The National Survey on Drug Use and Health (NSDUH) generates state-level estimates for 23 measures of substance use and mental health problems for four age groups: the entire state population over the age of 12 (12+); individuals age 12 to 17; individuals age 18 to 25; and individuals age 26 and older (26+). Since state estimates of substance use and abuse were first generated using the combined 2002 2003 NSDUHs and continuing until the most recent state estimates based on the combined 2005 2006 surveys, Hawaii has consistently ranked among those States with the lowest rates of the following measures (Table 1).

Abuse and Dependance

Questions in NSDUH are used to classify persons as being dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) (American Psychiatric Association, 1994).

Rates of past year abuse or dependence on alcohol in Hawaii have been quite variable over time, and in 2005–2006 the rates for all age groups were at or below the national rates; with those for individuals age 12 to 17 among the 10 lowest rates in the country (Chart1).

Rates of past year dependence on or abuse of illicit drugs have also been quite variable over time in Hawaii. In 2005–2006, however, the rates were among the lowest in the country for all age groups except those age 26 and older (Chart 2).

Substance Abuse Treatment Facilities

According to the 2006 National Survey of Substance Abuse Treatment Services (N-SSATS),3 94 facilities in Hawaii (80 %) were private nonprofit. Another 12 facilities (13%) were private for-profit, and the remainder were owned or operated by Federal, State, or local government. Since 2002, the number of treatment facilities in Hawaii has increased overall, with the addition of 21 private nonprofit facilities and the loss of 8 private for-profit facilities.

Although facilities may offer more than one modality of care, in 2006 the majority of facilities (97 of 105, or 92%) offered some form of outpatient treatment. Additionally, 17 facilities (16%) offered some form of residential care, 3 facilities offered an opioid treatment program, and 37 physicians and 7 programs were certified to provide bupenorphine treatment for opiate addiction.

In 2006, 87 percent of all facilities (91 of 105) received some form of Federal, State, county, or local government funds, and 43 facilities (41%) had agreements or contracts with managed care organizations for the provision of substance abuse treatment services.

Treatment

State treatment data for substance use disorders are derived from two primary sources—an annual one-day census in N-SSATS and annual treatment admissions from the Treatment Episode Data Set (TEDS).4 In the 2006 N-SSATS survey, Hawaii showed a one-day total of 3,787 clients in treatment, the majority of whom (3,284 or 87%) were in outpatient treatment. Of the total number of clients in treatment on this date, 864 (23%) were under the age of 18.

Chart 3 shows the percent of admissions mentioning particular drugs or alcohol at the time of admission.5 Across the last 15 years, there has been a steady decline in the number of admissions mentioning alcohol and cocaine and a sharp increase in the number of admissions mentioning methamphetamine.

Across the years for which TEDS data are available, Hawaii has seen a shift in the constellation of problems present at treatment admission. Alcohol-only admissions have declined from over 24 percent of all admissions in 1992, to just over 14 percent in 2006. Concomitantly, drug-only admissions have doubled from 18 percent in 1992, to 37 percent in 2005 (Chart 4).

Unmet Need For Treatment

NSDUH defines unmet treatment need as an individual who meets the criteria for abuse of or dependence on illicit drugs or alcohol according to the DSM-IV, but who has not received specialty treatment for that problem in the past year.

Rates of unmet drug treatment need in Hawaii have been quite variable over time and among age groups. In 2005–2006; however, the rates for those age 12 to 17 and those age 18 to 25 were among the lowest in the country. The rate for those age 26 and older, however, was among the 10 highest in the country (Chart 5).