Results:  2002 National Survey on Drug Use & Health (NSDUH)

Highlights

This report presents, for the first time, information from the 2002 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). 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.

Because of improvements to the survey in 2002, estimates from the 2002 NSDUH should not be compared with estimates from the 2001 and earlier NHSDAs to assess change over time in substance use. Therefore, the 2002 data constitute a new baseline for tracking trends in substance use and other measures. However, it is possible to develop trend estimates based on respondents' reports of past substance use in the 2002 NSDUH. The estimates are presented in terms of lifetime and first-time substance use.

Illicit Drug Use

• In 2002, an estimated 19.5 million Americans, or 8.3 percent of the population aged 12 or older, were current illicit drug users. Current drug use means use of an illicit drug during the month prior to the survey interview.
• Marijuana is the most commonly used illicit drug, with a rate of 6.2 percent. Of the 14.6 million past month marijuana users in 2002, about one third, or 4.8 million persons, used it on 20 or more days in the past month.
• In 2002, an estimated 2.0 million persons (0.9 percent) were current cocaine users, 567,000 of whom used crack. Hallucinogens were used by 1.2 million persons, including 676,000 users of Ecstasy. There were an estimated 166,000 current heroin users.
• An estimated 6.2 million persons, or 2.6 percent of the population aged 12 or older, were current users of psychotherapeutic drugs taken nonmedically. An estimated 4.4 million used pain relievers, 1.8 million used tranquilizers, 1.2 million used stimulants, and 0.4 million used sedatives.
• In 2002, approximately 1.9 million persons aged 12 or older had used OxyContin nonmedically at least once in their lifetime.
• Among youths aged 12 to 17, 11.6 percent were current illicit drug users. The rate of use was highest among young adults (18 to 25 years) at 20.2 percent. Among adults aged 26 or older, 5.8 percent reported current illicit drug use.
• Among pregnant women aged 15 to 44 years, 3.3 percent reported using illicit drugs in the month prior to their interview. This rate was significantly lower than the rate among women aged 15 to 44 who were not pregnant (10.3 percent).
• The rates of current illicit drug use were highest among American Indians/Alaska Natives (10.1 percent) and persons reporting two or more races (11.4 percent). Rates were 9.7 percent for blacks, 8.5 percent for whites, and 7.2 percent for Hispanics. Asians had the lowest rate at 3.5 percent.
• Among youths aged 12 to 17, the rate of current illicit drug use among American Indians/Alaska Natives (20.9 percent) was significantly higher than the rate among all youths (11.6 percent), and the rate among Asian youths (4.8 percent) was significantly lower compared with the overall rate for all youths.
• An estimated 17.4 percent of unemployed adults aged 18 or older were current illicit drug users in 2002 compared with 8.2 percent of those employed full time and 10.5 percent of those employed part time. However, most drug users were employed. Of the 16.6 million illicit drug users aged 18 or older in 2002, 12.4 million (74.6 percent) were employed either full or part time.
• In 2002, an estimated 11.0 million persons reported driving under the influence of an illicit drug during the past year. This corresponds to 4.7 percent of the population aged 12 or older. The rate was 10 percent or greater for each age from 17 to 25, with 21 year olds reporting the highest rate of any age (18.0 percent). Among adults aged 26 or older, the rate was 3.0 percent.

Alcohol Use

• An estimated 120 million Americans aged 12 or older reported being current drinkers of alcohol in the 2002 survey (51.0 percent). About 54 million (22.9 percent) participated in binge drinking at least once in the 30 days prior to the survey, and 15.9 million (6.7 percent) were heavy drinkers.
• The prevalence of current alcohol use increased with increasing age in 2002, from 2.0 percent at age 12 to 6.5 percent at age 13, 13.4 percent at age 14, 19.9 percent at age 15, 29.0 percent at age 16, and 36.2 percent at age 17. The rate reached a peak of 70.9 percent for persons 21 years old.
• About 10.7 million persons aged 12 to 20 reported drinking alcohol in the month prior to the survey interview in 2002 (28.8 percent of this age group). Of these, nearly 7.2 million (19.3 percent) were binge drinkers and 2.3 million (6.2 percent) were heavy drinkers.
• About 1 in 7 Americans aged 12 or older in 2002 (14.2 percent, or 33.5 million persons) drove under the influence of alcohol at least once in the 12 months prior to the interview.

