National Household Survey On Drug Abuse Research Articles

A new methodological approach to adjust alcohol exposure distributions to improve the estimation of alcohol-attributable fractions.

To assess the burden of excessive alcohol use, researchers estimate alcohol-attributable fractions (AAFs) routinely. However, under-reporting in survey data can bias these estimates. We present an approach that adjusts for under-reporting in the estimation of AAFs, particularly within subgroups. This framework is a refinement of a previous method conducted by Rehm et al. We use a measurement error model to derive the 'true' alcohol distribution from a 'reported' alcohol distribution. The 'true' distribution leverages per-capita sales data to identify the distribution average and then identifies the shape of the distribution with self-reported survey data. Data are from the National Alcohol Survey (NAS), the National Household Survey on Drug Abuse (NHSDA) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We compared our approach with previous approaches by estimating the AAF of female breast cancer cases. Compared with Rehm et al.'s approach, our refinement performs similarly under a gamma assumption. For example, among females aged 18-25years, the two approaches produce estimates from NHSDA that are within a percentage point. However, relaxing the gamma assumption generally produces more conservative evidence. For example, among females aged 18-25years, estimates from NHSDA based on the best-fitting distribution are only 19.33% of breast cancer cases, which is a much smaller proportion than the gamma-based estimates of approximately 28%. A refinement of Rehm et al.'s approach to adjusting for underreporting in the estimation of alcohol-attributable fractions provides more flexibility. This flexibility can avoid biases associated with failing to account for the underlying differences in alcohol consumption patterns across different study populations. Comparisons of our refinement with Rehm et al.'s approach show that results are similar when a gamma distribution is assumed. However, results are appreciably lower when the best-fitting distribution is chosen versus gamma-based results.

Mental Health Service Use Among Suicidal Adolescents: Findings From a U.S. National Community Survey

This study assessed patterns of mental health service use among adolescents who had attempted suicide and examined factors associated with their service use at individual, family, and community levels. Bivariate and multiple logistic regression analyses were conducted with data from 877 adolescents aged 12-17 who had attempted suicide in the past 12 months and who participated in the 2000 National Household Survey on Drug Abuse. Of the 877 adolescents, less than half (45%) reported that they had used mental health services in the past 12 months. Adolescents from racial-ethnic minority groups were less likely than whites to receive inpatient or outpatient mental health treatment, even when the analyses controlled for other demographic, individual, and family and community characteristics. Poor self-perceived health and living in a single-parent family were associated with use of inpatient services. Female gender, higher family income, participation in extracurricular activities, and the presence of symptoms of anxiety or disruptive disorders were associated with use of outpatient services. Use of school-based mental health services was associated only with participation in extracurricular activities. The mental health service needs of suicidal adolescents, especially those from ethnic minority groups and lower-income families, too frequently remain unmet. Larger racial-ethnic disparities were found in use of inpatient and outpatient mental health services than in use of school-based services. Mental health services offered within school settings can reach suicidal adolescents who need services but may experience barriers to standard types of care.

Mental Health Services Use and Symptom Prevalence in a Cohort of Adults on Probation

This study examined the prevalence of mental disorder symptoms among adult probationers and the probability of mental health service use. Data from the 2001 National Household Survey on Drug Abuse were used to obtain information on adults reporting mental disorder symptoms who had been on probation within the past year and those who had not. Twenty-seven percent of probationers (N=311 of 1,168) and 17% of nonprobationers (N=5,830 of 34,230) had mental disorder symptoms. Mental health service use was reported by 23% of both groups. Compared with persons who had not been on probation, probationers were more likely to report psychosis, mania, and posttraumatic stress disorder; both groups were as likely to report depression. The prevalence of mental disorder symptoms did not differ by probation status. However, the type and distribution of symptoms were significantly different in the two groups. These are important considerations when planning for service connection with mental health providers.

