According to the 2001 National Household Survey on Drug Abuse, the use of illicit drugs in the United States is once again on the increase, after leveling off in 2000 and declining in 1999. The survey found that 15.9 million Americans aged 12 years or older—7.1 percent of the population in that age group—were current users of illicit drugs in 2001 (defined as use during the previous month), compared with 6.3 percent in 2000. The survey also found statistically significant increases in the use of particular illicit drugs or groups of drugs, such as marijuana (from 4.8 to 5.4 percent) and cocaine (.5 to .7 percent) and in the nonmedical use of pain relievers (1.2 to 1.6 percent).
The trends for young people are particularly disturbing: 10.8 percent of youths aged 12 to 17 years were current drug users in 2001, compared with 9.7 percent in 2000; among young adults between the ages of 18 and 25 years, current drug use increased from 15.9 to 18.8 percent.
The rate of alcohol use and the number of drinkers also increased. An estimated 109 million persons aged 12 years or older were current drinkers in 2001 (48.3 percent), compared with 104 million (46.6 percent) in 2000. Among 12- to 20-year-olds—for whom alcohol is an illicit substance—10.1 million (28.5 percent) were current drinkers in 2001. Nearly 6.8 million (19 percent) were binge drinkers and 2.1 million (6 percent) were heavy drinkers.
The survey results indicate that 11.1 percent of Americans in the survey's age bracket (25.1 million persons) had driven under the influence of alcohol at least once during the previous 12 months, up from 10 percent in 2000. Among 18- to 25-year-olds, the proportion was 22.8 percent.
An estimated 66.5 million Americans aged 12 years or older, or 29.5 percent of the survey population, reported use of tobacco in 2001. Of this number, 56.3 million smoked cigarettes, 12.1 million smoked cigars, 7.3 million used smokeless tobacco, and 2.3 million smoked pipes. No significant changes were observed between 2000 and 2001. On a positive note, smoking among youths declined slightly, a continuation of a downward trend since 1999. Another encouraging finding was the growth in the proportion of persons over the age of 12 years who believe that smoking one or more cigarettes a day is harmful, from 69.3 percent in 2000 to 71 percent in 2001.
However, the perceived risk of smoking marijuana once or twice a week decreased from 56.4 percent in 2000 to 53.5 percent in 2001. When the survey results were released at a press conference during National Drug and Alcohol Addiction Recovery month in September, Tommy G. Thompson, U.S. Secretary of Health and Human Services, noted that this finding is cause for concern, given that perceived risk of marijuana use is an important predictor of drug use, especially among youths.
The survey estimated that 16.6 million persons aged 12 years or older (7.3 percent of the population) were dependent on or abused alcohol or illicit drugs in 2001, representing an increase from 14.5 million (6.5 percent of the population) in 2000. The survey highlighted the growing number of Americans who could benefit from drug treatment. An estimated 6.1 million persons were in need of treatment for an illicit drug problem in 2001, up from 4.7 million in 2001. Overall, the number of persons who needed but did not receive treatment increased from 3.9 million to 5 million. When the survey report was released, John Walters, director of national drug control policy, noted that "We have a large and growing denial gap when it comes to drug abuse and dependency in this country."
The 2001 survey included, for the first time, questions about mental illness. An estimated 14.8 million persons aged 18 years or older had serious mental illness in 2001, representing 7.3 percent of all adults. Of these, 6.9 million had received mental health treatment during the previous 12 months. Among adults with serious mental illness, 20.3 percent were dependent on or abused alcohol or illicit drugs, compared with 6.3 percent of adults who did not have mental illness. An estimated 3 million adults had both serious mental illness and substance abuse or dependence during 2001. The data suggest that the likelihood of mental illness decreases with age whereas the likelihood of receiving treatment for mental illness increases.
The National Household Survey on Drug Abuse is a project of the Substance Abuse and Mental Health Services Administration. Initiated in 1971, the survey has become the primary source of information about the use of illicit drugs, alcohol, and tobacco by the civilian, noninstitutionalized population in the United States. The data are based on interviews with approximately 70,000 people aged 12 years or older in every state.
Complete findings of the survey are available at http://www.drugabusestatistics.samhsa.gov.
