Results from the 2013 National Survey on Drug Use and Health

Results from the 2013

National Survey on Drug Use and Health:

Summary of National Findings

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Behavioral Health Statistics and Quality

Acknowledgments

This report was prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ),

Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of

Health and Human Services (HHS), and by RTI International (a trade name of Research Triangle

Institute), Research Triangle Park, North Carolina. Work by RTI was performed under Contract

No. HHSS283201000003C.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied

without permission from SAMHSA. However, this publication may not be reproduced or

distributed for a fee without the specific, written authorization of the Office of Communications,

SAMHSA, U.S. Department of Health and Human Services. When using estimates and

quotations from this report, citation of the source is appreciated.

Recommended Citation

Substance Abuse and Mental Health Services Administration, Results from the 2013 National

Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS

Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services

Administration, 2014.

Electronic Access and Copies of Publication

This publication may be downloaded from http://store.samhsa.gov/home. Hard copies may be

obtained from SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Originating Office

Substance Abuse and Mental Health Services Administration

Center for Behavioral Health Statistics and Quality

1 Choke Cherry Road, Room 2-1067

Rockville, MD 20857

September 2014

iii

Table of Contents

Chapter Page

List of Tables .................................................................................................................... vii

List of Figures .................................................................................................................... ix

Highlights .........................................................................................................................................1

1. Introduction ..........................................................................................................................9

Summary of NSDUH .......................................................................................................... 9

Limitations on Trend Measurement .................................................................................. 10

Format of Report and Data Presentation ........................................................................... 11

Other NSDUH Reports and Data ...................................................................................... 12

2. Illicit Drug Use ..................................................................................................................15

Age .................................................................................................................................... 19

Youths Aged 12 to 17 ....................................................................................................... 21

Young Adults Aged 18 to 25 ............................................................................................ 21

Adults Aged 26 or Older ................................................................................................... 24

Gender ............................................................................................................................... 25

Pregnant Women ............................................................................................................... 26

Race/Ethnicity ................................................................................................................... 26

Education .......................................................................................................................... 26

College Students ............................................................................................................... 27

Employment ...................................................................................................................... 28

Geographic Area ............................................................................................................... 29

Criminal Justice Populations............................................................................................. 29

Frequency of Marijuana Use ............................................................................................. 30

Association with Cigarette and Alcohol Use .................................................................... 31

Driving Under the Influence of Illicit Drugs .................................................................... 31

Source of Prescription Drugs ............................................................................................ 31

3. Alcohol Use .......................................................................................................................35

3.1. Alcohol Use among Persons Aged 12 or Older ....................................................... 35

Age ........................................................................................................................ 36

Gender ................................................................................................................... 37

Pregnant Women ................................................................................................... 37

Race/Ethnicity ....................................................................................................... 38

Education .............................................................................................................. 39

College Students ................................................................................................... 40

Employment .......................................................................................................... 41

Geographic Area ................................................................................................... 41

Association with Illicit Drug and Tobacco Use .................................................... 41

Driving Under the Influence of Alcohol ............................................................... 42

3.2. Underage Alcohol Use ............................................................................................. 44

Table of Contents (continued)

Chapter Page

4. Tobacco Use.......................................................................................................................47

Age .................................................................................................................................... 48

Gender ............................................................................................................................... 48

Pregnant Women ............................................................................................................... 51

Race/Ethnicity ................................................................................................................... 52

Education .......................................................................................................................... 52

College Students ............................................................................................................... 53

Employment ...................................................................................................................... 53

Geographic Area ............................................................................................................... 53

Association with Illicit Drug and Alcohol Use ................................................................. 54

Frequency of Cigarette Use .............................................................................................. 54

5. Initiation of Substance Use ................................................................................................57

Initiation of Illicit Drug Use ............................................................................................. 58

Comparison, by Drug ........................................................................................................ 59

Marijuana .......................................................................................................................... 61

Cocaine ............................................................................................................................. 62

Heroin ............................................................................................................................... 62

Hallucinogens ................................................................................................................... 63

Inhalants ............................................................................................................................ 64

Psychotherapeutics ............................................................................................................ 64

Alcohol .............................................................................................................................. 67

Tobacco ............................................................................................................................. 67

6. Youth Prevention-Related Measures .................................................................................71

Perceived Risk of Substance Use ...................................................................................... 71

Perceived Availability ....................................................................................................... 75

Perceived Parental Disapproval of Substance Use ........................................................... 77

Attitudes toward Peer Substance Use ............................................................................... 77

Fighting and Delinquent Behavior .................................................................................... 78

Religious Involvement and Beliefs ................................................................................... 78

Exposure to Substance Use Prevention Messages and Programs ..................................... 79

Parental Involvement ........................................................................................................ 80

7. Substance Dependence, Abuse, and Treatment .................................................................81

7.1 Substance Dependence or Abuse ............................................................................. 81

Age at First Use .................................................................................................... 85

Age ........................................................................................................................ 86

Gender ................................................................................................................... 87

Race/Ethnicity ....................................................................................................... 88

Education .............................................................................................................. 88

Employment .......................................................................................................... 88

Table of Contents (continued)

Chapter Page

Criminal Justice Populations................................................................................. 89

Geographic Area ................................................................................................... 89

7.2 Past Year Treatment for a Substance Use Problem ................................................. 89

7.3 Need for and Receipt of Specialty Treatment .......................................................... 92

Illicit Drug or Alcohol Use Treatment and Treatment Need ................................ 93

Illicit Drug Use Treatment and Treatment Need .................................................. 96

Alcohol Use Treatment and Treatment Need ....................................................... 97

8. Comparison of Trends in Substance Use among Youths and Young Adults ....................99

Description of NSDUH and Other Data Sources .............................................................. 99

Comparison of NSDUH, MTF, and YRBS Trends for Youths ...................................... 100

Comparison of NSDUH and MTF Trends for Young Adults......................................... 105

Appendix

A Description of the Survey ................................................................................................113

A.1 Sample Design ....................................................................................................... 113

A.2 Data Collection Methodology ................................................................................ 115

A.3 Data Processing ...................................................................................................... 117

B Statistical Methods and Measurement .............................................................................123

B.1 Target Population ................................................................................................... 123

B.2 Sampling Error and Statistical Significance .......................................................... 123

B.3 Other Information on Data Accuracy .................................................................... 129

B.4 Measurement Issues ............................................................................................... 133

C Other Sources of Data ......................................................................................................147

C.1 Other National Surveys of Substance Use ............................................................. 147

C.2 Substance Abuse Treatment Data Sources ............................................................ 155

C.3 Surveys of Populations Not Covered by NSDUH ................................................. 157

D References ........................................................................................................................163

E List of Contributors ..........................................................................................................169

vii

List of Tables

Table Page

8.1 Comparison of NSDUH, MTF, and YRBS Lifetime Prevalence Estimates among

Youths: Percentages, 2002-2013 .................................................................................... 107

8.2 Comparison of NSDUH, MTF, and YRBS Past Year Prevalence Estimates among

Youths: Percentages, 2002-2013 .................................................................................... 108



8.3 Comparison of NSDUH, MTF, and YRBS Past Month Prevalence Estimates

among Youths: Percentages, 2002-2013 ......................................................................... 109

8.4 Comparison of NSDUH and MTF Lifetime Prevalence Estimates among Young

Adults: Percentages, 2002-2013 ..................................................................................... 110

8.5 Comparison of NSDUH and MTF Past Year Prevalence Estimates among Young

Adults: Percentages, 2002-2013 ..................................................................................... 111

8.6 Comparison of NSDUH and MTF Past Month Prevalence Estimates among

Young Adults: Percentages, 2002-2013 ......................................................................... 112

A.1 Weighted Statistical Imputation Rates (Percentages) for the 2013 NSDUH, by

Interview Section ............................................................................................................ 122

B.1 Demographic and Geographic Domains Forced to Match Their Respective U.S.

Census Bureau Population Estimates through the Weight Calibration Process,

2013................................................................................................................................. 140

B.2 Summary of 2013 NSDUH Suppression Rules .............................................................. 141

B.3 Weighted Percentages and Sample Sizes for 2012 and 2013 NSDUHs, by Final

Screening Result Code .................................................................................................... 142

B.4 Weighted Percentages and Sample Sizes for 2012 and 2013 NSDUHs, by Final

Interview Code ................................................................................................................ 143



B.5 Response Rates and Sample Sizes for 2012 and 2013 NSDUHs, by Demographic

Characteristics ................................................................................................................. 144

B.6 Past Year Initiates of Marijuana and Any Illicit Drug among Persons Aged 12 or

Older, Aged 26 or Older, or Aged 26 to 49: Numbers in Thousands, 2002-2013 .......... 145



B.7 Mean Age at First Use of Marijuana and Any Illicit Drug among Past Year

Initiates Aged 26 to 49, 2002-2013................................................................................. 145



C.1 Use of Specific Substances in Lifetime, Past Year, and Past Month among 8th,

10th, and 12th Graders in MTF and NSDUH: Percentages, 2012 and 2013 .................. 160

viii

List of Tables (continued)

Table Page

C.2 Lifetime and Past Month Substance Use among Students in Grades 9 to 12 in

YRBS and NSDUH: Percentages, 2005, 2007, 2009, 2011, and 2013 ........................... 161

List of Figures

Figure Page

1.1 U.S. Census Bureau Regions ............................................................................................ 13

2.1 Past Month Illicit Drug Use among Persons Aged 12 or Older: 2013 .............................. 16

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

2013................................................................................................................................... 17



2.3 Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons

Aged 12 or Older: 2002-2013 ........................................................................................... 18

2.4 Past Month and Past Year Heroin Use among Persons Aged 12 or Older: 2002-

2013................................................................................................................................... 19

2.5 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2012 and

2013................................................................................................................................... 20

2.6 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2002-2013 ....... 20

2.7 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-

2013................................................................................................................................... 22

2.8 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2013 ............... 22

2.9 Past Month Use of Selected Illicit Drugs among Young Adults Aged 18 to 25:

2002-2013 ......................................................................................................................... 23

2.10 Past Month Illicit Drug Use among Adults Aged 50 to 64: 2002-2013 ........................... 24

2.11 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2013 ......... 25

2.12 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity:

2002-2013 ......................................................................................................................... 27

2.13 Past Month Illicit Drug Use among Persons Aged 18 or Older, by Employment

Status: 2012 and 2013 ....................................................................................................... 28

2.14 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type:

2013................................................................................................................................... 29

2.15 Daily or Almost Daily Marijuana Use in the Past Year and Past Month among

Persons Aged 12 or Older: 2002-2013 .............................................................................. 30

2.16 Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use

among Past Year Users Aged 12 or Older: 2012-2013..................................................... 32

List of Figures (continued)

Figure Page

3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by

Age: 2013 .......................................................................................................................... 36

3.2 Binge Alcohol Use among Adults Aged 18 to 25, by Gender: 2002-2013 ...................... 38

3.3 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older,

by Race/Ethnicity: 2013 .................................................................................................... 39



3.4 Binge Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-

2013................................................................................................................................... 40

3.5 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 12

or Older: 2002-2013 .......................................................................................................... 42

3.6 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 16

or Older, by Age: 2013 ..................................................................................................... 43

3.7 Current Alcohol Use among Persons Aged 12 to 20, by Age: 2002-2013 ....................... 44

3.8 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by

Gender: 2013 ..................................................................................................................... 45

4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2013 ........................ 47

4.2 Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2013 .............................. 49

4.3 Past Month Cigarette Use among Persons Aged 12 or Older, by Age: 2013 ................... 49

4.4 Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2013 ........... 50

4.5 Past Month Cigarette Use among Women Aged 15 to 44, by Pregnancy Status:

Combined Years 2002-2003 to 2012-2013 ....................................................................... 51

4.6 Past Month Smokers of One or More Packs of Cigarettes per Day among Daily

Smokers, by Age Group: 2002-2013 ................................................................................ 55

5.1 First Specific Drug Associated with Initiation of Illicit Drug Use among Past Year

Illicit Drug Initiates Aged 12 or Older: 2013 .................................................................... 59

5.2 Past Year Initiates of Specific Illicit Drugs among Persons Aged 12 or Older:

2013................................................................................................................................... 60

5.3 Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged

12 to 49: 2013 ................................................................................................................... 60

List of Figures (continued)

Figure Page

5.4 Past Year Marijuana Initiates among Persons Aged 12 or Older and Mean Age at

First Use of Marijuana among Past Year Marijuana Initiates Aged 12 to 49: 2002-

2013................................................................................................................................... 61

5.5 Past Year Hallucinogen Initiates among Persons Aged 12 or Older: 2002-2013 ............. 63

5.6 Past Year Nonmedical Psychotherapeutic Initiates among Persons Aged 12 or

Older: 2002-2013 .............................................................................................................. 65

5.7 Past Year Methamphetamine Initiates among Persons Aged 12 or Older and Mean

Age at First Use of Methamphetamine among Past Year Methamphetamine

Initiates Aged 12 to 49: 2002-2013 .................................................................................. 66

5.8 Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First

Use: 2002-2013 ................................................................................................................. 68

5.9 Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never

Smoked Prior to the Past Year, by Gender: 2002-2013 .................................................... 69

5.10 Past Year Specific Tobacco Product Initiates among Persons Aged 12 or Older:

2002-2013 ......................................................................................................................... 70

6.1 Past Month Binge Drinking and Marijuana Use among Youths Aged 12 to 17, by

Perceptions of Risk: 2013 ................................................................................................. 72

6.2 Perceived Great Risk of Marijuana Use among Youths Aged 12 to 17: 2002-2013 ........ 73

6.3 Perceived Great Risk of Cigarette and Alcohol Use among Youths Aged 12 to 17:

2002-2013 ......................................................................................................................... 74

6.4 Perceived Great Risk of Use of Selected Illicit Drugs Once or Twice a Week

among Youths Aged 12 to 17: 2002-2013 ........................................................................ 75



6.5 Perceived Availability of Selected Illicit Drugs among Youths Aged 12 to 17:

2002-2013 ......................................................................................................................... 76

6.6 Exposure to Substance Use Prevention Messages and Programs among Youths

Aged 12 to 17: 2002-2013 ................................................................................................ 79



7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or

Older: 2002-2013 .............................................................................................................. 82



7.2 Specific Illicit Drug Dependence or Abuse in the Past Year among Persons Aged

12 or Older: 2013 .............................................................................................................. 83

xii

List of Figures (continued)

Figure Page

7.3 Illicit Drug Dependence or Abuse in the Past Year among Persons Aged 12 or

Older: 2002-2013 .............................................................................................................. 84

7.4 Alcohol Dependence or Abuse in the Past Year among Adults Aged 21 or Older,

by Age at First Use of Alcohol: 2013 ............................................................................... 85



7.5 Alcohol and Illicit Drug Dependence or Abuse among Youths Aged 12 to 17:

2002-2013 ......................................................................................................................... 86

7.6 Substance Dependence or Abuse in the Past Year, by Age and Gender: 2013 ................ 87

7.7 Locations Where Past Year Substance Use Treatment Was Received among

Persons Aged 12 or Older: 2013 ....................................................................................... 91

7.8 Substances for Which Most Recent Treatment Was Received in the Past Year

among Persons Aged 12 or Older: 2013 ........................................................................... 91

7.9 Received Most Recent Treatment in the Past Year for the Use of Pain Relievers

among Persons Aged 12 or Older: 2002-2013 .................................................................. 92

7.10 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment

among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit

Drug or Alcohol Use: 2013 ............................................................................................... 94

7.11 Reasons for Not Receiving Substance Use Treatment among Persons Aged 12 or

Older Who Needed and Made an Effort to Get Treatment But Did Not Receive

Treatment and Felt They Needed Treatment: 2010-2013 Combined ............................... 95

8.1 Past Month Alcohol Use among Youths in NSDUH and MTF: 2002-2013 .................. 101

8.2 Past Month Cigarette Use among Youths in NSDUH and MTF: 2002-2013................. 101

8.3 Past Month Marijuana Use among Youths in NSDUH and MTF: 2002-2013 ............... 102

8.4 Past Month Marijuana Use among Youths in NSDUH, MTF, and YRBS: 1971-

2013................................................................................................................................. 104

8.5 Past Year Nonmedical Pain Reliever Use among Youths in NSDUH and MTF:

2002-2013 ....................................................................................................................... 105



8.6 Past Year Nonmedical Pain Reliever Use among Young Adults in NSDUH and

MTF: 2002-2013 ............................................................................................................. 106

xiii

List of Figures (continued)

Figure Page

B.1 Required Effective Sample in the 2013 NSDUH as a Function of the Proportion

Estimated......................................................................................................................... 141

xiv

Highlights

This report presents detailed results from the 2013 National Survey on Drug Use and

Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health

Services Administration (SAMHSA). The survey is the primary source of information on the use

of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United

States aged 12 years old or older. Approximately 67,500 persons are interviewed in NSDUH

each year. Unless otherwise noted, all comparisons in this report that are described using terms

such as "increased," "decreased," or "more than" are statistically significant at the .05 level.

Illicit Drug Use

• In 2013, an estimated 24.6 million Americans aged 12 or older were current (past month)

illicit drug users, meaning they had used an illicit drug during the month prior to the survey

interview. This estimate represents 9.4 percent of the population aged 12 or older. Illicit

drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants,

or prescription-type psychotherapeutics (pain relievers, tranquilizers, stimulants, and

sedatives) used nonmedically.

• The rate of current illicit drug use among persons aged 12 or older in 2013 (9.4 percent) was

similar to the rates in 2010 (8.9 percent) and 2012 (9.2 percent), but it was higher than the

rates in 2002 to 2009 and in 2011 (ranging from 7.9 to 8.7 percent).

• Marijuana was the most commonly used illicit drug in 2013. There were 19.8 million past

month users in 2013 (7.5 percent of those aged 12 or older), which was similar to the number

and rate in 2012 (18.9 million or 7.3 percent). The 2013 rate was higher than the rates in

2002 to 2011 (ranging from 5.8 to 7.0 percent). Marijuana was used by 80.6 percent of

current illicit drug users in 2013.

• Daily or almost daily use of marijuana (used on 20 or more days in the past month) increased

from 5.1 million persons in 2005 to 2007 to 8.1 million persons in 2013.

• In 2013, there were 1.5 million current cocaine users aged 12 or older, or 0.6 percent of the

population. These estimates were similar to the numbers and rates in 2009 to 2012 (ranging

from 1.4 million to 1.7 million or from 0.5 to 0.7 percent), but they were lower than those in

2002 to 2007 (ranging from 2.0 million to 2.4 million or from 0.8 to 1.0 percent).

• The number of past year heroin users in 2013 (681,000) was similar to the numbers in 2009

to 2012 (ranging from 582,000 to 669,000) and was higher than the numbers in 2002 to 2005,

2007, and 2008 (ranging from 314,000 to 455,000).

• An estimated 1.3 million persons aged 12 or older in 2013 (0.5 percent) used hallucinogens

in the past month. The number of users in 2013 was similar to that in 2012 (1.1 million), but

it was higher than in 2011 (1.0 million).

• The percentage of persons aged 12 or older who used prescription-type psychotherapeutic

drugs nonmedically in the past month in 2013 (2.5 percent) was similar to the percentages in

2010 to 2012 (ranging from 2.4 to 2.7 percent).

• The number and percentage of past month methamphetamine users in 2013 (595,000 or

0.2 percent) were similar to those in 2012 (440,000 or 0.2 percent) and 2011 (439,000 or

0.2 percent), but they were higher than the estimates in 2010 (353,000 or 0.1 percent).

• Among youths aged 12 to 17, the rate of current illicit drug use was lower in 2013

(8.8 percent) than in 2002 to 2007 (ranging from 9.6 to 11.6 percent) and in 2009 to 2012

(ranging from 9.5 to 10.1 percent).

• The rate of current marijuana use among youths aged 12 to 17 in 2013 (7.1 percent) was

similar to the 2012 rate (7.2 percent) and the rates in 2004 to 2010 (ranging from 6.7 to

7.6 percent); however, it was lower than the rates in 2002, 2003, and 2011 (ranging from

7.9 to 8.2 percent).

• Among youths aged 12 to 17, the rate of current nonmedical use of prescription-type drugs

declined from 4.0 percent in 2002 and 2003 to 2.2 percent in 2013. The rate of nonmedical

pain reliever use among youths also declined from 3.2 percent in 2002 and 2003 to

1.7 percent in 2013.

• The rate of current use of illicit drugs among young adults aged 18 to 25 in 2013

(21.5 percent) was similar to the rates in 2009 to 2012 (ranging from 21.3 to 21.6 percent),

which was consistent with the steady rate of current marijuana use in this age group during

this time (19.1 percent in 2013 and ranging from 18.2 to 19.0 percent in 2009 to 2012).

• Among young adults aged 18 to 25, the rate of current nonmedical use of prescription-type

drugs in 2013 was 4.8 percent, which was similar to the rates in 2011 (5.0 percent) and 2012

(5.3 percent), but it was lower than the rates in the years from 2002 to 2010 (ranging from

5.5 to 6.5 percent).

• The rate of current cocaine use in 2013 among young adults aged 18 to 25 was 1.1 percent,

which was similar to the rates in 2009, 2011, and 2012, but it was lower than the rates from

2002 to 2008 and in 2010.

• Among adults aged 26 or older, the rate of current illicit drug use in 2013 (7.3 percent) was

similar to the rate in 2012 (7.0 percent), but it was higher than the rates in 2002 to 2011

(ranging from 5.5 to 6.6 percent). This was driven by rates of current marijuana use, which

also remained steady between 2013 and 2012 (5.6 and 5.3 percent, respectively). However,

the rate of current marijuana use in 2013 was higher than the rates in 2002 to 2011 (ranging

from 3.9 to 4.8 percent).

• Among adults aged 50 to 64, the rate of current illicit drug use increased from 2.7 percent in

2002 to 6.0 percent in 2013. For adults aged 50 to 54, the rate increased from 3.4 percent in

2002 to 7.9 percent in 2013. Among those aged 55 to 59, the rate of current illicit drug use

increased from 1.9 percent in 2002 to 5.7 percent in 2013. Among those aged 60 to 64, the

rate of current illicit drug use increased from 1.1 percent in 2003 and 2004 to 3.9 percent in

2013.

• Among unemployed adults aged 18 or older in 2013, 18.2 percent were current illicit drug

users, which was higher than the rates of 9.1 percent for those who were employed full time

and 13.7 percent for those who were employed part time. However, most illicit drug users

were employed. Of the 22.4 million current illicit drug users aged 18 or older in 2013,

15.4 million (68.9 percent) were employed either full or part time.

• In 2013, 9.9 million persons (3.8 percent of those aged 12 or older) reported driving under

the influence of illicit drugs during the past year, which was similar to the rate in 2012

(3.9 percent). In 2013, the rate was highest among young adults aged 18 to 25 (10.6 percent),

although this rate was lower than the rate in 2012 for this age group (11.9 percent).

• Among persons aged 12 or older in 2012-2013 who used pain relievers nonmedically in the

past 12 months, 53.0 percent got the drug they used most recently from a friend or relative

for free, and 10.6 percent bought the drug from a friend or relative. Another 21.2 percent

reported that they got the drug through a prescription from one doctor. An annual average of

4.3 percent got pain relievers from a drug dealer or other stranger, and 0.1 percent bought

them on the Internet.

Alcohol Use

• Slightly more than half (52.2 percent) of Americans aged 12 or older reported being current

drinkers of alcohol in the 2013 survey, which was similar to the rate in 2012 (52.1 percent).

This translates to an estimated 136.9 million current drinkers in 2013.

• In 2013, nearly one quarter (22.9 percent) of persons aged 12 or older were binge alcohol

users in the past 30 days. This translates to about 60.1 million people. The rate in 2013 was

similar to the estimate in 2012 (23.0 percent). Binge drinking is defined as having five or

more drinks on the same occasion on at least 1 day in the 30 days prior to the survey.

• In 2013, heavy drinking was reported by 6.3 percent of the population aged 12 or older, or

16.5 million people. This rate was similar to the rate of heavy drinking in 2012 (6.5 percent).

Heavy drinking is defined as binge drinking on at least 5 days in the past 30 days.

• Among young adults aged 18 to 25 in 2013, the rate of binge drinking was 37.9 percent, and

the rate of heavy drinking was 11.3 percent. These rates were lower than the corresponding

rates in 2012 (39.5 and 12.7 percent, respectively).

• The rate of current alcohol use among youths aged 12 to 17 was 11.6 percent in 2013. Youth

binge and heavy drinking rates in 2013 were 6.2 and 1.2 percent, respectively. The rates for

current and binge alcohol use were lower than those reported in 2012 (12.9 and 7.2 percent,

respectively).

• In 2013, an estimated 10.9 percent of persons aged 12 or older drove under the influence of

alcohol at least once in the past year. This percentage was lower than in 2002 (14.2 percent),

but it was similar to the rate in 2012 (11.2 percent). The rate was highest among persons aged

21 to 25 and persons aged 26 to 29 (19.7 and 20.7 percent, respectively). Among persons

aged 12 to 20 and those aged 21 to 25, the rates of driving under the influence of alcohol

were lower in 2013 (4.7 and 19.7 percent, respectively) than in 2012 (5.7 and 21.9 percent,

respectively).

• An estimated 8.7 million underage persons (aged 12 to 20) were current drinkers in 2013,

including 5.4 million binge drinkers and 1.4 million heavy drinkers. Corresponding

percentages of underage persons in 2013 were 22.7 percent for current alcohol use,

14.2 percent for binge alcohol use, and 3.7 percent for heavy use. All of these percentages

were lower than those in 2012.

• Past month, binge, and heavy drinking rates among underage persons declined between 2002

and 2013. Past month alcohol use declined from 28.8 to 22.7 percent, binge drinking declined

from 19.3 to 14.2 percent, and heavy drinking declined from 6.2 to 3.7 percent.

• In 2013, 52.2 percent of current underage drinkers reported that their last use of alcohol

occurred in someone else's home, and 34.2 percent reported that it had occurred in their own

home. Most current drinkers aged 12 to 20 (77.6 percent) were with two or more other people

the last time they drank alcohol. The rate of drinking alone the last time that underage

persons drank alcohol was highest among youths aged 12 to 14 (14.5 percent).

• Among current underage drinkers, 28.7 percent paid for the alcohol the last time they drank,

including 7.8 percent who purchased the alcohol themselves and 20.5 percent who gave

money to someone else to purchase it. Among those who did not pay for the alcohol they last

drank, 36.6 percent got it from an unrelated person aged 21 or older; 24.5 percent got it from

a parent, guardian, or other adult family member; and 16.4 percent got it from another person

younger than 21 years old.

• In 2013, underage current drinkers were more likely than current alcohol users aged 21 or

older to use illicit drugs within 2 hours of alcohol use on their last reported drinking occasion

(19.9 vs. 5.7 percent, respectively). The most commonly reported illicit drug used by

underage drinkers in combination with alcohol was marijuana.

Tobacco Use

• In 2013, an estimated 66.9 million Americans aged 12 or older were current (past month)

users of a tobacco product. This represents 25.5 percent of the population in that age range.

Also, 55.8 million persons (21.3 percent of the population) were current cigarette smokers;

12.4 million (4.7 percent) smoked cigars; 8.8 million (3.4 percent) used smokeless tobacco;

and 2.3 million (0.9 percent) smoked tobacco in pipes.

• Between 2002 and 2013, past month use of any tobacco product among persons aged 12 or

older decreased from 30.4 to 25.5 percent, and past month cigarette use declined from 26.0 to

21.3 percent. Rates of past month use of smokeless tobacco and pipe tobacco in 2013 were

similar to corresponding rates in 2002. However, past month cigar use decreased from

5.4 percent in 2002 to 4.7 percent in 2013.

• The rate of past month tobacco use among 12 to 17 year olds declined from 15.2 percent in

2002 to 7.8 percent in 2013, including a decline from 2012 (8.6 percent) to 2013. The rate of

past month cigarette use among 12 to 17 year olds also declined between 2002 and 2013,

from 13.0 to 5.6 percent.

• Among youths aged 12 to 17 who smoked cigarettes in the past month, 53.9 percent also

used an illicit drug compared with only 6.1 percent of youths who did not smoke cigarettes.

