1. Focus Area 26 Substance Abuse Progress Review Richard J. Klein National Center for Health Statistics October 2, 2008

2. Substance Abuse Source: Excerpt from SAMHSA & NIH/NIDA congressional appropriations testimonies, 2004; National Survey on Drug Use and Health, SAMHSA. Estimated costs (2004) Substance abuse costs the U.S. more than $346 billion per year Illicit drug use alone costs about $161 billion Usage (2007) Almost 20 million (8.3%) Americans 12 years and older are current users of illicit drugs Roughly 7 million Americans are abusing prescription drugs (increased 13% since 2004)

3. *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant. 26-1 a. Alcohol-related motor vehicle crash deaths 26-2. Cirrhosis deaths 26-3. Drug-induced deaths 26-6. Adolescents riding with a driver who has been drinking 26-9 b. Average age at 1 st use 26-9 c. High school seniors abstaining from alcohol 26-10 b, c.Illicit drug use in the past 30 days 26-11 a. High school seniors binge drinking in the past 2 weeks 26-16 a-f. Disapproval of substance abuse 26-18 a, b. Treatment for illicit drugs and/or alcohol abuse 26-20. Treatment admissions for injection drug use 26-21. Treatment for alcohol abuse 26-24. Administrative license revocation laws for DUI 26-25. Blood alcohol concentration laws for drivers > 0.08% Highlighted Objectives ImprovingGetting worseLittle or no change*Target met

4. Percent 200220042006 0 10 20 40 50 2000 30 2007 Never drank alcohol HS Seniors Adolescent Alcohol Behavior Obj. 26-9c Note: Data are for High School seniors who have never had more than just a few sips of alcohol in their life. Source: Monitoring the Future, NIH, NIDA. 2010 Target : 29 Increase desired 19981999200120032005

5. Percent 200220042006 0 10 20 40 50 2000 30 200719981999200120032005 Binge drinking HS Seniors 2010 Target: 11 Decrease desired Note: Binge drinking is defined as drinking five or more alcoholic beverages in a row during the past 2 weeks. Source: Monitoring the Future, NIH, NIDA. Adolescent Alcohol Behavior Obj. 26-11a

6. 0 20 19992007 Riding with a driver who has been drinking 10 50 40 30 Objs. 26-6, 9c & 11a Note: Data for riding with a driver who has been drinking are for students in grades 9 – 12 during the past 30 days. Binge drinking is drinking 5+ alcoholic beverages in a row during the past 2 weeks. Data for never drinking are for High School seniors who have never had more than just a few sips of alcohol in their life. Source: Youth Risk Behavior Surveillance System, CDC, NCCDPHP; Monitoring the Future, NIH, NIDA. Adolescent Alcohol Behavior 200220042006 0 10 20 40 50 2000 30 200719981999200120032005 Binge drinking HS Seniors Never drank alcohol HS Seniors 2010 Target : 30 Percent

7. Disapproval of Drinking Alcohol Daily, Adolescents Obj. 26-16 a-c Percent 20071998 Increase desired 8 th grade 12 th grade 10 th grade 2010 Target: 83 Note: Data are for students who report their disapproval of people who take 1-2 drinks nearly every day. Source: Monitoring the Future, NIH, NIDA.

8. Note: Data are for ICD-10 codes K70, K73-K74. Data are age-adjusted to the 2000 standard population. Legend represents quintiles of the rates. Rates are calculated by health service area. Rates are per 100,000 population. Source: National Vital Statistics System—Mortality, CDC, NCHS. Cirrhosis Deaths, 2001-2005 Obj. 26-2 Age-adjusted per 100,000 population 1.3 – 6.6 6.7 – 8.1 8.2 – 9.4 9.5 – 11.3 11.4 – 45.6 2010 Target: 3.2

9. Note: Cirrhosis deaths - ICD-10 codes K70, K73-K74. Alcohol-induced deaths - ICD-10 codes can be found in National Vital Statistics Reports, Vol. 56, Num.10, 4/24/2008. Rates are per 100,000 population and age-adjusted to the 2000 standard population. American Indian includes Alaska Native. Asian includes other Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. Source: National Vital Statistics System—Mortality, CDC, NCHS. Cirrhosis Deaths Total White American Indian Hispanic Male Female Per 100,000 population Cirrhosis and Alcohol-Induced Deaths, 2005 Black Asian 0102025515 Alcohol-Induced Deaths 2010 Target: 3.2 Decrease desired Obj. 26-2 2515502010

10. Per 100,000 population Decrease desired TotalAmerican Indian BlackAsian White Hispanic (2007) 1998 Alcohol-Related Motor Vehicle Fatalities Obj. 26-1a 2010 Target: 4.8 2006 Note: Data are for deaths in crashes involving a driver, motorcycle rider, or nonoccupant (i.e. pedestrian, pedalist) with a BAC of.08 g/dL or greater American Indian includes Alaska Native. Asian includes Other Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race Source: Fatality Analysis Reporting System, Department of Transportation (DOT), National Highway Traffic Safety Administration (NHTSA).

