Current Trends in Substance Use and Dependence

Research Update

The following is a Research Update excerpt from the Butler Center for Research. Download the PDF to read the entire Update.

Population-based surveys are used to track the changing nature and extent of drug and alcohol abuse in the general population. Knowledge gained from these surveys directs research and health care efforts focused on resolving the issue of substance abuse and dependence. This Research Update presents an overview of current trends in substance use based on the most recent national data.

National Survey on Drug Use and Health

The NSDUH is a population-based survey used to assess substance use trends among non-institutionalized U.S. citizens aged 12 and older.1 The survey is conducted annually by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) through face-to-face interviews. Data collected from the survey are analyzed and included in an annual report that highlights prevalence rates of alcohol and illicit drug use and dependence.


Alcohol Use
For 2012 a sample of 68,309 U.S. citizens completed NSDUH surveys and from this sample estimates for the entire nation were calculated.1 Similar to previous years, approximately half of the respondents (51.1%) indicated they were a current alcohol drinker; translating into an estimated 135.5 million current drinkers in the United States. Of this 23% reported binge alcohol use (5 or more drinks on one occasion during the last 30 days), and 6.5% reported heavy alcohol use (5 or more drinks on the same occasion on each of five or more days in the last 30 days).

Alcohol Dependence
The NSDUH also collects data on prevalence rates of substance use disorders as classified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.4 The 2012 national estimates of substance dependence indicated that 8.5% of the population aged 12 years or older was diagnosed with a substance dependence disorder. Of that total, 13% were dependent on both alcohol and an illicit drug, 20% were dependent on illicit drugs alone, and 67% were diagnosed with alcohol dependence only.1

Drug Associated with First Illicit Drug Use among Initiates Aged 12 or Older

National trends suggest a strong relationship between age of initial alcohol use and the likelihood of alcohol dependence in adulthood. For example, those who initially tried alcohol at age 14 were seven times more likely to be diagnosed with alcohol dependence compared to adults who had their first drink at age 21 or older.1

Illicit Drugs

Illicit Drug Use
In 2012, an estimated 23.9 million (9.2%) Americans aged 12 years or older reported illicit drug use within the past year and historic trends indicate particularly large increases in heroin use. For example, between 2002 and 2012 the estimated number of heroin users increased from 166,000 to 335,000. Among the illicit drugs individuals reported using for the first time, marijuana was ranked number one (65.6%) followed by prescription pain relievers (17%).1

Age is also an important factor in illicit drug use. From 2002 to 2012 illicit drug use among 12-to 17-year-olds decreased from 11.6% to 9.5% while rates among 18- to 25-year-olds remained stable at approximately 20%. In contrast, rates of illicit substance use have increased from 3.4% to 7.2% in adults aged 50–59.1

Similar to previous years, the 2012 NSDUH report indicated that men were more likely than women to report using an illicit drug during the past month (11.6% vs. 6.9%). With respect to employment status, among adults (18 and older) those who were unemployed were approximately twice as likely to report illicit drug use compared to adults employed full-time (18.1% vs. 8.9%).

Illicit Drug Dependence
The number of individuals with past-year dependence on a specific drug was greatest for marijuana (4.3 million), followed by pain relievers (2.1 million), and then cocaine (1.1 million). The number of individuals with dependence on a pain reliever increased from 1.4 million in 2004 to 2.1 million in 2012. Similarly, the number of individuals with heroin dependence in 2012 rose to approximately twice the number reported in 2002 (467,000 vs. 214,000). In contrast, rates of marijuana dependence remained the same and cocaine dependence rates decreased in 2012.

The age of initial illicit drug use is an important predictor of subsequent drug dependence. Data from 2012 indicate that individuals who were 14 or younger when they first tried marijuana were six times more likely to have dependence on an illicit drug compared to those who reported first using marijuana at age 18 or older (prevalence rates = 13.2% vs. 2.2%). In 2012 substance dependence (illicit drugs and alcohol) among men was approximately twice that of women (11.5% vs. 5.7%); however, between the ages of 12 to 17, men and women were approximately equal in substance dependence rates. Employment status was also related to rates of illicit drug dependence in 2012 with higher rates reported among individuals who were unemployed compared to those employed full-time (16.9% vs. 9.1%).1

Treatment and Hospitalization Trends

Treatment Need
In 2012, an estimated 23.1 million people aged 12 or older were in need of treatment for substance dependence. Of this total, only 9.2% received treatment at a facility specializing in the treatment of substance dependence, 5.4% reported they did not feel the need for treatment, 31.3% indicated they made an effort to get treatment, and 38.2% stated a lack of insurance coverage and an inability to pay the cost as the primary reason for not attending treatment.2

Trends in Emergency Room Visits
The Drug Abuse Warning Network (DAWN) is a nationwide public health surveillance system that collects data on drug-related emergency room visits. Emergency room visits related to opiate/opioid use accounted for the largest proportion of drug-related visits in 2011 and has been on the increase since 2004. Between 2007 and 2011 the number of opiate/opioid related emergency room visits surpassed all other drugs.3

National Estimate of Drug-Related Emergency Room Visits 2004-2011 

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