Mental Health Services Use and Symptom Prevalence in a Cohort of Adults on Probation

Mental Health Services Use and Symptom Prevalence in a Cohort of Adults on Probation

Drinking Level, Neighborhood Social Disorder, and Mutual Intimate Partner Violence

Intimate partner violence (IPV) remains a significant public health problem. The purpose of this study is to assess the contribution of drinking patterns to risk for mutual IPV among married/cohabiting adults in the general population, and to determine if the association between drinking level and mutual IPV varies by level of neighborhood social disorder. The study sample consists of 19,035 non-Hispanic black, Hispanic, and non-Hispanic white married/cohabiting adults who participated in the 2000 National Household Survey on Drug Abuse (NHSDA), and whose responses were available through the NHSDA public use file. Gender-specific multivariate logistic regression models of mutual IPV were developed to assess the association between drinking level and mutual IPV, and to test whether these associations vary by neighborhood social disorder. Compared with men who are abstainers, men who are past-30 day heavy drinkers are at a more than 6-fold increased risk for mutual IPV. Men in less hazardous drinking categories are at a 2- to 3-fold increased risk of mutual IPV. Neighborhood disorder is independently associated with men's risk for mutual IPV (odds ratio=1.61). Except for women in the most hazardous drinking category, neighborhood disorder moderates the association between women's drinking level and risk of mutual IPV such that risk for mutual IPV significantly increases under conditions of high neighborhood disorder, and decreases to insignificant risk under conditions of low neighborhood disorder. Compared with abstainers, women who are past-30 day heavy drinkers are at an approximate 6-fold risk for mutual IPV regardless of level of neighborhood disorder. Drinking level and neighborhood characteristics should be taken into account when assessing risk for mutual IPV among married/cohabiting men and women in the general population. An environmental approach to IPV prevention and intervention which addresses the neighborhood context in which couples reside may be a promising strategy for reducing IPV occurrence.

Who is becoming hallucinogen dependent soon after hallucinogen use starts?

This study, based upon epidemiological survey data from the United States (U.S.) National Household Surveys on Drug Abuse (NHSDA) from 2000 to 2001, presents new estimates for the risk of developing a hallucinogen dependence syndrome within 24 months after first use of any hallucinogen (median elapsed time ∼12 months). Subgroup variations in risk of becoming hallucinogen dependent also are explored. Estimates are derived from the NHSDA representative samples of non-institutionalized U.S. residents ages 12 and older ( n = 114,241). A total of 2035 respondents had used hallucinogens for the first time within 24 months prior to assessment. An estimated 2–3% of these recent-onset hallucinogen users had become dependent on hallucinogens, according to the NHSDA DSM-IV computerized diagnostic algorithm. Controlling for sociodemographic and other drug use covariates, very early first use of hallucinogens (age 10–11 years) is associated with increased risk of hallucinogen dependence ( p < 0.01). Excess risk of developing hallucinogen dependence was found in association with recent-onset use of mescaline; excess risk also was found for recent-onset users of ecstasy and of PCP. This study's evidence is consistent with prior evidence on a tangible but quite infrequent dependence syndrome soon after the start of hallucinogen use; it offers leads that can be confirmed or disconfirmed in future investigations.

Workplace Drug Testing and Worker Drug Use

To examine the nature and extent of the association between workplace drug testing and worker drug use. Repeated cross-sections from the 2000 to 2001 National Household Surveys on Drug Abuse (NHSDA) and the 2002 National Survey on Drug Use and Health (NSDUH). Multivariate logistic regression models of the likelihood of marijuana use are estimated as a function of several different workplace drug policies, including drug testing. Specific questions about penalty severity and the likelihood of detection are used to further evaluate the nature of the association. Individuals whose employers perform drug tests are significantly less likely to report past month marijuana use, even after controlling for a wide array of worker and job characteristics. However, large negative associations are also found for variables indicating whether a firm has drug education, an employee assistance program, or a simple written policy about substance use. Accounting for these other workplace characteristics reduces-but does not eliminate-the testing differential. Frequent testing and severe penalties reduce the likelihood that workers use marijuana. Previous studies have interpreted the large negative correlation between workplace drug testing and employee substance use as representing a causal deterrent effect of drug testing. Our results using more comprehensive data suggest that these estimates have been slightly overstated due to omitted variables bias. The overall pattern of results remains largely consistent with the hypothesis that workplace drug testing deters worker drug use.

