Substance Abuse Trends and Consequences

1. Substance Abuse Trends and Consequences Martin Arocena

2. Outline Introduction Substance Consumption Patterns Consequences Need Assessment and Identification of Critical Needs

3. Strategic Prevention Framework DSHS applied for and received a grant to participate in SAMHSA�s Strategic Prevention Framework initiative. Part of the requirements of the grant is that each funded state organize a state epidemiological workgroup (SEW).

4. State Epi Workgroup The purpose of the SEW is to: Assess the status of the state with respect to substance abuse prevalence Select consumption-related consequences and measure the state�s status on them

5. State Epi Workgroup Identify the state�s critical needs in terms of problem, population, and geographical location where problems are more severe. Work with the Advisory Council to inform them and provide data as needed to help them make informed decisions.

6. State Epi Workgroup Texas� epi workgroup consists of representatives from several state agencies, community organizations and academia that have information and access to consumption and consequences databases; We receive technical assistance from researchers from the Pacific Institute for Research and Evaluation and work closely with CSAP. They provide advice, leadership, and participate in the decision-making process.

7. State Epi Workgroup Drs. Cervantes and Rey from Behavioral Assessment Inc. as the program evaluators are members of the group. Liang Liu, the principal investigator of the Texas School Survey and I are the co-coordinators of the group. The collaborators provided the databases to us and we performed the statistical analyses and reporting.

8. Databases Consulted Consumption: 2002-2003 National Survey on Drug Use and Health 2004 Texas School Survey 2000 Texas Survey of Substance Abuse among Adults Behavioral Risk Factor Surveillance, and Youth Risk Behavior Surveillance System

9. Substances Selected: Alcohol Tobacco Marijuana Inhalants Cocaine/crack Any other illicit drug used Measures: Current use (past 30 days) Past year use Age of initiation Binge drinking Heavy drinking

10. Consequences Alcohol and Drug Dependency Alcohol-related fatalities Crime statistics Mortality rates

11. Databases Consulted Consequences: 2003 Fatalities Analyses Reporting System 2003 Uniform Crime Reports Vital Statistics Census of the Population data

12. Age of Initiation

17. Binge Drinking Binge Drinking The 2004 Texas School Survey reports that approximately 23% of the students in grades 7 � 12 had 5 or more drinks on one occasion during the past year. The rate of binge drinking is decreasing from 27% in 2000 to 26% in 2002. Based on YRBSS, 25.7% of high school students in Texas reported episodic heavy drinking (5 drinks or more in a row during the past 30 days).

19. Binge Drinking Binge Drinking Among the 18 to 25 years old group, about 58% were current drinkers and 40% were binge drinkers. The current drinkers among the older group drops to about 50%. Binge drinkers drops to about 23%, and 5% heavy drinkers

20. Drinking and Driving About 14% of students in grades 9 through 12 admitted they had driven a car after having had a good bit to drink at least once in the past year, and 24% of the seniors said so. 11% of students in grades 9 through 12 reported having driving when they were high from drugs and 18% of the seniors said so.

26. Inhalants About 7% of the youth had used inhalants in the past month. Due to its harmful effects on the brain and the relative easiness of getting the product the use of inhalants is considered a serious problem in the state

27. Cocaine The use of crack/cocaine in Texas has higher prevalence rates than in the other 50 states. Approximately 7% of the 18 to 25 years old population reported using cocaine.

28. Methamphetamines The proportion of clients admitted to treatment that mentioned methamphetamines as their primary drug has increased from 5% to 10% in 2004. Unlike the other drugs, more than one half (53%) of these clients were women.

29. At Risk Populations Use of alcohol, but not cigarettes, marijuana and cocaine, is higher among college students than among non-college youth of the same age. There is a significant difference in the use of cocaine between border and non-border Hispanics.

30. Regional Differences Wallisch in the TCADA 2000 Adult Survey found that compared to the mean level for the state: Region 6 had higher-than-average rates of alcohol use. Region 7 had the highest rate of marijuana use in the state Region 8 had the highest rate of cocaine use.

31. CONSEQUENCES CONSEQUENCES

32. Substance Abuse Dependence The 2002-2003 NSDUH included questions designed to measure dependence and abuse of alcohol and drugs based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).

33. Substance Abuse Dependence According to the national survey in Texas: 12 to 17 group: 6 % = 123,088 18 to 25 group: 17 % = 460,320 26 and older: 6 % = 1,123,054 Texans were alcohol dependent or abusers.

