The Arizona factbook on addictions

              Table of Contents
Chapter One: Overview
The nature of addiction
6
How the fact book was developed
7
A note about the information and terms in the fact book
7
Chapter Two: Substance Dependence
Introduction
9
Table 2.1: DSM-IV Criteria for Substance Dependence.
10
National estimates of substance use and dependence
10
Table 2.2: Percentages of Persons Aged 12 or Older Reporting Past Year Illicit Drug or Alcohol Dependence by Demographic Characteristics: 1999.
12
Table 2.3: Percent of Population Age 12 and Older Dependent on any Illicit Drug by Year and Demographic Characteristics.
13
Table 2.4: Percentages Reporting Past Year Substance Dependence, by Age Group: 1999, U.S.
13
Table 2.5: Percentages Reporting Past Year Illicit Drug or Alcohol Dependence, by Detailed Age Categories: 1999, U.S.
14
Table 2.6: Percentages of Persons Aged 12 to 17 Reporting Past Year Illicit Drug or Alcohol Dependence by Demographic Characteristics: 1999.
15
Table 2.7: Percentages of Persons Aged 18 to 25 Reporting Past Year Illicit Drug or Alcohol Dependence, by Demographic Characteristics: 1999.
16
Table 2.8: Percentages of Persons Aged 26 or Older Reporting Past Year Illicit Drug or Alcohol Dependence, by Demographic Characteristics: 1999, U.S.
17
Table 2.9: Percentage Reporting Dependence on Alcohol, by Race/Ethnicity, Gender, and Age, 1991-1993.
18
Table 2.10: Percentage of Persons 12 and Older Using Cigarettes, Alcohol, Any Illicit Drugs, Marijuana, and Cocaine in the Past Year, Percentage in Need of Illicit Drug Abuse Treatment, Percentage Reporting Dependence on Alcohol, Percentage Reporting Heavy Cigarette Use in the Past Month, and Percentage Reporting Heavy Alcohol Use in the Past Month, by Race/Ethnicity, 1991-1993.
19
Table 2.11: Estimates of Number of Persons Needing and Receiving Treatment for Drug Abuse Problems: NHSDA, 1991-96 (Number of Persons in 1,000s).
20
Table 2.12: Percent of Population Age 12 and Older with Drug Abuse Treatment Need, by Year and Demographic Characteristics.
21Table 2.13: Percent of Population Age 12 and Older with Level 2 Drug Abuse Treatment Need, by Year and Demographic Characteristics.
22
Table 2.14: Percentage in Need of Illicit Drug Abuse Treatment, by Race/Ethnicity, Gender, and Age, 1991-1993.
22
Table 2.15: Estimated Numbers (in Thousands) of Past Month "Binge" Alcohol Users, by Age Group and State: 1999.
24
Table 2.16: Estimated Numbers (in Thousands) of Persons Reporting Past Year Illicit Drug Dependence, by Age Group and State: 1999.
26
Table 2.17: Estimated Numbers (in Thousands) of Persons Reporting Past Year Illicit Drug or Alcohol Dependence, by Age Group and State: 1999.
29
Table 2.18: Percentages Reporting Past Month "Binge" Alcohol Use, by Age Group and State: 1999.
31
Table 2.19: Percentages Reporting Past Year Illicit Drug Dependence, by Age Group and State: 1999.
34
Table 2.20: Percentages Reporting Past Year Illicit Drug or Alcohol Dependence, by Age Group and State: 1999.
36
Children and substance dependence
39
Table 2.21: Estimated Number and Percentage of Children in Household Who Had One or More Parent in Need of Treatment for Illicit Drug Abuse, by Children’s Ages: NHSDA 1996.
39
Table 2.22: Estimated Number and Percentage of Children in the Household Who Had One or More Parent Dependent on Illicit Drugs, by Children’s Ages: NHSDA 1996.
40
Table 2.23: Estimated Number and Percentage of Children in the Household Who Had One or More Parent Dependent on Alcohol, by Children’s Ages: NHSDA 1996.
40
Table 2.24: Estimated Number and Percentage of Children in the Household Who Had One or More Parent Dependent on Alcohol and/or Illicit Drugs, by Children’s Ages: NHSDA 1996.
41
Arizona and substance dependence
41
Table 2.25: Estimates of Past Month Use of Selected Drugs and Past Year Substance Dependence in Arizona, by Age Group: 1999.
42
Table 2.26: Prevalence of Current and Past Problems: Arizona Adults.
43
Table 2.27: Prevalence of Current Alcohol/Drug Problems: National Comparisons.
43
Table 2.28: Prevalence of Current Alcohol/Drug Problems by Area.
43
Table 2.29: Weighted Prevalence Estimates by County or Region.
44
Table 2.30: Prevalence of Current Substance Abuse Problems by Gender.
45
Table 2.31: Prevalence of Current Substance Abuse Problems by Race/Ethnicity.
45
Table 2.32: Profile of Adults with and without Substance Abuse Problems
45
2
Chapter 3: Pathological Gambling
Introduction
46
Table 3.1: DSM-IV Criteria for Pathological Gambling.
47
Nonproblematic gambling
47
Table 3.2: Percentage of the Adult Population Reporting Lifetime and Past-Year Gambling for Different Types of Gambling (Surveys Conducted 1988-1997).
48
Table 3.3: Key findings from the Gambling Impact and Behavior Study, 1999.
49
Table 3.4: Comparison of 1975 and 1998 Studies on Various Items.
50
Problem Gambling
50
Table 3.5: Key Findings from Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Meta-analysis.
51
Table 3.6: Percentage Classified as Pathological or Problem Gamblers in Adult Population Samples (Surveys Conducted 1988-1997).
52
Table 3.7: Percentage of (Level 3) Pathological and/or (Level 2) Problem Gamblers in Adult Population Samples in States with Repeated Surveys.
53
Table 3.8: Participation Rates in Different Types of Gambling for Nonproblem and Problem and Pathological Gamblers Combined.
54
Table 3.9: Mean Disordered Gambling Prevalence Estimates and Prediction Intervals for 4 Study Populations.
54
Table 3.10: Mean Adult Disordered Gambling Prevalence Estimates for Premedian-Year and Post median-Year Groups.
55
Table 3.11: Prevalence of Pathological and Problem Gambling.
55
Table 3.12: Prevalence of Gambling by Demographic Group, Phone Survey and Patron Survey Combined.
56
Table 3.13: Attitudes Toward Gambling in Phone and Patron Survey by Lifetime and Past-Year Gambler Type.
57
Table 3.14: Employment Experiences, by Type of Gambler (Lifetime Only).
57
Table 3.15: Financial Characteristics and Impacts, by Type of Gambler.
58
Table 3.16: Weighted Occurrence of Criminal Justice Consequences, by Type of Gambler.
58
Table 3.17: Economic Impact of Major Health Problems.
58
Table 3.18: Gambling Involvement and Prevalence of Pathological Gambling in the General Population.
59
Table 3.19: Characteristics of Pathological Gamblers in Professional Treatment Programs and in the General Population.
60
Table 3.20: Percentages of Adolescents Reporting that They Have Participated in Various Types of Gambling.
61
Table 3.21: Percentage Classified as Pathological and/or Problem Gamblers in Adolescent Samples (Surveys Conducted 1988-1997).
62
3
Table 3.22: Serious Gambling-Related Problems among Juveniles in the United States (1984-1988).
62
Table 3.23: Serious Gambling-Related Problems among Juveniles in the United States (1989-1999).
63
Gambling and other disorders
64
Table 3.24: Comparison of U.S. Adult Pathological and Problem Gambling with Alcohol and Drug Dependence and Abuse.
63
Table 3.25: Comparison of U.S. Adolescent Pathological Gambling, Alcohol Use, and Drug Use Rates.
64
Table 3.26: Percentage of Lifetime and Past-Year Gambler Types by Health, Mental Health, Substance Abuse, and Other Problems.
65
Table 3.27: Substance Misuse among Pathological Gamblers.
66
Chapter Four: Problematic Internet Use
Introduction
67
Internet user characteristics and behaviors
68
Table 4.1: Internet Growth by Demographic Characteristic.
68
Table 4.2: The Percent of Internet Users Who Say They Have Gone Online for Various Reasons.
69
Table 4.3: Percent Reporting Various Internet Use Behaviors.
69
Table 4.4: Percentage of 341 Subjects Reporting Various Behaviors Related to Internet Use.
70
Prevalence of problematic Internet use and associated behaviors
70
Table 4.5: Comparison of Dependent and Non-dependent Internet Users by Various Factors.
71
Table 4.6: Comparison of Dependent and Non-dependent Internet Users by Various Factors.
71
Table 4.7: Various Statistics Reported in Internet Use Surveys.
72
Table 4.8: Degree of Pathology by Time Online, Gender, Number of Internet Sites Used and Number of Reasons for Using the Internet.
73
Table 4.9: Percent of Agreement with Pathological Use Scale Items by Degree of Pathology.
73
Table 4.10: Sexual Behaviors of Non-addicted and Addicted Internet Users.
74
Table 4.11: Percentages of People Reporting Various Experiences while Online.
74
References
75
4
Chapter One: Overview
The nature of addiction
Developing a fact book about addiction is a difficult task because there is no consensus on the nature or defining qualities of addiction. While we might refer to such behavior as indiscriminate sexual activity or intemperate eating habits as addictions, the average person might have a hard time describing addiction in objective terms or explaining when normal behavior crosses the line and becomes unhealthy and compulsive. Similarly, professionals and scientists who work with people experiencing these problems have yet to agree on criteria that define and differentiate addiction from other mental or physical disorders that could also account for the displayed behavior. Some believe that addictions do not exist at all. All this confusion makes it difficult to determine which behaviors should be considered addictions and included in this fact book.
Even with all this confusion in the addictions field, four definitions of addiction have been identified. The first describes addiction as a physical dependence. This dependence is characterized by an increasing tolerance for a drug or substance or a need to use more and more of the substance in order to achieve the same level of satisfaction. Dependence is also characterized by physical or mental reactions to discontinuation of the substance also know as withdrawal symptoms.
There are two problems with this definition. First, this description can only be used for addictions where a substance is ingested, inhaled, or injected. This would leave out behaviors such as gambling or Internet use. Second, not all substances create physical tolerance nor does stopping their use result in stereotypical withdrawal symptoms. Cocaine and marijuana do not create the physical dependency described here but many people would still consider them to be addictive.
The second definition explains addiction as a psychological dependence characterized by the craving for or compulsion to engage in the behavior, a continued use or engagement in the behavior despite negative consequences, and an inability to control the behavior (Shaffer, 1999). This is probably what most people think about when referring to something as addictive and some believe that this is the facet of addiction with which we should be most concerned.
The third definition has only recently begun to emerge and traces addiction to genetic, physiological, or chemical origins. For example, levels of dopamine, a chemical in the brain associated with pleasure, have been found to be associated with the ingestion of a wide variety of drugs (Stilkind, 1997). A person’s genetic make-up may also affect how their body regulates dopamine and consequently how they will respond to a substance (Nash, 1997).
The fourth definition relies on criteria specified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This manual is the clinical standard for defining and diagnosing a wide range of psychological disorders. Drug
5
dependency and pathological gambling are defined in the DSM-IV and the criteria for these disorders are provided later in the fact book.
Given the disagreement about the definition of addiction and the uncertainty with which some addictions are perceived, the concept of addiction should be applied cautiously. This fact book does not intend to advocate for or refute the existence of any addiction. It is only meant to present data from studies that have investigated these problematic behaviors.
How the fact book was developed
Knowing that the field of addictions is large and varied, a brief search of the popular and scientific literature was conducted to determine the kinds of behaviors that were being written about and studied. Based on this initial review, five behaviors were identified whose addictive potential was frequently mentioned: drug use, gambling, Internet use, eating, and sexual activity. A more extensive review was conducted in each of these five areas to determine if:
1. Criteria for defining and identifying an addiction associated with the behavior had been adequately established, and
2. There was enough information about the addiction to report in a fact book format.
It was decided to include drug dependency, pathological gambling, and problematic Internet use in the fact book.
As mentioned above, drug dependency and pathological gambling both have clinical definitions and are considered diagnosable disorders by the American Psychiatric Association. In addition, these two disorders have been studied in national surveys and a significant amount of research has been devoted to them. Problematic Internet use does not have an agreed upon definition and has yet to be clinically recognized. It was included because the small body of research provides interesting information about possible clinical criteria for problematic Internet use, its impact on well-being, and its prevalence in the population.
The literature on food and sexual addictions lacked criteria that could be used to differentiate these addictions from other related food and sexual disorders such as bulimia or fetishes. The material reviewed also failed to provide data on the occurrence of these behaviors, their consequences on well-being, or characteristics of the people affected by the behavior.
A note about the information and terms in the fact book
All information in this book was collected from research that has already been conducted. The monitoring systems for these behaviors are limited if they exist at all and there is no one, definitive source for information about this topic. The research reported in this book runs the gamut from national surveys whose findings can be generalized to the U.S. population to research conducted on smaller and specific groups of people. Where possible, data specific to Arizona is included.
6
To provide some consistency, the terms substance dependency, pathological gambling, and problematic Internet use will be used in the fact book’s narrative. Information in the tables is presented as it appears in the original source so the terms used to refer to a behavior in the tables may vary from those appearing in the narrative.
Citations are provided for all tables and information presented in the narrative. The reference list also includes addresses for information that is available on the Internet. Interpretation or positions based on the data have been avoided but positions from other sources are stated to help make the data more meaningful.
7
Chapter 2: Substance Dependence
Introduction
Substance use and dependence exact a large toll on our society both financially and socially. According to the National Drug Control Strategy 2000 Annual Report, illegal drugs cost the U.S. $110 billion in 1995 in expenses and lost revenue (Office of National Drug Control Policy [ONDCP], 2000). $9.9 billion in 1992 and nearly $12 billion in 1995 was spent on health care due to drug abuse. A recent report from the National Center on Addiction and Substance Abuse (2001) estimates that of the $620 billion state governments spent on public services in 1998, 13.1 percent or $81.3 billion was spent addressing directly or indirectly the affects of substance abuse.
Drug use is associated with a variety of social problems including crime, family violence, sexual assaults, and child abuse (ONDCP, 2000). More than 1.5 million Americans were arrested for drug law violations in 1999 (ONDCP, 2001). Of the adult male arrestees in 34 study sites, at least 50 percent of them tested positive for at least one drug. Drug related offenses have accounted for 19 percent of the total growth in the state inmate population (ONDCP, 2000) and nearly 60 percent of inmates in the federal prison system were sentenced for drug offenses. Approximately one in four inmates are drug offenders.
Studies have found that one fourth to one half of men who commit domestic violence acts have substance abuse problems (ONDCP, 2000) and substance abusing women are more likely to become victims of domestic violence. Alcohol contributes to more cases of sexual violence than any other drug. It is involved in 46 to 75 percent of date rapes among college students and two-thirds of sexual offenders in state prison reported being under the influence of alcohol or other drugs at the time the crime was committed. Reports estimate that seven of ten cases of child maltreatment in the United States can be attributed in some way to substance abuse.
In 1997, 15,973 drug-induced deaths were reported in the United States (ONDCP, 2000). It is estimated that 52,624 drug related deaths occurred in 1995. In 1998, approximately 982,856 visits were made to emergency rooms across the country in which drug use was mentioned. TIME Magazine reported in 1997 that addiction to drugs, cigarettes, and alcohol was considered to account for a third of all hospital admission and a quarter of all deaths (Nash, 1997).
It is important to draw a distinction between substance use and substance dependence. Substance dependence, or the intense craving for and desire to use substances, has a physical and psychological component. Some drugs such as alcohol and heroin can create a physiological reliance so that when the drug ceases to be taken, a physical response or withdrawal symptom occurs (Stilkind, 1997). Other drugs, such as cocaine or methamphetamine, do not display these dramatic withdrawal symptoms when they cease to be taken. However these drugs do create a psychological reliance characterized by intense craving and compulsivity to obtain and use the substance, often even when doing so could result in serious health or social consequences. A person may use a drug,
8
sometimes repeatedly, and not experience the physical or psychological effects that define dependency.
The DSM-IV’s criteria for substance dependence is presented in Table 2.1.
Table 2.1: DSM IV Criteria for Substance Dependence.
1. Tolerance, as defined by either of the following:
• A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
• Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal as manifested by either of the following:
• The characteristic withdrawal syndrome for the substance.
• The same substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than was intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
Source: American Psychiatric Association, 1994. Desk Reference to the Diagnostic Criteria from DSM-IV.
The reader should note that the terms substance dependence and drug addiction are often used interchangeably. Substance dependence will be used in this fact book to remain consistent with DSM-IV terminology.
National estimates of substance use and dependence
The following section presents information about substance dependence and the need for drug treatment in the U.S.
Current estimates of substance use and dependency can be obtained from the National Household Survey on Drug Abuse. This annual study measures the use of alcohol and
9
illicit drugs and dependence on these substances in the U.S. The Survey uses the DSM-IV criteria to screen for substance dependency.
