Substance abuse treatment needs and access in the USA: interstate variations.

Aims This study investigated interstate substance abuse treatment needs and access in the USA. Design After assessing the validity of recently developed survey and indicator measures, the study analysed the geographic distribution and nature of state substance abuse treatment needs. Substance abuse treatment utilization index scores were regressed on the need measurements to identify differences among state populations in treatment access. Findings The interstate substance abuse treatment need measures had evidence of reliability and construct validity. Treatment needs clustered in stable, distinct geographic patterns. The most severe problems, primarily reflecting alcoholism, were in the west. Drug and alcohol substance use disorders and related problems were not significantly correlated at this level of aggregation. There was evidence of regionalization of the drug-of-choice mix in treatment admissions. Only 21% of the variations in state treatment utilization rates stemmed from the prevalence of substance use disorders and related problems. The biggest treatment gaps were in the south and south-west, regions with large minority populations. Conclusions Development of interstate survey and indicator measures of treatment needs has created new opportunities to broaden our understanding of substance abuse epidemiology and treatment access in the USA. The nature and severity of drug and alcohol problems vary from state to state, but the interstate disparities in treatment services remain even after variations in treatment need have been discounted. Further research is needed to understand the causes of these differences in treatment access.

[1]  Jack Darkes,et al.  The validity of self-reports of alcohol consumption: state of the science and challenges for research. , 2003, Addiction.

[2]  George S. Yacoubian,et al.  Measuring alcohol and drug dependence with New York City ADAM data. , 2003, Journal of substance abuse treatment.

[3]  R. LaBrie,et al.  State substance abuse treatment gaps. , 2003, The American journal on addictions.

[4]  A. Chandra,et al.  Geography and Racial Health Disparities , 2003 .

[5]  T. Johnson,et al.  Cross-Cultural Sources of Measurement Error in Substance Use Surveys , 2003, Substance use & misuse.

[6]  W. McAuliffe,et al.  Identifying substance abuse treatment gaps in substate areas. , 2002, Journal of substance abuse treatment.

[7]  J. Epstein.  Substance Dependence, Abuse, and Treatment: Findings from the 2000 National Household Survey on Drug Abuse: (437862005-001) , 2002 .

[8]  D. Regier,et al.  Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates. , 2002, Archives of general psychiatry.

[9]  K. Kip,et al.  COMMENTARY ON WHY NATIONAL EPIDEMIOLOGICAL ESTIMATES OF SUBSTANCE ABUSE BY RACE SHOULD NOT BE USED TO ESTIMATE PREVALENCE AND NEED FOR SUBSTANCE ABUSE SERVICES AT COMMUNITY AND LOCAL LEVELS , 2002, The American journal of drug and alcohol abuse.

[10]  T. Gregoire.  THE VALIDITY OF A SOCIAL INDICATOR APPROACH TO SUBSTANCE MISUSE NEEDS ASSESSMENT , 2002, Substance use & misuse.

[11]  W. Ling,et al.  If a US Drug Abuse Epidemic Fails to Include a Major East Coast City, Can It Be Called an Epidemic? , 2001, Journal of addictive diseases.

[12]  R. Caetano.  Non-response in alcohol and drug surveys: a research topic in need of further attention. , 2001, Addiction.

[13]  Charles F. Manski,et al.  Executive summary of the National Research Council's Report 'Informing America's policy on illegal drugs: what we don't know keeps hurting us'. , 2001, Addiction.

[14]  S. Lapham,et al.  Prevalence of psychiatric disorders among persons convicted of driving while impaired. , 2001, Archives of general psychiatry.

[15]  R. Flewelling,et al.  USING SOCIAL INDICATORS TO ESTIMATE COUNTY-LEVEL SUBSTANCE USE INTERVENTION AND TREATMENT NEEDS , 2001, Substance use & misuse.

[16]  R. Bijl,et al.  Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study. , 2000, American journal of public health.

[17]  Scott H. Decker,et al.  Are arrest statistics a valid measure of illicit drug use? The relationship between criminal justice and public health indicators of cocaine, heroin, and marijuana use , 1999 .

[18]  C. Berg,et al.  Abortion surveillance--United States, 1999. , 2002, Morbidity and mortality weekly report. Surveillance summaries.

[19]  S. Sudman,et al.  Validity of drug use reporting in a high-risk community sample: a comparison of cocaine and heroin survey reports with hair tests. , 1999, American journal of epidemiology.

[20]  R. LaBrie,et al.  Measuring interstate variations in drug problems. , 1999, Drug and alcohol dependence.

[21]  D. Levy,et al.  Surveillance for waterborne-disease outbreaks--United States, 1995-1996. , 1998, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[22]  J. Chong.  Crime Indicators for Alcohol and Drug Abuse , 1998 .

[23]  J. Rolph,et al.  Review and Evaluation of the Substance Abuse and Mental Health Services Block Grant Allotment Formula , 1998 .

[24]  R. Spitzer,et al.  Diagnosis and need for treatment are not the same. , 1998, Archives of general psychiatry.

[25]  Paul Neuhaus,et al.  United States Bureau of the Census , 1998 .

[26]  Annette Scherpenzeel,et al.  The Validity and Reliability of Survey Questions , 1997 .

