Heroin Data Tables and References

Analyses of Substance Abuse and Treatment Need Issues

Heroin Data Tables and References

Table 1: Percent Distribution of the U.S. Population Ages 12 and Older Reporting Past Year Use of Heroin, by Demographic Characteristics: 1991-92 and 1995-96

Table 1 continued:

Table 2: Percentage of the U.S. Population Ages 12 and Older Reporting Past Year Use of Heroin, by Demographic Characteristics: 1991-92 and 1995-96

Table 2 continued:

Table 3: Percentage of the U.S. Population Ages 12 and Older Reporting Lifetime Use of Heroin, by Demographic Characteristics: 1995 and 1996 Combined

Table 3 continued:

Table 4: Distribution of Heroin-Related Deaths in Selected Metropolitan Areas, by Demographic Characteristics: 1992-1995

Table 5: Distribution of Heroin-Related Deaths by Characteristics of Episode: 1992-1995

Table 6: Distribution of Heroin-Related Emergency Department Visits by Selected Demographic Characteristics: 1991-1995

Table 7: Distribution of Heroin-Related Emergency Department Visits by Characteristics of Episode: 1991-1995

Table 8: Distribution of Primary Heroin Admissions to Treatment Units Receiving Public Funds, by Selected Demographic and other Characteristics: 1995

Table 9: Number and Percent Distribution of Admissions to Publicly-Funded Treatment Units for Primary Heroin Use by Route of Administration and Age: 1995

Table 10: Heroin-Related Emergency Department Visits by Age and Route of Administration: 1991-1995

Table 11: Percent of Eighth, Tenth and Twelfth Graders Using Heroin in the Past Year and Lifetime: 1991-1996

Table 12: Distribution of the U.S. Population Age 12 and Older Reporting Using Heroin for the First Time: 1989-91 and 1993-95

Table 13: Estimated Number (in Thousands) of Persons Who First Used Heroin During Each Year 1962-1995, Their Mean Age at First Use, and Annual Age-Specific Rates of First Use (per 1000 Person-Years of Exposure) , Based on 1994-1996 NHSDAs

References

1) Epidemiological Trends in Drug Abuse, Advance Report, June, 1996. Community Epidemiology Work Group, National Institute on Drug Abuse, National Institutes of Health, Public Health Service, DHHS.

2) Office of National Drug Control Strategy. "Pulse Check National Trends in Drug Abuse-Winter 1995"

3) Domestic Unit of the Strategic Intelligence Section. Drug Enforcement Administration. Illegal Drug Price/Purity Report United States: January 1992-December 1995 Drug Intelligence Report

4) National Narcotics Intelligence Consumers Committee. The NNICC Report 1985-1986 The Supply of Illicit Drugs to the United States from Foreign and Domestic Sources in 1985 and 1986-June 1987

5) Drug Abuse Warning Network Series D-1: Annual Medical Examiner data 1995. Public Health Service, Rockville Maryland: US Department of Health and Human Services

6) Drug Abuse Warning Network Series: D-2, Mid-Year Preliminary Estimates From the 1996 Drug Abuse Warning Network. Public Health Service, Rockville, Maryland: US Department of Health and Human Services

7) Data from the 1995 Treatment Episode Data Set, Office of Applied Studies, Substance Abuse and Mental Health Services Administration.

8) Preliminary Results From the 1996 National Household Survey on Drug Abuse. Public Health Service, Rockville, Maryland: US Department of Health and Human Services.

9) U. S. Department of Health and Human Services. (1996) . Monitoring the Future. HHS News Release (December 19, 1996) .

10) Person, P.H., Retka, R.L., Woodward, J.A. Technical Paper: A Method for Estimating Heroin Use Prevalence. National Institute on Drug Abuse, National Institutes of Health, Public Health Service, Rockville, Maryland: US Department of Health and Human Services.

11) Demaree, R.G., Hudiburg, R.A., Fletcher, B.W., Estimates of the Prevalence of Heroin Use in 24 Metropolitan Areas 1976-1979. National Institute on Drug Abuse, National Institutes of Health, Public Health Service, Rockville, Maryland: US Department of Health and Human Services.