Initiation of Substance Use (Incidence, or First-Time Use) within the Past 12 Months

• In 2013, an estimated 2.8 million persons aged 12 or older used an illicit drug for the first

time within the past 12 months. This averages to about 7,800 initiates per day and was

similar to the estimate for 2012 (2.9 million). A majority of these past year illicit drug

initiates reported that their first drug was marijuana (70.3 percent). About 1 in 5 initiated

with nonmedical use of prescription drugs (20.6 percent, including 12.5 percent with pain

relievers, 5.2 percent with tranquilizers, 2.7 percent with stimulants, and 0.2 percent with

sedatives). In 2013, 6.3 percent of initiates reported inhalants as their first illicit drug, and

2.6 percent used hallucinogens as their first drug.

• In 2013, the illicit drug categories with the largest number of past year initiates were

marijuana use (2.4 million) and nonmedical use of pain relievers (1.5 million). The marijuana

estimate was similar to the numbers in 2008 to 2012; however, the estimate for nonmedical

use of pain relievers was lower in 2013 than in 2002 through 2012.

• The number of past year initiates of methamphetamine was 144,000 in 2013, which was

similar to the estimates in 2007 to 2012.

• The number of past year initiates of Ecstasy was 751,000 in 2013, which was similar to the

number in 2012 (869,000), but was lower than the numbers in 2009, 2010, and 2011

(1.1 million, 949,000, and 922,000, respectively). Most (69.4 percent) of the recent Ecstasy

initiates in 2013 were aged 18 or older at the time they first used Ecstasy.

• The number of past year cocaine initiates was 601,000 in 2013, which was similar to the

numbers in 2008 to 2012, but was lower than the estimates from 2002 through 2007. The

number of crack cocaine initiates was 58,000 in 2013, which was similar to the estimates in

2009 to 2012, but was lower than the estimates from 2002 through 2008.

• In 2013, there were 169,000 persons aged 12 or older who used heroin for the first time

within the past year, which was similar to the estimates in 2002 to 2005 and from 2007 to

2012.

• Most (83.5 percent) of the 4.6 million past year alcohol initiates in 2013 were younger than

age 21 at the time of initiation.

• The number of persons aged 12 or older who smoked cigarettes for the first time within the

past 12 months was 2.1 million in 2013, which was lower than the estimates from 2008 to

2012 (ranging from 2.3 million to 2.5 million). About half of new smokers in 2013 were

younger than 18 when they first smoked cigarettes (50.5 percent).

• The number of persons aged 12 or older who used smokeless tobacco for the first time within

the past year was 1.1 million in 2013, which was similar to the estimates in 2011 and 2012.

Youth Prevention-Related Measures

• In 2013, 39.0 percent of youths aged 12 to 17 perceived great risk in having five or more

drinks once or twice a week. Similarly, 39.5 percent of youths perceived great risk in

smoking marijuana once or twice a week.

• The percentage of youths aged 12 to 17 perceiving great risk in smoking marijuana once or

twice a week decreased from 54.6 percent in 2007 to 39.5 percent in 2013.

• The percentage of youths who reported great risk in smoking one or more packs of cigarettes

per day was 64.3 percent in 2013. The 2013 rate was lower than the rates between 2004 and

2009 (ranging from 65.5 to 69.5 percent) and was similar to the rates in 2002 (63.1 percent)

and 2003 (64.2 percent).

• About half (48.6 percent) of youths aged 12 to 17 reported in 2013 that it would be "fairly

easy" or "very easy" for them to obtain marijuana if they wanted some. One in eleven

reported it would be easy to get heroin (9.1 percent), 11.3 percent indicated that LSD would

be easily available, and 14.4 percent reported easy availability for cocaine. In comparison

with the rates in 2002, the 2013 rates represent declines in perceived availability for all four

of these drugs.

• About one in eight youths aged 12 to 17 (12.4 percent) indicated that they had been

approached by someone selling drugs in the past month, which was similar to the rate in

2012 (13.2 percent).

• A majority of youths aged 12 to 17 (88.4 percent) in 2013 reported that their parents would

strongly disapprove of their trying marijuana once or twice, which was a decline from 2012

(89.3 percent). Current marijuana use was much less prevalent among youths who perceived

strong parental disapproval for trying marijuana once or twice than for those who did not

(4.1 vs. 29.3 percent, respectively).

• In 2013, 72.6 percent of youths aged 12 to 17 reported having seen or heard drug or alcohol

prevention messages from sources outside of school, which was lower than in 2002

(83.2 percent) and in 2012 (75.9 percent). The percentage of school-enrolled youths reporting

that they had seen or heard prevention messages at school also declined during this period,

from 78.8 percent in 2002 to 73.5 percent. The prevalence of past month illicit drug use in

2013 was lower among youths who reported having such exposure to prevention messages

compared with youths who did not have such exposure.

Substance Dependence, Abuse, and Treatment

• In 2013, an estimated 21.6 million persons aged 12 or older (8.2 percent) were classified with

substance dependence or abuse in the past year based on criteria specified in the Diagnostic

and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Of these, 2.6 million

were classified with dependence or abuse of both alcohol and illicit drugs, 4.3 million had

dependence or abuse of illicit drugs but not alcohol, and 14.7 million had dependence or

abuse of alcohol but not illicit drugs.

• The annual number of persons with substance dependence or abuse in 2013 (21.6 million)

was similar to the number in each year from 2002 through 2012 (ranging from 20.6 million

to 22.7 million).

• The specific illicit drugs with the largest numbers of persons with past year dependence or

abuse in 2013 were marijuana (4.2 million), pain relievers (1.9 million), and cocaine

(855,000). The number of persons with marijuana dependence or abuse was similar between

2002 and 2013. The number with pain reliever dependence or abuse in 2013 was similar to

the numbers from 2006 to 2012. The number with cocaine dependence or abuse in 2013 was

similar to the numbers in 2010 to 2012.

• The number of persons who had heroin dependence or abuse in 2013 (517,000) was similar

to the numbers in 2009 to 2012 (ranging from 361,000 to 467,000), but it was higher than the

numbers in 2002 to 2008 (ranging from 189,000 to 324,000).

• In 2013, adults aged 21 or older who had first used alcohol at age 14 or younger were more

likely to be classified with alcohol dependence or abuse than adults who had their first drink

at age 21 or older (14.8 vs. 2.3 percent).

• Between 2002 and 2013, the percentage of youths aged 12 to 17 with substance dependence

or abuse declined from 8.9 to 5.2 percent. For young adults aged 18 to 25, substance

dependence or abuse also declined during this period from 21.7 percent in 2002 to

17.3 percent in 2013.

• Treatment need is defined as having substance dependence or abuse or receiving substance

use treatment at a specialty facility (hospital inpatient, drug or alcohol rehabilitation, or

mental health centers) within the past 12 months. In 2013, 22.7 million persons aged 12 or

older needed treatment for an illicit drug or alcohol use problem (8.6 percent of persons aged

12 or older). Of these, 2.5 million (0.9 percent of persons aged 12 or older and 10.9 percent

of those who needed treatment) received treatment at a specialty facility. Thus, 20.2 million

persons (7.7 percent of the population aged 12 or older) needed treatment for an illicit drug

or alcohol use problem but did not receive treatment at a specialty facility in the past year.

• Of the 20.2 million persons aged 12 or older in 2013 who were classified as needing

substance use treatment but did not receive treatment at a specialty facility in the past year,

908,000 persons (4.5 percent) reported that they felt they needed treatment for their illicit

drug or alcohol use problem. Of these 908,000 persons who felt they needed treatment,

316,000 (34.8 percent) reported that they made an effort to get treatment. Based on combined

2010-2013 data, the most commonly reported reason for not receiving treatment among this

group of persons was a lack of insurance coverage and inability to afford the cost

(37.3 percent).

1. Introduction

This report presents a detailed look at results from the 2013 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. The report presents national estimates of rates of use,

numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products.

The report focuses on trends between 2012 and 2013 and from 2002 to 2013, as well as

differences across population subgroups in 2013. A first glimpse of the NSDUH substance use

and mental health data was provided in September 2014 through a shorter report available on the

Substance Abuse and Mental Health Services Administration (SAMHSA) Web site

(http://www.samhsa.gov/data/). Detailed NSDUH national estimates related to mental health and

NSDUH State-level estimates related to both substance use and mental health will be published

in separate releases in the fall of 2014.

Summary of NSDUH

NSDUH is the primary source of statistical information on the use of illegal drugs,

alcohol, and tobacco by the U.S. civilian, noninstitutionalized population aged 12 or older.

Conducted by the Federal Government since 1971, the survey collects data through face-to-face

interviews with a representative sample of the population at the respondent's place of residence.

The survey is sponsored by SAMHSA, U.S. Department of Health and Human Services, and is

planned and managed by SAMHSA's Center for Behavioral Health Statistics and Quality

(CBHSQ). Data collection and analysis are conducted under contract with RTI International.

This section briefly describes the survey methodology; a more complete description is provided

in Appendix A.

NSDUH collects information from residents of households and noninstitutional group

quarters (e.g., shelters, rooming houses, dormitories) and from civilians living on military bases.

The survey excludes homeless persons who do not use shelters, military personnel on active

duty, and residents of institutional group quarters, such as jails and hospitals. Appendix C

describes sources of data on substance use and treatment, including those that include

populations outside the NSDUH target population.

From 1971 through 1998, the survey employed paper-and-pencil data collection. 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 mode for

responding to questions in order 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.

The 2013 NSDUH continued to employ a State-based design with an independent,

multistage area probability sample within each State and the District of Columbia. The eight

States with the largest population (which together account for about half of the total U.S.

RTI International is a trade name of Research Triangle Institute.

population aged 12 or older) are designated as large sample States (California, Florida, Illinois,

Michigan, New York, Ohio, Pennsylvania, and Texas) and have a sample size of about 3,600

each. For the remaining 42 States and the District of Columbia, the sample size is about 900 per

State. In all States and the District of Columbia, the design oversampled youths and young

adults; each State's sample was approximately equally distributed among three age groups:

12 to 17 years, 18 to 25 years, and 26 years or older.

Nationally, screening was completed at 160,325 addresses, and 67,838 completed

interviews were obtained. The survey was conducted from January through December 2013.

Weighted response rates for household screening and for interviewing were 83.9 and

71.7 percent, respectively. See Appendix B for more information on NSDUH response rates.

Limitations on Trend Measurement

Trend analysis using NSDUH data is limited to 2002 to 2013, even though the survey has

been conducted since 1971. Because of the change in interviewing method in 1999, the estimates

from the pre-1999 surveys are not comparable with estimates from the current CAI-based

surveys. Although the design of the 2002 through 2012 NSDUHs is similar to the design of the

1999 through 2001 surveys, methodological differences affect the comparability of the 2002 to

2013 estimates with estimates from prior surveys. The most important change was the addition

of a $30 incentive in 2002. Also, the name of the survey was changed in 2002, from the National

Household Survey on Drug Abuse (NHSDA) to the current name. Improved data collection

quality control procedures were introduced in the survey starting in 2001, and updated

population data from the 2000 decennial census were incorporated into the sample weights

starting with the 2002 estimates. Analyses of the effects of these factors on NSDUH estimates

have shown that 2002 and later data should not be compared with 2001 and earlier data from the

survey series to assess changes over time. Appendix C of the 2004 NSDUH report on national

findings discusses this in more detail (Office of Applied Studies, 2005).

Because of changes in the questionnaire, estimates for methamphetamine, stimulants, and

psychotherapeutics in this report should not be compared with corresponding estimates presented

in previous reports for data years prior to 2007. Estimates for 2002 to 2006 for these drug

categories in this report, as well as in the 2007 and 2008 reports, incorporate statistical

adjustments that enable year-to-year comparisons to be made over the period from 2002 to 2013.

The calculation of NSDUH person-level weights includes a calibration step that results in

weights that are consistent with population control totals obtained from the U.S. Census Bureau

(see Section A.3.3 in Appendix A). These control totals are based on the most recently available

decennial census; the Census Bureau updates these control totals annually to account for

population changes after the census. For the analysis weights in the 2002 through 2010

NSDUHs, the control totals were derived from the 2000 census data; starting with the 2011

NSDUH weights, the control totals were based on data from the 2010 census. This shift to the

2010 census data could affect comparisons between substance use estimates for 2011 onward

and those from prior years. Analyses of the impact of this change for the 2011 NSDUH weights

show that estimates of the number of substance users for some demographic groups were

substantially affected, but percentages of substance users within these groups (i.e., rates) were

not. Details for this investigation are provided in Section B.4.3 in Appendix B of the 2011

national findings report for NSDUH (CBHSQ, 2012b). This change in control totals does not

affect comparisons between 2012 and 2013 because the control totals for each of these years

were based on the 2010 census. However, some trends between 2013 and years prior to 2011

may need to be interpreted with caution because of differences in how the control totals for each

of these years were developed.

Format of Report and Data Presentation

This report has separate chapters that discuss findings on the use of illicit drugs; use of

alcohol; use of tobacco products; initiation of substance use; prevention-related issues; and

substance dependence, abuse, and treatment. A final chapter discusses key findings on trends in

substance use among youths and young adults, including comparisons with other survey results.

The data and findings described in this report are based on a comprehensive set of tables,

referred to as "detailed tables," that include population estimates (e.g., numbers of drug users),

rates (e.g., percentages of the population using drugs), and standard errors of estimates. These

tables are available separately at http://www.samhsa.gov/data/. In addition, the tables are

accompanied by a glossary that covers key definitions used in this report and in the detailed

tables. Appendices in this report describe the survey (Appendix A), technical details on the

statistical methods and measurement (Appendix B), and other sources of related data (Appendix

C). A list of references cited in the report (Appendix D) and a list of contributors to this report

(Appendix E) also are provided.

Text, figures, and detailed tables present prevalence measures for the population in terms

of both the number of persons and the percentage of the population and by lifetime (i.e., ever

used), past year, and past month use. Analyses focus primarily on past month use, also referred

to as "current use." Where applicable, footnotes are included in tables and figures to indicate

whether the 2013 estimates are significantly different from 2012 or earlier estimates. In addition,

some estimates are based on data combined from two or more survey years to increase precision

of the estimates; those estimates are annual averages based on multiple years of data.

During regular data collection and processing checks for the 2011 NSDUH, data errors

were identified. These errors affected the data for Pennsylvania (2006 to 2010) and Maryland

(2008 and 2009). Data and estimates for 2011 onward were not affected, including those for

2013. The errors had minimal impact on the national estimates. The only 2008 to 2011 estimates

appreciably affected were estimates for the mid-Atlantic division and the Northeast region.

Cases with erroneous data were removed from data files, and the remaining cases were

reweighted to provide representative estimates. Therefore, some estimates for 2010 and other

prior years in the 2013 national findings report and the 2013 detailed tables will differ from

corresponding estimates found in some previous reports and tables. Further information is

available in Section B.3.5 in Appendix B of this report.

All estimates presented in the report have met the criteria for statistical reliability

(see Section B.2.2 in Appendix B). Estimates that do not meet these criteria are suppressed and

do not appear in tables, figures, or text. Statistical tests have been conducted for all statements

appearing in the text of the report that compare estimates between years or subgroups of the

population. Suppressed estimates are not included in statistical tests of comparisons. For

example, a statement that "whites had the highest prevalence" means that the rate among whites

was higher than the rate among all nonsuppressed racial/ethnic subgroups, but not necessarily

higher than the rate among a subgroup for which the estimate was suppressed. Unless explicitly

stated that a difference is not statistically significant, all statements that describe differences are

significant at the .05 level. Statistically significant differences are described using terms such as

"higher," "lower," "increased," and "decreased." Statements that use terms such as "similar,"

"no difference," "same," or "remained steady" to describe the relationship between estimates

denote that a difference is not statistically significant. When a set of estimates for survey years or

population subgroups is presented without a statement of comparison, statistically significant

differences among these estimates are not implied and testing may not have been conducted.

Data are presented for racial/ethnic groups based on guidelines for collecting and

reporting race and ethnicity data (Office of Management and Budget [OMB], 1997). Because

respondents could choose more than one racial group, a "two or more races" category is included

for persons who reported more than one category (i.e., white, black or African American,

American Indian or Alaska Native, Native Hawaiian, Guamanian or Chamorro, Samoan,

Other Pacific Islander, Asian, Other). Respondents choosing more than one category from

among Native Hawaiian, Guamanian or Chamorro, Samoan, and Other Pacific Islander but no

other categories are classified as being in the "Native Hawaiian or Other Pacific Islander"

category instead of the "two or more races" category. Except for the "Hispanic or Latino" group,

the racial/ethnic groups include only non-Hispanics. The category "Hispanic or Latino" includes

Hispanics of any race.

Data in this report also are presented for four U.S. geographic regions as defined by the

U.S. Census Bureau (Figure 1.1). Other geographic comparisons also are made based on county

type, a variable that reflects different levels of urbanicity and metropolitan area inclusion of

counties. This county classification was originally developed and subsequently updated by the

U.S. Department of Agriculture (Butler & Beale, 1994). All U.S. counties and county

equivalents were grouped based on revised definitions of metropolitan statistical areas (MSAs)

and definitions of micropolitan statistical areas as defined by the OMB in June 2003 (OMB,

2003). 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 outside of MSAs.

Counties in nonmetropolitan areas are further 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 a population of 20,000 or more 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 populations of fewer than 2,500 in urbanized areas. Additional

details about this county type definition are included in the glossary that accompanies the 2013

detailed tables.

Other NSDUH Reports and Data

Other reports using the 2013 NSDUH data and focusing on specific topics of interest will

be made available on SAMHSA's Web site. In particular, detailed estimates on mental health

will be released later in 2014 in a separate report: Results from the 2013 National Survey on

Since 2013, the question about race has included categories for Guamanian or Chamorro and for Samoan.

Prior to 2013, these groups were reported in the interview as Other Pacific Islander.

Figure 1.1 U.S. Census Bureau Regions

Drug Use and Health: Mental Health Findings. State-level estimates for substance use and

mental health for 2012-2013 are scheduled to be released later this year as well.

The detailed tables, other descriptive reports and in-depth analytic reports focusing on

specific issues or populations, and methodological information on NSDUH are all available at

http://www.samhsa.gov/data/. In addition, CBHSQ makes public use data files available through

the Substance Abuse and Mental Health Data Archive (SAMHDA) at

http://www.datafiles.samhsa.gov. Currently, files are available from the 1979 to 2012 surveys.

The 2013 NSDUH public use file will be available by the end of 2014. CBHSQ also makes

confidential restricted-use data available in two ways. Restricted-use data, including State codes

and other detailed variables, can be included in tables as part of the online Restricted-use Data

Analysis System (R-DAS). In the R-DAS, data are not available for downloading, but estimates

can be generated by State and other restricted variables that are specified by the data user.

Estimates that are generated by the R-DAS do not require any further review for protection of

respondent confidentiality. CBHSQ also makes restricted-use microdata files available through a

data portal on the SAMHDA Web site. More details on both of these programs are available at

http://www.datafiles.samhsa.gov.

WEST

(including AK and HI)

MIDWEST

SOUTH

NORTHEAST

2. Illicit Drug Use

The National Survey on Drug Use and Health (NSDUH) obtains information on nine

categories of illicit drug use: use of marijuana, cocaine, heroin, hallucinogens, and inhalants, as

well as the 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, psilocybin mushrooms, and "Ecstasy" (MDMA). Inhalants include a variety

of substances, such as nitrous oxide, amyl nitrite, cleaning fluids, gasoline, spray paint, other

aerosol sprays, and glue. Respondents are asked to report use of inhalants to get high but not to

report times when they accidentally inhaled a substance.

The four categories of prescription-type drugs (pain relievers, tranquilizers, stimulants,

and sedatives) cover numerous medications that currently are or have been available by

prescription. They also include drugs within these groupings that originally were prescription

medications but currently may be manufactured and distributed illegally, such as

methamphetamine, which is included under stimulants. Respondents are asked to report only

"nonmedical" use of these drugs, defined as use without a prescription of the individual's own or

simply for the experience or feeling the drugs caused. Use of over-the-counter drugs and

legitimate use of prescription drugs are not included. NSDUH reports combine the four

prescription-type drug groups into a category referred to as "psychotherapeutics."

Estimates of "illicit drug use" reported from NSDUH reflect the use of any of the nine

drug categories listed above. Use of alcohol and tobacco products, while illegal for youths, is not

included in these estimates, but is discussed in Chapters 3 and 4.

• In 2013, an estimated 24.6 million Americans aged 12 or older were current (past month)

illicit drug users, meaning they had used an illicit drug during the month prior to the survey

interview (Figure 2.1). The estimate represents 9.4 percent of the population aged 12 or

older.

• The overall rate of current illicit drug use among persons aged 12 or older in 2013

(9.4 percent) was similar to the rates in 2010 (8.9 percent) and 2012 (9.2 percent), but it was

higher than the rates in 2002 to 2009 and in 2011 (Figure 2.2).

• In 2013, marijuana was the most commonly used illicit drug, with 19.8 million current

(past month) users. It was used by 80.6 percent of current illicit drug users. Nearly two thirds

(64.7 percent) of current illicit drug users used only marijuana in the past month. Also, in

2013, 8.7 million persons aged 12 or older were current users of illicit drugs other than

marijuana (or 35.3 percent of illicit drug users aged 12 or older). Current use of other drugs

but not marijuana was reported by 19.4 percent of illicit drug users, and 15.9 percent reported

using both marijuana and other drugs.

Figure 2.1 Past Month Illicit Drug Use among Persons

Aged 12 or Older: 2013

Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-

type psychotherapeutics used nonmedically.

• The number and percentage of persons aged 12 or older who were current users of marijuana

in 2013 (19.8 million or 7.5 percent) were similar to the estimates in 2012 (18.9 million or

7.3 percent) (Figure 2.2). The rate of current marijuana use in 2013 was higher than the rates

in 2002 to 2011. For example, during the period from 2002 to 2008, the rates varied from

5.8 to 6.2 percent. By 2009, the rate increased to 6.7 percent, then continued to increase to

the rate in 2013.

• An estimated 8.7 million persons aged 12 or older (3.3 percent) were current users of illicit

drugs other than marijuana in 2013. The majority of these users (6.5 million persons or

2.5 percent of the population) were nonmedical users of psychotherapeutic drugs, including

4.5 million users of pain relievers (1.7 percent), 1.7 million users of tranquilizers

(0.6 percent), 1.4 million users of stimulants (0.5 percent), and 251,000 users of sedatives

(0.1 percent).

• The percentage of persons aged 12 or older who were current nonmedical users of

psychotherapeutic drugs in 2013 (2.5 percent) was lower than the percentages in 2006, 2007,

and 2009 (ranging from 2.8 to 2.9 percent), but it was similar to the percentages in all of the

other years from 2002 to 2012 (ranging from 2.4 to 2.7 percent) (Figure 2.2). The number of

persons aged 12 or older who were current nonmedical users of psychotherapeutic drugs in

2013 (6.5 million) was similar to the number of users in 2002 to 2012 (ranging from

6.1 million to 7.1 million).

Numbers in Millions

Illicit Drugs

Marijuana

Psychotherapeutics

Cocaine

Hallucinogens

Inhalants

Heroin

24.6

19.8

1.5

6.5

1.3

0.5

0.3

0 5 10 15 20 25

Figure 2.2 Past Month Use of Selected Illicit Drugs

among Persons Aged 12 or Older:

2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• The number and percentage of persons aged 12 or older who were current nonmedical users

of pain relievers in 2013 (4.5 million or 1.7 percent) were similar to those in 2011 and 2012

(4.5 million and 4.9 million, respectively, or 1.7 and 1.9 percent) (Figure 2.3).

• The number and percentage of persons aged 12 or older who were current nonmedical users

of the pain reliever OxyContin

in 2013 (492,000 or 0.2 percent) were similar to the numbers

in 2007 to 2012 (ranging from 358,000 to 566,000 or 0.1 to 0.2 percent).

• The number and percentage of current nonmedical users of tranquilizers in 2013 (1.7 million

or 0.6 percent) were lower than the estimates in 2012 (2.1 million or 0.8 percent).

• The number and percentage of persons aged 12 or older who were current nonmedical users

of stimulants in 2013 (1.4 million or 0.5 percent) were similar to those in 2012 (1.2 million or

0.5 percent), but were higher than the estimates in 2011 (970,000 or 0.4 percent).

Percent Using in Past Month

0.5 0.5

0.4

0.5

0.40.40.4 0.4

Psychotherapeutics

0.9

1.0

0.8

1.0

0.8

0.7

2.7 2.7

2.5

2.7

2.9

2.8

2.5

2.8

6.2

6.1

6.0

5.8

6.1

6.7

8.3

8.2

7.9

8.1

8.3

8.0

8.1

8.7

7.0

2.4

0.5

9.4

7.5

2.5

0.6

8.9

6.9

2.7

0.6

0.4 0.4

Illicit Drugs

Cocaine

Marijuana

Hallucinogens

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011

2013

2012

0.4

9.2

7.3

2.6

0.6

Figure 2.3 Past Month Nonmedical Use of Types of

Psychotherapeutic Drugs among Persons

Aged 12 or Older: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• The number and percentage of persons aged 12 or older who were current users of

methamphetamine in 2013 (595,000 or 0.2 percent) were similar to those in 2012 (440,000 or

0.2 percent) and 2011 (439,000 or 0.2 percent). However, the estimates in 2013 were higher

than those in 2010 (353,000 or 0.1 percent).

• The number and percentage of persons aged 12 or older who were current users of cocaine in

2013 (1.5 million or 0.6 percent) were similar to those in 2009 to 2012 (ranging from

1.4 million to 1.7 million or from 0.5 to 0.7 percent), but were lower than those in 2002 to

2007 (ranging from 2.0 million to 2.4 million or from 0.8 to 1.0 percent) (Figure 2.2).

• The number and percentage of persons aged 12 or older who were current heroin users in

2013 (289,000 or 0.1 percent) were similar to those in 2008 to 2012 (ranging from 193,000 to

335,000 or 0.1 percent for all 4 years) (Figure 2.4). The number of current heroin users in

2013 was higher than the number of users in 2002 to 2005 (ranging from 119,000 to 166,000)

and in 2007 (161,000). The number of persons aged 12 or older who were past year heroin

users in 2013 also was higher than the numbers in 2002 to 2005, 2007, and 2008 (ranging

from 314,000 to 455,000). (See Section B.2.3 in Appendix B for additional discussion of the

estimated numbers of past year and past month heroin users in 2006.)

Percent Using in Past Month

Pain Relievers

Stimulants

Tranquilizers

Sedatives

1.9

2.0

1.8

1.9

2.1

1.9

1.7

2.1

0.6 0.6

0.5 0.5

0.6

0.4 0.4

0.5

0.2

0.1 0.1 0.1

0.2

0.1 0.1

0.4

0.1 0.1

0.8 0.8

0.7 0.7 0.7 0.7 0.7

0.8

0.7

1.9

0.5

0.1

0.8

2.0

0.4

0.1

0.9

2002

0.0

0.5

1.0

1.5

2.0

2.5

2003 2004 2005 2006 2007 2008 2009 2010 2011 20132012

1.7

0.5

0.6

0.1

• The number and percentage of persons aged 12 or older who were current users of

hallucinogens in 2013 (1.3 million or 0.5 percent) were similar to those in 2012 (1.1 million

or 0.4 percent), but were higher than in 2011 (1.0 million or 0.4 percent) (Figure 2.2).

Figure 2.4 Past Month and Past Year Heroin Use

among Persons Aged 12 or Older: 2002-

2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Age

• In 2013, the rate of current illicit drug use varied by age. Among youths aged 12 to 17 in

2013, the rate increased from 2.6 percent at ages 12 or 13 to 7.8 percent at ages 14 or 15 to

15.8 percent at ages 16 or 17 (Figure 2.5). The highest rate of current illicit drug use was

among 18 to 20 year olds (22.6 percent), with the next highest rate occurring among 21 to 25

year olds (20.9 percent). Thereafter, the rate generally declined with age, although not all

decreases between consecutive age groups were significant.

• In 2013, the rate of current use of illicit drugs was highest among young adults aged 18 to 25

(21.5 percent), followed by youths aged 12 to 17 (8.8 percent), then by adults aged 26 or

older (7.3 percent) (Figure 2.6). The number and percentage of current illicit drug users

among youths aged 12 to 17 decreased from 2.4 million (9.5 percent) in 2012 to 2.2 million

(8.8 percent) in 2013.

