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, Rhode Island has ranked among the 10 States with the highest rates on the following measures (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). Rates for both past year alcohol dependence (Chart 1) and past year drug dependence (Chart 2) have been among the 10 highest in the country across all survey years.

Substance Abuse Treatment Facilities

According to the National Survey of Substance Abuse Treatment Services (N-SSATS),3 the number of treatment facilities in Rhode Island has remained constant at approximately 57 facilities. Of these, 43 facilities (75%) are private nonprofit and 12 facilities are private for-profitAlthough facilities may offer more than one modality of care, in 2006, 49 of 57 facilities in Rhode Island offered some form of outpatient care. An additional 16 facilities offered some form of residential care; 19 facilities offered an opioid treatment program; and 42 physicians and 21 programs were certified to provide buprenorphine treatment.In 2006, 42 of 57 facilities (70%) received some form of Federal, State, county, or local government funds, and 40 facilities (70%) 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, Rhode Island showed a total of 6,415 clients in treatment, 6,026 of whom (94%) were in outpatient treatment. Of the total number of clients in treatment on this date, 251 (4%) 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 or cocaine as abused substances and a concomitant increase in mentions of opiates other than heroin.Across the years for which TEDS data are available, Rhode Island has seen a substantial shift in the constellation of problems present at treatment admission. Alcohol in combination with other drugs has declined, from over 53 percent of all admissions in 1992 to just over 29 percent in 2006. Concomitantly, drug-only admissions have doubled, from 21 percent in 1992 to 46 percent in 2006 (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.Rates of unmet drug treatment need in Rhode Island have remained above the national rates for all age groups and across all survey years; however, the rates for individuals age 18 to 25 have consistently been among the 10 highest in the country (Chart 5).Similarly, rates of unmet treatment need for alcohol use have been consistently above the national rates for all age groups and across all survey years (Chart 6).