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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 the age of 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, Pennsylvanias rates of past month and past year marijuana use have generally been at or above the national rates. Rates of past year use of an illicit drug other than marijuana as well as the nonmedical use of pain relievers, however, have generally been at or below the national rates.
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 (DSM-IV) (American Psychiatric Association, 1994).
Across all survey years, rates of past year drug dependence for Pennsylvania's State population age 12 and older have been among the lowest2 in the country (Chart 1). Rates of past year alcohol dependence have also been at or below the national rates, and in 2005-2006 were among the lowest in the country for the age 12 and older population (Chart 2).
Substance Abuse Treatment Facilities
According to the National Survey of Substance Abuse Treatment Services (N-SSATS),3 the number of treatment facilities in Pennsylvania has decreased from 488 in 2002, to 446 in 2006. In 2006, the majority of facilities (317 of 447, or 71%) were private nonprofit, and 114 facilities (25%) were private for-profit.
Although facilities may offer more than one modality of care, in 2006 the majority of facilities in Pennsylvania (345 or 77%) offered some form of outpatient treatment, and an additional 132 facilities (29%) offered some form of residential care. Opioid treatment programs were available at 52 facilities, and 417 physicians and 56 treatment programs were certified to provide buprenorphine care for opiate addiction.
In 2006, 65 percent of all facilities (290) received some form of Federal, State, county, or local government funds, and 367 facilities (82%) 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).4 In the 2006 N-SSATS survey, Pennsylvania showed an one1-day total of 44,349 clients in treatment, the majority of whom (39,286 or 89%) were in outpatient treatment. Of the total number of clients in treatment on this date, 2,660 (6%) were under the age of 18.
The chart shows the percent of admissions mentioning particular drugs or alcohol at the time of admission.5 Across the last 14 years, there has been a steady decline in the number of admissions mentioning alcohol (82% vs. 55%) and a concomitant increase in the percent of admissions mentioning heroin (9% vs. 24% (Chart 3)).
Across the years for which TEDS data are available, Pennsylvania has seen a substantial shift in the constellation of problems present at treatment admission. Alcohol-only admissions have declined from 38 percent of all admissions in 1992, to 22 percent in 2005. Concomitantly, drug-only admissions have increased from 18 percent in 1992, to 44 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.
In Pennsylvania, the rate of unmet drug treatment need has been among the lowest in the country across all survey years (Chart 5).