Health Indicator Report of Drug Use - Needed but Not Receiving Treatment - Adults (18+) (NSDUH)
Substance use disorders (SUDs) represent clinically significant impairment caused by the recurrent use of alcohol or illicit drugs (or both), including health problems, disability, and failure to meet major responsibilities at work, school, or home. The consequences of SUD can be costly to people and the nation as a whole because they are often associated with negative outcomes, such as involvement with the justice system, occurrence of chronic health conditions, and poorer health outcomes.^1^ The Substance Abuse and Mental Health Services Administration (SAMHSA) has established a working definition of recovery that defines recovery as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations. Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations. SAMHSA has delineated four major dimensions that support a life in recovery: * Health -- overcoming or managing one's disease(s) or symptoms -- for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem -- and, for everyone in recovery, making informed, healthy choices that support physical and emotional well-being * Home -- having a stable and safe place to live * Purpose -- conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society * Community -- having relationships and social networks that provide support, friendship, love, and hope.^6^ This indicator on needing but not receiving treatment is particularly useful for state infrastructure planning, budgeting and priority-setting.^7^ Government, health care and treatment providers need an accurate estimate of the demand for treatment of illicit drug use and its associated consequences. Policy-makers and treatment funders can use these estimates for resource allocation and to identify potential service gaps. In 2016, an estimated 19.9 million adults aged 18 or older and an estimated 5.3 million young adults aged 18 to 25 across the U.S. needed substance use treatment. These numbers represent about 1 in 12 adults aged 18 or older and 1 in 6 young adults aged 18 to 25. In 2016, approximately 2.1 million adults aged 18 or older who needed substance use treatment had received treatment at a specialty facility in the past year, representing 10.8% of the 19.9 million adults needing treatment. Approximately 383,000 young adults needing treatment had received treatment at a specialty facility, representing 7.2% of the 5.3 million needing treatment. Of the adults aged 18 or older who needed but did not receive treatment, 95.5% felt that they did not need treatment for their use of illicit drugs or alcohol, 2.6% felt that they needed treatment but did not make an effort to get treatment, and 2.0% felt that they needed treatment and tried to get treatment. Among the adults who tried to get treatment for their substance use and were unsuccessful, the top five reasons for not receiving treatment were not being ready to stop using (38.1%), having no health insurance or not being able to afford the cost of treatment (26.9%), not knowing where to go for treatment (19.1%), not being able to find a program that offered the type of treatment they wanted (14.4%), and concern over the negative opinion of neighbors or the community (13.5%). Understanding the demand for substance use treatment and the barriers encountered by those attempting to get treatment is important to build treatment capacity and improve accessibility, such that anyone seeking help for a substance use disorder can get treatment.^7^
Notes** = Data not available Data are from the [http://pdas.samhsa.gov/saes/state Interactive NSDUH State Estimates] for 2002-2003 through 2013-2014 and the [https://www.samhsa.gov/data/sites/default/files/NSDUHsaePercents2016/NSDUHsaePercents2016.pdf 2015-2016 National Survey on Drug Use and Health: Model-Based Prevalence Estimates (50 States and the District of Columbia] for the 2015-2016 period.
Data Source[https://www.samhsa.gov/data/population-data-nsduh National Survey on Drug Use and Health (NSDUH)], Substance Abuse and Mental Health Administration, U.S. Department of Health and Human Services.