12) The National Drug Control Strategy: 1996. Executive Office of the President of the United States, The White House.

13) Unpublished Data from the NHSDA

14) Unpublished Data from the DAWN

15) Advance Report Number 9A, Overview of the FY94, National Drug and Alcoholism Treatment Unit Survey (NDATUS) : Data From 1993 and 1980-1993. Public Health Service, Rockville, Maryland: US Department of Health and Human Services.

16) Statistical Series. Annual Data, 1981; Data from the Client Oriented Data Acquisition Process (CODAP) Series E, Number 25. Public Health Service, Rockville Maryland: US Department of Health and Human Services.

17) Advance Report Number 16, Historical Estimates From the Drug Abuse Warning Network Statistical Series. Annual Medical Examiner data, 1994; Data from the Drug Abuse Warning Network (DAWN) Series I, Number 14-B: 1996. Public Health Service, Rockville Maryland: US Department of Health and Human Services.

Table 1: Percent Distribution of the U.S. Population Ages 12 and Older Reporting Past Year Use of Heroin, by Demographic Characteristics: 1991-92 and 1995-96

1991-92 (Annual Average)

1995-96 (Annual Average)

Demographic

Characteristics

Percent of Users

Number

(in 1,000's)

Percent of Users

Number

(in 1,000's)

Total

Age

12-17

18-25

26-34

35+

12-25

Race/Ethnicity

White

Black

Hispanic

Other

Sex

Male

Female

Adult Education¹

< High School

High School

Some College

College Grad

100.0

9.4

33.9

25.7

31.0

43.3

58.3

21.2

15.1

5.5

59.2

40.8

48.0

30.0

12.3

9.8

352

119

109

152

205

209

144

153

100.0

21.6^b

40.2

17.3

21.0

61.8^b

68.8

20.7

8.9^a

1.6

67.5

32.5

40.5

26.2

24.6^b

8.7

441

178

273

304

298

144

140

1.Data on adult education and current employment not shown for persons age 12-17. Estimates for both adult education and current employment are for persons _ 18.

aThe difference between the 1991-92 estimate and the 1995-96 estimate is statistically significant at the .05 level.

bThe difference between the 1991-92 estimate and the 1995-96 estimate is statistically significant at the .01 level.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse.

Table 1 continued:

1991-92 (Annual Average)

1995-96 (Annual Average)

Demographic

Characteristics

Percent of Users

Number

(in 1,000's)

Percent of Users

Number

(in 1,000's)

Adult Employment¹

Full Time

Part Time

Unemployed

Homemaker

Student Only

Retired

Disabled

College Student, Age 17-22

Yes

Region

Northeast

North Central

South

West

Population Density

In MSA with

> 1 million

In MSA with

< 1 million

Not in MSA

44.5

5.9

36.0

4.7

1.3*

3.2*

4.4*

4.3*

95.7

22.4

24.5

28.5

24.7

67.4

14.8

17.8

142

115

337

100

238

32.7

20.6^b

14.1^b

2.0*

11.6^b

12.9*

6.1

14.6^b

85.4^b

18.2

21.7

45.2^b

15.0

38.5^b

38.2^b

23.3

113

377

199

170

169

103

1.Data on adult education and current employment not shown for persons age 12-17. Estimates for both adult education and current employment are for persons _ 18.

*Relative Standard Error >0.5

aThe difference between the 1991-92 estimate and the 1995-96 estimate is statistically significant at the .05 level.

bThe difference between the 1991-92 estimate and the 1995-96 estimate is statistically significant at the .01 level.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse.

Table 2: Percentage of the U.S. Population Ages 12 and Older Reporting Past Year Use of Heroin, by Demographic Characteristics: 1991-92 and 1995-96

Percent Using Heroin

Demographic

Characteristics

1991-1992

1995-1996

Total

Age

12-17

18-25

26-34

35+

12-25

Race/Ethnicity

White

Black

Hispanic

Other

Sex

Male

Female

Adult Education¹

< High School

High School

Some College

College Grad

0.2

0.4

0.2

0.1

0.3

0.1

0.3

0.2

0.1

0.4

0.1

0.1*

0.2

0.4^a

0.6

0.2

0.1*

0.5

0.2

0.4

0.2^a

0.1

0.3

0.1

0.4

0.1

0.2^a

0.1*

1.Data on adult education and current employment not shown for persons age 12-17. Estimates for both adult education and current employment are for persons _ 18.

