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H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment Substance Abuse Mental H

North Dakota Conference on Injury Prevention & Control. “The Ripple Effect of Substance Abuse on Family and Community”. October 29, 2008 Mandan, ND. H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment

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H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment Substance Abuse Mental H

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  1. North Dakota Conference on Injury Prevention & Control “The Ripple Effect of Substance Abuse on Family and Community” October 29, 2008 Mandan, ND H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment Substance Abuse Mental Health Services Administration U.S. Department of Health & Human Services

  2. President George W. Bush “Alcohol addiction and drug addiction continue to challenge our Nation. Addiction to alcohol or drugs destroys family ties, friendship, ambition, and moral conviction, and reduces the richness of life to a single destructive desire.” September 2003 2

  3. Substance Abuse and Mental Health Services Administration/CSAT • SAMHSA’s Mission: • To build resilience and facilitate recovery for people with or at risk for substance abuse and mental illness. • Center for Substance Abuse Treatment (CSAT) Mission: • To improve the health of the nation by bringing effective alcohol and drug treatment to every community.

  4. The Impact of Addiction Addiction impacts an individual’s behavior, health, thinking process, quality of life, and overall functioning. Alcohol & other drugs are powerful reinforcing psychoactive substances that take on a life of their own. 4

  5. SAMHSA’s Role in Supporting Recovery from Substance Use Problems & Disorders SAMHSA works to ensure that science, rather than ideology or anecdote, forms the foundation for the Nation’s addiction treatment system. SAMHSA serves health professionals and the public by disseminating scientifically sound, clinically relevant information on best practices in the treatment of addictive disorders and by working to enhance public acceptance of that treatment. 5

  6. SAMHSA/CSAT’s Public Health Approach • Population-based • Comprehensive and holistic • Incorporates early intervention, treatment, recovery support, and health promotion • Works across systems and professions • Involves people in recovery, the community, the public and private sectors • Evidence-based

  7. We Face Multiple Challenges Reaching those in need of services Providing adequate resources Developing culturally-appropriate, evidence-based interventions Building and sustaining a qualified workforce Integrating substance use disorder services into the public health paradigm 7

  8. Greater Burden on Public Sector Projections indicate that the burden on the public sector will continue to increase Private Private Public Public 1986 All SA = $9.3B Public = $4.6 B Private = $4.6 B 2003 All SA = $20.7 B Public = $16.0 B Private = $4.7 B 8 Source: Health Affairs, July-August 2007

  9. A Greater Burden & Tighter Budgets At the same time that a larger percentage of substance abuse treatment costs are being placed on the public sector, states are facing tighter budgets: According to the Center on Budget and Policy Priorities, 29 states face budget shortfalls in 2009 – ranging from $59 Million to $22.2 Billion. Funds need to be used effectively for programs that can show evidence of their success All of these factors make the challenges facing treatment providers even more difficult.

  10. The Challenges Remain • Despite tightening budgets and changing populations, the challenges of alcohol and substance abuse remain. According to the 2007 National Survey on Drug Use and Health (NSDUH): • In 2007, an estimated 19.9 million Americans aged 12 or older were current (past month) illicit drug users. • Slightly more than half of Americans (12 and older) reported being current drinkers of alcohol – more than a fifth of them participated in binge drinking at least once in the 30 days prior to the 2007 survey.

  11. Drug Abuse

  12. Past Month Use of Specific Illicit Drugs among Persons Aged 12 or Older: 2002-2007 Source: NSDUH, 2007

  13. Past Month Nonmedical Use of Prescription Drugs (Psychotherapeutics) among Persons 12+: 2002-2007 Percent Using in Past Month + Difference between this estimate and the 2006 estimate is statistically significant at the .05 level.

  14. Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2007 Source Where Respondent Obtained Source Where Friend/Relative Obtained Bought on Internet0.5% More than One Doctor2.9% Drug Dealer/Stranger4.1% Free from Friend/Relative6/6% Other 14.2% More than One Doctor 2.6% Bought/Took fromFriend/Relative5.9% OneDoctor 81.0% Free from Friend/Relative56.5% One Doctor 18.1% Drug Dealer/Stranger1.8% Bought/Took from Friend/Relative14.1% Bought on Internet0.1% Other 11.8% Note: Totals may not sum to 100% because of rounding or because suppressed estimates are not shown. 1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”

  15. Estimated numbers of new nonmedical users in past year by type of drug, US, 1990-2007 Source: SAMHSA NSDUH, 2006 and 2007

