Trends in Alcohol, Tobacco, and Other Drug Use in Indiana

Findings from the State Epidemiology and Outcomes Workgroup

Marion Greene, MPHSEOW Lead Epidemiologist

Public Health Research AnalystPhD Student in Epidemiology

Weekend U: Sex, Drugs and Rock and RollMarch 8th, 2014

I have nothing to disclose.

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

State Epidemiological Profiles• Annual publications (2006-2012) – currently

working on 2013 report• Companion documents (fact sheets, related

research briefs)• www.healthpolicy.iupui.edu

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

Epidemiological Key Findings

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]

Key Concern: Underage Drinking

Note: Lifetime and monthly alcohol use among 8th, 10th, and 12th graders Source: ATOD and MTF Surveys, 2012 [3, 4]

Underage drinking is a

major concern NATIONWIDE.

8th Grade 8th Grade 10th Grade 10th Grade 12th Grade 12th GradeLifetime Monthly Lifetime Monthly Lifetime Monthly

0%

10%

20%

30%

40%

50%

60%

70%

80%

Key Concern: Binge Drinking Among Young Adults

Note: Estimates on binge drinking in the past month among 18- to 25-year-oldsSource: National Survey on Drug Use and Health, 1999-2011 [1]

High-risk behavior among

18- to 25-year-olds.

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0%

10%

20%

30%

40%

50%

60%

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]

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)

Smoking-attributable

mortality rate higher in

Indiana than U.S.

Key Concern: Smoking in Vulnerable Populations

Note: Adult smoking prevalenceSource: Behavioral Risk Factor Surveillance System, 2011 [5]

Highest rates

among those with

less education &

low income.

Smoking 0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Smoking0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

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

Key Concern: Marijuana Use among Young Adults in Indiana

Note: Estimates on current (past-month) marijuana use among 18- to 25-year-oldsSource: National Survey on Drug Use and Health, 2000-2011 [1]

Highest among

18- to 25-year-olds.

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Key Concern: Marijuana Use in Indiana’s Treatment Population

Note: Marijuana use reported at treatment admission in Indiana, by age groupSource: Treatment Episode Data System, 2000-2010 [7]

Highest percentage

among Hoosiers

under the age of 18.20

00

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0%

20%

40%

60%

80%

100%

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

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]

Highest percentage

among black Hoosiers.

Cocaine UseCocaine

DependenceGender Male 13.3% 5.0%

Female 17.6% 8.1%Race White 11.3% 3.9%

Black 32.7% 17.4%Other 16.3% 5.8%

Age Group Under 18 2.4% 0.2%18-24 7.0% 1.7%25-34 13.8% 4.9%35-44 23.0% 11.4%45-54 22.6% 10.4%55 and over 15.9% 6.9%

Total 14.8% 6.1%

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

Key Concern: Heroin Use in Indiana’s Treatment Population

Note: Heroin use reported at treatment admissionSource: Treatment Episode Data System, 2000-2010 [7]

Use increased

among Hoosiers ages 18-34.

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0%

2%

4%

6%

8%

10%

12%

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]

Key Concern: Meth Use in Indiana’s Treatment Population

Note: Meth use reported at treatment admissionSource: Treatment Episode Data System, 2000-2010 [7]

Indiana’s percentage

of tx admissions

more than doubled.20

00

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0%

2%

4%

6%

8%

10%

12%

14%

Key Concern:Meth Labs in Indiana

Source: Indiana State Police Lab Seizures, 1995-2012 [8]

Meth lab seizures on the

rise again.

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

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

Controlled Rx Drugs Dispensed in Indiana

Source: Indiana Board of Pharmacy, 2012 [9]

2008 2009 2010 2011

Opioids 5,849,460(50.3%)

6,376,664(50.2%)

5,591,679(49.3%)

5,830,367(45.8%)

CNS Depressants 3,558,007(30.6%)

3,902,414(30.7%)

3,514,361(31.0%)

3,889,652(30.5%)

Stimulants 1,149,939(9.9%)

1,353,939(10.6%)

1,309,265(11.5%)

1,419,003(11.1%)

Others 1,077,686(9.3%)

1,080,914(8.5%)

926,234(8.2%)

1,604,214(12.6%)

Total 11,635,092(100.0%)

12,713,931(100.0%)

11,341,539(100.0%)

12,743,236(100.0%)

Key Concern: Rx Abuse in Indiana’sTreatment Population

Note: Nonmedical Rx use reported at treatment admissionSource: Treatment Episode Data System, 2000-2010 [7]

Indiana’s percentage above the nation.

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

22%

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]

Key Concern: Polysubstance Use in Indiana’s Treatment Population

Note: Two or more substances reported at treatment admissionSource: Treatment Episode Data System, 2000-2010 [7]

Over half of the treatment

population used 2

or more drugs.

0%

10%

20%

30%

40%

50%

60%

70%

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]

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]

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]

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]

Any Questions or Comments?

Center for Health PolicyThe 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, MPHPublic Health Research Analyst, Center for Health Policy IU Richard M. Fairbanks School of Public Health at IUPUI

714 N Senate Ave, Suite 220Indianapolis, IN 46202

317-278-3247msgreene@iu.edu

www.healthpolicy.iupui.edu

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.