Tobacco Use

• An estimated 71.5 million Americans (30.4 percent of the population aged 12 or older) reported current use (past month use) of a tobacco product in 2002. About 61.1 million (26.0 percent) smoked cigarettes, 12.8 million (5.4 percent) smoked cigars, 7.8 million (3.3 percent) used smokeless tobacco, and 1.8 million (0.8 percent) smoked tobacco in pipes.
• A higher proportion of males than females aged 12 or older smoked cigarettes in 2002 (28.7 vs. 23.4 percent). However, among youths aged 12 to 17, girls were slightly more likely than boys to smoke (13.6 vs. 12.3 percent).
• In 2002, 17.3 percent of pregnant women aged 15 to 44 smoked cigarettes in the past month compared with 31.1 percent of nonpregnant women of the same age group.

Trends in Lifetime Substance Use

• The percentage of youths aged 12 to 17 who had ever used marijuana declined slightly from 2001 to 2002 (21.9 to 20.6 percent). Among young adults aged 18 to 25, the rate increased slightly from 53.0 percent in 2001 to 53.8 percent in 2002.
• The percentage of youths aged 12 to 17 who had ever used cocaine increased slightly from 2001 to 2002 (2.3 to 2.7 percent). Among young adults aged 18 to 25, the rate increased slightly from 14.9 percent in 2001 to 15.4 percent in 2002.
• Lifetime nonmedical pain reliever prevalence among youths aged 12 to 17 increased from 2001 (9.6 percent) to 2002 (11.2 percent), continuing an increasing trend from 1989 (1.2 percent). Among young adults aged 18 to 25, the rate increased from 19.4 percent in 2001 to 22.1 percent in 2002. The young adult rate had been 6.8 percent in 1992.
• The rate of lifetime cigarette use among youths aged 12 to 17 declined from 37.3 percent in 2001 to 33.3 percent in 2002.
• The rate of lifetime daily cigarette use among youths aged 12 to 17 declined from 10.6 percent in 2001 to 8.2 percent in 2002. There also was a small decline in lifetime prevalence among young adults (37.7 to 37.1 percent) from 2001 to 2002.

Trends in Initiation of Substance Use (Incidence)

• There were an estimated 2.6 million new marijuana users in 2001. This number is similar to the numbers of new users each year since 1995, but above the number in 1990 (1.6 million).
• Pain reliever incidence increased from 1990, when there were 628,000 initiates, to 2000, when there were 2.7 million. In 2001, the number was 2.4 million, not significantly different from 2000.
• The number of new daily cigarette smokers decreased from 2.1 million in 1998 to 1.4 million in 2001. Among youths under 18, the number of new daily smokers decreased from 1.1 million per year between 1997 and 2000 to 757,000 in 2001. This corresponds to a decrease from about 3,000 to about 2,000 new youth smokers per day.

Youth Prevention-Related Measures

• Among youths indicating that "smoking marijuana once a month" was a "great risk," only 1.9 percent indicated that they had used marijuana in the past month. However, among youths who indicated "moderate, slight, or no risk," the prevalence rate was almost 6 times larger (11.3 percent).
• The percentages of youths reporting that it was fairly or very easy to obtain specific drugs were 55.0 percent for marijuana, 25.0 percent for cocaine, 19.4 percent for LSD, and 15.8 percent for heroin.
• Most youths (89.1 percent) reported that their parents would strongly disapprove of their trying marijuana once or twice. Among these youths, only 5.5 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, 30.2 percent reported past month use of marijuana.

Substance Dependence or Abuse

• An estimated 22.0 million Americans in 2002 were classified with substance dependence or abuse (9.4 percent of the total population aged 12 or older). Of these, 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 14.9 million were dependent on or abused alcohol but not illicit drugs.
• Among persons aged 12 or older in 2002, the rate of substance dependence or abuse was highest among American Indians/Alaska Natives (14.1 percent). The next highest rate was among persons reporting two or more races (13.0 percent). Asians had the lowest rate of dependence or abuse (4.2 percent). The rate was similar among blacks and whites (9.5 and 9.3 percent, respectively). Among Hispanics, the rate was 10.4 percent.
• In 2002, an estimated 19.7 percent of unemployed adults aged 18 or older were classified with dependence or abuse, while 10.6 percent of full-time employed adults and 10.5 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 19.8 million adults classified with dependence or abuse, 15.3 million (77.1 percent) were employed.

Treatment and Treatment Need for Substance Problems

• An estimated 3.5 million people aged 12 or older (1.5 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 2002. Of these, 2.2 million received treatment for alcohol during their most recent treatment. An estimated 974,000 persons received treatment for marijuana, 796,000 persons for cocaine, 360,000 for pain relievers, and 277,000 for heroin. Most people receiving treatment received it at a "specialty" substance abuse facility (2.3 million).
• In 2002, the estimated number of persons aged 12 or older needing treatment for an illicit drug problem was 7.7 million (3.3 percent of the total population). Of these persons, 1.4 million (18.2 percent) received treatment for drug abuse at a specialty substance abuse facility in the past 12 months. Of the 6.3 million people who needed drug treatment but did not receive treatment at a specialty facility in 2002, an estimated 362,000 (5.7 percent) reported that they felt they needed treatment for their drug problem. This included an estimated 88,000 (24.4 percent) who reported that they made an effort but were unable to get treatment and 274,000 (75.6 percent) who reported making no effort to get treatment.
• In 2002, the estimated number of persons aged 12 or older needing treatment for an alcohol problem was 18.6 million (7.9 percent of the total population). Of these, 8.3 percent (1.5 million) received alcohol treatment at a specialty substance abuse facility in the past 12 months. Of the 17.1 million people who needed but did not receive alcohol treatment, an estimated 761,000 (4.5 percent) reported that they felt they needed treatment for their alcohol problem. Of the 761,000 persons, 266,000 (35 percent) reported that they made an effort but were unable to get treatment, and 495,000 (65 percent) reported making no effort to get treatment.
• Among the 1.4 million persons who received specialty treatment for an illicit drug problem in the past year, 33.9 percent reported "own savings or earnings" as a source of payment for their most recent specialty treatment. An estimated 30.0 percent reported private health insurance, 26.1 percent reported Medicaid, and 23.3 percent reported public assistance other than Medicaid as a source of payment.
• Among the 1.5 million persons who received specialty treatment for an alcohol problem in the past year, 46.3 percent reported "own savings or earnings" as a source of payment for their most recent specialty treatment. An estimated 31.7 percent reported using private health insurance, 21.5 percent reported public assistance other than Medicaid, and 21.4 percent reported Medicaid.

Serious Mental Illness among Adults

• In 2002, there were an estimated 17.5 million adults aged 18 or older with serious mental illness (SMI). This represents 8.3 percent of all adults. Rates of SMI were highest for persons aged 18 to 25 (13.2 percent) and lowest for persons aged 50 or older (4.9 percent). The percentage of females with SMI was higher than the percentage of males (10.5 vs. 6.0 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 2002, among adults who used an illicit drug in the past year, 17.1 percent had SMI in that year, while the rate was 6.9 percent among adults who did not use an illicit drug.
• SMI was highly correlated with substance dependence or abuse. Among adults with SMI in 2002, 23.2 percent (4.0 million) were dependent on or abused alcohol or illicit drugs, while the rate among adults without SMI was only 8.2 percent.
• Among adults with substance dependence or abuse, 20.4 percent had SMI. The rate of SMI was 7.0 percent among adults who were not dependent on or abusing a substance.

Treatment for Mental Health Problems

• In 2002, an estimated 27.3 million adults (13.0 percent) received mental health treatment in the 12 months prior to the interview.
• Among the 17.5 million adults with SMI in 2002, 8.4 million (47.9 percent) received treatment for a mental health problem in the 12 months prior to the interview.
• Among adults with SMI, 30.5 percent perceived an unmet need for mental health treatment in the 12 months prior to their interview. The most often reported reasons for not getting needed treatment were "could not afford the cost" (44.3 percent) and "did not know where to go for services" (20.5 percent).
• In 2002, an estimated 4.8 million youths aged 12 to 17 received treatment or counseling for emotional or behavior problems in the year prior to the interview. This represents 19.3 percent of this population.
• The reason cited most often by youths for their latest treatment session was "felt depressed" (49.5 percent of youths receiving treatment), followed by "breaking rules or acting out" (26.7 percent), "thought about killing self or tried to kill self" (19.5 percent), and "felt very afraid or tense" (19.5 percent).
• The rate of mental health treatment among youths who used illicit drugs in the past year (26.7 percent) was higher than the rate among youths who did not use illicit drugs (17.2 percent).

Results:  2002 National Survey on Drug Use & Health (NSDUH)

1. Introduction

This report presents the first information from the 2002 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 2002 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, based on a complex small area estimation (SAE) method, will be presented in other reports to be released separately.

Because of improvements to the survey in 2002, estimates from the 2002 NSDUH should not be compared with estimates from the 2001 and earlier NHSDAs to assess change over time in substance use. Therefore, the 2002 data will constitute a new baseline for tracking trends in substance use and other measures.

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 place of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is planned and managed by SAMHSA's Office of Applied Studies (OAS). Data collection is conducted by 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 E describes surveys that cover populations outside the NSDUH sampling frame.