  16. Mean Age at First Use for Specific Drugs among Past Year Initiates Aged 12 to 49: 2007 Source: SAMHSA NSDUH 2007

  17. Illicit Drug Use in Past Month among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2005-2006 NSDUHs

  18. Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs

  19. Alcohol Misuse

  20. Past Month Alcohol Use - 2007 Any Use: 51% (127 million) Binge Use: 23% (58 million) Heavy Use: 7% (17 million) (Current, Binge, and Heavy Use estimates are similar to those in 2002-2006) Source: NSDUH 2007

  21. Alcohol Use in past Month among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs

  22. Binge Alcohol Use in Past Month among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs

  23. Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs

  24. Perceptions of Great Risk of Having Five or more Drinks of an Alcoholic beverage Once or Twice A Week among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs

  25. Alcohol Related Deaths There are approximately 79,000 deaths attributable to excessive alcohol use each year in the United States This makes excessive alcohol use the 3rd leading lifestyle-related cause of death for the nation. Source: Centers for Disease Control

  26. Alcohol-Related Emergency Room Visits • According to the Drug Abuse Warning Network (DAWN), in 2005 approximately 492,655 Emergency Department (ED) visits involved alcohol alone or in combination with another drug – 34% of all drug misuse/abuse ED visits. • Approximately 145,759 of these were alcohol-related ED visits for patients under the age of 21. • Two-thirds of the alcohol-related ED visits for minors involved alcohol alone.

  27. Immediate Health Risks from Inappropriate Drinking Unintentional injuries. Risky sexual behaviors. Miscarriage and stillbirth among pregnant women, and a combination of physical and mental birth defects among children that last throughout life. Alcohol poisoning Violence, including intimate partner violence and child maltreatment. Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005

  28. Unintentional Injuries • Falls • An average of 5,532 deaths per year are related to alcohol • Drownings • An average of 868 deaths per year are related to alcohol • Traffic injuries • An average of 13,819 deaths per year are related to alcohol-related motor vehicle traffic crashes • An average of 183 deaths per year are related to motor-vehicle non-traffic crashes Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005

  29. Intimate Partner Violence & Child Maltreatment About 35% of victims report that offenders are under the influence of alcohol. Alcohol use is also associated with 2 out of 3 incidents of intimate partner violence. Studies have also shown that alcohol is a leading factor in child maltreatment and neglect cases, and is the most frequent substance abused among these parents. An average of 168 children die every year as a result of alcohol related child maltreatment Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005

  30. Alcohol Impaired Driving: 2004-2006 • In 2006, approximately 30.5 Million persons aged 12 or older drove under the influence of alcohol at least once during the past twelve months. • North Dakota – at 24.9% -- reported the second highest rate of drivers 18 and older who reported driving under the influence of alcohol during the past year – only Wisconsin (at 26.4%) reported more. Source: OAS, NSDUH 2007, combined data 2004-2006

  31. Other Unintentional Injuries Other annual deaths related to alcohol include: • An average of 1,158 deaths related to burns • An average of 123 unintentional firearm deaths • An average of 370 poisoning deaths related to alcohol poisoning • An average of 5,416 deaths per year related to alcohol related poisoning (not alcohol) • An average of 269 deaths per year related to hypothermia • An average of 7,787 homicide deaths Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005

  32. Alcohol-related Suicide • Suicide • Alcohol related suicide has been related to an average of 7,235 deaths per year • Another 31 deaths per year have been attributed to suicide by and exposure to alcohol Source CDC: Alcohol-Attributable Deaths Report, Average for United States 2001-2005

  33. Substance Misuse can: • Lead to: • Worsened medical conditions (e.g. diabetes, hypertension, dental) and • Worsened brain disorders (e.g. depression, psychosis, anxiety & sleep disorders) • Unintentional injuries & violence • Result in: • Dependence, which may require multiple treatment services • Low birth weight, premature deliveries, and developmental disorders, child abuse & neglect

  34. Substance Misuse can: • Contribute to or be associated with : • Homelessness • Criminal justice involvement • The effect and abuse of prescribed medications • Unemployment • Gambling • Bankruptcy • Legal Issues (e.g. DUI, DWI, domestic violence) • Dropping out of school

  35. Substance Misuse can: • Induce or facilitate: • Medical diseases (e.g. Stroke, dementia, hypertension, cancers, dental) • Acquiring Infectious diseases & infections (e.g. HIV, Hepatitis C) • Suicide attempts or tendencies

