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Results from the 2004 National Survey on Drug Use and Health: National Findings

REVISIONS AS OF 9/8/2005

NOTE: Several updates have been incorporated into this report since it was published. These changes were made in the Web documents and are listed below, indicating the relevant page and paragraph in the published version.

In several places, the published version of this report indicates that 2004 estimates are similar to 2002 estimates. However, statistical testing indicates a significant difference between 2004 and 2002, so the text in this updated Web document was revised to remove the reference to no change from the 2002 data. This occurs on the following pages in the published report: page 1 in bullets 3 and 6; page 12 in bullets 1 and 2; page 30 in bullet 3; and page 61 in bullet 1 under Feelings about Peer Substance Use. In addition, the following changes were also made in the web document, with the relevant page in the published version indicated:

On page 35: bullet 1 was changed to correct the statement; there was only one exception (not two) to the stable trend.

On page 69: in bullet 2 the estimate for persons who drank before age 21 was changed from 9.2 to 9.6.

On page 161: in the definition of Ecstasy Use, the spelling of "methylenedioxymethamphetamine" was corrected.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Office of Applied Studies

Acknowledgments

This report was prepared by the Division of Population Surveys, Office of Applied Studies, SAMHSA, and by RTI International, a trade name of Research Triangle Institute, Research Triangle Park, North Carolina. Work by RTI was performed under Contract No. 283-03-9028. Contributors and reviewers at RTI listed alphabetically include Jeremy Aldworth, Katherine R. Bowman, Walter R. Boyle, Allison Burns, Sara L. Calvin, Jessica Duncan Cance, Patrick Chen, James R. Chromy, Andrew Clarke, Elizabeth Copello, David B. Cunningham, Teresa R. Davis, Steven L. Emrich, Ralph E. Folsom, Jr., Misty Foster, G. G. Frick, Eric A. Grau, David C. Heller, Erica Hirsch, Susan Hunter, B. Kathleen Jordan, Larry A. Kroutil, Judith T. Lessler, Bing Liu, Mary Ellen Marsden, Peilan Martin, Breda Munoz, Christine Murtha, Scott Novak, Lisa E. Packer, Michael R. Pemberton, Lanny Piper, Jeremy Porter, Tania Robbins, Kathryn Spagnola, Thomas G. Virag (Project Director), Michael Vorburger, Jill Webster, Matthew Westlake, and Li-Tzy Wu. Contributors at SAMHSA listed alphabetically, with chapter authorship noted, include Peggy Barker (Chapter 8), James Colliver (Chapters 4 and 6), Joan Epstein (Chapters 7 and 8), Joseph Gfroerer (Chapters 1, 2, 5, and 9), Joe Gustin, Arthur Hughes (Project Officer), Joel Kennet (Chapter 3), Sharon Larson (Chapters 7 and 8), Pradip Muhuri, Dicy Painter, and Doug Wright (Chapter 6). At RTI, Richard S. Straw edited the report with assistance from Jason Guder and Claudia Clark. Also at RTI, Diane G. Eckard and Danny Occoquan prepared the graphics; Brenda K. Porter and Tracy Woodall formatted the tables; Joyce Clay-Brooks, Debbie Bond, and Judy Cannada formatted and word processed the report; and Pamela Couch Prevatt, Teresa F. Gurley, Kim Cone, David Belton, and Shari B. Lambert prepared its press and Web versions. Final report production was provided by Beatrice A. Rouse, Coleen Sanderson, and Jane Feldmann at SAMHSA.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration. However, this publication may not be reproduced or distributed for a fee without specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services. Citation of the source is appreciated. Suggested citation:

Substance Abuse and Mental Health Services Administration. (2005). Results from the 2004 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-28, DHHS Publication No. SMA 05-4062). Rockville, MD.

Obtaining Copies of Publications from SAMHSA's Office of Applied Studies

Web Access: http://oas.samhsa.gov/

Originating Office: SAMHSA, Office of Applied Studies

September 2005

Highlights

This report presents the first information from the 2004 National Survey on Drug Use and Health (NSDUH). This survey, formerly called the National Household Survey on Drug Abuse (NHSDA), is a project of the Substance Abuse and Mental Health Services Administration (SAMHSA). This survey was initiated in 1971 and is the primary source of information on the use of illicit drugs, alcohol, and tobacco by the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year.

Illicit Drug Use

In 2004, 19.1 million Americans, or 7.9 percent of the population aged 12 or older, were current illicit drug users. Current drug use means use of an illicit drug during the month prior to the survey interview.
The rate of illicit drug use among persons aged 12 or older in 2004 was similar to the rates in 2002 and 2003 (8.3 and 8.2 percent). Among youths aged 12 to 17, the rate declined between 2002 and 2004 (11.6 percent in 2002, 11.2 percent in 2003, and 10.6 percent in 2004).
Marijuana was the most commonly used illicit drug in 2004, with a rate of 6.1 percent (14.6 million current users). There were 2.0 million current cocaine users, 467,000 of whom used crack. Hallucinogens were used by 929,000 persons, and there were an estimated 166,000 heroin users. All of these estimates are similar to estimates for 2003.
Between 2002 and 2004, past month marijuana use declined for male youths aged 12 to 17 (9.1 percent in 2002, 8.6 percent in 2003, and 8.1 percent in 2004), but it remained level for female youths (7.2, 7.2, and 7.1 percent, respectively) during the same time span.
The number of current users of Ecstasy had decreased between 2002 and 2003, from 676,000 to 470,000, but the number did not change between 2003 and 2004 (450,000).
In 2004, 6.0 million persons were current users of psychotherapeutic drugs taken nonmedically (2.5 percent). These include 4.4 million who used pain relievers, 1.6 million who used tranquilizers, 1.2 million who used stimulants, and 0.3 million who used sedatives. These estimates are all similar to the corresponding estimates for 2003.
There were significant increases in the lifetime prevalence of use from 2003 to 2004 in several categories of pain relievers among those aged 18 to 25. Specific pain relievers with statistically significant increases in lifetime use were Vicodin^®, Lortab^®, or Lorcet^® (from 15.0 to 16.5 percent); Percocet^®, Percodan^®, or Tylox^® (from 7.8 to 8.7 percent); hydrocodone products (from 16.3 to 17.4 percent); OxyContin^® (from 3.6 to 4.3 percent); and oxycodone products (from 8.9 to 10.1 percent).
Among youths aged 12 to 17, rates of current illicit drug use varied significantly by major racial/ethnic groups in 2004. The rate was highest among American Indian or Alaska Native youths (26.0 percent). Rates were 12.2 percent for youths reporting two or more races, 11.1 percent for white youths, 10.2 percent for Hispanic youths, 9.3 percent for black youths, and 6.0 percent for Asian youths.
In 2004, 19.2 percent of unemployed adults aged 18 or older were current illicit drug users compared with 8.0 percent of those employed full time and 10.3 percent of those employed part time. However, of the 16.4 million illicit drug users aged 18 or older in 2004, 12.3 million (75.2 percent) were employed either full or part time.

