Nevada County Drug and Alcohol Data Report

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1 Nevada County 2010 Drug and Alcohol Data Report Sponsored by: Coalition for a Drug Free Nevada County Nevada County Health and Human Services Agency Community Recovery Resources Submitted by Ariel King Lovett and Pamela Geisler, Evaluation Consultants Revised 4/11/2011 1

2 Table of Contents 1. Executive Summary Introduction Objectives of the Report How the Report is Organized Data sources Drug and Alcohol Trends and Prevalence Data and Analysis Youth Use Adult Use Current Substance Abuse Prevention and Treatment Strategies Prevention Strategies Treatment Strategies Conclusions and Recommendations Citations Special thanks to the following organizations for providing information and support to make this report possible: Grass Valley Police Department Nevada County Courts Nevada County Department of Information and General Services Nevada County Sheriff s Department Nevada County Superintendent of Schools Sierra Nevada Memorial Hospital 2

3 1. Executive Summary Headlines were made in mid-september 2010 when the Substance Abuse and Mental Health Administration (SAMHSA) released the 2009 National Survey on Drug Use and Health (NSDUH) showing that the use of illicit drugs among Americans had increased. According to this survey, the overall rate of current illicit drug use in the United States rose from 8.0 percent of the population aged 12 and older in 2008 to 8.7 percent in This rise in overall drug use was driven in large part by increases in marijuana use, non-medical use of prescription drugs, and increased methamphetamine use. ( However, while the nation struggles with increased methamphetamine use, this reports shows that at the same time Nevada County reduced overall methamphetamine use, demonstrated by multiple indicators. This represents an incredible result of a targeted community focus to combat the meth problem over the last five years. This community has demonstrated that focused cross-sector community engagement works; that coordinated prevention and treatment efforts can impact a large-scale public health and safety problem. However, drug and alcohol abuse remains a persistent and major problem in this rural county. Data shows the California substate Region 2 1 in which Nevada County is located as having the third highest rate of illicit drug use in the past month in the State 2. Further, our region demonstrates the highest average in the State for those needing but not receiving treatment for alcohol and illicit drug use (Office of Applied Studies, SAMHSA). This data is underscored by evidence suggesting that substance abuse is a prevalent and persistent concern for local community members. According to the th Annual Grass Valley Police Department Citizen Attitude Survey, our community still considers drug abuse to be our most serious problem, followed by alcohol abuse. Multiple stakeholders brought together by the Coalition for a Drug Free Nevada County, including local healthcare providers, schools, treatment providers, and the criminal justice entities, combined efforts to develop this report. Partners collected and aggregated local data and standardized data to create an overall picture of substance abuse in Nevada County. The report focuses on two subgroups (adults and youth) and four primary substances of abuse: alcohol, marijuana, methamphetamine, and opiates. These four make up 97% of all treatment admission in Nevada County. A trajectory of local alcohol and other drug (AOD) trends over time and as compared with State and National statistics is shown to the extent possible. The picture that emerges, over the past decade, shows that high rates of alcohol use have stayed fairly flat ; methamphetamine use has increased and then decreased dramatically; marijuana use indicators have increased incrementally, while prescription drug indicators have increased exponentially. In terms of arrests, alcohol-related crimes dwarf all other substances. A wide range of prevention and treatment services are available and some strategies have proven effective at reducing the impact of substance abuse on the community. Gaps also exist, and burgeoning waiting lists for treatment services and funding limitations threaten even successful 1 El Dorado, Napa, Nevada, Placer, Sacramento, Sierra, Solano, Sonoma, Sutter, Yolo, Yuba 2 Also notable is that our region is among the top 15 of regions needing and not receiving treatment nationwide. 3

4 programs. While some excellent services are available, it is a fragile structure, with much to be done to create a service system with the capacity to meet the needs of this community. At the same time, overwhelming evidence demonstrates that substance abuse treatment is cost-effective and reduces violent crime. Based on what has worked, and where gaps exist, this report concludes that Nevada County should focus on five principle strategies to reduce substance abuse and its impacts: 1) Enhance Collaboration among Sectors; 2) Foster Community Engagement; 3) Support treatment services, and focus on proactive, early treatment 4) Sustain programming related to alcohol and prescription drug use prevention 5) Effect systemic and environmental changes (community changes in norms and policies). 4

