Results from the 2003 National Survey on Drug Use and Health: National Findings

2003 National Survey on Drug Use & Health: Results

List of Figures
List of Tables

Highlights

1. Introduction
     1.1. Summary of NSDUH
     1.2. Trend Measurement
     1.3. Format of Report and Explanation of Tables
     1.4. Other NSDUH Reports

2. Illicit Drug Use
     Age
     Gender
     Pregnant Women
     Race/Ethnicity
     Education
     College Students
     Employment
     Geographic Area
     Criminal Justice Populations
     Frequency of Use
     Association with Cigarette and Alcohol Use
     Driving Under the Influence of Illicit Drugs
     How Marijuana Is Obtained

3. Alcohol Use
     Age
     Underage Alcohol Use
     Gender
     Pregnant Women
     Race/Ethnicity
     Education
     College Students
     Employment
     Geographic Area
     Association with Illicit Drug and Tobacco Use
     Driving Under the Influence of Alcohol

4. Tobacco Use
     Age
     Gender
     Pregnant Women
     Race/Ethnicity
     Education
     College Students
     Employment
     Geographic Area
     Frequency of Cigarette Use
     Association with Illicit Drug and Alcohol Use
     Usual Brand of Cigarettes Smoked
     Youth Access to Cigarettes
     Nicotine Dependence

5. Trends in Initiation of Substance Use
     Marijuana
     Cocaine
     Heroin
     Hallucinogens
     Inhalants
     Psychotherapeutics
     Alcohol
     Tobacco

6. Youth Prevention-Related Measures
     Perceptions of Risk
     Availability
     Parental Disapproval of Substance Use
     Attitudes about School
     Delinquent Behavior
     Participation in Religious and Other Activities
     Exposure to Prevention Messages and Programs

7. Substance Dependence, Abuse, and Treatment
     7.1 Substance Dependence and Abuse
          Age at First Use
          Age
          Gender
          Race/Ethnicity
          Education/Employment
          Criminal Justice Populations
          Geographic Area
     7.2 Past Year Treatment for a Substance Use Problem
          Age, Gender, and Race/Ethnicity
          Location of Treatment and Substance Treated
     7.3 Needing and Receiving Specialty Treatment
          Illicit Drug Treatment and Treatment Need
          Alcohol Treatment and Treatment Need

8. Prevalence and Treatment of Mental Health Problems
     8.1 Serious Mental Illness
          Prevalence of Serious Mental Illness
          Serious Mental Illness and Substance Use
          Co-Occurrence of Serious Mental Illness with Substance Dependence/Abuse
          Serious Mental Illness among Adults on Probation or Parole
     8.2 Treatment and Unmet Need for Treatment among Adults
          Treatment and Unmet Need for Treatment among Adults with Serious Mental Illness
     8.3 Treatment among Adults with Co-Occurring Serious Mental Illness and Substance Use Disorders
     8.4 Treatment for Mental Health Problems among Youths

Tables on mental health treatment: (Tables G.61 to G.65)

Table B.21 Serious Mental Illness in Past Year, by Age Group and State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

9. Discussion
Recent Trends in Youth and Young Adult Substance Use

Appendix

A. Description of the Survey
B. Statistical Methods and Measurement
C. Key Definitions, 2003
D. Other Sources of Data
E. References
F. Sample Size and Population Tables
G. Selected Prevalence Tables

Overview of Findings

Detailed Tables from the 2003 NSDUH

Available at SAMHSA's website:
http://www.oas.samhsa.gov/nsduh.htm
http://www.oas.samhsa.gov

Highlights

This report presents the first information from the 2003 National Survey on Drug Use and Health (NSDUH). This survey, formerly called the National Household Survey on Drug Abuse (NHSDA), is a project of the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services. This survey was initiated in 1971 and is the primary source of information on the use of illicit drugs, alcohol, and tobacco by the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year.

Illicit Drug Use

In 2003, an estimated 19.5 million Americans, or 8.2 percent of the population aged 12 or older, were current illicit drug users. Current illicit drug use means use of an illicit drug during the month prior to the survey interview.
There was no change in the overall rate of illicit drug use between 2002 and 2003. In 2002, there were an estimated 19.5 million illicit drug users (8.3 percent).
The rate of current illicit drug use among youths aged 12 to 17 did not change significantly between 2002 (11.6 percent) and 2003 (11.2 percent), and there were no changes for any specific drug. The rate of current marijuana use among youths was 8.2 percent in 2002 and 7.9 percent in 2003. There was a significant decline in lifetime marijuana use among youths, from 20.6 percent in 2002 to 19.6 percent in 2003. There also were decreases in rates of past year use of LSD (1.3 to 0.6 percent), Ecstasy (2.2 to 1.3 percent), and methamphetamine (0.9 to 0.7 percent).
Marijuana is the most commonly used illicit drug, with a rate of 6.2 percent (14.6 million) in 2003. An estimated 2.3 million persons (1.0 percent) were current cocaine users, 604,000 of whom used crack. Hallucinogens were used by 1.0 million persons, and there were an estimated 119,000 current heroin users. All of these 2003 estimates are similar to the estimates for 2002.
The number of current users of Ecstasy (i.e., MDMA) decreased between 2002 and 2003, from 676,000 (0.3 percent) to 470,000 (0.2 percent). Although there were no significant changes in the past month use of other hallucinogens, there were significant declines in past year use of LSD (from 1 million to 558,000) and in past year overall hallucinogen use (from 4.7 million to 3.9 million) between 2002 and 2003, as well as in past year use of Ecstasy (from 3.2 million to 2.1 million).
An estimated 6.3 million persons were current users of psychotherapeutic drugs taken nonmedically. This represents 2.7 percent of the population aged 12 or older. An estimated 4.7 million used pain relievers, 1.8 million used tranquilizers, 1.2 million used stimulants, and 0.3 million used sedatives. The 2003 estimates are all similar to the corresponding estimates for 2002.
There was a significant increase in lifetime nonmedical use of pain relievers between 2002 and 2003 among persons aged 12 or older, from 29.6 million to 31.2 million. Specific pain relievers with statistically significant increases in lifetime use were Vicodin^®, Lortab^®, or Lorcet^® (from 13.1 million to 15.7 million); Percocet^®, Percodan^®, or Tylox^® (from 9.7 million to 10.8 million); Hydrocodone (from 4.5 million to 5.7 million); OxyContin^® (from 1.9 million to 2.8 million); methadone (from 0.9 million to 1.2 million); and Tramadol (from 52,000 to 186,000).
Rates of current illicit drug use varied significantly among the major racial/ethnic groups in 2003. Rates were highest among American Indians or Alaska Natives (12.1 percent), persons reporting two or more races (12.0 percent), and Native Hawaiians or Other Pacific Islanders (11.1 percent). Rates were 8.7 percent for blacks, 8.3 percent for whites, and 8.0 percent for Hispanics. Asians had the lowest rate at 3.8 percent.
An estimated 18.2 percent of unemployed adults aged 18 or older were current illicit drug users in 2003 compared with 7.9 percent of those employed full time and 10.7 percent of those employed part time. However, most drug users were employed. Of the 16.7 million illicit drug users aged 18 or older in 2003, 12.4 million (74.3 percent) were employed either full or part time.

