U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Assistant Secretary for Planning and Evaluation
Public Health Service
National Institutes of Health / National Institute on Drug Abuse
December 1994
ACKNOWLEDGEMENTS
This report was developed under the joint sponsorship of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the National Institute on Drug Abuse (NIDA).
The analyses for the report were prepared by CSR, Incorporated under Contract No. 271-89-8325 with NIDA. CSR staff responsible for developing the report were James Colliver and Elizabeth Quinn. Andrea Kopstein served as the NIDA Project Officer, and Sharman Stephens and Laura Feig served as ASPE Liaison Representatives. The report subsequently was modified by James Colliver and Arthur Hughes of NIDA to incorporate statistical testing of differences in prevalence estimates. Joseph Gfroerer of the Office of Applied Studies of the Substance Abuse and Mental Health Services Administration reviewed the manuscript at each stage and provided statistical consultation.
EXECUTIVE SUMMARY
This report provides data on substance use among participants in three Federal programs: Aid to Families with Dependent Children (AFDC), medicaid, and food stamps. The study is based on data from the 1991 National Household Survey on Drug Abuse (NHSDA) and was sponsored jointly by the Office of the Assistant Secretary for Planning and Evaluation and the National Institute on Drug Abuse, with technical assistance form the Substance Abuse and Mental Health Services Administration. Estimates from the NHSDA should be regarded as conservative because of potential underreporting of drug use and program participation.
Another study expands upon this work and examines not only the prevalence of substance use in households participating in AFDC, but importantly further analyzes a combined 1991 and 1992 data set to examine extent of use and impairment related to that use.<1>
The study of the basic prevalence of substance use among program participants found that:
The vast majority of all past-month users, or other members of their family residing with them, are not participants in AFDC, medicaid, or food stamps. Overall, the proportions of all reported past-month users who participate in AFDC, medicaid, and food stamps are 5.4 percent, 8.9 percent, and 9.9 percent, respectively.
The prevalence rates of self-reported non-medical drug use are somewhat higher among program participants than in the general population. In 1991, past-month drug use for persons 15 years of age and older are 10.5 percent for those in AFDC households, 9.4 percent for those in medicaid households, and 10.1 percent for those in food stamp households compared to 6.5 percent in the overall population in that age group.
Three or more episodes of binge drinking in the past month is reported by 8.2 percent of women in AFDC households and 3.8 percent of all women age 15 and older. Among men and women combined, this level of heavy episodic drinking is reported by 8.6 percent of all persons 15 years of age and older and 8.7 percent of those in AFDC households. Binge drinking is defined as having had five or more drinks in a row.
Marijuana is the most frequently reported illicit drug used by persons 15 years of age and older, with 5 percent of the general population, 8.7 percent of individuals in AFDC households, 6.3 percent of those in medicaid households, and 7.8 percent of those in food stamp households reporting past-month use.
Although the proportion of persons reporting cocaine use is small, the rates among persons 15 years of age and older of both sexes, with few exceptions, are higher among those in households receiving AFDC, medicaid, or food stamps than in the total population in that age range. For past-year cocaine use, for example, the rates are 6.4 percent, 4.8 percent, and 6.4 percent for persons in AFDC, medicaid, and food stamp households, respectively. The rate in the total population is 3.1 percent.
In all three program participant groups, drug use tends to be concentrated among younger persons; 42 to 52 percent of females in the three participant groups are 30 years of age or younger, while 62 to 72 percent of those reporting past-month drug use are in this age bracket. Similarly, the prevalence of reported drug use is highest among younger persons. The relatively young ages of the reported drug users probably influence the findings on several other characteristics, such as marital status, employment status, and income, since younger persons are less likely to be married, employed full-time, or earning higher incomes.
Other findings on the characteristics of program participants who report drug use include:
Persons in participating households who report drug use are much less likely to be married and much more likely never to have married than all persons in the participant groups.
In each participant group, a substantially larger proportion who report past-month drug use are unemployed and a smaller proportion are in the "other" category (full-time homemakers, postsecondary school students, retired persons, and disabled persons) than are all persons in the participant groups.
Contrary to expectations, illicit drug use is not concentrated in large cities. Program participants who report past-month drug use are substantially more likely to live in small metropolitan areas (population 50 thousand to 1 million) than are all program participants. AFDC and medicaid participants who report past-month drug use generally are less likely to live in large metropolitan areas (population over 1 million) than are all program participants.
Among persons who live in AFDC and medicaid households and who report past-month drug use, a larger proportion are below the poverty level than among all AFDC and medicaid participants. However, among food stamp participants, a smaller proportion of reported past-month drug users are below the poverty level.
The finding of relatively higher rates of reported drug use among program participants is not surprising. These programs serve persons in poverty, and poor people are at a higher risk for a number of problems, including drug use.
The finding suggests that the programs should recognize the presence of persons with substance abuse problems in their caseloads, in order to improve their ability to serve these persons and better focus prevention and treatment.
<1> 1 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Substance Abuse and Mental Health Services Administration, and National Institute on Drug Abuse, Patterns of Substance Use and Substance-Related Impairment Among Participants in the Aid to Families with Dependent Children Program (AFDC), 1994.