5 2. Introduction 2.1 Objectives of the Report The primary objective of this report is to provide an overall perspective of substance abuse in Nevada County for service providers, community stakeholders, and policymakers. To do this, indicators have been drawn from multiple sources as available, aggregated, and analyzed to provide a trend or brief analysis. Alcohol and other drug (AOD) problems have many causes and manifestations. AOD use creates or exacerbates multiple health, safety, and social problems. The labor and costs of taxpayer supported systems are driven or complicated by AOD use schools (in which student readiness to learn or school climate is compromised), law, justice and correctional system operations, foster care placements, community and personal health problems, domestic violence, and mental health care. The foundation for meaningful action to address any public health problem is information. However, alcohol and other drug abuse and dependence are not directly observable and are difficult to quantify. Stigma, denial, illegality, and lack of established data collection systems can conceal AOD use and dependence. The use of AOD creates ripples throughout society. As the County Alcohol and Drug Program Administrators Association of California (CAADPAC) writes Not every alcoholic is arrested for DUI. Not every heroin addict overdoses. Until an individual shows up on the radar screen of law enforcement, the health system, a treatment program, or in some other institutional setting, they are statistically invisible even though they have long made their impact felt in other ways. For example, the Nevada County Child Protective Services Program Manager reports that at least 85% ( low estimate ) of current cases are related to substance abuse. ( communication, October 2010). This report provides a snapshot of recent Nevada County AOD trends and indicators. Despite data limitations of varied indicators, the report provides context and comparison over time or comparison to state or national data. Utilizing over a dozen data sources, evaluators and Coalition for a Drug Free Nevada County members have identified trends, both positive and challenging, as well as current strategies, promising practices, and next steps in prevention and treatment. 5

6 2.2 How the Report is Organized This report contains six sections: 1. Executive Summary. 2. Introduction includes objectives, organization, and primary data sources of the report. 3. Drug and Alcohol Trends and Prevalence Data and Analysis highlights key indicators in local substance use patterns and prevalence separately for adults and youth specific to four primary substances: alcohol, marijuana, methamphetamine, and opiates. These were chosen due to their prevalence and risk, and presented separately to allow for the demonstration of varied trends and patterns of use. Data for each substance is condensed in charts to show status of various AOD problems, followed by a brief analysis of salient trends or relevant related data. 4. Current Substance Abuse Prevention and Treatment Strategies provides a summary of current programs, services and providers in Nevada County as well as service gaps or deficits. 5. Conclusions and Recommendations. 6. Citations. 2.3 Data sources Data was collected from standardized sources as well as local sources as follows: 1) Standardized Data Sources: California Department of Justice California Department of Public Health California Department of Education National Institute on Drug Abuse (NIDA): Indicators of Substance Abuse Consequences (ISAC) California Healthy Kids Surveys National Survey on Drug Use and Health, Substance Abuse and Mental Health Administration 2) Local partner data Local Sheriff and Police Departments Sierra Nevada Memorial Hospital Emergency Room Admission Data Local service providers (Community Recovery Resources) admission and testing data Nevada County Sheriff s Department Coroner Nevada County Behavioral Health, CalOMS Data 6

7 3. Drug and Alcohol Trends and Prevalence Data and Analysis 3.1 Data, Trends and Analysis of Youth Substance Use Summary and Scope of Problem: Research shows that the earlier a person starts using AOD, the more likely they are to develop serious problems as an adult. Nevada County parents and youth perceive an urgency to address alcohol and other drug use. In the California School Climate Survey, 95% of school teachers and other school personnel in Nevada Joint Union High School district see substance abuse as a problem. As a matter of fact, 67% see it as moderate to severe, more than any other problems (e.g. bullying, disruptive student behavior, or truancy etc.). AOD prevention was the primary need indicated by both students and parents in 1046 surveys collected during preparation for the 2009 Safe School/Healthy Students proposal, and data supports this: 42% of youth have used marijuana by 11 th grade, and overall, 64% of all youth have consumed alcohol or drugs (2007 California Health Kids Survey, CHKS). Nevada County currently ranks 7 th in the State for the highest rate of juvenile drug arrests (Socioeconomic Mapping and Resource Topography System 2007) an improvement from third in the last measured period (2006). We know that escalation of substance use occurs at certain points. For example, with regard to marijuana use in the past 30 days among kids in Western Nevada County, 0% of 5 th graders, 6% of 7 th graders, and 22% of 9 th graders have used, while 42% of 11 th graders have used (CHKS). Not only does prevalence of use increase with age but it increases at a disproportionately high rate compared to regional and state averages for the same indicators. In general, Nevada County has lower averages for 5 th graders; is on par with or below state averages in 7 th and 9 th grades, and by high school grades may exceed regional and state averages. For example, in the 2005/2006 CHKS, 37 percent of 11th grade respondents in Nevada County reported being high from using drugs at least once. This is one of the highest rates reported in the Nine County Region. In the same survey, 39% of 11 th graders responded that had been offered drugs on school campuses, slightly higher than the state average. This may demonstrate an opportunity for targeted interventions at specific points in time. While there is widespread concern regarding youth substance use, this perception is somewhat juxtaposed by the fact that 30-40% of youth believe that alcohol and marijuana are harmless (NC Drug Free Coalition 2005). Generational use and abuse within families may contribute to youth AOD use/abuse; according to Community Recovery Resources (CoRR), 80% of the youth enrolled in their programs report a family history of substance abuse, and 36% of youth report they obtain alcohol in their homes, while 29% report obtaining marijuana at home (2005). A combination of data from a variety of sources demonstrates that early and frequent alcohol and other drug use is very real and problematic in Nevada County. Figure 1. Juvenile Misdemeanor Arrests Reported Nevada County Marijuana Other Drugs Drunk and Liquor laws Driving Under Influence TOTAL (Source: 7

