National data      State level data       Metropolitan and other subState area data

Substance Abuse in States and Metropolitan Areas:
Model Based Estimates from the 1991-1993 National Household Surveys on Drug Abuse

Appendices:

The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Addition (DSM-III-R), published by the American Psychiatric Association is designed to be used by clinicians as well as researchers for making diagnosis of psychiatric disorders. Substance abuse and dependence are considered psychiatric disorders under DSM-III-R. DSM-III-R defines a person as dependent on a substance if they meet 3 out of 9 criteria for that substance. The method for estimating dependence from the NHSDA is based on the NHSDA questionnaire items that are assumed to approximate five of the nine DSM-III-R criteria. These five criteria include: unable to cut down on use; reduced social, occupational, or recreational activities; continued use despite knowledge of having a problem; tolerance; withdrawal. In the NHSDA algorithm, respondents are defined as dependent on a substance if they responded affirmatively to at least two of the five NHSDA criteria for that substance.

To evaluate this method for estimating dependence, NHSDA dependence estimates were compared to estimates from the National Comorbidity Survey (NCS).^1,2 Conducted in 1991, the NCS was designed to provide nationally representative estimates of 14 psychiatric disorders, including substance abuse and dependence, using a structured diagnostic interview. It employed a multistage area probability sample of 8,098 respondents in the household population.

Based on this analysis it was concluded that the approximation to the DSM-III-R definition of drug dependence produces dependence estimates which are comparable to the NCS. The table below indicates estimates of dependence from the NHSDA from 1991 through 1993 and estimates of dependence from the NCS.

¹This is included in a paper by Joan Epstein and Joe Gfroerer, A Method for Estimating Substance Abuse Treatment Need from a National Household Survey, that was presented at the 37th International Congress on Alcohol and Drug Dependence, August 20-25, 1995.

²Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States. Results from the National Comorbidity Survey. R.C. Kessler, PhD; K.A.McGonagle, PhD; S. Zhao, PhD; C.B. Nelson, MPH; M. Hughes, PhD; S. Eshleman, MA; H.U. Wittchen, PhD; K.S.Kendler, MD. Arch Gen Psychiatry, Vol.51, P.P. 8-19, January 1994.

Appendix B. Definition of 25 MSAs Selected for Small Area Estimation:  1992 Population Projection