Alcohol Use

An estimated 119 million Americans aged 12 or older were current drinkers of alcohol in 2003 (50.1 percent). About 54 million (22.6 percent) participated in binge drinking at least once in the 30 days prior to the survey, and 16.1 million (6.8 percent) were heavy drinkers. These 2003 numbers are all similar to the corresponding estimates for 2002.
The highest prevalence of binge and heavy drinking in 2003 was for young adults aged 18 to 25, with the peak rate of both measures occurring at age 21. The rate of binge drinking was 41.6 percent for young adults aged 18 to 25 and 47.8 percent at age 21. Heavy alcohol use was reported by 15.1 percent of persons aged 18 to 25 and by 18.7 percent of persons aged 21.
About 10.9 million persons aged 12 to 20 reported drinking alcohol in the month prior to the survey interview in 2003 (29.0 percent of this age group). Nearly 7.2 million (19.2 percent) were binge drinkers and 2.3 million (6.1 percent) were heavy drinkers. These 2003 rates were essentially the same as those obtained from the 2002 survey.
An estimated 13.6 percent of persons aged 12 or older drove under the influence of alcohol at least once in the 12 months prior to the interview in 2003 (a decrease from 14.2 percent in 2002). These percentages represent 32.3 million persons in 2003 and 33.5 million persons in 2002.

Tobacco Use

An estimated 70.8 million Americans reported current (past month) use of a tobacco product in 2003. This is 29.8 percent of the population aged 12 or older, similar to the rate in 2002 (30.4 percent). There were 60.4 million (25.4 percent) who smoked cigarettes in the past month, 12.8 million (5.4 percent) who smoked cigars, 7.7 million (3.3 percent) who used smokeless tobacco, and 1.6 million (0.7 percent) who smoked tobacco in pipes. These 2003 rates all remained unchanged from 2002.
Young adults aged 18 to 25 reported the highest rate of past month cigarette use (40.2 percent). This was similar to the rate among young adults in 2002 (40.8 percent).
Among those aged 12 or older, a higher proportion of males than females smoked cigarettes in 2003 (28.1 vs. 23.0 percent). Among youths aged 12 to 17, however, girls (12.5 percent) were as likely as boys (11.9 percent) to smoke. There was no change in cigarette use among boys aged 12 to 17 between 2002 and 2003. However, among girls, cigarette use decreased from 13.6 percent in 2002 to 12.5 percent in 2003.
An estimated 35.7 million Americans aged 12 or older in 2003 were classified as nicotine dependent in the past month because of their cigarette use (15.0 percent of the total population). These estimates are similar to the estimates for 2002.

Trends in Initiation of Substance Use (Incidence)

There were an estimated 2.6 million new marijuana users in 2002. This means that each day an average of 7,000 Americans tried marijuana for the first time. About two thirds (69 percent) of these new marijuana users were under age 18, and about half (53 percent) were female.
The annual number of marijuana initiates generally increased from 1965 until about 1973. From 1973 to 1978, the annual number of marijuana initiates remained level at over 3 million per year. After that, the number of initiates declined, reaching a low point in 1990, then rose again until 1995. From 1995 to 2002, there was no consistent trend, with estimates varying between 2.4 million and 2.9 million per year.
Decreases in initiation of both LSD (from 631,000 to 272,000) and Ecstasy (from 1.8 million to 1.1 million) were evident between 2001 and 2002, coinciding with an overall drop in hallucinogen incidence from 1.6 million to 1.1 million.
Pain reliever incidence increased from 1990 (573,000 initiates) to 2000 (2.5 million). In 2001 and 2002, the number also was 2.5 million.
The number of new daily cigarette smokers decreased from 2.0 million in 1997 to 1.4 million in 2002. Among youths under 18, the number of new daily smokers decreased from 1.1 million per year between 1997 and 2000 to 734,000 in 2002. This corresponds to a decrease from about 3,000 to about 2,000 new youth smokers per day.

Youth Prevention-Related Measures

The percentage of youths aged 12 to 17 indicating that smoking marijuana once a month was a great risk increased from 32.4 percent in 2002 to 34.9 percent in 2003. There were no changes between 2002 and 2003 in the percentages of youths perceiving a great risk associated with using cigarettes, alcohol, cocaine, heroin, and LSD.
The percentage of youths reporting that it would be easy to obtain marijuana declined slightly between 2002 and 2003, from 55.0 to 53.6 percent. The percentage of youths reporting that LSD would be easy to obtain also decreased between 2002 and 2003, from 19.4 to 17.6 percent.
Most youths (89.4 percent) reported that their parents would strongly disapprove of their trying marijuana once or twice. Among these youths, only 5.4 percent had used marijuana in the past month. However, among youths who perceived that their parents would only somewhat disapprove or neither approve nor disapprove of their trying marijuana, 28.7 percent used marijuana.

