OFFICE OF APPLIED STUDIES Substance Use and Mental Health Characteristics by Employment Status DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration ACKNOWLEDGMENTS This publication was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies (OAS), by the National Opinion Research Center (NORC), under Contract No. 283-95-0002. Dean Gerstein, Ph.D. was the principal investigator and Janet Greenblatt was the OAS project officer. The authors were Tara N. Townsend, Ph.D., Julie D. Lane, Ph.D., Carolyn S. Dewa, Ph.D., Angela M. Brittingham, M.A, and Michael Pergamit, Ph.D. PUBLIC DOMAIN NOTICE All material appearing in this report is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration. Citation of the source is appreciated. OBTAINING ADDITIONAL COPIES OF PUBLICATIONS Copies may be obtained, free of charge, from the National Clearinghouse for Alcohol and Drug Information (NCADI). NCADI is a service of the Substance Abuse and Mental Health Services Administration (SAMHSA). Write or call NCADI at: National Clearinghouse for Alcohol and Drug Information (NCADI) P.O. Box 2345 Rockville, MD 20847-2345 (301) 468-2600 1-800-729-6686 1-800-487-4889 (TDD) ELECTRONIC ACCESS TO PUBLICATION This publication can be accessed electronically through the Internet Worldwide Web connections listed below: http://www .samhsa.gov http://www health.org ORIGINATING OFFICE: SAMHSA, Office of Applied Studies 5600 Fishers Lane, Room 16-105 Rockville, MD 20857 June 1999 il Qn) ‘ r YS | 7 P( 1X oe TABLE OF CONTENTS Page LISTOF TABLES : nus romsnioissomsssssonanmessmamansssmmmmes sameness smn: ss WV LIST OF FIGURES . . «ee 1X HIGHITGIITS cic como ss oimmiminsmmonmsssnmsmmnssasmans ss sommes vsmmnss sunnsss 1 CHAPTERS 1. INTRODUCTION ii iinnoaisivnsnmesssnsdi ois nansss smmams vs mumusesmwess 3 Statement of the Problem . ............ 3 Overview of the Report ....... 5 2. METHODOLOGY «oe ee 7 Summary of NHSDA Methodology ............. i... 7 Weighting Procedures ........... 8 Measurement of Employment Status . ................... 9 Measurement of Substance Dependence ..................................... 11 Other Mental Health Diagnoses . .............. iii iin 11 Measurement of Other Variables ................ i... 11 SASHA TREND vonn 110 snnvnc sts sunsets nusmws ss LUGER ss LUBBI FE LOEAS + 3 mms 12 Limitations of the Data ............. 13 3 SUBSTANCE USE AND MENTAL HEALTH CHARACTERISTICS BY EMPLOYMENT STATUS 21 Lifetime Substance Use ........... ii 21 Past-Year Substance IISE . : onus: isunsasisnamssss saunas smbmdsss mummers men 22 Past-Month Substance Use ........... ii 23 Binge and HeaVY DIINKING uum cis nnoni iss onubuissassns ss abmsssonmen ns mmm 23 Substance Dependence . . .......... 25 Other Mental Health CONCEINE xc: +: uns ri susmmas so ssbossnsois ss mbm mmn 27 iii TABLE OF CONTENTS (continued) Page 4. SUBSTANCE USE AND MENTAL HEALTH CHARACTERISTICS OF AFDC RECIPIENTS ..cvvvn sis vnvnn sv sbnman sds asnan iss mana ts ABs snny +s 37 SUBSTANCE LIER ov ev vvwum es rnin sn ha BEA IRD ARSRA SI ARBRE ISR NE A HERA 37 Binge and Heavy Drinking ............ 40 Substance Dependence and Other Mental Health Concerns ...................... 40 5. CONCLUSIONS ...ii0c550si: 00808: 005082152 nREaE I NEES FRORS 25 RTE HE 45 REFERENCES ....ocoiiiincsssissonsones i nosnbiribsmenss sunssss snseet suns ss 47 APPENDICES A. DEMOGRAPHIC AND INCOME CHARACTERISTICS BY EMPLOYMENT STATUS i. ititi itt it tn tess tsarnnanrernanssanarararasasesasanses 49 B. STANDARD ERROR TABLES ...... connec cmmnusiosssasstasiassnanesss 61 1v Table 2.1 Table 2.2 Table 3.1a Table 3.1b Table 3.2a Table 3.2b Table 3.3a Table 3.3b Table 3.4 LIST OF TABLES DSM-IV Criteria for Substance Dependence and the Corresponding NHSDA Questionnaire Items Used to Represent Them .................. NHSDA Questionnaire Items Used to Screen for Probable Mental Health DIAGNOSES « «ott te Percentage of Total Population Age 18-64 Reporting Lifetime, Past-Year, and Past-Month Substance Use by Employment Status (Weighted), 1994-96 . Percentage of Not in Labor Force Population Age 18-64 Reporting Lifetime, Past-Year, and Past-Month Substance Use by Category (Weighted), 1994-96... oot eee eee Distribution of Usual Number of Drinks per Day on Days Drank and Number of Days Had Five or More Drinks on the Same Occasion and Percentage Reporting Past-Month Binge and Heavy Drinking for Past-Month Alcohol Users Age 18-64 by Employment Status (Weighted), 1994-96... civuiiiisomansss aman ss Is naEsa ss uama st anuRL rs bua §4 Distribution of Usual Number of Drinks per Day on Days Drank and Number of Days Had Five or More Drinks on the Same Occasion and Percentage Reporting Past-Month Binge and Heavy Drinking for Not in Labor Force Past-Month Alcohol Users Age 18-64 by Category (Weighted), 1994-98 oc inuumsrsrnpanats paaan ess saBEm iss Erna ess uuemes noms s Percentage of Total Population Age 18-64 with a Substance Dependence by Employment Status (Weighted), 1994-96 ............................. Percentage of Past-Month Heavy Drinkers Age 18-64 with a Substance Dependence by Employment Status (Weighted), 1994-96 ................ Gender, Age, Racial/Ethnic, Educational, Marital, and Regional Distribution of Total Population Age 18-64 with and without a Substance Dependence by Employment Status (Weighted), 1994-96 ................ + 29 Table 3.5 Table 3.6a Table 3.6b Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table A.la Table A.1b LIST OF TABLES (continued) Annual Family Income Distribution and Percentage Designated Single Women Supporting a Family, who Received Supplementary Security Income (SSI) and Aid to Families with Dependent Children (AFDC), and who Lived in a Household that Received Food Stamps for Total Population Age 18-64 with and without a Substance Dependence by Employment Status (Weighted), 1994-96... 35 Percentage of Total Population Age 18-64 with Probable Mental Health Diagnoses by Employment Status (Weighted), 1994-96 ................... 36 Percentage of Not in Labor Force Population Age 18-64 with Probable Mental Health Diagnoses by Category (Weighted), 1994-96 ............... 36 Percentage of Population Age 18-64 who Received Aid to Families with Dependent Children (AFDC) Reporting Lifetime, Past-Year, and Past- Month Substance Use by Employment Status (Weighted), 1994-96 ......... 41 Percentage of Total Population Age 18-64 Reporting Lifetime, Past- Year, and Past-Month Substance Use who Received Aid to Families with Dependent Children (AFDC) by Employment Status (Weighted), VIOYDB, css nouns css unanms ss auasss 13 FUBHE? LERREILS NERABE§ RAR £7 42 Distribution of Usual Number of Drinks per Day on Days Drank and Percentage Reporting Past-Month Binge and Heavy Drinking for Past-Month Alcohol Users Age 18-64 who Received Aid to Families with Dependent Children (AFDC) by Employment Status (Weighted), 1994-96 . . . . 43 Percentage of Population Age 18-64 who Received Aid to Families with Dependent Children (AFDC) with a Substance Dependence and Probable Mental Health Diagnoses by Employment Status (Weighted), 1994-96 . ...... 44 Gender, Age, Racial/Ethnic, Educational, Marital, and Regional Distribution of Total Population Age 18-64 (Weighted), 1994-96 ........... 52 Gender, Age, Racial/Ethnic, Educational, Marital, and Regional Distribution of Total Population Age 18-64 by Employment Status (Weighted), 1994-96 ....... 53 vi Table A.lc Table A.1d Table A.2a Table A.2b Table A.2¢c Table A.2d LIST OF TABLES (continued) Age, Racial/Ethnic, Educational, Marital, and Regional Distribution of Total Population Age 18-64 by Gender within Employment Status (Weighted), 1994-96 ..:cnuansrinumnnrcsnununss onnnus t uenmms s mann? Gender, Age, Racial/Ethnic, Educational, Marital, and Regional Distribution of Not in Labor Force Population Age 18-64 by Category (Weighted), 1999-08 .u:ivvmsnusrronnunsasis ARaRL Iss ume Rt 4 HARK EIS HR MRAS LUND? Annual Family Income Distribution and Percentage Designated Single Women Supporting a Family, who Received Supplementary Security Income (SSI) and Aid to Families with Dependent Children (AFDC), and who Lived in a Household that Received Food Stamps for Total Population Age 183-64 (Weighted), 1994-06 ....cuusissnssnarrunenersnnmnvssnnns Annual Family Income Distribution and Percentage Designated Single Women Supporting a Family, who Received Supplementary Security Income (SSI) and Aid to Families with Dependent Children (AFDC), and who Lived in a Household that Received Food Stamps for Total Population Age 18-64 by Employment Status (Weighted), 1994-96 .................. Annual Family Income Distribution and Percentage Designated Single Women Supporting a Family, who Received Supplementary Security Income (SSI) and Aid to Families with Dependent Children (AFDC), and who Lived in a Household that Received Food Stamps for Total Population Age 18-64 by Gender within Employment Status (Weighted), 1994-96 . . . . .. Annual Family Income Distribution and Percentage Designated Single Women Supporting a Family, who Received Supplementary Security Income (SSI) and Aid to Families with Dependent Children (AFDC), and who Lived in a Household that Received Food Stamps for Not in Labor Force Population Age 18-64 by Category (Weighted), 1994-96 ............ vil viii Figure 2.1 Figure 2.2 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 3.5 Figure 3.6 Figure 3.7 Figure 3.8 Figure 4.1 Figure 4.2 LIST OF FIGURES Percent Distribution and Estimated Number of Working-Age Population by Employment Status Percent Distribution and Estimated Number of Not in Labor Force Population by Category ...........oiiiiiiir rrr Percentage of Working-Age Population Reporting Substance Use in their Lifetime by Employment Status Percentage of Working-Age Population Reporting Substance Use in the Past Year by Employment Status . . . cc. ovvvvenursvrsnsnssmsnssasnuses Percentage of Working-Age Population Reporting Substance Use in the Past Month by Employment Status Distribution of Usual Number of Drinks per Day on Days Drank for Working-Age Past-Month Alcohol Users by Employment Status Percentage of Working-Age Past-Month Alcohol Users Reporting Past- Month Binge and Heavy Drinking by Employment Status ................. Percentage of Working-Age Population with a Substance Dependence by Employment SIUUS ...uccrr nner rssvmmmncaansidssntsnsss runs ens Education Distribution of the Working-Age Population with and without a Substance Dependence by Employment Status .......................... Percentage of Working-Age Population with Probable Mental Health Diagnoses by Employment Status Percentage of Working-Age Population Reporting Substance Use in their Lifetime by Employment Status Percentage of Working-Age AFDC Recipients Reporting Substance Use in the Past Yearby Employment Status . . ................ivviiiinntn 1X Figure 4.3 Figure 4.4 Figure 4.5 LIST OF FIGURES (continued) Percentage of Working-Age AFDC Recipients Reporting Alcohol Use in the Past Month by Employment Status ................................ 38 Percentage of Not in Labor Force Population Reporting Substance Use who Received AFDC by Substance Used .............................. 39 Percentage of Working-Age Past-Month Alcohol Users Reporting Past-Month Binge Drinking by Employment Status ...................... 40 HIGHLIGHTS This report uses data from the combined 1994-96 National Household Survey on Drug Abuse (NHSDA) to examine the prevalence of alcohol and illicit drug use/dependence and other mental health concerns among the working-age United States population. The presented data are derived from 38,501 NHSDA respondents, age 18-64, representing over 157 million people. Nearly three-quarters of this population (74%), representing approximately 117 million people, had either full-time or part-time employment. The remainder were either unemployed (5% or about 8.1 million people) or not in the labor force (i.e., full-time homemakers, non-working students, retired, or disabled; 21% or about 32.5 million people). In addition to a detailed comparison of the demographic, economic, substance use and mental health characteristics of the working-age population by employment status, this report also provides an examination of the prevalence of substance use/dependence and other mental health concerns of individuals who received public assistance or welfare, specifically Aid to Families with Dependent Children (AFDC). The principal findings from analysis of these data include the following: « The unemployed and those not in the labor force were generally less educated (more than one quarter had not graduated from high school compared to 12% of full-time workers and 15% of part-time workers), had lower annual household incomes (more than 40% had annual family incomes of less than $20,000 compared to 14% of full-time workers and 29% of part- time workers), and were more likely to receive government assistance (e.g, 26% of the unemployed and 18% of those not in the labor force received food stamps compared to 4% of full-time workers and 9% of part-time workers). Substance Use « The unemployed were the most likely to report lifetime, past-year, and past-month illicit drug use. For example, 13 percent of the unemployed reported past-year illicit drug use, whereas 7 percent of part-time workers and 5 percent of full-time workers and those not in the labor force reported illicit drug use in the past year. « Full-time workers were more likely than part-time workers, the unemployed, and those not in the labor force to report lifetime, past-year, and past-month alcohol use. + Among current alcohol users, however, the unemployed generally consumed larger quantities of alcohol than those employed full-time. Among past-month alcohol users, the unemployed reported higher rates of binge drinking (46%) and heavy drinking (19%) than full-time workers (35%, 12%, respectively), part-time workers (29%, 11%), and those not in the labor force (30%, 