Evidence for a hallucinogen dependence syndrome developing soon after onset of hallucinogen use during adolescence

This study uses latent class methods and multiple regression to shed light on hypothesized hallucinogen dependence syndromes experienced by young people who have recently initiated hallucinogen use. It explores possible variation in risk. The study sample, identified within public-use data files of the 1999 National Household Survey on Drug Abuse (NHSDA), consists of 1186 recent-onset hallucinogen users, defined as having initiated hallucinogen use within 24 months of assessment (median elapsed time since onset of use -12 to 13 months). The recent-onset users in this sample were age 12 to 21 at the time of assessment and were between the ages of 10 and 21 at the time of their first hallucinogen use. The NHSDA included items to assess seven clinical features often associated with hallucinogen dependence, which were used in latent class modelling. Latent class analysis, in conjunction with prior theory, supports a three-class solution, with 2% of recent-onset users in a class that resembles a hallucinogen dependence syndrome, whereas 88% expressed few or no clinical features of dependence. The remaining 10% may reflect users who are at risk for dependence or in an early stage of dependence. Results from latent class regressions indicate that susceptibility to rapid transition from first hallucinogen use to onset of this hallucinogen dependence syndrome might be influenced by hallucinogenic compounds taken (for example, estimated relative risk, RR = 2.4, 95% CI = 1.6, 7.6 for users of MDMA versus users of LSD). Excess risk of rapid transition did not appear to depend upon age, sex, or race/ethnicity.

Trends in Initiation of Alcohol Use in the United States 1975 to 2003

Alcohol is the drug of choice for youth in the United States. By 8th grade, more than 40% of youth have used alcohol; by 12th grade, almost 80% have done so (MTF, 2003). And many of these young people begin drinking at relatively early ages. On average, boys start drinking earlier than girls, and whites and Native Americans start drinking earlier than youth of other race/ethnicities. As alcohol consumption is such a high prevalence behavior among young people, it is crucial to understand the initiation of drinking as well as possible, so as to facilitate and inform interventions to delay this behavior. One facet of this involves investigating trends in the initiation of drinking. Multiple years of data from 3 national surveys, Monitoring the Future (MTF)-1975 to 2003 for 12th graders, 1993 to 2003 for 8th and 10th graders; the National Household Survey on Drug Abuse (NHSDA) [now called the National Survey on Drug Use and Health (NSDUH)]-1991 to 1998; and the Youth Risk Behavior Surveillance System (YRBSS)-1991 to 2003, were analyzed using joinpoint analysis to further understanding of trends in the initiation of drinking by youth. The present analysis examines whether the age of drinking initiation has changed over time and evaluates trends in the percentages of youth who start drinking by various grades. Simultaneous examination of data from the 3 surveys indicates that 7th and 8th grades (when most youth are 13-14) are peak years for the initiation of drinking. Further, the present analysis shows that although the percentage of youth who start drinking early (before age 13) has declined (YRBSS, MTF), the average age of initiation of drinking for these "very early starters" did not change over the period 1991 to 1998 (NHSDA/NSDUH). At the same time, an upward shift in the "normative" age of initiation has occurred (NHSDA/NSDUH, MTF). Results of analyses by gender and race/ethnicity indicate similar trends over time. A more nuanced understanding of the initiation of drinking can have important implications for prevention.

Is there epidemiological evidence to support the idea that a cocaine dependence syndrome emerges soon after onset of cocaine use?

The present study uses latent class methods and multiple regression to shed light on hypothesized cocaine dependence syndromes experienced by community residents, who initiated cocaine use within 24 months of survey assessment, and explores possible variation in risk. Identified within public use data files from the United States National Household Surveys on Drug Abuse (NHSDA), and with assessments completed between 1995 and 1998, the study sample consists of 927 recent-onset cocaine users, defined as having initiated cocaine use no more than 24 months prior to assessment (approximate median elapsed time since onset of use approximately 12-13 months). The NHSDA included items to assess seven clinical features often associated with cocaine dependence, which were used in latent class modeling. Empirically derived latent classes, in conjunction with prior theory, tend to support a three-class solution, according to which 4% of recent-onset users are members of a class that resembles the DSM-IV cocaine dependence syndrome (mean: 5.4 clinical features (CF)); 16% might be in a cocaine dependence prodrome (mean: 2.4 CF); 80% of recent-onset cocaine users had few or no clinical features (mean<1 CF). Results from latent class regressions indicate that susceptibility to rapid transition from first cocaine use to onset of the LCA-assigned cocaine dependence syndrome might depend upon whether the user starts smoking crack-cocaine and, independently, age at first cocaine use.

