Treatment Data


Sometimes the pictures just speak for themselves. 

Figure 1. Percentage of Discharges from Outpatient Substance Abuse Treatment, by Reason for Discharge



Percentage of Discharges from Outpatient Substance Abuse Treatment, by Primary Substance of Abuse and Reason for Discharge


Percentage of Discharges from Outpatient Substance Abuse Treatment, by Race/Ethnicity and Reason for Discharge


Percentage of Discharges from Outpatient Substance Abuse Treatment, by Educational Level, Employment Status, and Reason for Discharge


A Day in the life of an Adolescent


A Day in the Life of American Adolescents: Substance Use Facts

In the United States in 2006, one third of adolescents aged 12 to 17 drank alcohol in the past year, one fifth used an illicit drug, and one sixth smoked cigarettes.  Although

the percentage of adolescents using alcohol and drugs declined between 2002 and

2006, the percentage of persons aged 12 to 17 receiving substance abuse treatment

has remained relatively stable.  In 2005, 7.7 percent of all persons admitted to

publicly funded treatment facilities were aged 12 to 17.  Office of Applied Studies

(OAS) in the Substance Abuse and Mental Health Services Administration (SAMHSA)

collects, analyzes, and disseminates critical public health data. OAS manages three

national data collections that offer insight into adolescent substance use and

treatment: the National Survey on Drug Use and Health (NSDUH), the Treatment

Episode Data Set (TEDS), and the National Survey of Substance Abuse Treatment

Services (N-SSATS). This issue of The OAS Report presents facts about

adolescent substance use, including initiation, and receipt of treatment for substance

use “on an average day. Data presented in this report from the 2006 NSDUH and

the 2005 TEDS are for adolescents aged 12 to 17; data presented from the 2005 N-

SSATS are for youth under 18.

First Substance Use

According to the 2006 NSDUH, 10.6 percent of adolescents aged 12 to 17 drank

alcohol for the first time in the past year, and 5.8 percent used an illicit drug for the first

time. The 2006 NSDUH also indicates that on an average day during the past year,

 adolescents aged 12 to 17 used the following substances for the first time (Figure 1):

  • 7,970 drank alcohol for the first time;
  • 4,348 used an illicit drug for the first time;
  • 4,082 smoked cigarettes for the first time;
  • 3,577 used marijuana for the first time;
  • 2,517 used pain relievers nonmedically for the first time;
  • 1,603 used inhalants for the first time;
  • 1,281 used hallucinogens for the first time;
  • 909 used cocaine for the first time;
  • 860 used stimulants nonmedically for the first time;
  • 236 used methamphetamine for the first time; and
  • 86 used heroin for the first time.

 Number of Adolescents Aged 12 to 17 Who Used Cigarettes, Alcohol, or Illicit Drugs for the First Time on an Average Day: 2006 NSDUH
Substance Number of Adolescents
Alcohol 7,970
Any Illicit Drug 4,348
Cigarettes 4,082
Marijuana 3,577
Pain Relievers* 2,517
Inhalants 1,603
Hallucinogens 1,281
Cocaine    909
Stimulants*    860

Source: SAMHSA, 2006 NSDUH.

Cigarette, Alcohol, and Illicit Drug Use

According to the 2006 NSDUH, more than 8 million adolescents aged 12 to 17 drank alcohol in the past year, nearly 5 million used an illicit drug, and more than 4 million smoked cigarettes. In addition, on an average day during the past year, adolescents aged 12 to 17 used the following substances (Figure 2):

  • 1,245,240 smoked cigarettes;
  • 630,539 drank alcohol;
  • 586,454 used marijuana;
  • 49,263 used inhalants;
  • 26,645 used hallucinogens;
  • 13,125 used cocaine; and
  • 3,753 used heroin.

Number of Adolescents Aged 12 to 17 Who Used Cigarettes, Alcohol, or Illicit Drugs on an Average Day: 2006 NSDUH
Substance Number of Adolescents
Cigarettes 1,245,240
Alcohol    630,539
Marijuana    586,454
Inhalants      49,263
Hallucinogens      26,645
Cocaine      13,125
Heroin        3,753

Source: SAMHSA, 2006 NSDUH.

The 2006 NSDUH also indicates that:

  • adolescents who used alcohol in the past month drank an average of 4.7 drinks per day on the days they drank; and
  • adolescents who smoked cigarettes in the past month smoked an average of 4.6 cigarettes per day on the days they smoked.

Substance Abuse Treatment

TEDS reported that in 2005 there were 142,646 admissions for adolescents aged 12 to 17 to substance abuse treatment programs (TEDS data come primarily from facilities that receive some public funding). TEDS also indicates that on an average day in 2005, adolescent admissions to treatment presented with the following substances as the primary substance of abuse11 (Figure 3):

  • 255 with marijuana;
  • 72 with alcohol;
  • 24 with stimulants;
  • 10 with cocaine;
  • 7 with opiates; and
  • 7 with other drugs.