11. 010205 0 51 States with Alcohol Related Laws Administrative License Revocation Laws.08 Blood Alcohol Concentration Laws 0 51 200719989906040300010205990604 28 0020071998 Objs. 26-24 & 25 Source: Department of Transportation (DOT), National Highway Traffic Safety Administration (NHTSA). States and DC 03 50 46 32 51 19 18 15 42 2010 Targets: 51 Increase desired

12. * New users used marijuana for the first time in the past 12 months. Source: National Survey on Drug Use and Health, SAMHSA. Marijuana Use, Adolescents 12-17 Objs. 26- 9b & 10b 2002 – 15.0 years 2007 – 15.3 years Average age at 1 st use among new users* Percent 0 2 4 8 10 20022003200420052007 6 Use in past month 2006 Decrease desired 2010 Target:.7

13. Disapproval of Trying Marijuana, Adolescents Obj. 26-16 d-f Percent 20071998 Increase desired 8 th grade 12 th grade 10 th grade 2010 Target: 72 Note: Data are for students who disapprove of trying marijuana or hashish once or twice. Source: Monitoring the Future, NIH, NIDA.

14. Per 100,000 population Decrease desired TotalAmerican Indian BlackAsian White Hispanic 1999 Obj. 26-3 Drug-Induced Deaths Note: Drug induced deaths ICD-10 codes can be found in National Vital Statistics Reports, Vol. 56, Num. 10, 4/24/08. Methadone and Cocaine deaths are ICD-10 codes T40.3 and T40.5 respectively Data are age-adjusted to the 2000 standard population. The categories black and white exclude persons of Hispanic origin. American Indian includes Alaska Natives. Asian includes other Pacific Islander. Persons of Hispanic origin may be any race. Only one race could be recorded prior to 2003. For 2003 and later years, one or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded. Source: National Vital Statistics System—Mortality, CDC, NCHS.

15. Decrease desired 20051999 Drug-Induced Deaths Number Methadone 468% increase Cocaine 63% increase Per 100,000 population TotalAmerican Indian BlackAsian White Hispanic Obj. 26-3 Note: Drug induced deaths ICD-10 codes can be found in National Vital Statistics Reports, Vol. 56, Num. 10, 4/24/08. Methadone and Cocaine deaths are ICD-10 codes T40.3 and T40.5 respectively Data are age-adjusted to the 2000 standard population. The categories black and white exclude persons of Hispanic origin. American Indian includes Alaska Natives. Asian includes other Pacific Islander. Persons of Hispanic origin may be any race. Only one race could be recorded prior to 2003. For 2003 and later years, one or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded. Source: National Vital Statistics System—Mortality, CDC, NCHS. 2010 Target: 1.2

16. Note: Data are for a number of ICD-10 codes which can be found in the National Vital Statistics Reports, Vol. 56, Num. 10, April 24, 2008. Data are age-adjusted to the 2000 standard population. Legend represents quintiles of the rates. Rates are calculated by health service area. Rates are per 100,000 population. Source: National Vital Statistics System—Mortality, CDC, NCHS. Drug-Induced Deaths, 2001-2005 Obj. 26-3 0.0 – 4.5 4.6 – 7.1 7.2 – 8.9 9.0 – 11.8 11.9 – 37.2 Age-adjusted per 100,000 population 2010 Target: 1.2

17. 2010 Target: 24 2010 Target: 16 2010 Target: 11.9 Needing and Receiving Treatment Objs. 26-18, 20 & 21 1997 – 215,560 2006 – 237,945 Percent 0 5 10 20 25 AlcoholDrugsAlcohol and/or Drugs 15 Treatment for alcohol & drugs, 2007 Increase desired 2010 Target: 256,680 Note: Data are for people needing treatment for a drug and/ or alcohol problem if he or she was dependent on or abused alcohol and/or drugs or received specialty treatment in the past 12 months. Specialty treatment is treatment received at drug or alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient only), or mental health centers. Source: Treatment Episodes Data System, OAS, SAMHSA,; National Survey on Drug Use and Health, SAMHSA. Admissions for injection drug use

18. *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant. Progress Toward 2010 Targets Target met or exceeded Improving Little or no change* Getting worse No trend data (baseline only) Dropped at midcourse Retained as developmental 4 16 15 3 2 3 5

19. Summary Adolescent attitudes and behavior regarding substance abuse are improving. BAC Laws have been enacted by all States. Drug deaths are increasing, especially those caused by methadone and cocaine. Although rates are improving, most people who need substance abuse treatment do not receive it. Major disparities exist, especially for the American Indian/Alaska Native population.

20. Acknowledgements Elizabeth Jackson Health Statistician CDC/NCHS EMW6@cdc.gov Contributors: Nancy Brady, SAMHSA Deepthi Kandi, CDC/NCHS Jeffrey Pearcy, CDC/NCHS Carter Roeber, LTG Associate Asel Ryskulova, CDC/NCHS

21. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm