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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 age 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, rates in Maryland have been among the lowest in the country on the following measures (Table 1):
|Past Month Use of an Illicit Drug Other than Marijuana||12+, 12-17|
|Past Year Cocaine Use||12-17|
|Past Year Nonmedical Use of Pain Relievers||All Age Groups|
|Past Month Binge Alcohol Use||12-17,12-20|
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).
On the global measure of any past year dependence on or abuse of illicit drugs or alcohol, Maryland�''s rates have been at or below the national averages for all survey years. Notably, in 2005-2006, the rates of past year alcohol dependence were among the lowest in the country for all age groups (Chart 1).
Substance Abuse Treatment Facilities
According to the National Survey of Substance Abuse Treatment Services (N-SSATS),3 the number of treatment facilities in Maryland has increased from 345 in 2002 to 371 in 2006, the most recent year for which data are available. The increase is primarily accounted for by the addition of 11 private nonprofit facilities and 18 private for-profit facilities. Although facilities may offer more than one modality of care, in 2006 the majority of facilities in Maryland (313 of 371 or 84%) offered some form of outpatient treatment. And additional 82 facilities offer residential care, and 51 facilities offer an opioid treatment program. An additional 286 physicians and 97 treatment programs are certified to provide buprenorphine treatment for opioid addiction.
In 2006, 54 percent of all facilities (200 of 371) received some form of Federal, State, county or local government funds, and 167 facilities (45%) 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 In the 2006 N-SSATS survey, Maryland showed an one-day total of 35,224 clients in treatment, the majority of whom (32,683 or 93%) were in outpatient treatment. Of the total number of clients in treatment on this date, 2,201 (6%) were under the age of 18.
Since 1992, there has been a steady increase in the annual number of admissions to treatment from 58,000 in 1992 to 65,000 in 2006 (the most recent year for which data are available). Chart 2 shows the percentage 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 as a substance of abuse and a concomitant increase in the number of admissions for heroin use.
Across the years for which TEDS data are available, Maryland has seen a substantial shift in the constellation of problems present at treatment admission (Chart 3). Alcohol-only admissions have declined from 35 percent of all admissions in 1992 to 20 percent in 2006. Concomitantly, drug-only admissions have increased from 24 percent in 1992 to 41 percent in 2005.
Unmet Need For Treatment
NSDUH defines unmet treatment 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. In Maryland, the rates for unmet alcohol treatment needs for all age groups and across all survey years have remained at or below the national levels (Chart 4).
Notably, the rate for unmet treatment for drug use for the State population age 12 and older was among the lowest in the country in 2005-2006 (Chart 5).