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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; individuals age 12 to 17; individuals age 18 to 25; and individuals age 26 and older. 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, Washingtons rates on many measures of use and abuse of alcohol and illicit substances have remained at or above the national rates. Of particular note are the rates of past year nonmedical use of pain relievers for all individuals 12 and older, those age 18 to 25, and those age 26 and older. These rates have consistently been among the highest in the country. In addition, the rates of past month illicit drug use and marijuana use among individuals age 26 and older were consistently above the national rates; likewise, the rate of past month alcohol use for this age group was above the national rate for all survey years.
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 (American Psychiatric Association, 1994).
While rates of past year alcohol abuse or dependence have been quite variable across all survey years, the rates for individuals age 12 to 17 and those age 18 to 25 have generally been similar to rates for the country as a whole (Chart 1). The rate of past year illicit drug dependence, however, has remained among the highest in the country for the State population age 12 and older, particularly among individuals age 18 to 25 (Chart 2).
Substance Abuse Treatment Facilities
According to the annual National Survey of Substance Abuse Treatment Services (N-SSATS), the number of treatment facilities in Washington recognized or certified by the Single State Agency has increased steadily, from 310 facilities in 2002 to 439 facilities in 2006, which is the most recent year data are available. The increase is primarily accounted for by additional private for-profit and private nonprofit facilities.
Although facilities may offer more than one modality of care, the majority of facilities (395 or 90%) in Washington State in 2006 offered some form of outpatient care; an additional 60 facilities offered residential treatment; and 17 programs offered opioid treatment. In addition, 96 physicians were certified to provide buprenorphine care. There were 241 facilities (55%) that received some form of Federal, State, county, or local government funds, and 234 facilities (53%) had agreements or contracts with a managed care organization 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). With all facilities responding to the 2006 N-SSATS survey, Washington State showed an one-day census total of 42,701 clients in treatment, the majority of whom (40,480 or 95%) were in outpatient treatment. Of the total number of clients in treatment on this date, 3,384 (8 %) were under the age of 18.
There has been a steady increase in the annual number of admissions to treatment in Washington State between 1992 and 2005 (the most recent year for which data are available). Chart 3 shows the percentage of admissions mentioning particular drugs or alcohol at the time of admission. Across the last 13 years, there has been a steady decline in the number of admissions mentioning alcohol as a substance of abuse (from 88% in 1992 to 72% in 2005), and a substantial increase in mentions of methamphetamine abuse (from 1% in 1992 to 30% in 2005).
Across the years for which TEDS data are available, Washington State has seen a substantial shift in the constellation of problems present at treatment admission. Alcohol-only admissions have declined, from over 45 percent of all admissions in 1992 to just over 19 percent in 2005. Concomitantly, drug-only admissions have increased, from 11 percent in 1998 to 27 percent in 2005 (Chart 4).
Unmet Need For Treatment
While rates of unmet treatment need for alcohol use have generally been at or below the national rate, rates of unmet need for drug treatment in Washington State have generally been at or above the national rates for the population as a whole, as well as for those age 18 to 25 and those age 26 and older.