Treatment for Substance Use Disorders

Subsections:

Related Chapters:

Looking for a referral to, or more information about, mental health or substance use treatment services? The American Board of Preventive Medicine provides this service to locate physicians who are certified in specialists in Addiction Medicine

The federal Substance Abuse and Mental Health Services Administration has a free, confidential National Helpline at 1-800-662-HELP (4357).
"SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information."
SAMHSA's website also offers a free, confidential Behavioral Health Treatment Services Locator.

1. Estimated Number of Persons in the US Classified with Substance Dependence or Abuse

"NSDUH’s overall estimates of SUD include people who met the DSM-IV criteria for either dependence or abuse for alcohol or illicit drugs. In 2017, approximately 19.7 million people aged 12 or older had an SUD in the past year, including 14.5 million people who had an alcohol use disorder and 7.5 million people who had an illicit drug use disorder (Figure 39). Among the 7.5 million people aged 12 or older who had an illicit drug use disorder, the most common disorders were for marijuana (4.1 million people) and misuse of prescription pain relievers (1.7 million people).

"The estimated 14.5 million people aged 12 or older in 2017 who had an alcohol use disorder in the past year represent nearly 3 out of 4 people who had an SUD (73.6 percent) (Figure 40).24 The 7.5 million people who had an illicit drug use disorder represent about 2 out of 5 people who had an SUD (38.3 percent). An estimated 2.3 million people had both an alcohol use disorder and an illicit drug use disorder in the past year, or about 1 in 8 people who had a past year SUD (11.9 percent).

"In 2017, the 19.7 million people with a past year SUD represented 7.2 percent of people aged 12 or older (Figure 41). This percentage of people who had an SUD corresponds to about 1 in 14 people aged 12 or older. An estimated 992,000 adolescents aged 12 to 17 had an SUD, which represents 4.0 percent of adolescents. An estimated 5.1 million young adults aged 18 to 25 had an SUD.

"This number represents 14.8 percent of young adults. An estimated 13.6 million adults aged 26 or older had an SUD, which represents 6.4 percent of adults in this age group. Stated another way, about 1 in 25 adolescents, 1 in 7 young adults, and 1 in 16 adults aged 26 or older had an SUD in the past year."

Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
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2. NSDUH's Method For Estimating Prevalence Of "Illicit Drug Use Disorders" In The US

"Illicit drug use disorder is defined as meeting DSM-IV criteria for either dependence or abuse for one or more of the following illicit drugs: marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, or prescription psychotherapeutic drugs that were misused (i.e., pain relievers, tranquilizers, stimulants, and sedatives). There are seven possible dependence criteria for specific illicit drugs:

"1. spent a lot of time engaging in activities related to use of the drug,
"2. used the drug in greater quantities or for a longer time than intended,
"3. developed tolerance to the drug,
"4. made unsuccessful attempts to cut down on use of the drug,
"5. continued to use the drug despite physical health or emotional problems associated with use,
"6. reduced or eliminated participation in other activities because of use of the drug, and
"7. experienced withdrawal symptoms when respondents cut back or stopped using the drug.

"For most illicit drugs, dependence is defined as meeting three or more of these seven criteria. However, experiencing withdrawal symptoms is not included as a criterion for some illicit drugs based on DSM-IV criteria. For these substances, dependence is defined as meeting three or more of the first six criteria.

"Respondents who used (or misused) a specific illicit drug in the past 12 months and did not meet the dependence criteria for that drug were defined as having abuse were defined as meeting the abuse criteria for that drug if they reported one or more of the following:

"1. problems at work, home, and school because of use of the drug;
"2. regularly using the drug and then doing something physically dangerous;
"3. repeated trouble with the law because of use of the drug; and
"4. continued use of the drug despite problems with family or friends.

"Application of these criteria is discussed briefly in the respective SUD sections for specific illicit drugs. Detailed definitions for SUDs for specific illicit drugs also can be found in a glossary of key definitions for the 2016 NSDUH.9"

Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
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3. Estimated Cost Savings for Treatment vs. Law Enforcement

"This study found that the savings of supply-control programs are smaller than the control costs (an estimated 15 cents on the dollar for source-country control, 32 cents on the dollar for interdiction, and 52 cents on the dollar for domestic enforcement). In contrast, the savings of treatment programs are larger than the control costs; we estimate that the costs of crime and lost productivity are reduced by $7.46 for every dollar spend on treatment."