  36. Impact of Addiction on the Family • Addiction is a developmental and inter-generational disease • Majority of persons who abuse or are dependent on psychoactive substances begin alcohol and drug use as teens • Children of parents who use are more likely to use themselves • Children of substance abusing and dependent parents are at increased risk for • Abuse and neglect • Poor academic, health and psycho-social outcomes • Genetic propensity to addiction

  37. Drug Use and Criminal Activities • An annual average of 1.2 Million adults (18 years & older) were arrested for serious violent or property offenses from 2002 to 2004. • An annual average of 60.1% of adults who were arrested from 2002 to 2004 for any serious offense were more likely to have used an illicit drug in the past 12 months than those who were not arrested (13.6%). Source: Illicit Drug use among Persons Arrested for Serious Crimes, NSDUH Report, December 16, 2005

  38. Drug Use and Criminal Activities • The rate of substance abuse or dependence among adult offenders on probation or parole supervision is more than four times that of the general population1 (38.5% vs. 9%) • Nearly 3/4ths of state prison inmates are in need of some substance abuse intervention: • 31.5% of male inmates and 52.3% of all female inmates require intensive services such as residential treatment programs.2 1 NSDUH Report (2006) 2 Belenko and J. Peugh, Estimating drug treatment needs among state prison inmates, Drug and Alcohol Dependence (2005),

  39. 72% of persons under justice supervision - jail/prison/probation/parole have a Co-Occurring Substance Abuse Disorder More than 60% of male arrestees have tested positive for at least 1 illegal drug 670,000+ offenders return to the community from State prison each year Almost 70% recidivate within 3 years of release 69% have Substance Abuse disorder Less than 10% receive treatment Criminal Justice, Substance Abuse and Mental Health: The Impact on Society Source: US Department of Justice, Office of Justice Programs, The Bureau of Justice Statistics

  40. Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2007 Felt They Needed Treatment and Did Not Make an Effort Did Not Feel They Needed Treatment (955,000) 93.6% 1.8% (19.5 Million) Felt They Needed Treatment and Did Make an Effort (380,000) 20.8 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use

  41. Reasons for Not Receiving Substance Use Treatment: Persons Aged 12+ Those who Needed & Made the Effort to Get Treatment But Did Not Receive Specialty Treatment Did Not Know Where to Go for Treatment Might Have Negative Effect on Job No Program Having Type of Treatment Might Cause Neighbors/Community to Have Negative Opinion No Transportation/Inconvenient Able to Handle Problem without Treatment Not Ready to Stop Using No Health Coverage and Could Not Afford Cost Percent Reporting Reason Source: NSDUH, 2004-2007 combined

  42. North Dakota State Indicators Source: NSDUH 2004-2005 average

  43. Special Populations: Underage Drinkers & Adolescents

  44. Underage Drinking • According to the 2007 National Survey on Drug Use and Health (NSDUH), 10.7 million persons aged 12 to 20 reported drinking alcohol in the past month. • Approximately 18.6% of them were binge drinkers, and 6% were heavy drinkers. • 56.3% of current underage drinkers reported that their last use of alcohol in the past month occurred in someone else’s home (vs. 29.4% who reported it occurred in their own home).

  45. Underage Drinking • 30.2% of underage drinkers paid for the alcohol the last time they drank – 8.2% bought it themselves. • Among those who had someone else pay for the alcohol, 37.2% got it from an unrelated person aged 21+, 20.7% from another person under 21, and 19.5% got it from a parent, guardian, or other adult family member. Source: 2007 NSDUH

  46. Adolescents Drink Less Frequently than Adults But More Per Occasion Source: SAMHSA National Survey on Drug Use and Health 2007

  47. Alcohol Use and Binge Drinking Rise Rapidly Over Ages 12 to 20 Source: SAMHSA National Survey on Drug Use and Health 2007

  48. Alcohol use in Past Month among Persons Aged 12 to 20, by State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs

  49. Binge Alcohol use in Past Month among Persons Aged 12 to 20, by State: Percentages, Annual Averages Based on 2005 and 2006 NSDUHs

  50. 5,000 deaths among youth under 21 per year from alcohol related injuries including homicides (1,600) and suicides (300) Physical and sexual assaults; unwanted/unintended sexual activity Altered academic/vocational trajectories Possible adverse effects on developing brain Direct Consequences of Underage Drinking

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