Alcohol Use

121 million Americans aged 12 or older were current drinkers of alcohol in 2004 (50.3 percent). 55 million (22.8 percent) participated in binge drinking, defined as five or more drinks on at least one occasion in the 30 days prior to the survey. 16.7 million (6.9 percent) were heavy drinkers, defined as binge drinking on 5 or more days in the past month. These numbers are all similar to the corresponding estimates for 2002 and 2003.
The highest prevalence of binge and heavy drinking in 2004 was for young adults aged 18 to 25 (41.2 and 15.1 percent, respectively). The peak rate of both measures occurred at age 21 (48.2 and 19.2 percent, respectively).
The rate of underage drinking remained the same in 2004 as in 2002 and 2003. About 10.8 million persons aged 12 to 20 reported drinking alcohol in the month prior to the survey interview in 2004 (28.7 percent of this age group). Of these, nearly 7.4 million (19.6 percent) were binge drinkers, and 2.4 million (6.3 percent) were heavy drinkers.
Among persons aged 12 to 20 in 2004, past month alcohol use rates were 16.4 percent among Asians, 19.1 percent among blacks, 24.3 percent among American Indians or Alaska Natives, 26.4 percent among those reporting two or more races, 26.6 percent among Hispanics, and 32.6 percent among whites.
Among pregnant women aged 15 to 44, 11.2 percent reported past month alcohol use and 4.5 percent reported past month binge drinking, based on combined 2003 and 2004 data.
32.5 million persons aged 12 or older in 2004 (13.5 percent) drove under the influence of alcohol at least once in the 12 months prior to the interview. This was similar to the rate in 2003.
Young adults aged 18 to 22 enrolled full time in college were more likely than their peers not enrolled full time (this category includes part-time college students and persons not enrolled in college) to use alcohol, binge drink, and drink heavily in 2004. Binge and heavy use rates for college students were 43.4 and 18.6 percent, respectively, compared with 39.4 and 13.5 percent, respectively, for other persons aged 18 to 22.

Tobacco Use

70.3 million Americans were current users of a tobacco product in 2004. This is 29.2 percent of the population aged 12 or older. 59.9 million (24.9 percent) smoked cigarettes, 13.7 million (5.7 percent) smoked cigars, 7.2 million (3.0 percent) used smokeless tobacco, and 1.8 million (0.8 percent) smoked tobacco in pipes.
The rate of tobacco use declined between 2002 and 2004, from 30.4 to 29.2 percent, primarily due to a decline in cigarette use from 26.0 to 24.9 percent. The rate of cigar use remained steady, but smokeless tobacco use dropped from 3.3 to 3.0 percent.
Young adults aged 18 to 25 continued to have the highest rate of past month cigarette use (39.5 percent). The rate did not change significantly between 2002 and 2004. The rate of cigarette use among youths aged 12 to 17 declined from 13.0 percent in 2002 to 11.9 percent in 2004.
A higher proportion of males than females aged 12 or older smoked cigarettes in 2004 (27.7 vs. 22.3 percent). Among youths aged 12 to 17, however, girls (12.5 percent) were more likely than boys (11.3 percent) to smoke.
Based on 2003 and 2004 data combined, 18.0 percent of pregnant women aged 15 to 44 smoked cigarettes in the past month compared with 30.0 percent of women in that age group who were not pregnant. However, among those aged 15 to 17, this pattern did not hold. The rate of cigarette smoking among pregnant women aged 15 to 17 was 26.0 percent compared with 19.6 percent among nonpregnant women of that age (not a statistically significant difference).
In completely rural nonmetropolitan counties, current cigarette use among persons aged 12 or older declined from 31.8 percent in 2002 to 22.8 percent in 2004.
Among the 93.4 million persons who had ever smoked cigarettes daily in their lifetime, nearly half (46.2 percent) had stopped smoking in 2004; that is, they did not smoke at all in the past 30 days. The remaining 53.8 percent were still current smokers.

Initiation of Substance Use (Incidence)

Based on a new approach to estimating incidence, the 2004 NSDUH shows that the illicit drug category with the largest number of new users was nonmedical use of pain relievers. 2.4 million persons used pain relievers nonmedically for the first time within the past 12 months. The average age at first use among these new initiates was 23.3 years.
In 2004, 2.1 million persons had used marijuana for the first time within the past 12 months. This estimate was not significantly different from the number in 2003 (2.0 million). The average age at first use among the 2.1 million recent marijuana initiates was 18.0 years. Most (63.8 percent) of the recent initiates were younger than age 18 when they first used.
In 2004, 4.4 million persons had used alcohol for the first time within the past 12 months. The number of alcohol initiates increased from 3.9 million in 2002 and 4.1 million in 2003. Most (86.9 percent) of the 4.4 million recent alcohol initiates in 2004 were younger than age 21 at the time of initiation.
The number of persons who smoked cigarettes for the first time within the past 12 months was 2.1 million in 2004, not significantly different from the estimates in 2002 (1.9 million) or 2003 (2.0 million). About two thirds of new smokers in 2004 were under the age of 18 when they first smoked cigarettes (67.8 percent).

