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 in North Carolina for most measures have been at or below the national rates and for the following measures were among the ten lowest in the country (Table 1).

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).

On the global measure of any past year abuse of or dependence on illicit drugs or alcohol, rates in North Carolina have generally been below the national rates (Chart 1). When alcohol and illicit drugs are considered separately, however, some differences can be seen in that alcohol dependence rates are lower than the national rates and drug dependence rates are at or above the national rates (Chart 2).

Substance Abuse Treatment Facilities

According to the 2006 National Survey of Substance Abuse Treatment Services (N SSATS),3 North Carolina had a total of 362 treatment facilities. Private non-profit and private for-profit organizations each had 147 facilities. One facility was owned/operated by a tribal government. The number of treatment facilities in North Carolina has increased by more than 80 since 2002. The change is primarily accounted for by increases in both private for-profit and private non-profit facilities (60 and 61 facilities respectively) and a decrease in those facilities owned or operated by Federal, State, or local government(s).

Although facilities may offer more than one modality of care, the majority of facilities in 2006 (300 of 362) offered some form of outpatient treatment. Sixty additional facilities offered some form of residential care, and 34 facilities offered an opioid treatment program. In addition, 126 physicians and 48 treatment programs are certified to provide buprenorphine care.

In 2006, 42 percent of all facilities (153) received some form of Federal, State, county or local government funds, and 143 facilities (40%) 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).4 In the 2006 N-SSATS survey, North Carolina showed a one-day total of 25,845 clients in treatment, the majority of whom (23,411 or 90%) were in outpatient treatment. Of the total number of clients in treatment on this date, 1,682 (6%) were under the age of 18.

Chart 3 shows the percentage 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 number of admissions mentioning alcohol and concomitant increases in the mentions of cocaine and opiates other than heroin. Across the years for which TEDS data are available, North Carolina has seen a substantial shift in the constellation of problems present at treatment admission. Alcohol-only admissions have declined from over 40 percent of all admissions in 1992 to less than 20 percent in 2006. Concomitantly, drug-only admissions have increased from 15 percent in 1992 to 35 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.

Unmet need for alcohol treatment in North Carolina has generally been below the national rates and in 2005-2006 was among the lowest in the country for all age groups except those 26 and older (Chart 5).

Rates of unmet need for drug treatment, however, have been more variable and in 2005 2006 were among the highest in the country for those age 26 and older (Chart 6).