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What’s the matter with Georgia? Thoughts on substance abuse statistics, policy, and history

Updated: Aug 30, 2023

Last month, I attended the American Public Health Association conference in San Francisco. While there were many interest groups  and high-profile lectures that appealed to my interest in the history of addiction, I wound up spending most of my time at the Public Health Expo. In a stadium-like open space, my research team’s posters competed for attention with potential employers, university recruiters, and lots of public health swag.

Public Health swag!

As I was making the rounds, I stopped by the SAMDHA table. SAMDHA —short for the Substance Abuse and Mental Health Data Archive—is a fabulous database of survey results collected by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The University of Michigan’s Inter-University Consortium for Political and Social Research (ICPSR) maintains the archive, from which researchers or quant-savvy members of the public can download datasets and run analyses using a range of different statistical software programs. They can also use the online analysis tool provided on the SAMDHA website.

Finding this tool even cooler than swag, I asked the representative to help me run some basic descriptive statistics about Georgia’s alcoholism treatment admissions, drawn from the Treatment Episode Data Set (or TEDS) survey. We clicked through the site to the analysis tool, and clicked again. No data. We tried another year—no luck. Toggling through the site, we discovered that Georgia had not reported its treatment data to SAMHSA since 2006—and that it was the only state to fail to do so.

Wait.. where’s Georgia’s data?

Since 2006, there have been big changes in Georgia’s substance abuse policies. Governor Nathan Deal (a former Democrat who switched parties in 1995) was elected in 2010 and immediately began an overhaul of the substance abuse policies that had driven Georgia’s rate of incarceration, which was among the highest in the nation. While pursuing other austerity measures for the cash-strapped state, Deal recommended over $5 million for the creation of residential substance abuse treatment centers and $10 million to support the creation of new drug courts that would divert offenders from jail and prison. The Obama administration and other media outlets hailed Deal’s enlightened drug policy. But without accessible TEDS data from previous years, it will be more difficult for the public to evaluate the impact of policies designed to increase access to residential addiction treatment or encourage treatment rather than incarceration.

The rapid expansion of addiction treatment and drug courts was accompanied, ironically, with a populist challenge to Georgia’s long-standing Blue Laws. A coalition of libertarians, fiscal conservatives, and unchurched beer enthusiasts passed ballot initiatives allowing Georgia counties to overturn the state-wide ban on Sunday alcohol sales. Of the 128 cities that placed Sunday sales on the November 2011 ballot, 105 approved the referendum. While several extra hours of access might not lead to an increase in individuals seeking alcoholism treatment, the circumstance is exactly the kind of natural experiment that has occupied alcohol policy researchers—and historians—for decades. That is, when they can get the statistics.

Georgia: finally totally red [Source: Creative Loafing Atlanta]

Scholars will face a challenge in determining whether the new Georgia policies moved population-level treatment data. According to my later correspondence with a SAMDHA representative, the state reportedly “had issues with their data system contractors” which “caused them to have no data in the TEDS database since 2006.” The problem has apparently been solved, and figures will be reported again beginning with 2011. The five years of data from 2006-2010 is probably lost.

I admit, I was disappointed— until it occurred me that the missing survey data makes early twenty-first century Georgia a lot like the vast expanse of alcohol and drugs history. Most of the blockbuster surveys that fall under SAMHSA’s purview today—including studies like the Drug Abuse Warning Network (DAWN) and the National Survey on Drug Use and Health (NSDUH) — didn’t get underway until the 1970s, when federal officials began viewing addiction as a large-scale social problem and promoting the expansion of drug treatment.

The surveys like TEDS and DAWN work a lot like the epidemiological approach to monitoring diseases: hospitals or treatment centers report cases of drug overdose or drug treatment admission up the chain of command. When states report the cases to the federal government, officials are able to analyze particular areas of interest, identify national trends, and coordinate appropriate responses. The research process is far from perfect—there are some lively debates in early National Institute on Drug Abuse publications— but I still view the longevity of surveys like TEDS as evidence of a moment in which government officials sought to align new drug policies like the promotion of treatment with an ambitious national research agenda. The studies continue to be a wonderful resource for historians as well as policymakers.

In the absence of representative national survey data, we synthesize secondary data, estimate, and speculate. Those three useful tools have inspired provocative arguments about the validity of addiction statistics from the Anslinger era, or the hypothesis that national alcohol Prohibition was a short-lived public health success. But the systematic, national, population-based research of the last 40 years helps us say with some confidence that, for example, marijuana is making a comeback among youth or the main source for non-medical prescription drug use is doctors, not dealers. While all surveys have limitations, the insights they provide offer a useful starting point for research questions and plenty of fodder for historical interpretation.

Doctors, not dealers National Survey on Drug Use and Health (NSDUH) 2011

One scholar summed up the importance of Census data to historians thusly:

“Imagine a history of the Revolutionary era written with Census returns. Imagine a history of the Civil War era written without them.” As an alcohol and drugs historian, you could say that the addiction treatment revival of the 1960s and 1970s is my Civil War, and surveys like TEDS are my Census.

And Georgia? It’s on the wrong side.

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