Substance Dependence or Abuse

An estimated 21.6 million Americans in 2003 were classified with substance dependence or abuse (9.1 percent of the total population aged 12 or older). Of these, 3.1 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.8 million were dependent on or abused illicit drugs but not alcohol, and 14.8 million were dependent on or abused alcohol but not illicit drugs.
Between 2002 and 2003, there was no change in the number of persons with substance dependence or abuse (22.0 million in 2002 and 21.6 million in 2003).
In 2003, an estimated 17.0 percent of unemployed adults aged 18 or older were classified with dependence or abuse, while 10.2 percent of full-time employed adults and 10.3 percent of part-time employed adults were classified as such. However, most adults with substance dependence or abuse were employed either full or part time. Of the 19.4 million adults classified with dependence or abuse, 14.9 million (76.8 percent) were employed.

Treatment and Treatment Need for Substance Problems

An estimated 3.3 million people aged 12 or older (1.4 percent of the population) received some kind of treatment for a problem related to the use of alcohol or illicit drugs in the 12 months prior to being interviewed in 2003. Of these, 1.2 million persons received treatment at a rehabilitation facility as an outpatient, 752,000 at a rehabilitation facility as an inpatient, 729,000 at a mental health center as an outpatient, 587,000 at a hospital as an inpatient, 377,000 at a private doctor's office, 251,000 at an emergency room, and 206,000 at a prison or jail. (Note that the estimates of treatment by location include persons reporting more than one location.)
Between 2002 and 2003, there were decreases in the number of persons who received treatment for a substance use problem at a hospital as an inpatient, at a rehabilitation facility as an inpatient, at a mental health center as an outpatient, and at an emergency room.
In 2003, the estimated number of persons aged 12 or older needing treatment for an alcohol or illicit drug problem was 22.2 million (9.3 percent of the total population), about the same as in 2002 (22.8 million). The number needing but not receiving treatment also did not change between 2002 (20.5 million) and 2003 (20.3 million). However, a decline in the number receiving specialty treatment, from 2.3 million to 1.9 million, was statistically significant. This decline was driven by a decrease in treatment among adults aged 26 or older, from 1.7 million in 2002 to 1.2 million in 2003.
Of the 20.3 million people who needed but did not receive treatment in 2003, an estimated 1.0 million (5.1 percent) reported that they felt they needed treatment for their alcohol or drug problem. Of the 1.0 million persons who felt they needed treatment, 273,000 (26.3 percent) reported that they made an effort but were unable to get treatment and 764,000 (73.7 percent) reported making no effort to get treatment.
Among the 1.0 million people who needed but did not receive treatment and felt they needed treatment, the most often reported reasons for not receiving treatment were not ready to stop using (41.2 percent), cost or insurance barriers (33.2 percent), reasons related to stigma (19.6 percent), and did not feel the need for treatment (at the time) or could handle the problem without treatment (17.2 percent).
The number of persons needing treatment for an illicit drug problem in 2003 (7.3 million) was similar to the number needing treatment in 2002 (7.7 million). However, the number receiving treatment for drug abuse at a specialty facility was lower in 2003 (1.1 million) than in 2002 (1.4 million).

Serious Mental Illness among Adults

In 2003, there were an estimated 19.6 million adults aged 18 or older with serious mental illness (SMI). This represents 9.2 percent of all adults and is higher than the rate of 8.3 percent in 2002. Rates of SMI were highest for young adults aged 18 to 25 (13.9 percent) and lowest for persons aged 50 or older (5.9 percent). The percentage of females with SMI was higher than the percentage of males (11.5 vs. 6.7 percent).
Adults who used illicit drugs were more than twice as likely to have SMI as adults who did not use an illicit drug. In 2003, 18.1 percent of adult past year illicit drug users had SMI in that year, while the rate was 7.8 percent among adults who had not used an illicit drug.

Co-Occurrence of Serious Mental Illness and Substance Use Disorders

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

Treatment for Mental Health Problems

In 2003, an estimated 28 million adults (13.2 percent) received treatment for mental health problems in the 12 months prior to the interview. These 2003 estimates are similar to the 2002 estimates.
The most prevalent type of treatment for mental health problems in the adult population in 2003 was prescription medication (10.9 percent), followed by outpatient treatment (7.2 percent). An estimated 1.8 million adults (0.8 percent) were hospitalized for mental health problems at some time within the past 12 months.
Among the 5.5 million adults who did not receive treatment but perceived an unmet need for treatment for mental health problems in the past year, the most commonly reported reasons for not receiving treatment were cost or insurance issues (45.1 percent), not feeling a need for treatment (at the time) or thinking the problem could be handled without treatment (40.6 percent), not knowing where to go for services (22.9 percent), perceived stigma associated with receiving treatment (22.8 percent), and did not have time (18.1 percent).
Among the 19.6 million adults with SMI in 2003, 9.3 million, or 47.3 percent, received treatment for a mental health problem in the 12 months prior to the interview. This estimate is similar to the estimate in 2002 (47.9 percent). The rate of inpatient treatment among adults with SMI increased between 2002 and 2003 (from 3.8 to 5.6 percent).
Among the 4.2 million adults with co-occurring SMI and a substance use disorder in 2003, 47.3 percent (about 2.0 million) received treatment for mental health problems and 11.2 percent (0.5 million) received specialty substance use treatment, including 7.5 percent (0.3 million) who received both types of treatment.
In 2003, an estimated 5.1 million youths aged 12 to 17 (20.6 percent) received treatment or counseling for emotional or behavior problems in the year prior to the interview. This is higher than the 2002 estimate of 4.8 million (19.3 percent).

1. Introduction

This report presents the first information from the 2003 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. Prior to 2002, the survey was called the National Household Survey on Drug Abuse (NHSDA). This initial report on the 2003 data presents national estimates of rates of use, numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products. Measures related to mental health problems also are included. State-level estimates from NSDUH will be presented in a separate report.

