Substance Abuse

 Chapter 3, Part B: Trends cont'd

Alcohol & Tabacco Use

B.  Alcohol Use

The National Survey on Drug Use and Health (NSDUH) includes questions about the recency and frequency of consumption of alcoholic beverages, such as beer, wine, whiskey, brandy, and mixed drinks. Prior to the administration of the alcohol use questions, an extensive list of examples of the kinds of beverages included is given to respondents. A "drink" is defined as a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. Times when the respondent only had a sip or two from a drink are not considered as consumption. For this report, estimates for the prevalence of alcohol use are reported primarily at the following three levels for males and females and all ages:

Current (past month) use - At least one drink in the past 30 days (includes binge and heavy use).

Binge use - Five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) at least once in the past 30 days (includes heavy use).

Heavy use - Five or more drinks on the same occasion on at least 5 different days in the past 30 days.

• About half (50.3 percent) of Americans aged 12 or older reported being current drinkers of alcohol in 2004. This translates to an estimated 121 million people and is similar to the 2002 and 2003 estimates.
• More than one fifth (22.8 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2004. This translates to about 55 million people, comparable with the 2002 and 2003 estimates.
• In 2004, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 16.7 million people. These figures are similar to those of 2002 and 2003, when 6.7 and 6.8 percent, respectively, reported heavy drinking.

Age

• Among young people, the prevalence of current alcohol use in 2004 increased with age, from 2.3 percent at age 12 to 69.8 percent of persons at age 21 (Figure 3.1). Among older persons, the prevalence of alcohol use decreased with increasing age, from 63.2 percent among 26 to 29 year olds to 49.9 percent among 60 to 64 year olds and 35.3 percent among persons aged 65 or older.

Figure 3.1 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2004

• Rates of binge alcohol use also increased with age among young people, from 1.1 percent at age 12 to 26.6 percent at age 17. Binge alcohol use peaked at age 21 (48.2 percent) and then decreased beyond young adulthood (Figure 3.1).
• Both binge and heavy drinking in 2004 were highest for the 18- to 25-year-old age group compared with other age groups, with the peak rate for both measures occurring at age 21. The rate of binge drinking was 41.2 percent for young adults aged 18 to 25 and 48.2 percent at age 21. Heavy alcohol use was reported by 15.1 percent of young adults aged 18 to 25 and by 19.2 percent of 21 year olds.
• Rates of binge and heavy drinking were relatively low among people aged 65 or older, with rates of 6.9 and 1.8 percent, respectively.
• Among youths aged 12 to 17, an estimated 17.6 percent used alcohol in the month prior to the survey interview (i.e., were current drinkers). An estimated 11.1 percent of youths aged 12 to 17 were binge drinkers, and 2.7 percent were heavy drinkers. These percentages for current, binge, and heavy drinking were similar to those obtained in 2002 and 2003.

Underage Alcohol Use

• In 2004, about 10.8 million underage persons aged 12 to 20 (28.7 percent) reported drinking alcohol in the past month. Nearly 7.4 million (19.6 percent) were binge drinkers, and 2.4 million (6.3 percent) were heavy drinkers. These figures were similar to the 2002 and 2003 estimates.
• More males than females aged 12 to 20 reported binge drinking (22.1 vs. 17.0 percent) and heavy drinking (8.2 vs. 4.3 percent) in 2004.
• Among persons aged 12 to 20, past month alcohol use rates ranged from 16.4 percent among Asians to 19.1 percent among blacks, 24.3 percent among American Indians or Alaska Natives, 26.4 percent among those reporting two or more races, 26.6 percent among Hispanics, and 32.6 percent among whites.
• Among persons aged 12 to 20, binge drinking was reported by 22.8 percent of whites, 19.0 percent of American Indians or Alaska Natives, 19.3 percent of Hispanics, and 18.0 percent of persons reporting two or more races. However, binge drinking was reported by only 9.9 percent of blacks and 8.0 percent of Asians. The binge drinking rate among underage Hispanics increased significantly from the 2003 rate of 16.9 percent.
• Across geographic regions in 2004, underage current alcohol use rates were higher in the Northeast (32.3 percent) and Midwest (31.4 percent) than in the South and the West (26.2 and 27.3 percent, respectively) (Figure 3.2). This pattern was similar to that in 2002 and 2003.

Figure 3.2 Past Month Alcohol Use among Persons Aged 12 to 20, by Geographic Region: 2003 and 2004

     D

• In 2004, underage current alcohol use rates were higher in small metropolitan areas than in large metropolitan areas. Rates were 31.6 percent in small metropolitan areas, 27.0 percent in large metropolitan areas, and 28.8 percent in nonmetropolitan areas. The rate in nonmetropolitan rural areas was 28.7 percent.