Youth Prevention-Related Measures

The percentage of youths aged 12 to 17 indicating that smoking marijuana once a month was a great risk increased from 32.4 percent in 2002 to 34.9 percent in 2003, but did not change between 2003 and 2004 (35.0 percent). There were declines between 2003 and 2004 in the percentages of youths perceiving a great risk in using cocaine and heroin. Perceived risk of cigarette use increased between 2003 and 2004, but there was no change in the perceived risk of having four or five drinks of alcohol nearly every day or having five or more drinks once or twice a week.
The percentage of youths reporting that it would be easy to obtain marijuana declined between 2002 and 2003, from 55.0 to 53.6 percent, and again between 2003 and 2004, to 52.2 percent. The percentage of youths reporting that LSD would be easy to obtain also decreased between 2002 and 2004, from 19.4 to 16.9 percent, as did the perceived availability of heroin (15.8 to 14.0 percent).
Most youths (89.8 percent) reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice. Among these youths, only 5.1 percent had used marijuana in the past month. However, among youths who perceived that their parents would only somewhat disapprove or neither approve nor disapprove of their trying marijuana, 30.0 percent used marijuana.

Substance Dependence, Abuse, and Treatment

22.5 million Americans aged 12 or older in 2004 were classified with past year substance dependence or abuse (9.4 percent of the population), about the same number as in 2002 and 2003. Of these, 3.4 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.2 million were dependent on or abused alcohol but not illicit drugs.
In 2004, 19.9 percent of unemployed adults aged 18 or older were classified with dependence or abuse, while 10.5 percent of full-time employed adults and 11.9 percent of part-time employed adults were classified as such. However, most adults with substance dependence or abuse were employed either full or part time. Of the 20.3 million adults classified with dependence or abuse, 15.7 million (77.6 percent) were employed.
In 2004, 3.8 million people aged 12 or older (1.6 percent of the population) received treatment in the past 12 months for a drug or alcohol use problem. Of these, 2.3 million received treatment at a specialty facility for substance use treatment, including 1.7 million at a rehabilitation facility as an outpatient, 947,000 at a rehabilitation facility as an inpatient, 775,000 at a hospital as an inpatient, and 982,000 at a mental health center as an outpatient. Nonspecialty treatment locations were self-help groups (2.1 million persons), private doctor's offices (490,000 persons), emergency rooms (453,000 persons), and prisons or jails (310,000 persons). (Note that the estimates of treatment by location include persons reporting more than one location.)
Persons dependent on or abusing a substance in the past 12 months, or who received specialty treatment for a substance use problem within the past 12 months, are classified as needing treatment. In 2004, the number of persons aged 12 or older needing treatment for an alcohol or illicit drug use problem was 23.48 million (9.8 percent). Of these, 2.33 million received treatment at a specialty facility in the past year. Thus, 21.15 million people needed but did not receive treatment at a specialty facility in 2004. The number needing but not receiving treatment did not change significantly from 2002 to 2004.
Of the 21.1 million people who needed but did not receive treatment in 2004, an estimated 1.2 million (5.8 percent) reported that they felt they needed treatment for their alcohol or drug use problem. Of the 1.2 million persons who felt they needed treatment, 441,000 (35.8 percent) reported that they made an effort but were unable to get treatment, and 792,000 (64.2 percent) reported making no effort to get treatment.
Among people who needed but did not receive treatment and felt they needed treatment for a substance use problem, the most often reported reasons for not receiving treatment were not ready to stop using (40.0 percent) and cost or insurance barriers (34.5 percent). However, among the people who made an effort but were unable to get treatment, 42.5 percent reported cost or insurance barriers, and only 25.3 percent reported that they were not ready to stop using. These results are based on 2003 and 2004 combined data.
The number of persons needing treatment for an illicit drug use problem in 2004 (8.1 million) was higher than the number needing treatment in 2003 (7.3 million); similarly, the number of persons receiving treatment for drug use at a specialty facility was higher in 2004 (1.4 million) than in 2003 (1.1 million). These 2004 estimates were similar to the corresponding estimates in 2002 (7.7 million needing treatment, 1.4 million receiving treatment).
6.6 million people needed but did not receive treatment for an illicit drug use problem in 2004. Of these, 598,000 (9.0 percent) felt they needed treatment. This number increased from 362,000 in 2002 and from 426,000 in 2003. Of the 598,000 persons who felt they needed treatment in 2004, 194,000 (32.4 percent) reported that they made an effort but were unable to get treatment, and 404,000 (67.6 percent) reported making no effort to get treatment.

Prevalence and Treatment of Mental Health Problems

In 2004, there were 35.1 million (14.7 percent) persons aged 12 or older who had at least one major depressive episode (MDE) in their lifetime. Of these, 19.3 million persons (8.1 percent of the population) had an MDE in the past 12 months, including 2.2 million youths aged 12 to 17 and 17.1 million adults aged 18 or older.
The past year prevalence of MDE was highest for persons aged 18 to 25 (10.1 percent) and lowest for those aged 26 or older (7.6 percent). The rate among youths aged 12 to 17 was 9.0 percent. Females were more likely than males to have MDE in the past year (10.6 vs. 5.5 percent).
Persons with past year MDE were more likely than those without MDE to have used an illicit drug in the past year (28.8 vs. 13.8 percent). Similarly, substance dependence or abuse was more prevalent among persons with MDE than among those without MDE (22.0 vs. 8.6 percent, respectively).
Among persons aged 12 or older with past year MDE, 62.3 percent received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression within the past 12 months.
While MDE estimates describe persons with a specific mental disorder, the survey also produces estimates of serious psychological distress (SPD), which describe persons with a high level of distress due to any type of mental problem. In 2004, there were 21.4 million adults aged 18 or older with SPD. This represents 9.9 percent of all adults, a rate that increased since 2002 when it was 8.3 percent.
SPD was highly correlated with substance dependence or abuse. Among adults with SPD in 2004, 21.3 percent (4.6 million) were dependent on or abused alcohol or illicit drugs, while the rate among adults without SPD was 7.9 percent.
Among the 21.4 million adults with SPD in 2004, 10.3 million, or 48.1 percent, received treatment for a mental health problem in the past year.
Among the 4.6 million adults with SPD and a substance use disorder in 2004, 47.5 percent (about 2.2 million) received treatment for mental health problems, and 11.0 percent (503,000) received specialty substance use treatment. Only 6.0 percent (274,000) received both types of treatment.
In 2004, 27.5 million adults (12.8 percent) received treatment for mental health problems in the past year. This estimate is similar to the estimates in 2002 and 2003.
The most prevalent type of treatment for mental health problems among adults in 2004 was prescription medication (10.5 percent of the population), followed by outpatient treatment (7.1 percent). 1.9 million adults (0.9 percent) received inpatient care for mental health problems at some time within the past 12 months.
In 2004, 5.7 million youths aged 12 to 17 (22.5 percent) received treatment or counseling for emotional or behavior problems in the year prior to the interview. This is higher than the estimates for 2002 (19.3 percent) and 2003 (20.6 percent).