12%). Rates of binge drinking and heavy drinking were high among two subsets of the not in the labor force population--non-working students (50%, 22%) and the disabled (40%, 26%). Substance Dependence * Consistent with the finding of a higher prevalence of illicit drug use for the unemployed, the prevalence of illicit drug dependence was also higher for the unemployed (5%) than for full- time workers (1%), part-time workers (2%), and those not in the labor force (2%). * Consistent with the finding of a higher prevalence of binge and heavy drinking among the unemployed, the unemployed had a higher prevalence of alcohol dependence (8%) than did full-time workers (5%), part-time workers (5%), and those not in the labor force (3%). * In all employment categories, there was a higher prevalence of substance dependence (34% with alcohol dependence, and 9% with illicit drug dependence) among those who reported past-month heavy drinking. Other Mental Health Concerns * The unemployed and those not in the labor force were more likely than those employed full- time or part-time to report mental health symptoms consistent with probable diagnoses for a major depressive episode, a general anxiety disorder, agoraphobia, and panic attacks. * In particular, the unemployed and those not in the labor force were substantially more likely to report a major depressive episode in the past year (11% in each group) than full-time workers (6%) and part-time workers (8%). Among those not in the labor force this syndrome was particularly common for the disabled (22%). AFDC Recipients * There was a higher prevalence of illicit drug use, excluding marijuana use, among AFDC recipients age 18 to 64 (28% lifetime, 9% past-year, 5% past-month) than the overall working-age population (23% lifetime, 6% past-year, 3% past-month). * By contrast, AFDC recipients, compared to the overall working-age population, did not have a higher prevalence of past-month alcohol use (54% vs. 64% for full-time workers, 59% vs. 59% for part-time workers, 53% vs. 60% for the unemployed, and 40% vs. 43% for those not in the labor force). * AFDC recipients not in the labor force were more likely than non-AFDC recipients not in the labor force to report having 2 or more drinks per day on the days they drank (79% vs. 59%). * There was a high prevalence of substance dependence (8%) and other mental health diagnoses (24%) among AFDC recipients compared to the overall working-age population (5%, 11%, respectively). CHAPTER 1: INTRODUCTION The relationship between substance abuse and labor market participation is an issue with important policy implications, particularly in the areas of workplace drug policies and programs, welfare reform, and substance abuse treatment. Data from the National Household Survey on Drug Abuse (NHSDA) and other surveys, such as the National Longitudinal Survey of Youth (NLSY), have consistently revealed differences in the rates of substance use among respondents in different employment categories. The most prominent finding is that the unemployed generally have higher rates of illicit drug and alcohol use than people in other employment categories (Hoffman, Brittingham, & Larison, 1996; Office of Applied Studies, 1998a). As presented in the Substance Abuse and Mental Health Statistics Source Book 1998, NHSDA data from 1985-1993 show a slight decline in past-month heavy alcohol use by full-time workers age 18-49. During the same period, there was an increase in past-month heavy alcohol use among the unemployed. In 1996, 12.5 percent of unemployed adults age 18 and older were current illicit drug users; 6.2 percent of full-time workers were current illicit drug users. Those not in the labor force have consistently lower prevalence of past-month illicit drug and heavy alcohol use (Office of Applied Studies, 1998b). Many other studies have also found a relationship between employment status and substance abuse. For example, levels of alcohol consumption have been linked with the stress caused by unemployment (Perrucci & Perrucci, 1990). In another study, data collected from two inner-city communities indicated that those who were not working (i.e., either out of the labor force or unemployed) generally had higher rates of illicit drug use and considerably higher rates of hard illicit drug use (Harrell & Peterson, 1992). This report further explores the prevalence and patterns of alcohol and illicit drug use among the U.S. population age 18-64 by employment status. The data presented in this report are taken from the combined 1994-96 National Household Survey on Drug Abuse (NHSDA). Statement of the Problem Even though studies suggest that there is a higher prevalence of alcohol and drug use among those who are not working, drug use among the employed is also an important public health concern. A study conducted by the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that in 1992 alcohol and drug abuse cost the economy an estimated $245.7 billion. In particular, alcohol and drug abuse had a profoundly negative effect on the workplace in terms of decreased productivity, increased accidents, absenteeism, job turnover, and medical costs (Harwood, Fountain, Livermore et al., 1998). As measured by the SmithKline Beecham Drug Testing Index, the percentage of positive drug tests among workers has declined from 18.1 percent in 1987 to 5.8 percent in 1996. Marijuana and cocaine are the most frequently detected drugs among those tested in the total U.S. workforce. Since 1993, about 3.5 percent of drug tests conducted have tested positive for marijuana. There has been a decline in the percentage of drug tests conducted that test positive for cocaine from 2.4 percent in 1993 to 1.2 percent in 1996. In addition, even though the safety- sensitive transportation workforce has had a lower rate of positive drug tests than the rest of the workforce, since 1993, two to three percent of periodic and random drug tests conducted in the transportation workforce have been positive (Office of Applied Studies, 1998b). A study on workplace drug use, policies, and programs which used data from the 1991-93 NHSDA found that full-time workers age 18-49 with current illicit drug use (i.e., in the past 30 days) lacked job stability. These workers were more likely than full-time workers who did not use illicit drugs to have worked for three or more employers in the past year, to have taken unexcused absences in the past month, to have voluntarily left an employer in the past year, and to have been fired in the past year. The study also reported similar findings for heavy alcohol users (Hoffmann, Brittingham, & Larison, 1996). Drug use among the unemployed is a major public health concern with important implications for welfare reform. Studies have shown that substance abuse is a substantial barrier to economic self-sufficiency with deleterious effects for welfare recipients (Gerstein, Johnson, Larison, Harwood, & Fountain, 1997). A study of the prevalence of alcoholism and drug abuse among female Aid to Families with Dependent Children (AFDC) recipients in a welfare-to-work program in Maryland revealed that 16.1 percent were alcoholics or drug abusers. An additional 26.8 percent were possible alcoholics and drug users (Sisco & Pearson, 1994). Data from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) revealed that while welfare recipients had similar prevalence rates of alcohol abuse and dependence as the total population, there was a higher prevalence of drug use and dependence among welfare recipients (Grant & Dawson, 1996). A study of data from the combined 1991-92 NHSDA also found that AFDC recipients had a higher prevalence of substance abuse related impairments than individuals not receiving AFDC. Approximately five percent of female AFDC recipients had significant functional impairment related to substance abuse (i.e., alcohol and/or drug dependence), and an additional 11 percent of female AFDC recipients were somewhat impaired by substance abuse problems (i.e., used alcohol and/or drugs on a weekly basis). The study points out that these levels of impairment would significantly affect participation in proposed education and job training programs for welfare recipients (Office of the Assistant Secretary for Planning and Evaluation, 1994). This report further examines the relationship between substance use and employment status. Additionally, this report examines mental health characteristics by employment status and the interaction between mental health issues and substance use. Finally, this report measures the prevalence of substance use and dependence among individuals who receive public assistance or welfare, specifically Aid to Families with Dependent Children (AFDC). Overview of the Report This report highlights statistically significant findings from the analysis of data from the combined 1994-96 NHSDA. The goal of this report is to describe the substance use and mental health characteristics of individuals age 18-64 by employment status, as well those individuals receiving AFDC. Employment status is defined as: full-time employment (i.e. employed 35 hours or more a week), part-time employment (i.e., employed less than 35 hours a week), unemployed (i.e., currently not working), or not in the labor force (i.e. full-time homemaker, non-working student, retired, or disabled). Chapter 2 of this report describes the methodology used in the analysis of the NHSDA data. Chapter 3 summarizes the substance use patterns and mental health characteristics of the population by employment status. Chapter 4 presents comparable information on the subgroup of NHSDA respondents who were AFDC recipients. The final chapter summarizes the findings of this report and discusses the relationship among drug abuse patterns, employment status, and public assistance in terms of welfare reform policy and drug treatment and prevention. The appendices provide a brief summary of the demographic characteristics of the population by employment status and standard errors for all estimates presented in this report which can be used to conduct further analysis of the data presented. CHAPTER 2: METHODOLOGY This chapter describes the statistical methodology used in the collection and analysis of the data presented in this report. Summary of NHSDA Methodology The National Household Survey on Drug Abuse (NHSDA) is the principal source of statistical information on the use of tobacco, alcohol, and illicit drugs in the United States. Conducted by the Federal Government since 1971, the NHSDA is administered to a representative sample of the population age 12 and older at their place of residence. The NHSDA has been directed by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services since October 1992. The main goal of the survey is to estimate and monitor trends in the prevalence of substance use in the United States. The sample for the NHSDA is selected so that the data may be used to make inferences about the United States civilian, noninstitutionalized population age 12 and older. The NHSDA sample consists of residents of households, persons living in non-institutional group quarters (e.g., shelters, dormitories, rooming houses), and civilians living on military bases. The sample excludes active military personnel, U.S. citizens living abroad, residents of institutional settings (e.g., prisons and hospitals), and homeless persons not living in a shelter at the time of the survey. The NHSDA sample design is a multistage area probability sample. The basic design involves five stages of sampling: . The selection of primary sampling units (e.g., counties), . The selection of subareas within selected primary sampling units (i.e., blocks or block groups), . The selection of listing units within selected subareas (i.¢., housing units or individual dwelling units within non-institutional group quarters occupied by one or more civilians), . The selection of age domains within sampled listing units (i.e., age groups 12-17, 18-25, 26-34, 35-49, and 50 and older), and . The selection of eligible individuals within sampled age domains. 