[27]  P. Miller.  Review: Is Up Right? The National Household Survey on Drug Abuse , 1997 .

[28]  L. Brammer,et al.  Influenza surveillance--United States, 1992-93 and 1993-94. , 1997, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[29]  R. Doyle.  Deaths caused by alcohol. , 1996, Scientific American.

[30]  R. L. Fulton,et al.  Identification of the motor vehicle accident victim who abuses alcohol: an opportunity to reduce trauma. , 1996, Journal of studies on alcohol.

[31]  J D Graham,et al.  The role of heavy drinking in the risk of traffic fatalities. , 1996, Risk analysis : an official publication of the Society for Risk Analysis.

[32]  B. Rush,et al.  Assessing the need for substance abuse services: A critical review of needs assessment models☆ , 1996 .

[33]  James W. Altschuld,et al.  Planning and Conducting Needs Assessments: A Practical Guide , 1995 .

[34]  J. Bunn,et al.  The effects of travel barriers and age on the utilization of alcoholism treatment aftercare. , 1995, The American journal of drug and alcohol abuse.

[35]  M. Beenstock.  An indicator model of drug use in Israel. , 1995, Addiction.

[36]  D. Shai,et al.  Problems of accuracy in official statistics on drug-related deaths. , 1994, The International journal of the addictions.

[37]  G. Pope,et al.  State variations in public and private alcoholism treatment at specialty substance abuse treatment facilities. , 1994, Journal of Studies on Alcohol.

[38]  Malay Ghosh,et al.  Small Area Estimation: An Appraisal , 1994 .

[39]  S. L. Hansen,et al.  Correlation between college students' driving offenses and their risks for alcohol problems. , 1993, Journal of American college health : J of ACH.

[40]  C. Weisner.  Toward an alcohol treatment entry model: a comparison of problem drinkers in the general population and in treatment. , 1993, Alcoholism, clinical and experimental research.

[41]  W R Williford,et al.  Problem drinking and high-risk driving: an analysis of official and self-reported drinking-driving in New York State. , 1993, Addiction.

[42]  B. Rounsaville,et al.  Contrast of treatment-seeking and untreated cocaine abusers. , 1992, Archives of general psychiatry.

[43]  K. Lui,et al.  Discrepancies in the reported frequency of cocaine-related deaths, United States, 1983 through 1988. , 1991, JAMA.

[44]  C. Spino,et al.  Assessment of drug abuser treatment needs in Rhode Island. , 1991, American journal of public health.

[45]  E. Spitznagel,et al.  Difficult-to-recruit respondents and their effect on prevalence estimates in an epidemiologic survey. , 1987, American journal of epidemiology.

[46]  W. E. Ford,et al.  Predicting alcoholism service needs from a National Treatment Utilization Survey. , 1983, The International journal of the addictions.

[47]  M. Adrian.  Mapping the severity of alcohol and drug problems in Ontario. , 1983, Canadian journal of public health = Revue canadienne de sante publique.

[48]  L. Beckman,et al.  Validity of synthetic estimates of problem-drinker prevalence. , 1981, American journal of public health.

[49]  P. Cleary.  A standardized estimator of the prevalence of alcoholism based on mortality data. , 1979, Journal of studies on alcohol.

[50]  D. Lipton,et al.  Seeking truth in heroin indicators: the case of New York City. , 1978, Drug and alcohol dependence.

[51]  L. Defleur.  Biasing influences on drug arrest records: implications for deviance research. , 1975, American sociological review.

[52]  J. Ball,et al.  The Epidemiology of opiate addiction in the United States , 1972 .

[53]  D. Campbell,et al.  Convergent and discriminant validation by the multitrait-multimethod matrix. , 1959, Psychological bulletin.

[54]  J. French,et al.  Using social indicators to predict addiction. , 1998, Substance use & misuse.

[55]  A. Mclellan,et al.  Substance abuse treatment. , 1994, Hospital & community psychiatry.

[56]  B. Frank,et al.  Needs assessment in substance misuse: a comparison of approaches and case study. , 1993, The International journal of the addictions.

[57]  D. Chalmers,et al.  Dispositional traits as risk in problem drinking. , 1993, Journal of substance abuse.

[58]  J. Westermeyer.  Methodological issues in the epidemiological study of alcohol-drug problems: sources of confusion and misunderstanding. , 1990, The American journal of drug and alcohol abuse.

[59]  R. Dunham,et al.  Adoption of the Uniform Alcoholism Act and the availability of alcoholism treatment programs: a state-by-state examination. , 1985, The International journal of the addictions.

[60]  J. Woodward,et al.  Construct validity of heroin abuse estimators. , 1984, The International journal of the addictions.

[61]  N. Beshai.  Assessing needs of alcohol-related services: a social indicators approach. , 1984, The American journal of drug and alcohol abuse.

[62]  R. Room.  Region and Urbanization as Factors in Drinking Practices and Problems , 1983 .

[63]  E. Vingilis.  Drinking Drivers and Alcoholics Are They From the Same Population , 1983 .

[64]  C. Furst.  Estimating alcoholic prevalence. , 1983, Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism.

[65]  D. Kandel.  Longitudinal research on drug use: Empirical findings and methodological issues , 1978 .

[66]  L. Cronbach,et al.  Construct validity in psychological tests. , 1955, Psychological bulletin.