A major focus of this report is changes in substance use between 2002 and 2003. Because of improvements to the survey in 2002, the 2002 data constitute a new baseline for tracking trends in substance use and other measures. Therefore, estimates from the 2002 and 2003 NSDUHs should not be compared with estimates from the 2001 and earlier NHSDAs to assess changes in substance use over time.

1.1. Summary of NSDUH

NSDUH is the primary source of statistical information on the use of illegal drugs by the U.S. population. Conducted by the Federal Government since 1971, the survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their places of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services and is planned and managed by SAMHSA's Office of Applied Studies (OAS). Data collection is conducted under contract with RTI International, Research Triangle Park, North Carolina.¹ This section briefly describes the survey methodology; a more complete description is provided in Appendix A.

NSDUH collects information from residents of households, noninstitutional group quarters (e.g., shelters, rooming houses, dormitories), and civilians living on military bases. Persons excluded from the survey include homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails and hospitals. Appendix D describes surveys that cover populations outside the NSDUH sampling frame.

Since 1999, the NSDUH interview has been carried out using computer-assisted interviewing (CAI). Most of the questions are administered with audio computer-assisted self-interviewing (ACASI). ACASI is designed to provide the respondent with a highly private and confidential means of responding to questions to increase the level of honest reporting of illicit drug use and other sensitive behaviors. Less sensitive items are administered by interviewers using computer-assisted personal interviewing (CAPI).

Consistent with the 2002 survey, the 2003 NSDUH employed a 50–State sample design with an independent, multistage area probability sample for each of the 50 States and the District of Columbia. The eight States with the largest population (which together account for 48 percent of the total U.S. population aged 12 or older) were designated as large sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas). For these States, the design provided a sample sufficient to support direct State estimates. For the remaining 42 States and the District of Columbia, smaller, but adequate, samples were selected to support State estimates using small area estimation (SAE) techniques. The design also oversampled youths and young adults, so that each State's sample was approximately equally distributed among three major age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.

Nationally, 130,605 addresses were screened for the 2003 survey, and 67,784 completed interviews were obtained. The survey was conducted from January through December 2003. Weighted response rates for household screening and for interviewing were 90.72 and 77.39 percent, respectively. See Appendix B for more information on NSDUH response rates.

1.2. Trend Measurement

Although the design of the 2002 and 2003 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are important methodological differences that impact comparability of 2002 and 2003 estimates with estimates from prior surveys. In addition to the name change, each NSDUH respondent is now given an incentive payment of $30. These changes, both implemented in 2002 and continued in 2003, resulted in a substantial improvement in the survey response rate. The changes also affected respondents' reporting of many critical items that are the basis of prevalence measures reported by the survey each year. Comparability also could be affected by improved data collection quality control procedures that were introduced in the survey beginning in 2001, and by incorporating new population data from the 2000 decennial census into NSDUH sample weighting procedures. Analyses of the effects of each of these factors on NSDUH estimates have shown that 2002 and 2003 data should not be compared with 2001 and earlier NHSDA data to assess changes over time. Therefore, this report presents data only from the 2002 and 2003 NSDUHs.

Using only the 2002 and 2003 data, however, limited trend assessment can be done using information collected in NSDUH on prior substance use. Specifically, questions on age at first use of substances, in conjunction with respondents' ages and interview dates, provide data that can be used to estimate the rates of first-time use (incidence) for years prior to 2002 and 2003. Trends for 1965 to 2002 in these incidence measures for youths and young adults are discussed in Chapter 5. Estimates of lifetime prevalence rates for years prior to 2002 were produced from 2002 NSDUH data on age at first use and included in last year's NSDUH report (OAS, 2003). However, a recent evaluation assessing the validity of those estimates determined they were subject to significant bias (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004). Therefore, they are not included in this report. Further discussion of incidence estimates is given in Chapter 5 and Appendix B.

1.3. Format of Report and Explanation of Tables

The results from the 2003 NSDUH are given in this report, which has separate chapters that discuss the national findings on seven topics: use of illicit drugs; use of alcohol; use of tobacco products; trends in initiation of substance use; prevention-related issues; substance dependence, abuse, and treatment; and mental health. A final chapter summarizes the results and discusses key findings in relation to other research and survey results. Technical appendices describe the survey (Appendix A), provide technical details on the statistical methods and measurement (Appendix B), offer key NSDUH definitions (Appendix C), discuss other sources of related data (Appendix D), list the references cited in the report (as well as other relevant references) (Appendix E), and present selected tabulations of estimates (Appendices F and G).

Tables, text, and figures present prevalence measures for the population in terms of both the number of substance users and the rate of use for illicit drugs, alcohol, and tobacco products. Tables show estimates of drug use prevalence by lifetime (i.e., ever used), past year, and past month use. Analyses focus primarily on past month use, which also is referred to as "current use." Tables and figures have footnotes indicating whether the 2003 and 2002 estimates were significantly different.

Data are presented for racial/ethnic groups in several categorizations, based on current standards for collecting and reporting race and ethnicity data (Office of Management and Budget [OMB], 1997) and on the level of detail permitted by the sample. Because respondents were allowed to choose more than one racial group, a "two or more races" category is presented that includes persons who reported more than one category among the seven basic groups listed in the survey question (white, black/African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, Other). It should be noted that, except for the "Hispanic or Latino" group, the racial/ethnic groups discussed in this report include only non-Hispanics. The category "Hispanic or Latino" includes Hispanics of any race. Also, more detailed categories describing specific subgroups were obtained from survey respondents if they reported either Asian race or Hispanic ethnicity. Data on Native Hawaiians and Other Pacific Islanders are combined in this report.

Data also are presented for four U.S. geographic regions and nine geographic divisions within these regions. These regions and divisions, defined by the U.S. Bureau of the Census, consist of the following groups of States:

Northeast Region - New England Division: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont; Middle Atlantic Division: New Jersey, New York, Pennsylvania.

Midwest Region - East North Central Division: Illinois, Indiana, Michigan, Ohio, Wisconsin; West North Central Division: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota.

South Region - South Atlantic Division: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia; East South Central Division: Alabama, Kentucky, Mississippi, Tennessee; West South Central Division: Arkansas, Louisiana, Oklahoma, Texas.

West Region - Mountain Division: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming; Pacific Division: Alaska, California, Hawaii, Oregon, Washington.

Geographic comparisons for 2002 and 2003 also are made based on county type, which reflects different levels of urbanicity and metropolitan area inclusion of counties. For this purpose, counties are grouped based on the 2003 rural-urban continuum codes. These codes were originally developed by the U.S. Department of Agriculture (Butler & Beale, 1994). Each county is either inside or outside a metropolitan statistical area (MSA), as defined by the OMB.

Large metropolitan areas have a population of 1 million or more. Small metropolitan areas have a population of fewer than 1 million. Nonmetropolitan areas are areas outside MSAs. Small metropolitan areas are further classified as having either fewer than or greater than 250,000 population. Counties in nonmetropolitan areas are classified based on the number of people in the county who live in an urbanized area, as defined by the Census Bureau at the subcounty level. "Urbanized" counties have 20,000 or more population in urbanized areas, "less urbanized" counties have at least 2,500 but fewer than 20,000 population in urbanized areas, and "completely rural" counties have fewer than 2,500 population in urbanized areas.

In June 2003, the OMB issued revised definitions for metropolitan areas (OMB, 2003), and these revised definitions are reflected in the county type variable used in this report. Counties no longer have to meet certain urban characteristics to be considered part of an MSA. Simplified commuting criteria concerning the percentage of residents who work in the central county of an MSA determine the metropolitan status for outlying counties. As a result of these changes, analyses based on county type information for 2003 are not fully comparable with analyses based on county type information in prior years. To make the analyses by county type presented in this report comparable for 2002 and 2003 data, county type classifications for both years are based on the 2003 rural-urban continuum codes. The 2002 county type analyses presented in this report are therefore not directly comparable with those presented in the 2002 NSDUH report (OAS, 2003).

1.4. Other NSDUH Reports

This report provides a comprehensive summary of the 2003 NSDUH, including results, technical appendices, and selected data tables. A companion report, Overview of Findings from the 2003 National Survey on Drug Use and Health, is a shorter, more concise report that highlights the most important findings of the survey and includes only a brief discussion of the methods. A report on State-level estimates for 2003 will be available in 2005.

In addition to the tables included in Appendices F and G of this report, a more extensive set of tables, including standard errors, is available upon request from OAS or through the Internet at http://www.oas.samhsa.gov. Additional methodological information on NSDUH, including the questionnaire, is available electronically at the same Web address. Brief descriptive reports and in-depth analytic reports focusing on specific issues or population groups also are produced by OAS. A complete listing of previously published reports from NSDUH and other data sources is available from OAS. Most of these reports also are available through the Internet (http://www.oas.samhsa.gov). In addition, OAS makes public use data files available to researchers through the Substance Abuse and Mental Health Data Archive (SAMHDA, 2004). Currently, files are available from the 1979 to 2002 surveys at http://www.icpsr.umich.edu/SAMHDA/index.html. The NSDUH 2003 public use file will be available by the end of 2004.

2. Illicit Drug Use

The National Survey on Drug Use and Health (NSDUH) obtains information on nine different categories of illicit drug use: marijuana, cocaine, heroin, hallucinogens, inhalants, and nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives. In these categories, hashish is included with marijuana, and crack is considered a form of cocaine. Several drugs are grouped under the hallucinogens category, including LSD, PCP, peyote, mescaline, mushrooms, and "Ecstasy" (MDMA). Inhalants include a variety of substances, such as amyl nitrite, cleaning fluids, gasoline, paint, and glue. The four categories of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives) cover numerous drugs available through prescriptions and sometimes illegally "on the street." Methamphetamine is included under stimulants. Over-the-counter drugs and legitimate uses of prescription drugs are not included. Respondents are asked to report only uses of drugs that were not prescribed for them or drugs they took only for the experience or feeling they caused. NSDUH reports combine the four prescription-type drug groups into a category referred to as "any psychotherapeutics."

Estimates of "any illicit drug use" reported from NSDUH reflect use of any of the nine substance categories listed above. Use of alcohol and tobacco products, while illegal for youths, are not included in these estimates, but are discussed in Chapters 3 and 4.

In 2003, an estimated 19.5 million Americans aged 12 or older were current illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.2 percent of the population aged 12 years old or older.
There was no change in the overall rate of illicit drug use between 2002 and 2003. In 2002, there were an estimated 19.5 million illicit drug users (8.3 percent).
Marijuana is the most commonly used illicit drug (14.6 million past month users). In 2003, it was used by 75.2 percent of current illicit drug users. An estimated 54.6 percent of current illicit drug users used only marijuana, 20.6 percent used marijuana and another illicit drug, and the remaining 24.8 percent used an illicit drug but not marijuana in the past month (Figure 2.1).

Figure 2.1 Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2003

Figure 2.1 D

About 45.4 percent of current illicit drug users in 2003 (8.8 million Americans) used illicit drugs other than marijuana and hashish, either with or without using marijuana as well.
In 2003, an estimated 2.3 million persons (1.0 percent) were current cocaine users, 604,000 of whom used crack during the same time period (0.3 percent). Hallucinogens were used by 1.0 million persons (0.4 percent) (Figure 2.2). There were an estimated 119,000 current heroin users (0.1 percent). All of these estimates are similar to estimates for 2002.

Figure 2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002 and 2003

Figure 2.2 D

Note: Statistically significant differences (at 0.05 level) between 2002 and 2003 are denoted by " + ".

