Last Updated: April 2017

Author: State Epidemiological Outcomes Workgroup, Vermont Department of Health

Methodology Change: Please note that in 2015 NSDUH methodology changed and is not comparable with prior years. The NSDUH questionnaire underwent a partial redesign in 2015 to improve the quality of the NSDUH data and to address the changing needs of policymakers and researchers with regard to substance use and mental health issues. The prescription drug questions were redesigned to shift the focus from lifetime misuse to past year misuse. Additionally, questions were added about any past year prescription drug use rather than just misuse. New methamphetamine questions were added, replacing the methamphetamine questions that were previously asked within the context of prescription stimulants. Substantial changes were also made to questions about smokeless tobacco, binge alcohol use, inhalants, and hallucinogens. Finally, diagnostic data for substance use disorder will reflect the new DSM-5 criteria. These changes led to potential breaks in the comparability of 2015 estimates with estimates from prior years. Consequently, these changes potentially affected overall summary measures, such as illicit drug use, and other measures, such as initiation, substance use disorders, and substance use treatment.

Details on the 2015 NSDUH questionnaire changes, reasons for the changes, and implications of the changes for NSDUH data users are included in a brief report on these questionnaire changes, in a report on the design changes for the 2014 and 2015 NSDUHs, and in the methodological summary and definitions report for 2015.^11,12,13

This state-level indicator is measured by the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey of Drug Use and Health (NSDUH), and is used to estimate the level of unmet need for alcohol use disorders in the general population. “Needing but not receiving alcohol treatment” is defined as those persons who meet the criteria for abuse of or dependence on alcohol according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), but have not received specialty treatment for an alcohol use problem in the past year.

In the last 10 years, fewer than 10% of persons age 12 and older who needed treatment did not receive it. Overall, there was a modest decline from 9% in 2004 to 6% in 2012.

Providing access to treatment for those who do need it is an important objective for the state on fiscal, legal, and standard of care grounds. The many reasons why individuals who would qualify for an alcohol use disorder diagnosis and do not receive treatment are helpful for identifying potential intervention points. These reasons include general system issues such as limited treatment capacity, limited mobility, transportation issues, and person-specific issues such as affordability [lack of health care], not thinking there is a problem (self-assessed severity), self-treatment, perceived stigma attached with receiving treatment), etc.Of course, over time successful prevention efforts would also lead to lower numbers of persons in need of treatment, and therefore can also contribute to making progress on this particular indicator.

To properly interpret these data, it is important to remember that the percentage estimate is based on the general population aged 12 and over (and not just on those needing treatment), and therefore it is influenced both by the overall prevalence of alcohol dependence or abuse in the population and by the percent of persons needing treatment who did not receive it. Other caveats include: 1) that nationwide, 95% of those categorized as “needing but not receiving treatment” indicated they did not feel they needed treatment, and 2) that NSDUH data are based on self-report rather than clinical assessment. The methodology used is likely to somewhat overestimate the number of individuals who would actually qualify for a clinical illicit drug use disorder diagnosis.

This indicator is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. Click here for more information.

This indicator is also part of the State Health Improvement Plan (SHIP), a five-year plan that prioritizes broad Healthy Vermonters 2020 goals: reducing prevalence of chronic disease, reducing prevalence of substance abuse and mental illness, and improving childhood immunizations. The SHIP is a subset of HV2020 and details strategies and planned interventions. Click here for more information.

The Agency of Human Services (AHS) operates in support of the Governor’s overall agenda for the state and his seven statewide priorities. Additionally, AHS’ mission and the work of its six Departments are targeted to achieve results in four strategic areas: the reduction of the lasting impacts of poverty; promotion of the health, well being and safety of communities; enhancement of program effectiveness and accountability; reform of the health system. Click here for more information.

• Middle and High Schools
• Community coalitions to provide prevention services to youth and young adults
• Primary care providers
• Specialty treatment providers

• Sustained and comprehensive prevention efforts in schools, communities, and homes
• Increased access to treatment
• Screening by primary care providers to identify individuals with potential alcohol use problems.

As federal and state funding levels permit, the Vermont Department of Health plans to continue to:

• improve access to treatment and raise awareness of alcohol use disorders among the general public
• increase prevention efforts across the age continuum but especially among youth and young adults who appear to be most at risk for developing an alcohol use disorder
• Implement the Screening, Brief Intervention, and Referral for Treatment (SBIRT) grant to identify those at highest risk

Data is updated as it becomes available and timing may vary by data source. For more information about this indicator, click here.