The Impact of Adult Roles on Drinking Among Women in the United States

This paper examines the impact of three adult roles—spouse, parent, and worker—on psychological distress and drinking among a national sample of 10,193 women in the United States, using the 1992 National Household Survey on Drug Abuse (NHSDA). We found that the spouse and worker roles are negatively associated with the level of psychological distress, and the parent role is positively correlated with it. Controlling for level of psychological distress, those workers generally are more likely to be drinkers, but, among drinkers, they do not consume alcoholic beverages more than non-workers. The family roles do not affect a woman's likelihood of being a drinker. However, among the drinkers, being a spouse or a parent is negatively related with level of alcohol consumption. Separating three aspects of drinking behavior—whether a woman drinks at all and, if she drinks, her levels of alcohol consumption and problem drinking—our findings suggest that drinking is not a unidimensional construct. A woman's roles influence various dimensions of her drinking differently.

The differential impact of incentives on refusals: Results from the 2001 national household survey on drug abuse incentive experiment

Research has demonstrated that cash incentives paid to respondents in sample surveys can increase the level of cooperation, reduce non-response bias, and lower data collection costs. However, recent research has shown that gains in response rate and reduced data collection costs associated with monetary incentives may vary across sub-groups in the population. Consequently, monetary incentives may result in inconsistent reductions in non-response error and systemic changes in sample composition. This paper describes an incentive experiment conducted as part of the 2001 National Household Survey on Drug Abuse (NHSDA), and evaluates the impact of monetary incentives on measures of cooperation for different population sub-groups. Findings indicate that the incentive had a positive impact on cooperation. Furthermore, the incentive neither introduced additional differences in cooperation propensities, nor did it eliminate the pre-existing differences in cooperation among population sub-groups.

Unhealthy weight control behaviors and MDMA (Ecstasy) use among adolescent females

Purpose To estimate the prevalence of past year laxative use or vomiting weight control behaviors among adolescent females in the general population and to examine the relationship between these behaviors and substance use among adolescent females, with a specific focus on past year 3–4 methylenedioxymethamphetamine (MDMA) (“Ecstasy”) use. Methods Secondary analyses were conducted using a nationally representative sample of females aged 12 to 17 years (n = 4292) from the 2001 National Household Survey on Drug Abuse (NHSDA). Logistic regression was used to examine bivariate relationships between past year laxative use or vomiting weight control behaviors and substance use and the multivariate relationship between unhealthy weight control behaviors and Ecstasy use. Results Approximately 10% of adolescent females had used laxatives or vomited to lose weight in the past year. Adolescent females who had used laxatives or vomited to lose weight in the past year were more likely than those who had not to have used substances during the past year, including Ecstasy, inhalants, nonmedical psychotherapeutics, marijuana, cigarettes, and alcohol. After controlling for demographics and other substance use, past year laxative use or vomiting weight control behaviors were positively associated with past year Ecstasy use (OR = 1.81; 95% CI = 1.05, 3.14; p = 0.04). Conclusion Laxative use or vomiting weight control behaviors are a significant problem among the general population of adolescent females and are related to an increased risk of Ecstasy use.

Forward telescoping bias in reported age of onset: an example from cigarette smoking

Age at the onset of a disorder is one of its key descriptive characteristics. Early onset may indicate increased risk of a severe course and increased genetic liability. However, retrospectively reported onset in surveys is subject to forward telescoping, a bias in which respondents report events closer to the time of interview than is true. We examined the effect of this bias on age of onset for smoking initiation and daily smoking. Data came from the 1966-77 birth cohorts interviewed in the cross-sectional National Household Surveys on Drug Abuse (NHDSA) 1979-98 (N = 82,122). An association between age at onset and age at interview, within birth year, was found for experimenters and for daily smokers. This was indicative of forward telescoping. As age at interview increased from 12 to 25 the probability of reporting early onset dropped by half. An association was also found between early onset of daily smoking and age at interview. This response bias differed significantly by sex and race, created significant misclassification of smokers as late instead of early onset cases, and biased cohort comparisons from cross-sectional data. These results suggest efforts need to be made to limit the effect of forward telescoping in epidemiological studies by survey question and sampling design.