8 Figure 2. Juvenile Felon Arrests Reported Nevada County Narcotics Marijuana Dangerous Drugs* TOTAL (Source: * Dangerous drugs include stimulants, depressants, hallucinogens, illegally diverted pharmaceuticals, inhalants, and anabolic steroids. Juvenile felony arrests peak in 2005 and then decrease. Figure 3. High School Suspensions and Expulsions Nevada County (all 11 districts), Suspensions Expulsions Enrollment Percent Percent Expelled Suspended , % 4.67% , % 5.20% , % 4.24% , % 4.62% , % 4.87% (Source: California Department of Education Safe & Healthy Kids Program Office, ) The above chart shows fairly consistent trends in drug/violence related disciplinary actions at schools in Nevada County. Figure 4. Emergency Room Data Sierra Nevada Memorial Hospital, Youth 17 and Under Alcohol Marijuana Methamphetamine Prescription/ Opiate/Other Total (Source: Emergency Room Data, Sierra Nevada Memorial Hospital ) While causes of admissions vary year to year, this chart demonstrates a continual increase of 13 admissions a 22% increase from the first to most recent year. Youth Alcohol Use Data, Trends, and Analysis Data from all sources indicates that alcohol use by minors continues to be a serious problem for Nevada County. Parents and other adults perceive alcohol use to be a problem; data from state surveys, law enforcement, educational entities, hospital admissions, and local community-based organizations corroborate this perception. With respect to youth and alcohol, we can look at data sets for both acquisition and use. 8

9 California Healthy Kids Survey (CHKS) data demonstrates trends over the past few years. On average the onset of drinking age parallels the state average. Acquisition of alcohol by youth in Nevada County is easy. In a Youth Development Survey administered to all participants in Friday Night Live, FNL Mentoring, and Club Live programs in the County, respondents affirmed CHKS findings, reporting that it is easy for youth to get alcohol, tobacco, and other drugs in their community. Between 25%-44% of middle school participants and between 52%-93% of high school participants responded that it was easy. (STOP Baseline Data Report, Oct. 2010) Limited data from key informant interviews and surveys conducted in Grass Valley in 2010 as part of the STOP Act grant evaluation captures local youth and adult perceptions around youth alcohol use and acquisition. An important finding from the survey is that parents are less likely than others to think that youth are obtaining alcohol from homes. Perhaps the most important finding from this survey is that young females and young males (those under age 25 years) have very different answers to the question of how youth obtain alcohol. A much higher percentage of young females think that youth who drink get alcohol at parties two-thirds of young women compared to one-fifth of young men. Strangers are the number one source for alcohol according to young men in this sample, by far. Other data indicate that youth drinking is a problem. In 2008, the most recent year for which statistics are shown on the California Department of Justice website, 414 youth were arrested for being Drunk, and 755 youth were arrested for driving under the influence. Over the past three years, there has been an annual average admission rate of 38 youth ages 17 and younger to Sierra Nevada Memorial Hospital Emergency Room for alcohol-related problems such as poisoning and overdosing. CHKS data indicates that the frequency of alcohol use is also of concern. In the 2009 survey for Nevada Joint Union High School District (NJUHSD), past 30 day use was reported at 24% for 9 th graders and 38% for 11 th graders. Reporting of past 30 day use by NJUHSD students has increased in recent years as the chart below demonstrates. Figure 5. Reported Alcohol Use Nevada Joint Union High School District, (Source: California Healthy Kids Survey Data ) Above: Past 30 day use by NJUHSD 9 th and 11 th grade students has increased in recent years. Figure 6. Reported Alcohol Use Tahoe Truckee Unified School District,