1. Introduction

This report presents the first information from the 2004 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. Prior to 2002, the survey was called the National Household Survey on Drug Abuse (NHSDA). This initial report on the 2004 data presents national estimates of rates of use, numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products. Measures related to mental health problems also are presented, including data on the co-occurrence of substance use and mental health problems, and new data on depression among youths and adults. State-level and SubState-level estimates from NSDUH will be presented in separate reports.

A major focus of this report is changes in substance use between 2003 and 2004. Trends since 2002 also are discussed in a few instances. Because of improvements to the survey in 2002, the 2002 data constitute a new baseline for tracking trends in substance use and other measures. Therefore, estimates from the 2002, 2003, and 2004 NSDUHs should not be compared with estimates from the 2001 and earlier NSDUHs to assess changes in substance use and mental health problems over time. A discussion of long-term trends is included in the final chapter of this report.

1.1. Summary of NSDUH

NSDUH is the primary source of statistical information on the use of illegal drugs by the U.S. population. Conducted by the Federal Government since 1971, the survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their places of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services and is planned and managed by SAMHSA's Office of Applied Studies (OAS). Data collection is conducted under contract with RTI International, Research Triangle Park, North Carolina.¹ This section briefly describes the survey methodology; a more complete description is provided in Appendix A.

NSDUH collects information from residents of households, noninstitutional group quarters (e.g., shelters, rooming houses, dormitories), and civilians living on military bases. The survey does not include homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails and hospitals. Appendix E describes surveys that cover populations outside the NSDUH target population.

Since 1999, the NSDUH interview has been carried out using computer-assisted interviewing (CAI). Most of the questions are administered with audio computer-assisted self-interviewing (ACASI). ACASI is designed to provide the respondent with a highly private and confidential means of responding to questions to increase the level of honest reporting of illicit drug use and other sensitive behaviors. Less sensitive items are administered by interviewers using computer-assisted personal interviewing (CAPI).

Consistent with the 2002 and 2003 surveys, the 2004 NSDUH employed a 50-State sample design with an independent, multistage area probability sample for each of the 50 States and the District of Columbia. The eight States with the largest population (which together account for 48 percent of the total U.S. population aged 12 or older) were designated as large sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas). For these States, the design provided a sample sufficient to support direct State estimates. For the remaining 42 States and the District of Columbia, smaller, but adequate, samples were selected to support State estimates using small area estimation (SAE) techniques. The design also oversampled youths and young adults, so that each State's sample was approximately equally distributed among three major age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.

Nationally, 130,130 addresses were screened for the 2004 survey, and 67,760 completed interviews were obtained. The survey was conducted from January through December 2004. Weighted response rates for household screening and for interviewing were 90.9 and 77.0 percent, respectively. See Appendix B for more information on NSDUH response rates.

1.2. Trend Measurement

Although the design of the 2002, 2003, and 2004 NSDUHs is similar to the design of the 1999 through 2001 surveys, there are important methodological differences that have an impact on the comparability of the 2002-2004 estimates with estimates from prior surveys. In addition to the name change, each NSDUH respondent is now given an incentive payment of $30. These changes, both implemented in 2002 and continued in 2003 and 2004, resulted in a substantial improvement in the survey response rate. The changes also affected respondents' reporting of many critical items that are the basis of prevalence measures reported by the survey each year. Comparability also could be affected by improved data collection quality control procedures that were introduced beginning in 2001 and by incorporation of new population data from the 2000 decennial census into NSDUH sample weighting procedures. Analyses of the effects of each of these factors on NSDUH estimates have shown that 2002 and later data should not be compared with 2001 and earlier data from the survey series to assess changes over time. Appendix C of this report discusses this issue in more detail.

Limited trend assessment can be done using information on prior substance use collected in the 2002-2004 NSDUHs. Specifically, questions on age at first use of substances, in conjunction with respondents' ages and interview dates, provide data that can be used to estimate the rates of first-time use (incidence) for years prior to 2002. Trends for 1965 to 2003 in these incidence measures for youths and young adults are discussed in Chapter 5. However, these estimates are interpreted cautiously because they may be subject to significant bias due to long recall periods (Gfroerer, Hughes, Chromy, Heller, & Packer, 2004). Improved measures of recent patterns and trends in substance use initiation are included in Chapter 5 of this report. Long-term trends in some key measures of substance use, such as marijuana and cocaine, are assessed in Chapter 9 using data from prior NSDUHs by separately examining trends within periods during which the survey data are comparable. These periods are 1971-1998, 1999-2001, and 2002-2004.

1.3. Format of Report and Explanation of Tables

The results from the 2004 NSDUH are given in this report, which has separate chapters that discuss the national findings on seven topics: use of illicit drugs; use of alcohol; use of tobacco products; trends in initiation of substance use; prevention-related issues; substance dependence, abuse, and treatment; and mental health. A final chapter summarizes the results and discusses key findings in relation to other research and survey results, including trends prior to 2002. Technical appendices describe the survey (Appendix A), provide technical details on the statistical methods and measurement (Appendix B), discuss issues related to the methods changes in 2002 (Appendix C), offer key NSDUH definitions (Appendix D), discuss other sources of related data (Appendix E), list the references cited in the report (as well as other relevant references) (Appendix F), and present selected tabulations of estimates (Appendices G and H).

Tables, text, and figures present prevalence measures for the population in terms of both the number of substance users and the rate of use for illicit drugs, alcohol, and tobacco products. Tables show estimates of drug use prevalence by lifetime (i.e., ever used), past year, and past month use. Analyses focus primarily on past month use, which also is referred to as "current use." Tables and figures have footnotes indicating whether the 2003 and 2004 estimates were significantly different; in addition, figures have footnotes indicating whether the 2002 and 2004 estimates were significantly different.

