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Substance Abuse Trends and Consequences Martin Arocena.

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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 SAMHSAs 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 states status on them

5 State Epi Workgroup Identify the states 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 received 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 contracted 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 data to us and we did the statistical analyses and reporting.

8 Databases Consulted Consumption: 2002-2003 National Survey on Drug Use and Health (NSDUH) 2004 Texas School Survey 2000 Texas Survey of Substance Abuse among Adults (TCADA- Lynn Wallisch) 2004 Behavioral Risk Factor Surveillance 2003 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 (5 or +) Heavy drinking (2 +)

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 2003 Mortality Data from CHS/DSHS Census of the Population data


13 Age of Initiation

14 Prevalence Rates 12 to 17 Years Old 18 to 25 Years Old 26 and Older Alcohol Use Past Month 676,983 33% 1,570,504 58% 8,679,640 50% Tobacco Use Past Month 348,749 17% 1,164,339 43% 5,207,784 30% Marijuana Use past month 266,690 13% 352,010 13% 520,778 3% Cocaine Use past 30 days 92,316 4.5% 189,544 7% 347,186 2% Total Pop.2,051,4642,707,76617,359,279



17 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 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.



23 Adults Trends

24 The source for the Adult Trend information is: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse 1999, 2000, and 2001 The information is for Texas.

25 Demographics: Gender Ethnicity

26 Gender Differences Youth Males Youth Females Adult Males Adult Females Alcohol32.5%32.7%59.3%41.9% Tobacco18.9%15.3%28.1%21.2% Marijuana 14.3%11.0%6.1%2.5% Inhalants6.9%6.4%0.2%0.1% Cocaine/C 3.7%2.7%1.4%0.5% Any Illicit16.%12.7%7.9%3.5% S: sch. survey S: 2000 Adults



29 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

30 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.

31 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.

32 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.

33 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.


35 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).

36 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.

37 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.

38 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

39 Motor Vehicle Fatalities Texas was the state with the largest number of alcohol-related fatalities in the nation. Of the 42,643 MVF in the nation, 3,675 (1.58%) occurred in Texas. Of the total 3,765 crashes in the state, 1,709 (47%) were alcohol-related. It is higher than the national average, 41%.

40 Motor Vehicle Fatalities In 2003, of the 5,011 drivers involved in a MVF, 1,469 (29.3%) were identified as having had some alcohol. The age-group with the highest percentage of drunk drivers was the 21 – 29 years old group (38%)

41 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.

42 Motor Vehicle Fatalities The next slide will show 19 counties with 21 or more drivers during the past 3 years who were involved in a MVF. Together these 19 counties had : 60% of the 3,081 drivers involved in a MVF from the age-group. 59% of the 2,052 intoxicated drivers involved in a MVF from the same age group.

43 Motor Vehicle Fatalities The columns for the next slides present: Name of the County Total number of drivers involved in crashes in which at least one person died. The number of alcohol-involved drivers in crashes in which at least one person died. (Expressed as a fraction because the probability of alcohol involvement is imputed using a probabilistic model.) The percent of alcohol-involved drivers.

44 Sampled Population: From the Individual FARS; Years: 2001, 2002, 2003 Ages 12 to 17, 18 to 20, 21 to 29

45 Motor Vehicle Fatalities County Total # of Perc. Intox. D Of DD Galveston 49 21.0 45% Hays 46 21.0 48% Jefferson 74 22.7 32% Smith 91 23.9 29% Nueces 58 24.0 43% Bell 79 24.6 32% Williamson 79 24.9 31% Lubbock 70 30.9 44% Collin 78 32.8 44% Denton 97 33.4 38%

46 Motor Vehicle Fatalities County Total # of Perc Intox. Of DD Cameron (Valley) 81 38.147% Montgomery (N. of H) 126 40.4 33% El Paso 140 51.9 38% Hidalgo (Harlingen) 173 65.4 38% Travis (Austin ) 181 75.7 43% Tarrant (Ft. Worth) 223 78.6 35% Bexar (San Antonio) 270 99.9 38% Dallas 444167.5 38% Harris (Houston) 772 325.8 42%

47 Motor Vehicle Fatalities GroupsNumber of Total Drivers Number of Intoxicated Drivers All Counties5,151 (100%)2,052 (100%) The 19 Counties 3,081 (60%)2052 ( 59%) The Top 7 (> 21 DDs) 2,189 (42%)238.6 ( 42%)

48 Violence As reported in the 10 th Report to the U.S. Congress on Health and Alcohol: The relationship between the offenders drinking and the perpetration of violence has continued to show that the offenders drinking is related to violence

49 Violence The amount of alcohol consumed tends to be larger in more serious offenses; The connection between drinking and violence is stronger where the relationship between the perpetrator and victim is closer, and Persons consuming large amounts of alcohol were at greater risk for violence than those consuming smaller amounts.

50 Crime-Related Statistics Violence rate includes aggravated assault, rape, and robbery. It is associated with alcohol abuse. The UCR reports show that the Texas violence rate per population is higher than the national rate

51 Violent Crime 5-Year Trends, U.S. vs. Texas Source : 2003 Uniform Crime Report

52 Crime-Related Statistics The counties in Texas with the higher violence rates per population were: Victoria (-), Kleberg, Lamar, Potter, Nueces, Dallas, Wichita, Harris, Lubbock, and Jim Wells (+).

53 Crime-Related Statistics The counties with the higher number of reported violent offenses were: Jefferson (-), Lubbock, Nueces, Hidalgo, Travis, El Paso, Tarrant, Bexar, Dallas, and Harris (+)

54 Crime-Related Statistics Property crimes such as burglary, larceny, and motor vehicle theft have been associated statistically with drug consumption. The property crime rate in Texas is higher than the rate for the United States.

55 Crime-Related Statistics The counties with the highest numbers of property crime reports were: Harris, Dallas, Bexar, Tarrant, Travis, Hidalgo, and El Paso.

56 Property Crimes, U.S. vs. Texas, Five Years Trends, Source: Uniform Crime Reports, 2003

57 Crime-Related Statistics Taking into consideration property crime rates per 1,000 population, it was found that among the top 20 counties, 6 were in the Rio Grande Valley (Cameron, Hidalgo, Kleberg, Webb, and Nueces Counties)

58 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.

59 Homicides Texas homicide rate, 6.9 per 100 K population is higher than the United States (5.9). The 18 to 29 age group had the highest homicide rate. Although African-Americans have lower rates of substance abuse prevalence, they have higher rates of homicides. 1,516 deaths were attributed to homicide.

60 Suicide Alcohol and other drugs are a contributing factor in suicides. States rate was 10.8 vs. 10.5 for the nation. There were 2,354 suicides in Texas in 2,003. This is the leading cause of violent deaths each year.

61 Chronic Liver Disease The states 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.

62 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.

63 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.

64 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.

65 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 be 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.

66 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.


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