A report released by the Institute of Medicine that reviews the extensive scientific knowledge base about factors related to suicide concludes that we are still far from understanding how these many factors work in concert to evoke suicidal behavior or to prevent it. The primary recommendation of the report is the establishment of a national network of suicide research laboratories devoted to long-term, interdisciplinary research with large population samples to collect data on suicide and suicide prevention across the life cycle.
The 480-page report is part of a current national focus on reducing the suicide rate that began with the 1999 Surgeon General's Call to Action to Prevent Suicide, which was followed in 2001 by the Surgeon General's National Strategy for Suicide Prevention: Goals and Objectives (see Psychiatric Services, July 2001, page 985). Several federal agencies then asked the Institute of Medicine to assess the science base and suggest specific strategies for studying suicide. The report, Reducing Suicide: A National Imperative, is the result of an 18-month literature review and analysis by a 12-member committee and a panel of 14 reviewers from a wide variety of disciplines.
Every year approximately 30,000 people in the United State die by suicide—one million worldwide. To put the scope of the U.S. problem in perspective, the report points out that over the past 100 years, suicides have outnumbered homicides by a ratio of 3:2. A total of 58,000 Americans died in the Vietnam war, but 220,000 died by suicide during the same period. From 1979 to 1999, a total of 448,000 Americans died from AIDS and HIV-related diseases and 626,000 died by suicide. Breast cancer claims the lives of 40,000 women each year. In 1998 more than $400 million was allocated to research on the prevention, treatment, and cure of breast cancer, but less than $40 million was spent on similar research on suicide. The report calls for an investment of funds large enough to make meaningful progress.
According to the report, the relationship between suicide and mental illness is a "conundrum"—although more than 90 percent of suicides are associated with mental illness or substance abuse, 95 percent of people with mental disorders do not complete suicide. The report notes that determining who among those with mental disorders will attempt suicide is paramount to prevention and treatment efforts.
The first of the report's four main recommendations is for the creation of a national network of from five to ten research laboratories "equipped to perform safe, high-quality, large-sample, multisite studies" of at least ten years' duration. According to the report, a number of laboratories are necessary to capture data on "the profound effects of demographics, region, culture, socioeconomic status, race, and ethnicity." Large population samples of 100,000 per laboratory are necessary because of the relatively low base rate of suicide in the general population—ten to 12 suicides per 100,000 people.
The laboratories would be administered by the National Institute of Mental Health and funded through partnerships among federal agencies and private sources, including foundations. The report recommends that funding for the infrastructure of the laboratories should support dedicated National Institutes of Health staff, recruitment efforts and training programs, and research and training partnerships with other countries. The report describes ten specific areas of research, such as pharmacotherapy, brain-mapping studies, risks and protective effects of hospitalization, and ethnographic research.
The report's second major recommendation is for improved national monitoring of suicide and suicidality. The report emphasizes that national funding agencies should encourage measures of suicidality in all large and long-term studies of health behaviors, mental health interventions, and genetic studies of mental disorders. In addition, the report recommends that a national surveillance system of suicide attempts be developed and coordinated by the Centers for Disease Control and Prevention (CDC). Such a system would complement the CDC's National Violent Death Reporting System, which received initial funding in 2001, and would include data on mortality from suicide.
Because primary care providers are often the first and only medical contact for suicidal persons, the third main recommendation is for the development of screening tools for use in the primary care setting and for more training in this area in medical and nursing schools.
The fourth recommendation is for federal funding of the development, testing, expansion, and implementation of prevention programs through partnerships of federal, state, and local agencies and professional organizations. The report highlights the need for coping and resiliency training programs for school-aged children.
The full text of the report is available on the National Academy Press Web site at www.nap.edu.
First HIPAA compliance deadline and educational materials: October 16, 2002, is the first deadline for compliance with certain requirements of the Health Insurance Portability and Accountability Act (HIPAA). If a health care provider transmits any health information electronically or if a billing company or other third party transmits such information in electronic form on behalf of the provider, then the provider must comply with the HIPAA health care transactions and code sets standards by that date, or request an automatic one-year extension by October 15, 2002. The American Psychiatric Association (APA) has developed materials that describe these standards, identify who must comply, and alert providers to other upcoming HIPAA compliance deadlines. These materials are available on the APA Web site at http://www.psych.org//pub_pol_adv/hipaa/index.cfm. The site provide links to other resources and helps providers complete and file a request for an automatic extension.
CHADD named National Resource Center on ADHD: The Centers for Disease Control and Prevention (CDC) has awarded Children and Adults With Attention-Deficit/ Hyperactivity Disorder (CHADD) a $750,000 grant to establish and operate the National Resource Center on AD/HD. The center will be the CDC's third national resource center; the two other centers target paralysis and limb loss. It will allow CHADD, a national nonprofit organization founded in 1987, to maintain its role as a family support membership organization, while also creating new initiatives and a free information clearinghouse to benefit the ADHD community. The CDC-funded center will bring to CHADD several new staff members: a center director, a librarian, and four information specialists, including at least one Spanish-speaking specialist. In a press release about the CDC award, E. Clarke Ross, chief executive officer of CHADD, said "The national government's leading public health agency has declared that ADHD is not only a valid disorder but is significant and serious enough to warrant a National Resource Center for obtaining and disseminating science-based research and information." More information is available at www.chadd.org.
Madison Institute of Medicine Web site on PMDD: A new Web site, sponsored by the nonprofit Madison Institute of Medicine, is designed to assist health care professionals in helping patients who may have premenstrual dysphoric disorder (PMDD). In addition to providing descriptions of the disorder and its treatment and answers to numerous related questions, the site offers a brief screening test for patients, a physician referral service by zip code, and an online continuing medical education course. The Madison Institute, whose primary objective is to provide high-quality professional and public education and information, is the umbrella organization for three comprehensive information centers on lithium, on obsessive-compulsive disorders, and on bipolar disorders. In 2000 the institute launched an Internet health resource, www.factsforhealth.org, where the newly developed PMDD information is available.
Free online course about Alcoholics Anonymous: The division of alcoholism and drug abuse of the New York University School of Medicine has developed an Internet course focusing on providing information about combining spirituality with biomedical treatment for patients with an addictive illness. The course describes AA and the research support for its approach, provides a list of references, and presents four case histories. It also suggests effective ways for health care professionals to refer patients to AA. A certificate can be downloaded when the course is completed. To take the free course visit http://www.med.nyu.edu/substanceabuse.
New ACGME requirements for resident duty hours: The Accreditation Council for Graduate Medical Education (ACGME) has proposed new limits on the duty hours of medical residents. Under the new rules, which are scheduled to go into effect July 1, 2003, residents will be limited to an 80-hour work week and will have one day off in seven—both averaged over four weeks. They cannot be on call for longer than 24 continuous hours and no more often than every third night. A nearly identical proposal has been endorsed by the American Medical Association. The changes were made partly in response to growing concerns about medical errors, which, according to an Institute of Medicine report, may cause up to 98,000 deaths in hospitals annually. ACGME will monitor programs' compliance with the new requirements, which are available on the Web at www.acgme.org.
Appointments: Thomas R. Insel, M.D., has been appointed director of the National Institute of Mental Health (NIMH). Dr. Insel is currently professor in the department of psychiatry and director of the Center for Behavioral Neuroscience at Emory University School of Medicine in Atlanta. He also directs the Yerkes Regional Primate Research Center. Dr. Insel worked at NIMH from 1979 to 1994 as a clinical associate in the clinical neuropharmacology branch. He conducted research on obsessive-compulsive disorder and launched a research program in social neuroscience, focusing on the neurobiology of complex social behaviors in animals. As director of Yerkes, Dr. Insel has built one of the nation's leading HIV vaccine research programs. Dr. Insel continues to study the role of oxytocin in social attachment and behavior, and, under an NIMH grant, he is involved in the development of an autism research center. He is expected to begin his appointment in mid-November.
Ting-Kai Li, M.D., has been named the new director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Dr. Li was formerly distinguished professor in the department of medicine and professor of biochemistry and molecular biology at Indiana University School of Medicine in Indianapolis, where he also served as director of the Indiana Alcohol Research Center. He replaces Raynard Kington, M.D., Ph.D., who served as acting director of NIAAA since January following the retirement of Enoch Gordis, M.D., NIAAA director from 1986 to 2002. Dr. Li, who is the author of more than 400 journal articles and book chapters, has produced ground-breaking research in several areas, including alcohol metabolism and animal models of alcoholism. He is the current editor of the journal Alcoholism: Clinical and Experimental Research.