Since 1999, the NSDUH interview has been carried out using computer-assisted interviewing (CAI). The survey uses a combination of computer-assisted personal interviewing (CAPI) conducted by the interviewer and audio computer-assisted self-interviewing (ACASI). Use of ACASI is designed to provide the respondent with a highly private and confidential means of responding to questions and to increase the level of honest reporting of illicit drug use and other sensitive behaviors.

Consistent with the 1999 through 2001 surveys, the 2002 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, 136,349 addresses were screened for the 2002 survey, and 68,126 completed interviews were obtained. The survey was conducted from January through December 2002. Weighted response rates for household screening and for interviewing were 90.7 and 78.9 percent, respectively. See Appendix B for more information on NSDUH response rates.

1.2. Trend Measurement

Although the design of the 2002 NSDUH is similar to the design of the 1999 through 2001 surveys, there are important methodological differences in the 2002 survey that affect the 2002 estimates. Besides the name change, each NSDUH respondent is now given an incentive payment of $30. These changes, both implemented in 2002, 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. Further, the 2002 data could have been affected by improved data collection quality control procedures that were introduced in the survey beginning in 2001. In addition, new population data from the 2000 decennial census recently became available for use in NSDUH sample weighting procedures, resulting in another discontinuity between the 2001 and 2002 estimates. Analyses of the effects of each of these factors on NSDUH estimates (see Appendix C) have shown that 2002 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 NSDUH.

Using only the 2002 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), as well as the rates of lifetime prevalence (the percentage of the population that has ever used each substance) for years prior to 2002. Trends in these measures for youths and young adults are discussed in Chapters 5 and 6. Additional discussion of trends, including a comparison with the Monitoring the Future (MTF) study, is included in the final discussion in Chapter 10.

The methodological changes made to NSDUH in 2002 improved the quality of the data provided by the survey. As is typically the case in ongoing surveys, adjustments in survey procedures must be made periodically in order to maintain data quality in the context of the changing environment in which surveys are conducted (e.g., a general decline in the U.S. population's willingness to participate in surveys). OAS will continue to explore and test improvements to the survey design, but no additional changes to the survey that could impact trend measurement will be implemented in the foreseeable future. Thus, subsequent reports of NSDUH data will provide detailed analyses of trends in current substance use and other measures, with the 2002 estimates from this report providing the new baseline for measuring change.

1.3. Format of Report and Explanation of Tables

The results from the 2002 NSDUH are given in this report, which has separate chapters that discuss the national findings on eight topics: use of illicit drugs; use of alcohol; use of tobacco products; trends in lifetime use of substances; 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, provide technical details on the survey methodology, discuss the effects of survey protocol changes on trend measurement, offer key NSDUH definitions, discuss other sources of data, list the references cited in the report (as well as other relevant references), and present selected tabulations of estimates.

Tables and text 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."

Data are presented for racial/ethnic groups in several categorizations, based 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 race/ethnicity 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 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 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 "Rural-Urban Continuum Codes" 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 Office of Management and Budget (OMB). For New England, the New England County Metropolitan Areas (NECMA) are used for defining codes. 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.

1.4. Other NSDUH Reports

This report provides a comprehensive summary of the 2002 NSDUH, including results, technical appendices, and selected data tables. A companion report, Overview of Findings from the 2002 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 2002 will be available in early 2004.

In addition to the tables included in Appendices G and H 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, 2003). Currently, files are available from the 1979 to 2001 NHSDAs at http://www.icpsr.umich.edu/SAMHDA. The NSDUH 2002 public use file will be available by the end of 2003.

Results:  2002 National Survey on Drug Use & Health (NSDUH)

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. Findings from the 2002 NSDUH on illicit drug use are summarized below.

• In 2002, 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 8.3 percent of the population aged 12 years old or older.
• Marijuana is the most commonly used illicit drug. In 2002, it was used by 75 percent of current illicit drug users. Approximately 55 percent of current illicit drug users used only marijuana, 20 percent used marijuana and another illicit drug, and the remaining 25 percent used an illicit drug but not marijuana in the past month. About 45 percent of current illicit drug users in 2002 (8.8 million Americans) used illicit drugs other than marijuana and hashish, with or without using marijuana as well (Figure 2.1).
• In 2002, an estimated 2.0 million persons (0.9 percent) were current cocaine users, 567,000 of whom used crack during the same time period (0.2 percent). Hallucinogens were used by 1.2 million persons (0.5 percent), including 676,000 users of Ecstasy (0.3 percent) (Figure 2.2). There were an estimated 166,000 current heroin users (0.1 percent).
• Of the 8.8 million current users of illicit drugs other than marijuana, 6.2 million were current users of psychotherapeutic drugs. This represents 2.6 percent of the population aged 12 or older. Of those who reported current use of any psychotherapeutics, 4.4 million used pain relievers, 1.8 million used tranquilizers, 1.2 million used stimulants, and 0.4 million used sedatives.

