Highlights

This report presents State estimates for 22 measures of substance use or mental health problems based on the 2003 and 2004 National Surveys on Drug Use and Health (NSDUHs). Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), NSDUH is an ongoing survey of the civilian, noninstitutionalized population of the United States aged 12 years or older. Interview data from approximately 135,500 persons were collected in 2003-2004. Separate estimates have been produced for four age groups: 12 to 17, 18 to 25, 26 or older, and all persons 12 or older. For each measure, States have been ranked and categorized into quintiles, or fifths, in order to simplify the discussion. Estimates presented in this report are based on hierarchical Bayes estimation methods that combine survey data with a national model.

In addition to State estimates for 2003-2004, this report includes estimates of change between 2002-2003 and 2003-2004 for all 22 measures. Also in this report are estimates for youths aged 12 to 20 for two of the measures—past month alcohol and binge alcohol use.

Illicit Drug Use

• Estimates of past month use of any illicit drug in 2003-2004 ranged from a low of 5.8 percent in Mississippi to a high of 11.8 percent in Alaska for all persons aged 12 or older. Among youths, the percentage of past month use decreased from 11.4 percent in 2002-2003 to 10.9 percent in 2003-2004. Although there was no change in the prevalence rate in the total population aged 12 or older, four States showed decreases from 2002-2003 to 2003-2004 in the percentage that used an illicit drug in the past month: the District of Columbia, Florida, Nevada, and Washington. Six States showed decreases among youths: Illinois, Nebraska, North Carolina, South Dakota, Vermont, and Virginia. There were no statistically significant increases among States in any of the age groups (12 to 17, 18 to 25, and 26 or older). (Tables B.1 and C.1)



• Nationally in 2003-2004, 10.6 percent of all persons aged 12 or older reported marijuana use in the past year. State rankings for past year use were very similar to those for past month use among persons aged 12 or older. (Table B.2, Figures 2.5 and 2.9)



• Mississippi and Utah had the lowest rate of past month use of marijuana (4.2 percent) in 2003-2004 for the 12 or older population, and Alaska had the highest rate (9.9 percent). Eight States were ranked in the top fifth for past month marijuana use in all three age groups (12 to 17, 18 to 25, and 26 or older): Alaska, Maine, Massachusetts, New Hampshire, New Mexico, Oregon, Rhode Island, and Vermont. Seven States displayed decreases among persons aged 12 or older between 2002-2003 and 2003-2004 in the past month use of marijuana, while New Mexico was the only State that had an increase among that age group. (Tables B.3 and C.3, Figures 2.10 to 2.12)



• The State with the lowest rate in 2003-2004 of perceived great risk of using marijuana occasionally (once a month) among persons aged 12 or older was Washington (26.2 percent). However, slightly more than half (51.3 percent) of all persons aged 12 or older in Mississippi indicated that occasional use of marijuana was a great risk. The national percentage of persons aged 12 or older perceiving a great risk of using marijuana once a month increased significantly between 2002-2003 and 2003-2004, from 39.1 to 39.7 percent. Six States contributed significantly to this national increase in perceived risk in this population: California, Hawaii, Maryland, Massachusetts, Montana, and Nevada. One State, Iowa, countered the national trend with a decrease in perceived risk among the 12 or older population. (Tables B.4 and C.4)



• For the combined years 2003-2004, the national marijuana incidence rate for all persons aged 12 or older was 1.8 percent. Alaska had the highest rate, 2.6 percent; Florida and Tennessee shared the lowest rate, 1.4 percent. The rate of first use of marijuana decreased slightly between 2002-2003 and 2003-2004 (from 6.6 to 6.3 percent) among youths aged 12 to 17. Eight States had declines among that age group: Delaware, Florida, Nevada, New Hampshire, North Carolina, Texas, Vermont, and Virginia. Two States, Florida and Nevada, showed decreases in the marijuana incidence rates from 2002-2003 to 2003-2004 among the 12 or older population. (Tables B.5 and C.5)



• The national estimate of past month use of any illicit drug other than marijuana among persons aged 12 or older was 3.6 percent for 2003-2004 combined. Hawaii had the lowest rate (2.8 percent) of past month use of an illicit drug other than marijuana among persons 12 or older, and Colorado had the highest rate (4.7 percent). For the 12 or older population, past month use of any illicit drug other than marijuana was relatively stable between 2002-2003 and 2003-2004. Further, there were no statistically significant changes in any State among persons aged 12 or older during this period. (Tables B.6 and C.6)



• The national prevalence rate for the use of cocaine in the past year among all persons aged 12 or older was 2.4 percent in 2003-2004. Rhode Island had the highest percentage of persons aged 12 or older using cocaine in the past year (3.5 percent). Among persons aged 12 or older, Ohio was the only State to show a significant change between 2002-2003 and 2003-2004, a decline in the past year cocaine use from 2.5 to 2.1 percent. (Tables B.7 and C.7)



