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, Montanas rates have been among the highest in the country on the following measures (Table 1).

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). On the global measure of any past year dependence on or abuse of illicit drugs and alcohol, Montana’s rates have consistently been among the highest in the country and in 2005-2006, the rates were among the highest in the country for all age groups.Past year alcohol dependence rates in Montana have also consistently been among the highest in the country and in 2005-2006 were among the highest for all age groups (Chart1). Similarly, rates of past year dependence on or abuse of illicit drugs have consistently been among the highest in the country for individuals age 12 to 17 (Chart 2).

Substance Abuse Treatment Facilities

According to the National Survey of Substance Abuse Treatment Services (N-SSATS),3 the number of treatment facilities in Montana has remained relatively stable since 2002. In 2006, the 57 facilities comprised principally 31 private nonprofit, 11 physicians and 7 treatment programs were 5 private for-profit, and 11 facilities under the certified to provide buprenorphine for opiate aegis of the Federal Government. An additional addiction.four facilities were owned/operated by tribal In 2006, 46 of all facilities (84%) received some governments.form of Federal, State, county, or local government Although facilities may offer more than one funds, and 23 facilities (42%) had agreements or modality of care, in 2006, 52 of 55 facilities (95%) contracts with managed care organizations for the offered some form of outpatient treatment. Eight provision of substance abuse treatment services.facilities offered some form of residential care.

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, Montana showed a one-day total of 3,047 clients in treatment, the majority of whom (2,809 or 92%) were in outpatient treatment. Of the total number of clients in treatment on this date, 311 (10%) were under the age of 18.Chart 3 shows the percentage of admissions mentioning particular drugs or alcohol at the time of admission.5 Across the last 15 years, there has been a relatively steady rate of the number of admissions mentioning alcohol and increases in the mentions of marijuana and methamphetamine. The latter is particularly noteworthy in that the percentage of methamphetamine admissions has increased more than four-fold, from 7 percent in 1992 to 32 percent in 2006.Across the years for which TEDS data are available, Montana has seen a shift in the constellation of problems present at treatment admission. Alcohol-only admissions have declined from 45 percent of all admissions in 1992 to 26 percent in 2006. Concomitantly, drug-only admissions have increased from 2 percent in 1992 to 15 percent in 2006. Admissions with both alcohol and drug problems at treatment admissions have also increased from 50 percent to 60 percent across the same time period (Chart 4).

Unmet Need For Treatment

NSDUH defines unmet treatment 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.In Montana, rates of unmet need for drug treatment have generally been at or above the national rates for all age groups and across all survey years. In particular, the rate of individuals age 12 to 17 needing and not receiving drug treatment has consistently been among the highest in the country (Chart 5).Similarly, rates of unmet need for alcohol treatment have been at or above the national rates for all age groups and across all survey years (Chart 6).