*Relative Standard Error >0.5

aThe difference between the 1991-92 estimate and the 1995-96 estimate is statistically significant at the .05 level.

bThe difference between the 1991-92 estimate and the 1995-96 estimate is statistically significant at the .01 level.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse.

Table 2 continued:

Percent Using Heroin

Demographic

Characteristics

1991-1992

1995-1996

Adult Employment¹

Full Time

Part Time

Unemployed

Homemaker

Student Only

Retired

Disabled

Region

Northeast

North Central

South

West

Population Density

In MSA with

> 1 million

In MSA with

< 1 million

Not in MSA

0.2

0.1

1.0

0.1*

0.0*

0.3*

0.2

0.1

0.2

0.3

0.1

0.3^b

0.6

0.0*

0.8^b

0.2*

0.4*

0.2

0.3^a

0.1

0.2^a

0.2^b

0.2*

1.Data on adult education and current employment not shown for persons age 12-17. Estimates for both adult education and current employment are for persons _ 18.

*Relative Standard Error >0.5

aThe difference between the 1991-92 estimate and the 1995-96 estimate is statistically significant at the .05 level.

bThe difference between the 1991-92 estimate and the 1995-96 estimate is statistically significant at the .01 level.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse.

Table 3: Percentage of the U.S. Population Ages 12 and Older Reporting Lifetime Use of Heroin, by Demographic Characteristics: 1995 and 1996 Combined

1995-1996 (Annual Average)

Demographic

Characteristics

Percent Using Heroin

Number (in 1,000's)

Total

Age

12-17

18-25

26-34

35+

Race/Ethnicity

White

Black

Hispanic

Other

Sex

Male

Female

Adult Education¹

< High School

High School

Some College

College Grad

1.1

0.6

1.0

1.4

1.2

2.7

0.8

0.4

1.7

0.6

1.9

1.0

1.3

0.9

2,447

127

287

494

1,540

1,855

393

162

1,770

677

693

654

568

405

1.Data on adult education and current employment not shown for persons age 12-17. Estimates for both adult education and current employment are for persons _ 18.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse.

Table 3 continued:

1995-1996 (Annual Average)

Demographic Characteristics

Percent Using Heroin

Number (in 1,000's)

Adult Employment¹

Full Time

Part Time

Unemployed

Homemaker

Student Only

Retired

Disabled

Region

Northeast

North Central

South

West

Population Density

In MSA with

> 1 million

In MSA with

< 1 million

Not in MSA

1.4

1.1

4.1

0.0

0.8

0.2*

2.4

1.4

1.1

1.4

0.8

1,345

250

337

617

536

784

510

1,056

996

395

1.Data on adult education and current employment not shown for persons age 12-17. Estimates for both adult education and current employment are for persons _ 18.

*Relative Standard Error >0.5

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse.

Table 4: Distribution of Heroin-Related Deaths in Selected Metropolitan Areas, by Demographic Characteristics: 1992-1995

Demographic

Characteristics

1992

1993

1994

1995

Number

Percent

Number

Percent

Number

Percent

Number

Percent

Total

Sex

Male

Female

Unknown

Race

White

Black

Hispanic

Other

Unknown

Age

12-17

18-25

26-34

35-44

45-54

55+

Unknown

2,782

2,278

484

1,407

819

523

217

842

1,200

351

159

100

3,560

2,925

620

1,772

1,124

622

283

993

1,677

458

125

100

3,330

2,757

563

1,729

1,042

514

235

894

1,482

530

152

100

3,809

3,183

611

2,055

1,108

587

302

938

1,707

651

182

100

Note: Based on data from consistently reporting medical examiners in 25 metropolitan areas. Excludes deaths in which AIDS was reported, deaths in which "drug unknown" was the only substance mentioned, and homicides.