Number of Adolescents Aged 12 to 17 Admitted to Publicly Funded Substance Abuse Treatment Facilities on an Average Day, by Primary Substance of Abuse: 2005 TEDS
Substance Number of Adolescents
Marijuana 255
Alcohol   72
Stimulants   24
Cocaine   10
Opiates     7
Other Drugs     7

Source: SAMHSA, 2005 TEDS.

The 2005 TEDS also indicates that on an average day in 2005, the number of adolescent admissions to substance abuse treatment were referred by the following sources12 (Figure 4):

  • 189 by the criminal justice system;
  • 66 by self-referral or referral from other individuals;
  • 43 by schools;
  • 37 by community organizations;
  • 22 by alcohol or drug treatment providers; and
  • 18 by other health care providers.

Number of Substance Abuse Treatment Admissions among Adolescents Aged 12 to 17 on an Average Day, by Principal Source of Referral: 2005 TEDS
Source of Referral Number of Admissions
Criminal Justice System 189
Self or Other Individuals   66
Schools   43
Community Organizations   37
Treatment Providers   22
Other Health Care Providers   18

Source: SAMHSA, 2005 TEDS.

In addition, N-SSATS, which collects information on substance abuse treatment at both publicly and privately funded facilities, reports how many active clients13 under the age of 18 received the following types of substance abuse treatment on an average day in 2005 (Figure 5):

  • 76,240 were clients in outpatient treatment;
  • 10,313 were clients in non-hospital residential treatment; and
  • 1,058 were clients in hospital inpatient treatment.

 Number of Adolescents Under Age 18 Who Were Clients in Publicly or Privately Funded Substance Abuse Treatment Facilities on an Average Day, by Service Type: 2005 N-SSATS
Service Type Number of Adolescents
Outpatient 76,240
Non-hospital Residential 10,313
Hospital Inpatient   1,058

Source: SAMHSA, 2005 N-SSATS.

National Survey on Drug Use and Health part 3

      Continuing in the theme of providing you with the latest research information, the following just-published data is from the latest survey taken by SAMHSA and encompasses 2008. This is just the  summary data. For the complete report click here


Initiation of Substance Use (Incidence, or First-Time Use) within the Past 12 Months

   In 2008, an estimated 2.9 million persons aged 12 or older used an illicit drug for the first time within the past 12 months. This averages to almost 8,000 initiates per day and is similar to the estimate for 2007. A majority of these past year illicit drug initiates reported that their first drug was marijuana (56.6 percent). Nearly one third initiated with psychotherapeutics (29.6 percent, including 22.5 percent with pain relievers, 3.2 percent with tranquilizers, 3.0 percent with stimulants, and 0.8 percent with sedatives). A sizable proportion reported inhalants (9.7 percent) as their first illicit drug, and a small proportion used hallucinogens as their first drug (3.2 percent).In 2008, the illicit drug categories with the largest number of past year initiates among persons aged 12 or older were marijuana use (2.2 million) and nonmedical use of pain relievers (2.2 million). These estimates were not significantly different from the numbers in 2007.In 2008, there were 729,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 70.4 percent were under age 18 when they first used. There was no significant change in the number of inhalant initiates from 2007 to 2008, but the number in 2008 was significantly lower than the estimate in 2005 (877,000).The number of past year initiates of methamphetamine among persons aged 12 or older was 95,000 in 2008. This estimate was significantly lower than the estimate in 2007 (157,000) and was less than one third of the number estimated in 2004 (318,000).Following substantial drops in initiation between 2002 and 2003, estimates of initiation of Ecstasy and LSD among persons aged 12 or older have increased significantly. Between 2003 and 2008, the number of Ecstasy initiates increased from 642,000 to 894,000, and the number of LSD initiates increased from 200,000 to 394,000.Most (84.6 percent) of the 4.5 million past year alcohol initiates were younger than age 21 at the time of initiation.The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was 2.4 million in 2008, similar to the estimate in 2007 (2.2 million) but significantly higher than the estimate for 2002 (1.9 million). Most new smokers in 2008 were under age 18 when they first smoked cigarettes (58.8 percent); however, the number of persons initiating smoking at age 18 or older increased from about 600,000 in 2002 to 1 million in 2008.