Rydell, C.P. & Everingham, S.S., Controlling Cocaine, Prepared for the Office of National Drug Control Policy and the United States Army (Santa Monica, CA: Drug Policy Research Center, RAND Corporation, 1994), p. xvi.
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4. Opioid Substitution Treatment, Treatment Programs, and Insurance Coverage

"In 2016 only 13.8 percent of substance use treatment programs accepted Medicare and offered an FDA-approved medication for opioid use disorder treatment (exhibit 1). While the percentage of programs that offered such treatment was low across all insurance types (24.8 percent among programs that accepted Medicaid and 28.6 percent among programs that accepted private insurance), access for Medicare beneficiaries was nearly twice as limited. Furthermore, just 20.8 percent of US counties—home to roughly 60 percent of the Medicare population—had at least one treatment program that accepted Medicare and offered buprenorphine or injectable naltrexone for older adults (exhibit 2). The majority of counties with at least one treatment program that accepted Medicare and offered an opioid use disorder treatment medication (65.1 percent) were in urban areas (data not shown). In 2016, 36.4 percent of treatment programs accepted Medicare, compared to 63.7 percent that accepted Medicaid and 70.3 percent that accepted private insurance. Of the treatment programs that accepted private insurance, 46.5 percent also accepted Medicare. Of those that accepted Medicaid, 52.1 percent also accepted Medicare."

Samantha J. Harris, Amanda J. Abraham, Christina M. Andrews, and Courtney R. Yarbrough. Gaps In Access To Opioid Use Disorder Treatment For Medicare Beneficiaries. Health Affairs 2020 39:2, 233-237.
https://www.healthaffairs.org/...

5. Total Number of People Receiving Substance Use Treatment in the US

"The number of clients in treatment on the survey reference date increased by 21 percent from 2005 to 2015, from 1,081,049 in 2005 to 1,305,647 in 2015.

"Facility Operation
"Table 3.1 and Figure 4. Within the categories of facility operation, the proportions of clients in treatment demonstrated some gradual changes between 2005 and 2015.

"• Private non-profit facilities treated 55 percent of clients in 2005, decreasing to 51 percent in 2015. (The number of clients in private non-profit facilities increased by 13 percent, from 595,633 in 2005 to 670,593 in 2015.)
"• Private for-profit facilities treated 28 percent of clients in 2005, increasing to 36 percent in 2015. (The number of clients in private for-profit facilities increased by 57 percent, from 302,595 in 2005 to 475,531 in 2015.)
"• Local government-operated facilities treated 9 percent of clients in 2005, decreasing to 5 percent in 2015. (The number of clients in local government-operated facilities decreased by 30 percent, from 95,667 in 2005 to 67,060 in 2015.)
"• State government-operated facilities treated 4 percent of clients in 2005, decreasing to 2 percent in 2015. (The number of clients in state government-operated facilities decreased by 28 percent, from 42,431 in 2005 to 30,675 in 2015.)
"• Federal government-operated facilities treated 3 percent of clients in 2005 and 4 percent in 2015. (The number of clients in federal government-operated facilities increased by 29 percent, from 36,194 in 2005 to 46,721 in 2015.)8
"• Tribal government-operated facilities treated 1 percent of clients both in 2005 and in 2015. (The number of clients in tribal government-operated facilities increased by 77 percent, from 8,529 in 2005 to 15,067 in 2015.)"

Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2015. Data on Substance Abuse Treatment Facilities. BHSIS Series S-88, HHS Publication No. (SMA) 17-5031. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, pp. 17-18.
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6. Admissions to Treatment for Marijuana in the US

According to the Substance Abuse and Mental Health Service's Treatment Episode Data Set, in 2015 in the US there were 213,001 admissions to treatment with marijuana reported as the primary substance of abuse out of the total 1,537,025 admissions to treatment in the US for those aged 12 and older for all substances that year. This is the lowest number of marijuana admissions and total treatment admissions in at least a decade: marijuana admissions peaked in 2009 at 373,338, and total admissions peaked in 2008 at 2,074,974.