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network..

Table 5: Distribution of Heroin-Related Deaths by Characteristics of Episode: 1992-1995

Characteristics

1992

1993

1994

1995

Number

Percent

Number

Percent

Number

Percent

Number

Percent

Drug Concomitance

Single-Drug Episode

Multi-Drug Episode

Cause of Death

Drug Induced

Single-Drug

Multi-Drug

Drug Related

Physiological

Condition

Combination

Physiological Event

Medical Disorder

Unknown

Route of Administration

Injected

Other

Inhaled, Smoked, Sniffed

Unknown

Manner of Death

Accidental/

unexpected

Suicide

Other/unknown

Natural

290

2,492

179

2,179

150

155

103

892

101

1,748

2,068

161

394

159

315

3,245

265

2,895

135

138

1,218

128

2,146

2,721

153

569

117

311

3,019

236

2,628

171

210

809

161

2,302

2,529

136

530

135

368

3,441

308

3,114

160

143

742

157

2,820

2,869

155

633

152

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network.

Table 6: Distribution of Heroin-Related Emergency Department Visits by Selected Demographic Characteristics: 1991-1995

Demographic

Characteristics

1991

1992

1993

1994

1995¹

Number

Percent

Number

Percent

Number

Percent

Number

Percent

Number

Percent

Total

Sex

Male

Female

Unknown

Race

White

Black

Hispanic

Other

Unknown

Age

12-17

18-25

26-34

35-44

45-54

55+

Unknown

35,898

23,638

11,951

309

13,367

15,175

5,118

178

2,060

182

4,705

13,560

13,657

3,009

644

143

100

48,003

34,781

12,832

390

17,926

18,600

8,517

294

2,665

232

5,860

16,408

19,258

5,092

1,026

125

100

63,228

44,670

18,158

400

23,026

23,347

11,326

699

4,829

280

8,020

21,203

25,833

6,584

1,195

113

100

64,012

43,999

19,514

499

23,382

25,988

9,452

282

4,906

507

8,371

21,619

24,623

7,330

1,406

157

100

72,217

50,258

21,074

885

27,441

27,808

9,925

378

6,665

412

8,659

23.301

28,450

9,800

1,497

100

1 - Preliminary data.

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network.

Table 7: Distribution of Heroin-Related Emergency Department Visits by Characteristics of Episode: 1991-1995

Demographic

Characteristics

1991

1992

1993

1994

1995¹

Number

Percent

Number

Percent

Number

Percent

Number

Percent

Number

Percent

Total

Drug Concomitance

Single-Drug Episode

Multi-Drug Episode

Motive for Use

Recreational

Dependence

Suicide

Other/Unk Motive

Reason for Visit

Unexpected React. Overdose

Chronic Effects

Seeking Detox.

Withdrawal

Other/Unk Reason

35,898

15,550

20,348

2,803

28,222

1,160

3,713

3,781

7,110

10,759

7,982

3,133

100

48,002

21,844

26,158

3,786

36,271

1,563

6,384

5,219

12,226

13,310

9,204

3,535

4,509

100

63,228

30,432

32,796

5,337

47,911

2,115

7,869

6,848

16,557

14,280

14,396

5,559

5,591

100

64,011

29,715

34,296

4,154

50,505

2,282

7,071

6,306

13,752

16,532

14,831

6,933

5,659

100

72,217

33,349

38,869

5,416

56,414

2,624

7,764

6,338

16,280

18,148

16,668

8,350

6,432

100

1 - Preliminary data.

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network.