34. Substance Abuse Dependence Alcohol is the most frequently mentioned primary drug reported by the Adult population admitted to publicly-funded treatment centers in Texas. About 30 % of the clients reported this substance as their primary substance at admission.

35. Substance Abuse Dependence The national survey estimated the following percentages of residents in Texas who are dependent or abusers of any illicit drug: 12 to 17 group: 5 % = 102,573 18 to 25 group: 7 % = 189,543 26 and older: 1.5 % = 280,764

36. Motor Vehicle Fatalities Texas was the state with the largest number of alcohol-related fatalities in the nation. Of the total 3,765 in the state, 1,709 (47%) were alcohol-related. It is higher than the national average, 41%.

37. Motor Vehicle Fatalities In 2003, of the 4,917 drivers involved in a car crash that resulted in a fatality, 1,447 (29.3%) were intoxicated with alcohol. The age-group with the highest percentage of drunk drivers was the 21 � 29 years old group (38%).

38. Motor Vehicle Fatalities The counties with the larger metropolitan areas of the state have the larger number of MVF and had the higher number of intoxicated drivers involved in fatalities.

39. Motor Vehicle Fatalities The counties with the greatest concentration of population in Texas have the larger number of MVF and had the higher number of intoxicated drivers involved in fatalities.

40. Motor Vehicle Fatalities The next slide will show 18 counties with a high concentration of MVF in 2003 and where about 67% of the population live. Together these 18 counties had : 52% of the 1,828 drivers involved in a MVF from the age-group. 56% of the 644 intoxicated drivers involved in a MVF from the same age group.

41. Motor Vehicle Fatalities Fort Bend (s. of H) 26 7.0 Grayson (border with Ok) 12 7.6 Smith (Tyler) 27 7.9 Jefferson (border with La) 24 8.1 Cameron (Brownsville) 21 9.0 Nueces (Corpus) 15 9.1 Bell (Ft. Hood) 32 9.4 Denton 33 10.1 Lubbock

42. Motor Vehicle Fatalities Collin (N. of Dallas) 23 11.8 Montgomery (N. of H) 49 12.9 El Paso 35 18.1 Travis (Austin) 57 21.2 Hidalgo (Harlingen) 58 21.4 Tarrant (Ft. Worth) 63 21.4 Bexar (San Antonio) 79 35.9 Dallas 152 51.7 Harris (Houston) 220 87.0

43. Motor Vehicle Fatalities

45. Mortality For this project, the selection of causes of death was based on the strength of the relationship between the illness and consumption of alcohol, drugs and tobacco. Alcohol use is an intervening variable in homicides, suicides, and chronic liver disease.

46. Homicides Texas� homicide rate, 6.9 per 100 K population is higher than the United States. The 18 to 29 age group had the highest homicide rate. In Texas, the homicide rate statistics reveal a disparity by ethnic/racial group. Although African-Americans have lower rates of substance abuse prevalence, they have higher rates of homicides.

47. Suicide Alcohol and other drugs are a contributing factor in suicides. There were 2,354 suicides in Texas in 2,003. It is very prevalent among the older group, especially whites. Suicide rates are high among native-Americans.

48. Chronic Liver Disease The state�s chronic liver disease prevalence rate (10.5 per 100 K pop) is higher than the national rate (9.5). Over 90% of the deaths due to this disease happened to individuals in the older age groups. Hispanics have a greater rate of deaths due to chronic liver disease (25.5) than other groups, 18.6 for Whites and 12.7 for African-American.

49. Tobacco-related mortality According to the CDC, tobacco is the leading cause of preventable deaths in the United States. Lung cancer, heart disease, and illnesses such as emphysema, bronchitis, and chronic airways obstruction are responsible for the largest number of smoking related deaths.

50. Tobacco-related mortality The majority of the individuals whose cause of death was lung cancer were in the 65 years old or older group. This age disparity shows the long-term effect of cigarette smoking.

51. Summary Alcohol is the substance that is used by the greater percent of the population who use substances. Its use begins early, and the percent of users peaks in early adulthood. Its use continues to be high during adulthood, but the percent of users declines with age.

52. Summary Alcohol is strongly associated with the leading causes of death among the population under 20 years old: motor vehicle crashes, homicides and suicides. Although it can classified as the main problem of the state, the use of other substances such as inhalants at early age, cocaine, and other drugs cannot be ignored.

53. GOALS To reduce the percentage of adolescents who begin experimenting with alcohol, tobacco and other drugs by age 13. To reduce the percentage of binge drinkers among underage and young adults (18 to 25) To reduce the rates of intoxicated drivers involved in MVF especially among the 16 to 25 age group.