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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 age 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, the majority of drug use measures in Nebraska have been at or below the national rates for all age groups and across all survey years. Rates on measures of alcohol use and binge alcohol use, however, have been consistently above the national rates. This is particularly true for the State population age 12 and older, as well as for individuals age 12 to 17 where the rates of past month binge alcohol use have consistently been among the 10 highest in the country.
Abuse and Dependance
Questions in NSDUH are used to classify persons as 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). In Nebraska, there has been a consistent marked difference between abuse of and dependence on alcohol and abuse of and dependence on illicit drugs. While the rates for drug abuse (Chart 1) have been consistently at or below the rates for the country as a whole, rates for alcohol dependence or abuse (Chart 2) have consistently been above the national rates.
Substance Abuse Treatment Facilities
According to the National Survey of Substance Abuse Treatment Services (N-SSATS),3 the number of treatment facilities in Nebraska has remained relatively consistent since 2002. In 2006, Nebraska had 107 treatment facilities, 68 of which (64%) were private nonprofit. Another 20 facilities were private for-profit, and 4 facilities were owned or operated by tribal governments.
Although facilities may offer more than one modality of care, in 2006 84 facilities (78%) offered some form of outpatient treatment, and 40 facilities (37%) offered some form of residential care. One facility offered an opioid treatment program, and 22 physicians were certified to provide buprenorphine treatment. In 2006, 73 facilities (68%) received some form of Federal, State, county, or local government funds, and 58 facilities had agreements or contracts with managed care organizations for the provision of substance abuse treatment services.
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, Nebraska showed an one-day total of 4,893 clients in treatment, 4,042 of whom (83%) were in outpatient treatment. Of the total number of clients in treatment on this date, 654 (13%) were under the age of 18.
Chart 3 shows the percentage of admissions mentioning particular drugs or alcohol at the time of admission. Across the last 15 years, there has been a modest decline in the number of admissions mentioning alcohol and a sharp increase in the mentions of methamphetamine (2% in 1992 versus 20% in 2006).
Across the years for which TEDS data are available, Nebraska has seen a modest shift in the constellation of problems present at treatment admission (Chart 4). Alcohol-only admissions have remained relatively stable and drug-only admissions have increased from 4 percent in 1992 to 12 percent in 2006.
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.
Mirroring the rates for alcohol abuse and dependence, unmet treatment need for alcohol use in Nebraska has consistently been above the national rate for all age groups and across all survey years (Chart 5). This is particularly true for individuals age 12 to 17 for whom the rates of unmet need are among the highest in the country.
Similarly, rates for unmet drug treatment need have generally been at or below the national rates, and for individuals age 12 to 17 were among the lowest in the country for 2004-2005 and 2005-2006 (Chart 6).