Table 8: Distribution of Primary Heroin Admissions to Treatment Units Receiving Public Funds, by Selected Demographic and other Characteristics: 1995

Demographic

Characteristics

Number

Percent

Total

Sex

Male

Female

Race/Ethnicity

White

Black

Hispanic

Other

Age at Admission

<20

20-24

25-29

30-34

35-39

40+

Other Substances Reported

None

Alcohol

Cocaine

Marijuana/Hashish

Other Opiates/Non-RX Methadone

Methamphetamine/Amphetamine

All Other

190,881

126,180

64,701

85,997

48,066

51,079

5,740

3,167

13,714

26,822

38,032

42,603

66,543

74,840

46,162

77,182

18,725

8,678

5,411

7,664

100.0

66.1

33.9

45.1

25.2

26.8

3.0

1.7

7.2

14.1

19.9

22.3

34.9

39.2

24.2

40.4

9.8

4.5

2.8

4.0

Source: Office of Applied Studies, SAMHSA, Treatment Episode Data Set.

Table 9: Number and Percent Distribution of Admissions to Publicly-Funded Treatment Units for Primary Heroin Use by Route of Administration and Age: 1995

Number of Admissions

Age
Group

Route of Administration

Total

Injected

Inhaled

Smoked

Oral

Other

Unknown

Total
<20
20-24
25-29
30-34
35-39
40+

190,881
3,167
13,715
26,822
38,032
42,602
66,542

131,264
1,422
6,823
14,735
24,309
30,906
53,068

38,968
1,146
4,683
8,230
8,912
7,371
8,627

4,200
229
494
837
925
820
894

2,153
82
172
316
476
441
666

817
23
45
122
158
200
268

13,479
266
1,498
2,582
3,252
2,863
3,018

Percent Distribution

Age
Group

Route of Administration

Total

Injected

Inhaled

Smoked

Oral

Other

Unknown

Total
<20
20-24
25-29
30-34
35-39
40+

100.0
1.7
7.2
14.1
19.9
22.3
34.9

100.0
1.1
5.2
11.2
18.5
23.5
40.4

100.0
2.9
12.0
21.1
22.9
18.9
22.1

100.0
5.4
11.8
19.9
22.0
19.5
21.3

100.0
3.8
8.0
14.7
22.1
20.5
30.9

100.0
2.8
5.5
15.0
19.4
24.5
32.8

100.0
2.0
11.1
19.2
24.1
21.2
22.4

Source: Office of Applied Studies, SAMHSA, Treatment Episode Data Set.

Table 10: Heroin-Related Emergency Department Visits by Age and Route of Administration: 1991-1995

1991

1992

1993

1994

1995¹

Age 12-17:

Total

Oral

Inject

Inhale

Smoke

Sniff

Other

Unknown

Age 18-25:

Total

Oral

Inject

Inhale

Smoke

Sniff

Other

Unknown

Age 26-34:

Total

Oral

Inject

Inhale

Smoke

Sniff

Other

Unknown

Age 35+:

Total

Oral

Inject

Inhale

Smoke

Sniff

Other

Unknown

181

4,705

2,787

106

673

927

13,559

123

9,132

189

1,179

2,817

17,310

226

13,077

136

612

3,153

232

5,860

3,253

132

1,229

1,132

16,408

103

10,859

290

1,437

102

3,570

25,376

312

18,985

257

1,045

246

4,471

280

101

8,020

3,745

189

1,907

2,007

21,203

148

11,889

108

441

2,377

166

6,074

33,612

378

21,860

293

1,620

130

9,275

507

145

124

150

8,371

297

3,557

196

1,625

166

2,437

21,619

166

11,724

186

652

3,101

5,698

33,359

399

21,207

138

299

1,968

144

9,204

411

100

146

8,659

293

3,085

281

2,461

104

2,387

23,302

178

11,638

537

3,878

125

6,889

39,751

490

23,303

160

534

3,054

350

11,860

* Estimated number of emergency department visits less than 10.

1 - Preliminary data.

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network.

Table 11: Percent of Eighth, Tenth and Twelfth Graders Using Heroin in the Past Year and Lifetime: 1991-1996

Past Year

1991

1992

1993

1994

1995

1996

8th Grade
10th Grade
12th Grade

0.7
0.5
0.4

0.7
0.6
0.6

0.7
0.7
0.5

1.2
0.9
0.6

1.4
1.1
1.1

1.6
1.2
1.0

Lifetime

1991

1992

1993

1994

1995

1996

8th Grade
10th Grade
12th Grade

1.2
1.2
0.9

1.4
1.2
1.2

1.4
1.3
1.1

2.0
1.5
1.3

2.3
1.7
1.6

2.4
2.1
1.8

Source: Monitoring the Future Study.

