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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 (12+); individuals age 12 to 17; individuals age 18 to 25; and individuals age 26 and older (26+). 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, rates of past month illicit drug use, past month use of an illicit drug other than marijuana, and past year marijuana use have generally remained at or above the national rates. Rates of past month alcohol use and past month binge alcohol use have generally remained at or below the national average.
Abuse and Dependance
Questions in NSDUH are used to classify persons asbeing dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) (American Psychiatric Association, 1994).
While the rate of any abuse of or dependence on alcohol or illicit drugs has generally remained at or below the national rates for all age groups and across all survey years, there are some differences. Rates of alcohol dependence have generally remained well below the national rate, particularly since the 2003-2004 survey, and rates of dependence or abuse on illicit drugs has generally remained above the national rate for all age groups and across all survey years(Charts 1 and 2).
Substance Abuse Treatment Facilities
According to the National Survey of Substance Abuse Treatment Services (N-SSATS) annual surveys,2 the number of treatment facilities in Delaware has varied from a low of 42 in 2002, to a high of 47 in 2003. In 2006, the number of treatment facilities was 43, the majority of which (29 or 67%) were private nonprofit. Another 11 facilities were private for-profit and the remainder were owned/operated by Federal, State, local, or governments.
Although facilities may offer more than one modality of care, the majority of facilities (34 of 43) offered some form of outpatient care in 2006. Residential care was offered by 12 facilities. Delaware had four facilities offering methadone treatment and 24 physicians certified to deliver buprenorphine therapy. In 2006, 27 facilities (63%) received some form of Federal, State, county, or local government funds, and 23 facilities had agreements or contracts with managed care organizations 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).3 In the 2006 N-SSATS survey, Delaware showed an one-day census total of 4,042 clients in treatment, the majority of whom (3,754 or 93%) were in outpatient treatment. Of the total number of clients in treatment on this date, 261 (6.5%) were under the age of 18.
Since 2002, there has been a steady increase in the annual number of admissions to treatment in Delaware from 5,121 in 2002, to 8,227 in 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.4 Across the last 14 years, there has been a steady decline in the number of admissions mentioning alcohol as a substance of abuse and concomitant increases in the mentions of marijuana and heroin.
Across the years for which TEDS data are available, Delaware has seen a substantial shift in the constellation of problems present at treatment admission. Alcohol-only admissions have declined from over 42 percent of all admissions in 1992 to just over 10 percent in 2005. Concomitantly, drug-only admissions have increased from 25 percent in 1998 to 41 percent in 2005 (Chart 4).
Unmet Need For Treatment
NSDUH defines unmet treatment need as an individual who meets the criteria for abuse of or dependence on illicit drugs or alcohol according to the DSM-IV, but who has not received specialty treatment for that problem in the past year.
Delaware has consistently ranked below the national average in the rate of individuals needing and not receiving treatment for alcohol abuse for all age groups. In 2005-2006, these rates were among the ten lowest5 in the country for all age groups except those age 12 to 17 (Chart 5).
The rates of individuals needing and not receiving drug treatment, however, are more variable across time. In the 2005-2006 surveys, Delaware ranked consistently higher in unmet drug treatment need than the national average (Chart 6).