>>Alcohol, Tobacco and Drugs Use and Trends

Illicit Drug Use

• In 2003, an estimated 19.5 million Americans aged 12 or older were current illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.2 percent of the population aged 12 years old or older.

•  There was no change in the overall rate of illicit drug use between 2002 and 2003. In 2002, there were an estimated 19.5 million illicit drug users (8.3 percent).

• Marijuana is the most commonly used illicit drug (14.6 million past month users). In 2003, it was used by 75.2 percent of current illicit drug users. An estimated 54.6 percent of current illicit drug users used only marijuana, 20.6 percent used marijuana and another illicit drug, and the remaining 24.8 percent used an illicit drug but not marijuana in the past month.

• About 45.4 percent of current illicit drug users in 2003 (8.8 million Americans) used illicit drugs other than marijuana and hashish, either with or without using marijuana as well.

• In 2003, an estimated 2.3 million persons (1.0 percent) were current cocaine users, 604,000 of whom used crack during the same time period (0.3 percent). Hallucinogens were used by 1.0 million persons (0.4 percent). There were an estimated 119,000 current heroin users (0.1 percent). All of these estimates are similar to estimates for 2002.

• The number of current users of Ecstasy decreased between 2002 and 2003, from 676,000 (0.3 percent) to 470,000 (0.2 percent). Although there were no significant changes in the past month use of other hallucinogens, there were significant declines in past year use of LSD (from 1 million to 558,000) and in past year overall hallucinogen use (from 4.7 million to 3.9 million) between 2002 and 2003, as well as in past year use of Ecstasy (from 3.2 million to 2.1 million).

• Of the 8.8 million current users of illicit drugs other than marijuana in 2003, 6.3 million were current users of psychotherapeutic drugs. This represents 2.7 percent of the population aged 12 or older. Of those who reported current use of any psychotherapeutics, 4.7 million used pain relievers, 1.8 million used tranquilizers, 1.2 million used stimulants, and 0.3 million used sedatives. These estimates are all similar to the corresponding estimates for 2002.

• There was a significant increase in the number of persons aged 12 or older with lifetime nonmedical use of pain relievers between 2002 and 2003, from 29.6 million to 31.2 million. Specific pain relievers with statistically significant increases in lifetime use were Vicodin^®, Lortab^®, or Lorcet^® (from 13.1 million to 15.7 million); Percocet^®, Percodan^®, or Tylox^® (from 9.7 million to 10.8 million); Hydrocodone (from 4.5 million to 5.7 million); OxyContin^® (from 1.9 million to 2.8 million); methadone (from 0.9 million to 1.2 million); and Tramadol (from 52,000 to 186,000.

  Source: 2003 National Survey on Drug Use & Health - http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch2

Race/Ethnicity and Gender

• Among persons aged 12 or older in 2003, the rate of substance dependence or abuse was highest among American Indians or Alaska Natives (17.2 percent). The next highest rates were among Native Hawaiians or Other Pacific Islanders (12.9 percent) and among persons reporting two or more races (11.3 percent). Asians had the lowest rate of dependence or abuse (6.3 percent). The rates among Hispanics (9.8 percent) and whites (9.2 percent) were higher than the rate among blacks (8.1 percent).

• Between 2002 and 2003, there were no statistically significant changes in the rates of substance dependence or abuse for any racial/ethnic group.

• In 2003, males were almost twice as likely to be classified with substance dependence or abuse as females (12.2 vs. 6.2 percent) (Figure 7.4). Among youths aged 12 to 17, however, the rate of substance dependence or abuse among females (9.1 percent) was similar to the rate among males (8.7 percent).

Source: 2003 National Survey on Drug Use & Health - http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#7.1

Criminal Justice Populations

• In 2003, adults aged 18 or older who were on parole or a supervised release from jail during the past year were more likely to be classified with dependence on or abuse of a substance (32.6 percent) than those who were not on parole or supervised release during the past year (9.0 percent).

• In 2003, probation status also was associated with substance dependence or abuse. The rate of substance dependence or abuse was 39.1 percent among adults who were on probation during the past year, while the rate was only 8.4 percent among adults who were not on probation during the past year.