7 The sampling design also incorporates a composite size measure methodology and a specially- designed within-dwelling selection procedure to ensure that desired sample sizes are achieved for subpopulations defined by age and race/ethnicity. Oversampling is used to meet specified precision constraints for subpopulations. For example, the 1994-96 NHSDA oversampled young people age 12-34, African Americans, and Hispanics. The NHSDA interview takes approximately one hour to complete and incorporates procedures designed to maximize truthful responses to potentially sensitive questions about illicit drug use (e.g., the use of self-administered answer sheets). Data are collected on the recency and frequency of use of various licit and illicit drugs, opinions about drugs, problems associated with drug use, and drug treatment experiences. In addition to detailed information about substance use, the NHSDA also collects basic demographic information on employment, race/ethnicity, age, education, income, marital status, health status, mental health problems, health insurance, utilization of health services, and access to health care. Weighting Procedures The estimates presented in this report are based on sample survey data, rather than data for the entire population, and therefore must be weighted to obtain unbiased estimates of drug use in the population represented by the NHSDA sample. The basic sampling weights are equivalent to the inverse of the probabilities of selection of sample respondents. That is, the smaller a respondent’s chance of entering the sample, the larger the weight of that respondent in the calculation of unbiased estimates for the target population. The probability of selecting a respondent is calculated as the product of the probabilities that the respondent would be selected given each of the stages of sampling. The final sampling weights are created by adjusting the basic sampling weights to reflect dwelling unit-level and individual-level nonresponse and to ensure consistency with intercensal population projections obtained from the U.S. Bureau of the Census. The final sampling weight can be interpreted as the number of persons in the NHSDA target population that are represented by a particular respondent. The sum of weights for all respondents estimates the size of the total target population. Given the near equivalence of sample designs and sample sizes of the 1994, 1995, and 1996 surveys, the analytic weights for the combined data set were calculated by dividing the final sampling weights for each year by three. ! For additional information about the NHSDA sample design, see Office of Applied Studies (1996). National Household Survey on Drug Abuse Methodological Resource Book 1998. Rockville, MD: U.S. Department of Health and Human Services. All estimates presented in this report are weighted to account for the complex sampling design of the NHSDA. Therefore, all estimates presented in this report are unbiased estimates for the U.S. civilian population age 18-64 or for specified subgroups of that population. Measurement of Employment Status The following question was used to develop a measure of current employment status: Which of these statements describes your present work situation: » Working full-time, 35 hours or more a week » Working part-time, less than 35 hours a week « Have a job, but not at work because of extended illness, maternity leave, furlough, or strike « Have a job but not at work because it is seasonal work « Unemployed or laid off and not looking for work * Full-time homemaker * In School Only * Retired * Disabled for work Other (specify)? Based on their responses to this question, respondents were classified into one of four employment categories. Those respondents who selected the response option “working full-time, 35 hours or more a week” were classified as full-time workers. Those respondents who selected the response option “working part-time, less than 35 hours a week” were classified as part-time workers. All respondents who selected one of the following response options were classified as unemployed: “have a job, but not at work because of extended illness, maternity leave, furlough, or strike;” “have a job but not at work because it is seasonal work;” “unemployed or laid off and not looking for work: and “Other (in labor force).” Finally, those respondents who chose either “full-time homemaker,” “in-school only,” “retired,” or “disabled for work” were classified as not in the labor force. The analysis in this report is limited to the 38,501 respondents age 18-64 from the 1994- 96 NHSDA who were classified in one of the four employment categories described above. These respondents represent more than 157 million working-age people. As indicated in Figure 2.2, nearly three-quarters of the surveyed population, representing approximately 117 million people, reported that they were currently employed full-time or part-time. A reported five percent of the surveyed population, representing approximately 8.1 million people, however, were unemployed. About one out of five surveyed, or about 32.5 million people, was not in the labor force. As indicated in Figure 2.2, about half of the not in the labor force population were full- time homemakers, representing about 16.5 million people. The remainder of those not in the labor force were almost equally divided among non-working students, the retired, and the disabled, with approximately five million people in each category. Figure 2.1 Percent Distribution and Estimated Number of Working-Age Population by Employment Status 61% Full-time 96,533 60% Et 5 126 HF ’ Ll Unemployed 20% | | ~ + 21% L se 13% 7, 2, | | | | | | 7/; - Not in Labor Force ow } Part-time ot in Labor Force | Part-time Not in Labor Force Full-time Unemployed Weighted Percentage Estimated Number (in 1000s) See Table 3.1a Source: OAS, SAMHSA, NHSDA 1994-96. Figure 2.2 Percent Distribution and Estimated Number of Not in Labor Force Population by Category 80% Homemaker 60% 16,545 | s1% \ 744 5,089 Student 7 5,432 Retired Lite Disabled | Student Disabled Homemaker Retired Weighted Percentage Estimated Number (in 1000s) See Table 3.1b Source: OAS, SAMHSA, NHSDA, 1994-96. 10 Measurement of Substance Dependence Substance dependence was determined using an algorithm developed by the Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA) based on a definition of substance dependence provided by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV). The DSM-IV defines substance dependence as a maladaptive pattern of substance use characterized by the concurrence of three or more of seven criteria for substance dependence during a 12-month period. The 1994 NHSDA contains questions that approximate five of the DSM-IV criteria and the 1995-96 NHSDA contain questions that approximate six of the DSM- IV criteria. Respondents were classified as substance dependent for the 1994 NHSDA if they met three of the five criteria measured. Respondents were classified as substance dependent in the 1995-96 NHSDA if they met three of the six criteria measured. Table 2.1 shows the DSM-IV criteria for substance dependence and the corresponding NHSDA questionnaire items that represent them. Other Mental Health Diagnoses Mental health data are drawn from a module of the NHSDA questionnaire that contains a series of questionnaire items designed to screen for the likely presence of four of the most common mood and anxiety syndromes: major depressive episode, general anxiety disorder, agoraphobia, and panic attacks. Even though the diagnostic questions presented in the NHSDA do not detect the presence of a mental syndrome at the same level of certainty a complete diagnostic interview would, they do discriminate with high probability whether with more extensive examination a respondent would be diagnosed with a particular syndrome. Therefore, if respondents have one or more of the mental health diagnoses, this indicates that their responses to the relevant NHSDA screening questions indicate a high probability that they have the mental syndrome. The NHSDA questionnaire items used in the determination of each of the mental health diagnoses are outlined in Table 2.2. Measurement of Other Variables For the purpose of this analysis, never married, widowed, divorced, or separated women, who live in a household with children (i.e., anyone younger than age 18) and no other person designated head of household are classified as single women supporting a family. There was no single questionnaire item that could be used to identify recipients of Aid to Families with Dependent Children (AFDC). Therefore, the response patterns for the following questions were examined in order to identify those respondents who were AFDC recipients: * In the past 12 months, did you receive public assistance or welfare payments from the state or local welfare office? Do not include SSI. 11 * In the past 12 months, did any other family member living here receive public assistance or welfare payments from the state or local welfare office? Do not include SSI. * Did you or another family member living in your household receive Aid to Families with Dependent Children, sometimes called AFDC or ADC, or was it some other type of assistance payments in the past 12 months? A crosstabulation of responses to these questions revealed that of the 3,940 individuals who reported that either they or someone else in their household received AFDC, 3,035 also reported that they received public assistance or welfare. The remaining 905 respondents reported that another family member received public assistance or welfare payments. Based on this response pattern, it can be concluded that 3,035 respondents, representing about five million people, were AFDC recipients. Statistical Testing The estimates of substance use presented in this report for the NHSDA target population, as well as subgroups of the target population, were calculated using the following formula: > wl, Py = 100 > wl, where py is the estimated percentage of respondents in “s” subgroup using substance “d”, w; is the weight of sample respondent “i,” I; is a variable coded “0” or “1” that takes on the value of “1” if respondent “i” belongs to subgroup “s,” and I; is a variable coded “0” or “1” that takes on the value of “1” if respondent “i”’ reported using substance “d.” All of the estimates presented in this report were tested to determine whether they met a required level of statistical precision. Low statistical precision typically occurs for small subgroups of the population in which prevalence estimates are close to zero or 100 percent. An estimate was considered “unreliable” if the relative standard error was greater than 17.5 percent of the log transformation of the estimate. All estimates that were suppressed because of low statistical precision are not discussed in the text and are indicated with an asterisk (*) in the data tables. Statistical tests were used to determine whether differences between estimates for various subgroups were statistically significant. All findings reported in the text are significant at the .05 12 level.? However, when two estimates are found to be significantly different it does not necessarily imply that the difference is large or meaningful. Rather, statistical significance means that one can conclude, with a small risk of error, that the two estimates would be found to be different if the survey were replicated with different samples drawn from the same population, using the same sampling procedures. That is, the differences cannot be attributed solely to sampling error. Limitations of the Data Data from the NHSDA allow for the estimation of the national prevalence of substance use among individuals in each employment category and among public assistance or welfare recipients. However, the analyses presented in this report have several important limitations that inhibit a complete understanding of the relationship among employment, AFDC receipt, and substance use. First, the data are self-reports of behavior, and their value depends on each respondent’s truthfulness and memory. As stated earlier, however, the NHSDA incorporates administration procedures that encourage honesty and recall. Nevertheless, some under-reporting and over- reporting is very likely to have occurred. Second, the data are cross-sectional rather than longitudinal. Therefore, the data provide an overview of behavioral prevalence at specific points in time rather than a view of behavior changes over time for groups or individuals. Third, the analyses presented in this report are purely descriptive, thus making causal inferences from the observed relationships impossible. More complex analyses would allow for the effects of any variables that could potentially confound the relationship of interest to be controlled. A final potential limitation of these data is the manner in which employment status was measured. In this report, employment status is defined in a manner that enables comparisons with population estimates presented in the National Household Survey on Drug Abuse Main Findings 1996 (Office of Applied Studies, 1997), as well as other reports summarizing NHSDA data published through the Substance Abuse and Mental Health Services Administration (SAMHSA). However, the definition of unemployment is not consistent with the definitions of unemployment used in other national studies, such as the Current Population Survey (CPS). The definition of unemployment used in the NHSDA encompasses more people than the definition used in the CPS. This difference is primarily due to the distinction between active and passive searches for work used in the CPS to distinguish the unemployed from those not in the labor force. In the CPS, an individual must have engaged in specific employment-seeking activities within the past month to be classified as unemployed, while in the NHSDA, a person only has to report his or her present work situation as unemployed or laid off and looking for work to be 2 For a more detailed discussion of significance testing, see Appendix B. 13 classified as unemployed. In addition, the following methodological differences between the NHSDA and the CPS should be noted: - The NHSDA estimates are for persons age 18 and older; the CPS estimates are for persons age 16 and older. . The NHSDA requests current employment status, essentially using no reference period; the CPS uses a one-week reference period. . The NHSDA is a continuing survey with separate samples allocated quarterly; the CPS uses a monthly sample taken for the survey week which includes the 12" of the month. 14 Sl Table 2.1 DSM-IV Criteria for Substance Dependence and the Corresponding NHSDA Questionnaire Items Used to Represent Them DSM-IV Criteria 1994-B NHSDA Questionnaire Items 1995-96 NHSDA Questionnaire Items 1. Tolerance, as defined by either of the following: (a) aneed for markedly increased amounts of the substance to achieve intoxication or the desired effect (b) markedly diminished effect with continued use of the same amount of the substance. Did you build up a tolerance for that drug so that the same amount of the drug had less effect than before during the past 12 months? Indicate whether you have built up a tolerance for the drug so that the amount of the drug had less effect than before during the past 12 months. 2. Withdrawal, as manifested by either of the following: (a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal for the specific substances) (b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms. 3. The substance is often taken in larger amounts or over a longer period than was intended. Did you use that kind of drug much more often or in larger amounts than you intended to during the past 12 months? Indicate whether you have used that kind of drug much more often or in larger amounts than you intended to during the past 12 months. 