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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, the rates of many measures of illicit drug and alcohol use in New York have been at or above the rates for the country as a whole. This is particularly seen in the rates of past month illicit drug use for the population age 26 and older, past year marijuana use, and past year cocaine use.

Abuse and Dependance

Questions in NSDUH are used to classify persons as 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). On the global measure of any past year dependence on or abuse of illicit drugs or alcohol, the rates for all population groups have consistently remained at or below the national rates (Chart 1).

Substance Abuse Treatment Facilities

According to the 2006 National Survey of Substance Abuse Treatment Services (N SSATS),2 in 2006 the majority of treatment facilities in New York'736 of 1,030 facilities (71%)'were private nonprofit. An additional 143 facilities were private for-profit, and 5 facilities were owned or operated by a Tribal government.The number of treatment facilities in New York State has declined from a high of 1,260 in 2002 to 1,030 in 2006. The difference is primarily accounted for by a loss of 150 private nonprofit facilities, 58 private for-profit facilities, and 10 facilities operated/owned by the State government.Although facilities may offer more than one modality of care, 707 of 1,030 facilities (68%) in New York in 2006 offered some form of outpatient care. There were 286 facilities that offered some form of residential care, and 209 that offered an opioid treatment program. In addition, 1,037 physicians and 282 programs were certified to provide buprenorphine treatment for opiate addiction. In 2006, 611 of all facilities (59%) received some form of Federal, State, county, or local government funds, and 585 facilities had agreements or contracts with managed care organizations for the provision of substance abuse treatment services.

Treatment

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, New York showed an one-day census of 118,892 clients in treatment, 104,790 of whom (88%) were in outpatient treatment. Of the total number of clients in treatment on this date, 5,981 (5%) were under the age of 18.

Chart 2 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 small decline in the number of admissions mentioning alcohol at treatment entry and modest increases in the number of admissions mentioning marijuana and heroin. Across the years for which TEDS data are available, New York has seen a modest shift in the constellation of problems present at treatment admission (Chart 3). Alcohol-only admissions have declined from over 32 percent of all admissions in 1992 to just over 18 percent in 2005. Concomitantly, drug-only admissions have increased from 20 percent in 1992 to 29 percent in 2005.

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. In New York, the unmet need for drug treatment has been quite variable and has been at or above the national rates (Chart 4); however, in the 2005-2006 survey, the rates were above the national rates for all age groups except for those individuals age 25+ for whom the rates were equal to the national rate.

Unmet need for alcohol treatment, however, has been at or below the national rate and, in the population of the State as a whole (those age 12 and older), has been consistently below the national rate (Chart 5).