Data Interpretation IssuesOccasionally, there are substantial changes in clinical diagnostic criteria that influence prevalence estimates. The most recent changes took place in 2013; a detailed report about this can be found here: [https://www.samhsa.gov/data/sites/default/files/NSDUH-DSM5ImpactAdultMI-2016.pdf] * NSDUH data are based on individual, self-report survey responses. Therefore the "need for illicit drug use treatment" is not defined by clinical observations. Rather, it is defined by applying diagnostic criteria to survey responses. Substance abuse disorder clinicians may offer a different opinion of individual cases, as a result NSDUH estimates may be an underestimation of actual prevalence. * Estimates derived from a small population should be interpreted with caution. Small increases or decreases in responses could dramatically influence the trend and comparative analysis of this indicator. This is especially important for Alaska's small population and warrants even closer scrutiny in sub-populations (regional reports, age groups, etc.). * This indicator may be more strongly influenced by stigmas associated with illegal drug use, as well as the illegal nature of the substances in question. Generally, individuals underreport stigmatized, criminal or immoral behaviors such as illicit drug use. ^2,3,4^ * Closely examine indicator definitions of "illicit" drugs to determine whether or not data of marijuana consumption is included. The NSDUH is a national-based survey and marijuana continues to be a federally illegal substance for recreational use. * Response rates in phone surveys have steadily declined due to changes in consumer technology (for example: caller ID allows potential survey takers to opt-out). Therefore, individual responses are self-selected to some degree.^5^
- Relevant Population Characteristics
- Risk Factors
- Drug Use - Cocaine - Adolescents (Grades 9-12)
- Drug Use - Cocaine - Adults (18+) (NSDUH)
- Drug Use - Illicit Drugs - Adults (Ages 18+) (NSDUH)
- Drug Use - Marijuana - Adolescents (Grades 9-12)
- Drug Use - Prescription Drug Abuse - Adolescents (Grades 9-12)
- Drug Use - Ecstasy - Adolescents (Grades 9-12)
- Drug Use - Heroin - Adults (18+) (NSDUH)
- Drug Use - Heroin - Adolescents (Grades 9-12)
- Drug Use - Inhalants - Adolescents (Grades 9-12)
- Drug Use - Marijuana - Adults (18+) (NSDUH)
- Drug Use - Methamphetamines - Adolescents (Grades 9-12)
- Health Status Outcomes
DefinitionThe percentage of adults [https://www.samhsa.gov/data/population-data-nsduh National Survey on Drug Use and Health (NSDUH)] classifies as needing substance use treatment if they meet the criteria for having a substance use disorder in the past year (based on symptoms they report) or if they received substance use treatment at a specialty facility in the past year.^1^
NumeratorWeighted number of adults (18+, 18-25, and 26+) [https://www.samhsa.gov/data/population-data-nsduh NSDUH] classifies as needing substance use treatment if they met the criteria for having a substance used disorder (SUD)^1^ in the past year (based on symptoms they report) or if they received substance use treatment at a specialty facility in the past year.
DenominatorWeighted number of adults (18+, 18-25, and 26+) with complete and valid responses for the questions on the NSDUH.
Healthy People Objective: Increase the proportion of persons who need alcohol and/or illicit drug treatment and received specialty treatment for abuse or dependence in the past year: Illicit drug treatmentU.S. Target: 17.6 percent
How Are We Doing?For all age groups (18+, 18 to 25, 26+), there has been no significant change in the percentage of Alaskan adults needing but not receiving treatment for substance use disorders from 2002 to 2016. Alaskans aged 18 to 25 consistently have the greatest burden of individuals needing but not receiving treatment, with 8.3% of Alaskans 18 to 25 needing but not receiving treatment during 2015-2016 compared to 3.3% of Alaskans 18 and older and 2.4% of Alaskans 26 and older. Results should be interpreted with caution, as this indicator reflects a small number of individuals in the population. When state treatment infrastructure matches the demand (need) for illicit drug use treatment, this indicator will go down over time. A downward trend could suggest a decrease in illicit drug use disorders and/or an increase in Alaska's capacity for treatment services. Suspected downward trends in illicit drug use for youth and adults should be confirmed with additional data sources, such as Alaska's [http://dhss.alaska.gov/dph/Chronic/Pages/yrbs/yrbs.aspx Youth Risk Behavior Survey (YRBS)], [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] results (respectively) and qualitative measures.
How Do We Compare With the U.S.?In Alaska, access to treatment faces significant geographic and technological challenges. Although there were no significant differences in the prevalence of unmet needs in 2015-2016 between Alaska adults (3.3%) and the U.S. average (2.5%), Alaska adults (18+) have generally had a higher prevalence of unmet treatment needs. Note: Individuals who do not have immediate access to substance use disorder treatment (and are placed on a waitlist) may choose not to wait for treatment and are under-represented on this indicator.
What Is Being Done?The Alaska Division of Behavioral Health awards funding to community-based and tribal substance use disorder treatment providers throughout the state. A complete list of residential and outpatient substance use disorder providers can be found [http://dhss.alaska.gov/dbh/Documents/TreatmentRecovery/FY18 SUD Res and OP Programs DRAFT 07.05.17.pdf HERE]. Additionally, the Alaska Department of Health & Social Services is working to expand and reform its Medicaid program to increase access to necessary treatment services. Medicaid expansion is associated with a reduction in unmet need for substance use disorder treatment for low-income adults.^6^ Updates on Medicaid redesign can be found here: [http://www.dhss.alaska.gov/HealthyAlaska/Pages/Redesign/Redesign_news.aspx].
Evidence-based PracticesThe Alaska Division of Behavioral Health strongly encourages substance use disorder treatment providers to implement evidence based practices and effective program models. More information and resources on this topic can be found on the Division's website here: [http://dhss.alaska.gov/dbh/Pages/Initiatives/EvidenceBasedPractices/docs_resources.aspx].
Page Content Updated On 07/16/2018, Published on 07/16/2018