Data are presented for racial/ethnic groups in several categorizations, based on current standards for collecting and reporting race and ethnicity data (Office of Management and Budget [OMB], 1997) and on the level of detail permitted by the sample. Because respondents were allowed to choose more than one racial group, a "two or more races" category is presented that includes persons who reported more than one category among the seven basic groups listed in the survey question (white, black/African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, Other). It should be noted that, except for the "Hispanic or Latino" group, the racial/ethnic groups discussed in this report include only non-Hispanics. The category "Hispanic or Latino" includes Hispanics of any race. Also, more detailed categories describing specific subgroups were obtained from survey respondents if they reported either Asian race or Hispanic ethnicity. Data on Native Hawaiians and Other Pacific Islanders are combined in this report.

Data also are presented for four U.S. geographic regions and nine geographic divisions within these regions. These regions and divisions, defined by the U.S. Bureau of the Census, consist of the following groups of States:

Northeast Region - New England Division: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont; Middle Atlantic Division: New Jersey, New York, Pennsylvania.

Midwest Region - East North Central Division: Illinois, Indiana, Michigan, Ohio, Wisconsin; West North Central Division: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota.

South Region - South Atlantic Division: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia; East South Central Division: Alabama, Kentucky, Mississippi, Tennessee; West South Central Division: Arkansas, Louisiana, Oklahoma, Texas.

West Region - Mountain Division: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming; Pacific Division: Alaska, California, Hawaii, Oregon, Washington.

Geographic comparisons for 2003 and 2004 also are made based on county type, which reflects different levels of urbanicity and metropolitan area inclusion of counties, based on metropolitan area definitions issued by OMB in June 2003 (OMB, 2003). For this purpose, counties are grouped based on the 2003 rural-urban continuum codes. These codes were originally developed by the U.S. Department of Agriculture (Butler & Beale, 1994). Each county is either inside or outside a metropolitan statistical area (MSA), as defined by the OMB.

Large metropolitan areas have a population of 1 million or more. Small metropolitan areas have a population of fewer than 1 million. Small metropolitan areas are further classified based on whether they have a population of 250,000 or more. Nonmetropolitan areas are areas outside MSAs. Counties in nonmetropolitan areas are further classified based on the number of people in the county who live in an urbanized area, as defined by the Census Bureau at the subcounty level. "Urbanized" counties have 20,000 or more population in urbanized areas, "less urbanized" counties have at least 2,500 but fewer than 20,000 population in urbanized areas, and "completely rural" counties have fewer than 2,500 population in urbanized areas.

1.4. Other NSDUH Reports and Data

This report provides a comprehensive summary of the 2004 NSDUH, including results, technical appendices, and selected data tables. A companion report, Overview of Findings from the 2004 National Survey on Drug Use and Health, is a shorter, more concise report that highlights the most important findings of the survey and includes only a brief discussion of the methods. A report on State-level estimates for 2004 will be available in early 2006.

In addition to the tables included in Appendices G and H of this report, a more extensive set of tables, including standard errors, is available upon request from OAS or through the Internet at http://www.oas.samhsa.gov. Tables included in Appendices G and H can be mapped back to the more extensive set of tables by using the table number in parentheses in the upper left corner of each table (e.g., Table G.1 in Appendix G is Table 8.1N in the detailed tables). Additional methodological information on NSDUH, including the questionnaire, is available electronically at the same Web address. Brief descriptive reports and in-depth analytic reports focusing on specific issues or population groups also are produced by OAS. A complete listing of previously published reports from NSDUH and other data sources is available from OAS. Most of these reports also are available through the Internet (http://www.oas.samhsa.gov). In addition, OAS makes public use data files available to researchers through the Substance Abuse and Mental Health Data Archive (SAMHDA, 2005) at http://www.icpsr.umich.edu/SAMHDA/index.html. Currently, files are available from the 1979 to 2003 surveys. The 2004 NSDUH public use file will be available by the end of 2005.

2. Illicit Drug Use

The National Survey on Drug Use and Health (NSDUH) obtains information on nine different categories of illicit drug use: any use of marijuana, cocaine, heroin, hallucinogens, and inhalants; and the nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives. In these categories, hashish is included with marijuana, and crack is considered a form of cocaine. Several drugs are grouped under the hallucinogens category, including LSD, PCP, peyote, mescaline, mushrooms, and "Ecstasy" (MDMA). Inhalants include a variety of substances, such as amyl nitrite, cleaning fluids, gasoline, paint, and glue. The four categories of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives) cover numerous drugs available through prescriptions as well as drugs within these groupings that may be manufactured illegally, such as methamphetamine, which is included under stimulants. Respondents are asked to report only uses of drugs that were not prescribed for them or drugs they took only for the experience or feeling they caused; therefore, over-the-counter drugs and legitimate uses of prescription drugs are not included. NSDUH reports combine the four prescription-type drug groups into a category referred to as "psychotherapeutics."

Estimates of "illicit drug use" reported from NSDUH reflect the use of any of the nine drug categories listed above. Use of alcohol and tobacco products, while illegal for youths, is not included in these estimates, but is discussed in Chapters 3 and 4.

NSDUH now collects more extensive data on respondents' history of drug use, including age at first use, age at last use, and use during the year prior to the past 12 months (i.e., during the period from 12 to 23 months ago). These data are useful in tracking trends over time in that they allow year-to-year changes in new use (incidence), continuing use, and discontinuation of use (quitting) to be measured separately in order to assess their impact on past year use rates. Results for marijuana use based on these new data are included in this chapter. Additional analysis of incidence for all substances is presented in Chapter 5.

In 2004, an estimated 19.1 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 7.9 percent of the population aged 12 years old or older.
The overall rate of current illicit drug use among persons aged 12 or older in 2004 (7.9 percent) was similar to the rate in 2003 (8.2 percent) and in 2002 (8.3 percent).
Marijuana was the most commonly used illicit drug (14.6 million past month users). In 2004, it was used by 76.4 percent of current illicit drug users. An estimated 56.8 percent of current illicit drug users used only marijuana, 19.7 percent used marijuana and another illicit drug, and the remaining 23.6 percent used only an illicit drug other than marijuana in the past month (Figure 2.1).

Figure 2.1 Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2004

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Among persons aged 12 or older, the overall rate of past month marijuana use was about the same in 2004 (6.1 percent) as it was in 2003 (6.2 percent) and 2002 (6.2 percent).
In 2004, an estimated 2.0 million persons (0.8 percent) were current cocaine users (Figure 2.2); of these, 467,000 used crack during the same time period (0.2 percent). Hallucinogens were used by 929,000 persons (0.4 percent). There were an estimated 166,000 current heroin users (0.1 percent). All of these estimates are similar to estimates for 2003.