The number of current users of Ecstasy decreased between 2002 and 2003, from 676,000 (0.3 percent) to 470,000 (0.2 percent). Although there were no significant changes in the past month use of other hallucinogens, there were significant declines in past year use of LSD (from 1 million to 558,000) and in past year overall hallucinogen use (from 4.7 million to 3.9 million) between 2002 and 2003, as well as in past year use of Ecstasy (from 3.2 million to 2.1 million) (Figure 2.3).

Figure 2.3 Numbers (in Millions) of Past Year Users of Selected Hallucinogens among Persons Aged 12 or Older: 2002 and 2003

Figure 2.3 D

Note: Statistically significant differences (at 0.05 level) between 2002 and 2003 are denoted by " + ".

Of the 8.8 million current users of illicit drugs other than marijuana in 2003, 6.3 million were current users of psychotherapeutic drugs. This represents 2.7 percent of the population aged 12 or older. Of those who reported current use of any psychotherapeutics, 4.7 million used pain relievers, 1.8 million used tranquilizers, 1.2 million used stimulants, and 0.3 million used sedatives. These estimates are all similar to the corresponding estimates for 2002.
There was a significant increase in the number of persons aged 12 or older with lifetime nonmedical use of pain relievers between 2002 and 2003, from 29.6 million to 31.2 million. Specific pain relievers with statistically significant increases in lifetime use were Vicodin^®, Lortab^®, or Lorcet^® (from 13.1 million to 15.7 million); Percocet^®, Percodan^®, or Tylox^® (from 9.7 million to 10.8 million); Hydrocodone (from 4.5 million to 5.7 million); OxyContin^® (from 1.9 million to 2.8 million); methadone (from 0.9 million to 1.2 million); and Tramadol (from 52,000 to 186,000) (Figure 2.4).

Figure 2.4 Numbers (in Millions) of Lifetime Nonmedical Users of Selected Pain Relievers among Persons Aged 12 or Older: 2002 and 2003

Figure 2.4 D

Note: Statistically significant differences (at 0.05 level) between 2002 and 2003 are denoted by " + ".

Age

Rates of drug use showed substantial variation by age. For example, 3.8 percent of youths aged 12 or 13 reported current illicit drug use in 2003 (Figure 2.5). As in other years, illicit drug use in 2003 tended to increase with age among young persons, peaking among 18 to 20 year olds (23.3 percent) and declining steadily after that point with increasing age.

Figure 2.5 Past Month Illicit Drug Use, by Age: 2003

Figure 2.5 D

Among youths, the types of drugs used differed by age in 2003, as was true in prior years. Among 12 or 13 year olds, 1.8 percent used prescription-type drugs nonmedically, 1.4 percent used inhalants, and 1.0 percent used marijuana (Figure 2.6). Among 14 or 15 year olds, marijuana was the dominant drug used (7.2 percent), followed by prescription-type drugs used nonmedically (4.1 percent) and inhalants (1.4 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (15.6 percent), followed by prescription-type drugs used nonmedically (6.1 percent), hallucinogens (1.9 percent), and cocaine (1.2 percent). Only 1.0 percent of youths aged 16 or 17 used inhalants.

Figure 2.6 Past Month Use of Selected Illicit Drugs among Youths, by Age: 2003

Figure 2.6 D

Among all youths aged 12 to 17 in 2003, 11.2 percent were current illicit drug users: 7.9 percent used marijuana, 4.0 percent used prescription-type drugs, 1.3 percent used inhalants, 1.0 percent used hallucinogens, and 0.6 percent used cocaine. Rates of use were highest for the young adult age group (18 to 25 years) at 20.3 percent, with 17.0 percent using marijuana, 6.0 percent using prescription-type drugs nonmedically, 2.2 percent using cocaine, and 1.7 percent using hallucinogens. Among adults aged 26 or older, 5.6 percent reported current illicit drug use: 4.0 percent used marijuana and 1.9 percent used prescription-type drugs. In this latter age group, less than 1 percent used cocaine (0.8 percent), hallucinogens (0.1 percent), and inhalants (0.1 percent).
The rate of current illicit drug use among youths aged 12 to 17 did not change significantly between 2002 (11.6 percent) and 2003 (11.2 percent), and there were no changes for any specific drug. The rate of current marijuana use among youths was 8.2 percent in 2002 and 7.9 percent in 2003. However, there were decreases in rates of past year use of LSD (1.3 to 0.6 percent), Ecstasy (2.2 to 1.3 percent), and methamphetamine (0.9 to 0.7 percent). In addition, there was a decline in past month marijuana use among youths aged 12 or 13, from 1.4 percent in 2002 to 1.0 percent in 2003. Past month inhalant use among youths aged 16 or 17 increased from 0.6 percent in 2002 to 1.0 percent in 2003.
Among young adults, past month Ecstasy use declined from 1.1 percent in 2002 to 0.7 percent in 2003 (Figure 2.7). However, there was an increase in past month nonmedical use of pain relievers, from 4.1 percent in 2002 to 4.7 percent in 2003. Past year use of hallucinogens declined in this age group from 8.4 percent in 2002 to 6.7 percent in 2003, with declines in the use of Ecstasy (5.8 to 3.7 percent) and LSD (1.8 to 1.1 percent). Rates of illicit drug use for adults aged 26 or older were unchanged between 2002 and 2003.

Figure 2.7 Past Month Use of Ecstasy and Nonmedical Use of Pain Relievers among Young Adults Aged 18 to 25: 2002 and 2003

Figure 2.7 D

Note: Statistically significant differences (at 0.05 level) between 2002 and 2003 are denoted by " + ".

Gender

As in prior years, men were more likely in 2003 to report current illicit drug use than women (10.0 vs. 6.5 percent). However, rates of nonmedical use of any prescription-type psychotherapeutic were similar for males (2.7 percent) and females (2.6 percent).
Among youths aged 12 to 17, the rate of current illicit drug use was similar for boys (11.4 percent) and girls (11.1 percent). While boys aged 12 to 17 had a higher rate of marijuana use than girls (8.6 vs. 7.2 percent), rates of nonmedical use of any prescription-type psychotherapeutics were 4.2 percent for girls and 3.7 percent for boys (not a statistically significant difference).