Numbers in Thousands

166

119

136

339

161

213

193

404

314

398

379

560

373

455

582

621 620

281

669

335

239

Past Month

Past Year

2002

100

200

300

400

500

600

700

2003 2004 2005 2006 2007 2008 2009 2010 2011

2013

2012

681

289

Figure 2.5 Past Month Illicit Drug Use among Persons

Aged 12 or Older, by Age: 2012 and 2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Figure 2.6 Past Month Illicit Drug Use among Persons

Aged 12 or Older, by Age: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

12-13

14-15

Percent Using in Past Month

2.6

3.5

7.8

8.2

15.8

16.6

22.6

23.9

20.9

19.7

15.9

14.6

14.7

13.2

9.3

8.8

7.7

7.3

7.7

7.9

7.2

5.7

6.6

3.9

3.6

1.5

1.3

16-17

18-20

21-25

26-29

30-34

35-39

50-54

55-59

60-64

65+

Age in Years

40-44

45-49

2012

2013

Percent Using in Past Month

12 to 17

18 to 25

26 or Older

20.2

20.3

19.4

20.1

19.8

19.7

21.4

11.6

11.2

10.6

9.9

9.8

9.6

9.3

10.1

5.8

5.6

5.5

5.8

6.1

5.8

5.9

6.3

21.4

21.5

10.1

8.8

6.3

7.3

21.6

10.1

6.6

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011

20132012

21.3

9.5

7.0

Youths Aged 12 to 17

• In 2013, 8.8 percent of youths aged 12 to 17 were current illicit drug users (Figure 2.7).

This rate was lower than the rates of current illicit drug use among 12 to 17 year olds in 2002

to 2007 and in 2009 to 2012, but was similar to the rate in 2008 (9.3 percent).

• In 2013, 7.1 percent of youths aged 12 to 17 were current users of marijuana, 2.2 percent

were current nonmedical users of psychotherapeutic drugs (including 1.7 percent who were

current nonmedical users of pain relievers), 0.6 percent were current users of hallucinogens,

0.5 percent were current users of inhalants, 0.2 percent were current users of cocaine, and

0.1 percent were current users of heroin. Current marijuana use among 12 to 17 year olds

declined from 8.2 percent in 2002 to 6.8 percent in 2005, remained similar through 2008,

then increased to 7.9 percent in 2011 before decreasing again to 7.2 percent in 2012 and

7.1 percent in 2013 (Figure 2.7). Current nonmedical use of psychotherapeutic drugs

declined from 4.0 percent in 2002 and 2003 to 2.2 percent in 2013. This includes a decrease

in the prevalence of current nonmedical use of pain relievers from 3.2 percent in 2002 and

2003 to 1.7 percent in 2013.

• Among youths aged 12 to 17, the specific types of illicit drugs used in the past month varied

by age in 2013 (Figure 2.8). Among 12 or 13 year olds, 1.3 percent used psychotherapeutic

drugs nonmedically, including 0.9 percent using pain relievers nonmedically (which was a

decrease from 1.5 percent in 2012), 1.0 percent used marijuana, and 0.6 percent used

inhalants. Among 14 or 15 year olds, 5.8 percent used marijuana, 2.2 percent used

psychotherapeutic drugs nonmedically, including 1.8 percent using pain relievers

nonmedically, 0.6 percent used inhalants, and 0.4 percent used hallucinogens. Among 16 or

17 year olds, 14.2 percent used marijuana, 3.1 percent used psychotherapeutic drugs

nonmedically (which was a decrease from 4.0 percent in 2012), 1.3 percent used

hallucinogens (including an increase in the use of LSD from 0.2 percent in 2012 to

0.5 percent in 2013), 0.4 percent used cocaine, and 0.3 percent used inhalants (which was a

decrease from 0.7 percent in 2012). Rates of current nonmedical use of psychotherapeutic

drugs among youths aged 16 or 17 included 2.3 percent for pain relievers (which was a

decrease from 3.1 percent in 2012) and 0.5 percent for tranquilizers (which was a decrease

from 1.2 percent in 2012).

Young Adults Aged 18 to 25

• Among young adults aged 18 to 25, the rate of current illicit drug use in 2013 (21.5 percent)

was similar to the rates in 2009 to 2012 (ranging from 21.3 to 21.6 percent), but was higher

than the rates in 2002 to 2008 (ranging from 19.4 to 20.3 percent) (Figure 2.9).

• The rate of current marijuana use in 2013 among young adults aged 18 to 25 (19.1 percent)

was similar to the rates in 2009 to 2012 (ranging from 18.2 to 19.0 percent), but was higher

than the rates in 2002 to 2008 (ranging from 16.1 to 17.3 percent) (Figure 2.9).

Figure 2.7 Past Month Use of Selected Illicit Drugs

among Youths Aged 12 to 17: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Figure 2.8 Past Month Use of Selected Illicit Drugs

among Youths Aged 12 to 17: 2013

Note: The prevalence of past month cocaine use among youths aged 12 or 13 rounds to less than 0.1 percent and is

not shown.

Percent Using in Past Month

Illicit Drugs

Psychotherapeutics

Hallucinogens

Marijuana

Inhalants

8.2

7.9

7.6

6.8

6.7 6.7 6.7

7.4

4.0

3.6

3.3

2.9

3.1

1.2

1.0

0.8

0.7 0.7

1.0

0.9

0.5

1.3

1.2

1.3

1.2

1.1

1.0

11.6

11.2

10.6

9.9

9.8

9.6

9.3

10.1

7.9

2.8

0.9

8.8

7.1

2.2

0.6

10.1

7.4

3.0

1.1

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011

20132012

0.6

9.5

7.2

2.8

0.8

Aged 12 or 13

Percent Using in Past Month

Aged 14 or 15 Aged 16 or 17

1.0

0.1

0.6

1.3

5.8

0.1

0.4

0.6

2.2

14.2

0.4

1.3

0.3

3.1

Psychotherapeutics

Marijuana

Inhalants

Hallucinogens

Cocaine

Figure 2.9 Past Month Use of Selected Illicit Drugs

among Young Adults Aged 18 to 25:

2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• Among young adults aged 18 to 25, the rate of current nonmedical use of psychotherapeutic

drugs in 2013 (4.8 percent) was similar to the rates in 2011 (5.0 percent) and 2012

(5.3 percent), but it was lower than the rates in 2002 to 2010 (ranging from 5.5 to

6.5 percent) (Figure 2.9). The rate of current nonmedical use of pain relievers among young

adults in 2013 (3.3 percent) was lower than the rates in 2012 (3.8 percent) and in 2002 to

2010 (ranging from 4.1 to 5.0 percent), but it was similar to the rate in 2011 (3.6 percent).

• In 2013, the rate of current cocaine use among young adults aged 18 to 25 was 1.1 percent,

which was similar to the rates in 2009, 2011, and 2012, but it was lower than the rates from

2002 to 2008 and in 2010 (Figure 2.9).

• Among 18 to 25 year olds in 2013, the rates of current use of hallucinogens (1.8 percent),

heroin (0.3 percent), and inhalants (0.3 percent) were similar to the rates in 2012.

1.4

Percent Using in Past Month

1.4

1.9 1.7

1.5

1.7

Illicit Drugs

Cocaine

Marijuana Psychotherapeutics

Hallucinogens

20.2

20.3

19.4

20.1

19.8

19.7

21.4

17.3

17.0

16.1

16.6

16.3

16.5

16.6

18.2

5.5

6.1

6.3

6.5

5.9

6.4

2.0

2.2

2.1

2.6

2.2

1.7

1.8

1.6

21.4

19.0

5.0

1.6

21.5

19.1

4.8

1.8

21.6

18.5

5.9

2.0

1.5 1.5

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

1.5

1.1

2012

21.3

18.7

5.3

1.7

1.1

Adults Aged 26 or Older

• In 2013, the rate of current illicit drug use among adults aged 26 or older was 7.3 percent,

including rates of 5.6 percent for current use of marijuana and 2.1 percent for current

nonmedical use of psychotherapeutic drugs. Less than 1 percent of adults in this age group

were current users of cocaine (0.5 percent), hallucinogens (0.3 percent), heroin (0.1 percent),

and inhalants (0.1 percent). The rate of current illicit drug use in 2013 was similar to the rate

in 2012 (7.0 percent), but it was higher than the rates in 2002 to 2011 (ranging from 5.5 to

6.6 percent). Also, the rate of current marijuana use in 2013 (5.6 percent) was similar to the

rate in 2012 (5.3 percent), but it was higher than the rates in 2002 to 2011 (ranging from

3.9 to 4.8 percent).

• Among adults aged 50 to 64, the rate of current illicit drug use increased from 2.7 percent in

2002 to 6.0 percent in 2013. For adults aged 50 to 54, the rate increased from 3.4 percent in

2002 to 7.9 percent in 2013 (Figure 2.10). Among those aged 55 to 59, the rate of current

illicit drug use increased from 1.9 percent in 2002 to 5.7 percent in 2013. Among those aged

60 to 64, the rate of current illicit drug use increased from 1.1 percent in 2003 and 2004 to

3.9 percent in 2013.

Figure 2.10 Past Month Illicit Drug Use among Adults

Aged 50 to 64: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Percent Using in Past Month

50 to 54

55 to 59

60 to 64

3.4

3.9

4.8

6.0

5.7

5.4

7.0

4.3

1.9

2.5

1.1

2.0

2.6

3.4

2.4

4.1

5.0

5.2

6.7

7.9

6.0

5.7

7.2

4.1

3.1

1.1

1.8

2.1

1.8

2.7

3.9

2.6

3.0

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011

20132012

7.2

6.6

3.6

Gender

• In 2013, as in prior years, the rate of current illicit drug use among persons aged 12 or older

was higher for males (11.5 percent) than for females (7.3 percent). Males were more likely

than females to be current users of several different illicit drugs, including marijuana (9.7 vs.

5.6 percent), cocaine (0.8 vs. 0.4 percent), and hallucinogens (0.7 vs. 0.3 percent).

• In 2013, the rate of current illicit drug use was higher for males than females aged 12 to 17

(9.6 vs. 8.0 percent). This represents a change from 2012, when the rates of current illicit

drug use were similar among males and females aged 12 to 17 (9.6 and 9.5 percent,

respectively), and reflects a decrease in the rate of current illicit drug use among females

from 2012 to 2013. Likewise, in 2013, the rate of current marijuana use was higher for males

than females aged 12 to 17 (7.9 vs. 6.2 percent), which is a change from 2012 when the rates

of current marijuana use for males and females were similar (7.5 and 7.0 percent).

• The rate of current marijuana use among males aged 12 to 17 declined from 9.1 percent in

2002 to 6.9 percent in 2006, then increased between 2006 and 2011 (9.0 percent)

(Figure 2.11). The rate decreased from 2011 to 2012 (7.5 percent) and remained stable in

2013 (7.9 percent). Among females aged 12 to 17, the rate of current marijuana use

decreased from 7.2 percent in 2002 and 2003 to 6.2 percent in 2013.

Figure 2.11 Past Month Marijuana Use among Youths

Aged 12 to 17, by Gender: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Male

Female

Percent Using in Past Month

8.4

6.3

9.1

7.2

8.6

7.2

7.3

6.1

7.5

5.8

8.1

7.1

7.5

6.2

6.9

6.5

9.0

7.9

6.7

6.2

8.4

6.4

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011 20132012

7.5

7.0

• The rate of current nonmedical use of psychotherapeutic drugs among males aged 12 to 17

decreased from a high of 3.7 percent in 2003 to 2.0 percent in 2013. Among females aged 12

to 17, the rate of current nonmedical use of psychotherapeutic drugs decreased from a high of

4.4 percent in 2002 to 2.4 percent in 2013, including a decrease from 3.2 percent in 2012.

Pregnant Women

• Among pregnant women aged 15 to 44, 5.4 percent were current illicit drug users based on

data averaged across 2012 and 2013. This was lower than the rate among women in this age

group who were not pregnant (11.4 percent). Among pregnant women aged 15 to 44, the

average rate of current illicit drug use in 2012-2013 (5.4 percent) was not significantly

different from the rate averaged across 2010-2011 (5.0 percent). Current illicit drug use in

2012-2013 was lower among pregnant women aged 15 to 44 during the third trimester than

during the first and second trimesters (2.4 percent vs. 9.0 and 4.8 percent).

• The rate of current illicit drug use in the combined 2012-2013 data was 14.6 percent among

pregnant women aged 15 to 17, 8.6 percent among women aged 18 to 25, and 3.2 percent

among women aged 26 to 44. These rates were not significantly different from those in the

combined 2010-2011 data (20.9 percent among pregnant women aged 15 to 17, 8.2 percent

among pregnant women aged 18 to 25, and 2.2 percent among pregnant women aged 26 to

44).

Race/Ethnicity

• In 2013, among persons aged 12 or older, the rate of current illicit drug use was 3.1 percent

among Asians, 8.8 percent among Hispanics, 9.5 percent among whites, 10.5 percent among

blacks, 12.3 percent among American Indians or Alaska Natives, 14.0 percent among Native

Hawaiians or Other Pacific Islanders, and 17.4 percent among persons reporting two or more

races.

• There were no statistically significant differences in the rates of current illicit drug use

between 2012 and 2013 for any of the racial/ethnic groups. Between 2002 and 2013, the rate

of current illicit drug use increased from 8.5 to 9.5 percent for whites. Among blacks, the rate

increased from 8.7 percent in 2003 and 2004 to 10.5 percent in 2013 (Figure 2.12).

Education

• Illicit drug use in 2013 varied by the educational status of adults aged 18 or older. The rate of

current illicit drug use was lower among college graduates (6.7 percent) than those with some

college education but no degree (10.8 percent), high school graduates with no further

education (9.9 percent), and those who had not graduated from high school (11.8 percent).

Figure 2.12 Past Month Illicit Drug Use among

Persons Aged 12 or Older, by

Race/Ethnicity: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Note: Sample sizes for American Indians or Alaska Natives, Native Hawaiians or Other Pacific Islanders, and

persons of two or more races were too small for reliable trend presentation for these groups.

College Students

• In 2013, the rate of current illicit drug use was 22.3 percent among full-time college students

aged 18 to 22. This was similar to the rate among other persons aged 18 to 22 (23.0 percent),

which included part-time college students, students in other grades or types of institutions,

and nonstudents.

• In 2013, about one quarter of male full-time college students aged 18 to 22 were current

illicit drug users (26.0 percent). This rate was higher than the rate of current illicit drug use

among female full-time college students aged 18 to 22 (19.2 percent). Similarly, 23.6 percent

of male full-time college students aged 18 to 22 were current marijuana users compared with

16.6 percent of female full-time college students aged 18 to 22.

• Among full-time college students aged 18 to 22 in 2013, the rate of current illicit drug use

was 9.4 percent for Asians, 19.7 percent for blacks, 21.5 percent for Hispanics, and

25.1 percent for whites.

Percent Using in Past Month

Black or African

American

White

10.0

9.8

10.0

8.7

8.4

3.8

10.5

9.5

8.8

3.1

10.7

9.1

8.1

3.5

9.7

8.7

Hispanic

or Latino

Asian

3.5

3.8

3.1

7.6

7.2

8.0

3.6

6.9

4.2

6.6

3.6

6.2

3.7

7.9

9.5

9.7 9.7

8.5

8.3

8.1

8.5

8.2

8.3

8.8

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011

20132012

11.3

9.2

8.3

3.7

Employment

• Current illicit drug use differed by employment status in 2013. Among adults aged 18 or

older, the rate of current illicit drug use was higher for those who were unemployed

(18.2 percent) than for those who were employed full time (9.1 percent), employed part time

(13.7 percent), or "other" (6.6 percent) (which includes students, persons keeping house or

caring for children full time, retired or disabled persons, or other persons not in the labor

force) (Figure 2.13). The percentage of adults employed full time who were current illicit

drug users in 2013 was similar to that in 2012 (8.9 percent).

Figure 2.13 Past Month Illicit Drug Use among

Persons Aged 18 or Older, by

Employment Status: 2012 and 2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

The Other Employment category includes students, persons keeping house or caring for children full time, retired

or disabled persons, or other persons not in the labor force.

• Although the rate of current illicit drug use was higher among unemployed persons in 2013

than it was among those who were employed full time, employed part time, or in the "other"

employment category, most of these users were employed. Of the 22.4 million current illicit

drug users aged 18 or older in 2013, 15.4 million (68.9 percent) were employed either full or

part time.

Percent Using in Past Month

Millions of Users

Number of UsersRate of Use

Full Time

Part Time

Unemployed

Other

Full Time

Part Time

Unemployed

Other

2012

2013

2012

2013

8.9

9.1

12.5

18.1

6.3

4.1

2.5

4.4

10.5

13.7

18.2

6.6

4.6

2.1

4.8

10.8

Geographic Area

• Among persons aged 12 or older, the rate of current illicit drug use in 2013 was 11.8 percent

in the West, 9.2 percent in the Northeast, 8.7 percent in the Midwest, and 8.3 percent in the

South.

• In 2013, the rate of current illicit drug use among persons aged 12 or older was 9.6 percent in

large metropolitan areas, 9.8 percent in small metropolitan areas, and 7.8 percent in

nonmetropolitan areas (Figure 2.14). Within nonmetropolitan areas, the rate was 8.9 percent

in urbanized counties and 6.9 percent in both less urbanized counties and rural counties.

Figure 2.14 Past Month Illicit Drug Use among

Persons Aged 12 or Older, by County

Type: 2013

Criminal Justice Populations

• In 2013, an estimated 1.7 million adults aged 18 or older were on parole or other supervised

release from prison at some time during the past year. About one quarter (27.4 percent) were

current illicit drug users, with 20.4 percent reporting current use of marijuana and

12.1 percent reporting current nonmedical use of psychotherapeutic drugs. These rates were

higher than those reported by adults aged 18 or older who were not on parole or other

supervised release during the past year (9.3 percent for current illicit drug use, 7.5 percent for

current marijuana use, and 2.4 percent for current nonmedical use of psychotherapeutic

drugs).

Large

Metropolitan

Percent Using in Past Month

Small

Metropolitan

Nonmetropolitan

Urbanized

Nonmetropolitan

Less

Urbanized

Nonmetropolitan

Completely

Rural

9.6

9.8

6.9

8.9

6.9

• In 2013, an estimated 4.5 million adults aged 18 or older were on probation at some time

during the past year. More than one quarter (31.4 percent) were current illicit drug users, with

23.5 percent reporting current use of marijuana and 12.3 percent reporting current

nonmedical use of psychotherapeutic drugs. These rates were higher than those reported by

adults who were not on probation during the past year (9.0 percent for current illicit drug use,

7.3 percent for current marijuana use, and 2.3 percent for current nonmedical use of

psychotherapeutic drugs).

Frequency of Marijuana Use

• In 2013, 5.7 million persons aged 12 or older used marijuana on a daily or almost daily basis

in the past 12 months (i.e., on 300 or more days in that period), which was an increase from

the 3.1 million daily or almost daily users in 2006 (Figure 2.15). The number of daily or

almost daily users of marijuana in 2013 represented 17.4 percent of past year users.

• In 2013, 8.1 million persons aged 12 or older used marijuana on 20 or more days in the past

month, which was an increase from the 5.1 million daily or almost daily past month users in

2005 to 2007 (Figure 2.15). The number of daily or almost daily users in 2013 represented

41.1 percent of past month marijuana users.

Figure 2.15 Daily or Almost Daily Marijuana Use in the

Past Year and Past Month among Persons

Aged 12 or Older: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Numbers in Millions

6.2

4.1

4.8

3.1

4.9

3.1

5.5

3.9

5.1

3.6

4.9

3.2

5.1

3.4

5.1

3.1

7.1

8.1

5.0

5.7

6.9

4.6

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011

2013

Used Marijuana on 300 or

More Days in the Past Year

Used Marijuana on 20 or

More Days in the Past Month

2012

7.6

5.4

Association with Cigarette and Alcohol Use

• In 2013, the rate of current illicit drug use among youths aged 12 to 17 who smoked

cigarettes in the past month was approximately 9 times the rate among youths who did not

smoke cigarettes in the past month (53.9 vs. 6.1 percent). Also, the rate of current marijuana

use in 2013 among youths aged 12 to 17 who smoked cigarettes in the past month was about

11 times the rate among youths who did not smoke cigarettes (49.5 vs. 4.6 percent).

• In 2013, the rate of current illicit drug use was associated with the level of past month

alcohol use. Among youths aged 12 to 17 who were heavy drinkers (i.e., consumed five or

more drinks on the same occasion on each of 5 or more days in the past 30 days),

62.3 percent were current illicit drug users and 57.9 percent were current marijuana users.

These rates were higher than the rates among youths who were not current alcohol users

(4.9 percent for current illicit drug use and 3.3 percent for current marijuana use).

Additionally, among youths aged 12 to 17 who were binge but not heavy alcohol users

(i.e., consumed five or more drinks on the same occasion on 1 to 4 days in the past 30 days),

46.6 percent were current illicit drug users and 43.2 percent were current marijuana users

(with the marijuana use rate being higher than the 2012 rate of 37.8 percent).

• In 2013, the rate of current illicit drug use among youths aged 12 to 17 who both smoked

cigarettes and drank alcohol in the past month was approximately 16 times the rate among

those who neither smoked cigarettes nor drank alcohol in the past month (64.5 vs.

3.9 percent). Additionally, the rate of current marijuana use among youths aged 12 to 17 who

both smoked cigarettes and drank alcohol in the past month was about 25 times the rate

among those who neither smoked cigarettes nor drank alcohol in the past month (59.7 vs.

2.4 percent).

Driving Under the Influence of Illicit Drugs

• In 2013, 9.9 million persons, or 3.8 percent of the population aged 12 or older, reported

driving under the influence of illicit drugs during the past year. This rate was lower than the

rate in 2002 (4.7 percent), but was similar to the rate in 2012 (3.9 percent). Across age

groups, the rate of driving under the influence of illicit drugs in 2013 was highest among

young adults aged 18 to 25 (10.6 percent); this rate for young adults was lower than the rate

in 2012 (11.9 percent). Additionally, the rate of driving under the influence of illicit drugs

during the past year among youths aged 12 to 17 decreased from 2.3 percent in 2012 to

1.9 percent in 2013.

Source of Prescription Drugs

• Past year nonmedical users of psychotherapeutic drugs are asked how they obtained the

drugs for their most recent nonmedical use. Rates averaged across 2012 and 2013 show that

more than half of the nonmedical users of pain relievers, tranquilizers, stimulants, and

sedatives aged 12 or older got the prescription drugs they most recently used "from a friend

or relative for free." More than four in five of these nonmedical users who obtained

prescription drugs from a friend or relative for free indicated that their friend or relative had

obtained the drugs from one doctor.

• Among persons aged 12 or older in 2012-2013 who used pain relievers nonmedically in the

past year, 53.0 percent got the pain relievers they most recently used from a friend or relative

for free (Figure 2.16). About one in five (21.2 percent) received them through a prescription

from one doctor (which was higher than the 18.1 percent in 2010-2011). Another

10.6 percent of these nonmedical users in 2012-2013 bought pain relievers from a friend or

relative, and 4.0 percent took pain relievers from a friend or relative without asking.

An annual average of 4.3 percent got the pain relievers from a drug dealer or other stranger;

2.6 percent got pain relievers from more than one doctor; 0.1 percent bought pain relievers

on the Internet; and 4.3 percent got pain relievers in other ways, including 0.7 percent who

stole pain relievers from a doctor's office, clinic, hospital, or pharmacy.

Figure 2.16 Source Where Pain Relievers Were

Obtained for Most Recent Nonmedical Use

among Past Year Users Aged 12 or Older:

2012-2013

The Other category includes the sources "Wrote Fake Prescription," "Stole from Doctor's

Office/Clinic/Hospital/Pharmacy," and "Some Other Way."

Note: The percentages do not add to 100 percent due to rounding.

One Doctor (21.2%)

Free from Friend/

Relative (53.0%)

Other

(4.3%)

Bought on

Internet (0.1%)

Drug Dealer/

Stranger (4.3%)

Bought/Took from

Friend/Relative (14.6%)

More than One Doctor (2.6%)

Source Where User Obtained

One Doctor (83.8%)

Free from Friend/

Relative (5.1%)

Other

(1.2%)

Bought on Internet (0.3%)

Drug Dealer/

Stranger (1.4%)

Bought/Took from

Friend/Relative (4.9%)

More than One

Doctor (3.3%)

Source Where Friend/Relative Obtained

• Among persons aged 12 or older in 2012-2013 who used pain relievers nonmedically in the

past year and indicated that they most recently obtained the drugs from a friend or relative for

free in the past year, 83.8 percent reported that their friend or relative obtained the drugs

from just one doctor (Figure 2.16). About 1 in 20 (5.1 percent) of these past year nonmedical

users of pain relievers reported that the friend or relative got the pain relievers from another

friend or relative for free, 4.9 percent reported that the friend or relative bought or took them

from a friend or relative (including 3.7 percent who reported that the friend or relative bought

the pain relievers from a friend or relative and 1.2 percent who reported that the friend or

relative took the pain relievers from another friend or relative without asking), 1.4 percent

reported that the friend or relative bought the pain relievers from a drug dealer or other

stranger, and 0.3 percent reported that the friend or relative bought the pain relievers on the

Internet.

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. 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 to be 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 (past month) use - At least one drink in the past 30 days.

Binge use - Five or more drinks on the same occasion (i.e., at the same time or within a

couple of hours of each other) on at least 1 day in the past 30 days.

Heavy use - Five or more drinks on the same occasion on each of 5 or more days in the

past 30 days.

These levels are not mutually exclusive categories of use; heavy use is included in estimates of

binge and current use, and binge use is included in estimates of current use.

This chapter is divided into two main sections. Section 3.1 describes trends and patterns

of alcohol use among the population aged 12 or older. Section 3.2 is concerned particularly with

the use of alcohol by persons aged 12 to 20. These persons are under the legal drinking age in all

50 States and the District of Columbia.

3.1. Alcohol Use among Persons Aged 12 or Older

• Slightly more than half (52.2 percent) of Americans aged 12 or older reported being current

drinkers of alcohol in the 2013 survey, which was similar to the rate in 2012 (52.1 percent).

This translates to an estimated 136.9 million current drinkers in 2013.

• Nearly one quarter (22.9 percent) of persons aged 12 or older in 2013 were binge alcohol

users in the 30 days prior to the survey. This translates to about 60.1 million people. The rate

in 2013 was similar to the rate in 2012 (23.0 percent).

• In 2013, heavy drinking was reported by 6.3 percent of the population aged 12 or older,

or 16.5 million people. This percentage was similar to the rate of heavy drinking in 2012

(6.5 percent).

Age

• In 2013, rates of current alcohol use were 2.1 percent among persons aged 12 or 13,

9.5 percent for persons aged 14 or 15, 22.7 percent for 16 or 17 year olds, 43.8 percent for

those aged 18 to 20, and 69.3 percent for 21 to 25 year olds (Figure 3.1). The estimates for

persons aged 14 or 15 and those aged 16 or 17 were lower than those reported in 2012

(11.1 and 24.8 percent, respectively).

• Rates of binge alcohol use in 2013 were 0.8 percent among 12 or 13 year olds, 4.5 percent

for 14 or 15 year olds, 13.1 percent for 16 or 17 year olds, 29.1 percent for persons aged 18

to 20, and peaked at 43.3 percent for those aged 21 to 25 (Figure 3.1). The estimates for

persons aged 14 or 15, 16 or 17, and 21 to 25 were lower than those reported in 2012

(5.4, 15.0, and 45.1 percent, respectively).

• Rates of heavy alcohol use in 2013 were 0.1 percent among 12 or 13 year olds, 0.7 percent

for 14 or 15 year olds, 2.7 percent for 16 or 17 year olds, 8.5 percent for persons aged 18 to

20, and peaked at 13.1 percent for those aged 21 to 25 (Figure 3.1). The estimates for persons

aged 18 to 20 and 21 to 25 were lower than those reported in 2012 (10.0 and 14.4 percent,

respectively).

Figure 3.1 Current, Binge, and Heavy Alcohol Use

among Persons Aged 12 or Older, by Age:

2013

Note: The past month binge alcohol use estimate for 12 or 13 year olds was 0.8 percent, and the past month heavy

alcohol use estimate was 0.1 percent.