      Youth Prevention-Related Measures

   Perceived risk is measured by NSDUH as the percentage reporting that there is great risk in the substance use behavior. The percentage of youths aged 12 to 17 perceiving great risk in smoking marijuana once or twice a week increased from 51.5 percent in 2002 to 55.0 percent in 2005, but dropped to 53.1 percent in 2008. A decline from 2005 to 2008 also was observed for using LSD once or twice a week (76.2 percent in 2002, 76.1 percent in 2005, and 73.9 percent in 2008). Between 2002 and 2008, the percentages who reported great risk in using alcohol and cigarettes increased. In 2002, 63.1 percent of youths reported great risk in smoking one or more packs of cigarettes per day, and in 2008 the percentage increased to 69.7 percent. In 2002, 38.2 percent reported great risk in binge drinking once or twice a week, and in 2008 the percentage increased to 40.5 percent.Almost half (49.2 percent) of youths aged 12 to 17 reported in 2008 that it would be “fairly easy” or “very easy” for them to obtain marijuana if they wanted some. Around one quarter reported it would be easy to get cocaine (22.1 percent). About one in seven (13.8 percent) indicated that LSD would be “fairly” or “very” easily available, and 13.0 percent reported easy availability for heroin. Between 2002 and 2008, there were declines in the perceived availability for all four drugs.A majority of youths aged 12 to 17 (90.8 percent) in 2008 reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice. Current marijuana use was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than for those who did not (4.3 vs. 29.8 percent).In 2008, 11.1 percent of youths aged 12 to 17 reported that they had participated in substance use prevention programs outside of school within the past year. This was lower than the percentage reported in 2002 (12.7 percent). Almost four fifths (78.0 percent) reported having seen or heard drug or alcohol prevention messages from sources outside of school, lower than in 2002 when the percentage was 83.2 percent. The percentage of school-enrolled youths reporting that they had seen or heard prevention messages at school also declined during this period, from 78.8 to 75.9 percent.      

National Survey on Drug Use and Health part 2


As promised, here are SAMHSA’s findings on alcohol use in America. Pretty interesting stuff really. I hope you find it as enlightening as I did.

Alcohol Use

  • Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2008 survey (51.6 percent). This translates to an estimated 129.0 million people, which was similar to the 2007 estimate of 126.8 million people (51.1 percent).
  • In 2008, more than one fifth (23.3 percent) of persons aged 12 or older participated in binge drinking. This translates to about 58.1 million people, similar to the estimate in 2007. Binge drinking is defined as having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey.
  • In 2008, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.3 million people. This rate was the same as the rate of heavy drinking in 2007. Heavy drinking is defined as binge drinking on at least 5 days in the past 30 days.
  • Among young adults aged 18 to 25 in 2008, the rate of binge drinking was 41.0 percent, and the rate of heavy drinking was 14.5 percent. These rates were similar to the rates in 2007.
  • The rate of current alcohol use among youths aged 12 to 17 was 14.6 percent in 2008, which is lower than the 2007 rate (15.9 percent). Youth binge and heavy drinking rates in 2008 were 8.8 percent (lower than the 9.7 percent rate in 2007) and 2.0 percent, respectively.
  • Past month and binge drinking rates among underage persons (aged 12 to 20) declined between 2002 and 2008. The rate of past month underage drinking declined from 28.8 to 26.4 percent, and the rate of past month binge drinking declined from 19.3 to 17.4 percent.
  • Past month alcohol use rates declined between 2002 and 2008 for those aged 12 or 13 (4.3 to 3.4 percent), 14 or 15 (16.6 to 13.1 percent), 16 or 17 (32.6 to 26.2 percent), and 18 to 20 (51.0 to 48.7 percent).
  • Among persons aged 12 to 20, past month alcohol use rates in 2008 were 17.2 percent among Asians, 19.0 percent among blacks, 22.9 percent among those reporting two or more races, 23.1 percent among Hispanics, 26.4 percent among American Indians or Alaska Natives, and 30.1 percent among whites.
  • In 2008, 56.2 percent of current drinkers aged 12 to 20 reported that their last use of alcohol in the past month occurred in someone else’s home, and 29.6 percent reported that it had occurred in their own home. About one third (30.8 percent) paid for the alcohol the last time they drank, including 8.3 percent who purchased the alcohol themselves and 22.3 percent who gave money to someone else to purchase it. Among those who did not pay for the alcohol they last drank, 37.4 percent got it from an unrelated person aged 21 or older, 21.1 percent from another person under 21 years of age, and 21.0 percent from a parent, guardian, or other adult family member.
  • In 2008, an estimated 12.4 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage has dropped since 2002, when it was 14.2 percent. The rate of driving under the influence of alcohol was highest among persons aged 21 to 25 (26.1 percent).

We will provide additional findings from the National Survey on Drug Use and Health in future posts as time and money permit. Please stay tuned.

National Survey on Drug Use and Health part 1

I found some information just recently published by the Substance Abuse and Mental Health Services Administration, SAMHSA, which is a division within the U.S. Department of Health and Human Services. This information is from the latest National Survey on Drug use and Health for 2008. It is a  pretty exhaustive study but enlightening nevertheless.  This is not the place to go into the details of the full report but, I thought you might be interested in the Highlights which are presented below. If you would prefer to view the entire report follow the underlined link.

This report presents the first information from the 2008 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year. Unless otherwise noted, all comparisons in this report described using terms such as “increased,” “decreased,” or “more than” are statistically significant at the .05 level.