Pregnant Women

Among pregnant women aged 15 to 44 years, 4.3 percent reported using illicit drugs in the month prior to their interview during 2002 and 2003. This rate was significantly lower than the rate among women aged 15 to 44 who were not pregnant (10.4 percent). (These estimates are based on combined 2002 and 2003 NSDUH data.)

Race/Ethnicity

Rates of current illicit drug use varied significantly among the major racial/ethnic groups in 2003. The rate was highest among American Indians or Alaska Natives (12.1 percent), persons reporting two or more races (12.0 percent), and Native Hawaiians or Other Pacific Islanders (11.1 percent) (Figure 2.8). Rates were 8.3 percent for whites, 8.0 percent for Hispanics, and 8.7 percent for blacks. Asians had the lowest rate at 3.8 percent.

Figure 2.8 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2002 and 2003

Figure 2.8 D

Note: Statistically significant differences (at 0.05 level) between 2002 and 2003 are denoted by " + ".

Among youths aged 12 to 17, the rate of current illicit drug use among American Indians or Alaska Natives (19.3 percent) was higher than the rate among all youths (11.2 percent), and the rate among Asian youths (6.5 percent) was significantly lower compared with the overall rate for all youths (Figure 2.9)

Figure 2.9 Past Month Illicit Drug Use among Youths Aged 12 to 17, by Race/Ethnicity: 2002 and 2003

Figure 2.9 D

Note 1: Due to low precision, estimates for Native Hawaiians or Other Pacific Islanders are not shown.

Note 2: Statistically significant differences (at 0.05 level) between 2002 and 2003 are denoted by " + ".

There were no statistically significant changes between 2002 and 2003 in the rates of current illicit drug use for any racial/ethnic subgroup. This was the case both for all persons aged 12 or older and for youths aged 12 to 17.
Although estimates of current hallucinogen use for all racial/ethnic groups combined showed a decrease between 2002 and 2003, this decrease was not evident among Hispanics. Among Hispanics aged 12 or older, the rate of past month hallucinogen use was 0.3 percent in 2002 and 0.5 percent in 2003. Although this was not a statistically significant increase, the rate of use among Hispanics aged 18 to 25 did increase significantly, from 0.7 percent in 2002 to 1.3 percent in 2003.

Education

Illicit drug use rates in 2003 were correlated with educational status. Among adults aged 18 or older, the rate of current illicit drug use was lower among college graduates (5.2 percent) compared with those who did not graduate from high school (9.0 percent), high school graduates (8.3 percent), or those with some college (9.2 percent). However, adults who had completed 4 years of college were more likely to have tried illicit drugs in their lifetime when compared with adults who had not completed high school (51.1 vs. 38.0 percent).

College Students

In the college-aged population (persons aged 18 to 22 years old), the rate of current illicit drug use was nearly the same among full-time undergraduate college students (21.4 percent) as for other persons aged 18 to 22 years, including part-time students, students in other grades, and nonstudents (22.5 percent). The rate of current illicit drug use among college students and other 18 to 22 year olds did not change between 2002 and 2003.

Employment

Current employment status was highly correlated with rates of illicit drug use in 2003. An estimated 18.2 percent of unemployed adults aged 18 or older were current illicit drug users compared with 7.9 percent of those employed full time and 10.7 percent of those employed part time.
Although the rate of drug use was higher among unemployed persons compared with those from other employment groups, most drug users were employed. Of the 16.7 million illicit drug users aged 18 or older in 2003, 12.4 million (74.3 percent) were employed either full or part time.

Geographic Area

Among persons aged 12 or older, the rate of current illicit drug use in 2003 was 9.3 percent in the West, 8.7 percent in the Northeast, 7.9 percent in the Midwest, and 7.4 percent in the South.
The rate of illicit drug use in metropolitan areas was higher than the rate in nonmetropolitan areas. Rates were 8.3 percent in large metropolitan counties, 8.6 percent in small metropolitan counties, and 7.0 percent in nonmetropolitan counties as a group (Figure 2.10). Within nonmetropolitan areas, counties that were urbanized had a rate of 7.9 percent, while completely rural counties had a significantly lower rate (3.1 percent).

Figure 2.10 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2002 and 2003

Figure 2.10 D

Note: Statistically significant differences (at 0.05 level) between 2002 and 2003 are denoted by " + ".

The rate of current illicit drug use in completely rural counties declined between 2002 and 2003, from 6.7 to 3.1 percent. This was largely due to a decrease from 4.1 to 0.8 percent in the nonmedical use of prescription-type psychotherapeutic drugs in rural areas.

Criminal Justice Populations

In 2003, among the estimated 1.4 million adults aged 18 or older on parole or other supervised release from prison during the past year, 24.3 percent were current illicit drug users compared with 7.7 percent among adults not on parole or supervised release.
Among the estimated 4.8 million adults on probation at some time in the past year, 28.0 percent reported current illicit drug use in 2003. This compares with a rate of 7.4 percent among adults not on probation in 2003.

Frequency of Use

In 2003, 12.2 percent of past year marijuana users used marijuana on 300 or more days in the past 12 months. This translates into 3.1 million persons using marijuana on a daily or almost daily basis over a 12–month period. This was the same number as in 2002. However, the number of youths aged 12 to 17 using marijuana daily or almost daily declined from 358,000 in 2002 to 282,000 in 2003 (Figure 2.11). The number of youths using marijuana on 20 or more days in the past month declined from 603,000 in 2002 to 482,000 in 2003.

Figure 2.11 Numbers (in Thousands) of Daily or Almost Daily Marijuana Users in the Past Year and Past Month among Youths Aged 12 to 17: 2002 and 2003

Figure 2.11 D

Note: Statistically significant differences (at 0.05 level) between 2002 and 2003 are denoted by " + ".

