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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, Michigan has ranked at or above the national rates for past month illicit drug use, past year nonmedical use of pain relievers, and both past month and past year marijuana use for all age groups. Similarly, Michigan has ranked at or above the national levels for past month alcohol use and past month binge alcohol use for all age groups, including underage drinkers.
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).
In Michigan, the rates of past year drug dependence have been quite variable, especially for individuals age 12 to 17 (Chart 1). In 2002-2003 and 2003-2004, Michigan ranked among the 10 highest2 States for past year drug dependence among this age group. In 2005-2006, however, Michigan ranked among the lowest 10 States.
Rates of past year alcohol dependence, however, have generally been comparable to the national rates for this age group (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 Michigan has declined slightly from 562 facilities in 2002, to 539 facilities in 2006. In 2006, the majority of Michigan facilities (293 of 539) were private nonprofit and just over one-third were private for-profit (183). Michigan also had 12 facilities owned/operated by Tribal government(s) and two programs that offered treatment in American Indian/Alaska Native language(s).
Although facilities may offer more than one modality of care, the majority of facilities in Michigan in 2006 (502 or 93%) offered some form of outpatient treatment, and an additional 87 facilities (16%) offered some form of residential care. In addition, 37 programs provided an opioid treatment program, and 316 physicians and 69 treatment programs were certified to provide buprenorphine treatment for opiate addiction.
In 2006, 55 percent of all facilities (297) received some form of Federal, State, county, or local government funds, and 353 facilities (65%) 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, Michigan showed a total of 45,290 clients in treatment, the majority of whom (41,962 or 93%) were in outpatient treatment. Of the total number of clients in treatment on this date, 3,415 (7%) were under the age of 18.
Chart 3 shows the percent of admissions mentioning particular drugs or alcohol at the time of admission.5 Across the last 15 years, there has been a steady decline in the percentage of admissions mentioning alcohol. There have also been increases in the percentage of admissions mentioning marijuana, heroin, and opiates other than heroin.
Across the years for which TEDS data are available, Michigan has seen a substantial shift in the constellation of problems present at treatment admission (Chart 4). Alcohol-only admissions have declined from 40 percent of all admissions in 1992, to 24 percent in 2006. Concomitantly, drug-only admissions have nearly tripled from 13 percent in 1992, to 36 percent in 2006.
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.
Unmet need for drug treatment in Michigan has generally been at or slightly below the national rates for this measure. The rates for the age group of individuals from 12 to 17, however, mirror the drug dependence rates noted above (Chart 5).