According to the 1999 study (Substance Abuse and Mental Health Services Administration [SAMHSA], 2000), approximately 14.8 million Americans, 12 years and older, have used an illicit substance in the past 30 days. 3.6 million Americans, or 1.6 percent of the population age 12 and older, were dependent on illicit drugs. Another 8.2 million individuals, or 3.7 percent of the population, reported alcohol dependency. 1.5 million people were dependent on both alcohol and illicit drugs and 10.3 million people were dependent on either alcohol or illicit drugs.
The following tables present substance dependency statistics in a variety of ways. An overview of the nation’s dependence on illicit drugs and alcohol is presented in Table 2.2. Approximately 1.6 percent of the population meets the clinical definition of dependency for illicit drugs, 3.7 percent meet the definition for alcohol dependency, and 4.7 percent are dependent on either illicit drugs or alcohol. Males are almost twice as likely to be dependent on illicit drugs or alcohol. Native Americans are estimated to have the highest rates of illicit drug and alcohol dependency of all racial and ethnic groups.
Trends in illicit drug dependency are shown in Table 2.3. In 1994, the survey questionnaire was changed. Results using both the old (1994-A) and new (1994-B) questionnaire are included in the table below. With the exception of individuals between the ages of 12 and 17, drug dependency rates for all groups were highest in 1996.
More detailed information about how substance dependency affects various age groups is reported in Table 2.4. People between the ages of 18 and 25 report the highest rates of past year illicit drug dependency for almost all drugs. Substance dependency rates quickly decrease after the age of 25.
10
Table 2.2. Percentages of Persons Aged 12 or Older Reporting Past Year Illicit Drug or Alcohol Dependence, by Demographic Characteristics: 1999.
Type of past year dependence
Demographic
Characteristic
Any Illicit Drug
Alcohol
Any Illicit Drug or Alcohol
Total
1.6
3.7
4.7
Age
12-17
3.3
3.6
5.7
18-25
4.7
9.2
11.9
26 or Older
0.9
2.8
3.3
Gender
Male
2.0
4.9
6.0
Female
1.3
2.6
3.4
Hispanic origin and race
Not Hispanic
White Only
1.5
3.8
4.6
Black Only
2.3
3.1
4.6
American Indian or Alaska Native Only
4.7
5.1
9.0
Native Hawaiian or Other Pacific Islander
*
*
*
Asian Only
0.8
2.2
2.7
Multiple Race
2.6
7.7
9.3
Hispanic
1.9
3.9
4.8
*Low precision; no estimate reported.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
11
Table 2.3: Percent of Population Age 12 and Older Dependent on any Illicit Drug by Year and Demographic Characteristics.
Group
1991
1992
1993
1994-A
1994-B
1995
1996
Total
1.3
1.0
1.1
0.9
1.4
1.6
1.8
Gender
Male
Female
1.6
0.9
1.3
0.8
1.4
0.9
1.0
0.8
1.9
1.0
2.0
1.2
2.3
1.2
Race
White
Black
Hispanic
1.2
1.8
1.3
1.0
1.0
1.3
1.1
1.5
1.0
1.0
1.1
1.1
1.4
1.9
1.7
1.6
1.7
1.4
1.7
2.4
1.8
Age
12-17
18-25
26-34
35+
2.0
3.0
1.5
0.6
1.5
2.8
1.4
0.4
1.7
2.8
1.6
0.5
2.2
3.0
1.0
0.2
2.1
4.1
1.9
0.5
3.9
4.5
1.9
0.4
3.6
5.4
2.1
0.6
Note: Estimates are not ratio-adjusted to partially account for underestimation due to under reporting and undercoverage in the NHSDA.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
Table 2.4: Percentages Reporting Past Year Substance Dependence, by Age Group: 1999, U.S.
Age group (years)
Total
12-17
18-25
26 or Older
Any Illicit Drug
1.6
3.3
4.7
0.9
Marijuana and Hashish
1.0
2.6
3.5
0.4
Cocaine
0.3
0.2
0.9
0.3
Heroin
0.1
0.1
0.1
0.1
Hallucinogens
0.1
0.3
0.5
0.0
Inhalants
0.0
0.2
0.1
0.0
Nonmedical Use of Any Psychotherapeutic
0.3
0.7
0.7
0.2
Pain Relievers
0.2
0.5
0.5
0.1
Tranquilizers
0.1
0.1
0.2
0.0
Stimulants
0.1
0.2
0.3
0.1
Sedatives
0.0
0.1
0.1
0.0
Alcohol
3.7
3.6
9.2
2.8
Alcohol or Illicit Drugs
4.7
5.7
11.9
3.3
Alcohol and Illicit Drugs
0.7
1.2
2.0
0.4
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
12
Detailed age breakdowns are provided in Table 2.5.
Table 2.5: Percentages Reporting Past Year Illicit Drug or Alcohol Dependence, by Detailed AgeCategories: 1999, U.S.
Type of past year dependence
Age Category
Any Illicit Drug
Alcohol
Any Illicit Drug or Alcohol
Total
1.6
3.7
4.7
12
0.5
0.2
0.6
13
1.0
1.0
1.7
14
2.8
2.6
4.5
15
3.9
4.3
6.6
16
5.8
6.5
9.9
17
5.8
6.9
10.7
18
6.8
9.6
13.2
19
6.5
9.6
13.7
20
5.5
10.4
13.5
21
4.6
11.7
14.2
22
4.9
10.2
12.8
23
3.8
8.5
10.9
24
2.5
5.7
7.6
25
1.7
6.6
7.6
26-29
1.8
5.5
6.6
30-34
1.7
4.0
5.2
35-39
1.3
3.9
4.8
40-44
1.7
4.4
5.0
45-49
0.7
3.4
3.8
50-64
0.2
1.4
1.4
65+
*
0.5
0.5
*Low precision; no estimate reported.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
The following three tables provide drug and alcohol dependency rates by a variety of demographic characteristics for individuals in the 12 to 17, 18 to 25, and 25 and older age groups. 5.7 percent of youth, ages 12 to 17, report dependence on drugs and alcohol, 11.9 percent of young adults between the ages of 18 and 25 report substance dependency, and 3.3 percent of people over the age of 26 are dependent on alcohol or drugs.
Native Americans report the highest rates of illicit drug and alcohol dependency among those people ages 12 to 25. Nearly one in five Native Americans between the ages of 18 and 25 are dependent on alcohol or drugs. Unemployed people are more likely to have an alcohol or drug dependency, especially those who are 26 years or older.
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Table 2.6: Percentages of Persons Aged 12 to 17 Reporting Past Year Illicit Drug or Alcohol Dependence by Demographic Characteristics: 1999.
Type of past year dependence
Demographic
Characteristic
Any Illicit Drug
Alcohol
Any Illicit Drug or Alcohol
Total
3.3
3.6
5.7
Gender
Male
3.3
3.3
5.6
Female
3.3
3.9
5.8
Hispanic origin and race
Not Hispanic
White Only
3.4
4.0
6.0
Black Only
2.5
1.4
3.4
American Indian or Alaska Native Only
7.9
6.6
10.5
Native Hawaiian or Other Pacific Islander
*
*
*
Asian Only
2.2
1.9
3.6
Multiple Race
4.1
1.8
5.2
Hispanic
4.0
4.4
7.0
Gender/race/Hispanic origin
Male - White
2.8
3.7
5.5
Female - White
3.9
4.4
6.6
Male - Black
3.2
1.3
4.0
Female - Black
1.7
1.5
2.7
Male - Hispanic
4.9
4.2
7.7
Female - Hispanic
3.0
4.7
6.3
*Low precision; no estimate reported.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse. 14
Table 2.7: Percentages of Persons Aged 18 to 25 Reporting Past Year Illicit Drug or Alcohol Dependence, by Demographic Characteristics: 1999.
Type of past year dependence
Demographic
Characteristic
Any Illicit Drug
Alcohol
Any Illicit Drug or Alcohol
Total
4.7
9.2
11.9
Gender
Male
6.1
11.2
14.7
Female
3.4
7.1
9.1
Hispanic origin and race
Not Hispanic
White Only
4.9
10.5
13.4
Black Only
4.4
5.3
8.1
American Indian or Alaska Native Only
8.0
14.6
19.5
Native Hawaiian or Other Pacific Islander
*
*
*
Asian Only
3.3
6.0
7.5
Multiple Race
9.3
11.5
15.8
Hispanic
4.0
7.1
9.0
Adult education
< High School
7.3
8.9
13.1
High School Graduate
4.5
7.9
10.6
Some College
4.2
10.6
13.2
College Graduate
2.1
9.3
10.3
Current employment
Full-Time
4.3
8.5
11.3
Part-Time
4.9
10.0
12.6
Unemployed
8.3
11.0
15.5
Other1
4.6
9.2
11.6
*Low precision; no estimate reported.
1 Retired, disabled, homemaker, student, or "other."
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
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Table 2.8: Percentages of Persons Aged 26 or Older Reporting Past Year Illicit Drug or Alcohol Dependence, by Demographic Characteristics: 1999, U.S.
Type of past year dependence
Demographic
Characteristic
Any Illicit Drug
Alcohol
Any Illicit Drug or Alcohol
Total
0.9
2.8
3.3
Gender
Male
1.1
4.0
4.6
Female
0.7
1.7
2.2
Hispanic origin and race
Not Hispanic
White Only
0.7
2.8
3.2
Black Only
1.9
3.0
4.1
American Indian or Alaska Native Only
3.8
3.4
7.1
Native Hawaiian or Other Pacific Islander
*
*
*
Asian Only
*
1.5
1.6
Multiple Race
*
8.3
8.6
Hispanic
0.9
2.9
3.2
Adult education
< High School
1.4
3.6
4.2
High School Graduate
0.6
2.5
2.9
Some College
1.2
2.9
3.7
College Graduate
0.5
2.5
2.9
Current employment
Full-Time
0.8
3.3
3.8
Part-Time
0.8
2.6
3.0
Unemployed
6.0
11.6
14.8
Other1
0.5
1.4
1.7
*Low precision; no estimate reported.
1 Retired, disabled, homemaker, student, or "other."
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
16
Detailed race/ethnicity data for National Household Surveys conducted from 1991 to 1993 are presented in Tables 2.9 and 2.10. The following table reports alcohol dependency rates by demographic characteristics.
Table 2.9: Percentage Reporting Dependence on Alcohol, by Race/Ethnicity, Gender, and Age, 1991-1993.
Race/Ethnicity
Total
Female
Male
12-17
18-25
26-34
35+
Total surveyed population
3.5
2.1
4.9
2.7
8.0
4.7
2.2
Native American
5.6
6.8
4.3
*
*
*
*
Asian/Pacific Islander
1.8
0.7
3.0
0.4
2.3
2.9
1.5
Hispanic-Caribbean
1.9
0.3
3.6
0.0
*
1.3
1.5
Hispanic-Central America
2.8
0.8
5.4
1.6
5.0
3.9
1.0
Hispanic-Cuba
0.9
0.5
1.3
0.5
2.7
1.6
0.4
Hispanic-Mexico
5.6
2.6
8.4
3.5
7.3
8.4
3.8
Hispanic-Puerto Rico
3.0
1.6
4.7
1.7
4.2
4.8
2.3
Hispanic-South America
2.1
1.8
2.4
2.0
4.2
3.4
*
Hispanic-Other
3.1
1.9
4.5
2.7
8.5
4.7
1.7
Non-Hispanic black
3.4
2.0
5.2
1.6
4.6
4.5
3.1
Non-Hispanic white
3.4
2.2
4.8
3.0
9.1
4.5
2.0
*Low precision.
Source: SAMHSA, 1998b. Prevalence of Substance Use among Racial and Ethnic Subgroups in the United States, 1991-93.
Table 2.10 compares a variety of drug use and dependency statistics by detailed racial/ethnic categories.
Estimations of treatment need are necessary to predict demand on the health care system (SAMHSA, 1998a). The National Household Survey on Drug Abuse defines treatment need differently than substance use or substance dependence. It also makes a distinction between Level 1 treatment need or less severe problems and Level 2 treatment need or persons with severe problems (SAMHSA, 1998a). A person is considered to have a Level 1 treatment need if one or more of the following criteria are met:
1. Drug dependence: Use of a specific drug in the past year and meet three of the six DSM-IV criteria that define drug dependence.
2. Heavy drug use: Have done any of the following in the past year: a) used heroin daily, b) used marijuana daily, or c) used any other illicit drug on a weekly basis.
17
Table 2.10.Percentage of Persons 12 and Older Using Cigarettes, Alcohol, Any Illicit Drugs, Marijuana, and Cocaine in the Past Year, Percentage in Need of Illicit Drug Abuse Treatment, Percentage Reporting Dependence on Alcohol, Percentage Reporting Heavy Cigarette Use in the Past Month, and Percentage Reporting Heavy Alcohol Use in the Past Month, by Race/Ethnicity, 1991-1993.
Race/ethnicity
Cigarette use-past year
Alcohol use-past year
Any illicit
drug-past year
Marijuana
-past year
Cocaine-past year
Need drug
abuse treatment
Alcohol depen-dence
Heavy cigarette use-past month
Heavy alcohol use-past month
Total surveyed population
30.9%
66.4%
11.9%
9.0%
2.5%
2.7%
3.5%
13.8%
5.1%
Native American
52.7
63.7
19.8
15.0
5.2
7.8
5.6
23.9
4.6
Asian/Pac Islander
21.7
53.2
6.5
4.7
1.4
1.7
1.8
4.8
0.9
Hispanic-Caribbean
21.2
60.8
7.6
5.6
1.5
1.6
1.9
3.6
2.5
Hispanic-C America
17.9
51.1
5.7
2.7
1.1
1.5
2.8
2.3
2.2
Hispanic-Cuba
27.3
65.7
8.2
5.9
1.7
2.6
0.9
8.9
2.8
Hispanic-Mexico
29.1
63.7
12.7
9.1
3.9
3.6
5.6
4.7
6.9
Hispanic-Puerto Rico
32.7
59.5
13.3
10.8
3.7
3.7
3.0
11.8
4.0
Hispanic-S America
31.3
74.1
10.7
8.4
2.0
1.7
2.1
6.9
3.0
Hispanic-other
25.9
66.3
10.6
9.1
2.3
3.4
3.1
5.3
4.9
Non-Hispanic black
29.9
55.4
13.1
10.6
3.1
3.9
3.4
9.1
4.7
Non-Hispanic white
31.5
68.9
11.8
8.9
2.4
2.5
3.4
15.5
5.3
Note: Heavy cigarette use is defined as smoking a pack or more per day during the past 30 days. Heavy alcohol use is defined as drinking five or more drinks per occasion on 5 or more days during the past 30 days.
Source: SAMHSA, 1998b. Prevalence of Substance Use among Racial and Ethnic Subgroups in the United States, 1991-93. 18
3. Injection drug use: Administered heroin, cocaine, or stimulants with a needle in the past year.
4. Treatment: Received drug abuse treatment at any location in the past year.
A person considered to have a severe or Level 2 treatment need must meet one or more of the following criteria:
1. Drug dependence: Use of a specific drug in the past year and meet three of the six DSM-IV criteria that define drug dependence.
2. Heavy drug use: Have done any of the following in the past year: a) used heroin at least once, b) used marijuana daily and dependent on marijuana, c) used cocaine weekly, or d) used any illicit drug, other than marijuana, daily.
3. Injection drug use: Same as Level 1
4. Treatment: Received treatment for any illicit drug in a specialty facility in the past year.
Table 2.11 estimates the number of people in the United States that have needed and received treatment between 1991 and 1996. A substantial majority of those people needing treatment during this period of time did not receive the necessary services.
Table 2.11: Estimates of Number of Persons Needing and Receiving Treatment for Drug Abuse Problems: NHSDA, 1991-96 (Number of Persons in 1,000s).
1991
1992
1993
1994
1995
1996
Total Drug Abuse Treatment Need
8,991
8,599
8,067
8,329
8,906
9,383
Level 1 Treatment Need
Persons with Less Severe Problems needing treatment
3,843
3,881
3,326
3,719
4,260
4,080
Level 2 Treatment Need
Persons with Severe Problems Needing Treatment
5,148
4,718
4,741
4,610
4,646
5,303
Persons Receiving Treatment
1,649
1,814
1,848
1,984
2,121
1,973
Percent of Level 2 Treated
32%
38%
39%
43%
46%
37%
Percent of Level 2 Not Treated
68%
62%
61%
57%
54%
63%
Treatment Gap
3,499
2,904
2,893
2,626
2,525
3,330
Note: Estimates for 1991-96 are ratio-adjusted to partially account for underestimation due to underreporting and undercoverage in the NHSDA. Estimates for 1991-93 are also adjusted for trend consistency, to account for the change in the NHSDA questionnaire in 1994. Adjustment factors for trend consistency were 1.19020 for total treatment need and 1.21125 for Level 2 treatment need.
Source: SAMHSA, 1998a. Analyses of Substance Abuse and Treatment Need Issues. 19
The percent of the total population in need of treatment is presented in Table 2.12. Treatment need was at its highest in 1996 with 3.4 percent of the population meeting the criteria. Men were twice as likely as women to need treatment and people who were between the ages of 18 and 25 had the highest rates of treatment need.
Table 2.12: Percent of Population Age 12 and Older with Drug Abuse Treatment Need, by Year and Demographic Characteristics.
