged 26 or older was not significant. There were no significant changes in the rates of current use in any of the nine illicit drug categories for the Northeast, Midwest, and West between 2007 and 2008.
In 2008, 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 8.5 percent in large metropolitan counties, 8.1 percent in small metropolitan counties, and 6.3 percent in nonmetropolitan counties as a group (Figure 2.11). Within nonmetropolitan areas, the rate was 7.2 percent in urbanized counties, 5.6 percent in less urbanized counties, and 6.1 percent in completely rural counties.

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Figure 2.11 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2008

Figure 2.11

Criminal Justice Populations

In 2008, an estimated 1.6 million adults aged 18 or older were on parole or other supervised release from prison at some time during the past year. Almost one fifth of these (18.3 percent) were current illicit drug users, which was higher than the rate of 7.8 percent among adults not on parole or supervised release.
Among the 5.2 million adults on probation at some time in the past year, 23.9 percent reported current illicit drug use in 2008. This was higher than the rate of 7.5 percent among adults not on probation in 2008.

Frequency of Use

In 2008, an estimated 15.0 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 3.9 million persons using marijuana on a daily or almost daily basis over a 12-month period. An estimated 35.7 percent (5.4 million) of past month marijuana users aged 12 or older used the drug on 20 or more days in the past month.

Association with Cigarette and Alcohol Use

In 2008, the rate of current illicit drug use was more than 9 times higher among youths aged 12 to 17 who smoked cigarettes in the past month (49.0 percent) than it was among youths who did not smoke cigarettes in the past month (5.3 percent).
Past month illicit drug use also was associated with the level of past month alcohol use. Among youths aged 12 to 17 in 2008 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), 68.5 percent also were current illicit drug users, which was higher than the rate among nondrinkers (4.3 percent). The rate of current illicit drug use among youths reporting heavy drinking in the past month increased from 60.1 percent in 2007 to 68.5 percent in 2008, and a similar increase in illicit drug use (from 37.9 to 42.6 percent) was seen among youths who engaged in binge drinking (i.e., consumption of five or more drinks on the same occasion on at least 1 day in the past month).

Driving Under the Influence of Illicit Drugs

In 2008, 10.0 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 aged 12 or older, the same as the rate in 2007, but lower than the rate in 2002 (4.7 percent). Across age groups, the rate of driving under the influence of illicit drugs in 2008 was highest among young adults aged 18 to 25 (12.3 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. Rates averaged for 2007 and 2008 show that 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 2007-2008 who used pain relievers nonmedically in the past 12 months, 55.9 percent 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 5.4 percent took them from a friend or relative without asking. Nearly one fifth (18.0 percent) indicated that they got the drugs they most recently used through a prescription from one doctor. About 1 in 20 users (4.3 percent) got pain relievers from a drug dealer or other stranger, and 0.4 percent bought them on the Internet. These percentages are similar to those reported in 2006-2007.
In 81.7 percent of the instances in 2007-2008 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 the drugs from just one doctor. Only 1.6 percent reported that the friend or relative had bought the drugs from a drug dealer or other stranger.
In 2007-2008, 42.8 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, lower than the 49.7 percent reported in 2006-2007. In contrast, the percentage of past year methamphetamine users who bought it from a friend or relative increased from 25.1 percent in 2006-2007 to 30.1 percent in 2007-2008. About one in five users (21.7 percent) in 2007-2008 bought the methamphetamine they used most recently from a drug dealer or other stranger, which was comparable with the rate for 2006-2007 (20.5 percent).

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 2008 survey (51.6 percent). This translates to an estimated 129.0 million people, which is similar to the 2007 estimate of 126.8 million people (51.1 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 2008. This translates to about 58.1 million people. The rate in 2008 is the same as the rate in 2007 (23.3 percent).
In 2008, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.3 million people. This percentage is the same as the rate of heavy drinking in 2007 (6.9 percent).

Age

In 2008, rates of current alcohol use were 3.4 percent among persons aged 12 or 13, 13.1 percent of persons aged 14 or 15, 26.2 percent of 16 or 17 year olds, 48.7 percent of those aged 18 to 20, and 69.5 percent of 21 to 25 year olds (Figure 3.1). These estimates showed significant declines from 2007 for the 14 or 15 year olds (from 14.7 to 13.1 percent) and for the 16 or 17 year olds (from 29.0 to 26.2 percent).

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