Illicit Drug Use

  • In 2008, an estimated 20.1 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.0 percent of the population aged 12 years old or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.
  • The rate of current illicit drug use among persons aged 12 or older in 2008 (8.0 percent) was the same as the rate in 2007 (8.0 percent).
  • Marijuana was the most commonly used illicit drug (15.2 million past month users). Among persons aged 12 or older, the rate of past month marijuana use in 2008 (6.1 percent) was similar to the rate in 2007 (5.8 percent).
  • In 2008, there were 1.9 million current cocaine users aged 12 or older, comprising 0.7 percent of the population. These estimates were similar to the number and rate in 2007 (2.1 million or 0.8 percent), but lower than the estimates in 2006 (2.4 million or 1.0 percent).
  • Hallucinogens were used in the past month by 1.1 million persons (0.4 percent) aged 12 or older in 2008, including 555,000 (0.2 percent) who had used Ecstasy. These estimates were similar to the corresponding estimates for 2007.
  • There were 6.2 million (2.5 percent) persons aged 12 or older who used prescription-type psychotherapeutic drugs nonmedically in the past month. These estimates were lower than in 2007 (6.9 million or 2.8 percent).
  • The number of past month methamphetamine users decreased by over half between 2006 and 2008. The numbers were 731,000 in 2006, 529,000 in 2007, and 314,000 in 2008.
  • Among youths aged 12 to 17, the current illicit drug use rate remained stable from 2007 (9.5 percent) to 2008 (9.3 percent). Between 2002 and 2008, youth rates declined significantly for illicit drugs in general (from 11.6 to 9.3 percent) and for marijuana (8.2 to 6.7 percent), cocaine (0.6 to 0.4 percent), prescription-type drugs used nonmedically (4.0 to 2.9 percent), pain relievers (3.2 to 2.3 percent), stimulants (0.8 to 0.5 percent), and methamphetamine (0.3 to 0.1 percent).
  • The rate of current marijuana use among youths aged 12 to 17 decreased from 8.2 percent in 2002 to 6.7 percent in 2006 and remained unchanged at 6.7 percent in 2007 and 2008.
  • The rate of current hallucinogen use among youths aged 12 to 17 increased from 0.7 percent in 2007 to 1.0 percent in 2008.
  • Rates of current use of illicit drugs in 2008 were higher among young adults aged 18 to 25 (19.6 percent) than for youths aged 12 to 17 (9.3 percent) and adults aged 26 or older (5.9 percent). Among young adults, there were no changes from 2007 to 2008 in the rate of current use of marijuana (16.5 percent in 2008), psychotherapeutics (5.9 percent), and hallucinogens (1.7 percent). The rate of cocaine use in this age group declined from 2.6 percent in 2005 to 1.5 percent in 2008.
  • From 2002 to 2008, there was an increase among young adults aged 18 to 25 in the rate of current nonmedical use of prescription pain relievers (from 4.1 to 4.6 percent) and in LSD (from 0.1 to 0.3 percent). There were decreases in the use of inhalants (from 0.5 to 0.3 percent) and methamphetamine (from 0.6 to 0.2 percent).
  • Among those aged 50 to 59, the rate of past month illicit drug use increased from 2.7 percent in 2002 to 4.6 percent in 2008. This trend may partially reflect the aging into this age group of the baby boom cohort, whose lifetime rate of illicit drug use is higher than those of older cohorts.
  • Among persons aged 12 or older in 2007-2008 who used pain relievers nonmedically in the past 12 months, 55.9 percent got the drug they most recently used from a friend or relative for free. Another 18.0 percent reported they got the drug from one doctor. Only 4.3 percent got pain relievers from a drug dealer or other stranger, and 0.4 percent bought them on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 81.7 percent reported in a follow-up question that the friend or relative had obtained the drugs from just one doctor.
  • Among unemployed adults aged 18 or older in 2008, 19.6 percent were current illicit drug users, which was higher than the 8.0 percent of those employed full time and 10.2 percent of those employed part time. However, most illicit drug users were employed. Of the 17.8 million current illicit drug users aged 18 or older in 2008, 12.9 million (72.7 percent) were employed either full or part time. The number of unemployed illicit drug users increased from 1.3 million in 2007 to 1.8 million in 2008, primarily because of an overall increase in the number of unemployed persons.
  • In 2008, 10.0 million persons aged 12 or older reported driving under the influence of illicit drugs during the past year. This corresponds to 4.0 percent of the population aged 12 or older, the same as the rate in 2007 (4.0 percent), but lower than the rate in 2002 (4.7 percent). In 2008, the rate was highest among young adults aged 18 to 25 (12.3 percent).

Well, there you have the latest information as to what Americans are doing with illicit drugs. In a followup post we’ll provide the survey’s findings on Alcohol Abuse in America. Please stay tuned.


Monitoring the Future

The following text is a portion of the annual report by the University of Michigan Institute for Social Research on the drug use habits of American adolescents. It is only the “Overview” and “Summary”. For the full report in PDF format follow this link.

