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2018 National Survey on Drug Use and Health

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2018 National Survey on Drug Use and Health 2018 NATIONAL SURVEY ON DRUG USE AND HEALTH METHODOLOGICAL SUMMARY AND DEFINITIONS Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality Rockville, Maryland August 2019 This page intentionally left blank 2018 NATIONAL SURVEY ON DRUG USE AND HEALTH: METHODOLOGICAL SUMMARY AND DEFINITIONS Acknowledgments This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), under Contract No. HHSS283201700002C with RTI International. Production of the report at SAMHSA was managed by Rebecca D. Ahrnsbrak. Peter Tice served as the government project officer and as the contracting officer representative. Public Domain Notice All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS. Electronic Access This publication may be downloaded at https://www.samhsa.gov/data/. Recommended Citation Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health: Methodological summary and definitions. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/ Originating Office Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Room 15-E09D, Rockville, MD 20857. For questions about this report, please e-mail [email protected]. Nondiscrimination Notice SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality Populations Survey Branch August 2019 This page intentionally left blank ii Table of Contents Chapter Page List of Figures ............................................................................................................................... vii List of Tables ................................................................................................................................. ix 1 Introduction ......................................................................................................................... 1 2 Description of the Survey ................................................................................................... 3 2.1 Sample Design ........................................................................................................ 3 2.2 Data Collection Methodology ................................................................................. 6 2.2.1 Data Collection Procedures ......................................................................... 6 2.2.2 Notable Questionnaire Changes for 2018 ................................................... 9 2.3 Data Processing ....................................................................................................... 9 2.3.1 Criteria for Identifying Usable Interviews ................................................ 10 2.3.2 Data Coding and Editing ........................................................................... 11 2.3.3 Statistical Imputation ................................................................................ 15 2.3.4 Development of Analysis Weights ........................................................... 18 3 Statistical Methods and Measurement .............................................................................. 23 3.1 Target Population .................................................................................................. 23 3.2 Estimation and Statistical Significance ................................................................. 23 3.2.1 Variance Estimation for Estimated Numbers of Individuals .................... 24 3.2.2 Suppression Criteria for Unreliable Estimates .......................................... 26 3.2.3 Statistical Significance of Differences ...................................................... 27 3.3 Other Information on Data Accuracy ................................................................... 29 3.3.1 Screening and Interview Response Rate Patterns ..................................... 30 3.3.2 Item Nonresponse and Inconsistent Responses ........................................ 32 3.3.3 Reliability of NSDUH Measures .............................................................. 36 3.3.4 Validity of Self-Reported Substance Use ................................................. 38 3.3.5 Revised Estimates for 2006 to 2010 ......................................................... 40 3.4 Measurement Issues .............................................................................................. 41 3.4.1 Use and Misuse of Prescription Drugs...................................................... 41 3.4.2 Initiation of Substance Use or Misuse ...................................................... 45 3.4.3 Substance Use Disorders........................................................................... 51 3.4.4 Need for Services for Substance Use and Mental Health Issues .............. 56 3.4.5 Definition of County Type ........................................................................ 59 3.4.6 Effects of Questionnaire Changes Prior to 2015 on Mental Health Measures ................................................................................................... 60 3.4.7 Estimation of Serious and Other Levels of Mental Illness ....................... 63 3.4.8 Major Depressive Episode (Depression) .................................................. 73 iii Table of Contents (continued) Chapter Page 4 Special Topics for the NSDUH Prescription Drug Questions .......................................... 87 4.1 Definitions for Any Psychotherapeutic Drug and the Four Psychotherapeutic Drug Categories .................................................................................................... 87 4.1.1 Controlled Substances Act and Its Relevance to Psychotherapeutics ...... 88 4.1.2 Pain Reliever Subtypes and Their Status as Controlled Substances ......... 89 4.1.3 Tranquilizer Subtypes and Their Status as Controlled Substances ........... 91 4.1.4 Stimulant Subtypes and Their Status as Controlled Substances ............... 92 4.1.5 Sedative Subtypes and Their Status as Controlled Substances ................. 93 4.2 Misuse of Prescription Psychotherapeutic Drugs versus Nonmedical Use .......... 94 4.3 Handling of Missing Data for Prescription Drugs ................................................ 95 4.4 Measures of Opioid Misuse in NSDUH ............................................................... 97 4.4.1 Background ............................................................................................... 97 4.4.2 Prescription Pain Reliever and Prescription Opioid Misuse ..................... 98 4.4.3 Any Opioid Misuse, Including Heroin...................................................... 99 4.5 Measures of Tranquilizer or Sedative Use and Misuse in NSDUH...................... 99 4.5.1 Background ............................................................................................... 99 4.5.2 Creation of Measures for Tranquilizer or Sedative Misuse .................... 100 4.5.3 Measures Not Created for Tranquilizer or Sedative Use and Misuse ..... 101 4.6 Measures of Benzodiazepine Use and Misuse in NSDUH ................................. 102 4.6.1 Background ............................................................................................. 102 4.6.2 Creation of Measures for Benzodiazepine Use and Misuse ................... 102 4.6.3 Measures Not Created for Benzodiazepine Use and Misuse .................. 103 5 Other Sources of Data ..................................................................................................... 113 5.1 National Surveys Collecting Substance Use or Mental Health Data in the Civilian, Noninstitutionalized Population ........................................................... 113 5.1.1 Behavioral Risk Factor Surveillance System (BRFSS) .......................... 113 5.1.2 Monitoring the Future (MTF) ................................................................. 115 5.1.3 National Comorbidity Survey (NCS) Series ........................................... 117 5.1.4 National Health and Nutrition Examination Survey (NHANES) ........... 122 5.1.5 National Health Interview Survey (NHIS) ............................................. 125 5.1.6 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) .............................................................................................. 125 5.1.7 National Longitudinal Study of Adolescent Health (Add Health) .......... 128 5.1.8 National Survey of Children's Health (NSCH) ....................................... 129 5.1.9 Youth Risk Behavior Survey (YRBS) .................................................... 130 5.2 Substance Use Treatment Data Sources ............................................................
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