Little Progress in Cutting Drug Use as Treatment Resources Continue to Lag

The U.S. has made little progress in cutting the rate of illicit drug use since 2002 — in part because addiction treatment remains difficult to access — and a pair of prominent and closely watched national surveys offer mixed and sometimes divergent perspectives on adolescent drug-use trends.

The 2008 National Survey on Drug Use and Health (NSDUH), released last week by the Substance Abuse and Mental Health Services Administration (SAMHSA), found that the overall rate of current use of illicit drugs remained level at about 8 percent, a figure that has barely budged since 2002, when 8.2 percent of those contacted for the survey acknowledged using illicit drugs.

Progress was reported in certain segments of substance misuse, however, notably those that have received significant public attention in recent years: Nonmedical use of prescription drugs declined from about 2.8 percent of U.S. residents over age 12 in 2007 to 2.5 percent in 2008, for example, and the number of individuals reporting use of methamphetamine fell by more than half between 2006 and 2008. Heavy alcohol use among full-time college students ages 18-22 also declined, from 19.5 percent in 2005 to 16.3 percent in 2008.

“Some of these trends are not huge, but we can’t ignore them because they might be the start of a more consistent trend,” said Joe Gfroerer, principal statistician for the NSDUH at SAMHSA.

The NSDUH includes data on drug use among adults as well as adolescents, but the Obama administration emphasized a handful of findings about youths, notably that past-month use of illicit drugs fell from 11.6 percent in 2004 to 9.3 percent in 2008, and that reported youth misuse of prescription drugs declined to its lowest level since 2002.

The annual 2009 Pride Survey — released this week — drew somewhat different conclusions, finding “small but significant” increases in past-month illicit-drug use among the more than 122,000 6th- to 9th-grade students surveyed between August 2008 and June 2009. “Most of the increases witnessed were small (less than 1 percent),” according to a summary of the Pride Survey findings. “However, they suggest that decreases in adolescent drug use over the last several years may have come to a halt.”

(SAMHSA’s Gfroerer said that while both surveys are large, the findings aren’t comparable because the Pride Survey isn’t nationally representative, with data drawn only from schools that choose to take part.)

The NSDUH findings on prescription drugs were seemingly contradictory, at times: while overall and youth misuse of prescription drugs fell, for instance, more Americans began nonmedical use of prescription drugs than initiated use of any illicit drug other than marijuana.

“It’s a mixed report, frankly,” said Tom McLellan, deputy director of the Office of National Drug Control Policy (ONDCP). . “Everyone who has been pushing back against the abuse of pharmaceuticals should be proud that their work is having a positive effect. But I worry about flatlining of declines in drug abuse and young people perceiving drug use as less risky than they used to; in the past, that softening in attitudes has been a sign of trouble on the horizon.”

Gil Kerlikowske, director of ONDCP, said that, “Although we see some success in the reduction of overall illicit drug use, methamphetamine and prescription drug abuse among teens, there are indications that progress in other areas may be at a standstill, or even slipping back.”

“As we develop the Obama administration’s first drug-control strategy, we will emphasize a balanced approach that can respond to current and emerging drug-abuse trends. Improving substance-abuse prevention and treatment systems will be among our priorities,” said Kerlikowske.

Of course, past administrations and drug czars have also promised a “balanced” approach to battling the nation’s drug problem, but the rhetoric has rarely matched to reality, according to budget analyst and former ONDCP staffer John Carnevale, Ph.D. A new policy brief from Carnevale Associates, “The Continued Standstill in Reducing Illicit Drug Use: Is the Policy-Budget Mismatch to Blame?,” cites “the eight-year failure of ONDCP to meaningfully match its federal drug-control budget to the demand reduction goals set forth by its own policy.”

The Carnevale report noted that while total federal funding for drug-control activities grew by 39 percent between 2002 and 2009, 90 percent of the increase went to supply-reduction programs, and funding for drug prevention actually declined by 10 percent during the same time period. “Simply put, the only way to reduce the demand for drugs is to pay for programs that do just that,” according to the Carnevale policy report.

As Kerlikowske works on his first National Drug Control Strategy — typically released in January — Carnevale said that a straightforward reallocation of resources might be necessary in the current budget environment. “A first step in fixing the drug-control budget will mean cutting all wasteful spending, especially for the expansion of supply-reduction programs during this decade, and using those resources instead to offset the cost of expanding long underfunded, critical demand-reduction programs.”

The need for increased investment in addiction-treatment services was highlighted in the NSDUH data, which “continues to show a vast disparity between the number of people needing specialized treatment for a substance-abuse problem and the number who actually receive it,” according to SAMHSA. The survey found that only 10 percent of Americans who need addiction treatment get help, a figure that has remained basically unchanged since 2002.

“The national data released today confirms that untreated alcohol and drug addiction remains at pandemic levels, with 23 million Americans suffering from the disease, approximately the same number that suffers from type 2 diabetes,” said Victor Capoccia, director of the Closing the Addiction Treatment Gap initiative. “But you wouldn’t know it from the way our country responds to the problem. Only one in ten Americans affected by addiction is treated, as opposed to four out of five people with diabetes.”

Capoccia said that inability to pay for treatment was the biggest barrier cited by those who wanted help but didn’t get care, and called for addiction services to be fully covered in national healthcare reform proposals and by all health insurance plans.