Monitoring the Future 

Monitoring the Future (MTF) is a long-term study of American adolescents, college students,and adults through age 50. It has been conducted annually by the University ofMichigan’s, Institute for Social Research since its inception in 1975. It is supported under aseries of investigator-initiated, competing research grants from the National Institute onDrug Abuse.The need for a study such as MTF is clear. Substance use by American young people hasproven to be a rapidly changing phenomenon, requiring frequent assessments and reassessments.Since the mid-1960s, when it burgeoned in the general youth population, illicit druguse has remained a major concern for the nation. Smoking, drinking, and illicit drug useare leading causes of morbidity and mortality, both during adolescence as well as later in life.How vigorously the nation responds to teenage substance use, how accurately it identifies theemerging substance abuse problems, and how well it comes to understand the effectiveness ofpolicy and intervention efforts largely depend on the ongoing collection of valid and reliabledata. Monitoring the Future is designed to generate such data in order to provide an accuratepicture of what is happening in this domain and why, and has served that function well for thepast 33 years. Policy discussions in the media; in government, education, and public health institutions; and elsewhere have been informed by the ready availability of extensive and accurate information from the study relating to a large number of substances.The 2008 MTF survey encompassed over 46,000 eighth-, 10th-, and 12th-grade studentsin almost 400 secondary schools nationwide. The first published results are presented in this report. Recent trends in the use of licit and illicit drugs are emphasized, as well as trends inthe levels of perceived risk and personal disapproval associated with each drug. This studyhas shown these beliefs and attitudes to be particularly important in explaining trends in use.In addition, trends in the perceived availability of each drug are presented.A synopsis of the design and methods used in the study and an overview of the key resultsfrom the 2008 survey follow this introductory section. This is followed by a section foreach individual drug class, providing figures that show trends in the overall proportions ofstudents at each grade level (a) using the drug, (b) seeing a “great risk” associated with its use(perceived risk), (c) disapproving of its use, and (d) saying that they think they could get it“fairly easily” or “very easily” if they wanted to (perceived availability). The years for whichdata on each grade are available are 1975–2008 for 12th graders and 1991–2008 for 8th and10th graders, who were first included in the study in 1991.The tables at the end of this report provide the statistics underlying the figures; in addition,they present data on lifetime, annual, 30-day, and (for selected drugs) daily prevalence.1 Forthe sake of brevity, we present these prevalence statistics here only for the 1991–2008 interval,but statistics on 12th graders are available for earlier years in other publications from thestudy. For each prevalence period, the tables indicate which of the most recent one-yearchanges (between 2007 and 2008) are statistically significant. The graphic depictions of multiyear trends often indicate gradual, continuing change that may not reach significancein a given one-year interval. A much more extensive analysis of the study’sfindings on secondary school students may be found in Volume I, the second monographin this series, which will be published later in 2009.2 Volume I also contains a more completedescription of the study’s methodology, as well as an appendix explaining how to test the significance of differences between groups or of trends over time. The most recent such volumeis always available on the study’s Web site under Publications.MTF’s findings on American college students and adults through age 50 are not covered inthis early Overview report because the data from those populations become available laterin the year. These findings will be covered in Volume II, the third monograph in this annualseries, which will be published later in 2009.Volume II also contains a chapter dealing with national trends in HIV/AIDS-related riskand protective behaviors among young adults 21 to 30 years old. Volumes in these annualseries are available from the DrugPubs Research Dissemination Center at 877-NIDANIH(877-643-2644); or by e-mail at They also may beviewed and downloaded from the study’s Web site. Further information on the study,including its latest press releases, a listing of all publications, and the text of manyof them may be found on the Web site at Monitoring the Future’s main data collection involves a series of large, annual surveys of nationally representative samples of public and private secondary school students throughoutthe coterminous United States. Every year since 1975, a national sample of 12th gradershas been surveyed. In 1991, the study was expanded to include comparable, independentnational samples of 8th and 10th graders. The year 2008 marked the 34th survey of 12th graders and the 18th survey of 8th and 10th graders.  Sample Sizes The 2008 sample sizes were about 16,300, 15,500, and 14,600 in 8th, 10th, and 12thgrades, respectively. In all, about 46,000 students in 386 secondary schools participated.Because multiple questionnaire forms are administered at each grade level, and becausenot all questions are contained in all forms, the number of cases upon which a particular statisticis based may be less than the total sample size. The tables here contain notes on the numberof forms used for each statistic if less than the total sample is used. Field Procedures University of Michigan staff members administer the questionnaires to students, usually in theirclassrooms during a regular class period. Participation is voluntary. Parents are notified wellin advance of the survey administration and are provided the opportunity to decline their child’sparticipation. Questionnaires are self-completed and formatted for optical scanning.In 8th and 10th grades the questionnaires are completely anonymous, and in 12th grade theyare confidential (name and address information is gathered to permit the longitudinal follow-upsurveys of random subsamples of participants for some years after high school). Extensive to protect the confidentiality of subjects and their data. All procedures are reviewed and approvedon an annual basis by the University of Michigan’s Institutional Review Board (IRB)for compliance with federal guidelines for the treatment of human subjects.  