16-17

18-20

Percent Using in Past Month

21-25

26-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

Age in Years

12-13

14-15

Heavy Alcohol UseBinge Use (Not Heavy)Current Use (Not Binge)

4.5

13.1

29.1

43.3

40.0

35.2

29.6

25.7

25.8

23.0

15.9

14.1

9.1

9.5

22.7

43.8

69.3

69.0

63.6

60.2

60.7

58.9

59.9

52.5

53.6

41.7

2.1

0.7

2.7

8.5

13.1

11.2

10.5

7.5

7.3

6.9

5.6

3.9

4.7

2.1

• The rate of current alcohol use among youths aged 12 to 17 was 11.6 percent in 2013. Youth

binge and heavy drinking rates were 6.2 and 1.2 percent, respectively. The rates for current

and binge youth alcohol use were lower than those in 2012 (12.9 and 7.2 percent,

respectively).

• In 2013, the rate of current alcohol use was 59.6 percent among young adults aged 18 to 25,

which was similar to the rate in 2012 (60.2 percent). The rate of binge drinking in 2013 was

37.9 percent for young adults. Heavy alcohol use was reported by 11.3 percent of persons in

this age group. The binge and heavy drinking rates were lower than the rates in 2012

(39.5 and 12.7 percent, respectively).

• The prevalence of current, binge, and heavy alcohol use in 2013 was lower among adults

aged 65 or older (41.7, 9.1, and 2.1 percent, respectively) than among all other adult age

groups (Figure 3.1). These rates among adults aged 65 or older were similar to the current,

binge, and heavy drinking rates in this age group in 2012 (41.2, 8.2, and 2.0 percent,

respectively).

Gender

• In 2013, an estimated 57.1 percent of males aged 12 or older were current drinkers, which

was higher than the rate for females (47.5 percent). Among youths aged 12 to 17, however,

the percentage of males who were current drinkers (11.2 percent) was similar to the rate for

females (11.9 percent). The rates for male and female youths were lower than those reported

in 2012 (12.6 and 13.2 percent, respectively).

• Among young adults aged 18 to 25, an estimated 62.3 percent of males and 56.9 percent of

females were current drinkers in 2013. In this age group, 44.4 percent of males and

31.4 percent of females reported binge drinking in 2013 (Figure 3.2). In 2013, the rate of

binge drinking among females aged 18 to 25 was lower than the rate reported in 2012

(33.2 percent). The rate of binge alcohol use in 2013 among males in this age group was

similar to the rate in 2012 (45.8 percent).

• Among persons aged 26 or older, an estimated 62.2 percent of males and 50.1 percent of

females reported current drinking in 2013. In this age group, the rate of binge drinking for

males was approximately twice the rate for females (30.7 vs. 14.7 percent).

Pregnant Women

• Among pregnant women aged 15 to 44 in 2012-2013, an annual average of 9.4 percent

reported current alcohol use, 2.3 percent reported binge drinking, and 0.4 percent reported

heavy drinking. These rates were lower than the rates for nonpregnant women in the same

age group (55.4, 24.6, and 5.3 percent, respectively). Current alcohol use in 2012-2013 was

lower among pregnant women aged 15 to 44 during the second and third trimesters than

during the first trimester (5.0 and 4.4 percent vs. 19.0 percent).

Figure 3.2 Binge Alcohol Use among Adults Aged

18 to 25, by Gender: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Race/Ethnicity

• Among persons aged 12 or older, whites in 2013 were more likely than other racial/ethnic

groups to report current use of alcohol (57.7 percent) (Figure 3.3). The rates were

47.4 percent for persons reporting two or more races, 43.6 percent for blacks, 43.0 percent

for Hispanics, 38.4 percent for Native Hawaiians or Other Pacific Islanders, 37.3 percent for

American Indians or Alaska Natives, and 34.5 percent for Asians.

• The rate of binge alcohol use in 2013 was lowest among Asians (12.4 percent) (Figure 3.3).

Rates for other racial/ethnic groups were 19.6 percent for persons reporting two or more

races, 20.1 percent for blacks, 23.5 percent for American Indians or Alaska Natives

24.0 percent for whites, 24.1 percent for Hispanics, and 24.7 percent for Native Hawaiians or

Other Pacific Islanders.

• Among youths aged 12 to 17 in 2013, rates of current alcohol use were 8.0 percent among

Asians, 8.2 percent for Native Hawaiians or Other Pacific Islanders, 9.0 percent for those

reporting two or more races, 9.3 percent for American Indians or Alaska Natives, 9.7 percent

for blacks, 10.7 percent for Hispanics, and 12.9 percent for whites. The rates for Hispanic

and white youths were lower than those reported in 2012 (12.8 and 14.6 percent,

respectively).

Male

Female

Percent Using in Past Month

50.2

31.7

31.8

32.3

31.9

34.1

33.8

34.0

51.3

50.1

51.7

50.3

49.8

48.4

33.8

32.6

49.8

48.1

33.2

46.3

33.2

45.8

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20132012

31.4

44.4

Figure 3.3 Current, Binge, and Heavy Alcohol Use

among Persons Aged 12 or Older,

by Race/Ethnicity: 2013

Education

• Among adults aged 18 or older, the rate of past month alcohol use increased with increasing

levels of education. Among adults in 2013 with less than a high school education,

36.5 percent were current drinkers. In comparison, 69.2 percent of college graduates were

current drinkers.

• Among adults aged 18 or older, rates of binge and heavy alcohol use varied by level of

education. Among adults in 2013, those who had graduated from college were less likely

than those with some college education but no degree to be binge drinkers (23.1 vs.

26.4 percent) or heavy drinkers (6.0 vs. 7.6 percent).

Percent Using in Past Month

White Black or

African

American

Indian

or Alaska

Native

Asian Two or

Races

Hispanic

or Latino

Heavy Alcohol UseBinge Use (Not Heavy)

Current Use (Not Binge)

57.7

24.0

7.3

43.6

20.1

4.5

37.3

23.5

5.8

38.4

24.7

8.9

47.4

19.6

7.5

43.0

24.1

4.8

Native

Hawaiian

or Other

Pacific

Islander

34.5

12.4

2.0

College Students

• Young adults aged 18 to 22 who were enrolled full time in college were more likely than

their peers who were not enrolled full time (i.e., part-time college students and persons not

currently enrolled in college) to report current, binge, or heavy drinking. Among full-time

college students in 2013, 59.4 percent were current drinkers, 39.0 percent were binge

drinkers, and 12.7 percent were heavy drinkers. Among those not enrolled full time in

college, these rates were 50.6, 33.4, and 9.3 percent, respectively.

• The pattern of higher rates of current alcohol use, binge alcohol use, and heavy alcohol use

among full-time college students compared with rates for others aged 18 to 22 has remained

consistent since 2002 (Figure 3.4).

• Among young adults aged 18 to 22, the rate of binge drinking declined somewhat since 2002.

In 2002, the binge drinking rate within this age group was 41.0 percent compared with

35.6 percent in 2013. Among full-time college students, the rate decreased over this period

from 44.4 to 39.0 percent (Figure 3.4). Among part-time college students and others not in

college, the rate decreased from 38.9 to 33.4 percent during the same time period. For both

full-time college students and others aged 18 to 22, the rates in 2013 were similar to those in

2012 (40.1 and 35.0 percent, respectively).

Figure 3.4 Binge Alcohol Use among Adults Aged

18 to 22, by College Enrollment: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Enrolled Full Time in College

Not Enrolled Full Time in College

Percent Using in Past Month

44.4

38.9

38.7

39.4

38.3

38.5

38.6

38.2

43.5

43.4

44.8

45.6

43.6

40.7

38.0

35.4

43.6

42.2

35.4

39.1

35.0

40.1

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

33.4

39.0

• In 2013, male full-time college students aged 18 to 22 were more likely than their female

counterparts to be binge drinkers (44.8 vs. 33.9 percent) as well as heavy drinkers (16.5 vs.

9.3 percent). The rates for current drinking were similar for males and females who were

full-time college students (60.8 and 58.2 percent, respectively).

Employment

• The rate of current alcohol use in 2013 was 65.8 percent for full-time employed adults aged

18 or older, which was higher than the rate for unemployed adults (53.8 percent). The rates

of binge drinking were similar for adults who were employed full time and those who were

unemployed (30.5 and 31.3 percent, respectively).

• Among adults in 2013, most binge and heavy alcohol users were employed. Among the

58.5 million adults who were binge drinkers, 44.5 million (76.1 percent) were employed

either full or part time. Among the 16.2 million adults who were heavy drinkers, 12.4 million

(76.0 percent) were employed.

Geographic Area

• The rate of past month alcohol use for people aged 12 or older in 2013 was lowest in the

South (48.2 percent), followed by the West (50.7 percent), then the Midwest (55.7 percent),

then the Northeast (58.0 percent). Rates of binge drinking in these regions were 21.3, 22.2,

25.6, and 23.8 percent, respectively.

• In 2013, the rates of past month alcohol use among persons aged 12 or older in large and

small metropolitan areas (54.3 and 51.6 percent, respectively) were higher than in

nonmetropolitan areas (46.3 percent). Rates of binge drinking were similar in large and small

metropolitan areas (23.3 and 23.1 percent, respectively). However, binge drinking among

persons aged 12 or older was less prevalent in nonmetropolitan areas (21.1 percent) than in

large metropolitan areas.

• In 2013, roughly 1 in 9 youths aged 12 to 17 were current alcohol users, regardless of

whether they were in large metropolitan, small metropolitan, or nonmetropolitan areas

(11.7, 11.4, and 11.3 percent, respectively). Among youths aged 12 to 17 in 2013, the rates of

binge alcohol use in large and small metropolitan areas (6.2 percent in both areas) were

similar to the rate for youths in nonmetropolitan areas (6.6 percent). Youths in

nonmetropolitan areas were less likely to be current alcohol drinkers and to be binge alcohol

users than they were in 2012 (14.2 and 9.2 percent, respectively).

Association with Illicit Drug and Tobacco Use

• As was the case in prior years, the level of alcohol use was associated with illicit drug use in

2013. Among the 16.5 million heavy drinkers aged 12 or older, 33.7 percent were current

illicit drug users. Persons who were not current alcohol users were less likely to have used

illicit drugs in the past month (4.3 percent) than those who reported current use of alcohol but

no binge or heavy use (7.3 percent), binge use but no heavy use (18.5 percent), or heavy use

of alcohol (33.7 percent).

• Alcohol consumption levels also were associated with tobacco use in 2013. Among heavy

alcohol users aged 12 or older, 53.1 percent smoked cigarettes in the past month compared

with 16.2 percent of non-binge current drinkers and 15.5 percent of persons who did not

drink alcohol in the past month. Smokeless tobacco use and cigar use also were more

prevalent among heavy drinkers (12.1 and 15.4 percent, respectively) than among non-binge

drinkers (2.0 and 3.9 percent) and persons who were not current alcohol users (2.0 and

1.8 percent).

Driving Under the Influence of Alcohol

• In 2013, roughly 1 in 9 persons aged 12 or older (10.9 percent) drove under the influence of

alcohol at least once in the past year (Figure 3.5). This corresponds to 28.7 million persons.

The 2013 rate was lower than the rate in 2002 (14.2 percent), but was similar to the rate in

2012 (11.2 percent).

Figure 3.5 Driving Under the Influence of Alcohol in

the Past Year among Persons Aged 12 or

Older: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Percent Driving Under the

Influence in Past Year

14.2

13.6

13.5

13.0

12.4

12.7

12.0

11.2

11.1

11.4

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

10.9

• Driving under the influence of alcohol among persons aged 16 or older differed by age group

in 2013. The rate was highest among persons aged 21 to 25 and persons aged 26 to 29

(19.7 and 20.7 percent, respectively) (Figure 3.6). An estimated 3.8 percent of 16 or 17 year

olds and 10.8 percent of 18 to 20 year olds reported driving under the influence of alcohol in

the past year.

Figure 3.6 Driving Under the Influence of Alcohol in

the Past Year among Persons Aged 16 or

Older, by Age: 2013

• Among persons aged 12 to 20 and those aged 21 to 25, the rates of driving under the

influence of alcohol in 2013 (4.7 and 19.7 percent, respectively) were lower than the rates in

2012 (5.7 and 21.9 percent, respectively). The rates of driving under the influence for those

26 or older were similar in 2012 and 2013 (11.1 and 11.2 percent, respectively).

• Among persons aged 12 or older in 2013, males were more likely than females to drive under

the influence of alcohol in the past year (14.1 vs. 7.9 percent).

16-17

18-20

Percent Driving Under the

Influence in Past Year

3.8

10.8

19.7

20.7

17.6

14.3

12.7

12.5

12.3

8.2

8.4

3.7

21-25

26-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

Age in Years

3.2. Underage Alcohol Use

• In 2013, about 8.7 million persons aged 12 to 20 (22.7 percent of this age group) reported

drinking alcohol in the past month. Approximately 5.4 million (14.2 percent) were binge

drinkers, and 1.4 million (3.7 percent) were heavy drinkers. All three of these rates were

lower than those reported in 2012 (24.3, 15.3, and 4.3 percent, respectively).

• Rates of current, binge, and heavy alcohol use among underage persons declined between

2002 and 2013. The rate of current alcohol use among 12 to 20 year olds decreased from

28.8 percent in 2002 to 22.7 percent in 2013. The binge drinking rate declined from 19.3 to

14.2 percent, and the rate of heavy drinking declined from 6.2 to 3.7 percent between 2002

and 2013.

• Rates of current alcohol use increased with age among underage persons. In 2013,

2.1 percent of persons aged 12 or 13, 9.5 percent of persons aged 14 or 15, 22.7 percent of

16 or 17 year olds, and 43.8 percent of 18 to 20 year olds drank alcohol during the 30 days

before they were surveyed (Figure 3.7). This pattern by age has been observed since 2002.

The rates in 2013 for youths aged 14 or 15 and those aged 16 or 17 were lower than the rates

in 2012 (11.1 and 24.8 percent, respectively).

Figure 3.7 Current Alcohol Use among Persons Aged

12 to 20, by Age: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Percent Using in Past Month

12 or 13 14 or 15 16 or 17 18 to 20

51.0

51.5

51.1

51.6

50.8

48.6

48.5

46.8

32.6

4.3

4.5

4.3

4.2

3.9

3.5

3.4

3.2

2.5

16.6

17.0

16.4

15.1

15.6

14.7

13.3

12.4

11.3

31.8

32.5

30.1

29.8

29.2

26.3

24.6

49.5

3.5

13.1

26.5

25.3

45.8

2.2

11.1

24.8

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

43.8

2.1

22.7

9.5

• Males and females aged 12 to 20 in 2013 had similar rates of current alcohol use (23.0 and

22.5 percent) (Figure 3.8). However, underage males were more likely than underage females

to report binge (15.8 vs. 12.4 percent) or heavy alcohol use (4.6 vs. 2.7 percent).

Figure 3.8 Current, Binge, and Heavy Alcohol Use

among Persons Aged 12 to 20, by Gender:

2013

• Among persons aged 12 to 20, past month alcohol use rates in 2013 were 15.2 percent among

Asians, 17.8 percent for blacks, 17.8 percent for those reporting two or more races,

17.8 percent for American Indians or Alaska Natives, 20.6 percent for Hispanics, and

25.8 percent for whites. The rates of current alcohol use among Hispanics and whites were

lower than those reported in 2012 (23.2 and 27.4 percent, respectively).

• In 2013, among persons aged 12 to 20, binge drinking was reported by 16.8 percent of

whites, 13.9 percent of American Indians or Alaska Natives, 13.5 percent of Hispanics,

12.1 percent of Native Hawaiians or Other Pacific Islanders, 11.1 percent of persons

reporting two or more races, 8.4 percent of blacks, and 7.6 percent of Asians.

• Across geographic regions in 2013, the rate of current alcohol use among persons aged 12 to

20 was 25.9 percent in the Northeast, 24.5 percent in the Midwest, 22.5 percent in the West,

and 20.4 percent in the South. The rate of current alcohol use in the South in 2013 was lower

than it was in 2012 (22.3 percent).

Current Binge Heavy

Percent Using in Past Month

23.0

22.5

15.8

12.4

4.6

2.7

Level of Alcohol Use

Male

Female

• In 2013, the current alcohol use rates among underage persons were 22.7 percent in large

metropolitan areas, 23.1 percent in small metropolitan areas, and 21.9 percent in

nonmetropolitan areas. The underage current drinking rate in 2013 was lower in large

metropolitan areas than the rate reported in 2012 (24.7 percent).

• In 2013, 77.6 percent of current drinkers aged 12 to 20 were with two or more other people

the last time they drank alcohol, 16.3 percent were with one other person the last time they

drank, and 6.1 percent were alone. The rate of drinking alone the last time that underage

persons drank alcohol was highest among youths aged 12 to 14 (14.5 percent), followed by

youths aged 15 to 17 (7.8 percent), then by persons aged 18 to 20 (4.8 percent).

• A majority of underage current drinkers in 2013 reported that their last use of alcohol in the

past month occurred in a home setting, either in someone else's home (52.2 percent) or their

own home (34.2 percent). The rate for drinking at home was higher than it was in 2012

(31.4 percent). In 2013, underage females were more likely than males to have been in a

restaurant, bar, or club on their last drinking occasion (8.8 vs. 4.5 percent).

• Among underage current drinkers in 2013, 28.7 percent paid for the alcohol the last time they

drank, including 7.8 percent who purchased the alcohol themselves and 20.5 percent who

gave money to someone else to purchase it. These rates were similar to those reported in

2012 (28.2, 7.6, and 20.4 percent, respectively). Youths aged 12 to 14 were least likely to

report that they paid for the alcohol the last time they drank (6.3 percent), followed by youths

aged 15 to 17 (20.8 percent), then by persons aged 18 to 20 (33.6 percent).

• In 2013, among underage current drinkers who did not pay for the alcohol the last time they

drank, the most common source was an unrelated person aged 21 or older (36.6 percent).

Parents, guardians, or other adult family members provided the last alcohol to 24.5 percent of

nonpaying underage drinkers. Other underage persons provided the alcohol on the last

occasion for 16.4 percent of nonpaying underage drinkers. Additional sources of alcohol for

underage drinkers who did not pay included (a) took the alcohol from home (7.8 percent),

(b) took it from someone else's home (2.9 percent), and (c) got it some other way

(6.0 percent).

• In 2013, underage current drinkers were more likely than current alcohol users aged 21 or

older to use illicit drugs within 2 hours of alcohol use on their last reported drinking occasion

(19.9 vs. 5.7 percent). The most commonly reported illicit drug used by underage drinkers in

combination with alcohol was marijuana, which was used within 2 hours of alcohol use by

19.5 percent of current underage drinkers (1.6 million persons) on their last drinking

occasion.

4. Tobacco Use

The National Survey on Drug Use and Health (NSDUH) includes a series of questions

about the use of tobacco products, including cigarettes, chewing tobacco, snuff, cigars, and pipe

tobacco. Cigarette use is defined as smoking "part or all of a cigarette." For analytic purposes,

data for chewing tobacco and snuff are combined and termed "smokeless tobacco."

• In 2013, an estimated 66.9 million Americans aged 12 or older were current (past month)

users of a tobacco product. This represents 25.5 percent of the population in that age range

(Figure 4.1). Also, 55.8 million persons (21.3 percent of the population) were current

cigarette smokers; 12.4 million (4.7 percent) smoked cigars; 8.8 million (3.4 percent) used

smokeless tobacco; and 2.3 million (0.9 percent) smoked tobacco in pipes.

Figure 4.1 Past Month Tobacco Use among Persons

Aged 12 or Older: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Percent Using in Past Month

3.3

3.2

3.0

3.3

0.8 0.8 0.8 0.8

0.7

0.90.9

Tobacco Products

Cigarettes

Cigars

Smokeless Tobacco

Pipe Tobacco

30.4

28.4

24.3

25.0

28.7

24.9

25.4

29.2

24.9

29.8

26.0

29.4

29.6

24.0

27.7

26.5

23.3

22.1

5.4

5.3

5.0

5.4

5.7

5.4

5.6

3.4 3.2

3.5

0.8 0.8

26.7

22.1

5.2

3.5

1.0

27.5

23.0

5.2

3.5

0.8

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

25.5

21.3

4.7

0.9

3.4

• Between 2002 and 2013, past month use of any tobacco product among persons aged 12 or

older decreased from 30.4 to 25.5 percent, and past month cigarette use declined from 26.0 to

21.3 percent (Figure 4.1). Past month cigar use decreased from 5.4 percent in 2002 to

4.7 percent in 2013. Rates of past month use of smokeless tobacco and pipe tobacco were

similar in 2002 and 2013.

Age

• In 2013, young adults aged 18 to 25 had the highest rate of current use of a tobacco product

(37.0 percent), followed by adults aged 26 or older (25.7 percent), then by youths aged 12 to

17 (7.8 percent). Young adults also had the highest rates of current use of the specific

tobacco products. Among young adults, the rates of past month use in 2013 were

30.6 percent for cigarettes, 10.0 percent for cigars, 5.8 percent for smokeless tobacco, and

2.2 percent for pipe tobacco.

• The rate of current use of a tobacco product by young adults aged 18 to 25 declined from

45.3 percent in 2002 to 37.0 percent in 2013. The rate of current cigarette use among young

adults also declined from 40.8 percent in 2002 to 30.6 percent in 2013. However, the rates of

current use of smokeless tobacco and pipe tobacco by young adults increased from

4.8 percent in 2002 to 5.8 percent in 2013 for smokeless tobacco and from 1.1 percent in

2002 to 2.2 percent in 2013 for pipe tobacco. The rates in 2013 for current use of a tobacco

product, cigarettes, smokeless tobacco, and cigars among young adults were similar to the

rates in 2012 (38.1, 31.8, 5.5, and 10.7 percent, respectively). However, the rate of pipe

tobacco use among young adults in 2013 was higher than the rate in 2012 (1.8 percent).

• The rate of past month tobacco use among 12 to 17 year olds declined from 15.2 percent in

2002 to 7.8 percent in 2013, including a decline from 8.6 percent in 2012 (Figure 4.2).

The rate of past month cigarette use among 12 to 17 year olds declined from 13.0 percent in

2002 to 5.6 percent in 2013. The rate of past month cigar use among this age group declined

from 4.5 percent in 2002 to 2.3 percent in 2013. The rate of past month smokeless tobacco

use among 12 to 17 year olds declined from 2.5 percent in 2007 to 2.0 percent in 2013, which

was the same as the rate in 2002.

• Adults aged 21 to 34 had higher rates of current cigarette use than did persons in either older

or younger age groups (Figure 4.3). Rates of current cigarette use in 2013 were similar

among adults aged 30 to 34 (33.2 percent), those aged 21 to 25 (32.8 percent), and those aged

26 to 29 (32.7 percent). Among adults aged 35 or older in 2013, 19.0 percent smoked

cigarettes in the past month.

Gender

• In 2013, current use of a tobacco product among persons aged 12 or older was reported by a

higher percentage of males (31.1 percent) than females (20.2 percent). Males also had higher

rates of past month use than females of each specific tobacco product: cigarettes

(23.6 percent among males vs. 19.0 percent among females), cigars (7.7 vs. 2.0 percent),

smokeless tobacco (6.5 vs. 0.4 percent), and pipe tobacco (1.5 vs. 0.3 percent).

Figure 4.2 Past Month Tobacco Use among Youths

Aged 12 to 17: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Figure 4.3 Past Month Cigarette Use among Persons

Aged 12 or Older, by Age: 2013

Percent Using in Past Month

Tobacco Products

Cigarettes

Cigars

Smokeless Tobacco

Pipe Tobacco

0.7

0.9

0.7

4.5

3.8

4.3

4.8

4.5

4.2

4.1

15.2

11.5

12.4

14.4

13.1

12.9

11.8

10.0

13.0

9.2

9.9

11.9

12.2

10.8

10.4

9.0

7.8

4.0

3.4

2.0

2.4

2.0

2.3

2.1

0.6 0.6

0.6

0.7

2.5

2.2

2.4

2.1

0.7

8.6

6.6

2.6

2.1

0.6

10.7

8.4

3.2

2.3

0.7

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

0.6

7.8

5.6

2.3

2.0

12-13

14-15

Percent Using in Past Month

0.9

4.3

11.4

27.1

32.8

32.7

25.6

23.4

24.4

23.1

19.6

10.0

16-17

18-20

21-25

26-29

30-34

35-39

50-54

55-59

60-64

65+

Age in Years

40-44

45-49

33.2

16.4

• The rate of any tobacco use among males aged 12 or older declined from 37.0 percent in

2002 to 31.1 percent in 2013. The rate of any tobacco use for females aged 12 or older also

declined from 24.3 percent in 2002 to 20.2 percent in 2013. Rates of any tobacco use were

similar between 2012 and 2013 for females (20.9 and 20.2 percent, respectively), but

declined from 33.0 to 31.1 percent for males.

• Among youths aged 12 to 17, the rates of current cigarette smoking in 2013 were 5.7 percent

for males and 5.5 percent for females (Figure 4.4). From 2002 to 2013, the rate of current

cigarette smoking among youths decreased for both males (from 12.3 to 5.7 percent) and

females (from 13.6 to 5.5 percent). In 2013, the rate for males was lower than the rate in

2012 (6.8 percent), while the rate was similar to the rate in 2012 for females (6.3 percent).

Figure 4.4 Past Month Cigarette Use among Youths

Aged 12 to 17, by Gender: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• The rate of current cigarette smoking among male young adults aged 18 to 25 declined from

44.4 percent in 2002 to 36.3 percent in 2013. Among female young adults, the rate declined

from 37.1 percent in 2002 to 24.9 percent in 2013. For females aged 18 to 25, the rate of

current cigarette smoking in 2013 was lower than the rate in 2012 (27.1 percent), while the

rate for males in 2013 was similar to the rate in 2012 (36.6 percent).

Male

Female

Percent Using in Past Month

10.0

13.6

9.3

8.2

12.5

10.8

12.3

11.9

11.3

10.7

10.1

9.7

9.1

8.7

7.3

6.8

6.3

8.6

8.2

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

5.7

5.5

Pregnant Women

• The annual average rate of past month cigarette use in 2012 and 2013 among women aged 15

to 44 who were pregnant was 15.4 percent (Figure 4.5). The rate of current cigarette use

among women aged 15 to 44 who were pregnant was lower than that among women who

were not pregnant (24.0 percent). This pattern was also evident among women aged 18 to 25

(21.0 vs. 26.2 percent for pregnant and nonpregnant women, respectively) and among women

aged 26 to 44 (11.8 vs. 25.4 percent, respectively). Rates of current cigarette use in 2012-

2013 among pregnant women aged 15 to 44 were 19.9 percent in the first trimester,

13.4 percent in the second trimester, and 12.8 percent in the third trimester.

• The annual average rates of current cigarette use among women aged 15 to 44 who were not

pregnant decreased from 30.7 percent in 2002-2003 to 24.0 percent in 2012-2013

(Figure 4.5). However, the prevalence of cigarette use among pregnant women in this age

range did not change significantly during the same time period (18.0 percent in 2002-2003

and 15.4 percent in 2012-2013).

Figure 4.5 Past Month Cigarette Use among Women

Aged 15 to 44, by Pregnancy Status:

Combined Years 2002-2003 to 2012-2013

Difference between this estimate and the 2012-2013 estimate is statistically significant at the .05 level.

Percent Using in Past Month

Pregnant

30.7

27.5

25.4

27.4

29.6

30.0

29.5

28.4

18.0

15.2

17.6

24.6

15.9

26.8

16.2

16.3

16.6

18.0

16.4

16.3

Not Pregnant

2002-

2003

2003-

2004

2004-

2005

2005-

2006

2006-

2007

2007-

2008

2008-

2009

2009-

2010

2010-

2011

2012-

2013

2011-

2012

24.0

15.4

Race/Ethnicity

• In 2013, the prevalence of current use of a tobacco product was 40.1 percent for American

Indians or Alaska Natives, 31.2 percent for persons reporting two or more races, 27.7 percent

for whites, 27.1 percent for blacks, 25.8 percent for Native Hawaiians or Other Pacific

Islanders, 18.8 percent for Hispanics, and 10.1 percent for Asians. The rate of current

tobacco use among American Indians or Alaska Natives was higher than the rates for all

other groups except persons reporting two or more races. The rate of current tobacco use

among Asians was lower than the rates among other groups. The rate of current tobacco use

in 2013 for whites was lower than the rate in 2012 (29.2 percent). Otherwise, there were no

statistically significant changes in past month use of any tobacco product between 2012 and

2013 across racial/ethnic groups.

