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, Alabama has ranked among the ten states with the lowest rates on the following measures (Table 1):

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 [APA], 1994). In Alabama, rates of past year dependence on or abuse of alcohol or illicit drugs have been generally below the national rates (Chart 1). On the global measure of any dependence on or abuse of illicit drugs or alcohol, Alabama has generally ranked among those states with the lowest rates in the country.

Substance Abuse Treatment Facilities

According to the 2006 National Survey of Substance Abuse Treatment Services (N-SSATS)3 annual surveys, the number of treatment facilities in Alabama was 138. Of these, 66 were private for-profit and 43 were private non-profit. The remainder were owned/operated by federal, State or local government(s). Since 2002, the number of treatment facilities has remained relatively stable.

Although facilities may offer more than one modality of care, in 2006 the majority of facilities (114 or 83%) offered some form of outpatient treatment. Another 38 facilities offered some form of residential care; 19 facilities offered an opioid treatment program; and 104 physicians and 18 programs were certified to provide bupenorphine for opiate addiction.

In 2006, 56% of all facilities (77) received some form of Federal, State, county or local government funds, and 39 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).4 In the 2006 N-SSATS survey, Alabama showed a total of 14,953 clients in treatment, the majority of whom (13,855 or 93%) were in outpatient treatment. Of the total number of clients in treatment on this date, 1,541 (1%) were under the age of 18.

Chart 2 shows the percent of admissions mentioning particular drugs or alcohol at the time of admission. Across the last 15 years, there has been a steady decline in the number of admissions mentioning alcohol or cocaine and concomitant increases in the mentions of methamphetamine and opiates other than heroin.

Across the years for which TEDS data are available, Alabama has seen a substantial shift in the constellation of problems present at treatment admission (Chart 3).5 Alcohol-only admissions have declined from 29 % of all admissions in 1993 to 14% in 2006. Drug-only admissions have increased from 17% in 1993 to 48% 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.

In Alabama, rates of unmet need for alcohol treatment have generally been below the national rate, and for both the state population 12 and older and the population 26 and older, these rates have been among the lowest in the country (Chart 4).

Rates for unmet drug treatment have been somewhat more variable than the comparable rates for alcohol treatment need. These have varied from the national rate to the lowest in the country for three age groups (12+, 12-17, and 18-25) in 2005-2006 (Chart 5).