Measures A standard set of three questions is used to determine usage levels for the various drugs(except for cigarettes and smokeless tobacco).For example, we ask, “On how many occasions(if any) have you used marijuana . . . (a). . . in your lifetime? (b) . . . during the past 12months? (c) . . . during the last 30 days?” Each of the three questions is answered on the sameanswer scale: 0, 1–2, 3–5, 6–9, 10–19, 20–39, and 40 or more occasions.For the psychotherapeutic drugs (amphetamines, sedatives [barbiturates], tranquilizers,and narcotics other than heroin), respondents are instructed to include only use “. . . on yourown—that is, without a doctor telling you to take them.” A similar qualification is used inthe question on use of anabolic steroids. For cigarettes, respondents are asked two questionsabout use. First they are asked, “Have you ever smoked cigarettes?” (the answer categoriesare “never,” “once or twice,” and so on). The second question asks, “How frequentlyhave you smoked cigarettes during the past 30 days?” (the answer categories are “not at all,”“less than one cigarette per day,” “one to five  cigarettes per day,” “about one-half pack perday,” etc.). Smokeless tobacco questions parallel those for cigarettes. Alcohol use is measured using the three questions illustrated above for marijuana. A parallel set of three questions asks about the frequency of being drunk. A different question asks, for the prior two-week period, “How many timeshave you had five or more drinks in a row?” Perceived risk is measured by a question asking, “How much do you think people risk harming themselves (physically or in other ways), if they“try marijuana once or twice,” for example. The answer categories are “no risk,” “slight risk,” “moderate risk,” “great risk,” and “can’t say, drug unfamiliar.” Disapproval is measured by the question “Do YOU disapprove of people doing each of the following?”followed by “trying marijuana once or twice,” for example. Answer categories are “don’t disapprove,” “disapprove,” and “strongly disapprove.” In the 8th- and 10th-grade questionnairesa fourth category, “can’t say, drug unfamiliar,” is provided, and is included in the calculations.Perceived availability is measured by the question “How difficult do you think it would be foryou to get each of the following types of drugs, if you wanted some?” Answer categories are“probably impossible,” “very difficult,” “fairly difficult,” “fairly easy,” and “very easy.” For8th and 10th graders the additional answer category, “can’t say, drug unfamiliar,” is offeredand included in the calculations. In recent years, the trends in drug use havebecome more complex, and thus more difficult to describe. A major reason for thisincreased complexity is that cohort effects—lasting differences between classcohorts—have emerged, beginning with the increases in drug use during the early 1990s.These effects result in the various grades reaching peaks or valleys in different years,and thus usage rates sometimes move in different directions. We have seen such cohorteffects for cigarette smoking throughout most of the life of the study, but they were muchless evident for the illicit drugs until the mid- 1990s. The 8th graders have been first to showturnarounds in illicit drug use, and they have generally shown the greatest proportional declinesfrom recent peak levels of use, attained for the most part during the 1990s, while theproportional declines have generally been the least at 12th grade.This year we have introduced an additional set of tables providing an overview of drug usetrends for the three grades combined. While there are important differences by grade, thisapproach gives a more succinct summary of the general nature of trends over the last severalyears. Later sections in this monograph deal separately with each class of drugs and providedata for each grade individually. Overall, this was another year of modestchange in the use of most illicit drugs, much as was true in 2005–2007. Looking across Tables1–4, one can see that very few one-year changes (2007–2008) reached statistical significance, and those that did showed declines. In particular, amphetamines showed a significantdecrease again this year in lifetime, annual, and 30-day prevalence rates; all of these declineswere small this year, but many of them continue previous trends. Ritalin showed further declinethis year in two of the three grades, though the declines were not statistically significant.Other significant declines for all three grades combined occurred for annual prevalence ofcocaine and crack and for 30-day prevalence of any illicit drug other than marijuana.Some other drugs continued their gradual downward trends this year; though the2007–2008 changes are not significant, these declines have cumulated across the years tobecome significant, both statistically and substantively, including use of any illicit drug,amphetamines, Ritalin specifically, methamphetamine and crystal methamphetamine(ice). Most of the modest declines this year occurred for the stimulant drugs, including cocaineand crack. Among the drugs that generally held steady this year in at least two of the three grades monitored were any illicit drug, marijuana, any illicit drug other than marijuana (except for a signifi cant decline in 10th grade),inhalants, hallucinogens taken as a class (although 12th graders showed a non-significant increase in 2007–2008), LSD, hallucinogensother than LSD, PCP, ecstasy (MDMA), sedatives (barbiturates), tranquilizers, heroin,narcotics other than heroin (data available for 12th grade only), OxyContin specifically,and Vicodin specifically. Many of these drugs are holding steady at levels well below theirrecent peaks, LSD being a particularly notable example. As can be seen in Tables 1–4,the declines since the recent peak levels are highly significant for most drugs, indicatingthe