Source: SAMHSA Office of Applied Studies - http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch7

Alcohol

• SAMHSA's National Survey on Drug Use & Health defines alcohol dependence or abuse using criteria specified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). These criteria include such symptoms as recurrent alcohol use resulting in physical danger, trouble with the law due to alcohol use, increased tolerance to alcohol, and giving up or reducing other important activities in favor of alcohol use.

• In 2003, almost 74% of adults age 21 or older reported that they had started drinking alcohol before the current legal drinking age of 21: 4% started drinking before age 12; 14% started between ages 12-14; 33% started between ages 15-17; and 22% started drinking between ages 18-20.

• Among the 14 million adults aged 21 or older who were classified as having past year alcohol dependence or abuse, more than 13 million (95%) had started drinking alcohol before age 21.

• In SAMHSA's 2003 National Survey on Drug Use & Health, persons reporting first use of alcohol before age 15 were more than 5 times as likely to report past year alcohol dependence or abuse than persons who first used alcohol at age 21 or older (16% vs. 3%).

• Males aged 21 or older were more likely than females to report having first used alcohol before age 15.

Source: The NSDUH Report (10.22.04) - http://oas.samhsa.gov/2k4/ageDependence/ageDependence.htm

Tobacco

• An estimated 70.8 million Americans reported current (past month) use of a tobacco product in 2003. This is 29.8 percent of the population aged 12 or older, similar to the rate in 2002 (30.4 percent)

• Among that same population, 60.4 million (25.4 percent of the total population aged 12 or older) smoked cigarettes in the past month, 12.8 million (5.4 percent) smoked cigars, 7.7 million (3.3 percent) used smokeless tobacco, and 1.6 million (0.7 percent) smoked tobacco in pipes. These rates remained unchanged from 2002.

• Young adults aged 18 to 25 reported the highest rate of current use of any tobacco products (44.8 percent). Past month rates of use for this age group were 40.2 percent for cigarettes, 11.4 percent for cigars, 4.7 percent for smokeless tobacco, and 0.9 percent for pipes. These rates were unchanged from 2002 (45.3 percent for any tobacco product, 40.8 percent for cigarettes, 11.0 percent for cigars, 4.8 percent for smokeless tobacco, and 1.1 percent for pipes).

• An estimated 3.6 million youths aged 12 to 17 (14.4 percent) reported past month use of a tobacco product in 2003. There were no statistically significant changes in past month rates of the different tobacco products among this age group between 2002 and 2003. However, there were significant declines in past year (from 20.3 to 19.0 percent) and lifetime (from 33.3 to 31.0 percent) cigarette use between 2002 and 2003. In addition, the rate of past month cigarette use decreased among 13 year olds (from 4.7 percent in 2002 to 3.3 percent in 2003)

• In 2003, current cigarette smoking rates increased steadily with age up to age 20, from 1.7 percent at age 12 to 26.4 percent at age 17. The rate peaked at age 20 (44.1 percent). After age 22, rates generally declined with age: 30.9 percent for 30 to 34 year olds; 31.1 percent for 40 to 44 year olds; 25.0 percent for 50 to 54 year olds; 16.5 percent for 60 to 64 year olds; and 10.0 percent for persons aged 65 or older.

• Smokeless tobacco use was most prevalent among young adults aged 18 to 25. Past month use was reported by 4.7 percent of young adults in 2003, which was similar to the 2002 rate (4.8 percent). Rates also did not change between 2002 and 2003 for youths aged 12 to 17 (2.0 percent in both years) or among persons aged 26 or older (3.2 percent in both years).

• Current cigar use among the three age groups also was unchanged between 2002 and 2003. The rate was 4.5 percent in both years among youths aged 12 to 17; 11.4 percent in 2003 and 11.0 percent in 2002 among young adults aged 18 to 25; and 4.5 percent in 2003 and 4.6 percent in 2002 among adults aged 26 or older.

Source: 2003 National Survey on Drug Use & Health - http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch4

Marijuana

•  There were an estimated 2.6 million new marijuana users in 2002. This means that each day an average of 7,000 Americans tried marijuana for the first time. About two thirds (69 percent) of these new marijuana users were under age 18, and about half (53 percent) were female.

