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Marion Greene, MPH SEOW Lead Epidemiologist Public Health Research Analyst

Trends in Alcohol, Tobacco, and Other Drug Use in Indiana Findings from the State Epidemiology and Outcomes Workgroup. Weekend U: Sex, Drugs and Rock and Roll March 8 th , 2014. Marion Greene, MPH SEOW Lead Epidemiologist Public Health Research Analyst PhD Student in Epidemiology.

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Marion Greene, MPH SEOW Lead Epidemiologist Public Health Research Analyst

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  1. Trends in Alcohol, Tobacco, and Other Drug Use in Indiana Findings from the State Epidemiology and Outcomes Workgroup Weekend U: Sex, Drugs and Rock and Roll March 8th, 2014 Marion Greene, MPH SEOW Lead Epidemiologist Public Health Research Analyst PhD Student in Epidemiology

  2. I have nothing to disclose.

  3. SEOW • Collaboration of members from various state agencies • Monitor substance abuse and its consequences in Indiana • Identify prevention priorities and ‘hot spots’ • Disseminate findings to legislators, prevention planners, and community organizations to encourage data-driven decision-making

  4. State Epidemiological Profiles • Annual publications (2006-2012) – currently working on 2013 report • Companion documents (fact sheets, related research briefs) • www.healthpolicy.iupui.edu

  5. Supplement to the 2012 State Epi Report • Returning veterans • (Ex-)offenders/reentry population • Individuals with co-occurring mental health and substance use disorder (dual diagnosis) • LGBT community

  6. Epidemiological Key Findings

  7. ALCOHOL • Continues to be the most widely used and abused substance • Over half of all Hoosiers 12+ years drank in the past month and nearly 23% engaged in binge drinking [1] • Highest rates of use among population ages 18-25 (61% past month; 42% binge drinking) • Underage drinking: 33% of high school students drank in past month and 20% binged [2]

  8. Underage drinking is a major concern NATIONWIDE. Key Concern: Underage Drinking Note: Lifetime and monthly alcohol use among 8th, 10th, and 12th graders Source: ATOD and MTF Surveys, 2012 [3, 4]

  9. High-risk behavior among 18- to 25-year-olds. Key Concern: Binge Drinking Among Young Adults Note: Estimates on binge drinking in the past month among 18- to 25-year-olds Source: National Survey on Drug Use and Health, 1999-2011 [1]

  10. TOBACCO • Cigarette smoking remains the leading cause of preventable death in the U.S. [10] • Nearly one-third of Hoosiers ages 12+ currently use a tobacco product [1] • Adult smoking prevalence in Indiana is 26% [5] • Rates significantly higher among people with lower educational attainment and income level • 8% of MS and 26% of HS children reported using tobacco in the past 30 days [6]

  11. Smoking-attributable mortality rate higher in Indiana than U.S. Key Concern: Mortality • ~14-year reduction in adult life expectancy [10] • Contributes to deaths from lung cancer, heart disease, chronic lung diseases, and other illnesses • Over 9,700 Hoosiers die annually from smoking-attributable causes. • Indiana’s smoking-attributable mortality rate (309 per 100,000) higher than U.S. rate (263 per 100,000)

  12. Highest rates among those with less education & low income. Key Concern: Smoking in Vulnerable Populations Note: Adult smoking prevalence Source: Behavioral Risk Factor Surveillance System, 2011 [5]

  13. MARIJUANA • Marijuana is the most commonly used illicit substance in the United States • Current use within Indiana’s population ages 12+ was 7% [1] • Prevalence highest among young adults ages 18-25 (18%) • Percentage of Indiana treatment admissions with marijuana use (46%) [7] • Highest use among males, blacks, and those under the age of 18

  14. Highest among 18- to 25-year-olds. Key Concern: Marijuana Use among Young Adults in Indiana Note: Estimates on current (past-month) marijuana use among 18- to 25-year-olds Source: National Survey on Drug Use and Health, 2000-2011 [1]

  15. Highest percentage among Hoosiers under the age of 18. Key Concern: Marijuana Use in Indiana’s Treatment Population Note: Marijuana use reported at treatment admission in Indiana, by age group Source: Treatment Episode Data System, 2000-2010 [7]

  16. COCAINE • Approximately 1% of Hoosiers ages 12+ reported past-year cocaine use [1] • Rates were highest among 18- to 25-year-olds (3%) • Percentage of Indiana treatment admissions with cocaine use (15%) [7] • Highest use among females, blacks, and people ages 35-54

  17. Highest percentage among black Hoosiers. Key Concern: Cocaine Use in Indiana’s Treatment Population Note: Cocaine use reported at treatment admission in Indiana Source: Treatment Episode Data System, 2010 [7]

  18. HEROIN • Heroin prevalence in the general population is fairly low makes it difficult to assess • 2.1% of Indiana’s 12th grade students reported having used heroin at least once in their lifetime [3] • Percentage of Indiana treatment admissions with heroin use (7%) [7] • More than doubled from 3% in 2001 to 7% in 2010

  19. Use increased among Hoosiers ages 18-34. Key Concern: Heroin Use in Indiana’s Treatment Population Note: Heroin use reported at treatment admission Source: Treatment Episode Data System, 2000-2010 [7]

  20. METHAMPHETAMINE (METH) • Meth prevalence in general population fairly low • Past-year use among Hoosiers ages 12+ is an estimated 0.8% [1] • Percentage of Indiana treatment admissions with reported meth use (9.3%) [7] • Highest use among females, whites, and people ages 25-34 • ISP clandestine meth lab seizures at an all-time high in 2012 (1,663) [8]

  21. Indiana’s percentage of tx admissions more than doubled. Key Concern: Meth Use in Indiana’s Treatment Population Note: Meth use reported at treatment admission Source: Treatment Episode Data System, 2000-2010 [7]