cumulative impact of what have generally been gradual, steady changes. (Ecstasy andLSD are exceptions in that their declines were Rapid at certain times.One noteworthy point is that, in 8th and 12th grades, the declines in use of many drugs maybe ending, as indicated by the leveling of many of the drugs mentioned above. The declines appear ongoing for 10th graders, however. One of the most impressive declines has been inthe use of methamphetamine, which has fallen steadily and substantially since it was first measured in 1999. Given the high addiction potential of this drug, this is an important development. Annual prevalence for the use of methamphetamine in 2008 is 1.2%, 1.5%, and 1.2% for grades 8, 10, and 12, respectively—roughly two thirds below rates observed in 1999.Also of note this year is the slight increase in annual prevalence of marijuana use for thethree grades combined, reflecting increases in grades 8 and 12, but a slight decrease in grade10. None of these changes reached statistical significance, but they may signal a halt to thelong-term gradual decline that we have been reporting for some years. Largely because ofthese changes in marijuana use, the use of any illicit drug in the past year showed a similarpattern of change. Since 2007, particular emphasis has been placed on the use of prescription drugs outside of medical supervision, and on the use of over-the-counter cough and cold medicines to get high. As mentioned above, the use of amphetamines continues to decline. Use of sedatives (barbiturates) (measured in 12th grade only) continues a very gradual decline that began after 2005. Tranquilizer use held fairly steady this year (except for a slight decline in 10th grade), while use of narcotics other than heroin has been the exception, holding steady at historically high levels since 2002 among 12th graders (use for 8th and 10th graders is not reported). The use of two important narcotics, Vicodin and OxyContin, has not changed significantly since peak levels reached in recent years. The misuse of over-the-counter cough and cold medicines, most of which contain dextromethorphan, was first measured in 2006; thismisuse has been declining gradually in 8th and 12th grades since then, while holding steady in10th grade. The use of anabolic steroids had been steadily declining in recent years since peak levels were reached by 8th graders in 2000, by 10th graders in 2002, and by 12th graders in 2004. There was no further systematic change this year. The rates in 2008 are down from those peaks by roughly half. Implications for Prevention The wide divergence in historical trajectories of the various drugs over time helps to illustratethat, to a considerable degree, the determinants of use are often specific to each drug. Thesedeterminants include both perceived benefits and perceived risks that young people come toassociate with each drug. Unfortunately, word of the supposed benefits ofusing a drug usually spreads much faster than information about the adverse consequences.The former—supposed benefits—takes only rumor and a few testimonials, the spread ofwhich has been hastened greatly by the media and Internet. It usually takes much longer forthe evidence of adverse consequences (e.g., death, disease, overdose, addictive potential)to cumulate and then be disseminated. Thus, when a new drug comes onto the scene, it hasa considerable grace period during which its benefits are alleged and its consequences arenot yet known. We believe that ecstasy was the most recent example of this.To a considerable degree, prevention must occur drug by drug, because people will not necessarily generalize the adverse consequences of one drug to the use of others. Many beliefs and attitudes held by young people are drug specific. The figures in this Overview on perceived risk and disapproval for the various drugs—attitudes and beliefs that we have shown to beimportant in explaining many drug trends over the years—amply illustrate this assertion.These attitudes and beliefs are at quite different levels for the various drugs and, more importantly often trend differently over time.  “Generational Forgetting” Helps Keep the Epidemic Going Another point worth keeping in mind is that there tends to be a continuous flow of new drugsonto the scene and of older ones being rediscovered by young people. Many drugs have made acomeback years after they first fell from popularity, often because young people’s knowledgeof their adverse consequences faded as generational replacement took place. We call thisprocess “generational forgetting.” Examples include LSD and methamphetamine, two drugsused widely in the 1960s that made a comeback in the 1990s after their initial popularity fadedas a result of their adverse consequences becoming widely recognized during periods ofhigh use; heroin, cocaine, PCP, and crack are some others. At present, LSD and ecstasy areshowing the effects of generational forgetting, which puts future cohorts at greater risk of havinga resurgence in the use of these drugs. As for newly emerging drugs, examples includenitrite inhalants and PCP in the 1970s; crack and crystal methamphetamine in the 1980s;and Rohypnol, GHB, and ecstasy in the 1990s. The perpetual introduction of new drugs (orof new forms or new modes of administration of older ones, as illustrated by crack, crystalmethamphetamine, and noninjected heroin) helps to keep the country’s drug problem alive.Because of the lag times described previously, the forces of containment are always playingcatch up with the forces of encouragement and exploitation. Organized efforts to reduce thegrace period experienced by new drugs would seem to be among the most promising responsesfor minimizing the damage they will cause. Such efforts regarding ecstasy by the NationalInstitute on Drug Abuse and others appeared to pay off. The psychotherapeutic drugs now make up alarger part of the nation’s overall drug problem than was true 10 years ago, in part because usehas increased for many such drugs over that period, and in part because use of a number ofstreet drugs has declined substantially since themid-1990s. It seems likely that young peopleare less concerned about the dangers of using these drugs outside of medical regimen, likelybecause they are widely used