Figure 2.1  Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2002

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

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• In 2002, approximately 1.9 million persons aged 12 or older had used OxyContin nonmedically at least once in their lifetime. OxyContin is a controlled-release tablet form of the narcotic oxycodone that can have severe health consequences if the tablet is crushed and then ingested.

Age

• Rates of drug use showed substantial variation by age. For example, 4.2 percent of youths aged 12 or 13 reported current illicit drug use in 2002 (Figure 2.3). As in other years, illicit drug use in 2002 tended to increase with age among young persons. It peaked among 18 to 20 year olds (22.5 percent) and declined steadily after that point with increasing age.
• The types of drugs used also varied by age group. Among youths aged 12 to 17, 11.6 percent were current illicit drug users: 8.2 percent used marijuana, 4.0 percent used prescription-type drugs, 1.2 percent used inhalants, 1.0 percent used hallucinogens, and 0.6 percent used cocaine (Figure 2.4). Rates of use were highest for the young adult age group (18 to 25 years) at 20.2 percent, with 17.3 percent using marijuana, 5.4 percent using prescription-type drugs nonmedically, 2.0 percent using cocaine, and 1.9 percent using hallucinogens (Figure 2.5). Among adults aged 26 or older, 5.8 percent reported current illicit drug use: 4.0 percent used marijuana and 2.0 percent used prescription-type drugs. Less than 1 percent used cocaine (0.7 percent), hallucinogens (0.2 percent), and inhalants (0.1 percent) (Figure 2.6).
• Among youths, the types of drugs used also differed by age. Among 12 or 13 year olds, 1.7 percent used prescription-type drugs nonmedically, 1.4 percent used marijuana, and 1.4 percent used inhalants. Among 14 or 15 year olds, marijuana was the dominant drug used (7.6 percent), followed by prescription-type drugs used nonmedically (4.0 percent) and inhalants (1.6 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (15.7 percent), followed by prescription-type drugs used nonmedically (6.2 percent), hallucinogens (1.9 percent), and cocaine (1.3 percent). Only 0.6 percent of youths aged 16 or 17 used inhalants.
• Although most drug use rates in 2002 were higher among youths and young adults compared with older adults, the age distribution of users varied considerably by type of drug. Almost half (47 percent) of current illicit drug users were aged 12 to 25. However, in 2002, 71 percent of hallucinogen users, as well as 71 percent of inhalant users, were 12 to 25 year olds. Conversely, only 38 percent of cocaine users and 43 percent of nonmedical psychotherapeutics users were in that age grouping.

Gender

• As in prior years, men were more likely in 2002 to report current illicit drug use than women (10.3 vs. 6.4 percent). However, rates of nonmedical psychotherapeutic use were similar for males (2.7 percent) and females (2.6 percent), which was consistent with previous findings for these drugs.

Figure 2.3  Past Month Illicit Drug Use, by Age: 2002

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Figure 2.4  Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002

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Figure 2.5  Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25: 2002

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Figure 2.6  Past Month Use of Selected Illicit Drugs among Adults Aged 26 or Older: 2002

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• Among youths aged 12 to 17, the rate of current illicit drug use was higher for boys (12.3 percent) than for girls (10.9 percent) (Figure 2.7). Although boys aged 12 to 17 had a higher rate of marijuana use than girls (9.1 vs. 7.2 percent), girls were more likely to use psychotherapeutics nonmedically than boys (4.3 vs. 3.6 percent).

Figure 2.7  Past Month Illicit Drug Use among Youths Aged 12 to 17, by Gender: 2002

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Pregnant Women

• Among pregnant women aged 15 to 44 years, 3.3 percent reported using illicit drugs in the month prior to their interview. This rate was significantly lower than the rate among women aged 15 to 44 who were not pregnant (10.3 percent).

Race/Ethnicity

• Rates of current illicit drug use varied significantly among the major racial/ethnic groups in 2002. The rate was highest among American Indians/Alaska Natives (10.1 percent) and persons reporting two or more races (11.4 percent). Rates were 8.5 percent for whites, 7.2 percent for Hispanics, and 9.7 percent for blacks (Figure 2.8). Asians had the lowest rate at 3.5 percent.
• There were variations in rates of past month illicit drug use among Hispanic subgroups. Rates were 10.0 percent for Puerto Ricans, 7.3 percent for Mexicans, 6.5 percent for Cubans, and 5.0 percent for Central or South Americans.