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2005-2015. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-91, HHS Publication No. (SMA) 17-5037. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, Table 1.1A, p. 47.
https://www.samhsa.gov/data/si...

7. Admissions to Treatment in the US with Marijuana as Primary Substance, by Referral Source

"• Marijuana/hashish was reported as the primary substance of abuse by 14 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].

"• The average age at admission for primary marijuana/hashish admissions was 26 years [Table 2.1b]. Thirty-one percent of marijuana/hashish admissions were under age 20 (vs. 7 percent of all admissions combined), and primary marijuana/hashish abuse accounted for 78 percent of admissions aged 12 to 14 and 75 percent of admissions aged 15 to 17 years [Table 2.1c].

"• Non-Hispanic Whites accounted for 42 percent of primary marijuana/hashish admissions (29 percent were males and 13 percent were females), and non-Hispanic Blacks accounted for 31 percent (23 percent were males and 7 percent were females) [Table 2.3b].

"• Twenty-four percent of primary marijuana/hashish admissions had first used marijuana/hashish by age 12 and another 30 percent had first used it at age 13 or 14 [Table 2.5b].

"• Primary marijuana/hashish admissions were most likely to be referred by the court/criminal justice system (51 percent). Primary marijuana/hashish admissions were less likely than all admis-sions combined to be self or individually referred to treatment (19 vs. 41 percent) [Table 2.6b].

"• More than 4 in 5 marijuana/hashish admissions (85 percent) received ambulatory treatment; among all admissions combined, 3 in 5 (61 percent) received ambulatory treatment [Table 2.7b].• Fifty-four percent of primary marijuana/hashish admissions reported abuse of additional substances. Alcohol was reported by 35 percent [Table 3.8]."

Datatable for Admissions to Treatment in the US in 2015 with Marijuana as Primary Substance

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2005-2015. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-91, HHS Publication No. (SMA) 17-5037. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, p. 21, and Table 2.6B, p. 77.
https://www.samhsa.gov/data/si...

8. Federal Spending on Substance Use Disorder Treatment, 2003-2017

Federal spending on substance use disorder treatment and treatment research, as estimated by the Office of National Drug Control Policy (all figures final unless otherwise noted):

FY2017: (Requested) $14,281,600,000
FY2016: (Enacted) $13,248,600,000
FY2015: $9,596,800,000
FY2014: $8,825,100,000
FY2013: $7,888,600,000
FY2012: $7,848,300,000
FY2011: $7,659,700,000
FY2010: $7,544,500,000
FY2009: $7,208,700,000
FY2008: $6,725,100,000
FY2007: $6,493,900,000
FY2006: $6,229,400,000
FY2005: $6,151,700,000
FY2004: $5,906,400,000
FY2003: $5,229,900,000

"National Drug Control Budget: FY 2017 Funding Highlights" (Washington, DC: Executive Office of the President, Office of National Drug Control Policy), February 2016, Table 3, p. 19.
"National Drug Control Budget: FY 2015 Funding Highlights" (Washington, DC: Executive Office of the President, Office of National Drug Control Policy), March 2014, Table 3, p. 15.
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9. Unmet Need for Substance Use Treatment in the US

"NSDUH includes questions that are used to identify people who needed substance use treatment (i.e., treatment for problems related to the use of alcohol or illicit drugs) in the past year. For NSDUH, people are defined as needing substance use treatment if they had an SUD in the past year or if they received substance use treatment at a specialty facility32 in the past year.33,34
"In 2016, an estimated 21.0 million people aged 12 or older needed substance use treatment. Stated another way, about 1 in 13 people aged 12 or older (7.8 percent) needed substance use treatment (Figure 45).34 About 1.1 million adolescents aged 12 to 17 needed treatment for a substance use problem in the past year, representing 4.4 percent of adolescents. About 5.3 million young adults aged 18 to 25 needed treatment for a substance use problem in the past year, representing 15.5 percent of young adults. Stated another way, about 1 in 7 young adults needed substance use treatment. About 14.5 million adults aged 26 or older needed substance use treatment in the past year, which represents 6.9 percent of adults in this age group."

Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
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10. Likelihood of Dependence Among People Who Try Drugs

"Some 4.3 percent of Americans have been dependent on marijuana, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision(DSM-IV-TR; American Psychiatric Association,2000), at some time in their lives. Marijuana produces dependence less readily than most other illicit drugs. Some 9 percent of those who try marijuana develop dependence compared to, for example, 15 percent of people who try cocaine and 24 percent of those who try heroin. However, because so many people use marijuana,cannabis dependence is twice as prevalent as dependence on any other illicit psychoactive substance (cocaine, 1.8 percent; heroin, 0.7 percent; Anthony and Helzer,1991; Anthony, Warner, and Kessler, 1994)."

Budney, Alan J.; Roffman, Roger; Stephens, Robert S.; Walker, Denise, "Marijuana Dependence and Its Treatment," Addiction Science & Clinical Practice, Vol. 4, No. 1 (Rockville, MD: National Institute on Drug Abuse, December 2007), p. 5.
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11. Worldwide Treatment Need vs Availability

"Expressed in monetary terms, some US$ 200 billion-250 billion (0.3-0.4 per cent of global GDP) would be needed to cover all costs related to drug treatment worldwide. In reality, the actual amounts spent on treatment for drug abuse are far lower — and less than one in five persons who needs such treatment actually receives it."

UN Office on Drugs and Crime, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), p. 4.
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12. Estimated Worldwide Treatment Utilization and Unmet Treatment Need

"Globally, the extent to which people in need of drug treatment actually receive it remains limited. In 2016, as in previous years, an estimated one in six people who had drug use disorders received treatment. Despite limitations, information about people in treatment for drug use can provide useful insight into trends and geographical variations with respect to drug use disorders. However, this information should be interpreted with caution because treatment numbers reflect not only demand for treatment (the number of people seeking help) but also the extent of the provision of treatment (depending on government willingness to finance treatment services).

"Most people in drug treatment in Africa, the Americas and Oceania are being treated for cannabis use. In all regions except Africa, an increasing proportion of the drug treatment provided is related to cannabis use. Although cannabis has consistently been the most common drug of use among those receiving drug treatment in Africa, treatment for opioid use disorders is increasing in the region. This trend may be an indication that ongoing trafficking of heroin and pharmaceutical opioids in transit through Africa to other destinations has produced a worrying spillover effect on drug use within Africa. Opioids remain a major concern in Europe and Asia, especially in Eastern and South-Eastern Europe, where two of every three people in drug treatment are there for opioid use disorders.

"Cocaine continues to be a drug of concern among those receiving treatment in Latin America and the Caribbean, in particular, where one third of those in treatment for drug use disorders are being treated for cocaine use, although that proportion has been declining. Cocaine use disorders are reported as the primary reason for drug treatment, albeit to a lesser extent, in North America and Western and Central Europe as well. In North America, treatment primarily for cocaine use disorders has been declining in relative importance, while the proportion of those in treatment for opioid use disorders has increased. In the United States, between 2004 and 2014, the number of admissions related primarily to the use of cocaine declined by 65 per cent, from 248,000 to 88,000 individuals, and treatment for the use of opiates increased by 51 per cent, from 323,000 to 490,000 individuals. There is a higher proportion of treatment for the use of ATS in Asia and Oceania than in other regions."

World Drug Report 2018. United Nations publication, Sales No. E.18.XI.9.
https://www.unodc.org/wdr2018/
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13. Worldwide Treatment Need, by Substance, 2010