• The rate of past month cigarette use in 2013 was higher among American Indians or Alaska

Natives (36.5 percent) than among persons reporting two or more races (27.1 percent), blacks

(23.0 percent), whites (22.7 percent), Native Hawaiians or Other Pacific Islanders

(21.1 percent), Hispanics (16.8 percent), and Asians (8.5 percent). Rates of past month

cigarette use in 2013 were similar to rates in 2012 across racial/ethnic groups.

• Rates of past month cigar use in 2013 were 6.9 percent for blacks, 6.1 percent for American

Indians or Alaska Natives, 5.5 percent for persons reporting two or more races, 4.8 percent

for whites, 3.7 percent for Hispanics, 2.1 percent for Native Hawaiians or Other Pacific

Islanders, and 2.0 percent for Asians. There were no statistically significant changes in past

month cigar use between 2012 and 2013 across racial/ethnic groups, except for whites

(5.3 vs. 4.8 percent).

• Rates of past month smokeless tobacco use in 2013 were 5.3 percent for American Indians or

Alaska Natives, 4.3 percent for whites, 3.9 percent for Native Hawaiians or Other Pacific

Islanders, 3.1 percent for persons reporting two or more races, 1.8 percent for blacks,

1.3 percent for Hispanics, and 0.7 percent for Asians. Rates of past month smokeless tobacco

use in 2013 were similar to rates in 2012 across racial/ethnic groups.

Education

• Since 2002, cigarette smoking in the past month has been less prevalent among adults who

were college graduates compared with those who completed less education. Among adults

aged 18 or older, current cigarette use in 2013 was reported by 33.6 percent of those who had

not completed high school, 27.7 percent of high school graduates with no further education,

25.5 percent of persons with some college but no degree, and 11.2 percent of college

graduates. These rates by educational attainment were similar to the rates in 2012, except for

high school graduates who did not attend college (29.4 percent in 2012).

College Students

• Among young adults aged 18 to 22, full-time college students were less likely to be current

cigarette smokers than their peers who were not enrolled full time in college. The same

pattern was found among both males and females in this age range.

• The rate of past month cigarette use among full-time college students aged 18 to 22 declined

from 32.6 percent in 2002 to 21.0 percent in 2013. The rate among those who were not

enrolled full time declined from 45.8 percent in 2002 to 34.4 percent in 2013.

• Among males aged 18 to 22 who were full-time college students, the rate of past month

cigarette use in 2013 (25.3 percent) was lower than the rate in 2002 (33.3 percent). Among

males aged 18 to 22 who were not enrolled full time in college, the rate of current cigarette

use in 2013 (39.5 percent) also was lower than the rate in 2002 (49.5 percent).

• Among females aged 18 to 22 who were full-time college students, the rate of past month

cigarette use declined from 32.0 percent in 2002 to 17.2 percent in 2013. Among females

aged 18 to 22 who were not enrolled full time in college, the rate of current cigarette use in

2013 (28.6 percent) also was lower than the rate in 2002 (41.7 percent).

Employment

• In 2013, current cigarette smoking was more common among unemployed adults aged 18 or

older (40.1 percent) than among adults who were working full time or part time (22.8 and

23.4 percent, respectively). Cigar smoking followed a similar pattern, with 10.9 percent of

unemployed adults reporting past month use compared with 5.6 percent of full-time workers

and 5.0 percent of part-time workers.

• Current use of smokeless tobacco in 2013 was higher among adults aged 18 or older who

were employed full time (4.8 percent) and those who were unemployed (4.9 percent) than

among those who were employed part time (2.2 percent) and those in the "other"

employment category, which includes persons not in the labor force (1.9 percent).

Geographic Area

• In 2013, current cigarette smoking among persons aged 12 or older was lowest in the West

(17.6 percent), followed by the Northeast (19.6 percent), then the South (22.4 percent), then

the Midwest (24.6 percent). Use of smokeless tobacco was lowest in the Northeast

(2.0 percent), followed by the West (2.7 percent), then the Midwest and South (3.9 and

4.1 percent, respectively).

• Consistent with the findings in previous years since 2002, the rates of use of any tobacco

product in 2013 were associated with county type among persons aged 12 or older. The rate

of current cigarette use was lowest in large metropolitan areas (19.0 percent), followed by

small metropolitan areas (22.4 percent), then by nonmetropolitan areas (26.6 percent). Use of

smokeless tobacco in the past month in 2013 among persons aged 12 or older was lowest in

large metropolitan areas (2.1 percent), followed by small metropolitan areas (3.7 percent),

then by nonmetropolitan areas (6.7 percent).

Association with Illicit Drug and Alcohol Use

• Use of illicit drugs and alcohol was more common among current cigarette smokers than

among nonsmokers in 2013, as in previous years since 2002. Among persons aged 12 or

older, 24.1 percent of past month cigarette smokers reported current use of an illicit drug

compared with 5.4 percent of persons who were not current cigarette smokers. Among

youths aged 12 to 17 who smoked cigarettes in the past month, 53.9 percent also used an

illicit drug compared with 6.1 percent of youths who did not smoke cigarettes.

• In 2013, past month alcohol use was reported by 65.2 percent of current cigarette smokers

compared with 48.7 percent of those who did not use cigarettes in the past month. This

association also was found for binge alcohol use (42.9 percent of current cigarette smokers

vs. 17.5 percent of current nonsmokers) and heavy alcohol use (15.7 vs. 3.8 percent,

respectively).

Frequency of Cigarette Use

• Among the 55.8 million current cigarette smokers aged 12 or older in 2013, 33.2 million

(59.6 percent) used cigarettes daily. The percentage of daily cigarette smokers among past

month cigarette users increased with age (19.4 percent of past month cigarette users aged

12 to 17, 43.1 percent of those aged 18 to 25, and 64.9 percent of those aged 26 or older).

• The percentage of current smokers aged 12 or older who used cigarettes daily decreased from

63.4 percent in 2002 to 59.6 percent in 2013. During the same time period, daily cigarette use

declined among current smokers aged 12 to 17 (from 31.8 to 19.4 percent), those aged 18 to

25 (from 51.8 to 43.1 percent), and those aged 26 or older (from 68.8 to 64.9 percent).

• In 2013, 41.3 percent of daily smokers aged 12 or older reported smoking 16 or more

cigarettes per day (i.e., approximately one pack or more). The percentage of daily smokers

who smoked at least one pack of cigarettes per day increased with age, from 11.9 percent

among daily smokers aged 12 to 17, to 22.2 percent of those aged 18 to 25, then to

44.6 percent of those aged 26 or older (Figure 4.6).

• The percentage of daily smokers aged 26 or older who smoked one or more packs of

cigarettes per day was lower in 2013 (44.6 percent) than in 2002 (56.9 percent). Declines also

were seen among daily smokers from 2002 to 2013 for youths aged 12 to 17 (from 21.7 to

11.9 percent) and for young adults aged 18 to 25 (from 39.0 to 22.2 percent).

Definitions for binge alcohol use and heavy alcohol use are given in the introduction to Chapter 3 in this

report.

Figure 4.6 Past Month Smokers of One or More Packs

of Cigarettes per Day among Daily

Smokers, by Age Group: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Percent Smoking One or More Packs per Day

in Past Month

26 or Older

18 to 25

12 to 17

56.9

52.8

49.3

47.4

32.9

34.4

55.0

34.9

37.1

59.1

36.9

57.9

39.0

55.0

54.5

31.5

29.5

26.1

21.7

18.3

17.9

14.7

45.1

25.1

10.6

48.7

27.3

16.6

18.6

19.3

22.0

20.1

17.8

2002 2003 2004 2005 2006 2007 2008 2009 2010

2011

2013

2012

44.6

22.2

11.9

5. Initiation of Substance Use

Estimates of substance use initiation (also known as incidence or first-time use) are often

considered leading indicators that can be used to assess the volume of new users by drug or drug

category, track emerging patterns of use, and forecast the associated treatment needs in various

population subgroups. These estimates can also be useful to target prevention efforts and

evaluate prevention programs.

With its large sample size and oversampling of youths aged 12 to 17 and young adults

aged 18 to 25, the National Survey on Drug Use and Health (NSDUH) provides estimates of

recent (i.e., past year) initiation of use of illicit drugs, tobacco, and alcohol based on reported age

and on year and month at first use. Recent initiates are defined as those who reported use of a

particular substance for the first time within 12 months preceding the date of interview. There is

a caveat to the past year initiation measure worth mentioning. Because survey respondents are

aged 12 or older, the past year initiation estimates reflect only a portion of the initiation that

occurred at age 11 and none of the initiation that occurred at age 10 or younger. This

underestimation primarily affects estimates of initiation for cigarettes, alcohol, and inhalants

because they tend to be initiated at a younger age than other substances. See Section B.4.1 in

Appendix B for further discussion of the methods and bias in initiation estimates.

This chapter includes estimates of the number and rate of past year initiation of illicit

drug, tobacco, and alcohol use among the total population aged 12 or older and by selected age

and gender categories from the 2013 NSDUH, comparing with prior years. Also included are

initiation estimates that pertain to persons at risk for initiation. Persons at risk for initiation of use

of a particular substance are those who never used the substance in their lifetime plus those who

used that substance for the first time in the 12 months prior to the interview. In other words,

persons at risk are those who had never used as of 12 months prior to the interview date. Some

analyses are based on the age at the time of interview, and others focus on the age at the time of

first substance use. Readers need to be aware of these alternative estimation approaches when

interpreting NSDUH incidence estimates and pay close attention to the approach used in each

situation. Titles and notes on figures and associated detailed tables document which method

applies.

For trend measurement, initiation estimates for each year (2002 to 2013) are produced

independently based on the data from the survey conducted that year. Estimates of trends in

incidence based on longer recall periods have not been considered because of concerns about

their validity (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004).

Regarding the age at first use estimates, means, as measures of central tendency, are

heavily influenced by the presence of extreme values in the data for persons aged 12 or older.

To reduce the effect of extreme values, the mean age at initiation was calculated for persons aged

12 to 49, leaving out those few respondents who were past year initiates at age 50 or older.

Including data from initiates aged 26 to 49 in this broad age group also can cause instability of

estimates of the mean age at initiation among persons aged 12 to 49, but this effect is less than

that of including data from initiates aged 50 or older. Nevertheless, caution is needed in

interpreting these trends for persons aged 12 to 49. Section B.4.1 in Appendix B also discusses

this issue. Note, however, that this constraint affects only the estimates of mean age at initiation.

Other estimates in this chapter, including the numbers and percentages of past year initiates, are

not affected by extreme ages at initiation and therefore are reported for all persons aged 12 or

older.

Another important consideration in examining incidence estimates across different drug

categories is that substance users typically initiate use of different substances at different times in

their lives. Thus, the estimates for past year initiation of each specific illicit drug cannot be added

to obtain the total number of overall illicit drug initiates because some of the initiates previously

had used other drugs. The initiation estimate for any illicit drug represents the past year initiation

of use of a specific drug that was not preceded by use of other illicit drugs. For example, a

respondent who reported initiating marijuana use in the past 12 months is counted as a marijuana

initiate. The same respondent also can be counted as an illicit drug initiate with marijuana as the

first drug only if his or her marijuana use initiation was not preceded by use of any other drug

(cocaine, heroin, hallucinogens, inhalants, pain relievers, tranquilizers, stimulants, or sedatives).

In addition, past year initiates of lysergic acid diethylamide (LSD), phencyclidine (PCP), or

Ecstasy use are counted as past year initiates of any hallucinogen use only if they had not

previously used other hallucinogens. Similarly, past year initiates of crack cocaine, OxyContin

or methamphetamine use are counted as past year initiates for the broader category (i.e., any

cocaine, pain relievers, or stimulants, respectively) only if they did not report previous use for

the broader category.

Initiation of Illicit Drug Use

• In 2013, an estimated 2.8 million persons aged 12 or older used an illicit drug for the first

time within the past 12 months; this averages to about 7,800 new users per day. This estimate

was similar to the 2012 estimate of 2.9 million. Over half of initiates (54.1 percent) were

younger than age 18 when they first used, and 58.3 percent of new users were female.

The 2013 average age at initiation among persons aged 12 to 49 was 19.0 years, which was

similar to the 2012 estimate (18.7 years). See Section B.4.1 in Appendix B for a discussion of

the effects of older adult initiates on estimates of mean age at first use.

• Of the estimated 2.8 million persons aged 12 or older in 2013 who used illicit drugs for the

first time within the past 12 months, a majority reported that their first drug was marijuana

(70.3 percent) (Figure 5.1). About 1 in 5 initiated with nonmedical use of psychotherapeutics

(20.6 percent, including 12.5 percent with pain relievers, 5.2 percent with tranquilizers,

2.7 percent with stimulants, and 0.2 percent with sedatives). A notable proportion reported

inhalants (6.3 percent) as their first illicit drug, and a small proportion used hallucinogens

(2.6 percent). The percentage of persons in 2013 reporting marijuana as the first illicit drug in

past year initiation was greater than the corresponding percentage in 2012 (70.3 vs.

65.6 percent). The percentage reporting nonmedical use of pain relievers as the first illicit

drug was lower in 2013 than in 2012 (12.5 vs. 17.0 percent).

Initiation for pain relievers, tranquilizers, stimulants, or sedatives refers to first nonmedical use.

Figure 5.1 First Specific Drug Associated with

Initiation of Illicit Drug Use among Past

Year Illicit Drug Initiates Aged 12 or Older:

2013

Note: The percentages do not add to 100 percent due to rounding or because a small number of respondents initiated

multiple drugs on the same day. The first specific drug refers to the one that was used on the occasion of first-

time use of any illicit drug.

Comparison, by Drug

• In 2013, the specific illicit drug category with the largest number of recent initiates among

persons aged 12 or older was marijuana (2.4 million), followed by nonmedical use of pain

relievers (1.5 million), followed by nonmedical use of tranquilizers (1.2 million), followed by

Ecstasy (0.8 million), followed by stimulants, cocaine, and inhalants (0.6 million each)

(Figure 5.2).

• Among past year initiates aged 12 to 49 in 2013, the average age at first use was 17.1 years

for PCP, 18.0 years for marijuana, 19.2 years for inhalants, 19.7 years for LSD, 20.4 years

for cocaine, 20.5 years for Ecstasy, 21.6 years for stimulants, 21.7 years for pain relievers,

24.5 years for heroin, 25.0 years for sedatives, and 25.4 years for tranquilizers (Figure 5.3).

2.8 Million Initiates of Illicit Drugs

Marijuana (70.3%)

Pain Relievers (12.5%)

Inhalants (6.3%)

Tranquilizers (5.2%)

Hallucinogens (2.6%)

Stimulants (2.7%)

Sedatives (0.2%)

Cocaine (0.1%)

Figure 5.2 Past Year Initiates of Specific Illicit Drugs

among Persons Aged 12 or Older: 2013

Note: Numbers refer to persons who used a specific drug for the first time in the past year, regardless of whether

initiation of other drug use occurred prior to the past year.

Figure 5.3 Mean Age at First Use for Specific Illicit

Drugs among Past Year Initiates Aged 12 to

49: 2013

Marijuana

Pain Relievers

Numbers in Thousands

2,427

1,539

1,180

751

603

601

563

482

169

128

Tranquilizers

Ecstasy

Stimulants

Cocaine

Inhalants

LSD

Heroin

Sedatives

PCP

500

1,500

1,000

2,000

2,500

3,000

PCP

Marijuana

Age in Years

17.1

18.0

19.2

19.7

20.4

20.5

21.6

21.7

24.5

25.0

25.4

Inhalants

LSD

Cocaine

Ecstasy

Stimulants

Pain Relievers

Heroin

Sedatives

Tranquilizers

Marijuana

• In 2013, there were 2.4 million persons aged 12 or older who had used marijuana for the first

time within the past 12 months; this averages to about 6,600 new users each day. The 2013

estimate was similar to the estimates in 2008 through 2012 (ranging from 2.2 million to

2.6 million), but was higher than the estimates from 2002 through 2007 (ranging from

2.0 million to 2.2 million) (Figure 5.4).

• In 2013, among persons aged 12 or older, an estimated 1.4 million first-time past year

marijuana users initiated prior to the age of 18. This estimate was similar to the

corresponding estimate in 2012. The estimated 1.4 million persons in 2013 who initiated

prior to the age of 18 represented the majority (56.6 percent) of the 2.4 million recent

marijuana initiates.

Figure 5.4 Past Year Marijuana Initiates among

Persons Aged 12 or Older and Mean Age at

First Use of Marijuana among Past Year

Marijuana Initiates Aged 12 to 49: 2002-

2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Mean-age-at-first-use estimates are for past year initiates aged 12 to 49.

Past Year Initiates (Numbers in Millions)

Mean Age at First Use (Age in Years)

17.0

16.8

17.1

17.4 17.4

17.6

17.8

17.0

17.5

17.9

18.4

2.2

2.0

2.1

2.2

2.4

2.6

2.4 2.4

2002 2003 2004 2005 2006 2007

Mean Age at First Use

Past Year Initiates

2008 2009 2010 2011

20132012

2.4

18.0

• Among all youths aged 12 to 17, an estimated 4.8 percent had used marijuana for the first

time within the past year in 2013, which was similar to the rate in 2012 (5.0 percent). As a

percentage of those aged 12 to 17 who had not used marijuana prior to the past year (i.e.,

those at risk for initiation), the youth marijuana initiation rate in 2013 (5.5 percent) was

similar to the rate in 2012 (5.7 percent).

• In 2013, the average age at first marijuana use among recent initiates aged 12 to 49 was

18.0 years, which was similar to the average ages in 2005 through 2008 and 2010 through

2012, but was higher than the average ages in 2002 through 2004 and in 2009 (Figure 5.4).

Section B.4.1 in Appendix B discusses the potential instability of estimates of older adult

initiation and the impact on estimates of mean age at first use.

• In 2013, among recent initiates aged 12 or older who initiated marijuana use prior to the

age of 21, the mean age at first use was 16.2 years, which was similar to the 2012 estimate of

16.3 years.

Cocaine

• In 2013, there were 601,000 persons aged 12 or older who had used cocaine for the first time

within the past 12 months; this averages to approximately 1,600 initiates per day. This

estimate was similar to the number in 2008 to 2012 (ranging from 623,000 to 724,000).

The annual number of cocaine initiates in 2013 was lower than the estimates from 2002

through 2007 (ranging from 0.9 million to 1.0 million).

• The number of initiates of crack cocaine ranged from 209,000 to 353,000 in 2002 to 2008

and declined to 95,000 in 2009. The number of initiates of crack cocaine has been similar

each year since 2009 (e.g., 58,000 in 2013).

• In 2013, most (81.9 percent) of the 0.6 million recent cocaine initiates were aged 18 or older

when they first used. The average age at first use among recent initiates aged 12 to 49 was

20.4 years. The average age estimates have remained fairly stable since 2002.

Heroin

• In 2013, there were 169,000 persons aged 12 or older who had used heroin for the first time

within the past 12 months. This estimated number in 2013 was similar to the numbers in

2002 to 2005 and from 2007 to 2012, but it was higher than the number in 2006 (90,000).

The average age at first use among recent heroin initiates aged 12 to 49 in 2013 was

24.5 years, which was similar to the 2012 estimate (23.0 years).

Hallucinogens

• In 2013, there were 1.1 million persons aged 12 or older who had used hallucinogens for the

first time within the past 12 months (Figure 5.5). This estimate was similar to the estimates

for 2002, 2004 to 2008, and 2010 to 2012 (ranging from 0.9 million to 1.2 million).

However, this estimate for 2013 was higher than the 2003 estimate (886,000) and was lower

than the 2009 estimate (1.3 million). The average age at first use among recent hallucinogen

initiates aged 12 to 49 in 2013 was 19.9 years, which was similar to the 2012 estimate

(19.1 years).

• The number of past year initiates of LSD aged 12 or older was 482,000 in 2013, which was

similar to the numbers in 2008, 2010, and 2012 (ranging from 381,000 to 421,000), but was

higher than the numbers in 2002 to 2007, 2009, and 2011 (ranging from 200,000 to 358,000)

(Figure 5.5). The average age at first use among recent LSD initiates aged 12 to 49 in 2013

was 19.7 years, which was similar to the 2012 estimate (19.0 years).

Figure 5.5 Past Year Hallucinogen Initiates among

Persons Aged 12 or Older: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Numbers in Thousands

Any Hallucinogen Ecstasy LSD PCP

1,206

642

123

105

106

338

200

235

243

265

271

400

341

358

607

615

863

777

892

1,118

922

1,152

886

934

953

1,118

1,061

1,132

1,276

1,137

421

869

1,073

381

949

1,240

500

1,000

1,500

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

482

751

1,065

• The number of past year initiates of PCP aged 12 or older was 32,000 in 2013. This number

was lower than the numbers from 2002 through 2006 and in 2012 (ranging from 70,000 to

123,000), but was similar to the numbers in 2007 to 2011 (ranging from 45,000 to 58,000).

The average age at first use among recent PCP initiates aged 12 to 49 in 2013 was 17.1 years,

which was similar to the 2012 estimate (16.6 years). This average age at initiation of PCP has

remained fairly stable since 2002.

• The number of past year initiates of Ecstasy was 751,000 in 2013, which was similar to the

number in 2012 (869,000), but was lower than the numbers in 2009, 2010, and 2011

(1.1 million, 949,000, and 922,000, respectively) (Figure 5.5). The 2002 estimate of

1.2 million past year initiates declined to 642,000 in 2003, followed by an increase between

2004 and 2013.

• Most (69.4 percent) of the recent Ecstasy initiates in 2013 were aged 18 or older at the time

they first used Ecstasy. The number of Ecstasy initiates who first used prior to the age of 18

was 230,000, which was similar to the estimate in 2012 (255,000).

• Among past year initiates aged 12 to 49, the average age at initiation of Ecstasy in 2013 was

20.5 years. This average age at initiation of Ecstasy has remained fairly stable since 2002.

In 2013, among recent initiates aged 12 or older who initiated Ecstasy use prior to the age of

21, the mean age at first use was 17.4 years, which was similar to the 2012 estimate of

17.5 years.

Inhalants

• In 2013, there were 563,000 persons aged 12 or older who had used inhalants for the first

time within the past 12 months, which was similar to the 2012 estimate of 584,000, but was

lower than the numbers in 2002 to 2011 (ranging from 719,000 to 877,000). An estimated

46.8 percent of past year initiates of inhalants in 2013 were younger than age 18 when they

first used. The average age at first use among recent initiates aged 12 to 49 was 19.2 years,

which was higher than the 2012 estimate of 16.9 years.

Psychotherapeutics

• Nonmedical use of psychotherapeutics includes nonmedical use of any prescription-type pain

relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not

included. In 2013, there were approximately 2.0 million persons aged 12 or older who used

psychotherapeutics nonmedically for the first time within the past year, which averages to

about 5,500 initiates per day. The number of new nonmedical users of psychotherapeutics in

2013 was lower than the estimates for prior years from 2002 through 2012 (ranging from

2.3 million to 2.8 million).

• In 2013, the numbers of initiates were 1.5 million for pain relievers, 1.2 million for

tranquilizers, 603,000 for stimulants, and 128,000 for sedatives (Figure 5.6).

Figure 5.6 Past Year Nonmedical Psychotherapeutic

Initiates among Persons Aged 12 or Older:

2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• The number of new nonmedical users of pain relievers in 2013 (1.5 million) was lower than

the numbers in 2002 through 2012 (ranging from 1.9 million to 2.5 million) (Figure 5.6).

The number of past year initiates for nonmedical use of tranquilizers has been fairly stable

from 2002 to 2013 (ranging from 1.1 million to 1.4 million). The number of initiates for

nonmedical use of stimulants in 2013 was similar to the numbers in 2003, 2005, and in 2007

to 2012 (ranging from 602,000 to 715,000), but was lower than the numbers in 2002, 2004,

and 2006 (ranging from 783,000 to 846,000). The number of initiates for nonmedical use of

sedatives in 2013 was similar to the numbers in 2002, 2003, 2007 to 2009, 2011, and 2012

(ranging from 159,000 to 209,000), but was lower than the numbers in 2004 to 2006 and in

2010 (ranging from 240,000 to 267,000).

• In 2013, the average age at first nonmedical use of any psychotherapeutics among recent

initiates aged 12 to 49 was 22.4 years. Average ages at first nonmedical use were 21.6 years

for stimulants, 21.7 years for pain relievers, 25.0 years for sedatives, and 25.4 years for

tranquilizers. All of these 2013 estimates were similar to the corresponding estimates in

2012.

Numbers in Thousands

Pain Relievers Tranquilizers Stimulants Sedatives

2,320

209

194

240

783

715

793

647

846

640

602

710

670

1,180

1,234

1,184

2,422

2,155

2,159

2,189

2,193

1,888

676

1,880

626

2,013

1,000

1,500

2,500

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

603

1,539

500

2,000

2,456

2,193

1,071

1,286

1,118

1,231

1,134

1,244

1,204

1,427

1,180

159

267

247

198

183

186

253

166

128

• In 2013, the number of new nonmedical users of OxyContin

aged 12 or older was 436,000,

which was similar to the estimates for prior years from 2004 through 2012. The average age

at first use of OxyContin

among past year initiates aged 12 to 49 was similar in 2012 and

2013 (22.0 and 23.6 years, respectively).

• The number of recent new users of methamphetamine among persons aged 12 or older was

144,000 in 2013 (Figure 5.7), which was similar to the estimates in 2005 and from 2007

through 2012. However, the number of initiates in 2013 was lower than the estimates in 2002

to 2004 and in 2006 (ranging from 259,000 to 318,000). The average age at first use among

new methamphetamine users aged 12 to 49 in 2013 was 18.9 years, which was similar to the

corresponding estimates from 2002 to 2012 (ranging from 17.8 to 22.2 years).

Figure 5.7 Past Year Methamphetamine Initiates

among Persons Aged 12 or Older and Mean

Age at First Use of Methamphetamine

among Past Year Methamphetamine

Initiates Aged 12 to 49: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Mean-age-at-first-use estimates are for past year initiates aged 12 to 49.

Past Year Initiates (Numbers in Thousands)

Mean Age at First Use (Age in Years)

18.9

20.4

20.6

18.6

22.2

19.4

19.3 19.3

17.8

19.7

18.8

299

260

318

192

259

157

155

133 133

107

100

300

200

500

400

2002 2003 2004 2005 2006 2007

Mean Age at First Use

Past Year Initiates

2008 2009 2010 2011

20132012

18.9

144

Alcohol

• In 2013, there were 4.6 million persons aged 12 or older who had used alcohol for the first

time within the past 12 months; this averages to approximately 12,500 initiates per day.

• In 2013, most (83.5 percent) of the 4.6 million recent alcohol initiates were younger than

age 21 at the time of initiation. An estimated 59.1 percent initiated prior to age 18.

• In 2013, the average age at first alcohol use among recent initiates aged 12 to 49 was

17.3 years, which was similar to the 2008, 2010, 2011, and 2012 estimates, but was higher

than the estimates in 2002 to 2007 and in 2009 (ranging from 16.4 to 16.9 years). In 2013,

the mean age at first use among recent initiates aged 12 or older who initiated use prior to the

age of 21 was 16.2 years, which was slightly higher than the 2012 estimate of 16.0 years.

Tobacco

• The number of persons aged 12 or older who smoked cigarettes for the first time within the

past 12 months was approximately 2.1 million in 2013, which was lower than the estimates

for 2006 and from 2008 through 2012 (ranging from 2.3 million to 2.5 million), but was

similar to the estimates from 2002 to 2005 and 2007 (Figure 5.8). The 2013 estimate

averages to about 5,700 new cigarette smokers every day. About half of new cigarette

smokers in 2013 (50.5 percent) initiated prior to age 18.

• The number of cigarette initiates who were younger than age 18 when they first used was

lower in 2013 than in 2002 (1.0 million vs. 1.3 million). However, the number of cigarette

initiates who began smoking at age 18 or older increased from 623,000 in 2002 to 1.0 million

in 2013.

