1. Substance Abuse in Greenville County, SC RESULTS OF A 2003 STUDY

2. Study Project Management 80 member broad-based Steering Committee made up of community leaders, elected officials, and service providers. Executive Committee included: Jane Pressly, Marcia Barker, Kat Rice, Shannon Owen, Carol Reeves, Mark Ring, and Dr. Kevin Polley Retained Pittsburgh, PA-based Tripp Umbach Healthcare to conduct assessment and planning process.

3. Community Assessment Methodology Steering Committee interviews. Greenville County secondary data collection. Household telephone survey to 385 residents. Inventory survey to all substance abuse service providers. Mailed employer survey. 6 focus groups.

4. Planning, Implementation and Evaluation Process Steering Committee planning sessions. Substance abuse services asset map. Economic impact data collection and model development (frequent updates) Final report, strategic imperatives, and consultant recommendations.

5. The Results Are In!! South Carolina spends more than $5 BILLION on substance abuse including criminal justice, social service, healthcare, lost productivity and treatment. Greenville Countys share of the bill is more than $503 MILLION. Upwards of 5% of Greenville Countys total economy is lost to the cost of substance abuse. The effects of substance abuse cost every man, woman and child in Greenville County $1,300 per year.

6. Scope of the Problem 55% of Greenville County residents believe that substance abuse negatively affects the community. 60% of Greenville County residents are personally impacted by substance abuse. (Either they, someone they live with, or a close family member, friend or co-worker has a substance abuse problem that interferes with daily activity.) 34% in Greenville County drink compared to 58% nationally. Alternately, 46.6% of Americans age 12 and older reported being current drinkers of alcohol in 2002 survey. In Greenville 1.56 drinks per sitting is the norm while the national average is 1.38 drinks per sitting. Greenville County residents who do drink alcohol consume 8% more by volume than the national average.

7. Greenville County Ranks Highest in the State

8. Greenville County Population In Need of Treatment in 2000 (DSM-IV Diagnosis of Substance Abuse or Dependence) Total30,488 age 12 and older (40% are dependent, 60% are abusers) Male21,786Age 12-175,293 Female 8,702Age 18-247,556 Age 25-44 12,680 White26,761Age 45-644,696 African- Age 65-up 263 American/Other 3,727

9. Who drinks and who needs help? Pop. Of Greenville County 379,616 Pop. Of County 12 and older 297,962 # Drinkers/Users 101,307 (34%* 12 and older drink/use) # Needing Treatment 30,488 % Drinkers Needing Treatment 30 % * 2003 Substance Abuse Study * 1998 Assessing Greenvilles Health at 35%

10. Community Responses from Survey Respondents 94% believe that substance abuse/dependence is a treatable illness 59% believe that a person can overcome substance abuse with enough will power 73% believe that Jesus Christ is the answer to substance abuse and/or dependence When asked where do you turn for help, the top answers were: AA, Church, Hospital or Physicians, Phone Book According to faith-based focus group participants, substance abuse is involved in their counseling efforts 100% of the time!

11. Biology/Genes Environment DRUG Addiction Brain Mechanisms 1.ADDICTION INVOLVES MULTIPLE FACTORS

12. 2. ADDICTION IS A DEVELOPMENTAL DISEASE starts in adolescence and childhood 2. ADDICTION IS A DEVELOPMENTAL DISEASE starts in adolescence and childhood NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003 % in each age group who develop first- time cannabis use disorder 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 5 5 10 15 18 25 30 35 40 45 50 55 60 65 70 Age Age at cannabis use disorder as per DSM IV

13. Healthy Heart Diseased Heart Decreased Heart Metabolism in Heart Disease Patient 3. ADDICTION IS A DISEASE OF THE BRAIN as other diseases it affects the tissue function Sources: From the laboratories of Drs. N. Volkow and H. Schelbert Control Cocaine Abuser Decreased Brain Metabolism in Drug Abuse Patient

14. Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence Normal Control METH Abuser (1 month detox) METH Abuser (24 months detox) 0 3 ml/gm Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001. 4. ADDICTION CAN BE TREATED

15. Relapse Rates Are Similar for Drug Dependence And Other Chronic Illnesses Relapse Rates Are Similar for Drug Dependence And Other Chronic Illnesses 0 0 10 20 30 40 50 60 70 80 90 100 Drug Dependence Drug Dependence Type I Diabetes Type I Diabetes Hypertension Asthma 40 to 60% 30 to 50% 50 to 70% Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000. Percent of Patients Who Relapse Addiction Treatment Does Work

16. Treatment Works For every $1 invested in substance abuse treatment, $7 is saved in costs to the community.

17. Where are people who need treatment? The Teachable Moment: 40% of injured patients in trauma centers have positive blood alcohol levels Between 25% and 40% of all general hospital patients are there because of complications related to alcoholism At least 50% of all people arrested for major crimes were using illicit drugs at the time of their arrest. In 1990, 1 million+ arrests were made for drug offenses and 3 million+ for alcohol offenses. Substance Abuse: The Nations # 1 Health Problem Robert Wood Johnson Foundation 2001 study

18. But What Is Not Working…. SHAME AND STIGMA DENIAL BOLSTERED BY BILLION $ ADVERTISING LACK OF PARITY IN HEALTH INSURANCE COVERAGE = LACK OF EFFECTIVE TREATMENT 1947: ALCOHOL EXCLUSION LAW EMBEDDED IN MODEL UNIFORM ACCIDENT AND SICKNESS POLICY PROVISION LAW (UPPL): Allows insurers to deny coverage to individuals injured as a result of being under the influence of alcohol or narcotics CRIMINAL JUSTICE ISSUE VERSUS PUBLIC HEALTH ISSUE

19. Study Imperatives… Develop and implement a coordinated continuum of care Increase awareness of substance abuse issues, impacts and available services Increase community and spiritual-based approaches Increase services available for youth

20. RESULTS OF TASK FORCE WORK Develop a centralized system to access services; functions may include: awareness building, screening and referral, outreach, advocacy, education (to include programs for clergy and physicians) and evaluation. Increase/improve adult inpatient/residential treatment services, to include post-treatment housing. Develop/build a residential youth facility.

21. FAVOR Greenville New organization formed in 2004 by the original Leadership Council to see that results of study were achieved in the community: Independent Board Resource Team of Providers Members Aligned with national and state initiative

22. Make No Little Plans. They have no magic to stir mens blood and probably themselves will not be realized. Make big plans; aim high in hope and work, remembering that a noble, logical diagram once recorded will never die, but long after we are gone will be a living thing asserting itself with ever growing insistency. Daniel Burnham 1907