Chapter 5
Topics of Special Interest

Adolescent Substance Abuse (Ages 12-17)
Heroin Admissions by Usual Route of Administration and Opioid Replacement Therapy
Polydrug Abuse
Racial/Ethnic Subgroups

This chapter highlights topics that are of current or special interest:

• Adolescent substance abuse
  TEDS data indicate a 16 percent overall increase in adolescent admissions for substance abuse treatment between 1995 and 2005, attributable primarily to increased admissions involving marijuana and increased referral to treatment through the criminal justice system.
  
  
• Heroin admissions by route of administration and medication-assisted opioid treatment
  TEDS data indicate that heroin injection has been a growing problem among young adults since the 1990s. Despite increases in the numbers of admissions for heroin abuse, there was a decline in the number for whom medication-assisted opioid therapy was planned.
  
  
• Polydrug abuse
  Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance.
  
  
• Racial/ethnic subgroups
  TEDS permits analysis of racial/ethnic subgroups that are generally poorly represented in sample surveys. Substance abuse patterns differed widely among racial/ethnic subgroups; however, alcohol was the predominant substance for all racial/ethnic groups except persons of Puerto Rican origin, where the predominant substance was heroin.

Adolescent Substance Abuse (Ages 12-17)

TEDS data indicate an overall increase in adolescent admissions aged 12 to 17 for substance abuse treatment between 1995 and 2005, attributable primarily to increased admissions involving marijuana and increased referral to treatment through the criminal justice system.

Tables 5.1a and 5.1b and Figure 27. There was a 16 percent net increase in the number of adolescents aged 12 to 17 admitted to substance abuse treatment between 1995 and 2005. However, this represented a 31 percent increase between 1995 and 2002, followed by an 11 percent decrease between 2002 and 2005. These changes were largely accounted for by changes in the number of adolescent primary marijuana admissions (a 59 percent increase from 1995 to 2002, followed by an 8 percent decrease between 2002 and 2005, for an overall increase of 47 percent between 1995 and 2005). In contrast, the proportion of adolescent primary marijuana admissions rose steadily, from 52 percent of adolescent admissions in 1995 to 65 percent in 2005.

The numbers of adolescent primary opiate, stimulant, and cocaine admissions also increased (by 92 percent, 79 percent, and 14 percent, respectively) from 1995 to 2005, but the proportion of adolescent admissions for stimulants represented only 6 percent of all adolescent admissions in 2005, while the proportions of adolescent admissions for cocaine and opiates were 3 percent and 2 percent, respectively.

Adolescent treatment admissions for primary alcohol abuse decreased over this time period. The proportion of adolescent primary alcohol admissions decreased from 31 percent in 1995 to 18 percent in 2005, as the number of adolescent alcohol admissions fell 31 percent.

Table 5.2a. Overall, 69 percent of adolescent admissions were male, a proportion heavily influenced by marijuana admissions, who where 75 percent were male. The proportions of adolescent female admissions were equal to or greater than those for adolescent males for methamphetamine/amphetamines (58 percent female) and for heroin (50 percent female). Females made up between 47 and 49 percent of admissions for smoked and non-smoked cocaine, tranquilizers, and sedatives.

Table 5.3a. In 2005, half (50 percent) of adolescent admissions were referred to treatment through the criminal justice system. Seventeen percent were self- or individual referrals, and 11 percent were referred through schools.

Figure 28. The number of adolescent admissions referred by the criminal justice system increased every year from 1995 to 2002, but declined in 2003 to 2005. Admissions from schools declined slightly between 1995 and 2005, while those from self- or individual referrals and other referral sources increased slightly.

Table 5.4. In 2005, 44 percent of all adolescent admissions involved the use of both alcohol and marijuana. The number of admissions involving both alcohol and marijuana remained unchanged between 1995 and 2005. Admissions involving primary marijuana and no alcohol increased by 97 percent. Over the same period, admissions involving primary alcohol and no marijuana declined by 29 percent.