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

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• Among youths aged 12 to 17, the rate of current illicit drug use among American Indians/Alaska Natives (20.9 percent) was significantly higher than the rate among all youths (11.6 percent), and the rate among Asian youths (4.8 percent) was significantly lower compared with the overall rate for all youths (Figure 2.9).

Education

• As in other years, illicit drug use rates were correlated with educational status in 2002. Among adults aged 18 or older, the rate of current illicit drug use was lower among college graduates (5.8 percent) compared with those who did not graduate from high school (9.1 percent), high school graduates (8.0 percent), or those with some college (9.1 percent). This is despite the fact that 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 (50.5 vs. 37.1 percent).

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

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College Students

• In the college-aged population (i.e., those aged 18 to 22 years old), the rate of current illicit drug use was nearly the same among full-time undergraduate college students (20.7 percent) as for other persons aged 18 to 22 years, including part-time students, students in other grades, and nonstudents (22.4 percent).

Employment

• Current employment status was highly correlated with rates of illicit drug use in 2002. An estimated 17.4 percent of unemployed adults aged 18 or older were current illicit drug users compared with 8.2 percent of those employed full time and 10.5 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 16.6 million illicit drug users aged 18 or older in 2002, 12.4 million (74.6 percent) were employed either full or part time.

Geographic Area

• Among persons aged 12 or older, the rate of current illicit drug use in 2002 was 9.7 percent in the West, 8.2 percent in the Northeast, 8.1 percent in the Midwest, and 7.6 percent in the South.
• The rate of illicit drug use in metropolitan areas was higher than the rate in nonmetropolitan areas. Rates were 8.6 percent in large metropolitan counties, 8.9 percent in small metropolitan counties, and 6.6 percent in nonmetropolitan counties as a group (Figure 2.10). Within nonmetropolitan areas, counties that were urbanized had a rate of 8.0 percent, while completely rural counties had a rate of 5.4 percent. This is not a statistically significant difference, but this finding is consistent with the pattern reported in previous surveys.

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

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Criminal Justice Populations

• In 2002, among the estimated 1.8 million adults aged 18 or older on parole or other supervised release from prison during the past year, 29.1 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, 28.7 percent reported current illicit drug use in 2002. This compares with a rate of 7.4 percent among adults not on probation in 2002.

Frequency of Use

• In 2002, 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. Among past month users, about one third (32.6 percent, or 4.8 million persons) used marijuana on 20 or more days in the past month.

Association with Cigarette and Alcohol Use

• In 2002, the rate of current illicit drug use was approximately 8 times higher among youths who smoked cigarettes (48.1 percent) than it was among youths who did not smoke cigarettes (6.2 percent) (Figure 2.11).

Figure 2.11  Past Month Illicit Drug Use among Youths Aged 12 to 17, by Cigarette and Alcohol Use: 2002

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• Illicit drug use also was associated with the level of alcohol use. Among youths who were heavy drinkers, 67.0 percent also were current illicit drug users, whereas among nondrinkers, the rate was only 5.6 percent.

Driving Under the Influence of Illicit Drugs

• In 2002, an estimated 11.0 million persons reported driving under the influence of an illicit drug during the past year. This corresponds to 4.7 percent of the population aged 12 or older. The rate was 10 percent or greater for each age from 17 to 25, with 21 year olds reporting the highest rate of any age (18.0 percent). Among adults aged 26 or older, the rate was 3.0 percent.

How Marijuana Is Obtained

• NSDUH includes questions asking marijuana users how, from whom, and where they obtained the marijuana they used most recently. In 2002, most users (56.7 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; 79.0 percent who bought their marijuana and 81.8 percent who obtained the drug for free had obtained it from a friend.
• More than half (55.9 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 (67.2 percent). The percentages of youth users who obtained marijuana inside a home, apartment, or dorm were 34.7 percent for buyers and 48.0 percent for those who obtained it free.
• Almost 9 percent of youths who bought their marijuana obtained it inside a school building, and 4.8 percent bought it outside on school property.

Results:  2002 National Survey on Drug Use & Health (NSDUH)

3. Alcohol Use

The National Survey on Drug Use and Health (NSDUH) includes a set of questions asking about the recency and frequency of the 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.