• In 2013, among recent initiates aged 12 to 49, the average age of first cigarette use was

17.8 years, which was the same as the corresponding average age in 2012.

• Of persons aged 12 or older who had not smoked cigarettes prior to the past year (i.e., those

at risk for initiation), the past year initiation rate for cigarettes was 2.0 percent in 2013, which

was lower than the rate in 2012 (2.3 percent).

• Among youths aged 12 to 17 who had not smoked cigarettes prior to the past year (i.e.,

youths at risk for initiation), the first-time cigarette use rate in 2013 was 4.3 percent, which

was lower than the 2012 rate (4.8 percent). However, for each gender subgroup, this

incidence rate was similar in 2012 and 2013 (4.7 and 4.2 percent, respectively, for male

youths; 4.8 and 4.3 percent for female youths) (Figure 5.9). Past year initiation rates in 2013

among males and females aged 12 to 17 who were at risk for initiation of cigarette use were

lower than the rates in 2002 to 2011.

Due to rounding, percentages of past year initiates who initiated prior to age 18 that are calculated from

the estimated numbers in Figure 5.8 may differ from the actual percentages.

Figure 5.8 Past Year Cigarette Initiates among

Persons Aged 12 or Older, by Age at First

Use: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• In 2013, the number of persons aged 12 or older who had started smoking cigarettes daily

within the past 12 months was 813,000 (Figure 5.10). This estimate was similar to the

estimates in 2005, 2008, and from 2010 through 2012 (ranging from 778,000 to 965,000),

but was lower than the estimates from 2002 through 2004 and in 2006, 2007, and 2009

(ranging from 1.0 million to 1.1 million). Of the new daily smokers in 2013, 33.2 percent, or

270,000 persons, were younger than age 18 when they started smoking daily. This number is

equivalent to an average of approximately 700 persons per day under the age of 18 who

started smoking cigarettes on a daily basis.

• In 2013, the average age of first daily cigarette smoking among new daily smokers aged 12

to 49 was similar in 2012 and 2013 (19.9 and 19.8 years, respectively). Among male initiates

of daily cigarette smoking in this age group, the average age at first daily use also was similar

in 2012 and 2013 (19.1 and 19.0 years, respectively). Among female initiates, the 2013

estimate of 21.0 years was the same as the 2012 estimate.

Numbers in Millions

Initiated at Age 18 or Older

1.9

1.3

1.4

1.5

1.3

1.4

1.5

1.4

1.3

1.2

2.0

2.1

2.5

2.4

2.3

2.4

2.5

2.2

2.5

2.3

Initiated Prior to Age 18

0.0

0.5

1.0

1.5

2.0

2.5

2002 2003 2004 2005 2006 2007 2008 2009 2010 20122011 2013

1.0

2.1

Figure 5.9 Past Year Cigarette Initiation among

Youths Aged 12 to 17 Who Had Never

Smoked Prior to the Past Year, by Gender:

2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• In 2013, there were 2.8 million persons aged 12 or older who had used cigars for the first

time in the past 12 months, which was similar to the 2012 estimate (2.7 million)

(Figure 5.10). However, the 2013 estimate was lower than the estimate in 2005 (3.3 million)

and in 2009 (3.1 million). Among past year cigar initiates aged 12 to 49, the average age at

first use was 21.6 years in 2013, which was similar to the estimate in 2012 (20.5 years).

• The number of persons aged 12 or older initiating use of smokeless tobacco in the past year

was 1.1 million in 2013, which was similar to the estimates in 2011 and 2012 (Figure 5.10).

The number of smokeless tobacco initiates in 2013 was higher than the estimates in 2002 and

2003, but was lower than the estimates from 2006 through 2010 (ranging from 1.3 million to

1.5 million). In 2013, about three quarters (73.8 percent) of new initiates were male, and over

two fifths (47.9 percent) were younger than age 18. In 2013, the average age at first

smokeless tobacco use among recent initiates aged 12 to 49 was 18.4 years, which was

similar to the estimate in 2012.

Male

Female

Percent Initiating in Past Year

6.1

5.8

6.0

6.3

5.7

+ 5.8

7.4

7.5

7.8

7.1

6.9

6.0

6.8

6.3

5.5

6.2

5.4

4.8

4.7

6.0

5.7

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

2013

2012

4.3

4.2

Figure 5.10 Past Year Specific Tobacco Product

Initiates among Persons Aged 12 or Older:

2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Numbers in Thousands

2,858

1,983

951

928

999

965

1,049

983

945

1,136

878

1,016

1,064

1,101

1,134

1,335

1,299

1,413

1,468

1,297

2,122

2,282

2,456

2,231

2,453

2,545

2,394

1,940

2,736

3,058

3,349

3,061

3,078

2,918

3,146

2,800

778

997

2,336

2,664

962

1,425

2,403

2,950

500

1,000

1,500

2,000

2,500

3,000

3,500

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013

Cigars Cigarettes Smokeless Tobacco Daily Cigarette Use

2012

813

2,071

2,770

1,116

6. Youth Prevention-Related Measures

Research has shown that substance use by adolescents can often be prevented through

interventions involving risk and protective factors associated with the onset or escalation of use

(Catalano, Hawkins, Berglund, Pollard, & Arthur, 2002). Risk and protective factors include

variables that operate at different stages of development and reflect different domains of

influence, including the individual, family, peer, school, community, and societal levels

(Hawkins, Catalano, & Miller, 1992; Robertson, David, & Rao, 2003). Interventions to prevent

substance use generally are designed to ameliorate the influence of risk factors and enhance the

effectiveness of protective factors.

The National Survey on Drug Use and Health (NSDUH) includes questions for youths

aged 12 to 17 to measure the risk and protective factors that may affect the likelihood that they

will engage in substance use. This chapter presents findings on youth prevention-related

measures. Where applicable, findings from 2013 are compared with estimates from prior years

since 2002. Included in this chapter are measures of the perceived risk of substance use

(cigarettes, alcohol, and specific illicit drugs), perceived availability of substances (including

being approached by someone selling drugs), perceived parental disapproval of youth substance

use, attitudes about peer substance use, involvement in fighting and delinquent behavior,

religious involvement and beliefs, exposure to substance use prevention messages and programs,

and parental involvement. Also presented are findings on the associations between selected

measures of risk and protective factors and substance use from NSDUH. However, the cross-

sectional nature of these data precludes making any causal connections between these risk and

protective factors and substance use.

Perceived Risk of Substance Use

One factor that can influence whether youths will use tobacco, alcohol, or illicit drugs is

the extent to which they believe these substances might cause them harm. NSDUH respondents

were asked how much they thought people risk harming themselves physically and in other ways

when they use various substances in certain amounts or frequencies. Response choices for these

items were "great risk," "moderate risk," "slight risk," or "no risk."

• In 2013, 64.3 percent of youths aged 12 to 17 perceived great risk in smoking one or more

packs of cigarettes per day, 62.5 percent perceived great risk in having four or five drinks of

an alcoholic beverage nearly every day, and 39.0 percent perceived great risk in having five

or more drinks once or twice a week. For marijuana, 39.5 percent of youths perceived great

risk in smoking marijuana once or twice a week, and 24.2 percent perceived great risk in

smoking marijuana once a month. The percentages of youths who perceived great risk in

using other drugs once or twice a week were 79.8 percent for heroin, 78.4 percent for

cocaine, and 69.7 percent for LSD.

• The percentages of youths reporting binge alcohol use and the use of cigarettes and

marijuana in the past month were lower among those who perceived great risk in using these

substances than among those who did not perceive great risk. For instance, in 2013, past

month binge drinking (consumption of five or more drinks of an alcoholic beverage on a

single occasion on at least 1 day in the past 30 days) was reported by 3.5 percent of youths

aged 12 to 17 who perceived great risk from "having five or more drinks of an alcoholic

beverage once or twice a week," which was lower than the rate (8.1 percent) for youths who

saw moderate, slight, or no risk from having five or more drinks of an alcoholic beverage

once or twice a week (Figure 6.1). Past month marijuana use was reported by 0.6 percent of

youths who saw great risk in smoking marijuana once a month compared with 9.3 percent of

youths who saw moderate, slight, or no risk.

Figure 6.1 Past Month Binge Drinking and Marijuana

Use among Youths Aged 12 to 17, by

Perceptions of Risk: 2013

Risk of Having Five or More Drinks

Once or Twice a Week

Percent Using in Past Month

3.5

8.1

0.6

9.3

Perceive ʺGreat Riskʺ

Perceive ʺModerate,ʺ

ʺSlight,ʺ or ʺNo Riskʺ

Risk of Smoking Marijuana

Once a Month

Past Month Binge Drinking Past Month Marijuana Use

• Trends in substance use often coincide with trends in perceived risk. Increases in perceived

risk typically precede or occur simultaneously with decreases in use, and vice versa. For

example, the percentage of youths aged 12 to 17 indicating great risk in smoking marijuana

once a month decreased from 34.4 percent in 2007 to 24.2 percent in 2013 (Figure 6.2).

The rate of youths perceiving great risk in smoking marijuana once or twice a week also

decreased from 54.6 percent in 2007 to 39.5 percent in 2013. Consistent with these

decreasing trends in the perceived risk of marijuana use, the prevalence of past month

marijuana use among youths increased between 2007 (6.7 percent) and 2011 (7.9 percent).

Despite the perceived risk of marijuana use among youths continuing to decline between

2011 and 2013, however, the rate of past month marijuana use declined between 2011 and

2013 (7.1 percent). The rate of past month marijuana use among youths in 2013 was similar

to that in 2007.

• The proportion of youths aged 12 to 17 who reported perceiving great risk from smoking one

or more packs of cigarettes per day increased from 63.1 percent in 2002 to 69.5 percent in

2008 (Figure 6.3). This rate declined between 2009 (65.5 percent) and 2013 (64.3 percent).

Consequently, the 2013 rate was similar to the 2002 rate. Although rates of use often increase

as perceptions of risk decrease, the rate of past month adolescent cigarette use decreased

from 9.0 percent in 2009 to 5.6 percent in 2013. Also, the rate of past month cigarette use

among youths in 2013 was lower than that in 2002 (13.0 percent), despite similar percentages

of youths perceiving great risk from smoking one or more packs of cigarettes in both of these

years.

Figure 6.2 Perceived Great Risk of Marijuana Use

among Youths Aged 12 to 17: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Smoke Marijuana Once or Twice a Week

Smoke Marijuana Once a Month

Percent Perceiving Great Risk

32.4

34.9

35.0

34.0

34.6

34.4

33.4

30.3

27.6

51.5

54.4

54.7

55.0

54.2

54.6

52.8

49.0

44.8

26.5

43.6

29.6

47.2

20032002

2004 2005 2006 2007 2008 2009 2010 2011

2013

2012

24.2

39.5

Figure 6.3 Perceived Great Risk of Cigarette and

Alcohol Use among Youths Aged 12 to 17:

2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• The percentage of youths aged 12 to 17 indicating great risk in having four or five drinks of

an alcoholic beverage nearly every day increased from 62.2 percent in 2002 to 65.6 percent

in 2008 (Figure 6.3). This rate declined between 2009 (64.1 percent) and 2013 (62.5 percent),

such that the 2013 rate was similar to the 2002 rate. The percentage of youths perceiving

great risk in having five or more drinks of an alcoholic beverage once or twice a week

increased from 38.2 percent in 2002 to 40.7 percent in 2011. This rate declined between 2011

and 2013 (39.0 percent). Consistent with the increases in perceived risk of alcohol use among

youths aged 12 to 17 between 2002 and 2008, there were decreases during this period in the

rate of binge alcohol use (from 10.7 to 8.9 percent) and heavy alcohol use (from 2.5 to

2.0 percent). Although perceived risk of alcohol use peaked in 2008 for both measures of

perceived risk, the rate of adolescent alcohol use continued to decline between 2008 and

2013 for both binge alcohol use (to 6.2 percent in 2013) and heavy alcohol use (to

1.2 percent in 2013).

Percent Perceiving Great Risk

Smoke One or More Packs of Cigarettes per Day

Have Four or Five Drinks Nearly Every Day

Have Five or More Drinks Once or Twice a Week

38.2

38.5

38.1

38.4

39.3 39.3

40.0

39.6

40.7

62.2

61.6

61.8

63.8

64.5

65.1

65.6

64.1

64.8

63.1

64.2

67.5

68.3

68.7

68.8

69.5

65.5

66.2

39.7

63.9

65.7

40.4

64.7

65.3

20032002 2004 2005 2006 2007 2008 2009 2010 2011

20132012

39.0

62.5

64.3

• Between 2002 and 2013, the percentage of youths aged 12 to 17 perceiving great risk from

using an illicit drug once or twice a week declined for the following substances: heroin (from

82.5 to 79.8 percent), cocaine (from 79.8 to 78.4 percent), LSD (from 76.2 to 69.7 percent),

and marijuana (from 51.5 to 39.5 percent) (Figure 6.4). The rates remained unchanged

between 2011 and 2013 for heroin, cocaine, and LSD. For marijuana, the rate in 2013 was

lower than the rate in 2011 (44.8 percent). Youths were less likely to perceive great risk for

smoking marijuana once or twice a week than for corresponding use of the other listed illicit

drugs.

Figure 6.4 Perceived Great Risk of Use of Selected

Illicit Drugs Once or Twice a Week among

Youths Aged 12 to 17: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Perceived Availability

• In 2013, about half (48.6 percent) of youths aged 12 to 17 reported that it would be "fairly

easy" or "very easy" for them to obtain marijuana if they wanted some (Figure 6.5). About

1 in 11 (9.1 percent) indicated that heroin would be fairly or very easily available, and

11.3 percent reported so for LSD. Between 2002 and 2013, there were decreases in the

perceived easy availability of marijuana (from 55.0 to 48.6 percent), cocaine (from 25.0 to

14.4 percent), crack (from 26.5 to 14.9 percent), LSD (from 19.4 to 11.3 percent), and heroin

(from 15.8 to 9.1 percent). There was no change between 2012 and 2013 in the perceived

easy availability for marijuana, heroin, or LSD. However, the percentage of youths who

perceived that cocaine would be fairly easy or very easy to obtain was lower in 2013 than in

2012 (16.0 percent).

Percent Perceiving Great Risk

Use Heroin Once or Twice a Week

Use Cocaine Once or Twice a Week

Use LSD Once or Twice a Week

Use Marijuana Once or Twice a Week

82.5

82.6

81.4

81.8

81.2

81.0

81.3

80.9

79.7

51.5

76.2

79.8

80.7

79.8

79.9

79.2

78.9

79.1

78.4

78.1

76.9

76.4

76.1

74.7

74.1

73.8

71.7

70.4

54.4

54.7

55.0

54.2

54.6

52.8

49.0

44.8

80.0

78.9

70.6

43.6

80.4

78.3

71.3

47.2

20032002

2004 2005 2006 2007 2008 2009 2010 2011

20132012

79.8

69.7

39.5

78.4

Figure 6.5 Perceived Availability of Selected Illicit

Drugs among Youths Aged 12 to 17: 2002-

2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• Youths aged 12 to 17 in 2013 who perceived that it was easy to obtain specific illicit drugs

were more likely to be past month users of those illicit drugs than were youths who perceived

that obtaining specific illicit drugs would be fairly difficult, very difficult, or probably

impossible. For example, 15.8 percent of youths who reported that marijuana would be easy

to obtain were past month illicit drug users, but only 2.7 percent of those who thought

marijuana would be more difficult to obtain were past month users. Similarly, 13.9 percent of

youths who reported that marijuana would be easy to obtain were past month marijuana

users, but only 1.1 percent of those who thought marijuana would be more difficult to obtain

were past month users.

• The percentage of youths who reported that marijuana, cocaine, crack, heroin, and LSD

would be easy to obtain generally increased with age in 2013. For instance, 20.5 percent of

youths aged 12 or 13 reported it would be fairly or very easy to obtain marijuana compared

with 51.2 percent of those aged 14 or 15 and 71.5 percent of those aged 16 or 17. However,

the differences in perceived availability between youths aged 14 or 15 and those aged 16 or

17 were not significant for crack and heroin.

• In 2013, about one in eight youths aged 12 to 17 (12.4 percent) indicated that they had been

approached by someone selling drugs in the past month. This rate declined between 2002

(16.7 percent) and 2013, although the 2013 rate was similar to the 2012 rate (13.2 percent).

Percent Indicating Fairly or

Very Easy to Obtain

Marijuana LSDCocaine

Heroin

55.0

53.6

52.2

51.0

50.1

49.2

49.4

50.0

47.7

25.0

24.4

24.9

25.9

24.5

22.1

20.9

17.5

Heroin

LSD

19.4

17.6

16.9

15.7

14.0

14.4

13.7

13.4

12.2

15.8

15.3

14.0

14.4

14.2

12.9

12.8

10.7

47.8

16.0

11.5

9.9

48.9

19.1

13.0

11.6

20032002 2004 2005 2006 2007 2008 2009 2010 2011 2013

2012

48.6

14.4

11.3

9.1

Perceived Parental Disapproval of Substance Use

• Most youths aged 12 to 17 believed their parents would "strongly disapprove" of them using

substances. In 2013, 88.4 percent of youths reported that their parents would strongly

disapprove of them trying marijuana or hashish once or twice, which was lower than the rates

in 2012 (89.3 percent) and 2002 (89.1 percent). Most youths in 2013 (90.7 percent) reported

that their parents would strongly disapprove of them having one or two drinks of an alcoholic

beverage nearly every day, which was similar to the rate in 2012 (90.5 percent), but was

higher than the rate in 2002 (89.0 percent). In 2013, 93.5 percent of youths reported that their

parents would strongly disapprove of them smoking one or more packs of cigarettes per day,

which was similar to the rate reported in 2012 (93.1 percent), but was higher than the

89.5 percent reported in 2002.

• Youths aged 12 to 17 who believed their parents would strongly disapprove of them using

specific substances were less likely to use these substances than were youths who believed

their parents would somewhat disapprove or neither approve nor disapprove. For instance,

in 2013, past month cigarette use was reported by 4.0 percent of youths who perceived strong

parental disapproval if they were to smoke one or more packs of cigarettes per day compared

with 27.8 percent of youths who believed their parents would not strongly disapprove. Also,

past month marijuana use was much less prevalent among youths who perceived strong

parental disapproval for trying marijuana or hashish once or twice than among those who did

not perceive this level of disapproval (4.1 vs. 29.3 percent, respectively).

Attitudes toward Peer Substance Use

• A majority of youths aged 12 to 17 reported that they disapproved of their peers using

substances. In 2013, 91.4 percent of youths "strongly" or "somewhat" disapproved of their

peers smoking one or more packs of cigarettes per day, which was also the rate in 2012, but

was higher than the 87.1 percent in 2002. Also in 2013, 79.2 percent strongly or somewhat

disapproved of peers using marijuana or hashish once a month or more, which was lower

than the rates reported in 2012 (80.3 percent) and in 2002 (80.4 percent). In addition,

88.7 percent of youths strongly or somewhat disapproved of peers having one or two drinks

of an alcoholic beverage nearly every day in 2013, which was also the rate in 2012, but was

higher than the 84.7 percent reported in 2002.

• The percentage of youths who reported that they disapproved of their peers using substances

decreased with age in 2013. For instance, 92.4 percent of those aged 12 or 13 reported that

they strongly or somewhat disapproved of peers using marijuana once a month or more

compared with 80.6 percent of those aged 14 or 15 and 65.6 percent of those aged 16 or 17.

• In 2013, youths aged 12 to 17 who strongly or somewhat disapproved of their peers using

marijuana once a month or more were less likely to be past month marijuana users than those

who neither approved nor disapproved of this behavior from their peers (2.0 vs.

26.2 percent).

Fighting and Delinquent Behavior

• NSDUH includes questions for youths aged 12 to 17 about the number of times they had

engaged in fighting or other delinquent behavior in the 12 months prior to the interview.

In 2013, 17.7 percent of youths aged 12 to 17 reported that they had gotten into a serious

fight at school or at work in the past year; 11.0 percent had taken part in a group-against-

group fight; 5.1 percent attacked others in at least one instance with the intent to harm or

seriously hurt them; 3.4 percent had carried a handgun at least once; 2.8 percent had, at least

once, stolen or tried to steal something worth more than $50; and 2.4 percent sold illegal

drugs in the past year. The 2013 rates for taking part in a group-against-group fight and for

stealing or trying to steal something worth more than $50 among youths aged 12 to 17 were

lower than the 2012 rates.

• Rates of the following behaviors in the past year among youths aged 12 to 17 were lower in

2013 than in 2002: getting into a serious fight at school or work (17.7 vs. 20.6 percent);

taking part in a group-against-group fight (11.0 vs. 15.9 percent); attacking others with the

intent to harm or seriously hurt them (5.1 vs. 7.8 percent); stealing or trying to steal

something worth more than $50 (2.8 vs. 4.9 percent); and selling illegal drugs (2.4 vs.

4.4 percent). Percentages of youths who had carried a handgun in the past year were similar

in 2013 and 2002 (3.4 and 3.3 percent).

• Youths aged 12 to 17 who had engaged in fighting or other delinquent behaviors were more

likely than other youths to have used illicit drugs in the past month. In 2013, past month

illicit drug use was reported by 17.0 percent of youths who had gotten into a serious fight at

school or work in the past year compared with 7.1 percent of those who had not engaged in

fighting at school or work. An estimated 34.6 percent of youths who had stolen or tried to

steal something worth over $50 in the past year used illicit drugs in the past month compared

with 8.0 percent of those who had not attempted or had engaged in such theft.

Religious Involvement and Beliefs

• In 2013, 29.8 percent of youths aged 12 to 17 reported that they had attended religious

services 25 or more times in the past year; 73.3 percent agreed or strongly agreed with the

statement that religious beliefs are a very important part of their lives; and 66.2 percent

agreed or strongly agreed with the statement that religious beliefs influence their decision

making in life. These rates were lower than the corresponding rates in 2002, but were similar

to corresponding rates in 2012. In 2013, 32.0 percent of youths agreed or strongly agreed

with the statement that it is important for their friends to share their religious beliefs, which

was lower than the 2002 rate (35.8 percent) and the 2012 rate (33.7 percent).

• The rates of past month use of illicit drugs and cigarettes and binge alcohol use were lower

among youths aged 12 to 17 who agreed with statements about the importance of religious

beliefs than among those who disagreed. In 2013, past month illicit drug use was reported by

6.6 percent of those who agreed or strongly agreed that religious beliefs are a very important

part of their lives compared with 14.9 percent of those who disagreed with that statement.

Similar differences were found between those two subgroups for the past month use of

cigarettes (4.1 vs. 9.8 percent) and past month binge alcohol use (4.8 vs. 10.3 percent).

Exposure to Substance Use Prevention Messages and Programs

• In 2013, approximately one in nine youths aged 12 to 17 (11.5 percent) reported that they had

participated in drug, tobacco, or alcohol prevention programs outside of school in the past

year. This rate was similar to the 11.9 percent reported in 2012, but was lower than the rate

reported in 2002 (12.7 percent). In 2013, youths who did or did not participate in these

programs had similar rates of past month use for illicit drugs (8.9 and 8.7 percent), marijuana

(7.0 percent for both groups), cigarettes (6.5 and 5.4 percent), and binge alcohol use (5.2 and

6.3 percent).

• In 2013, 72.6 percent of youths aged 12 to 17 reported having seen or heard drug or alcohol

prevention messages in the past year from sources outside of school, such as from posters or

pamphlets, on the radio, or on television (Figure 6.6). This rate in 2013 was lower than the

75.9 percent reported in 2012 and the 83.2 percent reported in 2002. In 2013, the prevalence

of past month use of illicit drugs among those who reported having such exposure

(8.4 percent) was lower than the prevalence among those who reported having no such

exposure (10.0 percent).

Figure 6.6 Exposure to Substance Use Prevention

Messages and Programs among Youths

Aged 12 to 17: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Estimates are from youths aged 12 to 17 who were enrolled in school in the past year. Youths who were enrolled in

school in the past year included those who were home schooled.

Seen or Heard Drug or Alcohol Prevention

Messages from Sources Outside of School

Seen or Heard Drug or Alcohol Prevention

Messages at School

Percent Seeing or Hearing

Messages in Past Year

83.2

83.6

83.0

81.1

79.3

77.8

77.9

76.9

75.1

78.8

78.1

78.2

77.9

76.9

75.8

76.1

75.2

74.6

75.9

75.0

75.9

75.7

20032002

100

2004 2005 2006 2007 2008 2009 2010 2011 20132012

73.5

72.6

• In 2013, 73.5 percent of youths aged 12 to 17 who were enrolled in school in the past year

reported having seen or heard drug or alcohol prevention messages at school, which was

lower than the 75.0 percent reported in 2012 and the 78.8 percent reported in 2002

(Figure 6.6). In 2013, the prevalence of past month use of illicit drugs or marijuana was

lower among those who reported having such exposure in school (8.4 and 6.7 percent for

illicit drugs and marijuana, respectively) than among youths who were enrolled in school but

reported having no such exposure (10.2 and 8.7 percent).

Parental Involvement

• Youths aged 12 to 17 were asked several questions related to the extent of support, oversight,

and control that they perceived their parents provided or exercised over them in the year prior

to the survey interview. In 2013, among youths aged 12 to 17 who were enrolled in school in

the past year, 68.4 percent reported that their parents limited the amount of time that they

spent out with friends on school nights. This rate in 2013 was lower than the rate reported in

2012 (70.3 percent) and in 2002 (70.7 percent). In 2013, 83.0 percent reported that in the past

year their parents always or sometimes checked on whether or not they had completed their

homework, and 79.4 percent reported that their parents always or sometimes provided help

with their homework. The rate in 2013 for parents checking on whether youths had

completed their homework was higher than in 2012 (81.3 percent) and in 2002

(78.4 percent). However, the rate for parents providing help with homework in 2013 was

lower than the rate in 2012 (80.6 percent) and the rate in 2002 (81.4 percent).

• In 2013, 88.5 percent of youths aged 12 to 17 reported that their parents always or sometimes

made them do chores around the house in the past year, which was also the rate in 2012, but

was slightly higher than the rate in 2002 (87.4 percent). In 2013, 85.7 percent of youths

reported that their parents always or sometimes let them know that they had done a good job,

and 85.7 percent reported that their parents always or sometimes let them know they were

proud of something they had done. These percentages in 2013 were similar to those reported

in 2012 and 2002. In 2013, 40.8 percent of youths reported that their parents limited the

amount of time that they watched television, which was similar to the rate in 2012

(41.0 percent), but was higher than the 36.9 percent reported in 2002.

• In 2013, past month use of illicit drugs and cigarettes and binge alcohol use were lower

among youths aged 12 to 17 who reported that their parents always or sometimes engaged in

supportive or monitoring behaviors than among youths whose parents seldom or never

engaged in such behaviors. For instance, the rate of past month use of any illicit drug in 2013

was 7.3 percent for youths whose parents always or sometimes helped with homework

compared with 14.7 percent among youths who indicated that their parents seldom or never

helped. Rates of current cigarette smoking and past month binge alcohol use also were lower

among youths whose parents always or sometimes helped with homework (4.5 and

5.1 percent, respectively) than among youths whose parents seldom or never helped

(10.3 and 11.4 percent).

7. Substance Dependence, Abuse, and

Treatment

The National Survey on Drug Use and Health (NSDUH) includes a series of questions to

assess the prevalence of substance use disorders (substance dependence or abuse) in the past

12 months. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin,

hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutic drugs.

These questions are used to classify persons as dependent on or abusing specific substances

based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders,

4th edition (DSM-IV) (American Psychiatric Association [APA], 1994).

The questions related to dependence ask about health and emotional problems associated

with substance use, unsuccessful attempts to cut down on use, tolerance, withdrawal, reducing

other activities to use substances, spending a lot of time engaging in activities related to

substance use, or using the substance in greater quantities or for a longer time than intended.

The questions on abuse ask about problems at work, home, and school; problems with family or

friends; physical danger; and trouble with the law due to substance use. Dependence is

considered to be a more severe substance use problem than abuse because it involves the

psychological and physiological effects of tolerance and withdrawal.

