Highlights

This report presents State estimates on substance use or mental illness problems from the combined 2002 and 2003 National Surveys on Drug Use and Health (NSDUHs), formerly called the National Household Survey on Drug Abuse (NHSDA). The survey, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), collects information from residents of households, residents of noninstitutionalized group quarters, and civilians living on military bases. In 2002 and 2003, NSDUH collected interview data from approximately 136,000 respondents. The report provides estimates for 21 different measures related to substance use or mental illness based on the pooled 2002 and 2003 NSDUH data. Separate estimates have been produced for four age groups: 12 to 17, 18 to 25, 26 or older, and all persons 12 or older. For each measure, States have been ranked and categorized into quintiles, or fifths, in order to simplify the discussion. Estimates presented in this report are based on hierarchical Bayes estimation methods that combine survey data with a national model.

Methodological changes introduced in 2002 affected respondent participation rates and response patterns, resulting in changes in prevalence estimates. Therefore, the findings from the 2002 and 2003 NSDUHs should not be compared with results from the 2001 or earlier NHSDAs. The 2002 survey represented a new baseline for the State estimates, as well as for the national estimates. By combining the 2002 and 2003 survey data, the State-level small area estimates have been improved. This report updates the State estimates of substance use from the 2002 NSDUH (Wright, 2004).

Illicit Drug Use

• Estimates of past month use of any illicit drug ranged from a low of 6.3 percent in Utah to a high of 12.0 percent in Alaska for all persons aged 12 or older. The States with the highest rates of any illicit drug use for persons aged 12 or older were mostly in the West (six States) and the Northeast (three States). Most of the States that had the lowest rates in the Nation for persons aged 12 or older were either from the South (five States) or the Midwest (three States). (Table  B.1, Figure 2.1)



• An estimated 10.8 percent of the national population aged 12 or older had used marijuana in the past year. Tennessee had the lowest rate (7.4 percent) of past year use of marijuana among persons aged 12 or older. Alaska had the highest rate of past year marijuana use among persons aged 12 or older (16.7 percent). The States with the highest rates of past year marijuana use were mostly in the West (five States) and the Northeast (four States). (Table  B.2, Figure 2.5)



• Nationally, 6.2 percent of the population aged 12 or older had used marijuana in the past month. Utah had the lowest rate (4.0 percent) of past month use of marijuana among persons aged 12 or older, and New Hampshire had the highest rate (10.2 percent). An estimated 9 out of 10 States in the top fifth for past year use of marijuana were ranked in the top fifth for past month use of marijuana for persons aged 12 or older. The States with the lowest rates of past month use of marijuana among persons aged 12 or older were mostly in the South: Alabama, Georgia, Mississippi, Tennessee, and Texas. The other States in the lowest fifth were Idaho, Iowa, Kansas, New Jersey, and Utah. (Table  B.3, Figures 2.5 and 2.9)



• The State with the lowest rate of perceived great risk of using marijuana occasionally (once a month) among persons aged 12 or older was Washington (26.8 percent). The lowest perceptions of great risk of marijuana use among persons aged 12 or older were found in the Western (four) and Northeastern (five) States. (Table  B.4 and Figure 2.13)



• Vermont had the highest average annual rate of first use of marijuana among persons aged 12 or older (2.7 percent). The highest average annual rates of first use of marijuana among persons aged 12 or older were found in the West (five States) and the Northeast (four States). (Table  B.5, Figure 2.17)



• Five States that were in the top fifth for past month use of an illicit drug for persons aged 12 or older also were ranked in the top fifth for past month use of an illicit drug other than marijuana. These States were Colorado, Nevada, New Mexico, Oregon, and Rhode Island. Colorado had the highest prevalence rate for past month use of any illicit drug other than marijuana (4.7 percent) among all persons aged 12 or older. (Table  B.6, Figures 2.1 and 2.20)



• The highest rate of past year cocaine use among persons aged 12 or older was found in Colorado (3.9 percent), and the lowest rate was found in Idaho (1.6 percent). Arizona and Colorado were the only States that ranked in the top fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) for past year use of cocaine. (Table  B.7, Figures 2.24 to 2.27)

Alcohol Use

• Nationally, the rate for past month use of alcohol among persons aged 12 or older was 50.5 percent. The States in the top fifth for past month use of alcohol among persons aged 12 or older were primarily Northeastern (six States). The other four States in the top fifth were either Western or Midwestern. Among persons aged 12 or older, all of the States in the lowest fifth were from the South, except for Utah (West region). Utah had the lowest rate (29.6 percent) of past month alcohol use in the Nation, while New Hampshire had the highest rate in the 12 or older population (59.8 percent). (Table  B.8, Figure 3.1)