A summary of the findings from the 2002 NSDUH alcohol questions is given below:

• About half of Americans aged 12 or older reported being current drinkers of alcohol in the 2002 survey (51.0 percent). This translates to an estimated 120 million people.
• More than one fifth (22.9 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey. This translates to about 54 million people.
• Heavy drinking was reported by 6.7 percent of the population aged 12 or older, or 15.9 million people.

Age

• The prevalence of current alcohol use increased with increasing age in 2002, from 2.0 percent at age 12 to 6.5 percent at age 13, 13.4 percent at age 14, 19.9 percent at age 15, 29.0 percent at age 16, and 36.2 percent at age 17. The rate reached a peak of 70.9 percent for persons 21 years old.
• Rates of binge alcohol use were 0.8 percent at age 12, 2.8 percent at age 13, 7.0 percent at age 14, 11.6 percent at age 15, 17.9 percent at age 16, and 25.0 percent at age 17. The rate peaked at age 21 (50.2 percent). a peak of 70.9 percent for persons 21 years old.
• The highest prevalence of both binge and heavy drinking in 2002 was for young adults aged 18 to 25, with the peak rate of both measures occurring at age 21 (Figure 3.1). The rate of binge drinking was 40.9 percent for young adults and 50.2 percent at age 21. Heavy alcohol use was reported by 14.9 percent of persons aged 18 to 25 and by 20.1 percent of persons aged 21. Binge and heavy alcohol use rates decreased faster with increasing age than did rates of past month alcohol use. While 58.8 percent of the population aged 45 to 49 in 2002 were current drinkers, 22.5 percent of persons within this age range were binge drinkers and 7.7 percent drank heavily. Binge and heavy drinking were relatively rare among people aged 65 or older, with reported rates of 7.5 and 1.4 percent, respectively.

Figure 3.1  Past Month Alcohol Use, by Age: 2002

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• Among youths aged 12 to 17, an estimated 17.6 percent used alcohol in the month prior to the survey interview. Of all youths, 10.7 percent were binge drinkers, and 2.5 percent were heavy drinkers.

Underage Alcohol Use

• About 10.7 million persons aged 12 to 20 reported drinking alcohol in the month prior to the survey interview in 2002 (28.8 percent of this age group). Of these, nearly 7.2 million (19.3 percent) were binge drinkers, and 2.3 million (6.2 percent) were heavy drinkers.
• More males than females aged 12 to 20 reported binge drinking in 2002 (21.8 vs. 16.7 percent).
• Among persons aged 12 to 20, past month alcohol use rates in 2002 ranged from 15.5 percent for Asians and 19.3 percent among blacks to 32.8 percent for whites (Figure 3.2). Binge drinking was reported by 22.7 percent of underage whites, 22.6 percent of underage American Indians or Alaska Natives, and 16.8 percent of underage Hispanics, but only by 8.6 percent of underage Asians and 9.8 percent of underage blacks.

Figure 3.2  Past Month Alcohol Use among Persons Aged 12 to 20, by Race/Ethnicity: 2002

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• Across geographic divisions in 2002, underage current alcohol use rates ranged from 24.2 percent in the Pacific division and 26.4 percent in the East South Central division to 33.9 percent in New England.
• In 2002, underage current alcohol use rates were similar by population density. Rates were 27.2 percent in large metropolitan areas, 30.7 percent in small metropolitan areas, and 29.6 percent in nonmetropolitan areas. The rate in nonmetropolitan rural areas was 26.0 percent.

Gender

• Except among youths aged 12 to 17, males were more likely than females to report past month alcohol drinking. In 2002, 57.4 percent of males aged 12 or older were current drinkers compared with 44.9 percent of females.
• For the youngest age group (12 to 17), males and females had comparable rates of current alcohol use in 2002 (17.4 percent of males and 17.9 percent of females).

Pregnant Women

• Among pregnant women aged 15 to 44 in 2002, 9.1 percent used alcohol and 3.1 percent reported binge drinking in the month prior to the survey. These rates were significantly lower than the rates for nonpregnant women of that age (53.4 and 23.4 percent, respectively). Heavy alcohol use was relatively rare (0.7 percent) among pregnant women.