91 Table 2.1 DSM-IV Criteria for Substance Dependence and the Corresponding NHSDA Questionnaire Items Used to Represent Them (continued) DSM-IV Criteria 1994-B NHSDA Questionnaire Items 1995-96 NHSDA Questionnaire Items 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use. In Column A mark the “Yes” box on the right if you wanted to cut down or stop using the drug in the past 12 months. Mark the “No” box on the right if you did not want to cut down or stop using that drug in the past 12 months. For each “Yes” box in Column A, indicate in Column B if you were able to cut down or stop your use of that drug every time you wanted to in the past 12 months. Mark the “Yes” box in Column B if you were able to cut down or stop your use of that drug every time you wanted to during the past 12 months. Mark the “No” box if you were unable to cut down or stop your use of that drug every time you wanted to. Indicate whether, during the past 12 months, you have wanted or tried to stop or cut down on your use of that drug but found you couldn’t. 5. A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain smoking), or recover from its effects. Did you have a period of a month or more during the past 12 months when you spent a great deal of time getting the drug, using the drug, or getting over its effects? Indicate whether you had a period of a month or more during the past 12 months when you spent a great deal of time getting the drug, using the drug, or getting over its effects. 6. Important social, occupational, or recreational activities are given up or reduced because of substance use. Indicate whether your use of that drug has often kept you from working, going to school, taking care of children, or engaging in recreational activities during the past 12 months. £1 (continued) Table 2.1 DSM-IV Criteria for Substance Dependence and the Corresponding NHSDA Questionnaire Items Used to Represent Them DSM-IV Criteria 1994-B NHSDA Questionnaire Items 1995-96 NHSDA Questionnaire Items 7. The substance use is continued despite knowledge of having persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption). Indicate whether your use of the drug has caused you any health problems — such as liver disease, stomach disease, pancreatitis, feet tingling, numbness, memory problems, an accidental overdose, a persistent cough, a seizure or fit, hepatitis, or abscesses during the past 12 months. Indicate whether your use of the drug has caused you to have any emotional or psychological problems such as feeling uninterested in things, feeling depressed, feeling suspicious of people, feeling paranoid, or having strange ideas during the past 12 months. Table 2.2 NHSDA Questionnaire Items Used to Screen for Probable Mental Health Diagnoses Mental Health Syndrome NHSDA Questionnaire Items Used to Screen for Probable Diagnosis Major Depressive Episode (a) (b) (c) (d) (e) (f) (2 (h) (M 0 ®) M During the past 12 months, was there ever a time when you felt sad, blue, or depressed for two weeks or more in a row? During that time did the feeling of being sad, blue, or depressed usually last all day long, about half the day, or less than half the day? Did you feel this way every day, almost every day, or less often during those two weeks? During those two weeks did you lose interest in most things? Did you feel tired out or low on energy all the time? Did you gain/lose weight? About how much did you gain/lose? Did [you have more trouble falling asleep than you usually do] every night, nearly every night, or less often during those two weeks? Did you have a lot more trouble concentrating than usual? At these times, people sometimes feel down on themselves, no good, or worthless. Did you feel this way? Did you think a lot about death, either your own, someone else’s, or death in general? During the past 12 months, was there ever a time lasting two weeks or more when you lost interest in most things like hobbies, work, or activities that usually gave you pleasure? During those two weeks, did you feel tired out, or low on energy all the time? (m) During those two weeks, did you gain/lose weight? About how much did you (n) (0) (2) (@ gain/lose? Did [you have more trouble falling asleep than you usually do] every night, nearly every night, or less often during those two weeks? During those two weeks, did you have a lot more trouble concentrating than usual? At these times, people sometimes feel down on themselves, no good, or worthless. Did you feel this way? During those two weeks, did you think a lot about death, either your own, someone else’s, or death in general? General Anxiety Disorder (a) (b) (c) (d) (e) (f) (2) (h) (1) 0 (k) During the past 12 months, did you ever have a period lasting one month or longer when most of the time you felt worried or anxious? Has that period ended or is it still going? How many months or years did it go on before it ended? During that period, did you worry about things that were not likely to happen? Did you worry about things that were not really serious? During this period of worry or anxiety, did you have different worries on you mind at the same time? How many months or years has it been going on? Do you worry about things that are not likely to happen? Do you worry a great deal about things that are not really serious? Do you have different worries on your mind at the same time? When you (are/were) worried or anxious, (are/were) you also restless? 18 Table 2.2 NHSDA Questionnaire Items Used to Screen for Probable Mental Health Diagnoses (continued) Mental Health Syndrome NHSDA Questionnaire Items Used to Screen for Probable Diagnosis General Anxiety Disorder (continued) M When you (are/were) worried or anxious, (are/were) you also keyed up or on edge? (m) When you (are/were) worried or anxious, (are/were) you also irritable? (n) (0) (p) (@ When you (are/were) worried or anxious, (does/did) your heart pound or race? When you (are/were) worried or anxious, (are/were) you also easily tired? When you (are/were) worried or anxious, (do/did) you have trouble falling asleep? When you (are/were) worried or anxious, (do/did) you feel faint or unreal? Agoraphobia (a) (b) (0) (d) (e) (fH (2) (h) (1) During the past 12 months, did you have an unreasonably strong fear of being in a public place, or a crowd or line? During the past 12 months, did you have an unreasonably strong fear of leaving home or being away from home? During the past 12 months, did you have an unreasonably strong fear of crossing bridges? Do you get very upset or badly frightened every time you are in (this/these) situation(s), most of the time, or only some of the time? How long have you had (this/these) fear(s) — less than 1 year, between 1 and 5 years, or more than 5 years? About how many months have you had (this/these) fear(s)? When you are in (this/these) situation(s), are you afraid that you might faint, lose control, or embarrass yourself in other ways? When you are in (this/these) situation(s), do you worry that you might be trapped without any way to escape? When you are in (this/these) situation(s), do you worry that help might not be available if you needed it? Panic Attack (a) (b) (©) (d) (e) (fH (2) (h) (i) 0 (k) During the past 12 months, did you have a spell or an attack when all of a sudden you felt frightened, anxious, or very uneasy when most people would not be afraid or anxious? During the past 12 months, did you ever have a spell or attack when for no reason your heart suddenly began to race, you felt faint, or you couldn’t catch your breath? Did (this attack/these attacks) happen in a situation when you were not in danger or not the center of attention? When you have attacks of the sort you just described, do they usually occur in situations that cause you unreasonably strong fears? Did you ever have an attack in the past 12 months when you were not in a situation that usually causes you to have unreasonably strong fears? When you have attacks, does you heart pound? When you have attacks, do you have tightness in your stomach? When you have attacks, do you sweat? When you have attacks, do you shake? When you have attacks, do you have hot flashes/chills? When you have attacks, do things seem unreal? 19 20 CHAPTER 3: SUBSTANCE USE AND MENTAL HEALTH CHARACTERISTICS BY EMPLOYMENT STATUS This chapter provides data on the prevalence of substance use and substance dependence and other mental health concerns among the working-age population by employment status. Substance use prevalence is measured by reported lifetime, past-year, and past-month use of alcohol, marijuana, and other illicit drugs, including cocaine, crack, heroin, hallucinogens, inhalants, and non-medical use of analgesics, tranquilizers, stimulants, and sedatives. More detailed data about level of past-month alcohol use are also provided. As described in Chapter 2, substance dependence is determined using definitions provided in the DSM-IV and the presence of other mental health syndromes are determined from a series of questions designed to screen for probable diagnoses of mood and anxiety syndromes. Lifetime Substance Use As indicated in Figure 3.1, the unemployed were the most likely to report drug use at some point in their lifetime, while full-time workers were the most likely to report that they had used alcohol on at least one occasion. By contrast, the not in the labor force population was substantially less likely than the other groups to report that they had ever used any of the substances examined (See Table 3.1a). Figure 3.1 Percentage of Working-Age Population Reporting Substance Use in their Lifetime by Employment Status 100% 7 1 92% Rat 89% 80% — 60% | | 40% 20% 0% Part-Time Not in Labor Force Full-Time Unemployed = Alcohol I Marijuana /) Other Illicit Drugs Source: OAS, SAMHSA, NHSDA, 1994-96. 21 Among those not in the labor force, the retired were the most likely to report that they had used alcohol on at least one occasion in their lifetime (92%), while non-working students and the disabled were more likely than full-time homemakers to report that had ever used marijuana or other illicit drugs. Full-time homemakers were generally the least likely to report that they had ever used any of these substances (See Table 3.1b). Past-Year Substance Use The prevalence pattern for substance use during the past year was similar to that of lifetime substance use. As indicated in Figure 3.2, the unemployed were the most likely to report past-year use of marijuana or other illicit drugs and full-time workers were the most likely to report that they had used alcohol on at least one occasion during the past year. By contrast, the not in the labor force population was the least likely to report past-year alcohol or marijuana use (See Table 3.1a). Figure 3.2 Percentage of Working-Age Population Reporting Substance Use in the Past Year by Employment Status 100% — 80% ] 78% 74% 75% 60% : | 40% ] 20% - 12% 7% 7% 50, 0% - Part-Time Not in Labor Force Full-Time Unemployed = Alcohol BB Marijuana 7 Other Illicit Drugs Source: OAS, SAMHSA, NHSDA, 1994-96. Also similar to the findings for lifetime substance use, within the not in the labor force population, the retired were more likely than full-time homemakers and the disabled to report that they had used alcohol on at least one occasion in the past year. However, non-working students were just as likely as the retired to report past-year alcohol. Non-working students were 22 also substantially more likely than full-time homemakers and the disabled to report that they had used marijuana or other illicit drugs during the past year (See Table 3.1b). Past-Month Substance Use The findings for past-month substance use, which is used as an indicator of current substance use, are also similar to those for lifetime and past-year substance use. As shown in Figure 3.3, the unemployed were the most likely to report current use of marijuana or other illicit drugs; in fact, the unemployed were about three times as likely as full-time workers and those not in the labor force to report past-month use of illicit drugs other than marijuana. Full-time workers were the most likely to report current alcohol use, while those not in the labor force were the least likely to report current use of alcohol or marijuana (See Table 3.1a). Within the not in the labor force population, non-working students and the retired were more likely than full-time homemakers and the disabled to report current alcohol use; while non-working students were more likely than the disabled and full-time homemakers to report current marijuana use (See Table 3.1b). Figure 3.3 Percentage of Working-Age Population Reporting Substance Use in the Past Month by Employment Status 100% | 80% 60% 60% > 40% 20% 2% 3% 4% 90, 0% yr ’ Part-Time Not in Labor Force Full-Time Unemployed = Alcohol Marijuana ?/) Other Illicit Drugs Source: OAS, SAMHSA, NHSDA, 1994-96. Binge and Heavy Drinking Even though full-time workers were the most likely to report current alcohol use, among current alcohol users, the unemployed usually consumed more alcohol. As indicated in Figure 23 3.4, unemployed current alcohol users were the most likely to report that on the days that they drank during the past month, they usually had at least five drinks. In addition, even though the not in the labor force population was the least likely to report current alcohol use, among current alcohol users, those not in the labor force were also more likely than full-time workers to have usually consumed at least five drinks on those days that they drank (18% and 15%, respectively; See Table 3.2a). Within the not in the labor force population, non-working students and the disabled who were current alcohol users were nearly three times as likely as full-time homemakers who were current alcohol users to have usually consumed at least five drinks on the days they drank (See Table 3.2b). Figure 3.4 Distribution of Usual Number of Drinks per Day on Days Drank for Working- Age Past-Month Alcohol Users by Employment Status 60% 54% 49% 5166 41% 41% 40% 20% 0% Part-Time Not in Labor Force Full-Time Unemployed — drink BH 2-4 drinks ?