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The National Survey on Drug Use and Health (NSDUH) generates state-level estimates for 23 measures of substance use and mental health problems for four age groups: the entire state population over the age of 12 (12+); individuals age 12 to 17; individuals age 18 to 25; and individuals age 26 and older (26+). Since state estimates of substance use and abuse were first generated using the combined 2002 2003 NSDUHs and continuing until the most recent state estimates based on the combined 2005 2006 surveys, Massachusetts has ranked among the 10 States with the highest rates of the following measures (Table 1):
|Past Month Illicit Drug Use||12-17, 18-25|
|Past Month Marijuana Use||12+, 12-17, 18-25|
|Past Year Marijuana Use||12+, 18-25|
|Least Amount of Perception of Risk Associated with Smoking Marijuana Once a Month||All Age Groups|
|Past Month Use of an Illicit Drug Other than Marijuana||18-25|
|Past Year Cocaine Use||12+, 18-25, 26+|
|Past Month Alcohol Use||26+|
|Least Perception of Risk Associated with Having Five or More Drinks of an Alcoholic Beverage Once or Twice a Week||12+, 12-17, 26+|
Abuse and Dependance
Questions in NSDUH are used to classify persons as being dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) (American Psychiatric Association, 1994).
Rates of past year drug dependence in Massachusetts have generally been above the national rates for all survey years, and among the group age 18 to 25 have consistently been amongthe highest in the country (Chart 1).
Rates of past year alcohol abuse have also generally been at or above the national rates, with the exception of the 12 to 17 age group which has generally been at or below the national rate (Chart 2).
Substance Abuse Treatment Facilities
According to the National Survey of Substance Abuse Treatment Services (N-SSATS),3 the number of treatment facilities in Massachusetts has decreased from 352 in 2002, to 312 in
2006. The most recent N-SSATS survey showed that the majority of facilities were private nonprofit (250 or 80%), and another 49 facilities (16%) were private for-profit. Although facilities may offer more than one modality of care, in 2006 the majority of facilities (207 or 66%) offered some form of outpatient treatment. An additional 127 facilities (41%) offered some form of residential care, 58 facilities offered an opioid treatment program, and 276 physicians and 73 treatment programs were certified to provide buprenorphine treatment for opiate addiction.
In 2006, 67 percent of all facilities (209) received some form of Federal, State, county, or local government funds, and 179 facilities (57%) had agreements or contracts with managed care organizations for the provision of substance abuse treatment services.
State treatment data for substance use disorders are derived from two primary sources'an annual one-day census in N-SSATS and annual treatment admissions from the Treatment Episode Data Set (TEDS).4 The 2006 N-SSATS survey showed that Massachusetts had an one-day total of 39,065 clients in treatment, the majority of whom (34,904 or 89%) were in outpatient treatment. Of the total number of clients in treatment on this date, 1,890 (5%) were under the age of 18.
Chart 3 shows the percent of admissions mentioning particular drugs or alcohol at the time of admission.5 Across the last 15 years, there has been a steady decline in the number of admissions mentioning alcohol (82% vs. 55%) and cocaine (48% vs. 33%). Concomitantly, there have been increases in the percent of admissions mentioning heroin (27% vs. 48%) and opiates other than heroin (2.4% vs. 13%).
Across the years for which TEDS data are available, Massachusetts has seen a substantial shift in the constellation of problems present at treatment admission (Chart 4). Alcohol-only admissions have declined from 29 percent of all admissions in 1992, to 19 percent in 2006. Concomitantly, drug-only admissions have increased from 18 percent in 1992, to 45 percent in 2006.
Unmet Need For Treatment
NSDUH defines unmet treatment need as an individual who meets the criteria for abuse of or dependence on illicit drugs or alcohol according to the DSM-IV, but who has not received specialty treatment for that problem in the past year.
Rates of unmet drug treatment need for all age groups and across all survey years have generally been above the national rates; however, the rates for the age group 18 to 25 have consistently been among the highest in the country (Chart 5).
Similarly, rates of unmet alcohol treatment need have been above the national rates for all age groups and across all survey years (Chart 6).