Race/Ethnicity

• Whites were more likely than any other racial/ethnic group to report current use of alcohol in 2002. An estimated 55.0 percent of whites reported past month use. The next highest rate was for persons reporting two or more races (49.9 percent). The lowest current drinking rate was observed for Asians (37.1 percent). The rates were 39.9 percent for blacks, 44.7 percent for American Indians/Alaska Natives, and 42.8 percent for Hispanics.
• The rate of binge alcohol use was lowest among Asians (12.4 percent). Rates for other racial/ethnic groups were 21.0 percent for blacks, 23.4 percent for whites, 24.8 percent for Hispanics, 25.2 percent for Native Hawaiians and other Pacific Islanders, and 27.9 percent for American Indians/Alaska Natives.
• Among youths aged 12 to 17 in 2002, blacks and Asians were least likely to report past month alcohol use. Only 7.4 percent of Asian youths and 10.9 percent of black youths were current drinkers, while rates were above 15 percent for other racial/ethnic groups.

Education

• The rate of past month alcohol use increased with increasing levels of education. Among adults aged 18 or older with less than a high school education, 37.8 percent were current drinkers in 2002, while 67.4 percent of college graduates were current drinkers. However, binge drinking and heavy drinking were least prevalent among college graduates.

College Students

• Young adults aged 18 to 22 enrolled full time in college were more likely than their peers not enrolled full time (this category includes part-time college students and persons not enrolled in college) to use alcohol, binge drink, and drink heavily in 2002. Past month alcohol use was reported by 64.1 percent of full-time college students compared with 54.3 percent of persons 18 to 22 who were not currently enrolled full time. Binge and heavy use rates for college students were 44.4 and 18.8 percent, respectively, compared with 38.9 and 13.4 percent, respectively, for other persons aged 18 to 22.
• Among persons aged 18 to 22, full-time college students were more likely to be heavy drinkers than others (18.8 and 13.4 percent, respectively). However, at later ages (26 or older), those who had attended college were less likely to drink heavily than those who had not attended college (5.2 and 6.7 percent, respectively) (Figure 3.3).

Figure 3.3  Heavy Alcohol Use, by College Attendance and Age: 2002

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Employment

• Rates of current alcohol use were 61.8 percent for full-time employed adults aged 18 or older in 2002 compared with 57.9 percent of their unemployed peers. However, the patterns were different for binge and heavy alcohol use; rates were higher for unemployed persons (34.7 and 13.3 percent, respectively, for binge and heavy use) than for full-time employed persons (29.0 and 8.4 percent, respectively).

• Most binge and heavy alcohol users were employed. Among the 51.1 million adult binge drinkers in 2002, 40.8 million (80 percent) were employed either full or part time. Similarly, 12 million (79 percent) of the 15.2 million adult heavy drinkers were employed.

Geographic Area

• The rate of past month alcohol use for people aged 12 or older in 2002 was lowest in the East South Central division (36.7 percent) and highest in New England (57.2 percent).
• Among people aged 12 or older, the rate of alcohol use in 2002 in large metropolitan areas was 54.0 percent compared with 51.3 percent in small metropolitan areas and 42.9 percent in nonmetropolitan areas. There was less variation across county types in rates of binge and heavy drinking. The rate of heavy alcohol use was 6.3 percent in large metropolitan areas, 7.9 percent in small metropolitan areas, and 6.1 percent in nonmetropolitan areas.
• Among youths aged 12 to 17, the rate of past month binge alcohol use was slightly higher in nonmetropolitan areas (12.6 percent) than in large or small metropolitan areas (10.1 and 10.3 percent, respectively). In rural nonmetropolitan areas, 14.2 percent of youths reported binge drinking.

Association with Illicit Drug and Tobacco Use

• The level of alcohol use was strongly associated with illicit drug use in 2002. Among the 15.9 million heavy drinkers aged 12 or older, 32.6 percent were current illicit drug users. For binge drinkers who were not heavy drinkers, 16.6 percent reported past month illicit drug use. Other drinkers (i.e., past month alcohol use but not binge drinking) had a rate of 5.8 percent for current illicit drug use, and persons who did not use alcohol in the past month were least likely to use illicit drugs (3.6 percent).
• Drinking levels also were associated with tobacco use. Among heavy alcohol users, 61.3 percent smoked cigarettes in the past month, while only 21.8 percent of non-binge current drinkers and 17.7 percent of nondrinkers were current smokers. Smokeless tobacco and cigar use also were more prevalent among heavy drinkers than among non-binge drinkers and nondrinkers.

Driving Under the Influence of Alcohol

• About 1 in 7 Americans aged 12 or older in 2002 (14.2 percent, or 33.5 million persons) drove under the influence of alcohol at least once in the 12 months prior to the interview.
• Males were nearly twice as likely as females (18.8 vs. 9.9 percent, respectively) to have driven under the influence of alcohol.
• More than 1 in 4 (26.6 percent) young adults aged 18 to 25 reported driving under the influence of alcohol at least once in the prior year.