This chapter provides estimates from the 2013 NSDUH of the prevalence and patterns of

substance use disorders occurring in the past year and compares these estimates against the

results from the 2002 through 2012 surveys. It also provides estimates of the prevalence and

patterns of the receipt of treatment in the past year for problems related to substance use.

This chapter concludes with a discussion of the need for and the receipt of treatment at specialty

facilities for problems associated with substance use. Note that the terms "substance use

disorders," "substance dependence or abuse," and "alcohol or illicit drug dependence or abuse"

are used interchangeably.

7.1 Substance Dependence or Abuse

• In 2013, an estimated 21.6 million persons aged 12 or older were classified with substance

dependence or abuse in the past year (8.2 percent of the population aged 12 or older)

(Figure 7.1). Of these, 2.6 million were classified with dependence or abuse of both alcohol

and illicit drugs, 4.3 million had dependence or abuse of illicit drugs but not alcohol, and

14.7 million had dependence or abuse of alcohol but not illicit drugs. Overall, 17.3 million

had alcohol dependence or abuse, and 6.9 million had illicit drug dependence or abuse.

• The annual number of persons with substance dependence or abuse in 2013 (21.6 million)

was similar to the number in each year from 2002 through 2012 (ranging from 20.6 million

to 22.7 million) (Figure 7.1).

Figure 7.1 Substance Dependence or Abuse in the

Past Year among Persons Aged 12 or

Older: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Note: Due to rounding, the stacked bar totals may not add to the overall total.

• The rate of persons aged 12 or older who had substance dependence or abuse in 2013

(8.2 percent) was similar to the rates in 2011 (8.0 percent) and 2012 (8.5 percent), but it was

lower than the rate in each year from 2002 through 2010 (ranging from 8.8 to 9.4 percent).

• In 2013, 6.6 percent of the population aged 12 or older had alcohol dependence or abuse,

which was similar to the rates in 2011 (6.5 percent) and 2012 (6.8 percent), but it was lower

than the rate in each year from 2002 through 2010 (ranging from 7.1 to 7.8 percent).

• The rate of persons aged 12 or older who had illicit drug dependence or abuse in 2013

(2.6 percent) was similar to the rate in 2012 (2.8 percent) and in each year since 2005

(ranging from 2.5 to 2.9 percent), but it was lower than the rates in 2002 to 2004 (ranging

from 2.9 to 3.0 percent).

Numbers in Millions

2002 2003 2004 2005 2006 2008 2009 2010 2011 2013

Illicit Drugs Only

Both Alcohol and Illicit Drugs Alcohol Only

22.0

3.2

3.1

3.4

3.3

3.2

3.1

3.2

2.9

2.6

3.9

3.8

3.9

3.6

+ 3.8

3.7

3.9

4.3

3.9

4.3

14.9 14.8

15.2

15.4

15.6

15.5 15.4 15.5

15.1

14.1

14.7

2007

21.6

22.5

22.4

22.2

22.7

22.4

22.6

20.6

22.2

21.6

2012

2.8

4.5

14.9

22.2

• Marijuana was the illicit drug with the largest number of persons with past year dependence

or abuse in 2013, followed by pain relievers, then by cocaine. Of the 6.9 million persons aged

12 or older who were classified with illicit drug dependence or abuse in 2013, 4.2 million

persons had marijuana dependence or abuse (representing 1.6 percent of the total population

aged 12 or older, and 61.4 percent of all those classified with illicit drug dependence or

abuse), 1.9 million persons had pain reliever dependence or abuse, and 855,000 persons had

cocaine dependence or abuse (Figure 7.2).

Figure 7.2 Specific Illicit Drug Dependence or Abuse

in the Past Year among Persons Aged 12 or

Older: 2013

• The number of persons who had marijuana dependence or abuse in 2013 (4.2 million) was

similar to the number in 2012 (4.3 million) and in each year from 2002 through 2011

(ranging from 3.9 million to 4.5 million) (Figure 7.3). The rate of marijuana dependence or

abuse in 2013 (1.6 percent) was lower than the rates in 2002 (1.8 percent) and 2004

(1.9 percent). Otherwise, the rate in 2013 was similar to the rates in prior years (ranging from

1.6 to 1.8 percent).

• The number of persons who had pain reliever dependence or abuse in 2013 (1.9 million) was

similar to the number in 2012 (2.1 million) and in each year from 2006 through 2011

(ranging from 1.6 million to 1.9 million) (Figure 7.3). However, the number in 2013 was

higher than the numbers in 2002 to 2005 (ranging from 1.4 million to 1.5 million).

Numbers in Thousands

132

277

423

469

517

0 1,000 2,000 3,000 4,000 5,000

855

1,879

4,206

Marijuana

Pain Relievers

Cocaine

Tranquilizers

Heroin

Hallucinogens

Stimulants

Inhalants

Sedatives

Figure 7.3 Illicit Drug Dependence or Abuse in the

Past Year among Persons Aged 12 or

Older: 2002-2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

• The rate of pain reliever dependence or abuse in 2013 (0.7 percent) was higher than the rate

in 2004 (0.6 percent). However, the rate in 2013 was similar to the rates in 2012

(0.8 percent), 2002, 2003, and from 2005 through 2011 (ranging from 0.6 to 0.8 percent).

• The rate and the number of persons who had cocaine dependence or abuse in 2013

(0.3 percent and 855,000) were similar to those in 2010 to 2012 (ranging from 0.3 to

0.4 percent and from 821,000 to 1.1 million). However, the rate and the number in 2013 were

lower than those in 2002 to 2009 (ranging from 0.4 to 0.7 percent and from 1.1 million to

1.7 million).

• The number of persons who had heroin dependence or abuse in 2013 (517,000) was similar

to the numbers in 2009 to 2012 (ranging from 361,000 to 467,000), but it was higher than the

numbers in 2002 to 2008 (ranging from 189,000 to 324,000). The rate of persons who had

heroin dependence or abuse in 2013 (0.2 percent) was similar to the rate in 2006 and in 2009

to 2012 (ranging from 0.1 to 0.2 percent), but it was higher than the rate of 0.1 percent in

2002 through 2005, 2007, and 2008.

Numbers in Millions

Illicit Drugs

Marijuana

Cocaine

Pain Relievers

Cocaine

Pain

Relievers

7.1

6.8

7.3

6.8

7.0

6.9

7.0

7.1

6.5

1.5

1.6

1.5

1.7

1.6

1.4

1.1

0.8

1.5

1.4

1.5

1.6

1.7

1.9

1.8

4.3

4.2

4.5

4.1

4.2

3.9

4.2

4.3

4.2

6.9

0.9

1.9

4.2

7.1

1.0

1.9

4.5

20032002

2004 2005 2006 2007 2008 2009 2010 2011

20132012

7.3

1.1

2.1

4.3

Age at First Use

• In 2013, among adults aged 18 or older, age at first use of marijuana was associated with

illicit drug dependence or abuse. Among those who first tried marijuana at age 14 or

younger, 11.5 percent were classified with illicit drug dependence or abuse, which was

higher than the 2.6 percent of adults who had first used marijuana at age 18 or older.

• Among adults, age at first use of alcohol was associated with alcohol dependence or abuse.

In 2013, among adults aged 18 or older who first tried alcohol at age 14 or younger,

15.4 percent were classified with alcohol dependence or abuse, which was higher than the

3.8 percent of adults who had first used alcohol at age 18 or older.

• Adults aged 21 or older who had first used alcohol before age 21 were more likely than

adults who had their first drink at age 21 or older to be classified with alcohol dependence or

abuse. In particular, adults aged 21 or older who had first used alcohol at age 14 or younger

were more likely to be classified with alcohol dependence or abuse than adults who had their

first drink at age 21 or older (14.8 vs. 2.3 percent) (Figure 7.4).

Figure 7.4 Alcohol Dependence or Abuse in the Past

Year among Adults Aged 21 or Older, by

Age at First Use of Alcohol: 2013

Percent Dependent or Abusing

in Past Year

Alcohol Abuse

Alcohol Dependence

14.8

7.5

8.9

3.9

2.3

1.2

4.8

2.2

15 to 1714 or Younger 18 to 20 21 or Older

Age at First Use of Alcohol

Age

• Rates of substance dependence or abuse were associated with age. In 2013, the rate of

substance dependence or abuse among adults aged 18 to 25 (17.3 percent) was higher than

that among adults aged 26 or older (7.0 percent), followed by youths aged 12 to 17

(5.2 percent). From 2002 to 2013, the rate decreased for youths aged 12 to 17 (from 8.9 to

5.2 percent) (Figure 7.5) and for young adults aged 18 to 25 (from 21.7 to 17.3 percent).

• The rate of alcohol dependence or abuse among youths aged 12 to 17 was 2.8 percent in

2013, which was lower than the rates of 3.4 percent in 2012 and 5.9 percent in 2002

(Figure 7.5). Among young adults aged 18 to 25, the rate of alcohol dependence or abuse was

13.0 percent in 2013, which also was lower than the rates of 14.3 percent in 2012 and

17.7 percent in 2002. Among adults aged 26 or older, the rates were not significantly

different between 2012 (5.9 percent) and 2013 (6.0 percent) and between 2002 (6.2 percent)

and 2013.

Figure 7.5 Alcohol and Illicit Drug Dependence or

Abuse among Youths Aged 12 to 17: 2002-

2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

2002 2003 2004 2005 2006 2007 2008 2011 201320102009

Percent Dependent or Abusing

in Past Year

Alcohol or Illicit Drugs

Alcohol

Illicit Drugs

5.6

5.1

5.3

4.7

4.6

4.3

4.6

4.3

3.8

5.9

6.0

5.5

5.4

4.9

4.6

8.9

8.8

8.0

8.1

7.7

7.1

6.9

2.8

3.5

5.2

4.6

4.7

7.3

2012

3.4

4.0

6.1

• The rate of illicit drug dependence or abuse among youths aged 12 to 17 was 3.5 percent in

2013, which was lower than the rates in 2012 (4.0 percent), 2011 (4.6 percent), 2010

(4.7 percent), and 2002 (5.6 percent) (Figure 7.5). Among young adults aged 18 to 25, the

rate of illicit drug dependence or abuse was 7.4 percent in 2013, which was similar to the

rates in 2012 (7.8 percent), 2011 (7.5 percent), and 2010 (7.9 percent). Among adults aged 26

or older, the rate of illicit drug dependence or abuse remained stable between 2012

(1.8 percent) and 2013 (1.7 percent) and between 2002 (1.8 percent) and 2013.

Gender

• As was the case from 2002 through 2012, the rate of substance dependence or abuse for

males aged 12 or older in 2013 was greater than the rate for females (10.8 vs. 5.8 percent)

(Figure 7.6). Among youths aged 12 to 17, however, the rate of substance dependence or

abuse among males in 2013 (5.3 percent) was similar to the rate among their female

counterparts (5.2 percent).

Figure 7.6 Substance Dependence or Abuse in the

Past Year, by Age and Gender: 2013

Percent Dependent or Abusing

in Past Year

10.8

5.8

5.3

5.2

11.4

5.8

Male

Female

Aged 12 to 17 Aged 18 or OlderAged 12 or Older

Race/Ethnicity

• In 2013, among persons aged 12 or older, the rate of substance dependence or abuse was

4.6 percent among Asians, 7.4 percent among blacks, 8.4 percent among whites, 8.6 percent

among Hispanics, 10.9 percent among persons reporting two or more races, 11.3 percent

among Native Hawaiians or Other Pacific Islanders, and 14.9 percent among American

Indians or Alaska Natives. Except for Native Hawaiians or Other Pacific Islanders, the rate

for Asians was lower than the rates for the other racial/ethnic groups.

Education

• In 2013, rates of illicit drug or alcohol dependence or abuse among adults aged 26 or older

were not associated with levels of educational attainment.

Among this group, rates of illicit

drug or alcohol dependence or abuse were 6.4 percent for those who graduated from high

school but had no further education, 7.2 percent for college graduates, 7.3 percent for those

who did not graduate from high school, and 7.4 percent for those with some college

education but no degree.

• Among adults aged 26 or older in 2013, rates of alcohol dependence or abuse also were not

associated with levels of educational attainment. Rates of alcohol dependence or abuse for

this age group were 5.4 percent for those who graduated from high school but had no further

education, 5.7 percent for those who did not graduate from high school, 5.9 percent for those

with some college education but no degree, and 6.6 percent for college graduates.

• However, rates of illicit drug dependence or abuse were associated with levels of educational

attainment among adults aged 26 or older in 2013. Adults aged 26 or older who were college

graduates had a lower rate of illicit drug dependence or abuse (0.9 percent) than those who

did not graduate from high school (2.5 percent), those with some college education but no

degree (2.1 percent), and those who graduated from high school but had no further education

(1.9 percent).

Employment

• Rates of substance dependence or abuse were associated with current employment status in

2013. A higher percentage of unemployed adults aged 18 or older were classified with

dependence or abuse (15.2 percent) than were full-time employed adults (9.5 percent) or

part-time employed adults (9.3 percent).

Unlike other sections that present estimates among adults aged 18 or older, this section focuses on the

associations between educational attainment and substance use disorders among adults aged 26 or older. Age is

associated with both educational attainment and substance use disorders among adults aged 18 to 25. Many 18 year

olds are still in high school. Many 18 to 22 year olds have some college education but have not yet received a

college degree. College graduates generally are aged 22 or older. Moreover, in the United States, it is illegal to drink

alcohol before age 21. The prevalence of alcohol use disorders among adults under the age of 21 often is lower than

that among adults aged 21 to 25. Focusing on adults aged 26 or older minimizes the potential confounding effect of

age on the associations between educational attainment and substance use disorders.

• Over half of the adults aged 18 or older with substance dependence or abuse were employed

full time in 2013. Of the 20.3 million adults who were classified with dependence or abuse,

11.3 million (55.7 percent) were employed full time.

Criminal Justice Populations

• In 2013, adults aged 18 or older who were on parole or a supervised release from jail during

the past year had a higher rate of illicit drug or alcohol dependence or abuse (34.3 percent)

than their counterparts who were not on parole or supervised release during the past year

(8.4 percent).

• In 2013, probation status was associated with substance dependence or abuse. The rate of

substance dependence or abuse was 35.0 percent among adults who were on probation during

the past year, which was higher than the rate among adults who were not on probation during

the past year (8.0 percent).

Geographic Area

• In 2013, rates of illicit drug or alcohol dependence or abuse among persons aged 12 or older

were 8.9 percent in the West, 8.3 percent in the Northeast, 8.2 percent in the Midwest, and

7.8 percent in the South.

• Rates for illicit drug or alcohol dependence or abuse among persons aged 12 or older in 2013

were similar in large metropolitan areas (8.6 percent) and small metropolitan areas

(8.4 percent), but were higher than in nonmetropolitan areas (6.6 percent).

7.2 Past Year Treatment for a Substance Use Problem

Estimates described in this section refer to treatment received for illicit drug or alcohol

use, or for medical problems associated with the use of illicit drugs or alcohol. This includes

treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation

facility (outpatient or inpatient), mental health center, emergency room, private doctor's office,

prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous.

Persons could report receiving treatment at more than one location. Note that the definition of

treatment in this section is different from the definition of specialty treatment described in

Section 7.3. Specialty treatment includes treatment only at a hospital (inpatient), a rehabilitation

facility (inpatient or outpatient), or a mental health center.

Individuals who reported receiving substance use treatment but were missing information

on whether the treatment was specifically for alcohol use or illicit drug use were not counted in

estimates of either illicit drug use treatment or alcohol use treatment; however, they were

counted in estimates for "drug or alcohol use" treatment.

• In 2013, 4.1 million persons aged 12 or older (1.5 percent of the population) received

treatment for a problem related to the use of alcohol or illicit drugs. Of these, 1.3 million

received treatment for the use of both alcohol and illicit drugs, 0.9 million received treatment

for the use of illicit drugs but not alcohol, and 1.4 million received treatment for the use of

alcohol but not illicit drugs. (Note that estimates by substance do not sum to the total number

of persons receiving treatment because the total includes persons who reported receiving

treatment but did not report for which substance the treatment was received.)

• The rate and the number of persons in the population aged 12 or older receiving any

substance use treatment within the past year remained stable between 2012 (1.5 percent and

4.0 million) and 2013 (1.5 percent and 4.1 million). The rate and number of persons

receiving any substance use treatment within the past year in 2002 were 1.5 percent and

3.5 million. The rate in 2002 was similar to that in 2013, but the number of persons who

received substance use treatment in 2002 was lower than that in 2013.

• In 2013, among the 4.1 million persons aged 12 or older who received treatment for alcohol

or illicit drug use in the past year, 2.3 million persons received treatment at a self-help group,

and 1.8 million received treatment at a rehabilitation facility as an outpatient (Figure 7.7).

The numbers of persons who received treatment at other locations were 1.2 million at a

mental health center as an outpatient, 1.0 million at a rehabilitation facility as an inpatient,

879,000 at a hospital as an inpatient, 770,000 at a private doctor's office, 603,000 at an

emergency room, and 263,000 at a prison or jail. None of these estimates changed

significantly between 2012 and 2013. The number of persons receiving treatment at a private

doctor's office was lower in 2002 (523,000) than in 2013.

• In 2013, 2.5 million persons aged 12 or older reported receiving treatment for alcohol use

during their most recent treatment in the past year, 845,000 persons received treatment for

marijuana use, and 746,000 persons received treatment for pain relievers (Figure 7.8).

Estimates for receiving treatment for the use of other drugs were 584,000 for cocaine,

526,000 for heroin, 461,000 for stimulants, 376,000 for tranquilizers, and 303,000 for

hallucinogens. None of these estimates changed significantly between 2012 and 2013.

• The numbers of persons aged 12 or older who received their most recent treatment in the past

year for alcohol, marijuana, cocaine, hallucinogens, inhalants, and sedatives were similar in

2002 and 2013. However, the number of persons who received treatment for tranquilizers

increased from 2002 (197,000 persons) to 2013 (376,000 persons). The number who received

treatment for heroin increased from 277,000 persons in 2002 to 526,000 persons in 2013. The

number who received treatment for nonmedical use of prescription pain relievers increased

from 2002 (360,000 persons) to 2013 (746,000 persons) (Figure 7.9). The number who

received treatment for stimulants increased from 268,000 persons in 2002 to 461,000 persons

in 2013. (Note that respondents could indicate that they received treatment for more than one

substance during their most recent treatment.)

Figure 7.7 Locations Where Past Year Substance Use

Treatment Was Received among Persons

Aged 12 or Older: 2013

Figure 7.8 Substances for Which Most Recent

Treatment Was Received in the Past Year

among Persons Aged 12 or Older: 2013

Numbers in Thousands

Self-Help Group

Outpatient Rehabilitation

Inpatient Rehabilitation

Outpatient Mental Health Center

Hospital Inpatient

Private Doctorʹs Office

Emergency Room

Prison or Jail

2,292

1,753

1,176

1,042

879

770

603

263

0 500 1,000 1,500 2,000 2,500

Numbers in Thousands

Alcohol

Pain Relievers

Marijuana

Cocaine

Stimulants

Heroin

Hallucinogens

Tranquilizers

2,513

845

746

584

526

461

376

303

0 500 1,000 1,500 2,000 2,500 3,000

Figure 7.9 Received Most Recent Treatment in the

Past Year for the Use of Pain Relievers

among Persons Aged 12 or Older: 2002-

2013

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

7.3 Need for and Receipt of Specialty Treatment

This section discusses the need for and receipt of treatment for a substance use problem

at a "specialty" treatment facility. Specialty treatment is defined as treatment received at any of

the following types of facilities: hospitals (inpatient only), drug or alcohol rehabilitation facilities

(inpatient or outpatient), or mental health centers. It does not include treatment at an emergency

room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient. An

individual is defined as needing treatment for an alcohol or drug use problem if he or she met the

DSM-IV (APA, 1994) diagnostic criteria for alcohol or illicit drug dependence or abuse in the

past 12 months or if he or she received specialty treatment for alcohol use or illicit drug use in

the past 12 months.

In this section, an individual needing treatment for an illicit drug use problem is defined

as receiving treatment for his or her drug use problem only if he or she reported receiving

specialty treatment for illicit drug use in the past year. Thus, an individual who needed treatment

for illicit drug use but received specialty treatment only for alcohol use in the past year or who

received treatment for illicit drug use only at a facility not classified as a specialty facility was

not counted as receiving treatment for illicit drug use. Similarly, an individual who needed

treatment for an alcohol use problem was counted as receiving alcohol use treatment only if the

treatment was received for alcohol use at a specialty treatment facility. Individuals who reported

2002 2003 2004 2005 2006 2007

Numbers in Thousands

2009 2011 201320102008

360

415

424

466

547

565

726

973

761

736

604

200

400

600

1,000

800

2012

746

receiving specialty substance use treatment but were missing information on whether the

treatment was specifically for alcohol use or drug use were not counted in estimates of specialty

drug use treatment or in estimates of specialty alcohol use treatment; however, they were

counted in estimates for "drug or alcohol use" treatment.

In addition to questions about symptoms of substance use problems that are used to

classify respondents' need for treatment based on DSM-IV criteria, NSDUH includes questions

asking respondents about their perceived need for treatment (i.e., whether they felt they needed

treatment or counseling for illicit drug use or alcohol use). In this report, estimates for perceived

need for treatment are discussed only for persons who were classified as needing treatment

(based on DSM-IV criteria) but did not receive treatment at a specialty facility. Similarly,

estimates for whether a person made an effort to get treatment are discussed only for persons

who felt the need for treatment and did not receive it.

Illicit Drug or Alcohol Use Treatment and Treatment Need

• In 2013, 22.7 million persons aged 12 or older needed treatment for an illicit drug or alcohol

use problem (8.6 percent of persons aged 12 or older). The number in 2013 was similar to the

numbers in 2002 to 2012 (ranging from 21.6 million to 23.6 million). The rate in 2013 was

similar to the rates in 2011 (8.4 percent) and 2012 (8.9 percent), but it was lower than the

rates in 2002 to 2010 (ranging from 9.2 to 9.8 percent).

• In 2013, 2.5 million persons (0.9 percent of persons aged 12 or older and 10.9 percent of

those who needed treatment) received treatment at a specialty facility for an illicit drug or

alcohol problem. The number in 2013 was similar to the numbers in 2002 (2.3 million) and in

2004 through 2012 (ranging from 2.3 million to 2.6 million), and it was higher than the

number in 2003 (1.9 million). The rate in 2013 was not different from the rates in 2002 to

2012 (ranging from 0.8 to 1.0 percent).

• In 2013, 20.2 million persons (7.7 percent of the population aged 12 or older) needed

treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty

facility in the past year. The number in 2013 was similar to the numbers in 2002 to 2012

(ranging from 19.3 million to 21.1 million). The rate in 2013 was similar to the rates in 2010

to 2012 (ranging from 7.5 to 8.1 percent), but it was lower than the rates in 2002 to 2009

(ranging from 8.3 to 8.8 percent).

• Of the 2.5 million persons aged 12 or older who received specialty substance use treatment in

2013, 875,000 received treatment for alcohol use only, 936,000 received treatment for illicit

drug use only, and 547,000 received treatment for both alcohol and illicit drug use. These

estimates in 2013 were similar to the estimates in 2012 and 2002.

• Among persons in 2013 who received their most recent substance use treatment at a specialty

facility in the past year, 41.7 percent reported using private health insurance as a source of

payment for their most recent specialty treatment, 40.6 percent reported using their "own

savings or earnings," 29.0 percent reported using Medicaid, 29.0 percent reported using

public assistance other than Medicaid, 26.8 percent reported using Medicare, and

23.0 percent reported using funds from family members. None of these estimates changed

significantly between 2012 and 2013.

• In 2013, among the 20.2 million persons aged 12 or older who were classified as needing

substance use treatment but not receiving treatment at a specialty facility in the past year,

908,000 persons (4.5 percent) reported that they perceived a need for treatment for their illicit

drug or alcohol use problem (Figure 7.10). Of these 908,000 persons who felt they needed

treatment but did not receive treatment in 2013, 316,000 (34.8 percent) reported that they

made an effort to get treatment, and 592,000 (65.2 percent) reported making no effort to get

treatment. These estimates were stable between 2012 and 2013.

• The rate and the number of youths aged 12 to 17 who needed treatment for an illicit drug or

alcohol use problem in 2013 (5.4 percent and 1.3 million) were lower than those in 2012

(6.3 percent and 1.6 million), 2011 (7.0 percent and 1.7 million), 2010 (7.5 percent and

1.8 million), and 2002 (9.1 percent and 2.3 million). Of the 1.3 million youths who needed

treatment in 2013, 122,000 received treatment at a specialty facility (about 9.1 percent of the

youths who needed treatment), leaving about 1.2 million who needed treatment for a

substance use problem but did not receive it at a specialty facility.

Figure 7.10 Past Year Perceived Need for and Effort

Made to Receive Specialty Treatment

among Persons Aged 12 or Older Needing

But Not Receiving Treatment for Illicit

Drug or Alcohol Use: 2013

20.2 Million Needing But Not Receiving

Treatment for Illicit Drug or Alcohol Use

Did Not Feel They

Needed Treatment

2.9%

1.6%

Felt They Needed

Treatment and Did

Not Make an Effort

Felt They Needed

Treatment and Did

Make an Effort

95.5%

• Based on 2010-2013 combined data, commonly reported reasons for not receiving illicit drug

or alcohol use treatment among persons aged 12 or older who needed and perceived a need

for treatment but did not receive treatment at a specialty facility were (a) not ready to stop

using (40.3 percent), (b) no health coverage and could not afford cost (31.4 percent),

cause neighbors/community to have a negative opinion (10.1 percent), (e) not knowing where

to go for treatment (9.2 percent), and (f) no program having type of treatment (8.0 percent).

• Based on 2010-2013 combined data, among persons aged 12 or older who needed but did not

receive illicit drug or alcohol use treatment, felt a need for treatment, and made an effort to

receive treatment, commonly reported reasons for not receiving treatment were (a) no health

coverage and could not afford cost (37.3 percent), (b) not ready to stop using (24.5 percent),

cover treatment or did not cover cost (8.2 percent), and (e) no transportation or inconvenient

(8.0 percent) (Figure 7.11).

Figure 7.11 Reasons for Not Receiving Substance Use

Treatment among Persons Aged 12 or

Older Who Needed and Made an Effort to

Get Treatment But Did Not Receive

Treatment and Felt They Needed

Treatment: 2010-2013 Combined

Percent Reporting Reason

0 10203040

No Health Coverage and

Could Not Afford Cost

Not Ready to Stop Using

No Transportation/Inconvenient

Did Not Feel Need for

Treatment at the Time

Might Have Negative Effect on Job

Did Not Know Where to Go

for Treatment

Could Handle the Problem

without Treatment

37.3

24.5

9.0

8.2

8.0

6.6

5.0

Had Health Coverage But Did Not

Cover Treatment or Did Not Cover Cost

Illicit Drug Use Treatment and Treatment Need

• In 2013, the number of persons aged 12 or older needing treatment for an illicit drug use

problem was 7.6 million (2.9 percent of the total population). The number in 2013 was

similar to the number in each year from 2002 through 2012 (ranging from 7.2 million to

8.1 million). The rate of persons needing treatment for an illicit drug use problem in 2013

was lower than the rates in 2002 (3.3 percent) and 2004 (3.3 percent), but it was similar to

the rates in 2012 and 2003 (3.1 percent in each year) and in 2005 to 2011 (ranging from

2.8 to 3.2 percent).

• Of the 7.6 million persons aged 12 or older who needed treatment for an illicit drug use

problem in 2013, 1.5 million (0.6 percent of the total population and 19.5 percent of persons

who needed treatment) received treatment at a specialty facility for an illicit drug use

problem in the past year. The number in 2013 was similar to the numbers in 2012

(1.5 million), 2002 (1.4 million), and in 2004 to 2011 (ranging from 1.2 million to

1.6 million), but it was higher than the number in 2003 (1.1 million). The rate in 2013 was

similar to the rates in 2002 to 2012 (ranging from 0.5 to 0.6 percent).

• There were 6.1 million persons (2.3 percent of the total population) who needed but did not

receive treatment at a specialty facility for an illicit drug use problem in 2013. The number in

2013 was similar to the numbers in 2002 to 2012 (ranging from 5.8 million to 6.6 million).