Figure 2.2 Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2004

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An estimated 8.2 million people (3.4 percent of the population) were current users of illicit drugs other than marijuana in 2004. Most (6.0 million, 2.5 percent of the population) used psychotherapeutic drugs nonmedically (Figure 2.2). An estimated 4.4 million used pain relievers, 1.6 million used tranquilizers, 1.2 million used stimulants (including 583,000 using methamphetamine), and 0.3 million used sedatives. These estimates are all similar to the corresponding estimates for 2003.
The number of current users of Ecstasy remained the same in 2004 (450,000) as it had been in 2003 (470,000), after it had decreased significantly between 2002 (676,000) and 2003. There were no significant changes in the past month use of other hallucinogens between 2003 and 2004. Although an estimated 23.4 million persons had tried LSD in their lifetime, only 141,000 were current users in 2004.
There was no significant change in past month, past year, or lifetime nonmedical use of pain relievers among persons aged 12 or older between 2003 and 2004. The rate of past month use was 2.0 percent in 2003 and 1.8 percent in 2004.

Age

Rates of drug use showed substantial variation by age. For example, 3.8 percent of youths aged 12 or 13 reported current illicit drug use in 2004 (Figure 2.3). As in prior years, illicit drug use in 2004 tended to increase with age among young persons, peaking among 18 to 20 year olds (21.7 percent) and generally declining after that point with increasing age.

Figure 2.3 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2004

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Youths Aged 12 to 17

Among youths, the types of drugs used differed by age in 2004, as was the case in prior years. Among 12 or 13 year olds, 1.7 percent used prescription-type drugs nonmedically, 1.2 percent used inhalants, and 1.1 percent used marijuana. Among 14 or 15 year olds, marijuana was the dominant drug used (7.3 percent), followed by prescription-type drugs used nonmedically (4.1 percent) and inhalants (1.6 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (14.5 percent), followed by prescription-type drugs used nonmedically (5.1 percent), hallucinogens (1.7 percent), and cocaine (1.1 percent). Only 0.9 percent of youths aged 16 or 17 used inhalants.
Among all youths aged 12 to 17 in 2004, 10.6 percent were current illicit drug users: 7.6 percent used marijuana, 3.6 percent used prescription-type drugs nonmedically, 1.2 percent used inhalants, 0.8 percent used hallucinogens, and 0.5 percent used cocaine.
The rate of current illicit drug use among youths aged 12 to 17 gradually declined between 2002 and 2004. The rate was 11.6 percent in 2002, 11.2 percent in 2003, and 10.6 percent in 2004 (Figure 2.4). This represents a statistically significant change between 2002 and 2004, but not between 2002 and 2003 or between 2003 and 2004.

Figure 2.4 Past Month Use of Selected Illicit Drugs among Youths Aged 12 to 17: 2002-2004

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The rate of current marijuana use among youths was 8.2 percent in 2002, 7.9 percent in 2003, and 7.6 percent in 2004, indicating a steady but not statistically significant decline. However, declines in past year and lifetime use of marijuana among youths from 2002 to 2004 were statistically significant.

Young Adults Aged 18 to 25

Rates of current use of illicit drugs were highest for the young adult age group (18 to 25 years) at 19.4 percent, with 16.1 percent using marijuana, 6.1 percent using prescription-type drugs nonmedically, 2.1 percent using cocaine, and 1.5 percent using hallucinogens.
There were no changes in past month use of any drugs among young adults between 2003 and 2004. However, declines between 2002 and 2004 occurred for marijuana (17.3 percent in 2002, 17.0 percent in 2003, and 16.1 percent in 2004) and hallucinogens (1.9, 1.7, and 1.5 percent, respectively).
Past year use of Ecstasy among young adults declined from 5.8 percent in 2002 to 3.7 percent in 2003 and to 3.1 percent in 2004.
Current nonmedical use of prescription-type drugs showed no signs of decreasing among young adults, remaining at 6.1 percent in 2004, compared with 6.0 percent in 2003 and 5.4 percent in 2002. There were increases in lifetime prevalence of use from 2002 to 2004 of several categories of pain relievers among those aged 18 to 25: Vicodin^®, Lortab^®, or Lorcet^®; Percocet^®, Percodan^®, or Tylox^®; hydrocodone products; OxyContin^®; and oxycodone products (Figure 2.5).

Figure 2.5 Lifetime Nonmedical Use of Selected Pain Relievers among Young Adults Aged 18 to 25: 2002-2004

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Adults Aged 26 or Older

Among adults aged 26 or older, 5.5 percent reported current illicit drug use in 2004: 4.1 percent used marijuana, and 1.7 percent used prescription-type drugs. In this age group, less than 1 percent used cocaine (0.7 percent), hallucinogens (0.1 percent), and inhalants (0.1 percent). Rates of lifetime, past year, and past month illicit drug use for adults aged 26 or older were unchanged between 2003 and 2004.

Gender

As in 2002 and 2003, males were more likely in 2004 to report current illicit drug use than females (9.9 vs. 6.1 percent, respectively). Males were almost twice as likely to use marijuana as females (8.0 vs. 4.3 percent). However, rates of nonmedical use of any prescription-type psychotherapeutic were similar for males (2.6 percent) and females (2.4 percent).
Among youths aged 12 to 17, the rate of current illicit drug use was similar for boys and girls (10.6 percent for both). While boys aged 12 to 17 had a higher rate of marijuana use than girls (8.1 vs. 7.1 percent) (Figure 2.6), the rate for nonmedical use of prescription-type psychotherapeutics was higher for girls (4.1 vs. 3.2 percent).

Figure 2.6 Past Month Marijuana Use among Youths Aged 12 to 17, by Gender: 2002-2004

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Between 2002 and 2004, past month marijuana use declined for male youths (9.1 percent in 2002, 8.6 percent in 2003, and 8.1 percent in 2004), but it remained level for female youths (7.2, 7.2, and 7.1 percent) during the same time span.

