This report presents the first information from the 2004 National Survey on Drug Use and Health (NSDUH). This survey, formerly called the National Household Survey on Drug Abuse (NHSDA), is a project of the Substance Abuse and Mental Health Services Administration (SAMHSA). This survey was initiated in 1971 and is the primary source of information on the use of illicit drugs, alcohol, and tobacco by the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year.
Illicit Drug Use
In 2004, 19.1 million Americans, or 7.9 percent of the population aged 12 or older, were current illicit drug users. Current drug use means use of an illicit drug during the month prior to the survey interview.
The rate of illicit drug use among persons aged 12 or older in 2004 was similar to the rates in 2002 and 2003 (8.3 and 8.2 percent). Among youths aged 12 to 17, the rate declined between 2002 and 2004 (11.6 percent in 2002, 11.2 percent in 2003, and 10.6 percent in 2004).
Marijuana was the most commonly used illicit drug in 2004, with a rate of 6.1 percent (14.6 million current users). There were 2.0 million current cocaine users, 467,000 of whom used crack. Hallucinogens were used by 929,000 persons, and there were an estimated 166,000 heroin users. All of these estimates are similar to estimates for 2002 and 2003.
Between 2002 and 2004, past month marijuana use declined for male youths aged 12 to 17 (9.1 percent in 2002, 8.6 percent in 2003, and 8.1 percent in 2004), but it remained level for female youths (7.2, 7.2, and 7.1 percent, respectively) during the same time span.
The number of current users of Ecstasy had decreased between 2002 and 2003, from 676,000 to 470,000, but the number did not change between 2003 and 2004 (450,000).
In 2004, 6.0 million persons were current users of psychotherapeutic drugs taken nonmedically (2.5 percent). These include 4.4 million who used pain relievers, 1.6 million who used tranquilizers, 1.2 million who used stimulants, and 0.3 million who used sedatives. These estimates are all similar to the corresponding estimates for 2002 and 2003.
There were significant increases in the lifetime prevalence of use from 2003 to 2004 in several categories of pain relievers among those aged 18 to 25. Specific pain relievers with statistically significant increases in lifetime use were Vicodin®, Lortab®, or Lorcet® (from 15.0 to 16.5 percent); Percocet®, Percodan®, or Tylox® (from 7.8 to 8.7 percent); hydrocodone products (from 16.3 to 17.4 percent); OxyContin® (from 3.6 to 4.3 percent); and oxycodone products (from 8.9 to 10.1 percent).
Among youths aged 12 to 17, rates of current illicit drug use varied significantly by major racial/ethnic groups in 2004. The rate was highest among American Indian or Alaska Native youths (26.0 percent). Rates were 12.2 percent for youths reporting two or more races, 11.1 percent for white youths, 10.2 percent for Hispanic youths, 9.3 percent for black youths, and 6.0 percent for Asian youths.
In 2004, 19.2 percent of unemployed adults aged 18 or older were current illicit drug users compared with 8.0 percent of those employed full time and 10.3 percent of those employed part time. However, of the 16.4 million illicit drug users aged 18 or older in 2004, 12.3 million (75.2 percent) were employed either full or part time.
Alcohol Use
121 million Americans aged 12 or older were current drinkers of alcohol in 2004 (50.3 percent). 55 million (22.8 percent) participated in binge drinking, defined as five or more drinks on at least one occasion in the 30 days prior to the survey. 16.7 million (6.9 percent) were heavy drinkers, defined as binge drinking on 5 or more days in the past month. These numbers are all similar to the corresponding estimates for 2002 and 2003.
The highest prevalence of binge and heavy drinking in 2004 was for young adults aged 18 to 25 (41.2 and 15.1 percent, respectively). The peak rate of both measures occurred at age 21 (48.2 and 19.2 percent, respectively).
The rate of underage drinking remained the same in 2004 as in 2002 and 2003. About 10.8 million persons aged 12 to 20 reported drinking alcohol in the month prior to the survey interview in 2004 (28.7 percent of this age group). Of these, nearly 7.4 million (19.6 percent) were binge drinkers, and 2.4 million (6.3 percent) were heavy drinkers.
Among persons aged 12 to 20 in 2004, past month alcohol use rates were 16.4 percent among Asians, 19.1 percent among blacks, 24.3 percent among American Indians or Alaska Natives, 26.4 percent among those reporting two or more races, 26.6 percent among Hispanics, and 32.6 percent among whites.
Among pregnant women aged 15 to 44, 11.2 percent reported past month alcohol use and 4.5 percent reported past month binge drinking, based on combined 2003 and 2004 data.
32.5 million persons aged 12 or older in 2004 (13.5 percent) drove under the influence of alcohol at least once in the 12 months prior to the interview. This was similar to the rate in 2003.
Young adults aged 18 to 22 enrolled full time in college were more likely than their peers not enrolled full time (this category includes part-time college students and persons not enrolled in college) to use alcohol, binge drink, and drink heavily in 2004. Binge and heavy use rates for college students were 43.4 and 18.6 percent, respectively, compared with 39.4 and 13.5 percent, respectively, for other persons aged 18 to 22.