Group
1991
1992
1993
1994-A
1994-B
1995
1996
Total
3.1
2.7
2.4
2.9
3.1
3.3
3.4
Gender
Male
Female
3.8
2.4
3.3
2.1
3.2
1.8
4.2
1.7
4.3
2.0
4.3
2.4
4.7
2.2
Race/ethnicity
White
Black
Hispanic
2.8
4.5
3.3
2.6
3.5
3.4
2.1
3.6
3.2
2.4
5.3
2.5
3.0
3.9
3.2
3.2
4.2
3.1
3.3
4.9
3.1
Age
12-17
18-25
26-34
35+
3.6
6.6
3.9
1.9
3.2
5.9
4.6
1.2
3.5
5.6
3.9
1.0
4.0
6.2
3.1
1.8
3.7
6.0
4.0
2.0
5.4
7.2
4.3
1.7
4.8
8.5
4.8
1.7
Note: Estimates are not ratio-adjusted to partially account for underestimation due to underreporting and undercoverage in the NHSDA.
Source: SAMHSA, 1998a. Analyses of Substance Abuse and Treatment Need Issues.
Table 2.13 presents data for those people categorized as having a Level 2 treatment need. While there are fewer people with these severe problems, the patterns remain the same with men and individuals between 18 and 25 reporting greater treatment need.
A detailed racial/ethnic breakdown of treatment need is shown in Table 2.14.
20
Table 2.13: Percent of Population Age 12 and Older with Level 2 Drug Abuse Treatment Need, by Year and Demographic Characteristics.
Group
1991
1992
1993
1994-A
1994-B
1995
1996
Total
1.3
1.3
1.2
1.3
1.6
1.6
1.7
Gender
Male
Female
1.9
1.3
1.6
1.0
1.5
0.9
1.8
1.0
2.0
1.1
1.9
1.2
2.2
1.3
Race/ethnicity
White
Black
Hispanic
1.3
2.4
2.1
1.2
1.7
1.6
1.0
2.0
1.6
1.2
2.3
1.3
1.5
2.3
1.5
1.6
1.7
1.4
1.7
2.6
1.9
Age
12-17
18-25
26-34
35+
1.6
2.8
2.2
1.0
1.3
3.1
2.1
0.5
1.4
2.4
1.9
0.6
1.4
3.2
1.7
0.7
1.5
2.9
2.4
1.0
3.9
4.5
1.9
0.4
2.2
4.4
2.7
0.8
Note: Estimates are not ratio-adjusted to partially account for underestimation due to underreporting and undercoverage in the NHSDA.
Source: SAMHSA, 1998a. Analyses of Substance Abuse and Treatment Need Issues.
Table 2.14: Percentage in Need of Illicit Drug Abuse Treatment, by Race/Ethnicity, Gender, and Age, 1991-1993.
Race/Ethnicity
Total
Female
Male
12-17
18-25
26-34
35+
Total surveyed population
2.7
2.1
3.5
3.5
6.0
4.2
1.4
Native American
7.8
*
*
1.3
*
*
*
Asian/Pacific Islander
1.7
1.3
2.2
1.2
2.3
4.9
0.5
Hispanic-Caribbean
1.6
1.8
1.3
*
1.4
*
0.5
Hispanic-Central America
1.5
0.8
2.4
2.1
1.8
1.5
1.1
Hispanic-Cuba
2.6
1.3
4.1
2.9
7.9
7.7
0.4
Hispanic-Mexico
3.6
2.8
4.3
5.9
4.6
3.7
2.0
Hispanic-Puerto Rico
3.7
2.7
4.9
3.3
7.3
5.6
2.0
Hispanic-South America
1.7
2.1
1.4
3.0
2.9
2.9
0.4
Hispanic-Other
3.4
4.0
2.6
2.8
11.5
4.0
*
Non-Hispanic black
3.9
2.9
5.0
2.7
5.5
5.9
2.8
Non-Hispanic white
2.5
1.9
3.2
3.5
6.5
3.9
1.1
* Low precision.
Source: SAMHSA, 1998b. Prevalence of Substance Use among Racial and Ethnic Subgroups in the United States,1991-93.
21
Tables 2.15 through 2.20 present state comparisons for binge alcohol use, illicit drug dependence, and alcohol or illicit drug dependence. Data is presented in separate tables for numbers of person and percentages of persons engaging in each behavior.
22
Table 2.15. Estimated Numbers (in Thousands) of Past Month "Binge" Alcohol Users, by Age Group and State: 1999.
AGE GROUP (Years)
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Estimate
Prediction
Interval
Total
44,486
2,534
10,849
Alabama
-
621
-
(516
737)
35
(26
-
45)
153
(132
-
174)
(339
-
544)
Alaska
105
121)
(91
-
8
10)
(6
-
28
32)
(24
-
(57
-
85)
Arizona
725
860)
(602
-
53
67)
(42
-
176
203)
(150
-
(386
-
621)
Arkansas
399
-
(342
459)
28
(21
-
35)
96
(83
-
110)
(224
-
331)
California
4,692
(4,228
-
5,183)
296
(261
-
334)
1,175
(1,082
-
1,271)
(2,780
-
3,700)
Colorado
738
-
(626
858)
46
(35
-
59)
186
(162
-
210)
(405
-
620)
Total
Interval
31,102
434
70
495
275
3,221
506
Connecticut
558
(470
-
656)
33
(25
-
43)
131
(111
-
151)
394
(314
-
484)
Delaware
142
-
(120
165)
8
-
(6
10)
32
(28
36)
102
(82
-
125)
District of Columbia
74
(63
-
87)
3
(2
-
4)
18
(15
-
20)
54
(43
-
66)
Florida
2,181
-
(1,949
2,428)
97
(80
-
117)
451
(410
-
494)
1,633
(1,411
-
1,874)
Georgia
1,132
-
(950
1,331)
60
-
(47
74)
266
-
(227
308)
806
(640
-
994)
Hawaii
201
237)
(169
-
12
15)
(9
-
39
46)
(33
-
151
(120
-
184)
Idaho
197
230)
(167
-
13
16)
(10
-
47
55)
(40
-
137
(109
-
168)
Illinois
2,122
-
(1,937
2,316)
119
(103
-
137)
525
(488
-
563)
1,478
(1,303
-
1,665)
Indiana
988
1,143)
(845
-
56
71)
(44
-
253
285)
(222
-
679
(548
-
827)
Iowa
582
661)
(508
-
34
42)
(26
-
155
170)
(140
-
394
(326
-
469)
Kansas
471
542)
(406
-
25
32)
(19
-
123
137)
(109
-
324
(264
-
390)
Kentucky
612
-
(524
707)
34
-
(26
44)
166
(146
-
186)
412
(332
-
503)
Louisiana
768
-
(656
888)
51
-
(40
64)
206
-
(182
230)
511
(410
-
624)
Maine
209
241)
(179
-
12
15)
(9
-
49
55)
(43
-
148
(121
-
178)
Maryland
649
-
(537
775)
31
-
(23
42)
156
(132
-
182)
462
(360
-
580)
Massachusetts
1,244
(1,052
-
1,449)
74
(57
-
93)
293
(255
-
330)
878
(703
-
1,073)
Michigan
1,709
(1,560
-
1,865)
89
(76
-
104)
408
-
(375
442)
1,212
(1,073
-
1,360)
23
Table 2.15. Estimated Numbers (in Thousands) of Past Month "Binge" Alcohol Users, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Minnesota
946
-
(826
1,073)
59
-
(47
74)
258
-
(232
285)
628
(520
-
749)
Mississippi
413
-
(350
481)
29
-
(22
36)
111
(97
-
125)
273
(217
-
338)
Missouri
1,026
-
(875
1,189)
49
-
(38
63)
249
-
(217
281)
728
(591
-
881)
Montana
170
-
(148
194)
14
(11
-
17)
44
49)
(39
-
113
(93
-
136)
Nebraska
344
(302
-
392)
19
(14
-
24)
91
(81
-
101)
235
(195
-
278)
Nevada
331
(277
-
390)
22
(17
-
27)
61
(52
-
72)
248
(198
-
305)
New Hampshire
208
(178
-
240)
12
(9
-
16)
53
(46
-
60)
143
(116
-
173)
New Jersey
1,328
(1,116
-
1,560)
69
(53
-
86)
299
(259
-
340)
961
(764
-
1,184)
New Mexico
315
(273
-
360)
23
(18
-
29)
82
(70
-
93)
211
(173
-
252)
New York
3,062
(2,749
-
3,393)
163
(135
-
194)
729
(671
-
789)
2,170
(1,874
-
2,490)
North Carolina
1,038
(874
-
1,219)
58
(45
-
73)
239
(206
-
275)
741
(589
-
914)
North Dakota
153
(133
-
173)
11
(9
-
13)
41
(37
-
45)
101
(83
-
120)
Ohio
2,074
-
(1,890
2,268)
99
(84
-
116)
483
(449
-
517)
1,493
(1,316
-
1,681)
Oklahoma
500
(422
-
586)
36
(28
-
46)
135
(118
-
154)
328
(259
-
408)
Oregon
525
(443
-
617)
32
(25
-
40)
128
(110
-
146)
366
(290
-
453)
Pennsylvania
2,160
(1,958
-
2,373)
108
(90
-
127)
490
(455
-
525)
1,562
(1,368
-
1,771)
Rhode Island
175
(150
-
202)
10
(8
-
13)
41
(36
-
47)
124
(101
-
149)
South Carolina
539
(451
-
637)
28
(22
-
36)
127
(108
-
146)
384
(305
-
475)
South Dakota
155
(136
-
175)
12
(10
-
15)
42
(37
-
46)
101
(84
-
119)
Tennessee
788
(665
-
920)
38
(29
-
50)
200
(171
-
230)
549
(440
-
674)
Texas
3,373
(3,104
-
3,655)
211
(183
-
241)
847
(783
-
912)
2,316
(2,062
-
2,586)
Utah
258
(217
-
304)
19
(14
-
25)
76
(65
-
88)
163
(127
-
206)
Vermont
107
(92
-
124)
6
(5
-
8)
29
(25
-
32)
72
(58
-
88)
Virginia
1,021
(866
-
1,191)
45
(34
-
58)
263
(226
-
302)
712
(572
-
872)
Washington
839
(702
-
991)
52
(40
-
66)
218
(190
-
247)
569
(444
-
715)
West Virginia
271
(232
-
312)
15
(12
-
20)
72
(63
-
82)
183
(149
-
222)
24
Table 2.15. Estimated Numbers (in Thousands) of Past Month "Binge" Alcohol Users, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Wisconsin
1,141
(998
-
1,291)
70
(57
-
86)
280
(251
-
310)
790
(659
-
933)
Wyoming
101
(87
-
116)
8
(7
-
10)
31
(28
-
34)
63
(50
-
77)
NOTE: "Binge" Alcohol Use is defined as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days. By "occasion" is meant at the same time or within a couple hours of each other.
NOTE: Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and the prediction (credible) intervals are generated by Markov Chain Monte Carlo techniques.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
Table 2.16. Estimated Numbers (in Thousands) of Persons Reporting Past Year Illicit Drug Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Total
3,800
792
1,353
1,655
Alabama
52
(36
-
74)
10
(6
-
15)
20
(13
-
28)
23
(10
-
45)
Alaska
14
(9
-
20)
3
(2
-
4)
4
(2
-
5)
7
(3
-
14)
Arizona
75
(48
-
112)
13
(8
-
20)
23
(15
-
34)
39
(16
-
80)
Arkansas
29
(20
-
41)
8
(5
-
11)
9
(6
-
13)
12
(5
-
24)
California
586
(443
-
760)
111
(90
-
135)
172
(134
-
215)
304
(178
-
484)
Colorado
66
(44
-
95)
13
(8
-
19)
25
(17
-
36)
29
(12
-
59)
Connecticut
52
(34
-
76)
9
(6
-
14)
17
(10
-
25)
26
(12
-
51)
Delaware
15
(9
-
23)
3
(2
-
4)
5
(3
-
7)
7
(3
-
16)
25
Table 2.16. Estimated Numbers (in Thousands) of Persons Reporting Past Year Illicit Drug Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
District of Columbia
9
(6
-
14)
1
(1
-
2)
2
(2
-
3)
6
(3
-
10)
Florida
167
(127
-
215)
34
(26
-
45)
58
(44
-
74)
75
(43
-
121)
Georgia
94
(65
-
129)
19
(13
-
27)
37
(25
-
53)
38
(17
-
72)
Hawaii
13
(9
-
20)
4
(2
-
5)
4
(3
-
7)
6
(2
-
12)
Idaho
15
(10
-
22)
3
(2
-
5)
6
(4
-
9)
6
(2
-
13)
Illinois
155
(116
-
204)
33
(25
-
43)
55
(42
-
70)
68
(36
-
117)
Indiana
79
(56
-
107)
15
(10
-
22)
33
(23
-
47)
30
(14
-
58)
Iowa
29
(20
-
40)
7
(5
-
11)
11
(8
-
16)
10
(4
-
21)
Kansas
36
(23
-
53)
7
(5
-
10)
13
(9
-
18)
16
(6
-
33)
Kentucky
42
(31
-
57)
11
(7
-
16)
18
(12
-
26)
14
(6
-
27)
Louisiana
60
(43
-
81)
12
(8
-
17)
24
(17
-
32)
25
(12
-
46)
Maine
16
(11
-
23)
4
(2
-
5)
6
(4
-
9)
6
(3
-
13)
Maryland
70
(48
-
98)
12
(8
-
18)
28
(19
-
39)
29
(13
-
57)
Massachusetts
110
(69
-
164)
26
(17
-
38)
34
(22
-
49)
50
(19
-
106)
Michigan
144
(109
-
186)
29
(22
-
38)
52
(40
-
66)
63
(34
-
106)
Minnesota
67
(46
-
94)
16
(10
-
22)
27
(18
-
38)
25
(10
-
49)
Mississippi
39
(27
-
56)
10
(7
-
15)
11
(7
-
16)
18
(8
-
34)
Missouri
74
(51
-
105)
15
(9
-
22)
29
(19
-
42)
30
(13
-
60)
Montana
14
(10
-
20)
4
(3
-
6)
5
(4
-
8)
5
(2
-
10)
Nebraska
19
(13
-
27)
4
(3
-
7)
8
(5
-
11)
7
(3
-
14)
Nevada
41
(27
-
61)
8
(5
-
11)
11
(7
-
15)
23
(11
-
44)
New Hampshire
18
(12
-
26)
3
(2
-
5)
8
(5
-
11)
7
(3
-
16)
New Jersey
117
(78
-
167)
23
(15
-
34)
43
(28
-
63)
50
(20
-
105)
New Mexico
40
(28
-
55)
11
(8
-
15)
12
(8
-
17)
17
(8
-
33)
26
Table 2.16. Estimated Numbers (in Thousands) of Persons Reporting Past Year Illicit Drug Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
New York
270
(199
-
359)
49
(35
-
66)
107
(80
-
140)
115
(58
-
203)
North Carolina
92
(64
-
128)
21
(14
-
29)
27
(18
-
39)
44
(22
-
79)
North Dakota
8
(6
-
11)
2
(2
-
4)
3
(2
-
4)
2
(1
-
5)
Ohio
148
(113
-
191)
27
(20
-
36)
57
(44
-
71)
64
(36
-
107)
Oklahoma
40
(28
-
56)
9
(6
-
14)
17
(11
-
24)
14
(6
-
29)
Oregon
63
(40
-
95)
9
(6
-
13)
21
(15
-
30)
33
(14
-
67)
Pennsylvania
155
(118
-
200)
37
(28
-
48)
58
(44
-
75)
60
(31
-
106)
Rhode Island
17
(12
-
24)
4
(2
-
6)
7
(4
-
9)
7
(3
-
13)
South Carolina
42
(28
-
60)
9
(6
-
14)
14
(9
-
20)
19
(8
-
37)
South Dakota
9
(6
-
12)
2
(2
-
3)
4
(3
-
6)
3
(1
-
5)
Tennessee
70
(46
-
100)
13
(8
-
19)
23
(15
-
33)
34
(16
-
64)
Texas
218
(173
-
271)
58
(45
-
74)
87
(67
-
110)
73
(40
-
122)
Utah
33
(25
-
44)
8
(5
-
12)
16
(11
-
22)
9
(4
-
19)
Vermont
10
(7
-
14)
3
(2
-
4)
4
(3
-
6)
4
(1
-
8)
Virginia
70
(49
-
98)
15
(10
-
21)
28
(18
-
41)
28
(13
-
53)
Washington
101
(68
-
144)
20
(14
-
28)
37
(26
-
51)
44
(18
-
91)
West Virginia
19
(13
-
26)
6
(4
-
9)
6
(4
-
9)
7
(3
-
13)
Wisconsin
68
(49
-
90)
18
(12
-
25)
26
(18
-
37)
24
(11
-
45)
Wyoming
7
(5
-
10)
2
(1
-
3)
3
(2
-
4)
3
(1
-
6)
NOTE: Dependence is based on the definition found in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
NOTE: Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and the prediction (credible) intervals are generated by Markov Chain Monte Carlo techniques.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
27
Table 2.17. Estimated Numbers (in Thousands) of Persons Reporting Past Year Illicit Drug or Alcohol Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Total
10,518
1,347
3,359
5,811
Alabama
142
(105
-
187)
18
(12
-
25)
47
(35
-
61)
78
(47
-
121)
Alaska
35
(27
-
45)
4
(2
-
5)
9
(7
-
12)
22
(15
-
32)
Arizona
200
(147
-
265)
28
(20
-
38)
57
(42
-
74)
115
(71
-
178)
Arkansas
86
(65
-
110)
13
(9
-
17)
28
(22
-
36)
45
(28
-
67)
California
1,389
(1,147
-
1,665)
164
(137
-
194)
363
(308
-
424)
862
(638
-
1,137)
Colorado
183
(135
-
241)
18
(12
-
27)
60
(45
-
77)
105
(64
-
161)
Connecticut
130
(97
-
171)
16
(11
-
23)
45
(33
-
59)
69
(42
-
106)
Delaware
41
(29
-
55)
5
(3
-
6)
12
(9
-
15)
25
(15
-
38)
District of Columbia
23
(17
-
31)
2
(1
-
3)
6
(4
-
8)
16
(10
-
23)
Florida
474
(381
-
581)
54
(41
-
70)
131
(108
-
157)
288
(206
-
392)
Georgia
284
(211
-
373)
31
(22
-
42)
88
(66
-
114)
166
(104
-
249)
Hawaii
54
(38
-
74)
6
(4
-
8)
13
(9
-
17)
36
(21
-
56)
Idaho
48
(35
-
63)
7
(5
-
10)
15
(11
-
20)
25
(15
-
40)
Illinois
487
(402
-
585)
57
(45
-
70)
154
(131
-
180)
276
(201
-
370)
Indiana
227
(174
-
290)
30
(21
-
40)
80
(62
-
101)
118
(75
-
177)
Iowa
105
(82
-
131)
18
(13
-
25)
43
(33
-
54)
44
(27
-
68)
Kansas
100
(77
-
128)
15
(10
-
20)
38
(29
-
48)
48
(30
-
72)
Kentucky
125
(93
-
163)
16
(11
-
23)
42
(32
-
54)
66
(40
-
103)
Louisiana
187
(142
-
240)
21
(14
-
29)
63
(49
-
80)
104
(67
-
153)
Maine
41
(31
-
53)
6
(4
-
8)
14
(11
-
19)
21
(13
-
32)
Maryland
198
(145
-
262)
23
(16
-
33)
52
(38
-
69)
123
(78
-
183)
28
Table 2.17. Estimated Numbers (in Thousands) of Persons Reporting Past Year Illicit Drug or Alcohol Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Estimate
Prediction
Interval
Total
Interval
Massachusetts
277
(207
-
360)
50
(36
-
67)
96
(72
-
124)
132
(77
-
211)
Michigan
423
(353
-
501)
48
(38
-
59)
138
(117
-
161)
237
(175
-
312)
Minnesota
220
(173
-
274)
30
(22
-
40)
72
(56
-
89)
118
(78
-
169)
Mississippi
112
(82
-
147)
14
(10
-
20)
35
(27
-
44)
63
(38
-
97)
Missouri
227
(171
-
295)
25
(17
-
34)
75
(58
-
96)
128
(80
-
191)
Montana
37
(28
-
47)
7
(5
-
9)
12
(10
-
16)
18
(11
-
27)
Nebraska
75
(58
-
96)
9
(6
-
12)
28
(22
-
35)
39
(25
-
58)
Nevada
83
(61
-
109)
12
(8
-
16)
20
(15
-
27)
51
(31
-
77)
New Hampshire
43
(33
-
55)
6
(4
-
8)
18
(13
-
23)
19
(12
-
30)
New Jersey
258
(191
-
340)
39
(27
-
54)
97
(73
-
125)
123
(70
-
200)
New Mexico
95
(73
-
121)
14
(10
-
19)
33
(25
-
41)
49
(31
-
72)
New York
680
(561
-
816)
91
(70
-
115)
269
(225
-
318)
320
(220
-
450)
North Carolina
259
(192
-
342)
36
(26
-
48)
68
(51
-
89)
156
(97
-
236)
North Dakota
30
(23
-
38)
5
(4
-
7)
10
(8
-
13)
15
(9
-
22)
Ohio
409
(341
-
486)
-
47
(37
-
60)
137
(117
-
159)
225
(166
-
298)
Oklahoma
123
(93
-
160)
14
(10
-
21)
43
(33
-
54)
66
(41
-
99)
Oregon
150
(108
-
202)
16
(11
-
22)
44
(34
-
57)
89
(53
-
141)
Pennsylvania
421
(345
-
509)
65
(53
-
80)
143
(121
-
167)
213
(147
299)
Rhode Island
41
(31
-
53)
5
(3
-
7)
15
(12
-
20)
21
(13
-
32)
South Carolina
132
(96
-
176)
14
(10
-
20)
33
(24
-
44)
84
(54
-
126)
South Dakota
32
(25
-
41)
6
(4
-
7)
12
(10
-
16)
14
(9
-
22)
Tennessee
212
(158
-
277)
21
(14
-
29)
65
(49
-
84)
126
(81
-
187)
Texas
729
(608
-
867)
112
(92
-
134)
257
(219
-
299)
360
(257
-
490)
Utah
84
(64
-
108)
12
(8
-
16)
31
(24
-
39)
42
(26
-
64)
Vermont
24
(18
-
30)
4
(3
-
6)
10
(8
-
13)
10
(6
-
16)
29
Table 2.17. Estimated Numbers (in Thousands) of Persons Reporting Past Year Illicit Drug or Alcohol Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Virginia
230
(165
-
312)
26
(18
-
37)
59
(42
-
80)
145
(89
-
223)
Washington
266
(198
-
347)
27
(19
-
37)
81
(64
-
101)
158
(98
-
238)
West Virginia
58
(43
-
76)
9
(6
-
13)
19
(14
-
25)
31
(19
-
47)
Wisconsin
204
(161
-
254)
31
(22
-
41)
73
(57
-
92)
101
(66
-
147)
Wyoming
23
(18
-
30)
4
(3
-
5)
8
(6
-
10)
11
(7
-
18)
NOTE: Dependence is based on the definition found in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
NOTE: Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and the prediction (credible) intervals are generated by Markov Chain Monte Carlo techniques.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
Table 2.18. Percentages Reporting Past Month "Binge" Alcohol Use, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Total
20.1
10.9
38.1
18.4
Alabama
17.2
(14.3
-
20.4)
9.4
(7.0
-
12.2)
32.2
(27.9
-
36.8)
15.6
(12.2
-
19.6)
Alaska
21.8
(18.8
-
25.0)
12.3
(9.6
-
15.4)
40.1
(35.1
-
45.2)
19.8
(16.1
-
24.0)
Arizona
19.2
(16.0
-
22.8)
12.6
(9.8
-
15.8)
35.4
(30.1
-
40.9)
17.4
(13.6
-
21.8)
Arkansas
18.7
(16.0
-
21.5)
12.3
(9.5
-
15.6)
34.6
(30.0
-
39.5)
16.8
(13.8
-
20.3)
California
18.4
(16.6
-
20.3)
10.5
(9.3
-
11.9)
34.2
(31.5
-
37.0)
16.7
(14.4
-
19.2)
Colorado
22.1
(18.7
-
25.7)
13.0
(9.9
-
16.7)
42.5
(37.1
-
48.0)
19.8
(15.9
-
24.3)
30
Table 2.18. Percentages Reporting Past Month "Binge" Alcohol Use, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Connecticut
20.7
(17.4
-
24.3)
13.1
(9.9
-
16.9)
43.2
(36.7
-
49.8)
18.4
(14.7
-
22.7)
Delaware
22.8
(19.3
-
26.6)
12.5
(9.5
-
16.0)
41.6
(36.2
-
47.1)
21.2
(17.0
-
25.9)
District of Columbia
17.5
(14.7
-
20.5)
7.7
(5.5
-
10.5)
31.7
(27.0
-
36.7)
16.3
(13.1
-
20.0)
Florida
17.5
(15.6
-
19.5)
8.4
(6.9
-
10.1)
33.9
(30.8
-
37.0)
16.4
(14.1
-
18.8)
Georgia
18.1
(15.2
-
21.3)
8.9
(7.0
-
11.1)
31.6
(27.0
-
36.5)
17.0
(13.5
-
21.0)
Hawaii
20.8
(17.4
-
24.5)
12.1
(9.2
-
15.6)
33.8
(28.6
-
39.3)
19.9
(15.9
-
24.3)
Idaho
18.7
(15.8
-
21.8)
9.9
(7.5
-
12.7)
29.5
(25.1
-
34.2)
17.9
(14.3
-
22.0)
Illinois
21.8
(19.9
-
23.8)
11.9
(10.3
-
13.8)
40.8
(37.9
-
43.8)
19.9
(17.5
-
22.4)
Indiana
20.1
(17.2
-
23.3)
11.0
(8.6
-
13.8)
38.5
(33.8
-
43.3)
18.1
(14.6
-
22.1)
Iowa
24.4
(21.3
-
27.8)
13.3
(10.5
-
16.5)
49.2
(44.5
-
53.9)
21.7
(18.0
-
25.8)
Kansas
22.1
(19.0
-
25.4)
10.4
(7.9
-
13.5)
42.9
(38.0
-
48.0)
20.1
(16.4
-
24.2)
Kentucky
18.7
(16.1
-
21.7)
10.3
(7.9
-
13.2)
38.2
(33.7
-
42.8)
16.5
(13.3
-
20.1)
Louisiana
21.7
(18.5
-
25.1)
12.1
(9.5
-
15.1)
40.1
(35.5
-
44.8)
19.6
(15.7
-
23.9)
Maine
20.0
(17.2
-
23.1)
11.5
(8.8
-
14.7)
40.6
(35.6
-
45.8)
18.1
(14.7
-
21.8)
Maryland
15.3
(12.7
-
18.3)
7.6
(5.5
-
10.1)
31.3
(26.4
-
36.5)
13.9
(10.8
-
17.4)
Massachusetts
24.4
(20.7
-
28.5)
14.9
(11.5
-
18.9)
49.2
(42.9
-
55.5)
21.9
(17.5
-
26.8)
Michigan
21.7
(19.8
-
23.6)
10.7
(9.1
-
12.5)
39.8
(36.5
-
43.1)
20.1
(17.8
-
22.5)
Minnesota
24.2
(21.1
-
27.4)
13.7
(10.8
-
17.0)
49.5
(44.5
-
54.5)
21.2
(17.6
-
25.3)
Mississippi
18.3
(15.6
-
21.4)
11.110.3
(8.6
-
14.0)
34.3
(30.1
-
38.7)
16.4
(13.0
-
20.3)
Missouri
22.8
(19.4
-
26.5)
(7.9
-
13.2)
42.6
(37.2
-
48.2)
21.2
(17.2
-
25.6)
Montana
22.3
(19.4
-
25.5)
16.1
(13.0
-
19.7)
44.5
(39.5
-
49.5)
19.5
(16.0
-
23.4)
Nebraska
25.3
(22.1
-
28.7)
12.1
(9.3
-
15.6)
48.9
(43.5
-
54.3)
22.9
(19.1
-
27.1)
Nevada
22.2
(18.6
-
26.2)
15.1
(11.7
-
18.9)35.2
(29.6
-
41.0)
21.2
(16.9
-
26.0)
New Hampshire
20.9
(17.9
-
24.2)
11.9
(9.1
-
15.2)
45.8
(39.8
-
51.9)
18.4
(14.9
-
22.3)
New Jersey
19.9 (16.7
-
23.4)
11.1
(8.6
-
13.9) 38.5 (33.3-
43.8) 18.2(14.5-
22.5)
31
Table 2.18. Percentages Reporting Past Month "Binge" Alcohol Use, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
New Mexico
21.6
(18.7
-
24.7)
13.1
(10.2
-
16.5)
39.4
(34.0
-
45.0)
19.5
(16.0
-
23.3)
New York
20.7
(18.6
-
23.0)
11.2
(9.3
-
13.3)
40.4
(37.1
-
43.7)
18.9
(16.3
-
21.7)
North Carolina
16.6 (14.0
-
19.5)
9.1
(7.1
-
11.5)
31.3
(26.9
-
36.1)
15.2
(12.1
-
18.8)
North Dakota
28.7
(23.0
(25.1
-
32.4)
17.2
(13.8
-
21.0)
54.7
(49.7
-
59.7)
25.6
(21.1
-
30.4)
Ohio
22.4
(20.4- 24.5)
10.4
(8.8
-
12.2)
40.3
(37.5
-
43.1)
21.0
(18.5
-
23.7)
Oklahoma
18.4
(15.5
-
21.5)
11.8
(9.0
-
15.1)
37.5
(32.6
-
42.6)
16.0
(12.6
-
19.9)
Oregon
18.9
(15.9
-
22.2)
11.5
(9.0
-
14.6)
36.8
(31.6
-
42.3)
16.9
(13.4
-
21.0)
Pennsylvania
21.4
(19.4(18.3
-
23.5)
10.9
(9.2
-
12.9)
41.8
(38.8
-
44.8)
19.7
(17.2
-
22.3)
Rhode Island
21.4
-
24.7)
12.4
(9.5
-
15.8)
44.6
(38.9
-
50.4)
19.2
(15.7
-
23.2)
South Carolina
17.4
(14.6
-
20.6)
8.8
(6.7
-
11.3)
33.0
(28.1
-
38.1)
16.1
(12.8
-
19.9)
South Dakota
25.3
(22.2(14.5
-
28.5)
16.5
(13.2
-
20.2)
48.8
(43.7
-
53.9)
22.3
(18.5
-
26.4)
Tennessee
17.1
-
20.0)
8.3
(6.2
-
10.9)
34.0
(29.1
-
39.1)
15.5
(12.4
-
19.0)
Texas
21.3
(19.6- 23.1)
11.3
(9.8
-
12.9)
36.7
(33.9
-
39.5)
19.9
(17.7
-
22.2)
Utah
15.4
(13.0
-
18.1)
7.6
(5.6
-
10.0)
24.2
(20.7
-
28.0)
14.7
(11.4
-
18.5)
Vermont
21.2
(18.1
-
24.5)
11.2
(8.6
-
14.2)
46.7
(40.5
-
52.9)
18.5
(15.0
-
22.5)
Virginia
18.3
(15.5
-
21.3)
8.2
(6.2
-
10.6)
38.6
(33.2
-
44.3)
16.4
(13.2
-
20.1)
Washington
17.8
(14.9(14.9
-
21.0)
10.7
(8.3
-
13.5)
36.9
(32.2
-
41.7)
15.7
(12.2
-
19.7)
West Virginia
17.4
-
20.1)
10.8
(8.3
-
13.7)
36.4
(31.7
-
41.3)
15.2
(12.3
-
18.4)
Wisconsin
26.3
-
29.7)
14.7
(11.9
-
17.9)
48.6
(43.5
-
53.7)
24.0
(20.1
-
28.4)
Wyoming
24.2
(20.9
-
27.8)
16.5
(13.3
-
20.1)
50.7
(45.7
-
55.7)
20.3
(16.2
-
24.9)
NOTE: "Binge" Alcohol Use is defined as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days. By "occasion" is meant at the same time or within a couple hours of each other.
NOTE: Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and the prediction (credible) intervals are generated by Markov Chain Monte Carlo techniques.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
32
Table 2.19. Percentages Reporting Past Year Illicit Drug Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Total
1.7
3.4
4.8
1.0
Alabama (2.2
1.4
(1.0
-
2.0)
2.6
(1.6(3.0
-
4.0)
4.2
(2.8
-
5.9)
0.8
(0.4
-
1.6)
Alaska
2.8
(1.8
-
4.1)
4.7
-
6.9)
5.2
(3.4
-
7.5)
2.0
(0.9
-
3.9)
Arizona
2.0
(1.3
-
3.0)
3.1
(2.0
-
4.6)
4.7
(3.1
-
6.8)
1.4
(0.6
-
2.8)
Arkansas
1.4
(0.9
-
1.9)
3.4
(2.2(3.2
-
5.1)
3.4
(2.3
-
4.8)
0.7
(0.3
-
1.5)
California
2.3
(1.7
-
3.0)
4.0
-
4.8)
5.0
(3.9
-
6.3)
1.6
(0.9
-
2.5)
Colorado
2.0
(1.3
-
2.8)
3.5
(2.3(2.3
-
5.3)
5.7
(3.8
-
8.2)
1.1
(0.5
-
2.3)
Connecticut
1.9
(1.3
-
2.8)
3.7
-
5.6)
5.5
(3.5
-
8.3)
1.2
(0.5
-
2.4)
Delaware
2.4
(1.4
-
3.7)
4.3
(2.7(1.6
-
6.5)
6.4
(4.2
-
9.2)
1.5
(0.6
-
3.2)
District of Columbia
2.2
(1.4
-
3.2)
2.7
-
4.3)
4.2
(2.8
-
6.0)
1.7
(0.9
-
3.2)
Florida
1.3
(1.0
-
1.7)
3.0
-
3.9)
4.3
(3.3
-
5.6)
0.8
(0.4
-
1.2)
Georgia
1.5
(1.0
-
2.1)
2.8
(1.9
-
4.1)
4.4
(2.9
-
6.3)
0.8
(0.4
-
1.5)
Hawaii
1.4
(0.9
-
2.0)
3.8
(2.3
-
5.7)
3.6
(2.2
-
5.6)
0.7
(0.3
-
1.6)
Idaho
1.5
(1.0
-
2.1)
2.6
(1.6
-
3.9)
3.7
(2.5
-
5.4)
0.8
(0.3
-
1.7)
Illinois
1.6
(1.2
-
2.1)
3.3
(2.5
-
4.3)
4.2
(3.2
-
5.5)
0.9
(0.5
-
1.6)
Indiana
1.6
(1.1
-
2.2)
3.0
(2.0
-
4.3)
5.1
(3.5
-
7.1)
0.8
(0.4
-
1.6)
Iowa
1.2
(0.8
-
1.7)
2.9
(1.9
-
4.4)
3.6
(2.4
-
5.2)
0.6
(0.2
-
1.2)
Kansas
1.7
(1.1
-
2.5)
2.9
(1.9
-
4.3)
4.6
(3.1
-
6.5)
1.0
(0.4
-
2.0)
Kentucky
1.3
(0.9
-
1.7)
3.2
(2.1(1.8
-
4.7)
4.2
(2.8
-
5.9)
0.6
(0.2
-
1.1)
Louisiana
1.7
(1.2
-
2.3)
2.8
-
4.1)
4.6
(3.3
-
6.3)
1.0
(0.5
-
1.7)
Maine
1.5
(1.0
-
2.2)
3.4
(2.2(1.9
-
5.1)
5.1
(3.4
-
7.4)
0.8
(0.3
-
1.6)
Maryland
1.6
(1.1
-
2.3)
3.0
-
4.4)
5.6
(3.9
-
7.9)
0.9
(0.4
-
1.7)
Massachusetts
2.1
(1.3
-
3.2)
5.3
(3.5(2.6
-
7.6)
5.7
(3.8
-
8.3)
1.2
(0.5
-
2.6)
Michigan
1.8
(1.4
-
2.4)
3.5
-
4.5)
5.1
(3.9
-
6.5)
1.0
(0.6
-
1.8)
33
Table 2.19. Percentages Reporting Past Year Illicit Drug Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Minnesota
1.7
(1.2
-
2.4)
3.6
(2.4
-
5.2)
5.1
(3.5
-
7.3)
0.8
(0.3
-
1.7)
Mississippi (2.0
1.7
(1.2
-
2.5)
3.9(2.6
-
5.7)
3.4
(2.3
-
4.9)
1.1
(0.5
-
2.1)
Missouri
1.6
(1.1
-
2.3)
3.1
-
4.6)
5.0
(3.3
-
7.2)
0.9
(0.4
-
1.8)
Montana
1.9
(1.3
-
2.6)
4.8
(3.2
-
6.7)
5.6
(3.8
-
7.8)
0.8
(0.3
-
1.8)
Nebraska
1.4
(0.9
-
2.0)
2.9(1.7
-
4.5)
4.2
(2.7
-
6.1)
0.7
(0.3
-
1.4)
Nevada
2.8 6.1 (4.0-
(1.8
-
4.1)
5.2
(3.6
-
7.4)
8.8)
2.0
(0.9-
3.7)
New Hampshire
1.8(1.2
-
2.6)
2.9
(1.8
-4.5)
6.6
(4.3
-
9.6)
0.9
(0.3
-
2.0)
New Jersey
1.7
(1.2-
2.5)
3.7
(2.4-
5.4)
5.6
(3.7-
8.2)
1.0
(0.4-
2.0)
New Mexico - 2.7
(1.9
3.8)
6.4
(4.5
-
8.9)
5.7
(3.8
-
8.1)
1.6
(0.7
-
3.1)
New York
1.8
(1.3
-
2.4)
3.4
(2.4
-
4.5)
5.9
(4.4
-
7.7)
1.0
(0.5
-
1.8)
North Carolina
1.5
(1.0
-
2.0)
3.2
(2.2
-
4.6)
3.5
(2.4
-
5.1)
0.9
(0.5
-
1.6)
North Dakota
1.5
-
(1.0
-
2.0)
3.8
(2.5
-
5.6)
4.1
(2.7
-
6.0)
0.6
(0.2
-
1.2)
Ohio
1.6
(1.2
-
2.1)
2.9
(2.1
-
3.8)
4.7
(3.7
-
5.9)
0.9
(0.5
-
1.5)
Oklahoma
1.5
(1.0
-
2.0)
3.1
(1.9
-
4.6)
4.6
(3.1
-
6.6)
0.7
(0.3
-
1.4)
Oregon
2.3
(1.4
--
3.4)
3.3
(2.2
-
4.8)
6.1
(4.2
-
8.6)
1.5
(0.6
-
3.1)
Pennsylvania
1.5
(1.2
2.0)
3.7
(2.8
-
4.8)
4.9
(3.7
-
6.4)
0.8
(0.4
-
1.3)
Rhode Island
2.1
(1.5
2.9)
4.6
(2.9
-
6.9)
7.1
(4.8
-
10.1)
1.1
(0.5
-
2.1)
South Carolina
1.4
(0.9
-
1.9)
2.9
(1.9
-
4.3)
3.5
(2.3
-
5.2)
0.8
(0.4
-
1.5)
South Dakota
1.4
(1.0
-
1.9)
3.2
(2.1
-
4.6)
4.7
(3.2
-
6.6)
0.6
(0.2
-
1.2)
Tennessee
1.5
(1.0
-
2.2)
2.8
(1.8
-
4.1)
3.9
(2.6
-
5.6)
1.0
(0.4
-
1.8)
Texas
1.4
(1.1
-
1.7)
3.1
(2.4
-
4.0)
3.8
(2.9
-
4.8)
0.6
(0.3
-
1.1)
Utah
2.0
(1.5
-
2.6)
3.3
(2.2
-
4.7)
5.0
(3.6
-
6.8)
0.8
(0.3
-
1.7)
Vermont
2.0
(1.3
-
2.8)
4.6
(3.0
-
6.7)
6.4
(4.2
-
9.2)
0.9
(0.3
-
2.0)
Virginia
1.3
(0.9
--
1.8)
2.6
(1.7
-
3.8)
4.1
(2.7
-
6.0)
0.6
(0.3
-
1.2)
Washington
2.1
(1.4
3.1)
4.1
(2.8
-
5.8)
6.2
(4.4
-
8.6)
1.2
(0.5
-
2.5)
West Virginia
1.2
(0.9
-
1.7)
4.2
(2.7
-
6.1)
3.3
(2.1
-
4.8)
0.6
(0.2
-
1.1)
34
Table 2.19. Percentages Reporting Past Year Illicit Drug Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Wisconsin
1.6
(1.1
2.1)
3.7
(2.5
-
5.2)
4.6
(3.1
-
6.5)
0.7
(0.3
-
1.4)
Wyoming
1.7
(1.2
2.4)
4.0
(2.7
-
5.7)
4.3
(2.9
-
6.2)
0.9
(0.4
-
1.8)
NOTE: Dependence is based on the definition found in the 4 ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
th
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
Table 2.20: Percentages Reporting Past Year Illicit Drug or Alcohol Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Total
4.8
11.8
3.4
Alabama
3.9
(2.9
-
5.2)
(3.3
-
6.9)
9.8
(7.3
-
12.8)
2.8
(1.7
-
4.4)
Alaska
7.3
(5.5
-
9.4)
(3.9
-
7.9)
13.6
(10.4
-
17.3)
6.3
(4.2
-
9.1)
Arizona
5.3
(3.9
-
7.0)
(4.6
-
9.0)
11.4
(8.4
-
14.9)
4.1
(2.5
-
6.2)
Arkansas
4.0
(3.1
-
5.1)
(3.9
-
7.8)
10.2
(7.9
-
13.0)
2.7
(1.7
-
4.1)
California
5.4
(4.5
-
6.5)
(4.9
-
6.9)
10.5
(8.9
-
12.3)
4.5
(3.3
-
5.9)
Colorado
5.5
(4.0
-
7.2)
(3.3
-
7.5)
13.7
(10.4
-
17.6)
4.1
(2.5
-
6.3)
Connecticut
4.8
(3.6
-
6.4)
(4.3
-
9.2)
14.7
(10.7
-
19.5)
3.2
(2.0
-
5.0)
Delaware
6.5
(4.7
-
8.9)
(4.9
-
10.2)
15.3
(11.7
-
19.5)
5.1
(3.0
-
7.9)
District of Columbia
5.5
(4.0
-
7.3)
(2.8
-
6.5)
10.6
(7.9
-
13.9)
4.8
(3.1
-
7.0)
--
NOTE: Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and the prediction (credible) intervals are generated by Markov Chain Monte Carlo techniques.
Estimate
5.8
4.8
5.7
6.6
5.6
5.8
5.1
6.5
7.2
4.4
35
Table 2.20: Percentages Reporting Past Year Illicit Drug or Alcohol Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
12.1
(9.4
-
15.3)
3.2
(2.0
-
4.7)
Iowa
4.4
(3.4
-
5.5)
7.2
(5.2
-
9.8)
13.7
(10.6
-
17.2)
2.4
(1.5
-
3.7)
Kansas
4.7
(3.6
6.0)
6.1
(4.2
-
8.4)
13.3
(10.3
-
16.8)
3.0
(1.8
-
4.5)
Kentucky
3.8
(2.8
-
5.0)
5.0
(3.4
-
7.0)
9.7
(7.3
-
12.5)
2.7
(1.6
-
4.1)
Louisiana
5.3
(4.0
-
6.8)
4.9
(3.4
-
6.8)
12.3
(9.5
-
15.5)
4.0
(2.6
-
5.9)
Maine
3.9
(2.9
-
5.1)
5.5
(3.7
-
7.9)
12.0
(9.0
-
15.5)
2.6
(1.5
-
4.0)
Maryland
4.7
(3.4
-
6.2)
5.6
(3.8
-
7.8)
10.4
(7.6
-
13.8)
3.7
(2.3
-
5.5)
Massachusetts
5.4
(4.1
-
7.1)
10.0
(7.2
-
13.5)
16.1
(12.2
-
20.8)
3.3
(1.9
-
5.3)
Michigan
5.4
(4.5
-
6.4)
5.8
(4.6
-
7.1)
13.5
(11.4
-
15.7)
3.9
(2.9
-
5.2)
Minnesota
5.6
(4.4
-
7.0)
7.0
(5.1
-
9.3)
13.7
(10.8
-
17.1)
4.0
(2.6
-
5.7)
Mississippi
5.0
(3.7
-
6.5)
5.5
(3.7
-
7.7)
10.8
(8.3
-
13.8)
3.8
(2.3
-
5.8)
Missouri
5.1
(3.8
-
6.6)
5.2
(3.6
-
7.2)
12.9
(9.9
-
16.5)
3.7
(2.3
-
5.6)
Montana
4.8
(3.7
-
6.1)
7.8
(5.6
-
10.4)
12.6
(9.7
-
16.0)
3.0
(1.8
-
4.7)
Nebraska
5.5
(4.3
-
7.0)
5.6
(3.7
-
8.0)
15.0
(11.6
-
19.0)
3.8
(2.4
-
5.6)
Nevada
5.5
(4.1
-
7.3)
8.4
(5.9
-
11.5)
11.4
(8.3
-
15.2)
4.3
(2.7
-
6.5)
New Hampshire
4.3
(3.3
-
5.6)
5.7
(3.9
-
8.1)
15.2
(11.4
-
19.8)
2.5
(1.5
-
3.9)
New Jersey
3.9
(2.9
-
5.1)
6.3
(4.4
-
8.6)
12.4
(9.3
-
16.1)
2.3
(1.3
-
3.8)
New Mexico
6.5
(5.0
-
8.3)
8.1
(5.7
-
11.0)
15.8
(12.1
-
20.0)
4.5
(2.9
-
6.7)
New York
4.6
(3.8
-
5.5)
6.2
(4.8
-
7.9)
14.9
(12.5
-
17.6)
2.8
(1.9
-
3.9)
North Carolina
4.1
(3.1
-
5.5)
5.6
(4.0
-
7.5)
8.9
(6.7
-
11.6)
3.2
(2.0
-
4.8)
North Dakota
5.7
(4.4
-
7.2)
8.7
(6.3
-
11.8)
13.4
(10.5
-
16.7)
3.7
(2.4
-
5.6)
Florida
3.8
(3.1
-
4.7)
4.7
(3.5
-
6.0)
9.8
(8.1
-
11.8)
2.9
(2.1
-
3.9)
Georgia
-
4.5
(3.4
-
6.0)
4.6
(3.3
-
6.2)
10.4
(7.8
-
13.5)
3.5
(2.2
-
5.3)
Hawaii
5.5
(3.9
-
7.7)
6.0
(3.9
-
8.6)
10.7
(7.6
-
14.6)
4.7
(2.8
-
7.3)
Idaho
4.5
(3.3
-
6.0)
5.7
(4.0
-
7.9)
9.4
(7.0
-
12.3)
3.3
(2.0
-
5.2)
Illinois
5.0
(4.1
-
6.0)
5.7
(4.6
-
7.0)
12.0
(10.2
-
14.0)
3.7
(2.7
-
5.0)
Indiana
4.6
(3.5
-
5.9)
5.8
(4.1
-
7.9)
36
Table 2.20: Percentages Reporting Past Year Illicit Drug or Alcohol Dependence, by Age Group and State: 1999.
AGE GROUP (Years)
Total
12-17
18-25
26 or Older
State
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Estimate
Prediction
Interval
Ohio
4.4
(3.7
-
5.2)
5.0
(3.8
-
6.3)
11.4
(9.7
-
13.3)
3.2
(2.3
-
4.2)
Oklahoma
4.5
(3.4
-
5.9)
4.7
(3.1
-
6.7)
11.9
(9.1
-
15.1)
3.2
(2.0
-
4.8)
Oregon
5.4
(3.9
-
7.2)
5.7
(4.0
-
7.9)
12.8
(9.8
-
16.5)
4.1
(2.4
-
6.5)
Pennsylvania
4.2
(3.4
-
5.0)
6.6
(5.3
-
8.2)
12.2
(10.3
-
14.2)
2.7
(1.8
-
3.8)
Rhode Island
5.0
(3.8
-
6.5)
6.1
(4.1
-
8.7)
16.6
(12.7
-
21.2)
3.2
(2.0
-
4.9)
South Carolina
4.3
(3.1
-
5.7)
4.5
(3.0
-
6.3)
8.7
(6.4
-
11.5)
3.5
(2.2
-
5.3)
South Dakota
5.3
(4.1
-
6.7)
7.6
(5.5
-
10.1)
14.6
(11.3
-
18.3)
3.2
(2.0
-
4.8)
Tennessee
4.6
(3.4
-
6.0)
4.5
(3.1
-
6.3)
11.1
(8.4
-
14.2)
3.6
(2.3
-
5.3)
Texas
4.6
(3.8
-
5.5)
6.0
(5.0
-
7.2)
11.1
(9.5
-
13.0)
3.1
(2.2
-
4.2)
Utah
5.0
(3.8
-
6.4)
4.7
(3.3
-
6.5)
9.7
(7.6
-
12.3)
3.8
(2.3
-
5.7)
Vermont
4.7
(3.6
-
6.0)
7.5
(5.3
-
10.3)
16.3
(12.4
-
20.7)
2.5
(1.5
-
4.0)
Virginia
4.1
(3.0
-
5.6)
4.7
(3.2
-
6.6)
8.6
(6.1
-
11.8)
3.3
(2.1
-
5.1)
Washington
5.6
(4.2
-
7.4)
5.5
(3.9
-
7.6)
13.8
(10.8
-
17.1)
4.3
(2.7
-
6.6)
West Virginia
3.7
(2.8
-
4.9)
6.3
(4.3
-
8.8)
9.5
(7.1
-
12.4)
2.5
(1.6
-
3.9)
Wisconsin
4.7
(3.7
-
5.9)
6.4
(4.6
-
8.5)
12.6
(9.8
-
15.9)
3.1
(2.0
-
4.5)
Wyoming
5.5
(4.2
-
7.1)
8.0
(5.9
-
10.7)
12.8
(9.9
-
16.1)
3.7
(2.3
-
5.7)
NOTE: Dependence is based on the definition found in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
NOTE: Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and the prediction (credible) intervals are generated by Markov Chain Monte Carlo techniques.
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
.
37
Children and substance dependence
Children of parents who use substances are more at risk for alcohol and drug use, delinquency and depression, and poor school performance (NHSDA, 1998a). The following section uses data from the 1996 National Household Survey on Drug Abuse to estimate the number of children who may be affected by parental substance use.
Approximately four and a half million children under the age of 18, or 6 percent of all children under the age of 18, lived in a household where one or more parent was in need of substance abuse treatment. Almost 3 million children, or 3.8 percent, had one or more parents who were dependent on illicit drugs. Six million children, or 8.3 percent, lived with one or more parents who were dependent on alcohol and 7.5 million children, or 10 percent, lived with one or more parents who were dependent on alcohol or illicit drugs.
These data by detailed age groups are presented in Tables 2.21 through 2.24. A person is considered in need of treatment for illicit drug abuse when they report at least one of the following:
• Dependence on any illicit drug in the past year using criteria similar to those of the DSM-IV
• Frequent illicit drug use in the past year (i.e., using marijuana daily, using cocaine, hallucinogens or inhalants weekly; or nonmedical use of analgesics, sedatives, tranquilizers, or stimulants weekly)
• Injection drug use in the past year
• Any heroin use in the past year
• Having received treatment for illicit drug use in the past year
Table 2.21: Estimated Number and Percentage of Children1 in Household2 Who Had One or More Parent in Need of Treatment for Illicit Drug Abuse, by Children’s Ages: NHSDA 1996.
Ages of Children (Years)
Estimated population <17
Estimated population <17 who had one or more parent in need of treatment
Percentage of population <17 who had one or more parent in need of treatment
Under 2
8,590,119
539,433
6.3
2-5
18,766,120
1,206,827
6.4
6-9
18,333,494
1,076,074
5.9
10-13
15,015,264
797,348
5.3
14-17
13,801,727
840,883
6.1
Total
74,506,723
4,460,565
6.0
1 Children are defined as biological, step, adoptive or foster.
2 Children age 17 and younger who were not living with one or more parent for most of the quarter of the NHSDA interview are excluded from the present analysis. According to the March 1995 Current Population Survey this amounts to approximately 3 million or 4 percent of children under 18 years of age.
Source: SAMHSA, 1998a. Analyses of Substance Abuse and Treatment Need Issues. 38
Table 2.22: Estimated Number and Percentage of Children1 in the Household2 Who Had One or More Parent Dependent on Illicit Drugs, by Children’s Ages: NHSDA 1996.
Ages of Children
(Years)
Estimated Population < 172
Estimated Population < 172 who had one or more parent dependent on illicit drugs
Percentage of population < 172 who had one or more parent dependent on illicit drugs
Under 2
8,590,119
378,366
4.4
2 - 5
18,766,120
727,827
3.9
6 - 9
18,333,494
702,221
3.8
10-13
15,015,264
539,747
3.6
14-17
13,801,727
477,797
3.5
Total
74,506,723
2,825,957
3.8
1Children are defined as biological, step, adoptive or foster.
2Children age 17 and younger who were not living with one or more parent for most of the quarter of the NHSDA interview are excluded from the present analysis. According to the March 1995 Current Population Survey this amounts to approximately 3 million or 4 percent of children under 18 years of age.
Source: SAMHSA, 1998a. Analyses of Substance Abuse and Treatment Need Issues.
Table 2.23:Estimated Number and Percentage of Children1 in the Household2 Who Had One or More Parent Dependent on Alcohol, by Children’s Ages: NHSDA 1996.
Ages of Children
(Years)
Estimated Population < 172
Estimated Population < 172 who had one or more parent dependent on alcohol
Percentage of population < 172 who had one or more parent dependent on alcohol
Under 2
8,590,119
678,923
7.9
2 - 5
18,766,120
1,551,952
8.3
6 - 9
18,333,494
1,616,156
8.8
10-13
15,015,264
1,225,437
8.2
14-17
13,801,727
1,115,056
8.1
Total
74,506,723
6,187,524
8.3
1Children are defined as biological, step, adoptive or foster.
2Children age 17 and younger who were not living with one or more parent for most of the quarter of the NHSDA interview are excluded from the present analysis. According to the March 1995 Current Population Survey this amounts to approximately 3 million or 4 percent of children under 18 years of age.
Source: SAMHSA, 1998a. Analyses of Substance Abuse and Treatment Need Issues. 39
Table 2.24: Estimated Number and Percentage of Children1 in the Household2 Who Had One or More Parent Dependent on Alcohol and/or Illicit Drugs, by Children’s Ages: NHSDA 1996.
Ages of Children(Years)
Estimated Population < 17
who had one or more parent
dependent on alcohol and/or
illicit drugs
Estimated Population < 172
2
Percentage of population < 172 who had one or more parent dependent on alcohol and/or illicit drugs
Under 2
8,590,119 867,674 10.1
2 - 5 18,766,120 1,884,394 10.0
6 - 9
18,333,494
1,912,796
10.4
10-13
15,015,264
1,464,345
9.8
14-17
13,801,727
1,353,769
9.8
Total
74,506,723
7,482,978
10.0
1Children are defined as biological, step, adoptive or foster.
2Children age 17 and younger who were not living with one or more parent for most of the quarter of the NHSDA interview are excluded from the present analysis. According to the March 1995 Current Population Survey this amounts to approximately 3 million or 4 percent of children under 18 years of age.
Source: SAMHSA, 1998a. Analyses of Substance Abuse and Treatment Need Issues.
Arizona and substance dependence
This section contains substance dependency information specific to Arizona. Arizona estimates for substance abuse derived from the National Household Survey on Drug Abuse are presented in Table 2.25. 5.3 percent of Arizona’s population is estimated to be dependent on illicit drugs or alcohol. The highest rate, 11.4 percent, is found among people between the ages of 18 and 25.
Another estimate of substance dependence in Arizona comes from the Arizona Substance Abuse Needs Assessment Study conducted by the Arizona Department of Health Services in 1996 (Arizona Department of Health Services [ADHS], 1998). This telephone survey of more than 8,600 randomly selected households in Arizona measured alcohol and drug use as well as substance abuse problems using criteria for drug dependency in the third edition of the DSM, Revised.
In 1996, an estimated 10.2 percent of Arizona’s population had a current problem with alcohol or drugs and 6.3 percent had a past problem with these substances. A current problem was defined as at least one recurring abuse/dependence symptom within the past 18 months and active use of drugs and/or alcohol. Problems with alcohol were reported most frequently with 9.6 percent of Arizonans estimated to be dependent on alcohol. Among illicit drugs, problems with marijuana and stimulants were reported most frequently. This data can be found in Table 2.26.
40
Table 2.25. Estimates of Past Month Use of Selected Drugs and Past Year Substance Dependence in Arizona, by Age Group: 1999.
AGE GROUP (Years)
Drug Characteristic
Total
12-17
18-25
26 or Older
RATE ESTIMATES (Percent)
PAST MONTH USE
Any Illicit Drug1
7.1
10.7
13.7
5.4
Marijuana
5.4
7.5
12.1
3.9
Any Illicit Drug Other Than Marijuana1
3.4
5.2
5.9 2.8
Cigarette
24.4
14.5
39.1
23.3
Binge Alcohol2
19.2
12.6
35.4
17.4
PAST YEAR DEPENDENCE3
Illicit Drug
2.0
3.1
4.7
1.4
Illicit Drug or Alcohol
5.3
6.6
11.4
4.1
POPULATION ESTIMATES (In Thousands)
PAST MONTH USE
Any Illicit Drug1
267
46
68
153
Marijuana
203
32
60
111
Any Illicit Drug Other Than Marijuana1
130
22
29
78
Cigarette
919
62 194
663
Binge Alcohol2
725
53
176
495
PAST YEAR DEPENDENCE3
Illicit Drug
75
13
23
39
Illicit Drug or Alcohol
200
28
57
115
NOTE: Estimates are based on a survey-weighted hierarchical Bayes estimation approach.
1 Any Illicit Drug indicates use at least once of marijuana/hashish, cocaine (including crack), inhalants, hallucinogens (including PCP and LSD), heroin, or any prescription-type psychotherapeutic used nonmedically. Any Illicit Drug Other Than Marijuana indicates use at least once of any of these listed drugs, regardless of marijuana/hashish use; marijuana/hashish users who also have used any of the other listed drugs are included.
2 "Binge" Alcohol Use is defined as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days. By "occasion" is meant at the same time or within a couple hours of each other.
3 Dependence is based on the definition found in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Source: SAMHSA, 2000. Summary of Findings from the 1999 National Household Survey on Drug Abuse.
41
Table 2.26: Prevalence of Current and Past Problems: Arizona Adults.
Past Problems Current Problems
%
Number of Adults
%
Number of Adults
Alcohol
5.1%
108,000
9.6%
204,000
Drugs
2.0%
42,000
1.7% 36,000
Any Problem (alcohol or drug)
6.3%
134,000
10.2%
217,000
Illicit Drug Problems
Marijuana
1.4%
30,000
0.9%
19,000
Cocaine
1.3%
28,000
0.4%
*
Stimulants
0.9%
19,000
0.8%
17,000
Hallucinogens
0.4%
*
0.2%
*
Narcotics (plus Heroin)
0.6%
13,000
0.1%
*
Sedatives
0.3%
*
0.1%
*
Inhalants
<.01%
*
0%
*
Source: ADHS, 1998. Substance Abuse in Arizona: Final Report of the 1996 Telephone Household Survey.
Table 2.27 compares Arizona substance problem estimates with data available from other states.
Table 2.27: Prevalence of Current Alcohol/Drug Problems: National Comparisons.
Any Problem (alcohol or drugs)
Alcohol Problem
Drug Problem
Iowa
10.6%
9.5%
1.1%
Arizona
10.2%
9.6%
1.7%
South Carolina
8.2%
7.6%
Not available
Colorado
8.0%
7.5%
1.2%
Washington
7.8%
7.1% 1.8%
Maryland
5.6%
4.9%
0.7%
Source: ADHS, 1998. Substance Abuse in Arizona: Final Report of the 1996 Telephone Household Survey.
The Arizona Telephone Household Survey was also able to compare regions of the state. This information is detailed in Tables 2.28 and 2.29. The rural south reported more problems with alcohol than the urban counties of Maricopa and Pima and the rural north reported more problems with drugs than either of the urban counties. Mohave County has the highest rate of problems with drugs and alcohol and Apache and Navajo counties have the lowest percentage of people estimated to have problems with these substances. Note that the survey did not include reservations.
Table 2.28: Prevalence of Current Alcohol/Drug Problems by Area.
Alcohol
Drug
Pima 9.3%
1.4%
Maricopa
9.6%
1.6%
Rural North
9.2%
2.6%
Rural South
10.5%
1.8%
Source: ADHS, 1998. Substance Abuse in Arizona: Final Report of the 1996 Telephone Household Survey.
42
Table 2.29: Weighted Prevalence Estimates by County or Region1.
Past Problem
Current Problem
Population
SampleSize
Alcohol
Drugs
Weighted Total (Alcohol/Drugs
Alcohol
Drugs
Weighted Total(Alcohol/Drugs)
Apache and Navajo
28,815
202
6.1%
2.2%
7.8%
6.5%
1.9%
6.5%
Cochise, Graham, Greenlee and Santa Cruz
90,856
506
5.7%
0.6%
5.9%
9.3%
1.0%
9.4%
Coconino County
50,303
290
10.1%
5.1%
12.6%
7.6%
2.1%
8.9%
Gila and Pinal
80,927
479
3.2%
1.5% 4.4%
11.5%
2.4%
12.9%
La Paz and Yuma
63,922
329
4.3%
1.3%
5.2%
10.2%
2.0%
11.1%
Mohave
52,346
311
7.7%
4.0%
10.4%
13.3%
4.1%
15.5%
Yavapai
58,497
471
8.9%
1.7%
9.9%
8.7%
2.0%
9.5%
Maricopa East 394,899
1,361
4.8%
1.3%
5.4%
9.7%
1.6%
10.2%
Maricopa Northeast
447,642
1,408
4.2%
1.8%
5.2%
10.7%
2.1%
11.5%
Maricopa West
454,298
1,639
4.6%
2.3%
6.2%
8.6%
1.2%
8.9%
1 Estimates do not include reservations.
Source: ADHS, 1998. Substance Abuse in Arizona: Final Report of the 1996 Telephone Household Survey.
43
As shown in Table 2.30 men were more than twice as likely as women to have a current problem with any substance and close to three times as likely to have a problem with alcohol.
Table 2.30: Prevalence of Current Substance Abuse Problems by Gender.
Any Current Problem
Alcohol Problem
Drug Problem
Men
14.7%
13.9%
2.2%
Women
6.0%
5.5%
1.2%
Source: ADHS, 1998. Substance Abuse in Arizona: Final Report of the 1996 Telephone Household Survey.
Table 2.31 describes the relationship of substance problems to race and ethnicity.
Table 2.31: Prevalence of Current Substance Abuse Problems by Race/Ethnicity.
Any Problem (alcohol or drug)
Alcohol Problem
Drug Problem
White
10.6%
10%
1.7%
Hispanic
9.3%
8.6%
1.6%
Other
8.2%
7.3%
2.4%
Source: ADHS, 1998. Substance Abuse in Arizona: Final Report of the 1996 Telephone Household Survey.
According to the information provided in Table 2.32, the majority of people with drug and alcohol problems are men between the ages of 18 and 34. A larger percentage of adults with drug problems have not graduated from high school and earn less than $15,000. People with alcohol and drug problems are more likely to be unemployed and have no health insurance.
Table 2.32: Profile of Adults with and without Substance Abuse Problems.
Adults with Alcohol Problems
Adults with Drug Problems
Adults with No
Problem
Men
73%
60%
48%
White
79%
69%
76%
18-34 years old
65%
73%
46%
Not High School Grad
9%
22%
18%
Married
37%
27%
59%
Less than $15,000/year
12%
33%
12%
Unemployed
5%
7.4%
2.8%
No Health Insurance
21%
49%
18%
Source: ADHS, 1998. Substance Abuse in Arizona: Final Report of the 1996 Telephone Household Survey.
44
Chapter 3: Pathological Gambling
Introduction
An understanding of gambling behavior and its consequences is important for two reasons. First it is associated with a wide range of personal and social problems such as divorce, job loss, bankruptcy, and arrest and incarceration (National Opinion Research Center, 1999). Health problems have also been identified including insomnia, gastrointestinal disorders, cardiac problems, and high blood pressure (Petry and Armentano, 1999). Problem gambling also occurs in conjunction with mental health problems such as substance abuse, anxiety disorders, and depressive disorders (Petry and Armentano, 1999). Pathological and problem gamblers in the U.S. cost society approximately $5 billion per year and an additional $40 billion in lifetime costs for productivity reduction, social services, and creditor losses (National Opinion Research Center, 1999). This does not capture costs of divorce and family disruption. The social, physical, and financial consequences of problem gambling are significant.
Second, gambling opportunities and behaviors have increased. The total amount of money legally wagered nationwide increased from $17.3 billion in 1974 to $586.5 billion in 1996 (Shaffer, Hall, and Vander Bilt, 1997). Per capita spending on lottery products increased from $20 to $150 per year from 1975 to 1996 (Shaffer, Hall, and Vander Bilt, 1997). The number of state lotteries has also increased over 200% from a total of 7 in 1973 to 38 in 1997 (Clotfelter and Cook, 1990). The increase described in these figures may result in a similar increase in the social and financial costs associated with problem gambling.
Disordered gambling has been studied since the mid-1970s and was first accepted by the American Psychiatric Association in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). According to the most recent edition of the DSM, pathological gambling is a persistent and recurrent maladaptive gambling behavior indicated by five or more of the following criteria presented in Table 3.1.
Two sources provide substantial information on the prevalence of gambling behaviors and will be referred to frequently in this fact book. The first is a meta-analysis conducted by Howard J. Shaffer, Matthew N. Hall, and Joni Vander Bilt at the Harvard Medical School, Division on Addictions (1999). Meta-analysis is a research technique that integrates the findings of independent studies and allows for comparisons to be made between studies. One hundred and twenty studies from the U.S. and Canada were included in the meta-analysis.
The second source is a 1998 national study, the Gambling Impact and Behavior Study, conducted by the National Opinion Research Center for the National Gambling Impact Study Commission. This study used five methods of data collection including a representative telephone survey of 2,417 adults (aged 18 and older) and an intercept survey of 530 adult patrons of 21 gaming facilities.
45
Table 3.1: DSM-IV Criteria for Pathological Gambling.
1. Is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
2. Needs to gamble with increasing amounts of money in order to achieve the desired excitement
3. Is restless or irritable when attempting to cut down or stop gambling
4. Gambles as a way of escaping from problems or relieving dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, or depression)
5. After losing money gambling, often returns another day in order to get even (“chasing one’s losses”)
6. Lies to family members, therapists, or others to conceal the extent of involvement with gambling
7. Has made repeated unsuccessful efforts to control, cut back, or stop gambling
8. Has committed illegal acts (e.g., forgery, fraud, theft, or embezzlement) in order to finance gambling
9. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
10. Has relied on others to provide money to relieve a desperate financial situation caused by gambling.
Source: American Psychiatric Association, 1994. Desk Reference to the Diagnostic Criteria from DSM-IV.
Nonproblematic Gambling
The following tables provide information about the prevalence of gambling behaviors in the U.S.
Table 3.2 presents data from the meta-analysis conducted by Shaffer, Hall, and Vander Bilt and includes a review of 20 studies published from 1988 to 1997. A large percentage of the population, a median of 87 percent, reports ever gambling in their life. A more accurate measure of current gambling behaviors is reports of past year gambling. A median of 72 percent of people responding in these various surveys report having gambled in the past year.
46
Table 3.2: Percentage of the Adult Population Reporting Lifetime and Past-Year Gambling for Different Types of Gambling (Surveys Conducted 1988-1997).
Lifetime
Past Year
No. of Studies
% Range
Median %
No. of Studies
% Range
Median %
Any gambling
17
64-96
87
11
49-88
72
Lottery
11
28-81
64
10
5-40
24
Video Lottery terminal
9
09-54
26
6
6-44
26
Casino
8
19-66
36
7
6-44
27
Charitable
7
13-67
38
3
4-40
04
Pari-mutuel
11
15-37
30
9
4-12
08
Sports
11
20-45
29
9
9-26
17
Cards
9
20-49
26
5
10-20
18
Skill
6
13-25
18
2
11
11
Financial markets
9
07-20
12
5
5-7
5
Illicit
2
56-65
60
4
4-39
18
Source: The National Academy of Sciences, 1999. Pathological Gambling: A Critical Review.
Two national studies of gambling behavior have been conducted. The first was published in 1976 by the Commission on the Review of the National Policy Toward Gambling. The second study, referred to above, was conducted in 1998 and was sponsored by the National Gambling Impact Study Commission. Key findings from the 1998 study and comparisons with the 1975 are presented in Table 3.3
47
Table 3.3: Key findings from the Gambling Impact and Behavior Study, 1999.
Changes in Gambling Participation Over Time
Pathological and problem gambling
• Since the 1975 survey, the ratio of adults who have never gambled fell from one out of three to one out of seven. Gambling expenditures increased from 0.30 percent of personal income to 0.74 percent of personal income.
• Lotteries and casinos are the most common forms of gambling. Since 1975 the proportion of adults who played the lottery in the past year has doubled and the proportion who gambled in a casino in the past year has more than doubled.
• Since 1975, proportionately fewer people aged 18 to 44 years are gambling and proportionately more people 45 and older are gambling. The most dramatic increase is among adults 65 and older.
• Based on DSM-IV criteria, 2.5 million adults are pathological gamblers and another 3 million could be considered problem gamblers
• Fifteen million adults are at risk for problem gambling and about 148 million are low-risk gamblers.
• Pathological, problem, and at-risk gambling are proportionately higher among African Americans although African Americans comprise a minority of all pathological gamblers
• The availability of a casino within 50 miles is associated with about double the prevalence of problem and pathological gamblers
• Pathological gamblers and problem gamblers are more likely than other gamblers or nongamblers to have been on welfare, declared bankruptcy or to have been arrested or incarcerated
• Pathological and problem gamblers are more likely than low-risk gamblers to have been troubled by mental or emotional problems and to have received mental health care in the past year.
• Pathological and problem gamblers comprise about 2.5 percent of adults and account for 15 percent of casino, lottery, and pari-mutuel receipts from the gamblers represented in the surveys.
Source: National Opinion Research Center, 1999. Gambling Impact and Behavior Study.
48
A more detailed comparison of information from the two studies is presented in Table 3.4
Table 3.4: Comparison of 1975 and 1998 Studies on Various Items.
1975
1998
Past year bettors
61%
63%
Lifetime bettors
68%
86%
49%
64%
Past year gambling by selected games
Casino
10%
29%
Lottery
24%
52%
Bingo
19%
6%
Horse racing
14%
7%
Sex of past year gamblers
Male
52%
51%
Female
48%
Lifetime gaming by age group
18-24
75%
80%
25-44
74%
88%
45-64
67%
88%
65+
35%
80%
Past year gaming by age group
18-24
73%
25-44
69%
67%
45-64
60%
66%
65+
23%
50%
Source: National Opinion Research Center, 1999. Gambling Impact and Behavior Study.
Problem Gambling
The following section looks at information related to gambling behavior that various authors and studies have referred to as disordered, problematic, or pathological.
Key findings from the meta-analysis conducted by Shaffer, Hall, and Vander Bilt are presented in Table 3.5.
49
Table 3.5: Key Findings from Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Meta-analysis.
• Gambling disorders have increased among adults in the general population over the past two decades
• Gambling disorders have not increased over the past two decades among adolescents and adults in prison or treatment.
• Gambling disorders are significantly more prevalent among youth than among the adult general population.
• Males are significantly more likely to have a gambling disorder than females.
• Individuals with psychiatric problems have much higher rates of disordered gambling than either adolescents or adults from the general population.
• There is no significant regional variation in gambling disorder rates for the United States or Canada.
Source: Shaffer, Hall, & Vander Bilt, 1997. Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Meta-analysis.
Table 3.6 provides information about pathological gamblers from the meta-analysis. In an effort to standardize terms used in the various studies, a level system was created. Level 0 refers to nongamblers; Level 1 describes social or recreational gamblers who do not experience gambling problems; Level 2 represents gamblers with less serious gambling problems; and Level 3 denotes pathological gambling.
The median lifetime prevalence of pathological gambling (Level 3) across all the studies reviewed was 1.5 percent. A median of 5.4 percent was computed for the prevalence of lifetime problem and pathological gambling (Level 2 and Level 3 combined). The median past year problem gambling (Level 2) was computed at 2.2 percent across the studies and past year pathological gambling (Level 3) was computed to be 0.9 percent (National Academy of Sciences, 1999).
The researchers also looked at the percentage of problem and pathological gambling among those who gamble. This information is presented in the last two columns. Approximately 3 to 7 percent of those people who gambled in the year prior to the survey reported problem (Level 2) or pathological (Level 3) gambling (National Academy of Sciences, 1999).
50
Table 3.6: Percentage Classified as Pathological or Problem Gamblers in Adult Population Samples (Surveys Conducted 1988-1997).
Lifetime
(All Respondents)
Past Year
(All Respondents)
Past Year
(Gamblers Only)
Year
State
Level2 & 3
Level 2
Level
3
Level2 & 3
Level 2
Level 3
Level2 & 3
Level 3
1989
California
1.2
1996
Connecticut
5.4 4.2 2.8 0.7
2.8 1.2
1995 1.9 4.6
Louisiana 4.8 1.4
Washington
1.2
2.2
0.6
3.2
1994
Georgia
4.4
1.6
2.3
1.5
0.8
3.5
1990
Indiana
5.6
5.5
0.1
Iowa
5.4
3.5
3.3
2.3
1.0
1.4
1995
7.0
4.5
2.5
3.4
6.6
1.9
1988
Maryland
3.9
2.4
1.5
1989
Massachusetts
2.3
1994
Minnesota
4.4
3.2
1.2
6.8
1.8
1996
Mississippi
6.8
3.7
3.1
4.9
2.8
2.1
10.0
4.3
1992
Montana
3.6
2.3
1.3
2.2
1.5
0.7
1988
New Jersey
4.2
2.8
1.4
1996
New Mexico
14.7
11.2
3.4
1996
New York
7.3
4.7
2.6
3.6
2.2
1.4
4.5
1.8
1992
North Dakota
3.5
2.5
1.0
2.0
1.3
0.7
2.7
1.0
1993
South Dakota
2.3
1.4
0.9
1.2
0.7
0.5
1995
Texas
5.4
3.6
1.8
3.0
2.2
0.8
4.4
1.2
1992
5.0
3.4
1.4
2.8
1.9
0.9
3.5
1.1
1995
Wisconsin
12.9
12.0
0.9
1990
Not reported
2.0
Source: The National Academy of Sciences, 1999. Pathological Gambling: A Critical Review.
In order to see changes in gambling behavior over time, it is helpful to compare results of surveys that have been conducted more than once. Table 3.7 lists states that have conducted repeated surveys and their findings for problem (Level 2) and pathological (Level 3) gambling. The authors of the original report note that in the cases of Iowa, Minnesota, and Texas, survey dates encompassed the introduction of new gambling opportunities. In these states, pathological, problem, and pathological and problem gambling all showed increases. These increases were statistically significant for Iowa and Minnesota (National Academy of Sciences, 1999).
51
Table 3.7: Percentage of (Level 3) Pathological and/or (Level 2) Problem Gamblers in Adult Population Samples in States with Repeated Surveys.
Lifetime
(All Respondents)
Past Year
(All Respondents)
Past Year
(Gamblers Only)
Year
State
Level2 & 3
Level 2
Level 3
Level2 & 3
Level 2
Level 3
Level 2 & 3
Level 3
1991
Connecticut
6.3
3.6
2.7
1996
Connecticut
5.4
4.2
1.2
2.8
2.2
0.6
3.2
0.7
1988
Iowa
1.7
1.6
0.1
1995
Iowa
5.4
3.5
1.9
3.3
2.3
1.0
4.6
1.4
1990
Minnesota
2.5
1.6
0.9
4.0
1.4
1994
Minnesota
4.4
3.2
1.2
6.8
1.8
1986
New York
4.2
2.8
1.4
1996
New York
7.3
4.7
2.6
3.6
2.2
1.4
4.5
1.8
1991
South Dakotaa
2.8
1.8
1.0
1.4
0.8
0.6
1993
South Dakotaa
2.3
1.4
0.9
1.2
0.7
0.5
1992
Texas
4.8
3.5
1.3
2.5
1.7
0.8
5.1
1.6
1995
Texas
5.4
3.6
1.8
3.0
2.2
0.8
4.4
1.2
a The South Dakota surveys asked about gambling problems within the past six months rather than past year.
Source: The National Academy of Sciences, 1999. Pathological Gambling: A Critical Review.
Pathological gambling may be associated with certain types of gambling. Table 3.8 investigates this issue and presents the range of differentials between Level 1 and Level 2 and 3 combined gamblers for the various studies. The last column provides a median value for the differences. The percent of problem and pathological gamblers participating in each activity was greater than the percent of gamblers without problems. Problem and pathological gamblers were more active in bingo and charitable games, lotteries, racetrack betting, sports betting, and casino games.
52
Table 3.8: Participation Rates in Different Types of Gambling for Nonproblem and Problem and Pathological Gamblers Combined.
Gambling Activity
Number of Studies
Range of % Differences Between Level 1 and Level 2/3 Combined
Median % Difference Between Level 1 and Level 2/3 Combined
Bingo, charitable games
3
12-24
21
Lottery, general
9
8-29
20
Instant/daily lottery, pulltabs
11
7-33
16
Racetrack, horse races
3
10-27
18
Sports betting
11
6-35
16
Casino, casino games
8
7-24
15
Card games
6
8-34
12
Games of skill
2
12-13
12
Video poker
2
7-18
12
Source: The National Academy of Sciences, 1999. Pathological Gambling: A Critical Review.
Table 3.9 presents data in the meta-analysis categorized by population. The authors of the study concluded that adolescents participating in these surveys reported a significantly higher percentage of Level 3 and Level 2 gambling for both lifetime and past year reporting periods than did adults. College students also had consistently higher estimates of lifetime pathological gambling than the adults surveyed. The treatment/prison population had the highest prevalence of disordered gambling of all groups studied (Shaffer, Hall, and Vander Bilt, 1999).
Table 3.9: Mean Disordered Gambling Prevalence Estimates and Prediction Intervals for 4 Study Populations.
Adult
Adolescent
College
Treatment/Prison
Level 3 lifetime
1.6 (1.35, 1.85)
3.88 (2.33, 5.43)
4.67 (3.44, 5.90)
14.23 (10.70, 17.75)
Level 2 lifetime
3.85 (2.94, 4.76)
9.45 (7.62, 11.27)
9.28 (4.43,14.12)
15.01 (8.94, 21.07)
Level 1 lifetime
94.67 (93.71, 95.62)
89.56 (85.88, 93.25)
86.66 (80.90, 92.42)
71.54 (62.90, 80.18)
Level 3 past year
1.14 (0.90, 1.38)
5.77 (3.17, 8.37)
-
-
Level 2 past year
2.80 (1.95, 3.65)
14.82 (8.99, 20.66)
-
-
Level 1 past year
96.04 (95.04, 97.04)
82.31 (75.59, 89.03)
-
-
Source: Shaffer, Hall, and Vander Bilt, 1999. Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Research Synthesis.
53
The analysis also looked at the prevalence of Level 2 and Level 3 gambling over time. These data are reported in Table 3.10 and show that gambling disorders significantly increased between 1974 and 1997 (Shaffer, Hall, and Vander Bilt, 1999).
Table 3.10: Mean Adult Disordered Gambling Prevalence Estimates for Premedian-Year and Post median-Year Groups.
Early Studies (1977-1993)
Recent Studies (1994-1997)
Lifetime level 2
2.93
4.881
Lifetime combined
4.38
6.721
Past year level 3
0.84
1.291
1 Significantly higher than early studies’ estimates; P<.05
Source: Shaffer, Hall, and Vander Bilt, 1999. Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Research Synthesis
Findings from the Gambling Impact and Behavior Study are presented in the following tables. Table 3.11 shows prevalence estimates for pathological, problem, and at-risk gambling as reported by phone survey respondents and phone survey and patron survey combined. Pathological, problem, and at-risk gambling are defined in the second column.
About one in seven or 29 million adults have never gambled and about 148 million adults could be considered low-risk gamblers. The authors of the study estimate that there are about 2.5 million pathological gamblers, 3 million problem gamblers, and 15 million at-risk gamblers in the United States (National Opinion Research Center, 1999).
Table 3.11: Prevalence of Pathological and Problem Gambling.
Definition
Phone only
(n=2,417)
Phone and patron
(n=2,947)
Past-year pathological
0.1%
0.6%
Lifetime pathological
5+
DSM-IV criteria and lost more than $100 in a single day or year
0.8%
1.2%
Past-year problem
0.4%
0.7%
Lifetime problem
3 or 4
DSM-IV criteria and lost more than $100 in a single day or year
1.3%
1.5%
Past-year at-risk
2.3%
2.9%
Lifetime at-risk
1 or 2
DSM-IV criteria and lost more than $100 in a single day or year
7.9%
7.7%
Source: The Wager, 1999. National Gambling Impact Study Commission: Part I.
Table 3.12 shows the prevalence of gambling types by demographic group for the phone survey and patron survey combined. Men have higher rates than women of at-risk, problem, and pathological gambling do. People over 65 were less likely to engage in at-risk, problem, or pathological gambling than younger respondents. African Americans
54
reported higher rates of at-risk, problem, and pathological gambling than whites (National Opinion Research Center, 1999).
Table 3.12: Prevalence of Gambling by Demographic Group, Phone Survey and Patron Survey Combined.
At-risk (n=267)
Problem (n=56)
Pathological (n=67)
Lifetime
Past-year
Past-year
Lifetime
Past-year
Gender
Male
9.6
3.9
2.0
0.9
0.8
Female
6.0
2.0
1.1
0.6
0.8
0.3
Race
White
6.8
2.7
1.4
0.6
1.0
0.5
Black
9.2
4.2
2.7
1.7
3.2
1.5
Hispanic
3.7
0.9
0.7
0.5
0.1
Other
8.8
1.8
1.2
0.5
0.9
0.4
Age
18-29
10.1
3.9
2.1
1.0
1.3
0.3
30-39
6.9
2.1
1.5
0.8
0.6
40-49
8.9
3.3
1.9
0.7
1.4
0.8
Lifetime
1.7
12.7
1.0
50-64
6.1
3.6
1.2
0.3
2.2
0.9
65+
6.1
1.7
0.7
0.6
0.4
0.2
Education
Less than HS
10.0
2.4
1.7
1.2 2.1
1.0
HS graduate
8.0
3.5
2.2
1.1
1.9
1.1
Some college
7.9
3.5
1.5
0.8
1.1
0.3
College graduate
6.4
2.0
0.8
0.2
0.5
0.1
Income
<$24,000
7.3
2.6
1.6
0.7
1.7
0.9
$24,000-49,999
6.9
3.2
1.8
0.9
1.4
0.6
$50,000-99,999
8.0
2.5
1.3
0.7
0.9
0.2
>$100,000
13.4
4.9
1.4
0.4
0.7
0.2
Source: The Wager, 1999. National Gambling Impact Study Commission: Part I.
One might think that people with gambling related difficulties would perceive gambling to be a good thing. According to Table 3.13, pathological gamblers, more than any other group, believe the opposite and think that gambling has a negative impact. At-risk, problem, and pathological gamblers also differ from those people at low-risk for gambling in that they gamble for excitement and to win money (National Opinion Research Center, 1999).
55
Table 3.13: Attitudes Toward Gambling in Phone and Patron Survey by Lifetime and Past-Year Gambler Type.
Attitude Toward Gambling
Low Risk
At Risk
Problem Gamblers
Pathological Gamblers
Life
Past-year
Life
Past-year
Life
Past-year
Life
Past-year
Overall impact is bad/very bad
32%
24%
21%
11%
27%
18%
49%
19%
Excitement is important/very important
35%
36%
63%
81%
83%
93%
85%
86%
Winning money is important/very important
62%
63%
79%
88%
89%
84%
95%
94%
Usually gamble with friends, family
64%
65%
70%
64%
62%
71%
81%
81%
Source: National Opinion Research Center, 1999. Gambling Impact and Behavior Study.
The Gambling Impact and Behavior Study also looked at the economic consequences of gambling. Employment experiences by gambler type are presented in Table 3.14. Pathological gamblers reported high employment rates but were more likely to have lost or been fired from a job. Problem gamblers reported being significantly more likely to have been unemployed or not working at the time of their interview (National Opinion Research Center, 1999)
Table 3.14: Employment Experiences, by Type of Gambler (Lifetime Only).
Type of Characteristic
Non-gambler
Low risk
At risk
Problem gambler
Path. Gambler
Employed currently
55.3
73.3
71.5
58.9
76.3
Any employment past year
64.4
78.8
80.3
77.2
82.3
Among those Working Past Year
Any unemployment
21.5
12.7
17.7
23.8
15.9
Months unemployed
1.6
0.9
1.3
1.8
1.3
Lost a job/fired past year
2.6
4.0
5.6
10.8
13.8
Hourly wage (phone survey only)
$14.60
$18.20
$18.10
$18.00
$17.90
Source: National Opinion Research Center, 1999. Gambling Impact and Behavior Study.