• The annual number of marijuana initiates generally increased from 1965 until about 1973. From 1973 to 1978, the annual number of marijuana initiates remained level at over 3 million per year. After that, the number of initiates declined, reaching a low point in 1990, then rose again until 1995. From 1995 to 2002, there was no consistent trend, with estimates varying between 2.4 million and 2.9 million per year.  

• The proportion of marijuana initiates under age 18 (69 percent in 2002) has generally increased since the 1960s, when less than half of initiates were under age 18. The average age of marijuana initiates was around 19 in the late 1960s and 17.2 in 2002.

Source: 2003 National Survey on Drug Use & Health - http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch5

Cocaine

•  In 2002, approximately 1.1 million persons used cocaine for the first time. Incidence of cocaine use generally rose throughout the 1970s to a peak in 1980 (1.6 million new users) and subsequently declined until the early 1990s. Cocaine initiation steadily increased after 1993, averaging over a million new users per year during 2000 to 2002.

• First use of cocaine usually occurs at age 18 or later, a pattern consistent since the 1960s. Approximately 70 percent of cocaine initiates in 2002 were age 18 or older. During the early 1980s, when cocaine initiation reached a peak, approximately 80 percent of initiates were age 18 or older.

• The average age of cocaine initiates was around 22 years in the early 1980s, rose to about 23 in the late 1980s, then declined to about 21 by the late 1990s. The average age of initiates in 2002 was 20.3 years.

Source: 2003 National Survey on Drug Use & Health-  http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch5

Heroin

• From 1995 through 2002, the annual number of new heroin users ranged from 121,000 to 164,000. During this period, most new users were age 18 or older (on average 75 percent), and most were male (on average 63 percent).  

Source: 2003 National Survey on Drug Use & Health-  http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch5

Ecstasy

• In 2001, over 8 million persons aged 12 or older reported using Ecstasy at least once in their lifetime.

• The majority of past year Ecstasy users were young adults 18 to 25.

• Past year Ecstasy users aged 12 to 25 were more likely to have used other types of illicit drugs in the past year than those who did not use Ecstasy in the past year.

Source: The NSDUH Report (03.21.03) - http://oas.samhsa.gov/2k3/ecstasy/ecstasy.htm

Hallucinogens

• The incidence of hallucinogen use has exhibited two notable periods of increase. Between 1965 and 1969, there was a tenfold increase in the estimated annual number of initiates. This increase was driven primarily by the use of LSD. The second period of increase in first-time hallucinogen use occurred from around 1992 until 2000, fueled mainly by increases in use of Ecstasy (i.e., MDMA). Decreases in initiation of both LSD and Ecstasy were evident between 2001 and 2002, coinciding with an overall drop in hallucinogen incidence from 1.6 million to 1.1 million.

• Initiation of Ecstasy use increased from 1993 until 2001, when it peaked at 1.8 million new users. In 2002, the number declined to 1.1 million. Two thirds (66 percent) of new Ecstasy users in 2002 were 18 or older, and 50 percent were male.

• LSD incidence dropped from 872,000 new users in 2000 to 631,000 in 2001 and then to 272,000 in 2002.

Source: 2003 National Survey on Drug Use & Health-  http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch5

Methamphetamines

•  According to SAMHSA's Treatment Episode Data Set (TEDS), the primary methamphetamine/ amphetamine treatment admission rate in the United States increased from 10 admissions per 100,000 to 52 admissions per 100,000 population aged 12 or older between 1992 and 2002.

• Smoked methamphetamine/amphetamine is often referred to as "ice." In 1992, 12% of primary methamphetamine / amphetamine admissions reported smoking as the primary route of administration and 39% inhaled the substance. By 2002, 50% reported smoking as their primary route of administration for methamphetamine / amphetamine and only 17% inhaled it.
• In 2002, 19 States had rates in excess of the national rate (52 admissions per 100,000 population): 10 States were in the West, 7 were in the Midwest and 2 were in the South. The highest rates were in Oregon (324 admissions per 100,000), Hawaii (217 per 100,000), California (200 per 100,000), Iowa (198 per 100,000), Wyoming (167 per 100,000), Nevada (156 per 100,000), Washington State (150 per 100,000), and Arkansas (125 admissions per 100,000 population).