Table 12: Distribution of the U.S. Population Age 12 and Older Reporting Using Heroin for the First Time: 1989-91 and 1993-95

New Heroin Users during

1989-91

New Heroin Users during 1993-95

Demographic

Characteristics

Percentage

Number

(in 1,000's)

Percentage

Number

(in 1,000's)

Total

Age

12-17

18-25

26-34

35+

12-25

College Student, Age 17-22

Yes

Ever Used a Needle

Yes

Years Between First Use of Marijuana and Heroin

4-10

>10

100.0

13.4

47.8

18.3

20.5*

61.2

8.7

91.3

55.9

44.1

17.9

53.2

28.9

152

139

100.0

26.9

60.7

12.4

0.0^a*

87.6^b

16.5

83.5

43.4

56.7

43.1^b

42.5

14.4

249

151

218

141

108

208

107

106

aThe difference between the 1989-1991 estimate 1993-1995 estimate is statistically significant at the .05 level.

bThe difference between the 1989-1991 estimate 1993-1995 estimate is significant at the .01 level.

*Relative Standard Error >0.5

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse. 1989-1991 estimates based on 1991-1992 NHSDAs, and 1993-1995 estimates based on 1995-1996 NHSDAs.

Table 13: Estimated Number (in Thousands) of Persons Who First Used Heroin During Each Year 1962-1995, Their Mean Age at First Use, and Annual Age-Specific Rates of First Use (per 1000 Person-Years of Exposure) , Based on 1994-1996 NHSDAs

Age-Specific Rate of First Use¹

Year

Initiates

(1000s)

Mean

Age

12-17

18-25

26-34

1962

1963

1964

1965

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994²

1995³

114

125

119

126

109

141

16.5

19.0

18.7

18.4

19.1

23.5

19.1

21.1

22.3

20.9

22.0

20.7

20.4

20.2

26.0

27.4

23.3

20.2

20.4

27.3

25.0

24.3

23.3

19.6

19.5

19.7

19.3

0.2

0.3

3.0

0.6

1.0

0.9

1.3

0.3

0.4

0.2

0.3

0.4

0.2

0.4

0.1

1.3

0.4

0.2

0.6

0.2

0.4

0.5

1.2

1.8

2.5

0.7

0.6

0.2

1.3

3.9

3.1

3.3

1.3

1.6

2.2

0.7

1.8

1.4

1.6

1.0

1.3

0.9

1.2

0.8

1.1

1.2

1.4

1.3

0.8

0.7

0.9

0.7

0.6

1.7

2.4

0.2

1.1

0.2

0.1

1.5

0.6

1.0

0.4

0.2

0.3

0.2

0.1

0.8

0.3

0.2

0.3

0.4

0.7

0.6

0.2

0.4

0.6

0.5

*Low precision; no estimate reported.

**Estimate rounds to zero.

¹The numerator of each rate equals the number of persons who first used the drug in the year (times 1000) . The denominator of each rate equals the number of persons who were exposed to risk of first use during the year, weighted by their estimated exposure time measured in years. For example, for the age group 12-17 in 1990, the denominator is the sum of three components:

(1) those persons 12-17 years old in 1990 who first used the drug in 1989 or earlier, times a weight of zero. The weight is zero since they had zero exposure to the risk of first use in 1990.

(2) those who first used the drug in 1990 times a weight of .5. The weight of .5 assumes that these people, on average, first used the drug at midyear and consequently have a half year of exposure (i.e. the first half of the year.)

(3) those who never used, or those who first used the drug in 1991 or later, times a weight of one. The weight of one assumes their exposure to the risk of first use during 1990 was for the whole year.

Each person is also weighted by his/her sample weight.

²Estimated using 1995 and 1996 data only.

³Estimated using 1996 data only.

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1994-1996.

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This page was last updated on June 03, 2008.

SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.

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