for legitimate purposes. (Indeed, the low levels of perceivedrisk for sedatives and amphetamines observed among 12th graders illustrates this point.) Also,prescription psychotherapeutic drugs are now being advertised directly to the consumer,which implies both that they are in widespread use and that they can be used with low risk. Cigarettes and Alcohol The statistics for use of the licit drugs—cigarettes and alcohol—also remain a basis forconsiderable concern. Cigarettes. Nearly half (45%) of American youngpeople have tried cigarettes by 12th grade, and one out of five (20%) 12th graders are currentsmokers. Even as early as 8th grade, one in five (21%) have tried cigarettes, and 1 in 15 (7%) hasalready become a current smoker. Fortunately, there has been some real improvement in thesesmoking statistics over the last 11–12 years, following a dramatic increase earlier in the 1990s.Some of that improvement was simply regaining lost ground, but by 2008, cigarette use hasreached the lowest levels recorded in the life of the study, going back 33 years in the case of 12thgraders. It is particularly encouraging that, after seeming to end a couple of years ago, the declinein use is now continuing. Thirty-day prevalence of cigarette use reached a peak in 1996 at grades 8 and 10, capping a rapid climb from the 1991 levels (when data were first gathered on these grades). Between1996 and 2008, current smoking has fallen considerably in these grades (by 67% and 60%,respectively). For 12th graders, peak use occurred a year later, in 1997, and has had a moremodest decline, dropping to 44% by 2008. However, because of the strong cohort effectthat we have consistently observed for cigarette smoking, we expect the 12th graders tocontinue to show declines, as the lighter using cohorts of 8th and 10th graders become 12thgraders. Overall increases in perceived risk and disapproval appear to have contributed to thisdownturn. Perceived risk increased substantially and steadily in all grades from 1995 through2004, after which it leveled in 8th and 10th grades, but continued rising in 12th grade until2006, after which it leveled and then began to decline in 2008. Disapproval of smoking hadbeen rising steadily in all grades since 1996. After 2004, the rise decelerated in the lowergrades through 2006—again, reflecting a cohort effect in this attitude.It seems likely that some of the attitudinal change surrounding cigarettes is attributable tothe adverse publicity suffered by the tobacco industry in the 1990s, as well as a reductionin cigarette advertising and an increase in antismoking advertising reaching children. Priceis also likely to have been an important factor; cigarette prices rose appreciably in the late1990s and early 2000s as cigarette companies tried to cover the costs of the tobacco settlement,and as many states increased excise taxes on cigarettes. Various other attitudes toward smoking becamemore unfavorable during that interval, as well, though some have since leveled off. Forexample, among 8th graders, the proportions saying that they “prefer to date people whodon’t smoke” rose from 71% in 1996 to 83% by 2008 (with little change since 2003). Similarchanges occurred in 10th and 12th grades, as well. Thus, at the present time, smoking is likelyto make an adolescent less attractive to the great majority of potential romantic partners. Smokeless tobacco use had also been in decline in recent years, continuing into the early2000s, but the decline appears to have ended in all grades. The 30-day prevalence rates forsmokeless tobacco are now down by about half from peak levels. Alcohol use remains extremely widespread among today’s teenagers. Nearly three quartersof students (72%) have consumed alcohol (more than just a few sips) by the end of highschool, and about two fifths (39%) have done so by 8th grade. In fact, more than half (55%)of 12th graders and nearly a fifth (18%) of 8th graders in 2008 report having been drunk atleast once in their life. To a considerable degree, alcohol trends havetended to parallel the trends in illicit drug use. These include a modest increase in bingedrinking (defined as having five or more drinks in a row at least once in the past twoweeks) in the early and mid-1990s, though it was a proportionally smaller increase than wasseen for most of the illicit drugs. Fortunately, binge drinking rates leveled off seven to tenyears ago, just about when the illicit drug rates began to turn around, and in 2002 a drop indrinking and drunkenness began to appear in all grades. Gradual declines have continued inthe years since. The longer term trend data available for 12th graders show that alcohol usage rates, andbinge drinking in particular, are now substantially below peak levels in the early 1980s.  Where Are We Now? Clearly, the problem of substance abuse among American young people remains sufficientlywidespread to merit concern. Today, nearly half (47%) have tried an illicit drug by the timethey finish high school. Indeed, if inhalant use is included in the definition of illicit drug use,over a quarter (28%) have done so as early as 8th grade—when most students are only 13–14years old. One in four (25%) have used some illicit drug other than marijuana by the end of 12thgrade, and 18% of all 12th graders reported doing so during the 12 months prior to the survey.From the perspective of helping to deter future use, we emphasize the considerable proportionsof youth who do not use each of these drugs and who disapprove of their use. The majority (57%)of seniors today made it through the end of high school without ever having tried marijuana, andthree quarters (75%) without using an illicit drug other than marijuana. Further, the great majoritypersonally disapprove of using most illicit drugs, as has been true for many years.Despite the considerable progress made in the past decade, the nation must not be lulled intocomplacency. To some degree this happened in the early 1990s, after the considerable improvementsof the 1980s. Attention to the problem of drug use nearly disappeared from nationalnews coverage, and many governmental and non-governmental institutions withdrew attentionand programmatic support, which likely helped to set the stage for the costly relapse inthe drug epidemic during the 1990s