Gender

• In general, males were more likely than females to report past month alcohol use. In 2004, 56.9 percent of males aged 12 or older were current drinkers compared with 44.0 percent of females. However, among youths aged 12 to 17, the rates of past month alcohol use were not significantly different (17.2 percent for males vs. 18.0 percent for females).
• Among young adults aged 18 to 25, an estimated 56.0 percent of females reported current drinking in 2004, unchanged from 2003. However, 64.9 percent of 18- to 25-year-old males reported current alcohol use in 2004, which was 2 percent lower than the 2003 estimate of 66.9 percent, but not significantly lower than the 2002 estimate of 65.2 percent.

Pregnant Women

• Among pregnant women aged 15 to 44, an estimated 11.2 percent reported past month alcohol use and 4.5 percent reported past month binge drinking. These rates were significantly lower than the rates for nonpregnant women of that age (52.8 and 23.3 percent, respectively). Heavy alcohol use was relatively rare (0.5 percent) among pregnant women. These estimates were based on data averaged over 2003 and 2004.

Race/Ethnicity

• Among persons aged 12 or older, whites and persons reporting two or more races were more likely than other racial/ethnic groups to report current use of alcohol in 2004. An estimated 55.2 percent of whites and 52.4 percent of persons reporting two or more races used alcohol in the past month (Figure 3.3). The rates were 40.2 percent for Hispanics, 37.4 percent for Asians, 37.1 percent for blacks, and 36.2 percent for American Indians or Alaska Natives.

Figure 3.3 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Race/Ethnicity: 2004

     D

• The rate of binge alcohol use was lowest among Asians (12.4 percent). Rates for other racial/ethnic groups were 18.3 percent for blacks, 23.8 percent for whites, 24.0 percent for Hispanics, and 25.8 percent for American Indians or Alaska Natives.
• Among youths aged 12 to 17 in 2004, blacks and Asians reported the lowest rate of past month alcohol use. Only 9.4 percent of Asian youths and 9.8 percent of black youths were current drinkers, while rates were at or above 18 percent for whites, American Indians or Alaska Natives, Hispanics, and youths reporting two or more races.

Education

• The rate of past month alcohol use increased with increasing levels of education. Among adults aged 18 or older with less than a high school education, 36.4 percent were current drinkers in 2004, while 67.6 percent of college graduates were current drinkers.
• Rates of heavy drinking increased among college graduates from 2003 to 2004 (6.4 percent in 2004 vs. 5.3 percent in 2003) and decreased among adults with less than a high school education (6.2 percent in 2004 vs. 7.9 percent in 2003). Binge drinking also increased among college graduates, from 20.2 percent in 2003 to 21.9 percent in 2004.

College Students

• Young adults aged 18 to 22 enrolled full time in college were more likely than their peers not enrolled full time (i.e., part-time college students and persons not enrolled in college) to use alcohol, binge drink, and drink heavily. Past month alcohol use was reported by 62.4 percent of full-time college students compared with 55.7 percent of persons aged 18 to 22 who were not currently enrolled full time. Binge and heavy use rates for college students were 43.4 and 18.6 percent, respectively, compared with 39.4 and 13.5 percent, respectively, for other persons aged 18 to 22.
• There were no significant changes in rates of past month, binge, or heavy alcohol use between 2003 and 2004 among full-time college students aged 18 to 22.
• Among persons aged 18 to 22, full-time college students were more likely to be heavy drinkers than others (18.6 vs. 13.5 percent) (Figure 3.4). However, at later ages (26 or older), those who had graduated from college had rates of heavy drinking similar to those who had not graduated from college (i.e., those who had some college or less) (5.5 vs. 6.3 percent).

Figure 3.4 Heavy Alcohol Use among Adults Aged 18 or Older, by College Attendance and Age: 2004

     D

Employment

• Rates of current alcohol use were 61.3 percent for full-time employed adults aged 18 or older in 2004 compared with 56.6 percent of their unemployed peers (Figure 3.5). However, the patterns were different for binge and heavy alcohol use; rates were higher for unemployed persons (34.0 and 13.6 percent, respectively, for binge and heavy use) than for full-time employed persons (29.2 and 8.9 percent, respectively).

Figure 3.5 Current, Binge, and Heavy Alcohol Use among Adults Aged 18 or Older, by Employment Status: 2004

     D

• Most binge and heavy alcohol users were employed. Among the 51.9 million adult binge drinkers in 2004, 41.2 million (79.3 percent) were employed either full or part time. Similarly, 12.7 million (79.5 percent) of the 16.0 million adult heavy drinkers were employed.