Source: The DASIS Report (09.17.04) - http://oas.samhsa.gov/2k4/methTX/methTX.htm

Inhalants

• In 2002, more than 2.6 million youths aged 12 to 17 reported using inhalants at least once in their lifetime. Among youths, the rate of past year inhalant use was about the same for boys (4.6%) and girls (4.1%).

• Inhalants are defined in the survey as "liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good." The categories of inhalants asked about in the survey are: (1) amyl nitrite, "poppers," locker room odorizers, or "rush"; (2) correction fluid, degreaser, or cleaning fluid; (3) gasoline or lighter fluid; (4) glue, shoe polish, or toluene; (5) halothane, ether, or other anesthetics; (6) lacquer thinner or other paint solvents; (7) lighter gases, such as butane or propane; (8) nitrous oxide or "whippets"; (9) spray paints; and (10) other aerosol sprays.

• The categories of inhalants most frequently used in the youths' lifetime were glue, shoe polish or toluene (4.5%), gasoline or lighter fluid (3.5%), and spray paints (2.5%). Over half (53%) of the youths who used an inhalant, however, had used more than one type in their lifetime.

• Youths who had used an inhalant in the past year were about three times more likely to use marijuana, four times more likely to use prescription drugs nonmedically, and seven times more likely to use hallucinogens than those who had not used inhalants in the past year.

Source: The DASIS Report (03.18.04) - http://oas.samhsa.gov/2k4/inhalants/inhalants.htm

Treatment Admission

• Between 1997 and 2002, the number of treatment admissions involving narcotic painkillers in SAMHSA's Treatment Episode Data Set (TEDS) increased more than the overall increase in treatment admissions or the increase in admissions for primary heroin abuse.

• The number of treatment admissions in which narcotic painkillers were involved not only doubled between 1992 and 2000 but continued to increased even more between 2000 and 2002.

• The proportion of new users of narcotic painkillers (those entering treatment within 3 years of beginning use) increased from 26% in 1997 to 39% in 2002.

• By 2002, 31 States had an admission rate for narcotic painkillers of at least 24 per 100,000 persons age 12 or older. Five of the 6 New England States reported the highest rates in the nation, ranging from 89 per 10,000 in Connecticut to 207 per 100,000 in Maine.

Source: The DASIS Report: Treatment Admissions Involving Narcotic Painkillers: 2002 Update - http://www.drugabusestatistics.samhsa.gov/2k4/PainTX/PainTX.cfm

Treatment and Treatment Need for Substance Problems

• An estimated 3.3 million people aged 12 or older (1.4 percent of the population) received some kind of treatment for a problem related to the use of alcohol or illicit drugs in the 12 months prior to being interviewed in 2003. Of these, 1.2 million persons received treatment at a rehabilitation facility as an outpatient, 752,000 at a rehabilitation facility as an inpatient, 729,000 at a mental health center as an outpatient, 587,000 at a hospital as an inpatient, 377,000 at a private doctor's office, 251,000 at an emergency room, and 206,000 at a prison or jail. (Note that the estimates of treatment by location include persons reporting more than one location.)

• Between 2002 and 2003, there were decreases in the number of persons who received treatment for a substance use problem at a hospital as an inpatient, at a rehabilitation facility as an inpatient, at a mental health center as an outpatient, and at an emergency room.

• In 2003, the estimated number of persons aged 12 or older needing treatment for an alcohol or illicit drug problem was 22.2 million (9.3 percent of the total population), about the same as in 2002 (22.8 million). The number needing but not receiving treatment also did not change between 2002 (20.5 million) and 2003 (20.3 million). However, a decline in the number receiving specialty treatment, from 2.3 million to 1.9 million, was statistically significant. This decline was driven by a decrease in treatment among adults aged 26 or older, from 1.7 million in 2002 to 1.2 million in 2003.