As shown in Table 3.15 pathological gamblers have significantly higher rates of bankruptcy. Pathological gamblers also have greater debt, 25 percent greater than low risk gamblers and about 120 percent greater than non-gamblers. When debt is compared to income, pathological gamblers owe $1.20 for every dollar of annual income. Low-risk and nongamblers owe $0.80 and $0.60 respectively.
56
Table 3.15: Financial Characteristics and Impacts, by Type of Gambler.
Characteristic
Non-gambler
Low-risk
At-risk
Problem gambler
Path. Gambler
Any unemployment benefits, 12 mos.
4.6
4.0
10.9
10.9
15.0
Received welfare benefits, 12. Nos
1.9
1.3
2.7
7.3
4.6
Household income, 12 mos. (phone survey)
$36,000
$47,000
$48,000
$45,000
$40,000
Household debt (phone survey)
$22,000
$38,000
$37,000
$14,000
$48,000
Filed bankruptcy, ever
4.2
5.5
4.7
10.3
19.2
Source: National Opinion Research Center, 1999. Gambling Impact and Behavior Study.
Criminal justice consequences associated with the various gambler types is presented in Table 3.16. Almost one-third of problem and pathological gamblers has been arrested and one-fifth of pathological gamblers has been incarcerated.
Table 3.16: Weighted Occurrence of Criminal Justice Consequences, by Type of Gambler.
Non-gambler
Low risk
At risk
Problem gambler
Path. Gambler
Arrested
4.5
11.1
20.7
36.3
32.3
Times arrested
1.7
2.1
2.9
1.6
3.3
Incarcerated (phone survey only)
0.4
3.7
7.8
10.4
21.4
Source: National Opinion Research Center, 1999. Gambling Impact and Behavior Study.
Table 3.17 compares the costs of pathological and problem gambling with other health problems.
Table 3.17: Economic Impact of Major Health Problems.
Type of Problem
Annual Cost (billions)
Prevalence (millions)
Annual Cost per Prevalent Case
Path./prob. gambling
$5
5.4
$900
Drug abuse
$110
6.7
$10,000
Alcohol abuse
$166
13.8
$7,000
Mental illness
$105
44
$2,300
Stroke
$30
3
$10,000
Heart disease
$125
21
$6,000
Diabetes
$92
15.5
$5,800
Motor vehicle crashes
$71
19
$3,600
Smoking
$72
46
$1,500
Source: National Opinion Research Center, 1999. Gambling Impact and Behavior Study. 57
Results of a survey conducted in five states is presented in Tables 3.18 and 3.19. The survey used random digit dialing and random selection of respondents within households to ensure that inferences could be drawn between the sample and the population in the five states. While this survey was conducted between 1988 and 1990 and is older than data presented in the Gambling Impact Behavior Study, it may be useful for comparison purposes.
Table 3.18 shows lifetime gambling rates and rates for pathological gambling within the five states studied. The author of the study noted that lifetime gambling rates, mean number of gambling activities, and pathological gambling rates are statistically significantly lower in Iowa than in the other states.
Table 3.18: Gambling Involvement and Prevalence of Pathological Gambling in the General Population.
State
Lifetime Gambling Participation, % (n=4500)
Mean No of Gambling Activities (n=4500)
Prevalence Rate, % (n=4500)
Massachusetts
90
3.51
2.3
Maryland
89
3.66
1.5
New Jersey
92
4.05
1.4
California
89
3.86
1.2
Iowa
84
3.05
0.1
Source: Volberg, R, 1994. The Prevalence and Demographics of Pathological Gamblers: Implications for Public Health.
Table 3.19 presents characteristics of pathological gamblers when compared to the overall survey sample. Pathological gamblers are significantly more likely to be male, non-White, to have lower education, and to be unmarried. Figures are also provided for pathological gamblers entering treatment in each of the five states. These individuals are mostly white, middle-aged men.
Studying gambling behavior in adolescents is important because of the potential for future gambling problems and the harmful effects gambling problems might pose to this vulnerable population (National Academy of Sciences, 1999). Studies conducted in North America have found that two out of three underage youth have gambled for money (Jacobs, 2000). Approximately 15.3 million youth aged 12 to 17 have gambled with or without adult knowledge and approval and as many as 2.2 million of these may be experiencing serious gambling related problems. Between 1984 and 1999, a substantial increase was noted in the proportion of youth who report gambling in the past year and youth reporting serious gambling related problems.
58
Table 3.19: Characteristics of Pathological Gamblers in Professional Treatment Programs and in the General Population.
TotalSurveySample (n=4442)
Probable Pathological Gamblers in Survey Sample (n=58)
New Jersey (n=155)
Maryland (n=276)
Massachusetts (n=137)
Iowa (n=135)
California (n=71)
Male,%
43
76
93
91
93
86
93
White,%
80
64
90
89
93
92
94
High School Graduate, %
90
79
89
84
93
87
98
Not married, %
46
62
41
60
29
49
69
Median age,y
-
34
38
38
37
35
33
Source: Volberg, R, 1994. The Prevalence and Demographics of Pathological Gamblers: Implications for Public Health.
59
Adolescent gambling data from Shaffer’s meta-analysis are presented in Table 3.20. A high percentage of adolescents, a median of 85 percent, have gambled at some time in their life. A smaller proportion, a median of 75 percent, have gambled within the past year. The types of gambling in which adolescents engaged most frequently were card games, lotteries, and games of skill.
Table 3.20: Percentages of Adolescents Reporting that They Have Participated in Various Types of Gambling.
Lifetime
Past Year
Form of Gambling
Range
Median
Number of Studies
Range
Median
Number of Studies
Any gambling
39-92
85
21
52-89
73
6
Cards
21-59
53
17
32-71
42
9
Casino
3-84
27
13
1-71
10
6
Financial markets
15-23
18
7
-
-
-
Illicit
2-10
9
3
-
-
-
Lottery
15-69
42
19
10-65
29
11
Pari-mutuel
7-41
20
15
4-29
9
8
Skill
12-51
41
17
22-60
31
10
Sports betting
11-49
31
17
16-53
40
10
Video lottery terminal
24-28
26
3
-
-
-
Note: the estimates above are independent and not necessarily from the same studies (i.e., some studies reported only lifetime proportions, and some studies reported both lifetime and past-year proportions of various forms of gambling participation).
Source: The National Academy of Sciences. Pathological Gambling: A Critical Review (1999).
Rates of problem and pathological gambling among adolescents as identified in the various studies contributing to the meta-analysis are presented in Table 3.21. A median rate of 20 percent was found for adolescent problem gamblers and a median rate of 6.1 percent was found for pathological gamblers. The authors of the report urged caution when considering the data due to the differences between studies. The proportion of adolescent pathological gamblers could be more than three times that of adults.
60
Table 3.21: Percentage Classified as Pathological and/or Problem Gamblers in Adolescent Samples (Surveys Conducted 1988-1997).
Lifetime
Past Year
Year
State
Sample
Levels 2 & 3
Level 2
Level 3
Levels 2 & 3
Level 2
Level 3
1989
Connecticut
High School
9.9
8.2
1.7
-
-
-
1996
Connecticut
High School
-
-
-
18.1
9.4
8.7
1995
Connecticut
College
-
2.5
-
-
-
-
1995
Florida
High School
-
-
-
27.7
23.0
4.7
1996
Georgia
Adolescent
10.1
6.7
3.4
-
-
-
1997
Louisiana
Middle/high
-
-
-
16.0
10.0
6.0
1995
Massachusetts
Middle/high
-
-
-
19.1
14.8
4.3
1993
Massachusetts
High school
-
-
-
-
-
4.4
1994
Massachusetts
High school
-
-
-
20.0
13.0
7.0
1994
Massachusetts
High school
-
-
-
11.3
10.9
0.3
1994
Michigan
College
30.8
27.7
3.1
-
-
-
1995
Minnesota
High school
19.5
12.3
7.2
-
-
-
1990
Minnesota
High school
-
-
-
24.8
16.6
8.2
1992
Minnesota
High sch/coll
-
-
-
24.2
14.7
9.5
1995
Minnesota
College
7.7
4.8
2.9
-
-
-
1990
Minnesota
Adolescent
-
-
-
26.1
19.9
6.2
1988
Nevada
College
16.0
12.4
3.6
-
-
-
1992
Nevada
College
34.9
23.7
11.2
-
- -
-
5.5
1994
Nevada
College
25.4
17.4
8.0
-
-
-
1988
New Jersey
College
16.0
10.0
6.0
-
-
-
1990
New Jersey
Adolescent
18.9
7.7
1.2
-
-
-
1988
New York
College
18.0
10.4
7.6
-
-
-
1988
Oklahoma
College
11.0
6.0
5.0
-
-
-
1988
Texas
College
12.0
7.0
5.0
-
-
1992
Texas
Adolescent
16.7
11.7
5.0
-
-
-
1995
Texas
Adolescent
12.2
9.9
2.3
-
-
-
1988
Combination
College
15.0
9.5
-
-
-
Source: The National Academy of Sciences. Pathological Gambling: A Critical Review (1999).
Results from studies of serious gambling-related problems among youth conducted in the
United States from 1984 to 1988 are presented in Table 3.22 and studies conducted from
1989 to 1999 in Table 3.23. An increase from 10 percent to 14 percent in the median
level of gambling-related problems was found between these two periods of time (Jacobs,
2000).
Table 3.22: Serious Gambling-Related Problems among Juveniles in the United States (1984-1988).
Lesieur &
Klein
Jacobs et al.
Jacobs et al.
Kuley & Jacobs
Steinberg
Year study completed
1984
1985
1987
1987
1988
At-risk/Potential
5%
5%
5%
-
15%
Problem/Pathological
6%
4%
4%
-
5%
State
NJ
CA
CA
VA
CT
Source: Jacobs, 2000. Juvenile Gambling in North America: An Analysis of Long Term Trends and Future Prospects.
61
Table 3.23: Serious Gambling-Related Problems among Juveniles in the United States (1989-1999). Wa
Kuley&Jacobs
Winters et al.
llisch Volberg
Shaffer etal.
Wallisch
Volberg
Westpahalet al.
Volberg & Moore
Year study completed
1989
1990
1992
1993
1994
1995
1996
1998
1999
At-risk/Potential
-
20%
12%
9%
14%9%
10%
9%
10%
8%
Problem/
Pathological
-
6%
5%
1%
2%
2%
6%
1%
State
VA
MN
TX
WA
MA
TX
GA
LA
WA
Source: Jacobs, 2000. Juvenile Gambling in North America: An Analysis of Long Term Trends and Future Prospects.
Table 3.24: Comparison of U.S. Adult Pathological and Problem Gambling with Alcohol and Drug Dependence and Abuse.
PathologicalGambling
Alcohol Dependence
Drug Dependence
Pathological and Problem Gambling
Alcohol Dependence and Abuse
Drug Dependence and Abuse
12-month
0.9%
7.2%
2.8%
2.9%
9.7%
3.6%
Lifetime
1.5%
14.1%
7.5%
5.4%
23.5%
11.9%
Source
Committeeanalysis of Shaffer et al. 1997 data
National Comorbidity Survey (NCS): Kessler et al., 1994
National Comorbidity Survey (NCS): Kessler et al., 1994
Committee analysis of Shaffer et al. 1997 data
National Comorbidity Survey (NCS): Kessler et al., 1994
National Comorbidity Survey (NCS): Kessler et al., 1994
Source: The National Academy of Sciences. Pathological Gambling: A Critical Review (1999).
62
Gambling and other disorders
As noted earlier, pathological gambling is frequently associated with substance use, mood anxiety disorders, and interpersonal difficulties (Crockford and Nady el-Guebaly, 1998). This section provides information about the extent of this relationship.
Table 3.24 compares the prevalence of pathological gambling with alcohol and drug dependence. The rates of pathological gambling are lower than rates for alcohol or drug dependence.
Table 3.25 provides similar information for adolescents. Pathological gambling rates are comparable to past month alcohol and marijuana use and are equal to or exceed rates for past month use of illicit drugs.
Table 3.25: Comparison of U.S. Adolescent Pathological Gambling, Alcohol Use, and Drug Use Rates.
Gambling
Alcohol Use
Drug Use
1-6%
pathological gambling, past year
9-23%
pathological or problem
gambling, past year
8-23%
use alcohol once a month or more or have ever had an alcohol problem
3-9%
Marijuana use, past month
1-2.5%
use of other drugs, past month
Source: The National Academy of Sciences. Pathological Gambling: A Critical Review (1999).
Table 3.26 presents data from the Gambling Impact and Behavior Study on the correlation of pathological gambling and other disorders. Pathological gamblers are twice as likely as other gamblers to describe their general health in the past year as fair or poor (National Academy of Sciences, 1999). Lifetime pathological and problem gamblers are twice as likely as all other groups to have sought help for an emotional or mental health problem in the past 12 months. Lifetime and past year pathological gamblers are more likely to have manic disorder symptoms and the occurrence of a major depressive episode is significantly higher among problem and pathological gamblers. Drug and alcohol dependence and illicit drug use in the past 12 months is more likely among at-risk, problem, and pathological gamblers than in low-risk or non-gamblers. The occurrence of arrest and incarceration is highest among lifetime problem and pathological gamblers and these gamblers are more likely than all other group to have lost a job in the past year or ever declared bankruptcy.
63
Table 3.26: Percentage of Lifetime and Past-Year Gambler Types by Health, Mental Health, Substance Abuse, and Other Problems.
Non-gamblers
Low-risk gamblers
At-risk gamblers
Problem gamblers
Pathological gamblers
Life-time
Past year
Life-time
Past year
Life-time
Past year
Life-time
Past year
Life-time
Past year
Health poor/fair, past year
22.8
21.0
14.0
12.3
15.7
13.2
16.3
22.6
31.1
29.6
Mentally troubled (currently) (phone survey only)
10.7
14.6
15.9
17.1
26.5
28.5
42.3
24.241.9
66.5
Mental health tx, past year
5.1
6.9
6.8 0.1
6.3
6.4
10.1
12.8
5.4
13.3
12.9
Emotionally harmful family argument about gambling
NA
0.5
0.3
0.8
6.8
15.8
10.5
53.1
65.6
Manic symptoms, ever
NA
0.7
NA
1.6
11.3
17.6
16.8
13.4
32.5
40.1
Depressive episode, ever (phone survey only)
NA
0.1
NA
1.0
8.6
17.4
16.9
5.2
29.1
20.0
Alcohol/drug dependent, ever (phone survey only)
1.1
0.9
1.3
1.8
5.6
13.3
12.4
13.9
9.9
20.0
Drug use 5+ days, past year
2.0
2.4
4.2
5.1
9.2
13.5
16.8
16.1
8.1
13.9
Any job loss, past year
2.6
4.8
3.9
3.6
5.5
2.1
10.8
0.0
13.8
25.0
Bankruptcy, ever
3.9
3.3
5.5
6.4
4.6
10.9
10.3
13.8
19.232.3
10.7
Arrested,, ever
4.0
7.0
10.0
11.9
21.1
25.7
36.3
25.0
26.4
Incarcerated, ever (phone survey only)
0.4
-
3.7
-
7.8
-
10.4
-
21.4
-
Source: National Opinion Research Center, 1999. Gambling Impact and Behavior Study.
64
The information presented in Table 3.27 was taken from a literature review conducted in
1998 on the link between pathological gambling and substance misuse (Spunt, Dupont,
Lesieur, Liberty, and Hunt) and consists of a variety of findings linking pathological
gambling with substance use and dependency.
Table 3.27: Substance Misuse among Pathological Gamblers.
39% of pathological gamblers undergoing treatment at the Veterans Administration Medical Center in Cleveland, Ohio met criteria for alcohol misuse or drug misuse in the year prior to their admission to the treatment program.
•
•
•
•
•
•
47% of pathological gamblers undergoing treatment at the Veterans Administration Medical Center in Cleveland, Ohio met criteria for alcohol misuse or drug misuse at some point in their life.
The rate of alcohol and substance misuse among female pathological gamblers in a Gamblers Anonymous survey was two to three times higher than the general female population.
A Texas survey found that pathological gamblers disproportionately come from among people who used illicit drugs in the past year.
Among United States college students, pathological gambling was correlated with the use of alcohol and getting drunk
Pathological gambling has been found to relate to mild to severe depression, impulsiveness and inability to resist cravings, attempted suicide, eating disorders, and serious nervous disorders.
Source: Spunt et al., 1998. Pathological Gambling and Substance Misuse: A Review of the Literature.
65
Chapter 4: Problematic Internet Use
Introduction
Problematic Internet use differs from drug dependence and pathological gambling in several ways. The Internet is a relatively new phenomenon and research into Internet related behavior has only been conducted since the mid-1990s (Mitchell, 2000). Scientists who study impulse disorders and dependence note that very little empirical research has investigated the negative consequences of excessive Internet use and no research has been conducted on the prevalence of such behavior in the general population (Shaffer, Hall, Vander Bilt, 2000).
Maybe more importantly, there is no consensus among scientists and clinical practitioners on what constitutes problematic Internet use and whether or not such a phenomenon even exists. Unlike substance dependence and pathological gambling, which are both disorders recognized by the DSM-IV, there are no clinically agreed upon criteria for problematic Internet use. Some que