• Utah had the lowest rate in the Nation for binge alcohol use among all persons aged 12 or older (15.9 percent). North Dakota had the highest rate among all persons aged 12 or older (31.4 percent) and among persons aged 26 or older (28.4 percent). Most of the States in the top fifth for past month binge use of alcohol for persons aged 12 or older were from the Midwest (six States). (Table  B.9, Figure 3.5)



• People's perceptions of the risk of binge drinking were moderately related to their actual rates of binge drinking at the State level in 2002-2003. Eight of the States with the highest rates of binge use of alcohol in 2002-2003 also were States with the lowest perceived risk of binge drinking for the population aged 12 or older. Utah had the highest prevalence of perceived great risk of binge drinking: 50.9 percent for all persons aged 12 or older, 47.6 percent for youths aged 12 to 17, and 54.6 percent for persons aged 26 or older. (Table  B.10, Figures 3.5 and 3.9)

Tobacco Use

• The State with the highest prevalence rate for tobacco use among persons aged 12 or older was Kentucky (39.8 percent). Utah had the lowest rate in the Nation for tobacco use among all persons aged 12 or older (19.7 percent). Of the top 10 States with the highest rates of tobacco use among persons aged 12 or older, 6 were from the South. (Table  B.11, Figure 4.1)



• Nationally, the rate for past month use of cigarettes among persons aged 12 or older was 25.7 percent. All of the 10 States that ranked in the highest fifth for past month tobacco use also ranked in the highest fifth for cigarette use for all persons aged 12 or older. Four States were in the highest fifth for past month cigarette use in all three age groups (12 to 17, 18 to 25, and 26 or older): Arkansas, Kentucky, Missouri, and West Virginia. Kentucky had the highest rate of cigarette use in the Nation (34.8 percent), and Utah had the lowest rate (16.7 percent) for all persons aged 12 or older. (Table  B.12, Figures 4.1 and 4.5 to 4.8)



• States with high prevalence rates for cigarette use tended to have low rates of perceived risk of heavy cigarette use. Six of the States ranked in the lowest fifth for perceptions of great risk of smoking one or more packs of cigarettes a day also were ranked in the highest fifth for past month cigarette use for persons aged 12 or older. Kentucky had the lowest rate of perception of great risk for heavy cigarette use (62.5 percent). (Table  B.13, Figures 4.5 and 4.9)

Substance Dependence, Abuse, and Treatment Need

• State estimates for past year alcohol dependence or abuse among persons aged 12 or older ranged from 6.0 percent in Tennessee to 10.8 percent in North Dakota. States in the highest fifth (among persons aged 12 or older) tended to be Western (four States) or Midwestern States (four States), while States in the lowest fifth were mostly in the South (seven States). Tennessee had the lowest rate of past year alcohol dependence among persons aged 12 or older (2.7 percent). (Table s B.14 and B.15, Figure 5.1)



• The District of Columbia had the highest rate of past year illicit drug dependence or abuse (4.0 percent) among persons aged 12 or older, and Kansas had the lowest rate (2.5 percent). Most of the States in the highest fifth were in the West (four States) or the Northeast (four States). Similarly, the District of Columbia had the highest rate for past year illicit drug dependence among persons aged 12 or older (3.0 percent). (Table s B.16 and B.17, Figure 5.9)



• State percentages for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older ranged from a low of 7.4 percent in Alabama to a high of 12.0 percent in New Mexico. (Table  B.18)



• New Mexico had the highest percentage of persons aged 12 or older needing but not receiving treatment for an illicit drug use problem (3.5 percent). The States in the top fifth for needing but not receiving treatment for an illicit drug use problem were mainly in the West (five States) or the Northeast (four States). (Table  B.19, Figure 5.21)



• States in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older were primarily Western (four States) or Midwestern (four States). Montana, Nebraska, New Mexico, and South Dakota ranked in the top fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) for needing but not receiving treatment for alcohol problems. (Table  B.20, Figures 5.25 to 5.28)

Serious Mental Illness among Adults

• Serious mental illness (SMI) was estimated in NSDUH for persons aged 18 or older. The States with the highest rates of SMI were mostly in the South (four States) or in the West (four States). Rhode Island had the highest rate of SMI in the Nation (11.0 percent), and Hawaii had the lowest rate (7.2 percent). (Table  B.21, Figure 6.1)