Substance Abuse Trends and ConsequencesMartin Arocena
Outline
Introduction Substance Consumption Patterns Consequences Need Assessment and Identification of
Critical Needs
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).
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
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.
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.
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.
Databases Consulted
Consumption: 2002-2003 National Survey on Drug Use and
Health (NSDUH)2004 Texas School Survey2000 Texas Survey of Substance Abuse among
Adults (TCADA- Lynn Wallisch)2004 Behavioral Risk Factor Surveillance2003 Youth Risk Behavior Surveillance System
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 +)
Consequences
Alcohol and Drug Dependency Alcohol-related fatalities Crime statistics Mortality rates
Databases Consulted
Consequences:
2003 Fatalities Analyses Reporting System
2003 Uniform Crime Reports
2003 Mortality Data from CHS/DSHS
Census of the Population data
CONSUMPTION
Age of InitiationPercent of Secondary Students Who Reported Initiating Use before Age 13
(Source: Tx. S. S.)
56
30
50
0
10
20
30
40
50
60
Alcohol Marijuana Tobacco
Age of Initiation
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. 2,051,464 2,707,766 17,359,279
Comparison of Past Month Consumption of Alcohol, Tobacco, and marijuana by Age groups (Sources: TxSS & NSDUH)
33
58
50
13 13
3
17
42
30
0
10
20
30
40
50
60
70
12 to 17 18 to 25 26 and older
Alcohol Use
Marijuana use
Any tobacco use
Consumption of Alcohol By Age Groups (Sources: School S & NSDUH)
33
58
50
23
32
23
7
14
5
0
10
20
30
40
50
60
70
12 to 17 Group 18 to 25 Group 26 and older
Current Use Binge Drinking Heavy Drinkers
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).
Driving While Intoxicated
37%
29%
27%
26%
26%
25%
26%
23%
24%
14%
11%
8%
12%
17%
18%
18%
18%
18%
0% 5% 10% 15% 20% 25% 30% 35% 40%
SY-1988
SY-1990
SY-1992
SY-1994
SY-1996
SY-1998
SY-2000
SY-2002
SY-2004
Percent of Texas Seniors
Driving While High from Drugs
Driving While Drunk
Binge Drinking
Binge DrinkingAmong 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
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.
Alcohol Consumption Patterns
5962
57
52 51
26
32
22
18
12
8
14
5 5.3 4 5 4
38
33
37
0
10
20
30
40
50
60
70
12 to 17 18 to 24 25 to 34 35 to 44 45 - 54 55 to 64 65 and older
Current
Binge
Heavy
Trends for Youth (Source: School Survey)
42.843.6
32.6
20.9
24.2
26.2 26.3
22.4
18.217
12.6
37
39.4
37.3 38
36.134.5
22.9
11.5
7.8 6.812
15.9 15.2
13.7 14.4
0
5
10
15
20
25
30
35
40
45
50
SY-1988 SY-1990 SY-1992 SY-1994 SY-1996 SY-1998 SY-2000 SY-2002 SY-2004
Per
cen
t
Alcohol Tobacco Marijuana Inhalants Cocaine/Crack
Adults Trends
Past Month Measure 1999-2000 2000-2001 1999-2000 2000-2001
Alcohol 54.70% 54.90% 44.80% 46.20%
Binge Drinking 35.70% 36.70% 19.90% 20.20%
Any Illicits other than mj. 5.60% 7.00% 1.60% 1.60%
Marijuana 10.30% 10.30% 1.60% 1.90%
Cocaine 6% 5.60% 1.10% 1.20%
Tobacco 40% 38.90% 27.70% 27.90%
18 - 25 Years Old Group 26 ad Older Group
Adults Trends
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.
Demographics:
Gender
Ethnicity
Gender Differences
Youth Males
Youth Females
Adult Males
Adult Females
Alcohol 32.5% 32.7% 59.3% 41.9%
Tobacco 18.9% 15.3% 28.1% 21.2%Marijuana 14.3% 11.0% 6.1% 2.5%
Inhalants 6.9% 6.4% 0.2% 0.1%Cocaine/C 3.7% 2.7% 1.4% 0.5%
Any Illicit 16.% 12.7% 7.9% 3.5%S: sch. survey
S: 2000 Adults
Adults Consump by Ethnic (Source: Risk Survey)
58.8
43.5
48.549.6
16.1
12.1
19.4
10.7 10.9
6.44.6 5.7 5.4 5.2
23.7
20.218.7
27.426.3
0
10
20
30
40
50
60
70
White African-American Hispanic Other Multiracial
per
cen
t
Current Users
Binge Drinkers
Heavy Drinkers
Smokers
Youth Consumption of Drugs by Ethnic/Race Groups
5.8
5
8.4
13.9
12
16.8
12.2
11
14.3
2.5
0.9
6.2
0
2
4
6
8
10
12
14
16
18
Anglo African-American Hispanic
Per
cen
t
Inhalants Any Illict Drug Marijuana Cocaine/crack
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
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.
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.
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.
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.
CONSEQUENCES
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).
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.
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.
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
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%.
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%)
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.
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.
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.
Sampled Population:From the Individual FARS;
Years: 2001, 2002, 2003 Ages 12 to 17, 18 to 20, 21 to 29
Motor Vehicle Fatalities
County Total # of Perc. Intox. D Of DDGalveston 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%
Motor Vehicle Fatalities
County Total # of Perc Intox. Of DDCameron (Valley) 81 38.1 47%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 444 167.5 38%Harris (Houston) 772 325.8 42%
Motor Vehicle Fatalities
Groups Number of Total Drivers
Number of Intoxicated
Drivers
All Counties 5,151 (100%) 2,052 (100%)
The 19 Counties
3,081 (60%) 2052 ( 59%)
The Top 7
(> 21 DDs)
2,189 (42%) 238.6 ( 42%)
Violence
As reported in the 10th Report to the U.S. Congress on Health and Alcohol:
The relationship between the offender’s drinking and the perpetration of violence has continued to show that the offender’s drinking is related to violence
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.
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
Violent Crime 5-Year Trends, U.S. vs. Texas Source : 2003 Uniform Crime Report
Violent Crime 5-Year Trends, US. vs. Texas, 2003 UCR
523.0
506.5 504.5
494.4
475.0
560.3
545.1
572.8578.6
552.5
400.0
420.0
440.0
460.0
480.0
500.0
520.0
540.0
560.0
580.0
600.0
1999 2000 2001 2002 2003
Vio
len
t C
rim
e R
ate
per
100
,000
US. VC. TX. VC
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 (+).
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 (+)
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.
Crime-Related Statistics
The counties with the highest numbers of property crime reports were: Harris, Dallas, Bexar, Tarrant, Travis, Hidalgo, and El Paso.
Property Crimes, U.S. vs. Texas, Five Years Trends,Source: Uniform Crime Reports, 2003
Property Crimes, US vs. TX, Five Year Trends , 2003 UCR
3,588.40
4,595.30
3,743.60
3,630.603,658.103,618.30
4,611.00
4,410.404,471.50
4,579.90
2,500.00
3,000.00
3,500.00
4,000.00
4,500.00
5,000.00
1999 2000 2001 2002 2003
US. PC.
TX. PC
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)
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.
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.
Suicide
Alcohol and other drugs are a contributing factor in suicides. State’s 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.
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.
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.
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.
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.
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.
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.