The rate in 2013 was similar to the rates in 2006 to 2012 (ranging from 2.3 to 2.5 percent),

but it was lower than the rates in 2002 to 2005 (ranging from 2.6 to 2.8 percent).

• Of the 6.1 million persons aged 12 or older who needed but did not receive specialty

treatment for illicit drug use in 2013, 395,000 (6.4 percent) reported that they perceived a

need for treatment for their illicit drug use problem, and 5.7 million did not perceive a need

for treatment. The number of persons in 2013 who needed treatment for an illicit drug use

problem but did not perceive a need for treatment was similar to the number in 2012

(5.9 million). However, the number of persons who needed treatment and perceived a need

for treatment for an illicit drug problem in 2013 was lower than the number in 2012

(588,000 persons).

• Of the 395,000 persons aged 12 or older in 2013 who felt a need for treatment for use of

illicit drugs, 148,000 reported that they made an effort to get treatment, and 247,000 reported

making no effort to get treatment. These estimates in 2013 for making or not making an

effort to get treatment were similar to those in 2012.

• In 2013, among youths aged 12 to 17, 908,000 persons (3.6 percent) needed treatment for an

illicit drug use problem, but only 90,000 received treatment at a specialty facility

(10.0 percent of youths aged 12 to 17 who needed treatment), leaving 817,000 youths who

needed treatment but did not receive it at a specialty facility. These estimates in 2013 were

similar to those in 2012, except that the number and the rate of youths who needed treatment

for an illicit drug use problem in 2013 were lower than those in 2012 (1.0 million and

4.2 percent).

• Among persons aged 12 or older who needed but did not receive illicit drug use treatment

and felt they needed treatment (based on 2010-2013 combined data), the commonly reported

reasons for not receiving treatment were (a) no health coverage and could not afford cost

(42.1 percent), (b) not ready to stop using (27.5 percent), (c) concern that receiving treatment

might cause neighbors/community to have negative opinion (15.9 percent), (d) possible

negative effect on job (15.2 percent), (e) not knowing where to go for treatment

(12.8 percent), and (f) having health coverage that did not cover treatment or did not cover

the cost (9.6 percent).

Alcohol Use Treatment and Treatment Need

• In 2013, the number of persons aged 12 or older needing treatment for an alcohol use

problem was 18.0 million (6.9 percent of the population aged 12 or older). The number in

2013 was similar to the numbers in 2010 to 2012 (ranging from 17.4 million to 18.6 million)

and in 2002, 2003, and 2008 (ranging from 18.2 million to 19.1 million). However, the

number in 2013 was lower than the numbers in 2004 to 2007 and in 2009 (ranging from

19.4 million to 19.6 million). The rate in 2013 (6.9 percent) was similar to the rates in 2011

(6.8 percent) and 2012 (7.0 percent), but it was lower than the rates in 2002 to 2010 (ranging

from 7.3 to 8.0 percent).

• Among the 18.0 million persons aged 12 or older who needed treatment for an alcohol use

problem in 2013, 1.4 million (0.5 percent of the total population and 7.9 percent of the

persons who needed treatment for an alcohol use problem) received alcohol use treatment at

a specialty facility. The number and the rate of the need and receipt of treatment at a

specialty facility for an alcohol use problem in 2013 did not change significantly since 2002

(ranging from 1.3 million to 1.7 million and from 0.5 to 0.7 percent).

• The number of persons aged 12 or older who needed but did not receive treatment at a

specialty facility for an alcohol use problem in 2013 (16.6 million) was similar to the

numbers in 2002 (17.1 million), 2003 (16.9 million), and from 2008 to 2012 (ranging from

15.9 million to 17.7 million), but it was lower than the numbers from 2004 to 2007 (ranging

from 17.8 million to 18.0 million). The rate in 2013 (6.3 percent of the population aged 12 or

older) was similar to the rates in 2010 to 2012 (ranging from 6.2 to 6.7 percent), but it was

lower than the rates in 2002 to 2009 (ranging from 7.0 to 7.4 percent).

• Among the 16.6 million persons aged 12 or older who needed but did not receive specialty

treatment for an alcohol use problem in 2013, 554,000 persons (3.3 percent) felt they needed

treatment for their alcohol use problem. The number and rate in 2013 were similar to those in

2012 (665,000 persons and 4.0 percent) and 2002 (761,000 persons and 4.5 percent). Of the

554,000 persons in 2013 who perceived a need for treatment for an alcohol use problem but

did not receive specialty treatment, 353,000 did not make an effort to get treatment, and

201,000 made an effort but were unable to get treatment.

• The number and the rate of youths aged 12 to 17 who needed treatment for an alcohol use

problem in 2013 (735,000 and 3.0 percent) were lower than those in 2012 (889,000 and

3.6 percent). Of the youths in 2013 who needed treatment for an alcohol use problem, only

73,000 received treatment at a specialty facility (0.3 percent of all youths and 10.0 percent of

youths who needed treatment). These estimates were similar to those in 2012. The number

and the rate of youths who needed but did not receive treatment for an alcohol use problem in

2013 (662,000 and 2.7 percent) were lower than those in 2012 (814,000 and 3.3 percent).

• Among persons aged 12 or older who needed but did not receive alcohol use treatment and

felt they needed treatment (based on 2010-2013 combined data), commonly reported reasons

for not receiving treatment were (a) not ready to stop using (50.5 percent), (b) no health

coverage and could not afford cost (26.4 percent), (c) not finding a program that offered the

type of treatment (7.6 percent), (d) not knowing where to go for treatment (7.3 percent),

(e) possible negative effect on job (7.1 percent), (f) no transportation or inconvenient

(7.0 percent), (g) could handle the problem without treatment (6.8 percent), and (h) having

health coverage that did not cover treatment or did not cover cost (6.7 percent).

8. Comparison of Trends in Substance Use

among Youths and Young Adults

Previous chapters in this report presented findings from the 2013 National Survey on

Drug Use and Health (NSDUH) that describe trends and demographic differences for the

incidence and prevalence of use for a variety of substances. In this chapter, comparisons are

presented of NSDUH trend results with substance use results from other surveys of youths and

young adults.

Description of NSDUH and Other Data Sources

Conducted since 1971 and previously named the National Household Survey on Drug

Abuse (NHSDA), the survey underwent several methodological improvements in 2002 that have

affected prevalence estimates (see Chapter 1). As a result, the 2002 through 2013 estimates are

not comparable with estimates from 2001 and earlier surveys. Therefore, the primary focus of

this report is on comparisons of measures of substance use across subgroups of the U.S.

population in 2013, changes between 2012 and 2013, and changes between 2002 and 2013.

An important step in the analysis and interpretation of NSDUH or any other survey data is to

compare the results with those from other data sources. This can be difficult because the other

surveys typically have different purposes, definitions, and designs. Research has established that

surveys of substance use and other sensitive topics often produce inconsistent results because of

different methods that are used. Thus, it is important to understand that conflicting results often

reflect differing methodologies, not incorrect results. Despite this limitation, comparisons can be

very useful. Consistency across surveys can confirm or support conclusions about trends and

patterns of use, and inconsistent results can point to areas for further study. Further discussion of

this issue is included in Appendix C, along with descriptions of methods and results from other

sources of substance use data.

Unfortunately, few additional data sources are available to compare with NSDUH results.

One established source is Monitoring the Future (MTF), a study sponsored by the National

Institute on Drug Abuse (NIDA). MTF surveys students in the 8th, 10th, and 12th grades in

classrooms during the spring of each year. MTF also collects data by mail from a subsample of

adults who had participated earlier in the study as 12th graders. Further details about MTF are

available on the MTF Web site at http://www.monitoringthefuture.org/. Historically, NSDUH

rates of youth substance use have been lower than those of MTF. Although the two surveys

occasionally have shown different trends in youth substance use over a short time period, these

two sources of youth behavior have shown very similar long-term trends in prevalence. NSDUH

and MTF rates of substance use generally have been similar among young adults, and the two

sources also have shown similar trends for this age group.

Another source of data on trends in the use of drugs among youths is the Youth Risk

Behavior Survey (YRBS), sponsored by the Centers for Disease Control and Prevention (CDC).

The YRBS interviews students in the 9th through 12th grades in classrooms every other year

during February through May (Brener et al., 2013). The most recent survey was completed in

2013 (Kann et al., 2014). Generally, the YRBS has shown higher prevalence rates but similar

100

trends when compared with NSDUH and MTF. However, trend comparisons between the YRBS

and NSDUH or MTF can be less straightforward because of the different periodicity (i.e.,

biennially instead of annually) and ages covered, the limited number of drug use questions, and

smaller sample size in the YRBS.

Comparison of NSDUH, MTF, and YRBS Trends for Youths

A comparison of NSDUH and MTF estimates among youths for 2002 to 2013 is shown

in Tables 8.1 through 8.3 at the end of this chapter for several substances that are defined

similarly in the two surveys. For comparison purposes, MTF data on 8th and 10th graders are

combined to give an age range close to 12 to 17 years, the standard youth age group for NSDUH.

Table C.1 in Appendix C provides comparisons according to the MTF definitions for youths who

are in school. The NSDUH results in Tables 8.1 through 8.3 are remarkably consistent with MTF

trends for youths, as discussed in the following paragraphs.

Both surveys showed decreases between 2002 and 2013 in the percentages of youths who

used cocaine, Ecstasy, inhalants, alcohol, and cigarettes in the past month (Table 8.3). For youth

alcohol and cigarette use in the past month, both surveys showed lower rates in 2013 compared

with all other years from 2002 to 2012. Although the MTF rate has been consistently higher than

the NSDUH rate because of methodological differences between the surveys, the relative

changes over time have been similar. For example, NSDUH data for past month alcohol use

showed a 15 percent decline between 2010 and 2013 (from 13.6 to 11.6 percent), and the MTF

data showed a 16 percent decrease during those years (from 21.4 to 18.0 percent) (Figure 8.1).

There have been instances where the two surveys showed differing trends from 1 year to

the next, but these discrepancies usually "correct" themselves with 1 or 2 more years of data,

pointing to the need to use caution in the interpretation of 1-year shifts in prevalence levels.

For example, 2010 MTF data indicated a leveling or possible increase in current cigarette use

among youths, in contrast to the 2010 NSDUH data, which showed a lower rate in 2010

compared with rates in 2002 to 2008. The 2012 and 2013 MTF estimates, however, showed a

continuing decline, consistent with the NSDUH trend in youth smoking. Over the long term,

the two surveys showed consistent decreases in the prevalence of smoking among youths

(Figure 8.2). During the 4-year period from 2010 to 2013, NSDUH showed a 33 percent decline

(from 8.4 to 5.6 percent) and MTF showed a 35 percent decline (from 10.4 to 6.8 percent) in

current cigarette use.

For current marijuana use, both surveys showed declines from 2002 to 2006 and

increases from 2008 to 2011 (Figure 8.3). The estimate of current marijuana use was lower in

NSDUH in 2012 than in 2011, but the MTF change was not statistically significant over that

period. However, rates of current marijuana use remained similar between 2012 and 2013 in both

NSDUH and MTF.

101

Figure 8.1 Past Month Alcohol Use among Youths in

NSDUH and MTF: 2002-2013

MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health.

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Figure 8.2 Past Month Cigarette Use among Youths in

NSDUH and MTF: 2002-2013

MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health.

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

NSDUH 12 to 17

MTF 8th and 10th Grades Combined

Percent Using in Past Month

22.7

20.0

14.8

21.4

13.6

13.3

18.0

11.6

27.5

17.6

27.6

17.7

24.7

22.4

16.0

14.7

26.9

17.6

16.5

25.2

25.5

16.7

20032002

2004 2005 2006 2007 2008 2009 2010 2011

2012 2013

19.3

12.9

NSDUH 12 to 17

MTF 8th and 10th Grades Combined

Percent Using in Past Month

14.2

13.5

12.6

12.1

11.6

10.6

10.4

9.6

13.0

12.2

11.9

10.8

10.4

9.9

9.2

8.4

9.8

9.0

7.8

6.8

5.6

20032002

2004 2005 2006 2007 2008 2009 2010 2011

20132012

7.9

6.6

102

Figure 8.3 Past Month Marijuana Use among Youths

in NSDUH and MTF: 2002-2013

MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health.

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

NSDUH and MTF data showed generally consistent trends for past month use of Ecstasy,

with decreases in use from 2002 to the middle of the decade, then increases in use from 2007 to

2010, declines between 2010 and 2012, and no change between 2012 and 2013. For past month

use of cocaine, both surveys showed declines between 2013 and 2002 to 2008. Rates of past

month use of inhalants also were lower in both surveys in 2013 than in 2002 to 2011, although

NSDUH showed a continued decline from 2012 to 2013 that was not shown in MTF. For LSD,

most rates of current use in 2002 to 2012 were similar to the rates in 2013 for both surveys.

NSDUH and MTF also collect data on perceived risk of harm. The extent to which

youths believe that substances might cause them harm can influence whether or not they will use

these substances. Declining levels of perceived risk among youths historically have been

associated with subsequent increases in rates of use. Among youths aged 12 to 17, the percentage

reporting in NSDUH that they thought there was a great risk of harm in smoking marijuana once

or twice a week declined from 43.6 percent in 2012 to 39.5 percent in 2013. MTF data for

combined 8th and 10th graders showed a similar decline in perceived great risk of harm of

regular marijuana use over this time period, from 58.9 to 53.8 percent.

For the substances for which information on current use was collected in the YRBS,

including alcohol, cigarettes, marijuana, and cocaine, the YRBS trend results between 2001 and

2013 were consistent with NSDUH and MTF (see the link for the Youth Online interactive data

tables at http://www.cdc.gov/HealthyYouth/yrbs/; Grunbaum et al., 2002). YRBS data for the

combined grades 9 through 12 showed decreases in past month alcohol use (47.1 percent in

NSDUH 12 to 17

MTF 8th and 10th Grades Combined

Percent Using in Past Month

13.1

8.2

12.3

10.0

9.8

12.4

11.2

10.9

7.9

6.7 6.7

7.4

11.2

7.4

7.9

12.5

7.1

7.6

6.8

10.4

6.7

20032002

2004 2005 2006 2007 2008 2009 2010 2011

20132012

11.8

7.2

103

2001

and 34.9 percent in 2013) and cigarette use (28.5 percent in 2001 and 15.7 percent in

2013). YRBS showed a decline in past month marijuana use between 2001 (23.9 percent) and

2007 (19.7 percent) and an increase between 2007 and 2013 (23.4 percent). This increase

between 2007 and 2013 was consistent with the increase in MTF across that same period. The

prevalence of current marijuana use also increased between 2007 and 2011 both for NSDUH

(from 6.7 to 7.9 percent) and YRBS (from 19.7 to 23.1 percent). However, the prevalence in

NSDUH among youths declined between 2011 and 2013, such that the rates in 2007 and 2013

were similar for NSDUH. All three surveys showed no significant change in rates of current

marijuana use between their most recent pair of survey years (2012 and 2013 for NSDUH and

MTF; 2011 and 2013 for YRBS).

Although changes in NSDUH survey methodology preclude direct comparisons of recent

estimates with estimates before 2002, it is important to put the recent trends in context by

reviewing longer term trends in use. NSDUH data (prior to the design changes in 1999 and 2002)

on youths aged 12 to 17 and MTF data on high school seniors showed substantial increases in

youth illicit drug use during the 1970s, reaching a peak in the late 1970s. Both surveys then

showed declines throughout the 1980s until about 1992, when rates reached a low point. These

trends were driven by the trend in marijuana use (Figure 8.4). With the start of annual data

collection in NSDUH in 1991, along with the biennial YRBS and the annual 8th and 10th grade

samples in MTF, trends among youths are well documented since the low point that occurred in

the early 1990s. Although they employ different survey designs and cover different age groups,

the three surveys are consistent in showing increasing rates of marijuana use during the early to

mid-1990s, reaching a peak in the late 1990s (but lower than in the late 1970s). This peak in the

late 1990s was followed by declines in use after the turn of the 21st century and fairly stable

rates in the most recent years.

As noted in Chapter 2 of this report, NSDUH data indicated that nonmedical use of

prescription drugs among youths aged 12 to 17 in 2013 was the second most prevalent illicit drug

use category, with marijuana being first. The most prevalent category of misused prescription

drugs among youths in 2013 was pain relievers.

NSDUH and MTF both collect data on misuse of prescription drugs, but they use

somewhat different definitions and questioning strategies. For example, NSDUH defines misuse

as use of prescription drugs that were not prescribed for the respondent or use of these drugs only

for the experience or feeling they caused; MTF defines misuse as use not under a doctor's orders.

MTF also does not estimate overall prescription drug misuse. However, MTF asks questions

about "narcotics other than heroin," a category that is similar in coverage to the pain reliever

category in NSDUH. Also, MTF data on misuse of narcotics other than heroin are reported only

for 12th graders because of concerns about the validity of estimates for 8th and 10th graders

(Johnston, O'Malley, Bachman, Schulenberg, & Miech, 2014).

Estimates for the 2001 YRBS are not shown in Tables 8.1 and 8.3 for consistency with the new NSDUH

baseline in 2002.

104

Figure 8.4 Past Month Marijuana Use among Youths

in NSDUH, MTF, and YRBS: 1971-2013

MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health; YRBS = Youth Risk Behavior

Survey.

Note: NSDUH data for youths aged 12 to 17 are not presented for 1999 to 2001 because of design changes in the

survey. These design changes preclude direct comparisons of estimates from 2002 to 2013 with estimates

prior to 1999.

In addition, as has been the case with NSDUH trends, methodological changes in MTF

have sometimes resulted in discontinuities. For the data on narcotics other than heroin, there was

a questionnaire change in the 2002 MTF that resulted in increased reporting of misuse of

narcotics other than heroin, such that estimates prior to 2002 are not strictly comparable with

estimates for 2002 and beyond.

Figure 8.5 shows NSDUH data for past year misuse of pain relievers from 2002 to 2013

for youths aged 12 to 17 and MTF data for 12th graders. Both surveys showed lower rates of

nonmedical use in 2013 compared with rates in 2002 to 2011. The rate of nonmedical use of pain

relievers in 2013 in the past year among 12 to 17 year olds in NSDUH was 4.6 percent and

ranged from 5.9 to 7.7 percent in 2002 to 2011. The rate in 2012 among 12 to 17 year olds in

NSDUH also was lower than the rate in 2013. In MTF, the rate for nonmedical use of narcotics

other than heroin in the past year was 7.1 percent in 2013 and ranged from 8.7 to 9.5 percent in

2002 to 2011. The rates among 12th graders did not differ from 2011 to 2012 and from 2012 to

2013; see Johnston, O'Malley, Bachman, and Schulenberg (2013) for a comparison of rates

between 2011 and 2012.

Percent Using in Past Month

NSDUH 12 to 17

MTF 8th and 10th Grades Combined

MTF 12th Grade

YRBS 9th through 12th Grades

19751971

1980 1985 1990 1995 2000 2005 2010

105

Figure 8.5 Past Year Nonmedical Pain Reliever Use

among Youths in NSDUH and MTF: 2002-

2013

MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health.

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Note: Data for MTF are for "narcotics other than heroin."

Comparison of NSDUH and MTF Trends for Young Adults

MTF follow-up data on persons aged 19 to 24 provide the closest match on age to

estimates for NSDUH young adults aged 18 to 25. As shown in Tables 8.4 to 8.6, data for young

adults showed similar trends in NSDUH and MTF, although not as consistent as for the youth

data. Potential reasons for differences from the data for youths are the relatively smaller MTF

sample size for young adults and possible bias in the MTF sample due to noncoverage of school

dropouts and a low overall response rate; the MTF response rate for young adults is affected by

nonresponse by schools, by students in the 12th grade survey, and by young adults in the follow-

up mail survey.

Both surveys showed an increase in past month marijuana use among young adults from

2008 to 2013 (from 16.6 to 19.1 percent in NSDUH; from 17.3 to 21.6 percent in MTF)

(Table 8.6). Both surveys showed declines in past month cigarette use between 2002 and 2013,

with NSDUH showing a decline from 40.8 to 30.6 percent and MTF showing a decline from

31.4 to 20.2 percent. Both surveys showed no significant change in rates of past month cigarette

use among young adults between 2012 and 2013. There also was no significant change between

2012 and 2013 in the rate of current alcohol use among young adults in either survey. Both

Percent Using in Past Year

NSDUH 12 to 17

MTF 12th Grade

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011

2013

9.4

9.3

9.5

9.0

9.2

9.1

9.2

8.7

7.1

8.7

7.6

7.7

7.4

6.9

7.2

6.7

6.5

6.6

5.9

4.6

6.3

2012

7.9

5.3

106

surveys showed declines in past year and past month cocaine use from 2002 to 2013, with no

significant changes in rates between 2012 and 2013 (Tables 8.5 and 8.6, respectively). Similarly,

past year Ecstasy use among young adults increased between 2007 and 2010 and remained

steady in 2011 through 2013, according to both NSDUH and MTF.

As was the case for youths aged 12 to 17, NSDUH data indicated that nonmedical use of

prescription drugs among young adults aged 18 to 25 in 2013 was the second most prevalent

illicit drug use category (see Chapter 2). Both NSDUH and MTF indicated lower rates of past

year nonmedical use of pain relievers in 2013 than in 2003 to 2010 among young adults

(Figure 8.6). The rate of past year nonmedical use among young adults aged 18 to 25 in NSDUH

for 2013 (8.8 percent) also was lower than the rate in 2002 and showed continued declines since

2010. Trend data for adults aged 19 to 24 in MTF showed similar rates in 2011 to 2013.

Figure 8.6 Past Year Nonmedical Pain Reliever Use

among Young Adults in NSDUH and MTF:

2002-2013

MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health.

Difference between this estimate and the 2013 estimate is statistically significant at the .05 level.

Note: Data for MTF are for "narcotics other than heroin."

Percent Using in Past Year

NSDUH 18 to 25

MTF 19 to 24

2002

2003 2004 2005 2006 2007 2008 2009 2010 2011

2013

12.0

11.9

12.5

12.2

12.0

9.8

8.8

11.1

8.5

9.7

9.2

9.9

9.0

9.2

8.5

7.7

7.1

9.1

2012

10.1

7.1

12.4

11.4

107

Table 8.1 Comparison of NSDUH, MTF, and YRBS Lifetime Prevalence Estimates among

Youths: Percentages, 2002-2013

Substance/

Survey 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Marijuana

NSDUH 20.6

19.6

19.0

17.4 17.3 16.2 16.6 17.1 17.1 17.5

17.0 16.4

MTF 29.0

27.0 25.7 25.3 23.8

22.6

22.3

24.0

25.4 25.5 24.5

26.2

YRBS

-- 40.2 -- 38.4 -- 38.1 -- 36.8

-- 39.9 -- 40.7

Cocaine

NSDUH 2.7

2.6

2.4

2.3

2.2

1.9

1.6

1.5

1.3

1.1 0.9

MTF 4.9

4.4

4.5

4.1

4.2

3.8

3.6

3.2 2.8 2.6 2.5

YRBS

-- 8.7

-- 7.6

-- 7.2

-- 6.4 -- 6.8

-- 5.5

Ecstasy

NSDUH 3.3

2.4

2.1

1.6 1.9

1.8 2.1

2.3

2.5

2.4

2.0

1.5

MTF 5.5

4.3

3.6 3.4 3.5 3.8 3.4 3.9 4.9

4.6

3.5 3.8

YRBS

-- 11.1

-- 6.3 -- 5.8 -- 6.7 -- 8.2

-- 6.6

LSD

NSDUH 2.7

1.6

1.2

1.1

0.9 0.8 1.1 1.0 0.9 0.9 1.0 0.9

MTF 3.8

2.8

2.3 2.2 2.2 2.3 2.3 2.4 2.4 2.3 2.0 2.1

YRBS

-- -- -- -- -- -- -- -- -- -- -- --

Inhalants

NSDUH 10.5

10.7

11.0

10.5

10.1

9.6

9.3

8.3

7.5

6.5

5.3

MTF 14.4

14.3

14.9

15.1

14.7

14.6

14.3

13.6

13.3

11.6

10.9

9.8

YRBS

-- 12.1

-- 12.4

-- 13.3

-- 11.7

-- 11.4

-- 8.9

Alcohol

NSDUH 43.4

42.9

42.0

40.6

40.4

39.5

38.6

38.4

35.4

34.5

32.4

30.8

MTF 57.0

55.8

54.1

52.1

51.0

50.3

48.6

47.9

47.0

44.6

41.8

40.0

YRBS

-- 74.9

-- 74.3

-- 75.0

-- 72.5

-- 70.8

-- 66.2

Cigarettes

NSDUH 33.3

31.0

29.2

26.7

25.9

23.7

23.1

22.3

20.5

19.1

17.4

15.7

MTF 39.4

35.7

34.3

32.4

30.4

28.4

26.1

26.4

26.5

24.4

21.6

20.3

YRBS

-- 58.4

-- 54.3

-- 50.3

-- 46.3

-- 44.7

-- 41.1

MTF = Monitoring the Future; NSDUH = National Survey on Drug Use and Health; YRBS = Youth Risk Behavior Survey.

-- Not available.

NOTE: NSDUH data are for youths aged 12 to 17. Some 2006 to 2010 NSDUH estimates may differ from previously published

estimates due to updates (see Section B.3 in Appendix B of this report).

NOTE: MTF data are simple averages of estimates for 8th and 10th graders. MTF data for 8th and 10th graders are reported in

Johnston et al. (2014), as are the MTF design effects used for variance estimation.

NOTE: Statistical tests for the YRBS were conducted using the "Youth Online" tool at http://www.cdc.gov/HealthyYouth/yrbs/.

Results of testing for statistical significance in this table may differ from published YRBS reports of change.

Difference between this estimate and 2013 estimate is statistically significant at the .05 level.

Sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2002-2013.

National Institute on Drug Abuse, Monitoring the Future Study, University of Michigan, 2002-2013.

Centers for Disease Control and Prevention, Youth Risk Behavior Survey, 2003, 2005, 2007, 2009, 2011, and 2013.

108

Table 8.2 Comparison of NSDUH, MTF, and YRBS Past Year Prevalence Estimates

among Youths: Percentages, 2002-2013

Substance/

Survey 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Marijuana

NSDUH 15.8

15.0

14.5

13.3 13.2 12.5

13.1 13.7 14.0 14.2 13.5 13.4

MTF 22.5

20.5 19.7

19.4

18.5

17.5

17.4

19.3

20.6 20.7 19.7

21.3

YRBS

-- -- -- -- -- -- -- -- -- -- -- --

Cocaine

NSDUH 2.1

1.8

1.6

1.7

1.6

1.5

1.2

1.0

0.9

0.7

0.5

MTF 3.2

2.8

2.9

2.6

2.7

2.4

2.2

1.9 1.7 1.6 1.5

YRBS

-- -- -- -- -- -- -- -- -- -- -- --

Ecstasy

NSDUH 2.2

1.3

1.2

1.0 1.2

1.3

1.4

1.7

1.9

1.7

1.2 0.9

MTF 3.9

2.6

2.1 2.2 2.1 2.5 2.3 2.5 3.6

3.1

2.1 2.4

YRBS

-- -- -- -- -- -- -- -- -- -- -- --

LSD

NSDUH 1.3

0.6 0.6 0.6 0.4

0.5 0.7 0.6 0.6 0.6 0.6 0.6

MTF 2.1

1.5 1.4 1.4 1.3 1.5 1.6 1.5 1.6 1.5 1.3 1.4

YRBS

-- -- -- -- -- -- -- -- -- -- -- --

Inhalants

NSDUH 4.4

4.5

4.6

4.5

4.4

3.9

4.0

3.9

3.6

3.3

2.6

1.9

MTF 6.8

7.1

7.8

7.5

7.4

7.1

6.9

5.8

5.2

4.4

YRBS

-- -- -- -- -- -- -- -- -- -- -- --

Alcohol

NSDUH 34.6

34.3

33.9

33.3

33.0

31.9

31.0

30.5

28.7

27.8

26.3

24.6

MTF 49.4

48.3

47.5

45.3

44.7

44.1

42.3

41.6

40.7

38.4

36.1

34.6

YRBS

-- -- -- -- -- -- -- -- -- -- -- --

Cigarettes

NSDUH 20.3

19.0

18.4

17.3

17.0

15.7

15.1

14.2

13.2

11.8

10.3

MTF