• In 2003-2004, 4.8 percent of all persons aged 12 or older reported having used pain relievers nonmedically in the past year, a percentage that was unchanged from 2002-2003. For persons aged 12 or older, estimates ranged from a low of 3.1 percent in the District of Columbia and Hawaii to 6.3 percent in Kentucky. Kentucky and Washington were ranked in the top fifth in all three age groups (12 to 17, 18 to 25, and 26 or older). Although there were no significant changes at the national level, five States showed increases either among the 12 to 17 age group (Arkansas and Maine) or among the 18 to 25 age group (California, Montana, and New York). Hawaii was the only State to show a change among the 12 or older population between 2002-2003 and 2003-2004—a decrease from 3.9 to 3.1 percent. (Tables B.8 and C.8, Figures 2.29 to 2.31)

Alcohol Use

• In 2003-2004, the rate of past month alcohol use in States among all persons aged 12 or older ranged from a low of 29.3 percent in Utah to a high of 62.1 percent in Wisconsin. Although the use of alcohol at the national level remained unchanged between 2002-2003 and 2003-2004, four States showed significant changes among the 12 or older population. Three States had significant decreases: Missouri, Nevada, and New Jersey. Wisconsin had the only significant increase among persons aged 12 or older. (Tables B.9 and C.9)



• Nationally, almost a quarter (22.7 percent) of all persons aged 12 or older participated in binge use of alcohol in the past month in 2003-2004. North Dakota had the highest past month binge use of alcohol (31.8 percent), and Utah had the lowest rate (15.0 percent). The national rate in 2003-2004 (22.7 percent) was similar to the rate in 2002-2003 (22.8 percent). The only changes among the 12 or older population between 2002-2003 and 2003-2004 were increases in Kansas and Pennsylvania. (Tables B.10 and C.10)



• In 2003-2004, 41.3 percent of all persons aged 12 or older perceived a great risk of binge drinking. People's perceptions of the risk of binge drinking were moderately related to their actual rates of binge drinking at the State level in 2003-2004. Seven of the ten States (Iowa, Massachusetts, Montana, Nebraska, North Dakota, South Dakota, and Wisconsin) with the highest rates of binge use of alcohol in 2003-2004 also were States with the lowest perceived risk of binge drinking for the population aged 12 or older. Nationally, there was a slight decline in the percentage of persons aged 12 or older reporting a great risk in binge alcohol use between 2002-2003 and 2003-2004, from 42.0 to 41.3 percent. (Tables B.11 and C.11, Figures 3.5 and 3.9)



• North Dakota had the highest rate of underage (ages 12 to 20) alcohol use in the past month, 42.7 percent; Utah had the lowest rate, 18.6 percent. There was no change between 2002-2003 and 2003-2004 in underage alcohol use at the national level—28.9 percent were past month users. Both California and Wisconsin showed increases (from 24.7 to 26.3 percent and from 34.7 to 38.3 percent, respectively). Michigan and South Carolina showed decreases (from 31.8 to 30.2 percent and from 27.3 to 24.1 percent, respectively). (Tables B.12 and C.12)



• Eight of the States in the top fifth for underage use of alcohol also were ranked in the top fifth for underage binge use of alcohol: Iowa, Massachusetts, Montana, New Hampshire, North Dakota, Rhode Island, South Dakota, and Wisconsin. Although there was no change at the national level in the percentage of underage persons aged 12 to 20 reporting binge use of alcohol in the past month, two States showed increases (Iowa and Oklahoma) and three States showed decreases (North Carolina, South Carolina, and Tennessee). (Table C.12, Figures 3.13 and 3.14)

Tobacco Use

• Nationally among persons aged 12 or older, the rate for past month use of tobacco in 2003-2004 was 29.5 percent. Rates of tobacco use ranged from 39.5 percent in West Virginia to 20.1 percent in Utah. Past month tobacco use declined slightly between 2002-2003 and 2003-2004 among persons 12 or older, from 30.1 to 29.5 percent. Given 11 statistically significant State-level changes occurring across the four age categories (12 or older, 12 to 17, 18 to 25, and 26 or older), only 2 of them were increases: in California, the percentage of youths using tobacco in the past month increased from 9.2 to 10.9 percent, and in Kansas, the percentage of persons aged 18 to 25 reporting past month use of tobacco went from 45.7 to 49.9 percent. Even though California had an increase among youths, California had an overall decrease among persons aged 12 or older from 22.5 to 20.7 percent that was driven by a decrease among persons aged 26 or older. (Tables B.13 and C.13)