Ethnic Differences in Relationships Between Risk Factors and Adolescent Binge Drinking: A National Study

This study examines ethnic differences in relationships between a large number of risk factors and adolescent binge drinking with data collected from 14 to 17 year olds who participated in the 1999 National Household Survey on Drug Abuse (NHSDA). Logistic regression analyses were conducted to determine whether 39 risk factors in community, family, school, and peer-individual domains were differentially associated with past-30-day binge drinking among youth in ethnic minority groups (black, Hispanic and Asian) relative to whites. Forty-three percent (17) of the risk factors examined were differentially associated with binge drinking in at least one of the ethnic groups relative to whites. Most of these risk factors were more strongly associated with binge drinking among white adolescents than Hispanic and black youth, but not Asians. The direction of the relationships between these risk factors and binge drinking, however, was usually the same for whites and ethnic minority groups. A multivariate prediction model indicated that risk factors in the community, family, school, and peer-individual domains accounted for 27% of the variance in binge drinking for white adolescents, 22% for Hispanics, 10% for blacks, and 39% for Asians. These findings suggest that research is needed to identify additional risk factors that are associated with binge drinking among adolescents, particularly blacks, Hispanics and possibly other ethnic minority groups.

Detecting Serious Mental Illness Among Substance Abusers

Serious mental illnesses (SMIs) commonly co-occur with substance-use disorders and, if undetected and untreated, adversely affect their clinical course. This paper describes the use and scoring of the K6 scale, a brief and valid screening tool for SMI, in a large general population sample derived from the 2001 National Household Survey on Drug Abuse (NHSDA). Analyses examine the demographic characteristics and patterns of substance use disorders among persons with and without a co-occurring SMI.

Criminal Involvement Among Young Male Ecstasy Users

Ecstasy (MDMA) use increased rapidly in the U.S. between about 1995 and 2001. Most research on the drug focused on its psychopharmacological and public health contexts. Previous research on drugs-crime linkages suggests that there may have been a concommitant rise in ecstasy-related crimes. We explore this dimension here using data from 7794 arrested men, age 16 to 25, in the 2001 Arrestee Drug Abuse Monitoring (ADAM) sample and 9764 male respondents of similar age in the 2001 National Household Survey on Drug Abuse (NHSDA). Our results using a variety of bivariate and regression methods indicate that ecstasy use is less prevalent among young male arrestees than young men in general and that ecstasy use among arrestees is positively associated with various measures of drug market participation but negatively related to violent and property offenses. We recommend further investigation of ecstasy use in drug-oriented data sets and longitudinal studies to evaluate the link between ecstasy use and overall drug marketing.

Most smokeless tobacco use does not cause cigarette smoking: Results from the 2000 National Household Survey on Drug Abuse

Those who either never progress from smokeless tobacco (SLT) to smoking or smoked before using SLT logically cannot have smoking caused by SLT use. The prevalence of such use permits strong inferences about the overall importance of the potential causal effects of SLT on cigarette smoking. We found that the majority of SLT ever users (66%) in the 2000 National Household Survey on Drug Abuse (NHSDA) were noncausal users. For these individuals, SLT use cannot have caused them to smoke. We also compared our results in 2000 with a similar sample in 1987, using current SLT users only. Potentially, the causal uses of SLT were in the minority and had not increased significantly over time (24% in 1987 to 29% in 2000, P>.05). Logistic models showed that, when noncausal users were removed, SLT was a minor predictor of current smoking. This is likely due to linked experimentation. We argue that that the majority of SLT use cannot cause smoking, such that SLT effects on smoking initiation are minimal at best. Policy implications of these findings are discussed.

An improved method for predicting which heavy drinkers become intoxicated.