Table 5.5a and Figure 29. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. Between 1995 and 2005, the number of marijuana-involved adolescent admissions increased by 62 percent for criminal justice referrals and were relatively stable for other referral sources, increasing by only 1 percent. The net increase in all marijuana-involved adolescent treatment admissions was 26 percent. In 1995, the number of marijuana-involved adolescent treatment admissions referred by the criminal justice system was 28 percent lower than the number referred by other sources. It increased every year from 1995 to 2002 and in 1998, marijuana-involved adolescent treatment admissions referred by the criminal justice system outnumbered admissions referred by other sources. Adolescent admissions not involving marijuana declined by 9 percent between 1995 and 2005; there was also a decrease of 4 percent in criminal justice referrals and a decrease of 11 percent in referrals from other sources.

Heroin Admissions by Usual Route of Administration and Planned Use of Medication-Assisted Opioid Therapy

TEDS data indicate that heroin injection has been a growing problem among young adults since the 1990s. Despite increases in the numbers of admissions for heroin abuse, there was a decline in the number receiving medication-assisted opioid therapy.

Tables 5.6a and 5.6b. Heroin admissions increased by 12 percent between 1995 and 2005. Increases of 42 percent in admissions for heroin inhalation and 8 percent in admissions for heroin injection were largely responsible. The proportion of heroin admissions represented by injection declined from 69 percent in 1995 to 63 percent in 2005. Heroin inhalation made up 33 percent of all heroin admissions in 2005, an increase from 27 percent in 1995.

Tables 5.6a, 5.6b, and Figure 30. The number of admissions for whom medication-assisted opioid therapy was planned did not keep pace with the increase in heroin admissions. While heroin admissions increased by 12 percent between 1995 and 2005, the number for whom medication-assisted opioid therapy was planned decreased by 26 percent. In 2005, medication-assisted opioid therapy was more likely to be planned for heroin smokers (33 percent) than for the much larger groups of injectors and inhalers (30 percent and 28 percent, respectively). Among admissions for heroin injection, planned use of medication-assisted opioid therapy fell by 41 percent between 1995 and 2005. The proportion of admissions for heroin inhalation for whom medication-assisted opioid therapy was planned declined slightly in 1996 and 1997 to 23 percent from 28 percent in 1995. The proportion increased to 32 percent in 1998, and remained stable between 28 percent to 32 percent through 2005.

Table 5.7b and Figure 31. Between 1995 and 2005, the proportion of admissions under age 30 decreased among heroin inhalers and increased among heroin injectors. Until the year 2000, heroin inhalers admitted to treatment tended to be younger than heroin injectors admitted to treatment. In 1995, 37 percent of admissions for inhalation were under 30 years of age, compared to 18 percent of those injecting heroin. By 2005, the proportion of those admitted for inhaling heroin who were under age 30 had fallen to 22 percent. The proportion admitted for injecting heroin who were under age 30 had increased to 36 percent. Among heroin smokers, the proportion under age 30 was 41 percent in 2005.

Table 5.7a. Among heroin abusers experiencing a first treatment episode in 2005, the average duration of use was 11 years for smoking, 12 years for injection, and 13 years for inhalation.

Polydrug Abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance.

Table 5.8 and Figure 32. Polydrug abuse was reported by 56 percent of all TEDS admissions in 2005. Alcohol, marijuana, and cocaine were the most commonly reported secondary and tertiary substances.

Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of most treatment admissions. Thirty-nine percent of all treatment admissions were for primary alcohol abuse, and 22 percent of admissions for other drugs reported that they also had an alcohol problem. Overall, 61 percent of all treatment admissions reported alcohol as a substance of abuse.

Alcohol and opiates were reported more often as primary substances than as secon­dary or tertiary substances. Twenty-three percent of all admissions involved opiate abuse, with 17 percent reporting primary abuse and 6 percent reporting secondary or tertiary abuse.

For marijuana and cocaine, more admissions reported these drugs as secondary or tertiary substances than as primary substances. Marijuana was reported as a primary substance by 16 percent of all admissions, but was a secondary or tertiary substance for another 21 percent, so that 37 percent of all treatment admissions reported marijuana as a substance of abuse. Cocaine was a primary substance for 14 percent of admissions, but was a secondary or tertiary substance for an additional 17 percent. Thus nearly one-third (31 percent) of all treatment admissions involved cocaine abuse.