"It is estimated that 20 per cent of problem drug users in 2010 received treatment for their drug dependence. Opioids (largely heroin) continue to be the dominant drug type accounting for treatment demand in Asia and Europe (particularly in Eastern Europe and South-Eastern Europe, where they account for almost four out of every five drug users in treatment). Opioids also contribute considerably to demand for treatment in Africa, North America and Oceania. Only in South America is demand for treatment for opioid use negligible (accounting for 1 per cent of all demand for treatment for drug dependence in the region).
"Cannabis, the most widely consumed illicit drug world-wide, is considered to be the least harmful of the illicit drugs. Yet it is the dominant drug accounting for treatment demand in Africa, North America and Oceania, a major contributor to treatment demand in South America and the second most important contributor to such treatment in Europe.
"Treatment for cocaine use is largely associated with the Americas, particularly South America, where it accounts for nearly half of all treatment for illicit drug use, whereas in Asia, Eastern Europe, South-Eastern Europe and Oceania, the share of demand for treatment for drug use accounted for by cocaine use is negligible (less than 1 per cent).
"Demand for treatment for the use of ATS (mostly methamphetamine), is most noticeable in Asia where such drugs are the second major contributor to treatment demand, and to a lesser extent in Oceania, Western and Central Europe and North America."

UN Office on Drugs and Crime, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), pp. 15-16.
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14. Global Heroin Treatment Need and Overdose Deaths

"More than 60 per cent of drug treatment demand in Asia and Europe relate to opiates that are, especially heroin, the most deadly drugs. Deaths due to overdose are, in any single year, as high as 5,000-8,000 in Europe, and several times this amount in the Russian Federation alone."

United Nations Office on Drugs and Crime, "Addiction, Crime and Insurgency: The transnational threat of Afghan opium" (Vienna, Austria: October 2009, p. 7.
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15. Number of Treatment Programs in the US and Types of Treatment Provided

According to SAMHSA, "There was a net increase of 526 responding [substance abuse treatment] facilities between 2015 and 2016, to 14,399 facilities." (p. 11)

"The proportions of facilities offering the major types of care—outpatient, residential (non-hospital), and hospital inpatient—changed little between 2006 and 2016. Opioid treatment programs (OTPs), certified by SAMHSA, provide medication-assisted therapy with methadone, buprenorphine, and extended-release injectable naltrexone (Vivitrol®). Facilities with OTPs can be associated with any type of care. Facilities with OTPs made up 8 to 9 percent of all facilities between 2006 and 2016 [Table 2.4].

"• Outpatient treatment was provided by 80 to 82 percent of facilities during this period [Table 2.3].
"• Residential (non-hospital) treatment was provided by 28 percent in 2006 and 24 percent of facilities in 2016.
"• Hospital inpatient treatment was provided by 7 percent of facilities in 2006, decreasing to 5 percent of facilities in 2016.
"• Outpatient treatment was provided by 90 to 95 percent of OTP facilities from 2006 to 2016.
"• Residential (non-hospital) treatment was provided by 7 to 12 percent of OTP facilities from 2006 to 2016.
"• Hospital inpatient treatment was provided by 7 to 11 percent of OTP facilities from 2006 to 2016."

Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2016. Data on Substance Abuse Treatment Facilities. BHSIS Series S-93, HHS Publication No. (SMA) 17-5039. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, p. 11, p. 12.
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16. People in the US Receiving Substance Use Treatment, 2013

"• 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."

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, p. 93.
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17. Criminal Justice System Referrals to Treatment

"In 2007, the criminal justice system was the largest single source of referrals to the substance abuse treatment system, comprising 37 percent of all admissions in the Treatment Episode Data Set (TEDS) (approximately 670,500 of the 1.8 million admissions). Moreover, the majority of these referrals were from parole and probation offices (44 percent of criminal justice admissions where detailed criminal justice source information is known)."

The TEDS Report, "Substance Abuse Treatment Admissions Referred by the Criminal Justice System," Office of Applied Studies, SAMHSA (Arlington, VA: August 2009), p. 1.
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18. Treatment Admissions through Criminal Justice System Referral, by Substance

"Five primary substances of abuse accounted for 96 percent of all substance abuse treatment admissions in 2007: alcohol, opiates (including heroin and prescription painkillers), marijuana, cocaine, and methamphetamine. Criminal justice system referral admissions were more likely than all other referral admissions to report primary alcohol abuse, primary marijuana abuse, and primary methamphetamine abuse and less likely to report primary opiate abuse. The high rate of criminal justice system referral admissions younger than 18 years old may have contributed significantly to the high rate of admissions with marijuana as a primary substance of abuse."