Association with Cigarette and Alcohol Use

In 2003, the rate of current illicit drug use was approximately 8 times higher among youths aged 12 to 17 who smoked cigarettes (48.4 percent) than it was among youths who did not smoke cigarettes (6.1 percent).
Illicit drug use also was associated with the level of alcohol use. Among youths aged 12 to 17 who were heavy drinkers, 64.5 percent also were current illicit drug users, whereas among nondrinkers, the rate was only 5.1 percent.
Among youths who were both smokers and heavy drinkers, 72.4 percent used illicit drugs compared with only 3.7 percent among youths who did not drink or smoke.

Driving Under the Influence of Illicit Drugs

In 2003, an estimated 10.9 million persons reported driving under the influence of an illicit drug during the past year. This corresponds to 4.6 percent of the population aged 12 or older. The rate was 14.1 percent among young adults aged 18 to 25. Among adults aged 26 or older, the rate was 3.1 percent. These rates were all similar to the rates in 2002.

How Marijuana Is Obtained

NSDUH includes questions asking marijuana users how, from whom, and where they obtained the marijuana they used most recently. In 2003, most users (56.9 percent) got the drug for free or shared someone else's marijuana. Almost 40 percent of marijuana users bought it.
Most marijuana users obtained the drug from a friend; 77.8 percent of those who bought their marijuana and 81.3 percent of those who obtained the drug for free had obtained it from a friend.
More than half (54.3 percent) of users who bought their marijuana purchased it inside a home, apartment, or dorm. This also was the most common location for obtaining marijuana for free (62.7 percent).
Among youths who bought their marijuana, 30.9 percent bought it inside a home, apartment, or dorm. Among youths who obtained their marijuana for free, 48.8 percent obtained it inside a home, apartment, or dorm.
Almost 9 percent of youths aged 12 to 17 who bought their marijuana obtained it inside a school building, and 4.6 percent bought it outside on school property.

3. Alcohol Use

The National Survey on Drug Use and Health (NSDUH) includes questions about the recency and frequency of consumption of alcoholic beverages, such as beer, wine, whiskey, brandy, and mixed drinks. An extensive list of examples of the kinds of beverages covered is given to respondents prior to the question administration. A "drink" is defined as a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. Times when the respondent only had a sip or two from a drink are not considered as consumption. For this report, estimates for the prevalence of alcohol use are reported primarily at three levels defined for both males and females and for all ages as follows:

Current use - At least one drink in the past 30 days (includes binge and heavy use).

Binge use - Five or more drinks on the same occasion at least once in the past 30 days (includes heavy use).

Heavy use - Five or more drinks on the same occasion on at least 5 different days in the past 30 days.

About half of Americans aged 12 or older reported being current drinkers of alcohol in the 2003 survey (50.1 percent). This translates to an estimated 119 million people, similar to the 2002 estimate of 120 million current drinkers.
More than one fifth (22.6 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2003. This translates to about 54 million people, comparable with the number reported in 2002.
In 2003, heavy drinking was reported by 6.8 percent of the population aged 12 or older, or 16.1 million people. These figures are similar to those of 2002, when 6.7 percent (15.9 million people) reported heavy drinking.

Age

Among young people, the prevalence of current alcohol use in 2003 increased with age, from 2.9 percent at age 12 to about 70 percent of persons 21 or 22 years old (Figure 3.1). Among older age groups, the prevalence of alcohol use decreased with increasing age, from 61.7 percent among 26 to 29 year olds to 46.2 percent among 60 to 64 year olds and 34.4 percent among people aged 65 or older.

Figure 3.1 Current, Binge, and Heavy Alcohol Use, by Age: 2003

Figure 3.1 D

Rates of binge alcohol use were 0.9 percent at age 12, 2.2 percent at age 13, 7.1 percent at age 14, 11.7 percent at age 15, 18.0 percent at age 16, and 24.5 percent at age 17. The rate peaked at age 21 (47.8 percent) and then decreased beyond young adulthood.
The highest prevalence of both binge and heavy drinking in 2003 was for young adults aged 18 to 25, with the peak rate of both measures occurring at age 21. The rate of binge drinking was 41.6 percent for young adults aged 18 to 25 and 47.8 percent at age 21. Heavy alcohol use was reported by 15.1 percent of persons aged 18 to 25 and by 18.7 percent of persons aged 21.
While 57.7 percent of the population aged 45 to 49 in 2003 were current drinkers, 23.2 percent of persons within this age range were binge drinkers and 6.8 percent drank heavily. Rates of binge and heavy drinking were relatively low among people aged 65 or older, with rates of 7.2 and 1.8 percent, respectively.
Among youths aged 12 to 17, an estimated 17.7 percent used alcohol in the month prior to the survey interview. Of all youths, 10.6 percent were binge drinkers, and 2.6 percent were heavy drinkers. These percentages for binge drinking and heavy drinking were very similar to those obtained in 2002 (10.7 and 2.5 percent, respectively).

Underage Alcohol Use

About 10.9 million persons aged 12 to 20 reported drinking alcohol in the month prior to the survey interview in 2003 (29.0 percent of this age group). Nearly 7.2 million (19.2 percent) were binge drinkers, and 2.3 million (6.1 percent) were heavy drinkers. These figures were essentially the same as those obtained from the 2002 survey.
More males than females aged 12 to 20 reported binge drinking (21.7 vs. 16.5 percent) and heavy drinking (7.9 vs. 4.3 percent) in 2003.
Among persons aged 12 to 20, past month alcohol use rates ranged from 18.2 percent among Asians and blacks to 33.2 percent for whites. Binge drinking was reported by 22.8 percent of underage whites, 20.8 percent of underage American Indians or Alaska Natives, and 16.9 percent of underage Hispanics, but only by 9.6 percent of underage Asians and 9.1 percent of underage blacks.
Across geographic regions in 2003, underage current alcohol use rates were higher in the Northeast (32.0 percent) and Midwest (31.7 percent) than in the South and the West (26.7 percent and 27.6 percent, respectively) (Figure 3.2). This pattern was essentially the same in 2002.