• Kentucky had the highest rate of cigarette use in the Nation (33.3 percent), and Utah had the lowest rate (17.6 percent) for all persons aged 12 or older. The national rate for past month use of cigarettes among persons aged 12 or older declined slightly from 25.7 percent in 2002-2003 to 25.2 percent in 2003-2004. There were declines among both the 12 to 17 and the 18 to 25 age groups. Of a total of 14 statistically significant State changes in past month use of cigarettes between 2002-2003 and 2003-2004 across the four age groups, 13 of them were decreases. (Tables B.14 and C.14)



• States with high prevalence rates for cigarette use tended to have low rates of perceived risk of heavy cigarette use (i.e., smoking one or more packs a day). Six of the States (Kentucky, Missouri, Ohio, Oklahoma, South Dakota, and West Virginia) ranked in the lowest fifth for perceptions of great risk of smoking one or more packs of cigarettes a day also were ranked in the highest fifth for past month cigarette use among persons aged 12 or older. Nationally, in the 12 or older population, the rates of perception of great risk of smoking one or more packs of cigarettes a day increased from 71.3 percent in 2002-2003 to 72.8 percent in 2003-2004. There were increases among youths, young adults, and older adults aged 26 or older. (Tables B.15 and C.15, Figures 4.5 and 4.9)

Substance Dependence, Abuse, and Treatment Need

• Nationally in 2003-2004, 7.6 percent of the population aged 12 or older was classified with dependence on or abuse of alcohol in the past year. Wisconsin had the highest rate (11.3 percent), while Alabama and North Carolina shared the lowest rate (6.0 percent) among persons aged 12 or older. Five States ranked in the top fifth in all three age groups (12 to 17, 18 to 25, and 26 or older): Montana, New Mexico, South Dakota, Wisconsin, and Wyoming. Among all persons aged 12 or older, only three States showed significant changes from 2002-2003 to 2003-2004. Georgia and Michigan had decreases, whereas Wisconsin had an increase in past year alcohol dependence or abuse rates. (Tables B.16 and C.16, Figures 5.2 to 5.4)



• Seven States that ranked in the highest fifth in the 12 or older population for dependence on or abuse of alcohol in the past year also were ranked in the highest fifth for past year alcohol dependence. (Figures 5.1 and 5.5)



• In 2003-2004, New Mexico had the highest rate of past year illicit drug dependence or abuse (3.7 percent) among persons aged 12 or older, and South Dakota had the lowest rate (2.5 percent). The national average in 2003-2004 was 3.0 percent. There was no change in the rates of past year illicit drug dependence or abuse between 2002-2003 and 2003-2004 either nationally or in any State for persons aged 12 or older. (Tables B.18 and C.18)



• The percentage of persons aged 12 or older classified as being dependent on illicit drugs during the past year remained stable between 2002-2003 and 2003-2004 at 1.9 percent. (Table C.19)



• In 2003-2004, State percentages for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older ranged from a low of 7.4 percent in Alabama to a high of 12.2 percent in Wisconsin. There was no change in the rates of past year dependence on or abuse of alcohol or illicit drugs between 2002-2003 and 2003-2004 either nationally or in any State for persons aged 12 or older. (Tables B.20 and C.20)



• In 2003-2004, Alaska had the highest percentage of persons aged 12 or older needing but not receiving treatment for an illicit drug use problem (3.5 percent), while South Dakota had the lowest percentage (2.2 percent). There was no change in the rates of persons aged 12 or older needing but not receiving treatment for an illicit drug use problem between 2002-2003 and 2003-2004 either nationally or in any State. (Tables B.21 and C.21)



• Four States were ranked in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older and in each of the three age categories (12 to 17, 18 to 25, and 26 or older): Montana, New Mexico, Wisconsin, and Wyoming. The State percentages in the total 12 or older population ranged from a high of 10.8 percent in Wisconsin to a low of 5.6 percent in Alabama and North Carolina. Although there were a few changes among States in some of the individual age groups, only three States showed statistically significant changes in the percentage of persons 12 or older needing but not receiving treatment for alcohol problems. Georgia and Michigan both had decreases, whereas Wisconsin showed an increase during the period from 2002-2003 to 2003-2004. (Tables B.22 and C.22, Figures 5.25 to 5.28)

Serious Psychological Distress among Adults

• Serious psychological distress (SPD) was estimated in NSDUH for persons aged 18 or older. In 2003-2004, SPD was present in 9.6 percent of the population aged 18 or older. West Virginia had the highest rate of SPD in the past year (12.7 percent), while Hawaii had the lowest rate (7.1 percent). Ten States showed increases in SPD in the 18 or older population from 2002-2003 to 2003-2004: Arizona, California, Florida, Illinois, Iowa, New Jersey, Pennsylvania, Texas, West Virginia, and Wyoming. These increases were generally the result of increases among persons aged 26 or older. (Tables B.23 and C.23)