The TEDS Report, "Substance Abuse Treatment Admissions Referred by the Criminal Justice System," Office of Applied Studies, SAMHSA (Arlington, VA: August 2009, p. 2.
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19. Marijuana-Involved Admissions to Treatment in the US, 1999-2009

"An admission [to treatment] was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. In 1999, 43 percent of all adolescent admissions were marijuana-involved admissions referred to treatment by the criminal justice system, and 39 percent were marijuana involved but referred by other sources. Between 1999 and 2002, the proportion referred by the criminal justice system increased to 45 percent while the proportion referred by other sources decreased to 37 percent. The proportions started to converge in 2007.
"Adolescent admissions not involving marijuana that were referred by the criminal justice system fell from 8 percent in 1999 to 5 percent in 2009. Admissions not involving marijuana that were referred from other sources were fairly stable, at between 9 and 11 percent of adolescent admissions."

Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). 1999 - 2009. National Admissions to Substance Abuse Treatment Services, DASIS Series: S-56, HHS Publication No. (SMA) 11-4646, Rockville, MD; Substance Abuse and Mental Health Services Administration, 2011, p. 29.
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20. Trends in Treatment Admissions of People For Whom Their Primary Drug was Heroin or Other Opiates

Heroin
"• Heroin was reported as the primary substance of abuse for 26 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].

"• Sixty-seven percent of primary heroin admissions were non-Hispanic White (41 percent were males and 26 percent were females). Non-Hispanic Blacks made up 14 percent (9 percent were males and 5 percent were females). Admissions of Puerto Rican origin made up 7 percent of primary heroin admissions (6 percent were males and 1 percent were females) [Table 2.3b]. See Chapter 3 for additional data on heroin admissions.

"• Injection was reported as the usual route of administration by 68 percent of primary heroin admissions; inhalation was reported by 25 percent. Daily heroin use was reported by 63 percent of primary heroin admissions [Table 2.4b].

"• Twenty-two percent of primary heroin admissions had no prior treatment episode, and 25 percent had been in treatment five or more times previously [Table 2.5b].

"• Primary heroin admissions were less likely than all admissions combined to be referred to treatment by the court/criminal justice system (14 vs. 30 percent) and more likely to be self or individually referred (61 vs. 41 percent) [Table 2.6b].

"• Medication-assisted opioid therapy was planned for 37 percent of heroin admissions [Table 2.7b].

"• Only 17 percent of primary heroin admissions aged 16 and older were employed (vs. 25 percent of all admissions that age); 45 percent were not in labor force (vs. 39 percent of all admissions that age) [Table 2.8b].

"• Sixty-one percent of primary heroin admissions reported abuse of additional substances. Marijuana/hashish was reported by 18 percent, alcohol by 14 percent, and non-smoked cocaine by 13 percent [Table 3.8].

Opiates Other than Heroin
"• Opiates other than heroin were reported as the primary substance of abuse for 8 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b]. These drugs include methadone, buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

"• Admissions for primary opiates other than heroin were more likely than all admissions combined to be aged 20 to 39 (74 vs. 58 percent) [Table 2.1b].

"• Non-Hispanic Whites made up approximately 82 percent of admissions for primary opiates other than heroin (43 percent were males and 39 percent were females) [Table 2.3b].

"• The usual route of administration most frequently reported by admissions of primary opiates other than heroin was oral (61 percent); next were inhalation (18 percent) and injection (16 percent) [Table 2.4b].

"• Admissions for primary opiates other than heroin were more likely than all admissions combined to report first use after age 18 (66 vs. 39 percent) [Table 2.5b].

"• Medication-assisted opioid therapy was planned for 31 percent of admissions for primary opiates other than heroin [Table 2.7b].

"• Fifty-eight percent of admissions for primary opiates other than heroin reported abuse of other substances. The most commonly reported secondary substances of abuse were marijuana/hashish (22 percent), alcohol (16 percent), and tranquilizers (12 percent) [Table 3.8]."

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2005-2015. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-91, HHS Publication No. (SMA) 17-5037. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, Table 1.1A, pp. 17-19.
https://www.samhsa.gov/data/si...

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