Tobacco Use
70.3 million Americans were current users of a tobacco product in 2004. This is 29.2 percent of the population aged 12 or older. 59.9 million (24.9 percent) smoked cigarettes, 13.7 million (5.7 percent) smoked cigars, 7.2 million (3.0 percent) used smokeless tobacco, and 1.8 million (0.8 percent) smoked tobacco in pipes.
The rate of tobacco use declined between 2002 and 2004, from 30.4 to 29.2 percent, primarily due to a decline in cigarette use from 26.0 to 24.9 percent. The rate of cigar use remained steady, but smokeless tobacco use dropped from 3.3 to 3.0 percent.
Young adults aged 18 to 25 continued to have the highest rate of past month cigarette use (39.5 percent). The rate did not change significantly between 2002 and 2004. The rate of cigarette use among youths aged 12 to 17 declined from 13.0 percent in 2002 to 11.9 percent in 2004.
A higher proportion of males than females aged 12 or older smoked cigarettes in 2004 (27.7 vs. 22.3 percent). Among youths aged 12 to 17, however, girls (12.5 percent) were more likely than boys (11.3 percent) to smoke.
Based on 2003 and 2004 data combined, 18.0 percent of pregnant women aged 15 to 44 smoked cigarettes in the past month compared with 30.0 percent of women in that age group who were not pregnant. However, among those aged 15 to 17, this pattern did not hold. The rate of cigarette smoking among pregnant women aged 15 to 17 was 26.0 percent compared with 19.6 percent among nonpregnant women of that age (not a statistically significant difference).
In completely rural nonmetropolitan counties, current cigarette use among persons aged 12 or older declined from 31.8 percent in 2002 to 22.8 percent in 2004.
Among the 93.4 million persons who had ever smoked cigarettes daily in their lifetime, nearly half (46.2 percent) had stopped smoking in 2004; that is, they did not smoke at all in the past 30 days. The remaining 53.8 percent were still current smokers.
Initiation of Substance Use (Incidence)
Based on a new approach to estimating incidence, the 2004 NSDUH shows that the illicit drug category with the largest number of new users was nonmedical use of pain relievers. 2.4 million persons used pain relievers nonmedically for the first time within the past 12 months. The average age at first use among these new initiates was 23.3 years.
In 2004, 2.1 million persons had used marijuana for the first time within the past 12 months. This estimate was not significantly different from the number in 2003 (2.0 million). The average age at first use among the 2.1 million recent marijuana initiates was 18.0 years. Most (63.8 percent) of the recent initiates were younger than age 18 when they first used.
In 2004, 4.4 million persons had used alcohol for the first time within the past 12 months. The number of alcohol initiates increased from 3.9 million in 2002 and 4.1 million in 2003. Most (86.9 percent) of the 4.4 million recent alcohol initiates in 2004 were younger than age 21 at the time of initiation.
The number of persons who smoked cigarettes for the first time within the past 12 months was 2.1 million in 2004, not significantly different from the estimates in 2002 (1.9 million) or 2003 (2.0 million). About two thirds of new smokers in 2004 were under the age of 18 when they first smoked cigarettes (67.8 percent).
Youth Prevention-Related Measures
The percentage of youths aged 12 to 17 indicating that smoking marijuana once a month was a great risk increased from 32.4 percent in 2002 to 34.9 percent in 2003, but did not change between 2003 and 2004 (35.0 percent). There were declines between 2003 and 2004 in the percentages of youths perceiving a great risk in using cocaine and heroin. Perceived risk of cigarette use increased between 2003 and 2004, but there was no change in the perceived risk of having four or five drinks of alcohol nearly every day or having five or more drinks once or twice a week.
The percentage of youths reporting that it would be easy to obtain marijuana declined between 2002 and 2003, from 55.0 to 53.6 percent, and again between 2003 and 2004, to 52.2 percent. The percentage of youths reporting that LSD would be easy to obtain also decreased between 2002 and 2004, from 19.4 to 16.9 percent, as did the perceived availability of heroin (15.8 to 14.0 percent).
Most youths (89.8 percent) reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice. Among these youths, only 5.1 percent had used marijuana in the past month. However, among youths who perceived that their parents would only somewhat disapprove or neither approve nor disapprove of their trying marijuana, 30.0 percent used marijuana.
Substance Dependence, Abuse, and Treatment
22.5 million Americans aged 12 or older in 2004 were classified with past year substance dependence or abuse (9.4 percent of the population), about the same number as in 2002 and 2003. Of these, 3.4 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.2 million were dependent on or abused alcohol but not illicit drugs.
In 2004, 19.9 percent of unemployed adults aged 18 or older were classified with dependence or abuse, while 10.5 percent of full-time employed adults and 11.9 percent of part-time employed adults were classified as such. However, most adults with substance dependence or abuse were employed either full or part time. Of the 20.3 million adults classified with dependence or abuse, 15.7 million (77.6 percent) were employed.
In 2004, 3.8 million people aged 12 or older (1.6 percent of the population) received treatment in the past 12 months for a drug or alcohol use problem. Of these, 2.3 million received treatment at a specialty facility for substance use treatment, including 1.7 million at a rehabilitation facility as an outpatient, 947,000 at a rehabilitation facility as an inpatient, 775,000 at a hospital as an inpatient, and 982,000 at a mental health center as an outpatient. Nonspecialty treatment locations were self-help groups (2.1 million persons), private doctor’s offices (490,000 persons), emergency rooms (453,000 persons), and prisons or jails (310,000 persons). (Note that the estimates of treatment by location include persons reporting more than one location.)
Persons dependent on or abusing a substance in the past 12 months, or who received specialty treatment for a substance use problem within the past 12 months, are classified as needing treatment. In 2004, the number of persons aged 12 or older needing treatment for an alcohol or illicit drug use problem was 23.48 million (9.8 percent). Of these, 2.33 million received treatment at a specialty facility in the past year. Thus, 21.15 million people needed but did not receive treatment at a specialty facility in 2004. The number needing but not receiving treatment did not change significantly from 2002 to 2004.
Of the 21.1 million people who needed but did not receive treatment in 2004, an estimated 1.2 million (5.8 percent) reported that they felt they needed treatment for their alcohol or drug use problem. Of the 1.2 million persons who felt they needed treatment, 441,000 (35.8 percent) reported that they made an effort but were unable to get treatment, and 792,000 (64.2 percent) reported making no effort to get treatment.
Among people who needed but did not receive treatment and felt they needed treatment for a substance use problem, the most often reported reasons for not receiving treatment were not ready to stop using (40.0 percent) and cost or insurance barriers (34.5 percent). However, among the people who made an effort but were unable to get treatment, 42.5 percent reported cost or insurance barriers, and only 25.3 percent reported that they were not ready to stop using. These results are based on 2003 and 2004 combined data.
The number of persons needing treatment for an illicit drug use problem in 2004 (8.1 million) was higher than the number needing treatment in 2003 (7.3 million); similarly, the number of persons receiving treatment for drug use at a specialty facility was higher in 2004 (1.4 million) than in 2003 (1.1 million). These 2004 estimates were similar to the corresponding estimates in 2002 (7.7 million needing treatment, 1.4 million receiving treatment).
6.6 million people needed but did not receive treatment for an illicit drug use problem in 2004. Of these, 598,000 (9.0 percent) felt they needed treatment. This number increased from 362,000 in 2002 and from 426,000 in 2003. Of the 598,000 persons who felt they needed treatment in 2004, 194,000 (32.4 percent) reported that they made an effort but were unable to get treatment, and 404,000 (67.6 percent) reported making no effort to get treatment.
Prevalence and Treatment of Mental Health Problems
In 2004, there were 35.1 million (14.7 percent) persons aged 12 or older who had at least one major depressive episode (MDE) in their lifetime. Of these, 19.3 million persons (8.1 percent of the population) had an MDE in the past 12 months, including 2.2 million youths aged 12 to 17 and 17.1 million adults aged 18 or older.
The past year prevalence of MDE was highest for persons aged 18 to 25 (10.1 percent) and lowest for those aged 26 or older (7.6 percent). The rate among youths aged 12 to 17 was 9.0 percent. Females were more likely than males to have MDE in the past year (10.6 vs. 5.5 percent).
Persons with past year MDE were more likely than those without MDE to have used an illicit drug in the past year (28.8 vs. 13.8 percent). Similarly, substance dependence or abuse was more prevalent among persons with MDE than among those without MDE (22.0 vs. 8.6 percent, respectively).
Among persons aged 12 or older with past year MDE, 62.3 percent received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression within the past 12 months.
While MDE estimates describe persons with a specific mental disorder, the survey also produces estimates of serious psychological distress (SPD), which describe persons with a high level of distress due to any type of mental problem. In 2004, there were 21.4 million adults aged 18 or older with SPD. This represents 9.9 percent of all adults, a rate that increased since 2002 when it was 8.3 percent.
SPD was highly correlated with substance dependence or abuse. Among adults with SPD in 2004, 21.3 percent (4.6 million) were dependent on or abused alcohol or illicit drugs, while the rate among adults without SPD was 7.9 percent.
Among the 21.4 million adults with SPD in 2004, 10.3 million, or 48.1 percent, received treatment for a mental health problem in the past year.
Among the 4.6 million adults with SPD and a substance use disorder in 2004, 47.5 percent (about 2.2 million) received treatment for mental health problems, and 11.0 percent (503,000) received specialty substance use treatment. Only 6.0 percent (274,000) received both types of treatment.
In 2004, 27.5 million adults (12.8 percent) received treatment for mental health problems in the past year. This estimate is similar to the estimates in 2002 and 2003.
The most prevalent type of treatment for mental health problems among adults in 2004 was prescription medication (10.5 percent of the population), followed by outpatient treatment (7.1 percent). 1.9 million adults (0.9 percent) received inpatient care for mental health problems at some time within the past 12 months.
In 2004, 5.7 million youths aged 12 to 17 (22.5 percent) received treatment or counseling for emotional or behavior problems in the year prior to the interview. This is higher than the estimates for 2002 (19.3 percent) and 2003 (20.6 percent).