Pregnant Women

Among pregnant women aged 15 to 44 years, an estimated 4.6 percent reported using illicit drugs in the past month based on combined 2003 and 2004 NSDUH data. This rate was significantly lower than the rate among women aged 15 to 44 who were not pregnant (10.2 percent). The combined 2002-2003 rate of illicit drug use among pregnant women (4.3 percent) was not significantly different from the 2003-2004 combined rate.

Race/Ethnicity

Rates of current illicit drug use varied significantly among the major racial/ethnic groups in 2004. The rate was highest among persons reporting two or more races (13.3 percent) and American Indians or Alaska Natives (12.3 percent). Rates were 8.1 percent for whites, 7.2 percent for Hispanics, and 8.7 percent for blacks. Asians had the lowest rate at 3.1 percent.
Among youths aged 12 to 17, the rate of current illicit drug use was highest among American Indians or Alaska Natives, more than twice the overall rate among youths (26.0 vs. 10.6 percent). Rates for other groups were 12.2 percent among those reporting two or more races, 11.1 percent among whites, 10.2 percent among Hispanics, 9.3 percent among blacks, and 6.0 percent among Asians.
There were no statistically significant changes between 2003 and 2004 in the rates of current illicit drug use for any racial/ethnic subgroup. This was the case both for all persons aged 12 or older and for youths aged 12 to 17.
The overall decline in current marijuana use among male youths from 2002 to 2004 was consistent across major racial/ethnic groups. Among white male youths, rates were 9.7, 9.5, and 8.5 percent in 2002, 2003, and 2004, respectively. Rates were 8.7, 6.8, and 7.6 percent for black male youths and 8.6, 7.2, and 7.3 percent among Hispanic male youths in those 3 years.

Education

Illicit drug use rates in 2004 were correlated with educational status. Among adults aged 18 or older, the rate of current illicit drug use was lower among college graduates (5.6 percent) compared with those who did not graduate from high school (8.6 percent), high school graduates (7.8 percent), and those with some college (8.7 percent). However, adults who had completed 4 years of college were more likely to have tried illicit drugs in their lifetime when compared with adults who had not completed high school (51.8 vs. 37.2 percent).

College Students

In the college-aged population (persons aged 18 to 22 years old), the rate of current illicit drug use was slightly lower among full-time undergraduate college students (20.2 percent) than among other persons aged 18 to 22 years, including part-time students, students in other grades, and nonstudents (22.3 percent). The rate of current illicit drug use among college students and other 18 to 22 year olds did not change between 2002 and 2003 or between 2003 and 2004.

Employment

Current employment status was correlated with rates of illicit drug use in 2004. An estimated 19.2 percent of unemployed adults aged 18 or older were current illicit drug users compared with 8.0 percent of those employed full time and 10.3 percent of those employed part time. These rates are all similar to the corresponding rates in 2003.
Although the rate of drug use was higher among unemployed persons compared with those from other employment groups, most drug users were employed. Of the 16.4 million illicit drug users aged 18 or older in 2004, 12.3 million (75.2 percent) were employed either full or part time.

Geographic Area

Among persons aged 12 or older, the rate of current illicit drug use in 2004 was 8.9 percent in the West, 8.4 percent in the Northeast, 7.5 percent in the Midwest, and 7.3 percent in the South. Similar patterns were evident in 2003 and 2002.
The rate of illicit drug use in metropolitan areas was higher than the rate in nonmetropolitan areas in 2004. Rates were 8.1 percent in large metropolitan counties, 8.5 percent in small metropolitan counties, and 6.3 percent in nonmetropolitan counties as a group (Figure 2.7). Within nonmetropolitan areas, counties that were urbanized had a rate of 7.6 percent, less urbanized counties had a rate of 5.6 percent, while completely rural counties had a rate of 4.6 percent.

Figure 2.7 Past Month Illicit Drug Use among Persons Aged 12 or Older, by County Type: 2002-2004

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The rate of current illicit drug use in completely rural counties had declined between 2002 and 2003, from 6.7 to 3.1 percent, but was 4.6 percent in 2004. The rate in 2004 was not significantly different from the rate in 2003 or 2002.
Among youths aged 12 to 17, there was evidence of regional differences in trends of marijuana use between 2002 and 2004. Rates of current marijuana use were lower in 2004 than in 2002 in the Northeast, Midwest, and South (although the decrease was not statistically significant in the Northeast and Midwest) (Figure 2.8). However, in the West, rates were 8.0 percent in 2002, 8.7 percent in 2003, and 9.3 percent in 2004.

Figure 2.8 Past Month Marijuana Use among Youths Aged 12 to 17, by Geographic Region: 2002-2004

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Criminal Justice Populations

In 2004, among the estimated 1.5 million adults aged 18 or older on parole or other supervised release from prison during the past year, 25.3 percent were current illicit drug users compared with 7.5 percent among adults not on parole or supervised release.
Among the estimated 4.7 million adults on probation at some time in the past year, 26.2 percent reported current illicit drug use in 2004. This compares with a rate of 7.2 percent among adults not on probation in 2004.

Frequency of Use

In 2004, 12.7 percent of past year marijuana users used marijuana on 300 or more days in the past 12 months. This translates into 3.2 million persons using marijuana on a daily or almost daily basis over a 12-month period, similar to the estimates in 2002 and 2003.
The number of youths aged 12 to 17 using marijuana daily or almost daily in the past year declined from 358,000 in 2002 to 282,000 in 2003, but the estimate for 2004 was 342,000, which was not significantly different from the estimates for 2002 or 2003. Similarly, the number of youths using marijuana on 20 or more days in the past month declined from 603,000 in 2002 to 482,000 in 2003, but was 536,000 in 2004.
The number of past month daily or almost daily cocaine users increased from 133,000 in 2003 to 263,000 in 2004. Most of these daily users were aged 26 or older (96,000 in 2003, 203,000 in 2004).

Association with Cigarette and Alcohol Use

In 2004, the rate of current illicit drug use was approximately 8 times higher among youths aged 12 to 17 who smoked cigarettes (47.5 percent) than it was among youths who did not smoke cigarettes (5.6 percent).
Illicit drug use also was associated with the level of alcohol use. Among youths aged 12 to 17 who were heavy drinkers (i.e., drank five or more drinks on the same occasion on at least 5 different days in the past 30 days), 65.6 percent also were current illicit drug users, whereas among nondrinkers, the rate was only 5.0 percent.
Among youths who were both smokers and heavy drinkers, 70.1 percent used illicit drugs compared with only 3.5 percent among youths who did not drink or smoke.

Driving Under the Influence of Illicit Drugs

In 2004, an estimated 10.6 million persons reported driving under the influence of an illicit drug during the past year. This corresponds to 4.4 percent of the population aged 12 or older, which was similar to the rates in 2002 (4.7 percent) and 2003 (4.6 percent). In 2004, the rate was highest (13.3 percent) among young adults aged 18 to 25, a decrease from 14.7 percent in 2002.

How Marijuana Is Obtained

NSDUH includes questions asking marijuana users how, from whom, and from where they obtained the marijuana they used most recently. In 2004, most users (55.1 percent) got the drug for free or shared someone else's marijuana. About 40 percent of marijuana users bought it.
Most marijuana users obtained the drug from a friend; 76.0 percent of those who bought their marijuana and 81.1 percent of those who obtained the drug for free had acquired it from a friend.
More than half (52.7 percent) of users who bought their marijuana purchased it inside a home, apartment, or dorm. This also was the most common location for obtaining marijuana for free (65.1 percent).
Among youths aged 12 to 17, 60.4 percent got the drug for free and 33.1 percent bought it. Among youths who bought their marijuana, 33.6 percent bought it inside a home, apartment, or dorm. Among youths who obtained their marijuana for free, 47.4 percent obtained it inside a home, apartment, or dorm.
Among youths aged 12 to 17 who bought their marijuana, 10.5 percent obtained it inside a school building, and 4.0 percent bought it outside on school property.

Prior Marijuana Use History

Among the 25.5 million past year users of marijuana in 2004, an estimated 2.1 million (8.4 percent) were first-time users during the past year and 19.2 million (75.5 percent) were "continuing" users (i.e., they had used during the prior year, which is the period from 12 to 23 months ago, and had continued to use in the past year). Additionally, 4.1 million (16.1 percent) "resumed" use in the past 12 months (i.e., they had used marijuana prior to 24 months ago, did not use during the prior year, but did use in the past 12 months). These percentages are similar to the percentages among past year marijuana users in 2003 (7.8 percent first-time users, 77.0 percent "continuing" users, and 15.1 percent "resumed" users).
Among the 3.7 million past year marijuana users aged 12 to 17 in 2004, an estimated 1.3 million (34.2 percent) were first-time users, 2.1 million (57.0 percent) were "continuing" users, and 0.3 million (8.7 percent) had "resumed" their marijuana use in the past 12 months. These percentages are similar to the percentages among past year marijuana users in 2003.
A measure of "discontinuation" of marijuana use is obtained as the percentage of those who did not use marijuana in the past 12 months among those who did use in the prior year. Based on this calculation, marijuana discontinuation rates in 2004 were 27.2 percent among persons aged 12 or older, and 19.9 percent among youths aged 12 to 17. These rates are essentially the same as the rates in 2003.

3. Alcohol Use

The National Survey on Drug Use and Health (NSDUH) includes questions about the recency and frequency of consumption of alcoholic beverages, such as beer, wine, whiskey, brandy, and mixed drinks. Prior to the administration of the alcohol use questions, an extensive list of examples of the kinds of beverages included is given to respondents. A "drink" is defined as a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. Times when the respondent only had a sip or two from a drink are not considered as consumption. For this report, estimates for the prevalence of alcohol use are reported primarily at the following three levels for males and females and all ages:

Current (past month) use - At least one drink in the past 30 days (includes binge and heavy use).

Binge use - Five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) at least once in the past 30 days (includes heavy use).

Heavy use - Five or more drinks on the same occasion on at least 5 different days in the past 30 days.

About half (50.3 percent) of Americans aged 12 or older reported being current drinkers of alcohol in 2004. This translates to an estimated 121 million people and is similar to the 2002 and 2003 estimates.
More than one fifth (22.8 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2004. This translates to about 55 million people, comparable with the 2002 and 2003 estimates.
In 2004, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 16.7 million people. These figures are similar to those of 2002 and 2003, when 6.7 and 6.8 percent, respectively, reported heavy drinking.

Age

Among young people, the prevalence of current alcohol use in 2004 increased with age, from 2.3 percent at age 12 to 69.8 percent of persons at age 21 (Figure 3.1). Among older persons, the prevalence of alcohol use decreased with increasing age, from 63.2 percent among 26 to 29 year olds to 49.9 percent among 60 to 64 year olds and 35.3 percent among persons aged 65 or older.

Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2004

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Rates of binge alcohol use also increased with age among young people, from 1.1 percent at age 12 to 26.6 percent at age 17. Binge alcohol use peaked at age 21 (48.2 percent) and then decreased beyond young adulthood (Figure 3.1).
Both binge and heavy drinking in 2004 were highest for the 18- to 25-year-old age group compared with other age groups, with the peak rate for both measures occurring at age 21. The rate of binge drinking was 41.2 percent for young adults aged 18 to 25 and 48.2 percent at age 21. Heavy alcohol use was reported by 15.1 percent of young adults aged 18 to 25 and by 19.2 percent of 21 year olds.
Rates of binge and heavy drinking were relatively low among people aged 65 or older, with rates of 6.9 and 1.8 percent, respectively.
Among youths aged 12 to 17, an estimated 17.6 percent used alcohol in the month prior to the survey interview (i.e., were current drinkers). An estimated 11.1 percent of youths aged 12 to 17 were binge drinkers, and 2.7 percent were heavy drinkers. These percentages for current, binge, and heavy drinking were similar to those obtained in 2002 and 2003.

Underage Alcohol Use

In 2004, about 10.8 million underage persons aged 12 to 20 (28.7 percent) reported drinking alcohol in the past month. Nearly 7.4 million (19.6 percent) were binge drinkers, and 2.4 million (6.3 percent) were heavy drinkers. These figures were similar to the 2002 and 2003 estimates.
More males than females aged 12 to 20 reported binge drinking (22.1 vs. 17.0 percent) and heavy drinking (8.2 vs. 4.3 percent) in 2004.
Among persons aged 12 to 20, past month alcohol use rates ranged from 16.4 percent among Asians to 19.1 percent among blacks, 24.3 percent among American Indians or Alaska Natives, 26.4 percent among those reporting two or more races, 26.6 percent among Hispanics, and 32.6 percent among whites.
Among