Geographic Area

• The rate of past month alcohol use for people aged 12 or older in 2004 was lower in the South (45.1 percent) than in the Northeast (55.5 percent), Midwest (53.7 percent), or West (50.8 percent). This pattern was similar to that in 2002 and 2003.
• Among people aged 12 or older, the rate of past month alcohol use in large metropolitan areas was 52.7 percent compared with 49.7 percent in small metropolitan areas and 43.7 percent in nonmetropolitan areas. There was less variation across county types in rates of binge and heavy drinking. The rate of heavy alcohol use was 6.4 percent in large metropolitan areas, 7.9 percent in small metropolitan areas, and 7.0 percent in nonmetropolitan areas.
• Among youths aged 12 to 17, the rate of past month binge alcohol use varied by population density. In nonmetropolitan areas, the rate was 13.4 percent compared with 11.7 percent in small metropolitan areas and 10.0 percent in large metropolitan areas. In completely rural counties of nonmetropolitan areas, 16.9 percent of youths reported binge drinking.

Association with Illicit Drug and Tobacco Use

• The level of alcohol use was strongly associated with illicit drug use in 2004. Among the 16.7 million heavy drinkers aged 12 or older, 32.2 percent were current illicit drug users. Persons who did not use alcohol in the past month were less likely to have used illicit drugs in the past month (3.0 percent) than those who reported current, binge, or heavy use of alcohol in the past month.
• Drinking levels also were associated with tobacco use. Among heavy alcohol users aged 12 or older, 61.2 percent smoked cigarettes in the past month, while only 21.1 percent of non-binge current drinkers and 16.3 percent of persons who did not drink alcohol in the past month were current smokers. Smokeless tobacco and cigar use also were more prevalent among heavy drinkers than among non-binge drinkers and nondrinkers.

Driving Under the Influence of Alcohol

• In 2004, an estimated 13.5 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage was similar to that reported in 2003. The 2004 estimate corresponds to approximately 32.5 million persons.
• Driving under the influence varied by age group in 2004. An estimated 10.2 percent of 16 or 17 year olds, 20.2 percent of 18 to 20 year olds, and 28.2 percent of 21 to 25 year olds reported driving under the influence of alcohol (Figure 3.6). Beyond age 25, these rates declined with increasing age.

  Figure 3.6 Driving Under the Influence of Alcohol in the Past Year among Persons Aged 16 or Older, by Age: 2004

     D

• Males were nearly twice as likely as females (17.9 vs. 9.4 percent, respectively) to drive under the influence of alcohol.

C. Tobacco Use

The National Survey on Drug Use and Health (NSDUH) includes a series of questions about the use of tobacco products, including cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco. Cigarette use is defined as smoking "part or all of a cigarette." For analytic purposes, data for chewing tobacco and snuff are combined as "smokeless tobacco." Questions to determine nicotine dependence among current cigarette smokers also are included in NSDUH.

An estimated 70.3 million Americans aged 12 or older reported current (past month) use of a tobacco product in 2004. This represents 29.2 percent of the population in that age range. An estimated 59.9 million persons (24.9 percent of the population) were current cigarette smokers; 13.7 million (5.7 percent) smoked cigars; 7.2 million (3.0 percent) used smokeless tobacco; and 1.8 million (0.8 percent) smoked tobacco in pipes (Figure 4.1).

Figure 4.1 Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2004

     D

• These rates of current use were unchanged between 2003 and 2004, but between 2002 and 2004 past month use of a tobacco product declined from 30.4 to 29.2 percent, past month cigarette use decreased from 26.0 to 24.9 percent, and past month smokeless tobacco use decreased from 3.3 to 3.0 percent.

Age

• Among age groups, young adults aged 18 to 25 had the highest rate of current use of a tobacco product (44.6 percent) and of each specific product. In 2004, the rates of past month use among young adults were 39.5 percent for cigarettes, 12.7 percent for cigars, 4.9 percent for smokeless tobacco, and 1.2 percent for pipe tobacco (Figure 4.2). Current use of cigarettes and smokeless tobacco by young adults did not change significantly between 2002 and 2004. Use of pipe tobacco by young adults increased from 0.9 percent in 2003 to 1.2 percent in 2004, similar to its rate in 2002 (1.1 percent).

Figure 4.2 Past Month Use of Tobacco Products, by Age: 2004

     D

• Among youths aged 12 to 17 in 2004, an estimated 3.6 million (14.4 percent) used a tobacco product in the past month, and 3.0 million (11.9 percent) used cigarettes. The rate of past month cigarette use among 12 to 17 year olds declined from 13.0 percent in 2002 to 11.9 percent in 2004 (the rate was 12.2 percent in 2003). Cigar use in the past month was reported by 4.8 percent of youths in 2004, and past month smokeless tobacco use was reported by 2.3 percent; these rates were unchanged from 2002 and 2003.

Current cigarette use increased with age up to the mid-20s then declined. An estimated 2.8 percent of 12 or 13 year olds, 10.9 percent of 14 or 15 year olds, and 22.2 percent of 16 or 17 year olds were current cigarette smokers in 2004