Table 5.9. This table details the most common substance combinations for selected primary substances. For example, for primary alcohol admissions, 55 percent reported abuse of alcohol alone, 14 percent reported abuse of alcohol and marijuana but no other drugs, and 7 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.

Racial/Ethnic Subgroups

TEDS permits analysis of racial/ethnic subgroups that are generally poorly represented in sample surveys. Substance abuse patterns differed widely among racial/ethnic subgroups. Among Hispanics, substance abuse patterns differed according to country of origin. Patterns also differed between men and women within subgroups.

Table 3.3b and Figures 33-38. Among non-Hispanic Whites [Figure 33], alcohol as the primary substance accounted for 47 percent of male admissions and 34 percent of female admissions. Opiates and marijuana were the most frequently reported illicit drugs for non-Hispanic White men (16 per­cent and 15 percent, respectively), followed by stimulants and cocaine (9 percent each). For non-Hispanic White women, opiates were the primary illicit drug (20 percent), followed by stimulants (15 percent), and cocaine and marijuana (12 percent each).

Among non-Hispanic Blacks [Figure 34], 34 percent of male admissions used alcohol as the primary substance. Among non-Hispanic Black women, cocaine (36 percent) was more frequently reported as a primary substance than was alcohol (25 percent). Cocaine was the most commonly reported illicit substance for men (25 percent), followed by marijuana (23 percent) and opiates (14 percent). For women, other primary substances were opiates (18 percent) and marijuana (17 percent). Stimulants were reported by 1 percent each of non-Hispanic Black men and women.

Among persons of Mexican origin [Figure 35], alcohol was the primary substance involved in 43 percent of male admissions. Among women of Mexican origin, however, stimulants were more frequently reported as a primary substance than was alcohol (34 percent and 22 percent, respectively). Marijuana (18 percent) was the most commonly reported illicit substance for men, followed by stimulants and opiates (17 percent and 13 percent, respectively) and cocaine (7 percent). For women, other commonly reported primary substances were marijuana (15 percent), and opiates and cocaine (13 percent each).

Among persons of Puerto Rican origin [Figure 36], opiates were the main substances at treatment admission for both men and women (48 percent and 42 percent, respectively). Opiates were followed by alcohol for both men and women (27 percent and 21 percent, respectively). For men, other primary substances were marijuana (12 percent) and cocaine (10 percent). For women, other primary substances were cocaine (17 percent) and marijuana (13 percent). Admissions for stimulant use were 2 percent for women and 1 percent for men.

American Indians and Alaska Natives together accounted for 2 percent of all TEDS admissions [Table 3.1a]. Among American Indian/Alaska Native admissions, 64 percent of men and 47 percent of women entered treatment because of primary alcohol abuse [Figure 37]. Marijuana was the most frequently reported illicit substance for men (13 percent), followed by stimulants (7 percent), opiates (5 percent), and cocaine (4 percent). Stimulants were the most frequently reported illicit substances for women (16 percent), followed by marijuana (12 percent), opiates (10 percent), and cocaine (8 percent).

Asians and Pacific Islanders accounted for just under 1 percent of all TEDS admissions [Table 3.1a]. Among this group [Figure 38], alcohol was the primary substance involved in 36 percent of male admissions. Among women, however, stimulants were more frequently reported as a primary substance than was alcohol Asians and Pacific Islanders accounted for 1 percent of all TEDS admissions [Table 3.1a]. Among this group [Figure 38], alcohol was the primary substance involved in 35 percent of male admissions. Among women, however, stimulants were more frequently reported as a primary substance than was alcohol (35 percent and 26 percent, respectively). Stimulants and marijuana were the most commonly reported illicit drugs for men (26 percent and 20 percent, respectively), followed by opiates (9 percent) and cocaine (7 percent). For women, other commonly reported primary substances were marijuana (16 percent), opiates (10 percent), and cocaine (7 percent).

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