Technical Notes

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The Department of Social and Health Services (DSHS), Division of Alcohol and Substance Abuse (DASA) received a federal grant from the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment to conduct a statewide household survey to determine the need for substance abuse treatment among Washington adults. Data were collected from February 2003 through February 2004. The Research and Data Analysis Division (RDA) of DSHS conducted the project on behalf of DASA. Telephone interviews were performed by Washington State University's Social and Economic Sciences Research Center. The survey achieved a response rate of 50 percent and a cooperation rate of 69 percent. The sample was weighted to U.S. Census data to provide direct statewide estimates of substance use and the need for substance abuse treatment services.

Population Groups for Analysis

Overall prevalence estimates are provided for three primary populations of interest:

  1. All adult household residents: Household residents aged 18+, regardless of income.
  2. Adults above 200% FPL: Household residents aged 18+ living above 200 percent of the federal poverty level.
  3. Adults at or below 200% FPL: Household residents aged 18+ living at or below 200 percent of the federal poverty level.

In Washington State, 24 percent of adult household residents are at or below 200 percent of the federal poverty level.

Measures of Substance Use

The survey measured use of alcohol, tobacco, and illicit drugs. Measures of substance use include having: a) ever used a substance (lifetime use), b) used a substance in the past 12 months, and c) used a substance in the past 30 days.

Need for Treatment

The survey also assessed current need for alcohol or drug treatment. Respondents were classified as having a current need for treatment if they met any of the following four conditions:

  1. Reported symptoms of lifetime Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) alcohol or drug abuse or dependence, reported at least one symptom in the past 12 months,and used alcohol or drugs in the past 12 months. See pages 3-2 and 3-3 in the state report for a description of the DSM-IV substance abuse and dependence criteria.
  2. Received professional alcohol or drug treatment (excluding detoxification) during the past 12 months.
  3. Reported having a problem with alcohol or drugs and used alcohol or drugs regularly during the past 12 months. Regular alcohol use was defined as having 3 or more drinks at least one day per week. Regular drug use was defined as using marijuana 34 or more times in the past 12 months or as using other illicit drugs 8 or more times in the past 12 months.
  4. Reported heavy use of alcohol or drugs during the past 12 months. Heavy alcohol use was defined as having 4 or more drinks per drinking day, 3 or more days per week during the past 12 months. Heavy drug use was defined as using any illicit substance 34 or more times during the past 12 months.

Most respondents (72 percent) determined to need substance abuse treatment met the first condition.

Measuring Treatment and Penetration Rates

To measure treatment use and estimate treatment penetration, the WANAHS data are supplemented by data from DASA's Treatment Assessment Report Generation Tool (TARGET), a database of services provided under DSHS funded programs. Clients used to calculate the treatment penetration rate were selected based on the following conditions:

  1. Eligible treatment was limited to residential, outpatient, and methadone services. Clients who received detoxification or transitional housing services were not included.
  2. Clients had to reside in a personal residence or a group/foster home. The homeless or institutionalized were not included in these client counts.
  3. Treatment had to be funded by DASA. Clients who paid for services through private funds or had their treatment paid for by the Department of Corrections or non-DASA state funds were not counted.
  4. Clients had to receive treatment services during the 2003 calendar year.

In addition, penetration rates are calculated only for lower-income adults who are estimated to be eligible for DASA-funded services. Adults eligible for DASA-funded services include persons at or below 200 percent of the federal poverty level who need substance abuse treatment and who do not have primary private health insurance, Basic Health Plan coverage, or military health insurance.

This represents a change from previous reports using 1993-94 household survey data. Previously, all adult household residents living at or below 200 percent of the federal poverty level who needed substance abuse treatment were included in the penetration rate calculation, regardless of their health insurance coverage status. The net result of this change is that the 2003 treatment penetration rate estimates will be higher than earlier estimates.

Race/Ethnicity Categories

The race/ethnicity groups used for most state estimates are consistent with federal Office of Management and Budget guidelines. WANAHS respondents were read a list of five races: White, Black or African American, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Asian. Respondents were asked to indicate whether they considered themselves to belong to one or more of these groups. In a separate question, survey respondents were asked “Are you Hispanic or Latino(a)?” Respondents indicating they were Hispanic, regardless of whether they indicated other races, were classified as Hispanic. Non-Hispanic respondents indicating more than one race were all classified as 2+ Races.

A different race classification system was used for the county-level estimates and the state treatment penetration estimates. For these, respondents who indicated they belonged to more than one race or ethnic group were assigned to a single category in the following order:

  • Hispanic
  • American Indian or Alaska Native
  • Native Hawaiian or Other Pacific Islander
  • Black or African American
  • White
  • Asian

For example, respondents indicating that they were both American Indian and Black were categorized as American Indian. Similarly, respondents indicating they were both Hispanic and White were classified as Hispanic.

Hispanics were listed first, consistent with current U.S. Census conventions, and the subsequent ordering was determined based on an examination of need for treatment patterns among adults reporting two or more races. It was necessary to use this simplified race/ethnicity classification to calculate the treatment penetration rates. This is because penetration rates are calculated by combining need for treatment estimates with TARGET treatment data and very few TARGET clients are identified as belonging to more than one race. Due to the differences in the race groups used to construct state and county-level population weights, we have suppressed the state race/ethnicity population counts in the county supplemental tables.