Primary Care Corner with Geoffrey Modest MD: Substance use and mental health in youth and adults 2014

By: Dr. Geoffrey Modest

SAMHSA (Substance Abuse and Mental Health Services Administration) just released a 2014 report on where we are at in the US regarding substance abuse and mental health issues (see here). A pretty brief summary:

Youth substance use/mental health (note: there are different surveys used for these data):

–Past month marijuana use, 2002-2013

–slight decrease in adolescents 12-17 to 7.1% (peak in 2011 at 7.9%)

–9th-12th graders without much change, at 23%. 8th-10th graders at 12.5% (sl increase)

–Past-year nonmedical pain reliever use, 2002-2013

–12th grade males: significant decrease, was up to 11.6% in 2002, decreased to mid-10 range til 2009, now down to 8.4%

–12th grade females: pretty flat at around 8% til 2011, then decreased to 5.6%

–age 12-17 males and females was in the 7.2% range, now decreased to 4.5-4.8%

–Past-month illicit drug use, 2009-2013

–age 12-17 with overall decrease in total, White, Latino to 8.8%, but no change in black, at 10.5%

–comparing the different illicits: marijuana most common at 7.1%; nonmedical use of psychotherapeutics next at 2.2%; then hallucinogens, inhalants, cocaine and heroin, all 0.6% or less.

–Past-month cigarette use, 2009-2013

–age 12-17: decreasing in all ethnicities, but highest in white (7.2%), then latino (3.7%), then black (3.2%)

–Past month binge alcohol use, 2008-2013

​–age 12-17: similar in males and females, decreasing to 6.2%. highest in White (7.3%), then Latino (6.3%), then Native American/Alaskan (5.6%), then Black (3.9%), then Asian (2.8%)

–Past year initiated substance use, in age 12-17, from 2009-2013

–alcohol: dec from 10.8% to 9.7%

–marijuana: dec from 5.5% to 4.8%

–cigarettes: dec from 5.2% to 3.7%

–nonmedical use of psychotherapeutics: dec from 3.5% to 2.4%

–and pretty similar %’s of above for white, black, latino

–Major depressive disorders, in age 12-17,in 2013

–overall: 10.7% (2.6 million…)

​–males: highest in Asian (6.5%), then Latino (5.7%) and White (5.6%), then Black (3.0%)

–females: highest in Latino (17.4%), then White (16.3%), then Black (14.4%), and Asian (13.9%)

–Past year depression treatment for major depressive disorder, among age 12-17, in 2103

–around 60-70% did not receive treatment (males 70%, females 59%), and White 58%, Black 71%, Latino 63%

Adult substance use/mental health

–Suicidal thoughts, age 18 and older, in 2013

–highest in 18-25 (7.4%), then decreasing to 4.0% age 26-44, 3.7% age 45-64, and 1.5% if older than 65

–also higher in those not insured (5.7% vs 3.6%) and in those <100% of federal poverty level (6.6% vs 3.5%)

–Serious mental illness, age 18 and older, in 2103

–more female (4.9% vs 3.5%), more in uninsured (5.9% vs 3.9%), and more in those <100% of poverty level (7.7% vs 3.6%)

–did not receive treatment: more men (36.4% vs 28.4%), and more younger (46% in 18-25 yo vs 24% in 45-64), and (not a shocker) more without insurance (49.4% vs 28.6%)

–Alcohol dependence and abuse, age 12 and older, in 2103

–more male (8.7% vs 4.6%), most in the 18-25 age group (13%) then decreasing stepwise through the >65 yo group (2.1%)

–more in uninsured (9.7% vs 6.0%)

–trend decreasing from 2009-2013 (eg, in those 18-25, decreased from 16.1% to 13.0%)

–Illicit drug use, aged 12 and older, in 2013

–highest in 18-25 yo (7.4%),  then decreasing stepwise through the >65 yo group (0.4%)

–Enrollment in substance abuse treatment (single-day counts 2009-2013)

–increasing from 2010 to 2013, from 1.175 million to 1.250 million, pretty evenly divided between “drug use only” at 39.6% and “both drug and alcohol use” at 43.0%

–Past-year treatment for alcohol use, age 12 and older, in 2013

–Highest in 12-17yo (9.8%), then rest in 5.3%-7.3% range

–Of note, 90.6% did not receive treatment and did not perceive a need for treatment!

–People in opioid treatment programs 2009-2013

–methadone: increase from 2009 from 283K to 330K in 2013

–buprenorphine: increase from 2009 from 24K to 48K in 2013

–in 2013, only 13.4% were in treatment, 5.7% perceived need for treatment but did not receive it, and 80.9% did not perceive need for treatment.  those in treatment tended to be older (26-44 yo group, at 18.2%)

So, a few issues from the mass of numbers above:

–These surveys are subject to many biases in terms of reporting, both by sample selection and the general cultural issues (in the largest sense, including those related to ethnicity, as well as those relating to gender, age, local social environment, peer pressure, etc which affect one’s level of introspection/ability to verbalize it as well as interpreting what is “normal”)…all limiting the generalizability and interpretation of the results

–The trends for most of the above regarding substances are in fact getting better!! as well as the use of methadone/buprenorphine, etc

​–One sore point is the psych data: large numbers of people with serious mental illnesses. with lots who are poor and without insurance (there is certainly an aspect of “social drift”, in that those with serious mental illnesses tend to “drift” into poverty, but there is undoubtedly a component of poverty leading to lack of insurance, leading to lack of treatment, leading to lack of ability to function in society, leading to lack of ability to improve the situation…..