/, 5+ drinks Source: OAS, SAMHSA, NHSDA, 1994-96. Binge drinking is defined as consuming five or more drinks on one occasion. Heavy drinking is defined as binge drinking on five or more days in a 30-day period. As indicated in Figure 3.5, almost half of the current alcohol users who were unemployed (46%) reported binge drinking during the past month. The unemployed were the most likely to report binge drinking on more than one day in the past month (See Table 3.2a); nearly one out of five of the unemployed (19%) reported heavy drinking during the past month. Even though current alcohol users who were not in the labor force usually consumed more alcohol than those employed full-time, full-time workers were more likely than those not in 24 the labor force to report past-month binge drinking. As shown in Table 3.2b, among those not in the labor force, non-working students and the disabled were more likely than full-time homemakers to report past-month binge and heavy drinking. Figure 3.5 Percentage of Working-Age Past-Month Alcohol Users Reporting Past-Month Binge and Heavy Drinking by Employment Status 60% | | 40% 35% | 29% 30% | 29% 20% | == = = 0% Not in Labor Force Part-Time Full-Time Unemployed — Binge Drinking BR Heavy Drinking Source: OAS, SAMHSA, NHSDA, 1994-96. Substance Dependence As indicated in Figure 3.6, the unemployed were the most likely to report a substance dependence. Eight percent of the unemployed had an alcohol dependence. Furthermore, while only two percent of the working-age population had a drug dependence, the unemployed were more than twice as likely to have a drug dependence. Those not in the labor force were the least likely to have a substance dependence (See Table 3.3a). As also indicated in Figure 3.6, there was a substantially higher prevalence of substance dependence among heavy drinkers (i.e., those who consumed at least five drinks on one occasion on five or more days in the past month). More than one-third (34%) of the working-age past- month heavy drinkers had an alcohol dependence; nearly ten percent (9%) had a drug dependence (See Table 3.3b). Among heavy drinkers, the unemployed and part-time workers were more likely than full-time workers and those not in the labor force to have a drug dependence. 25 Figure 3.6 Percentage of Working-Age Population with a Substance Dependence by Employment Status 60% 60% | 0 40% 40% 40% ™ ES 36% 20% 20% 8% | 5% %_ ale 1% ree o a ee ° 0% - ee —— Reh = a Part-Time Not in Labor Force Part-Time Not in Labor Force Full-Time Unemployed Full-Time Unemployed = Alcohol Dependence = Alcohol Dependence & Drug Dependence Wik Drug Dependence Entire Population Past-Month Heavy Drinkers Source: OAS, SAMHSA, NHSDA, 1994-96. Tables 3.4 and 3.5 contain demographic and socioeconomic data for those with a probable substance dependence compared to those without a probable substance dependence within each employment status. There were several differences in the demographic composition of these two groups regardless of employment status. In general, these differences were expected given the demographic characteristics of substance users. In every employment category, a higher percentage of those with a substance dependence than of those without a substance dependence were male, young, never married, and had received food stamps in the past year (See Tables 3.4 & 3.5). Except for individuals not in the labor force, in every employment category a higher percentage of those with a substance dependence compared to those without a substance dependence did not graduate from high school (See Figure 3.7). In addition, in every employment category except for part-time, a higher percentage of individuals with a substance dependence had an annual family income of less than $10,000 (See Table 3.5). The only racial difference between individuals with and without a substance dependence was for those not in the labor force. Among those not in the labor force, a proportionately higher percentage of those with a substance dependence than of those without a substance dependence was black (See Table 3.4). There was also a regional difference between individuals with and without a substance dependence for those not in the labor force. Individuals not in the labor force who also had a substance dependence were more likely to be from the West than individuals not in the labor force without a substance dependence. 26 Figure 3.7 Education Distribution of the Working-Age Population with and without a Substance Dependence by Employment Status 60% 60% 47% 1 43% 42% 0, 40% r | 40% 39% Ete Z 40% - 1 30% | | 23% 24% | 20% — 19%) 20% 0% 2 7. Part-Time Not in Labor Force Part-Time Not in Labor Force Full-Time Unemployed Full-Time Unemployed = High school YJ >High school Substance Dependent Not Dependent Source: OAS, SAMHSA, NHSDA, 1994-96. Other Mental Health Concerns As indicated in Figure 3.8, the unemployed and those not in the labor force were more likely than full-time and part-time workers to have probable diagnoses for a major depressive episode, agoraphobia, and panic attacks. In fact, the unemployed and those not in the labor force were nearly twice as likely as full-time workers to have a probable diagnosis for a major depressive episode and three times as likely to have a probable diagnosis for agoraphobia (See Table 3.6a). Within the not in the labor force population, the disabled were the most likely to have probable mental health diagnoses. The disabled were twice as likely as full-time homemakers and non-working students to have a probable diagnosis for a major depressive episode (See Table 3.6b). In fact, while eight percent of the total population had a probable diagnosis for a major depressive episode (See Table 3.6a), the disabled were three times as likely to have the same probable diagnosis. The disabled were also about three times as likely as full-time homemakers and non-working students to have a probable diagnosis for an anxiety disorder (i.e., general anxiety disorder, agoraphobia, or panic attacks). 27 Figure 3.8 Percentage of Working-Age Population with Probable Mental Health Diagnoses by Employment Status 30% 25% | 20% 15% | 11% 11% 10% 8% = = = = 6% = o 59% Tw — f ] =—40, 4%" ° " gag Sanur | / ] | | 0% — 7/4 a — “ | = - 7) | Part-Time | Not in Labor Force Unemployed Major Depressive Episode Bl General Anxiety Disorder v/ Agoraphobia | Panic Attack Source: OAS, SAMHSA, NHSDA, 1994-96. 28 Table 3.1a Percentage of Total Population Age 18-64 Reporting Lifetime, Past-Year, and Past-Month Substance Use by Employment Status (Weighted), 1994-96 Full-Time Part-Time Unemployed Not in Labor Force' Substance Total Male Female Total Male Female Total Male Female Total Male Female TOTAL _(in 1000s) 96,533 56,731 40,161 20,295 5920 14,375 8,126 4,317 3.809 32,541 9,334 23,208 ALCOHOL Lifetime 92.4% 94.1% 90.0% 88.1% 87.2% 88.5% 88.7% 91.0% 86.1% 81.2% 89.0% 78.0% Past Year 77.7 79.7 75.0 74.2 76.2 73.4 74.5 78.0 70.5 59.3 67.8 559 Past Month 64.4 69.0 58.1 58.9 61.9 57.7 60.3 67.3 52.4 43.3 56.7 37.9 MARIJUANA Lifetime 433% 472% 37.9% 37.4% 41.6% 357% 473% 558% 37.6% 27.2% 29.5% 26.2% Past Year 9.3 11.3 6.5 11.7 19.7 83 18.2 24.1 11.5 6.8 11.0 3.1 Past Month 5.0 6.3 3.0 6.7 12.5 43 11.3 14.8 7.4 3.9 6.8 2.8 OTHER ILLICIT DRUGS? Lifetime 24.9% 28.0% 20.5% 23.6% 303% 209% 312% 363% 254% 15.6% 17.5% 14.9% Past Year 5.4 6.1 4.5 6.9 11.8 4.8 12.7 14.5 10.7 4.6 7.0 3.7 Past Month 2.4 27 20 3.2 6.2 % 6.3 2.2 53 23 3.6 1.8 ' Includes full-time homemakers, non-working students, the retired, and the disabled. 2 Includes cocaine, crack, heroin, hallucinogens, inhalants, and non-medical use of analgesics, tranquilizers, stimulants, and sedatives. * Estimate suppressed due to low precision. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 29 Table 3.1b Percentage of Not in Labor Force Population Age 18-64 Reporting Lifetime, Past-Year, and Past-Month Substance Use by Category (Weighted), 1994-96 Full-Time Non-Working Homemaker Student Retired Disabled Total Weighted Total Weighted Total Weighted Total Weighted Substance (in 1000s) Percent (in 1000s) Percent (in 1000s) Percent (in 1000s) Percent _ TOTAL 16,545 100.0% 5,284 100.0% 5.432 100.0% 5,089 100.0% ALCOHOL Lifetime 12,762 77.1 4,291 81.2 5,003 92.1 4,231 83.1 Past Year 9,030 54.6 3,817 722 3,769 69.4 2,581 50.7 Past Month 6,108 36.9 3,000 56.8 2,994 55.1 1,926 37.8 MARIJUANA Lifetime 4,455 26.9 1,988 37.6 * * 1,723 33.9 Past Year 720 4.4 1,052 19.9 * * 408 8.0 Past Month 377 23 603 11.4 * * 281 5.5 OTHER ILLICIT DRUGS' Lifetime 2,568 15.5 1,273 24.1 * 1,037 20.4 Past Year 554 3.4 540 10.2 % * 346 6.8 Past Month 297 1.8 206 39 * * * "Includes cocaine, crack, heroin, hallucinogens, inhalants, and non-medical use of analgesics, tranquilizers, stimulants, and sedatives. * Estimate suppressed due to low precision. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 30 I€ Table 3.2a Distribution of Usual Number of Drinks per Day on Days Drank and Number of Days Had Five or More Drinks on the Same Occasion and Percentage Reporting Past-Month Binge and Heavy Drinking for Past-Month Alcohol Users Age 18-64 by Employment Status (Weighted), 1994-96 Full-Time Part-Time Unemployed Not in Labor Force' TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED Alcohol Use (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT TOTAL 93,158 100.0% 62,211 100.0% 11,961 100.0% 4,902 100.0% 14,082 100.0% USUAL NUMBER OF DRINKS PER DAY ON DAYS DRANK 100.0% 100.0% 100.0% 100.0% 100.0% 1 drink 29,103 326 18,517 31.0 4,032 35.4 1,101 23.6 5,453 40.7 2 - 4 drinks 45,821 51.4 32,317 54.1 5,587 49.0 2,364 50.7 5,552 41.4 5 or more drinks 14,299 16.0 8,931 14.9 1,781 15.6 1,196 25.7 2,391 17.8 NUMBER OF DAYS HAD FIVE OR MORE DRINKS 100.0% 100.0% 100.0% 100.0% 100.0% 0 days 57,973 66.3 38,380 65.5 8,044 70.8 2,432 54.4 9,117 69.7 1 day 8,303 9.5 6,122 10.5 732 6.4 410 9.2 1,039 7.9 2 - 4 days 10,743 12.3 7172 12.2 1,394 12.3 774 17.3 1,403 10.7 5 or more days 10,445 11.9 6,881 11.8 1,187 10.5 859 19.2 1,517 11.6 REPORTED BINGE DRINKING? 29,490 33.7 20,175 34.5 3,313 29.2 2,043 45.6 3,959 30.3 REPORTED HEAVY DRINKING? 10,445 11.9 6,881 11.8 1,187 10.5 859 19.2 1,517 11.6 2 Had five or more drinks on the same occasion on at least one day. 3 Had five or more drinks on one occasion on five or more days. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. Includes full-time homemakers, non-working students, the retired, and the disabled. cg Table 3.2b Distribution of Usual Number of Drinks per Day on Days Drank and Number of Days Had Five or More Drinks on the Same Occasion and Percentage Reporting Past-Month Binge and Heavy Drinking for Not in Labor Force Past-Month Alcohol Users Age 18-64 by Category (Weighted), 1994-96 Not in Labor Force Full-time Homemaker ~~ Non-working Student Disabled TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED Alcohol Use (in 1000s) PERCENT _ (in 1000s) PERCENT _ (in 1000s) PERCENT (in 1000s) PERCENT TOTAL 14,029 100.0% 6.108 100.0% 3,000 100.0% 1,926 100.0% USUAL NUMBER OF DRINKS PER DAY ON DAYS DRANK 100.0% 100.0% 100.0% 100.0% 1 drink 5,424 40.6 2,843 49.7 667 23.4 467 26.0 2-4 drinks 5,537 41.5 2,254 39.4 1,319 46.3 785 43.7 5 or more drinks 2,383 17.9 628 11.0 863 30.3 546 30.4 NUMBER OF DAYS HAD FIVE OR MORE DRINKS 100.0% 100.0% 100.0% 100.0% 0 days 9,088 69.7 4,540 80.4 1,432 50.4 1,046 59.8 1 day 1,036 2.9 364 6.5 369 13.0 * * 2 - 4 days 1,396 10.7 505 8.9 428 15.1 * * 5 or more days 1,514 11.6 236 4.2 612 21.6 447 25.5 REPORTED BINGE DRINKING! 3,946 30.3 1,105 19.6 1,409 49.6 704 40.2 REPORTED HEAVY DRINKING? 1,514 11.6 236 4.2 612 21.6 447 25.5 Note: Data for the retired were omitted from this table due to low statistical precision. ' Had five or more drinks on the same occasion on at least one day. Had five or more drinks on one occasion on five or more days. * Estimate suppressed due to low precision. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 2 1 Table 3.3a_ Percentage of Total Population Age 18-64 with a Substance Dependence by Employment Status (Weighted), 1994-96 Total Full-Time Part-Time Unemployed Not in Labor Force' Substance TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED Dependence * (in 1000s) PERCENT _ (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT TOTAL 157,495 100.0% 96,533 100.0% 20,295 100.0% 8,126 100.0% 32,541 100.0% ALCOHOL DEPENDENCE 7,023 4.5 4,408 4.6 959 4.7 623 pA 1,032 3.2 ILLICIT DRUG DEPENDENCE’ 2,763 1.8 1,349 1.4 462 23 406 5.0 546 1.7 "Includes full-time homemakers, non-working students, the retired, and the disabled. ? Substance dependence is a maladaptive pattern of substance use characterized by the concurrence of three or more criteria for substance dependence during a 12-month period, as defined in the DSM-IV (See Chapter 2). 3 Includes dependence on marijuana, cocaine, heroin, hallucinogens, inhalants, analgesics, tranquilizers, stimulants, and sedatives. Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. Table 3.3b Percentage of Past-Month Heavy Drinkers Age 18-64 with a Substance Dependence by Employment Status (Weighted), 1994-96 Total Full-Time Part-Time Unemployed Not in Labor Force! Substance TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED Dependence * (in 1000s) PERCENT _ (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT TOTAL 10,445 100.0% 6,881 100.0% 1,187 100.0% 859 100.0% 1,517 100.0% ALCOHOL DEPENDENCE 3572 34.2 2,318 33.7 475 40.0 305 35.5 473 31.2 ILLICIT DRUG DEPENDENCE’ 967 9.3 528 7.7 148 12.4 143 16.6 148 9.8 "Includes full-time homemakers, non-working students, the retired, and the disabled. Substance dependence is a maladaptive pattern of substance use characterized by the concurrence of three or more criteria for substance dependence during a 12-month period, as defined in the DSM-IV (See Chapter 2). Includes dependence on marijuana, cocaine, heroin, hallucinogens, inhalants, analgesics, tranquilizers, stimulants, and sedatives. Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. Table 3.4 Gender, Age, Racial/Ethnic, Educational, Marital, and Regional Distribution of Total Population Age 18-64 with and without a Substance Dependence’ by Employment Status (Weighted), 1994-96 Full-Time Part-Time Unemployed Not in Labor Force? Demographic Not Not Not Not Characteristic Dependent Dependent Dependent Dependent Dependent Dependent Dependent Dependent TOTAL 91,461 5,072 19,065 1,230 7,299 827 31,199 1,342 GENDER 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Male 573 78.8 27.2 59.1 519 63.5 27.6 54.9 Female 42.7 21.2 72.8 40.9 48.1 36.5 72.4 45.1 AGE 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 18-19 Yrs 1.7 59 10.6 21.3 7.9 13.1 6.9 17.1 20-24 Yrs 8.4 20.6 16.0 33.5 16.0 26.0 9.5 25.4 25-44 Yrs 58.2 62.1 44.8 36.1 50.7 55.6 36.5 38.3 45-64 Yrs 31.7 11.4 28.5 * 25.4 * 47.1 * RACE/ETHNICITY 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% White 76.0 71.5 76.6 74.3 593 64.0 71.7 67.6 Black 11.0 10.4 9.2 11.3 21.4 23.1 11.9 17.9 Hispanic 9.2 9.4 9.4 11.4 13.5 9.9 11.9 9.2 EDUCATION 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% High school 54.9 42.6 54.4 47.4 36.8 24.1 36.2 42.0 MARITAL STATUS 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Married 64.6 37.7 56.7 24.9 44.5 17.4 68.2 22.0 Wid./Div./Sep. 14.1 17.8 11.1 * 15.2 22.7 12.3 19.9 Never married 21.3 44.5 32.1 63.6 40.3 59.8 19.5 58.1 REGION 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Northeast 19.6 16.4 21.8 18.9 22.6 16.6 19.5 16.3 North Central 24.6 25.0 26.0 25.6 19'5 21.6 21.5 18.3 South 34.5 34.0 29.4 33.6 32.8 36.0 39.1 36.5 West 21.4 24.6 22.9 220 25.1 25.8 20.0 28.8 "Substance dependence is a maladaptive pattern of substance use characterized by the concurrence of three or more criteria for substance dependence during a 12-month period, as defined in the DSM-IV (See Chapter 2). Includes dependence on alcohol, marijuana, cocaine, heroin, hallucinogens, inhalants, analgesics, tranquilizers, stimulants, and sedatives. * Includes full-time homemakers, non-working students, the retired, and the disabled. * Estimate suppressed due to low precision. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 34 Table 3.5 Annual Family Income Distribution and Percentage Designated Single Women Supporting a Family, who Received Supplemental Security Income (SSI) and Aid to Families with Dependent Children (AFDC), and who Lived in a Household that Received Food Stamps for Total Population Age 18-64 with and without a Substance Dependence’ by Employment Status (Weighted), 1994-96 Full-Time Part-Time Unemployed Not in Labor Force? Income Not Not Not Not Characteristic Dependent Dependent Dependent Dependent Dependent Dependent Dependent Dependent TOTAL 91,461 5,072 19,065 1,230 7,299 827 31,199 1,342 ANNUAL FAMILY INCOME 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% <$10,000 2.6 4.4 12.5 16.8 21.7 325 17.6 43.3 $10,000 - $19,999 10.4 18.7 16.3 23.1 23.4 21.1 23.2 24.7 $20,000 - $29,999 14.4 16.3 14.1 17.4 16.5 14.7 17.5 * $30,000 - $49,999 32.5 31.8 26.3 22.2 18.9 21.1 22.2 13.4 $50,000+ 40.1 28.8 30.8 20.6 19.5 * 19.5 %* SINGLE WOMAN SUPPORTING A FAMILY? 1.2 * 1.2 * 2.7 * 2.1 % RECEIVED SSI %* % ¥ ¥ 3.9 * 8.3 17.9 RECEIVED AFDC 0.9 * 29 %* 11.0 13.2 7.9 10.7 RECEIVED FOOD STAMPS 3.9 6.2 8.9 13.1 25.4 32.8 17.7 25.8 ' Substance dependence is a maladaptive pattern of substance use characterized by the concurrence of three or more criteria for substance dependence during a 12-month period, as defined in the DSM-IV (See Chapter 2). Includes dependence on alcohol, marijuana, cocaine, heroin, hallucinogens, inhalants, analgesics, tranquilizers, stimulants, and sedatives. 2 Includes full-time homemakers, non-working students, the retired, and the disabled. * Includes never married, widowed, divorced and separated women who live in a household with one or more children in which there is no other person designated as head of the household. * Estimate suppressed due to low precision. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 35 oC Table 3.6a Percentage of Total Population Age 18-64 with Probable Mental Health Diagnoses by Employment Status (Weighted), 1994-96 Total Full-Time Part-Time Unemployed Not in Labor Force! Mental Health TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED Syndrome (in 1000s) PERCENT _ (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT _ (in 1000s) PERCENT TOTAL 157,495 100.0% 96,533 100.0% 20,295 100.0% 8,126 100.0% 32,541 100.0% MAJOR DEPRESSIVE EPISODE 11,830 7.5 5,652 5.9 1,559 7.7 900 11.1 3,719 11.4 GENERAL ANXIETY DISORDER 3,448 22 1.527 1.6 425 21 228 2.8 1,267 3.9 AGORAPHOBIA 2,866 1.8 1,077 1:1 365 1.8 241 3.0 1,182 3.6 PANIC ATTACK 4,607 29 2,034 2.1 583 29 501 6.2 1,488 4.6 ' Includes full-time homemakers, non-working students, the retired, and the disabled. “ See Chapter 2 for description of how diagnoses were determined. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. Table 3.6b Percentage of Not in Labor Force Population Age 18-64 with Probable Mental Health Diagnoses by Category (Weighted), 1994-96 Not in Labor Force Full-Time Homemaker Non-Working Student Disabled TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED Mental Health Syndrome’ (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT TOTAL 32,541 100.0% 16,545 100.0% 5,284 100.0% 5,089 100.0% MAJOR DEPRESSIVE EPISODE 3,703 11.4 1,718 10.4 531 10.1 1,133 223 ANXIETY DISORDER? 3,049 9.4 1,273 7:7 330 6.3 1,028 20.2 Note: Data for retired were omitted from this table due to low statistical precision. ' See Chapter 2 for description of how diagnoses were determined. Includes general anxiety disorder, agoraphobia, and panic attack. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. CHAPTER 4: SUBSTANCE USE AND MENTAL HEALTH CHARACTERISTICS OF AFDC RECIPIENTS Substance use among welfare recipients may have important implications for welfare reform, especially welfare-to-work programs. As stated earlier, substance-use related impairment may substantially affect participation in education and job training programs (OASPE, 1994). This chapter describes the substance use and mental health characteristics of welfare recipients, specifically those who receive Aid to Families with Dependent Children (AFDC). Three percent of the total population age 18-64 received AFDC. The unemployed, followed by those not in the labor force, were the most likely to be AFDC recipients (See Table A.2b). In this chapter, where possible, the patterns of substance use and mental health concerns of AFDC recipients are compared with non-recipients and those of the overall working-age population. Implications of the findings are discussed in Chapter 5. Substance Use As indicated in Figure 4.1, similar to the overall working-age population, AFDC recipients who were not in the labor force were the least likely to report that they had ever used alcohol or marijuana. As indicated in Figures 4.2 and 4.3, AFDC recipients who were not in the labor force were also the least likely to report past-year and past-month alcohol use (See Table 4.1). However, there were no other significant differences in the reported substance use of AFDC recipients by employment status. Figure 4.1 Percentage of Working-Age Population Reporting Substance Use in their Lifetime by Employment Status 100% 100% — ° 2% 88% 89% ali 88% 1% g kd 80% 1 | 60% - 40% - 7% 16% 5% 20% - 3% | 0% Part-Time Not in Labor Force Part-Time Not in Labor Force Full-Time Unemployed Full-Time Unemployed =H Alcohol = Alcohol iE Marijuana || Marijuana /) Other Illicit Drugs Other Illicit Drugs Overall Population AFDC Recipients Source: OAS, SAMHSA, NHSDA, 1994-96. 37 Figure 4.2 Percentage of Working-Age AFDC Recipients Reporting Substance Use in the Past Year by Employment Status 80% — 77% 78% -— — 1 68% | BE 2 60% - — 57% 40% a, — 20% = 0% £ - Part-Time Not in Labor Force Full-Time Unemployed = Alcohol Ei Marijuana Source: OAS, SAMHSA, NHSDA, 1994-96. Figure 4.3 Percentage of Working-Age AFDC Recipients Reporting Alcohol Use in the Past Month by Employment Status 80% 60% | so% 54% 53% 40% 408s 5 = 20% — 0% — _ Part-Time Not in Labor Force Full-Time Unemployed Source: OAS, SAMHSA, NHSDA, 1994-96. 38 Generally, the prevalence of substance use among AFDC recipients was similar to the prevalence of substance use among the unemployed. In order to further examine the prevalence of substance use among AFDC recipients relative to the overall working-age population, Table 4.2 contains the percentage of the working-age population reporting substance use who were AFDC recipients. If substance use were not more common among AFDC recipients, then these percentages should roughly approximate the percentage of AFDC recipients in the overall working-age population. In fact, substance use was not more common among AFDC recipients with full-time or part-time employment or those who were unemployed. As shown in Table 4.2, approximately one percent of those employed full-time, three percent of those employed part-time, and 11 percent of the unemployed who reported lifetime, past-year, and past-month substance use were AFDC recipients. These percentages roughly approximate the overall percentage of AFDC recipients in each of these employment categories (1%, 3%, and 11%, respectively). By contrast, while eight percent of those not in the labor force were AFDC recipients, between 12 and 16 percent of those not in the labor force who reported illicit drug use were AFDC recipients (See Figure 4.4). Figure 4.4 Percentage of Not in Labor Force Population Reporting Substance Use who Received AFDC by Substance Used 40% | 30% | 20% | 16% 15%, 5 149% 15% 149 10% | 0% Marijuana Alcohol Other Illicit Drugs = Lifetime ii Past-Year Past-Month Source: OAS, SAMHSA, NHSDA, 1994-96. 39 Binge and Heavy Drinking Among AFDC recipients who were past-month alcohol users, more than half of full-time workers and those not in the labor force reported that they usually consumed between two and four drinks on the days they drank (55% for both groups; See Table 4.3). Nearly one-quarter of AFDC recipients who were not in the labor force and current alcohol users (24%) usually consumed five or more drinks per day. As indicated in Figure 4.5, more than one-third of AFDC recipients in each employment category who were current alcohol users reported past month binge drinking (See Table 4.3). This prevalence of binge drinking was similar to that of the overall working-age population (See Table 3.2a). Figure 4.5 Percentage of Working-Age Past-Month Alcohol Users Reporting Past-Month Binge Drinking by Employment Status 60% — 60% | 46% | 45% 40% - 40% | 38% J 35% | 34% 35% 29% 30% | 20% - 20% —| 1 | 0% : - : 0% - -. - Part-Time Not in Labor Force Part-Time Not in Labor Force Full-Time Unemployed Full-Time Unemployed Overall Population AFDC Recipients Source: OAS, SAMHSA, NHSDA, 1994-96. Substance Dependence and Other Mental Health Concerns Among AFDC recipients, the unemployed were more likely than those not in the labor force to have a substance dependence. Twelve percent of unemployed AFDC recipients were dependent on alcohol or drugs. By contrast, AFDC recipients who were part-time workers or not in the labor force were more likely than AFDC recipients with full-time employment to have a probable diagnosis for a major depressive episode, a general anxiety disorder, agoraphobia, or panic attack. More than one-quarter of part-time workers and those not in the labor force who were AFDC recipients (27% and 28%, respectively) had one of these syndromes. 40 Table 4.1 Percentage of Population Age 18-64 who Received Aid to Families with Dependent Children (AFDC) Reporting Lifetime, Past-Year, and Past-Month Substance Use by Employment Status (Weighted), 1994-96 Total Full-Time Part-Time Unemployed Not in Labor Force' TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT Substance TOTAL 4,990 100.0% 865 0.9% 605 3.0% 911 11.2% 2,608 8.0% ALCOHOL Lifetime 4,083 81.8 775 89.6 530 87.6 772 84.7 2,005 76.9 Past Year 3,238 64.9 669 77.3 470 77.6 615 67.5 1,485 56.9 Past Month 2,339 46.9 465 53.7 357 58.9 487 53.4 1,030 39.5 MARIJUANA Lifetime 2,233 44.7 422 48.7 302 49.9 460 50.5 1,049 40.2 Past Year 693 13.9 139 16.1 88 14.5 143 15.7 323 12.4 Past Month 429 8.6 * * * * 77 8.4 209 8.0 OTHER ILLICIT DRUGS? Lifetime 1,418 28.4 255 29.5 180 29.8 287 31.5 559 26.6 Past Year 468 9.4 % * * * 102 11.1 227 8.7 Past Month 233 4.7 * * * * * * * * Note: Table reads, “81.8 percent of AFDC recipients used alcohol on at least one occasion in their lifetime.” !' Includes full-time homemakers, non-working students, the retired, and the disabled. 2 Includes cocaine, crack, heroin, hallucinogens, inhalants, and non-medical use of analgesics, tranquilizers, stimulants, and sedatives. * Estimate suppressed due to low precision. Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 41 Table 4.2 Percentage of Total Population Age 18-64 Reporting Lifetime, Past-Year, and Past-Month Substance Use who Received Aid to Families with Dependent Children (AFDC) by Employment Status (Weighted), 1994-96 Total Full-Time Part-Time Unemployed Not in Labor Force! TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT Substance TOTAL 4,990 3.2% 865 0.9% 605 3.0% 911 11.2% 2,608 8.0% ALCOHOL Lifetime 4,083 29 775 0.9 530 3.0 772 10.7 2,005 7.6 Past-Year 3,238 2.8 669 0.9 470 3.1 615 10.2 1,485 7.7 Past-Month 2.339 23 465 0.7 357 3.0 487 9.9 1,030 7:3 MARIJUANA Lifetime 2,233 3.6 422 1.0 302 4.0 460 12.0 1,049 11.9 Past-Year 693 4.6 * * * * 143 9.7 323 14.6 Past-Month 429 5.1 * * * * 77 83 209 16.2 OTHER ILLICIT DRUGS? Lifetime 1,418 39 255 1.1 180 3.8 287 11.3 559 13.7 Past-Year 468 51 805 1.5 59 4.2 102 9.8 227 15.0 Past-Month 233 5.5 * * * * * ¥ 104 13.8 Note: Table reads “2.9% of respondents who reported using alcohol in their lifetime were AFDC recipients.” "Includes full-time homemakers, non-working students, the retired, and the disabled. ? Includes cocaine, crack, heroin, hallucinogens, inhalants, and non-medical use of analgesics, tranquilizers, stimulants, and sedatives. * Estimate suppressed due to low precision. Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 42 ey Table 4.3 Distribution of Usual Number of Drinks per Day on Days Drank and Percentage Reporting Past-Month Binge and Heavy Drinking for Past-Month Alcohol Users Age 18-64 who Received Aid to Families with Dependent Children (AFDC) by Employment Status (Weighted), 1994-96 Total Full-Time Part-Time Unemployed Not in Labor Force! TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED Alcohol Use (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT TOTAL 2,339 100.0% 465 100.0% 357 100.0% 487 100.0% 1,030 100.0% USUAL NUMBER OF DRINKS PER DAY ON DAYS DRANK 100.0% 100.0% 100.0% 100.0% 100.0% 1 drink 488 22.8 * * * * 108 235 198 21.1 2 - 4 drinks 1,136 53.0 223 55.4 * * 221 48.0 516 55.0 5+ drinks 517 24.2 * * * * 131 28.4 223 23.8 REPORTED BINGE DRINKING? 765 37.2 149 37.5 113 33.5 192 45.1 311 34.7 REPORTED HEAVY DRINKING? 275 13.4 * * * ¥ * * 114 12.7 "Includes full-time homemakers, non-working students, the retired, and the disabled. 2 Had at least five drinks on the same occasion on at least one day. 3 Had at least five drinks on one occasion on at least five days. * Estimate suppressed due to low precision. Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. Table 4.4 Percentage of Population Age 18-64 who Received Aid to Families with Dependent Children (AFDC) with a Substance Dependence and Probable Mental Health Diagnoses by Employment Status (Weighted), 1994-96 Total Full-Time Part-Time Unemployed Not in Labor Force! TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED TOTAL WEIGHTED (in 1000s) PERCENT (in 1000s) PERCENT (in 1000s) PERCENT __ (in 1000s) PERCENT _ (in 1000s) PERCENT TOTAL 100.0% 100.0% 100.0% 100.0% 100.0% & Substance Dependence’ 373 7.5 69 * 51 *® 109 12.0 144 55 Other Mental Health Concern’ 1,209 24.2 134 15.5 161 26.6 188 20.6 727 27.9 "Includes full-time homemakers, non-working students, the retired, and the disabled. ? Substance dependence is a maladaptive pattern of substance use characterized by the concurrence of three or more criteria for substance dependence during a 12-month period, as defined in the DSM-IV (See Chapter 2). Includes dependence on alcohol, marijuana, cocaine, heroin, inhalants, analgesics, tranquilizers, stimulants, and sedatives. * Includes major depressive episode, general anxiety disorder, agoraphobia, and panic attack. See Chapter 2 for description of how diagnoses were determined. * Estimate suppressed due to low precision Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. CHAPTER 5: CONCLUSIONS This report examines data from the combined 1994-96 National Household Survey on Drug Abuse (NHSDA) to estimate the prevalence of alcohol and illicit drug use/dependence and other mental health issues among the working-age population. Data were taken from 38,501 NHSDA respondents age 18-64, who represent over 157 million people. In general, the prevalence of both drug use and dependence were higher for the unemployed than for those with either full-time or part-time employment. However, the prevalence of alcohol use was higher for those with full-time employment than for the unemployed. Those not in the labor force (i.e., full-time homemakers, non-working students, the retired, and the disabled) were the least likely to report alcohol and/or illicit drug use. Even though those employed full-time had the highest prevalence of past-month (i.e, current) alcohol use, current alcohol users who were unemployed or not in the labor force reported consuming larger quantities of alcohol than current alcohol users who were employed full-time. Nearly half of unemployed current alcohol users reported past-month binge drinking. Greater alcohol use among those not in the labor force was due primarily to the high prevalence of binge and heavy drinking among non-working students and the disabled. Half of non-working students who were current alcohol users reported past-month binge drinking, and more than one- quarter of current alcohol users who were disabled reported past-month heavy drinking. As stated earlier, drug dependence was most common among the unemployed. In addition, alcohol dependence was also more common among the unemployed. In all employment categories, substance dependence was more prevalent among past-month heavy drinkers. In general, regardless of employment status, those who were substance dependent were predictably younger, and more likely to be male, never married, and the past-year recipients of food stamps. In every employment category except for not in the labor force, compared to those without a substance dependence, those with a substance dependence were less educated. The unemployed and those not in the labor force were more likely than those employed full-time or part-time to report other mental health issues. In particular, the unemployed and those not in the labor force were more likely to have experienced a probable major depressive episode in the past year. More than ten percent of both the unemployed and those not in the labor force had experienced a major depressive episode. Among those not in the labor force, mental health syndromes were most common among the disabled. The disabled were two to three times as likely as the entire not in the labor force population to report one of the four mental health syndromes examined. 45 Consistent with earlier studies, the prevalence of illicit drug use, but not alcohol use, was higher among recipients of Aid to Families with Dependent Children (AFDC) than among the overall population. The prevalence of substance dependence and other mental health syndromes was also higher among AFDC recipients than the overall population. However, unlike in the overall population, there were few differences in reported substance use by employment status for AFDC recipients. The data presented in this report may be used to guide the development of appropriate policies and prevention/intervention programs. However, there are several limitations to the data and analyses presented in this report that must be considered when interpreting the findings. Consistent with earlier research, the data presented in this report indicate that the unemployed have higher rates of illicit drug use than the working; and those not in the labor force have the lowest rates of substance use. These data also suggest that the unemployed, non- working students, and the disabled also have high rates of heavy alcohol use. Unfortunately, these data do not allow for causal statements about unemployment and drug use. The unemployed and the disabled are generally less educated and have lower incomes, characteristics that are also associated with higher rates of substance use. The data and analyses presented in this report do not allow for the determination of whether the differences in substance use patterns are related to employment status or these other demographic characteristics. We also cannot determine whether the substance abuse and mental health issues precede the unemployment or vice versa. Further analysis is needed in order to make any causal inferences, as well as to control for the effects of any variables that may confound the relationship of interest. Unfortunately, the unemployed do not have access to the same types of programs/resources available to the working population (e.g., health care and employee assistance programs). Therefore, targeting efforts to this group is difficult. The disabled and non-working students may be more easily targeted through, for example, school organizations and programs sponsored by the Social Security Administration. Finally, the data presented in this report suggest the need for targeted substance abuse treatment efforts for welfare recipients. As stated earlier, substance use can be viewed as a major obstacle to economic self-sufficiency. Given the higher prevalence of illicit drug use among AFDC recipients and the lack of a relationship between employment status and substance use for AFDC recipients, there would be substantial economic benefits to providing treatment to substance-abusing AFDC recipients in order to foster and facilitate the goals of welfare reform: work and responsibility (Grant & Dawson, 1996; Gerstein et al., 1997). 46 REFERENCES American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV). Washington, DC: American Psychiatric Association. Gerstein, D. R., Johnson, R. A., Larison, C. L., Harwood, H. J., & Fountain, D. (1997). Alcohol and Other Drug Treatment for Parents and Welfare Recipients: Outcomes, Costs, and Benefits (A final report prepared under contract HHS-100-95-0036). Rockville, MD: U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. Grant, B. F., & Dawson, D. A. (1996). Alcohol and Drug Use, Abuse, and Dependence among Welfare Recipients. American Journal of Public Health, 86, 1450-1454. Harrell, A.V., & Peterson, G. E. (eds.) (1992). Drugs, Crime, and Social Isolation: Barriers to Urban Opportunity. Washington, D.C.: Urban Institute Press. Harwood, H., Fountain, D., Livermore, G. et al. (1998). The Economic Costs of Alcohol and Drug Abuse in the United States, 1992. Bethesda, MD: National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism. Hoffmann, J. P., Brittingham, A., & Larison, C. (1996). Drug Use Among U.S. Workers: Prevalence and Trends by Occupation and Industry Categories. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Office of Applied Studies, SAMHSA. (1998a). National Household Survey on Drug Abuse: Main Findings 1996. Rockville, MD: U.S. Department of Health and Human Services. Office of Applied Studies, SAMHSA. (1998b). Substance Abuse and Mental Health Statistics Source Book 1998. Rockville, MD: U.S. Department of Health and Human Services. Office of Applied Studies, SAMHSA. (1997). National Household Survey on Drug Abuse Methodological Resource Book. Rockville, MD: U.S. Department of Health and Human Services. 47 Office of Applied Studies, SAMHSA. (1996). National Household Survey on Drug Abuse Methodological Resource Book. Rockville, MD: U.S. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. (1994). Patterns of Substance Abuse and Substance-Related Impairment among Participants in the Aid to Families with Dependent Children Program (AFDC). Rockville, MD: U.S. Department of Health and Human Services. Perrucci, R., & Perrucci C. C. (1990). Unemployment and Mental Health: Research and Policy Implications. In J. R. Greenley (ed.), Mental Disorder in Social Context (pp 237-264). Greenwich, CT: JAI Press. Sisco, C. B., & Pearson, C. L. (1994). Prevalence of Alcoholism and Drug Abuse among Female AFDC Recipients. Health & Social Work, 19(1), 75-77. 48 APPENDIX A: DEMOGRAPHIC AND INCOME CHARACTERISTICS BY EMPLOYMENT STATUS This appendix presents combined data from the 1994-96 NHSDA on the demographic and income characteristics of 38,501 NHSDA respondents age 18-64, who represent more than 157 million working-age persons. The purpose of this chapter is to describe demographic and economic differences among the four employment categories that may be related to differences in the prevalence of substance abuse and mental health concerns in these groups. Table A.1a presents the demographic distribution of the entire working-age population. Table A.1b presents demographic distributions within each employment status, while Table A.lc presents demographic distributions by gender within each employment status, and Table A.1d presents demographic distributions within each not in the labor force category. Gender Although only slightly more than half (52%) of the working-age population was female (See Table A.la), about seven out of 10 part-time workers and of those not in the labor force were female (71% in each group; See Table A.1b). The not in the labor force population was predominately female because nearly all full-time homemakers, who were about half of the not in the labor force population, were female (See Table A.1d). Age Those not in the labor force were generally older than the remainder of the working-age population. As indicated in Table A.1b, those not in the labor force were more likely than full- time and part-time workers to be age 55-64, and less likely than all others to be age 25-44. However, as indicated in Table A.1c, within the not in the labor force population, males were generally older than females. Males who were not in the labor force were 4.5 times as likely as males with full-time employment to be age 55-64, while females who were not in the labor force were only 2.5 times as likely as females employed full-time to be age 55-64. This is primarily because within the not in the labor force population, the retired and the disabled, which were predominately male groups, were more likely than full-time homemakers, which was an almost entirely female group, to be age 55-64 (See Table A.1d). Race/Ethnicity Given that nearly three-quarters (74%) of the working-age population was non-Hispanic white (See Table A.1a), the unemployed were disproportionately nonwhite (See Table A.1b). In particular, non-Hispanic blacks were disproportionately unemployed relative to their representation in the overall population (22% of the unemployed vs. 12% of the entire working- 49 age population). As shown in Table A.1d, within the not in the labor force