• Of the 20.3 million people who needed but did not receive treatment in 2003, an estimated 1.0 million (5.1 percent) reported that they felt they needed treatment for their alcohol or drug problem. Of the 1.0 million persons who felt they needed treatment, 273,000 (26.3 percent) reported that they made an effort but were unable to get treatment and 764,000 (73.7 percent) reported making no effort to get treatment.

• Among the 1.0 million people who needed but did not receive treatment and felt they needed treatment, the most often reported reasons for not receiving treatment were not ready to stop using (41.2 percent), cost or insurance barriers (33.2 percent), reasons related to stigma (19.6 percent), and did not feel the need for treatment (at the time) or could handle the problem without treatment (17.2 percent).

• The number of persons needing treatment for an illicit drug problem in 2003 (7.3 million) was similar to the number needing treatment in 2002 (7.7 million). However, the number receiving treatment for drug abuse at a specialty facility was lower in 2003 (1.1 million) than in 2002 (1.4 million).

 Source: 2003 National Survey on Drug Use & Health- http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch7

Serious Mental Illness among Adults

• In 2003, there were an estimated 19.6 million adults aged 18 or older with serious mental illness (SMI). This represents 9.2 percent of all adults and is higher than the rate of 8.3 percent in 2002. Rates of SMI were highest for young adults aged 18 to 25 (13.9 percent) and lowest for persons aged 50 or older (5.9 percent). The percentage of females with SMI was higher than the percentage of males (11.5 vs. 6.7 percent).

• Adults who used illicit drugs were more than twice as likely to have SMI as adults who did not use an illicit drug. In 2003, 18.1 percent of adult past year illicit drug users had SMI in that year, while the rate was 7.8 percent among adults who had not used an illicit drug.

Source: 2003 National Survey on Drug Use & Health- http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch7

Co-Occurrence of Serious Mental Illness and Substance Use Disorders

• SMI was highly correlated with substance dependence or abuse. Among adults with SMI in 2003, 21.3 percent (4.2 million) were dependent on or abused alcohol or illicit drugs, while the rate among adults without SMI was only 7.9 percent. Among adults with substance dependence or abuse, 21.6 percent had SMI compared with 8.0 percent among those who did not have dependence or abuse.

Source: 2003 National Survey on Drug Use & Health http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch7

Treatment for Mental Health Problems

• In 2003, an estimated 28 million adults (13.2 percent) received treatment for mental health problems in the 12 months prior to the interview. These 2003 estimates are similar to the 2002 estimates.

• The most prevalent type of treatment for mental health problems in the adult population in 2003 was prescription medication (10.9 percent), followed by outpatient treatment (7.2 percent). An estimated 1.8 million adults (0.8 percent) were hospitalized for mental health problems at some time within the past 12 months.

• Among the 5.5 million adults who did not receive treatment but perceived an unmet need for treatment for mental health problems in the past year, the most commonly reported reasons for not receiving treatment were cost or insurance issues (45.1 percent), not feeling a need for treatment (at the time) or thinking the problem could be handled without treatment (40.6 percent), not knowing where to go for services (22.9 percent), perceived stigma associated with receiving treatment (22.8 percent), and did not have time (18.1 percent).

• Among the 19.6 million adults with SMI in 2003, 9.3 million, or 47.3 percent, received treatment for a mental health problem in the 12 months prior to the interview. This estimate is similar to the estimate in 2002 (47.9 percent). The rate of inpatient treatment among adults with SMI increased between 2002 and 2003 (from 3.8 to 5.6 percent).

• Among the 4.2 million adults with co-occurring SMI and a substance use disorder in 2003, 47.3 percent (about 2.0 million) received treatment for mental health problems and 11.2 percent (0.5 million) received specialty substance use treatment, including 7.5 percent (0.3 million) who received both types of treatment.

• In 2003, an estimated 5.1 million youths aged 12 to 17 (20.6 percent) received treatment or counseling for emotional or behavior problems in the year prior to the interview. This is higher than the 2002 estimate of 4.8 million (19.3 percent).

Source: 2003 National Survey on Drug Use & Health- http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch7