Scope of the Problem

Key Points

• About 8.0 % of the U.S. population, or 20.1 million Americans, reported using illicit drugs in 2008.

• Marijuana has remained the most frequently used illicit drug in the United States.

• The prevalence of illicit drug use has been greatest in those 18 to 20 years of age.

• With the exception of hallucinogens such as "ecstasy," prevalence of drug use in teenagers age 12 to 17 has decreased since 2002.

• Illicit drug use is significantly higher among people with serious mental illness.

According to the 2008 Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health, an estimated 20.1 million Americans age 12 or older were current users of illicit drugs or reported having used an illicit substance 1 month before the survey. This represented 8.0% of the U.S. population. This rate has remained essentially stable since 2002. With an estimated 15.2 million current users, marijuana was the most frequently used illicit drug. Among people who used illicit drugs, marijuana was used by an estimated 75.7% of current illicit drug users. Following marijuana were nonmedical use of prescription psychotherapeutic drugs (6.2 million), cocaine (1.9 million), hallucinogens (1.1 million), and metham-phetamine (314,000).

The age group with the greatest prevalence of illicit substance abuse was individuals age 18 to 20, at 21.5%. Rates of illicit drug use among youths age 12 to 17 decreased from 11.6% in 2002 to 9.3% in 2008. The rate of substance abuse or dependence for males age 12 and older was almost twice as high as that for females (11.5% vs. 6.4%). However, males and females had similar rates of nonmedical use of psycho-therapeutic drugs, pain relievers, stimulants, and sedatives.

The prevalence of illicit drug use varies by race and ethnicity. Illicit substance use was highest among people reporting two or more races, at 14.1%. An estimated 10.1% of blacks, 9.5% of American Indians or Alaska Natives, 8.2% of whites, 7.3% of Native Hawaiians or other Pacific Islanders, 6.3% of Hispanics, and 3.6% of Asians were current illicit drug users in 2008. Illicit drug use also varies by education level. Among adults age 18 or older, the prevalence of current illicit drug use was 9.4% of adults with some college education, 8.1% of adults who did not complete high school, 8.6% of high school graduates, and 5.7% of college graduates. In 2008 an estimated 8000 people used an illicit substance for the first time each day. Most initiates were female and younger than 18. Between 2003 and 2008, the number of daily new

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preoccupation, compulsivity, physical dependence

Figure 51-1 Continuum of drug use in patients with substance use disorders. (Modified from Association for Medical Education and Research in Substance Abuse.)

preoccupation, compulsivity, physical dependence

Figure 51-1 Continuum of drug use in patients with substance use disorders. (Modified from Association for Medical Education and Research in Substance Abuse.)

Box 51-1 Diagnostic Criteria for Substance Abuse and Dependence (DSM IV)*

users of cocaine, psychotherapeutic drugs and inhalants had decreased. During the same 5-year interval, the number of people initiating use of hallucinogens, ecstasy, and LSD had increased significantly. Approximately, 19.6% of unemployed individuals age 18 and older were current illicit drug users. This was significantly higher than the prevalence of current drug use among individuals employed full time (8.0%) and part time (10.1%).

The prevalence of substance of abuse was also significantly higher among individuals with serious mental illness. Use of illicit drugs in the past year among adults age 18 or older with serious mental illness was 30.3%, whereas use among same-age adults without serious mental illness was 12.9%.

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