Not all heavy drinkers become intoxicated. We sought to improve predictability of intoxication of heavy drinkers. Based on criteria for heavy drinking in the National Household Survey on Drug Abuse (NHSDA), we identified characteristics related to heavy drinking. We then created a dichotomous heavy drinker typology variable (yes/no) and determined how well we were able to identify drinkers who became intoxicated at least twice a month. Of those who fit this heavy drinking profile, 54% drank regularly to the point of intoxication, the same percent as those who become intoxicated in the self-reported heavy drinking group. However, 77% of those who fit both the profile and were self-described heavy drinkers, drank regularly to intoxication. We concluded that a demographic typology combined with self-reported drinking improves predictability of intoxication in heavy drinkers, and is a promising direction for research.

Datapoints: adolescents with substance abuse: are health plans missing them?

Back to table of contents Previous article Next article ColumnsFull AccessDatapoints: Adolescents With Substance Abuse: Are Health Plans Missing Them?Margaret T. Lee, Ph.D., Deborah W. Garnick, Sc.D., Kay Miller, B.A., and Constance M. Horgan, Sc.D.Margaret T. LeeSearch for more papers by this author, Ph.D., Deborah W. GarnickSearch for more papers by this author, Sc.D., Kay MillerSearch for more papers by this author, B.A., and Constance M. HorganSearch for more papers by this author, Sc.D.Published Online:1 Feb 2004https://doi.org/10.1176/appi.ps.55.2.116AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This column examines whether health plans are adequately identifying adolescents with substance use problems. Three measures developed by the Washington Circle, a group focused on the development of substance abuse performance measures (1,2) (www.washingtoncircle.org), have been adapted for the 2004 Health Plan Employer Data and Information Set (www.ncqa.org). One measure—the identification rate—can be used to examine the extent to which private health plans are able to identify adolescent enrollees with substance use problems.We calculated this rate for adolescents using MarketScan, a database of private health plan claims for selected employers maintained by the MEDSTAT Group. About a quarter million adolescents were covered in 1997. The number of adolescents with any primary or secondary substance abuse claims during the year was divided by the member-years for adolescents aged 12 to 18.For enrolled adolescents, the overall identification rate was .5 percent (Figure 1)—.7 percent for males and .4 percent for females. We compared these results to the 6.8 percent rate of alcohol dependence or drug dependence—or both—obtained from a special analysis of a subset of adolescents covered by commercial insurance who were included in the 1998 National Household Survey on Drug Abuse (Harwood H, personal communication, July 2001). No meaningful variation was observed across health plan type.Several factors may contribute to the low rate. Primary care or other providers may fail to identify substance abuse because they lack adequate training in or incentives for screening and diagnosis. Stigma associated with the use of drugs or legal issues may make providers reluctant to record adolescents' substance abuse diagnoses.The low rate points to the urgent need to close the gap between the number of adolescents who need treatment and those who receive it. Steps needed include better training for primary care practitioners in recognition, early intervention, and referral. By making health plans accountable for identifying adolescents and for getting them into treatment quickly, a clear incentive is introduced for greater case finding.AcknowledgmentsThis research was supported by the Substance Abuse and Mental Health Services Administration and grant 5 P50 DA 10233 from the National Institute on Drug Abuse to the Brandeis/Harvard Center for Managed Care and Drug Abuse. The authors thank Mady Chalk, Ph.D., Sarah Wattenberg, L.C.S.W.-C., Frank McCorry, Ph.D., Doreen Cavanaugh, Ph.D., Pat Harrison, Ph.D., and Connie Weisner, Dr.P.H.Dr. Lee, Dr. Garnick, and Dr. Horgan are affiliated with the Schneider Institute for Health Policy of the Heller School for Social Policy and Management at Brandeis University 415 South Street, MS 035, Waltham, Massachusetts 02454-9110 (e-mail, [email protected]). Ms. Miller is with the MEDSTAT Group in Santa Barbara, California. Harold Alan Pincus, M.D., and Terri L. Tanielian, M.A., are editors of this column.Figure 1. Identification rate in private health plans for adolescents with substance use disorders compared with the rate derived from data from the NHSDAaa Respondents were classified as substance dependent if they met three of the six DSM-IV criteria on the 1998 National Household Survey on Drug Abuse (NHSDA) questionnaire. Items included questions about health and emotional problems associated with substance use, attempts to cut down, tolerance, withdrawal, and other symptoms.