  22. Key Concern:Meth Labs in Indiana Meth lab seizures on the rise again. Source: Indiana State Police Lab Seizures, 1995-2012 [8]

  23. PRESCRIPTION (Rx) DRUGS • Most commonly abused types • Pain relievers (opioids) • CNS depressants (sedatives, tranquilizers) • Stimulants • 6% of Hoosiers ages 12+ reported nonmedical pain reliever use in past year [1] • Highest rate among 18-25 year-olds (14%) • Percentage of Indiana treatment admissions with Rx abuse (20%) [7] • Highest use among females, whites, and 25-34 year olds

  24. Controlled Rx Drugs Dispensed in Indiana • Source: Indiana Board of Pharmacy, 2012 [9]

  25. Indiana’s percentage above the nation. Key Concern: Rx Abuse in Indiana’sTreatment Population Note: Nonmedical Rx use reported at treatment admission Source: Treatment Episode Data System, 2000-2010 [7]

  26. POLYSUBSTANCE ABUSE • Use of two or more (2+) substances • Percentage of Indiana treatment admissions with 2+ use (56%) [7] • Highest use among women, whites, 25-34 year-olds • Most polysubstance abuse involved alcohol and marijuana [7]

  27. Over half of the treatment population used 2 or more drugs. Key Concern: Polysubstance Use in Indiana’s Treatment Population Note: Two or more substances reported at treatment admission Source: Treatment Episode Data System, 2000-2010 [7]

  28. Special Populations:Returning Veterans (OIF/OEF) • No state-specific info • Nationally, 22% diagnosed with PTSD and 17% with depression • Deployed personnel experienced higher rates of work & family stress • Only 18% who screened positive for alcohol abuse is receiving mental health services [11]

  29. Special Populations:Indiana’s Offender Population • 28,000+ adults were incarcerated within IDOC in 2011 • Substance abuse & mental illness are prevalent, often contributing to incarceration and recidivism • 5,500+ inmates received substance abuse treatment services in 2011 • Most prevalent substances marijuana (81%), alcohol (67%), cocaine/crack (35%), & opioids (30%) [11]

  30. Special Populations:COD • COD is a complex phenomenon with serious consequences for individuals and society • require different approaches to treatment than singular disorder • Among Indiana’s treatment population (n=96,706) • SMI 49% • SUD 23% • COD 19% • COD risk higher for men, whites, and younger individuals • Women with COD respond not as well to treatment as men [11]

  31. Special Populations:LGBT • No state-specific info, developed survey • Substance use • Binge drinking: 42% • Heavy drinking: 24% • Lifetime illicit: 56% • Mental health • Depression: 54% • Anxiety: 40% [11]

  32. Any Questions or Comments?

  33. Center for Health Policy The Center for Health Policy collaborates with state and local government, as well as public and private healthcare organizations in health policy and program development to conduct high quality program evaluation and applied research on critical health policy-related issues. Marion S. Greene, MPH Public Health Research Analyst, Center for Health Policy IU Richard M. Fairbanks School of Public Health at IUPUI 714 N Senate Ave, Suite 220 Indianapolis, IN 46202 317-278-3247 msgreene@iu.edu www.healthpolicy.iupui.edu

  34. REFERENCES [1] Substance Abuse and Mental Health Services Administration. (2012). National Survey on Drug Use and Health (NSDUH). Retrieved December 12, 2012, from http://www.samhsa.gov/data/NSDUH.aspx [2] Centers for Disease Control and Prevention. (1991-2011). High School Youth Risk Behavior Survey Data. Retrieved December 12, 2012, from http://apps.nccd.cdc.gov/youthonline [3] Gassman R., Jun, M. K., Samuel, S., Agley, J. D., Lee, J., Agley, B. D., Oi, S. E., Pardue, N. L., Pardue, S. E., Quiroz, J. E., Shuffle, L. A., Smith, J. N., & Smith, M.D. (2012). Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents. Bloomington, IN: Indiana Prevention Resource Center. [4] Inter-university Consortium for Political and Social Research, University of Michigan. (2012). Monitoring the Future. Retrieved January 12, 2012, from http://www.monitoringthefuture.org/data/data.html [5] Centers for Disease Control and Prevention. (2011). Behavioral Risk Factor Surveillance System Survey Data. Retrieved December 12, 2012, from http://apps.nccd.cdc.gov/brfss/ [6] Indiana State Department of Health, Tobacco Prevention and Cessation Commission. (2011). Indiana Youth Tobacco Survey, 2000-2010. Data set made available to the Center for Health Policy at IUPUI (September 27, 2011). [7] Substance Abuse and Mental Health Data Archive. (2010). Treatment Episode Data Set - Admissions (TEDS-A), 2010. Available at http://www.icpsr.umich.edu/icpsrweb/SAMHDA/browse [8] Indiana State Police. (2013). Final 2012 ISP lab stats. Received February 6, 2013, from Niki Crawford, First Sergeant Commander, Methamphetamine Suppression Section, in an e-mail to the Center for Health Policy, Indiana University Richard M. Fairbanks School of Public Health at IUPUI. [9] Indiana Board of Pharmacy. (2012). INSPECT datasets for 2011. Received May 26, 2012, from the Indiana Board of Pharmacy, Indiana Professional Licensing Agency. [10] Centers for Disease Control and Prevention. (2012). Smoking and tobacco use: Fact sheets. Retrieved December 12, 2012, from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm [11] Indiana State Epidemiology and Outcomes Workgroup. (2013). Substance abuse and mental health concerns in special populations in Indiana: A supplemental report to the 2012 state epidemiological profile. Indiana University Center for Health Policy. Indianapolis, IN.

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