population, the retired were the most likely to be non-Hispanic white, while the disabled were the most likely to be non- Hispanic black. Education As indicated in Table A.1b, the unemployed and those not in the labor force generally had less education than those with either full-time or part-time employment. Both the unemployed and those not in the labor force were less likely than full-time and part-time workers to be college graduates (17% and 13% vs. 31% and 23%, respectively). In addition, the not in the labor force population was the most likely to have less than a high school education. As shown in Table A.1d, within the not in the labor force population, the disabled generally had the least amount of education. Marital Status As shown in Table A.1b, the unemployed were the least likely to be married (42%) and the most likely to have never been married (42%). Conversely, the not in the labor force population was the most likely to be married (66%), while both those not in the labor force and full-time workers were the least likely to have never been married (21% and 23%, respectively). For the not in the labor force population, this pattern was due primarily to the fact that full-time homemakers, half of the not in the labor force population, were very likely to be married (83%; See Table A.1d). As indicated in Table A.lc, however, there were gender differences in marital status within the employment categories. Among females, the pattern was the same as in the total population (i.e., not in labor force were the most likely to be married and the least likely to have never been married). By contrast, among males, full-time workers were the most likely to be married, while part-time workers were the most likely to have never been married. Region Full-time and part-time workers were more likely than the unemployed and those not in the labor force to be from the North Central region of the country (25% and 26% vs. 20% and 21%, respectively), and those not in the labor force were the most likely to be from the South (39%; See Table A.1b). Within the not in the labor force population, the disabled were more likely than full-time homemakers and non-working students to be from the South. In fact, nearly half (47%) of the disabled were from the South (See Table A.1d). Table A.2a presents the income distribution of the entire working-age population. Table A.2b presents income distributions within each employment status, while Table A.2c presents income distributions by gender within each employment status, and Table A.2d presents income distributions within each not in the labor force category. 50 Annual Family Income The unemployed and those not in the labor force generally had lower annual family incomes than those with either full-time or part-time employment. The unemployed were the most likely to have an annual family income less than $10,000 (23%). By contrast, full-time workers were the most likely to have an annual family income of at least $30,000 (72%; See Table A.2b). Within the not in the labor force population, the disabled generally had the lowest annual family incomes (See Table A.2d). Single Women Supporting a Family As shown in Table A.2a, two percent of the total population age 18-64 were designated single women supporting a family. A significantly higher percentage of the unemployed and those not in the labor force than of full-time or part-time workers were single women supporting a family (See Table A.2b). In fact, six percent of all unemployed women were single women supporting a family (See Table A.2c). Additional Sources of Income Those not in the labor force were more than twice as likely as the unemployed to receive Supplemental Security Income (SSI; See Table A.2b). In fact, males who were not in the labor force were particularly likely to receive SSI. Males who were not in the labor force were five times as likely as the total population to receive SSI (15% and 3%, respectively; See Tables A.2a and A.2c). This finding is due primarily to the fact that more than one-third of the disabled (35%), which was a predominately male group, received SSI (See Table A.2d). The unemployed were the most likely to receive Aid to Families with Dependent Children (AFDC). In fact, the unemployed were more than 10 times as likely as full-time workers to receive AFDC (11% and 1%, respectively; See Table A.2b). The not in the labor force population was also more likely than full-time and part-time workers to receive AFDC (8% vs. 1% and 3%, respectively). The unemployed were also the most likely to live in a household that received food stamps. As shown in Table A.2b, the unemployed were nearly 6.5 times as likely as full-time workers to live in a household that received food stamps (26% and 4%, respectively). In addition, the not in the labor force population was nearly 4.5 times as likely as full-time workers to live in a household that received food stamps (18% and 4%, respectively). This was due primarily to the fact that nearly 40 percent of the disabled lived in a household that received food stamps (See Table A.2d). 51 Table A.1a Gender, Age, Racial/Ethnic, Educational, Marital, and Regional Distribution of Total Population Age 18-64 (Weighted), 1994-96 Demographic TOTAL WEIGHTED Characteristic (in 1000s) PERCENT TOTAL 157,495 100.0% GENDER 100.0% Male 75,942 48.2 Female 81,553 51.8 AGE 100.0% 18-19 Yrs 7,200 4.6 20-24 Yrs 16,894 10.7 25-34 Yrs 39,799 25.3 35-44 Yrs 41,631 26.4 45-54 Yrs 30,616 19.4 55-64 Yrs 21,355 13.6 RACE/ETHNICITY 100.0% White 117,075 74.3 Black 18,192 11.6 Hispanic 15,752 10.0 Other 6,477 4.1 EDUCATION 100.0% High school 0.92 1.85 1.39 3.36 2.09 3.59 1.39 4.58 MARITAL STATUS Married 0.64 2.21 1.47 2.97 2.04 3.39 1.12 3.34 Wid./Div./Sep. 0.41 1.61 1.00 * 1.26 3.72 0.74 4.57 Never married 0.46 2.06 1.15 3.24 1.60 4.08 0.91 4.75 REGION Northeast 0.85 1.99 1.50 2.90 1.83 2.16 1.51 3.50 North Central 1.06 2.51 1.66 359 1.93 2.92 1.24 3.32 South 0.93 2.26 1.37 3.56 1.91 3.50 1.69 4.74 West 0.84 232 1.38 3.20 1.72 3.32 1.11 4.29 "Substance dependence is a maladaptive pattern of substance use characterized by the concurrence of three or more criteria for substance dependence during a 12-month period, as defined in the DSM-IV (See Chapter 2). Includes dependence on alcohol, marijuana, cocaine, heroin, hallucinogens, inhalants, analgesics, tranquilizers, stimulants, and sedatives. * Includes full-time homemakers, non-working students, the retired, and the disabled. * Estimate suppressed due to low precision. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 68 Table SE3.5 Annual Family Income Distribution and Percentage Designated Single Women Supporting a Family, who Received Supplemental Security Income (SSI) and Aid to Families with Dependent Children (AFDC), and who Lived in a Household that Received Food Stamps for Total Population Age 18-64 with and without a Substance Dependence’ by Employment Status (STANDARD ERRORS), 1994-96 Full-Time Part-Time Unemployed Not in Labor Force? Income Not Not Not Not Characteristic Dependent Dependent Dependent Dependent Dependent Dependent Dependent Dependent ANNUAL FAMILY INCOME <$10,000 0.16 0.66 1.02 2.41 1.51 3.47 0.94 4.21 $10,000 - $19,999 0.34 1.65 1.04 2.63 1.34 2.75 1.21 3.10 $20,000 - $29,999 0.45 1.39 0.93 2.79 1.25 3.01 0.99 * $30,000 - $49,999 0.66 2.14 1.20 2.55 1.40 2.75 0.95 2.44 $50,000+ 0.88 2.05 1.57 2.70 1.99 * 1.20 % SINGLE WOMAN SUPPORTING A FAMILY? 0.09 * 0.18 ¥ 0.30 * 0.17 * RECEIVED SSI * * * * 0.57 * 0.68 4.32 RECEIVED AFDC 0.08 * 0.32 * 0.92 2.00 0.38 1.76 RECEIVED FOOD STAMPS 0.19 0.76 0.74 1.88 1.54 3.11 0.92 3.17 "Substance dependence is a maladaptive pattern of substance use characterized by the concurrence of three or more criteria for substance dependence during a 12-month period, as defined in the DSM-IV (See Chapter 2). Includes dependence on alcohol, marijuana, cocaine, heroin, hallucinogens, inhalants, analgesics, tranquilizers, stimulants, and sedatives. 2 Includes full-time homemakers, non-working students, the retired, and the disabled. Includes never married, widowed, divorced and separated women who live in a household with one or more children in which there is no other person designated as head of the household. * Estimate suppressed due to low precision. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 69 Table SE3.6a Percentage of Total Population Age 18-64 with Probable Mental Health Diagnoses by Employment Status (STANDARD ERRORS), 1994-96 Mental Health Not in Labor Syndrome’ Total Full-Time Part-Time Unemployed Force’ MAJOR DEPRESSIVE EPISODE 0.23 0.26 0.54 0.80 0.68 GENERAL ANXIETY DISORDER 0.13 0.15 0.27 0.39 0.41 AGORAPHOBIA 0.12 0.10 0.23 0.51 0.44 PANIC ATTACK 0.17 0.17 0.30 0.84 0.43 "See Chapter 2 for description of how diagnoses were determined. ? Includes full-time homemakers, non-working students, the retired, and the disabled. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. Table SE3.6b Percentage of Not in Labor Force Population Age 18-64 with Probable Mental Health Diagnoses by Category (STANDARD ERRORS), 1994-96 Mental Health Not in Labor Force Full-Time Non-Working Syndrome’ Population Homemaker Student Disabled MAJOR DEPRESSIVE EPISODE 0.68 0.91 0.88 1.94 ANXIETY DISORDER? 0.41 0.45 0.31 1.83 ' See Chapter 2 for description of how diagnoses were determined. ? Includes general anxiety disorder, agoraphobia, and panic attack. Note: Data for the retired were omitted from this table due to low precision. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 70 Table SE4.1 Percentage of Population Age 18-64 who Received Aid to Families with Dependent Children (AFDC) Reporting Lifetime, Past-Year, and Past-Month Substance Use by Employment Status (STANDARD ERRORS), 1994-96 Substance Total Full-Time Part-Time Unemployed Not in Labor Force! ALCOHOL Lifetime 1.13 1.80 2.49 1.98 1.74 Past Year 1.56 2.80 3.18 3.39 2.07 Past Month 1.55 5.14 4.23 3.57 1.77 MARIJUANA Lifetime 1.40 4.31 4.45 3.53 1.69 Past Year 0.95 2.34 2.82 255 0.99 Past Month 0.70 % * 1.34 0.83 OTHER ILLICIT DRUGS? Lifetime 1.34 3.50 3.51 3.81 1.61 Past Year 0.59 * * 1.34 0.76 Past Month 0.46 * * % * Includes full-time homemakers, non-working students, the retired, and the disabled. 2 Includes cocaine, crack, heroin, hallucinogens, inhalants, and non-medical use of analgesics, tranquilizers, stimulants, and sedatives. * Estimates suppressed due to low precision. Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 7 Table SE4.2 Percentage of Total Population Age 18-64 Reporting Lifetime, Past-Year, and Past-Month Substance Use who Received Aid to Families with Dependent Children (AFDC) by Employment Status (STANDARD ERRORS), 1994-96 Substance Total Full-Time Part-Time Unemployed Not in Labor Force’ ALCOHOL Lifetime 0.13 0.08 0.33 0.95 0.40 Past Year 0.13 0.09 0.38 0.97 0.46 Past Month 0.13 0.08 0.42 1.12 0.50 MARIJUANA Lifetime 0.20 0.10 0.53 1.40 0.75 Past Year 0.37 * * 1.69 1.53 Past Month 0.47 ud * 1.28 2.02 OTHER ILLICIT DRUGS? Lifetime 0.29 0.18 0.60 1.87 1.13 Past Year 0.41 0.39 1.17 1.74 1.83 Past Month 0.65 * * * 2.53 "Includes full-time homemakers, non-working students, the retired, and the disabled. ? Includes cocaine, crack, heroin, hallucinogens, inhalants, and non-medical use of analgesics, tranquilizers, stimulants, and sedatives. * Estimates suppressed due to low precision. Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 72 Table SE4.3 Distribution of Usual Number of Drinks per Day on Days Drank and Percentage Reporting Past-Month Binge and Heavy Drinking for Past-Month Alcohol Users Age 18-64 who Received Aid to Families with Dependent Children (AFDC) by Employment Status (STANDARD ERRORS), 1994-96 Not in Labor Alcohol Use Total Full-Time Part-Time Unemployed Force' USUAL NUMBER OF DRINKS PER DAY ON DAYS DRANK 1 drink 1.74 * * 3.63 2.40 2 - 4 drinks 1.98 5.07 * 4.53 3.13 5+ drinks 1.78 * * 4.24 2.63 REPORTED BINGE DRINKING? 2.21 5.61 6.09 5.12 3.03 REPORTED HEAVY DRINKING? 1.29 * * * 1.84 Includes full-time homemakers, non-working students, the retired, and the disabled. 2 Had five or more drinks on the same occasion on at least one day. 3 Had five or more drinks on one occasion on five or more days. * Estimate suppressed due to low precision. Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 73 Table SE4.4 Percentage of Population Age 18-64 who Received Aid to Families with Dependent Children (AFDC) with a Substance Dependence and Probable Mental Health Diagnoses by Employment Status (STANDARD ERRORS), 1994-96 Substance Not in Labor Dependence Total Full-Time Part-Time Unemployed Force' Substance Dependence * 0.66 * * 1.94 0.72 Other Mental Health Concern? 1.47 2.52 4.09 2.77 2.11 "Includes full-time homemakers, non-working students, the retired, and the disabled. * Substance dependence is a maladaptive pattern of substance use characterized by the concurrence of three or more criteria for substance dependence during a 12-month period, as defined in the DSM-IV (See Chapter 2). Includes dependence on alcohol, marijuana, cocaine, heroin, inhalants, analgesics, tranquilizers, stimulants, and sedatives. * Includes major depressive episode, general anxiety disorder, agoraphobia, and panic attack. * Estimate suppressed due to low precision Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-96. 74 Table SEA.1b Gender, Age, Racial/Ethnic, Educational, Marital, and Regional Distribution of Total Population Age 18-64 by Employment Status (STANDARD ERRORS), 1994-96 Demographic Characteristic Full-Time Part-Time Unemployed Not in Labor Force! GENDER Male 0.53 1.32 1.70 1.15 Female 0.53 1.32 1.70 1.15 AGE 18-19 Yrs 0.08 0.49 0.57 0.46 20-24 Yrs 0.24 0.89 0.89 0.64 25-34 Yrs 0.47 0.77 1.22 0.52 35-44 Yrs 0.56 1.08 1.44 0.91 45-54 Yrs 0.53 1.27 1.99 0.76 55-64 Yrs 0.51 1.40 * 1.39 RACE/ETHNICITY White 0.70 1.11 1.92 1.18 Black 0.51 0.53 1.29 0.73 Hispanic 0.31 0.51 0.79 0.52 Other 0.36 0.75 1.14 0.54 EDUCATION