10 Percent 60% 40% 20% 0% 49% 45% 35% 31% Year % of 9th Grade Students Who Used Alcohol during the Past 30 Days % of 11th Grade Students Who Used Alcohol during the Past 30 Days (Source: California Healthy Kids Survey Data) Above: Student-reported rates of past 30 day use at Tahoe Truckee Unified show downward usage trends, but higher rates of use overall than NU. Figure 7. Drinking and Driving or Riding with a Driver Who Had Been Drinking, by Grade Level, Gender, and Number of Times Nevada County, Nevada County 7th Grade 9th Grade 11th Grade Non- Traditio nal 1 or more Times 1 Time Female 2 Times 3-6 Times 7 Times or More 1 or more Times 1 Time Male 2 Times 3-6 Times 7 Times or More 44.6% 19.1% 9.8% 6.7% 9.0% 44.8% 17.0% 7.3% 7.8% 12.7% 23.6% 7.8% 5.4% 5.1% 5.4% 18.2% 6.1% 4.0% 3.0% 5.8% 26.7% 11.3% 5.8% 6.4% 3.1% 25.3% 6.8% 4.9% 5.9% 7.7% 46.4% 1.8% 14.3% 17.9% 12.5% 63.1% 7.7% 9.2% 21.5% (Source: The above table indicates that nearly half of high school students have ridden with a driver who has been drinking, or have driven drunk themselves. Youth Marijuana Use Data, Trends, and Analysis Data regarding youth marijuana use reveals interesting trends that are similar for both girls and boys. The onset of use is on par or slightly less than state averages (with available comparative data beginning with 7 th grade youth.) By the time youth enter high school, Nevada County youth are using marijuana at approximately the same rate as their peers statewide. However, as Nevada County youth progress in high school, they begin to use marijuana at rates greater than the average of their peers statewide. 10

11 Figure 8. Reported Marijuana Use Nevada County Females, Percent 25% 20% 15% 10% 5% 0% 7th Grade 9th Grade 11th Grade Grade Level CA, Female NC, Female (Source: Above: Marijuana use in NC girls demonstrates significant increases between grades 7-11; equal to and then exceeding State rates. Figure 9. Reported Marijuana Use Nevada County Males, Percent 30% 20% 10% CA, Male NC, Male 0% 7th Grade 9th Grade 11th Grade Grade Level (Source: Above: Marijuana use in NC boys demonstrates significant increases between grades 7-11; first below, and then exceeding State rates. This data is concerning for two primary reasons: 1) marijuana use may continue to increase as youth become adults; and 2) marijuana may be a gateway drug that leads to use of other drugs, increasing the chances of these youth using other drugs as they transition out of high school and into adulthood. Nevada County s high adult other drug use rates indicate that this may be true. This data also suggests that high school may be the most opportune time to implement drug-focused prevention and intervention programs. Other data substantiates problems with youth marijuana-related use. From , there was annual average of 18 Emergency Room admissions of youth ages 17 from marijuana at Sierra Nevada Memorial Hospital. In 2008, the most recent year for which statistics are shown on the California Department of Justice website, 135 youth were arrested for marijuana with misdemeanor charges and four youth were arrested with a felony charge. 11

12 Youth Methamphetamine Use Data, Trends, and Analysis In April 2005, the Nevada County Grand Jury proclaimed that the manufacture and use of methamphetamine had risen to epidemic proportions. Emergency Room hospital data indicates that methamphetamine use is a serious problem for the adult population, although some youth use it as well. Research clearly demonstrates that adult methamphetamine use can be mitigated or prevented by intervening in the lives of youth who are using other less serious substance in their adolescence. There is no statistically significant data specific to youth methamphetamine use. Youth Prescription/Opiates Use Data, Trends, and Analysis Use of prescription opiates among youth is a primary concern among treatment providers locally and nationally. More teens abuse prescription drugs than any illicit drug except marijuana more than cocaine, heroin, and methamphetamine combined, according to the 2006 National Survey on Drug Use and Health (NSDUH). Nationally, more than 2.1 million teens ages 12 to 17 reported abusing prescription drugs in Among 12- and 13-year-olds, prescription drugs are their drug of choice (NSDUH, 2007). Prescription painkillers like Vicodin and OxyContin are the most often abused prescription drugs (NSDUH, 2007). The most recent Monitoring the Future Survey (MTF) found that past-year abuse of Vicodin is particularly high among 8th, 10th, and 12th graders, with nearly one in 10 high school seniors reporting taking it in the past year without a doctor s approval (MTF, 2007). And the trend is growing; over a five year period ( ), past year use of OxyContin increased by 30 percent (MTF, 2007). Locally, treatment providers report increasing admissions of youth using opiates, specifically prescription drugs and painkillers. Further, providers are concerned about the progression of prescription opiate abuse leading to heroin use, a trend that has been documented nationally. Heroin use involves needle use, increasing the risk of spreading diseases such as Hepatitis and HIV. Figure 10. Percent of 9th graders who have used/tried prescription pain killers not prescribed to them 4 or more times) 1 1 Percent NJUHSD 9th NJUHSD 11th TTUSD 9th TTUSD 11th (Source: California Healthy Kids Survey Data) Percentage of students reporting misuse of painkillers increased slightly for 9 th graders; and in Truckee, more 9 th graders than 11 th graders had misused prescription painkillers. 12

13 3.2 Data, Trends and Analysis of Adult Substance Use Summary and Scope of Problem: The SAMHSA Office of Applied Studies National Survey on Drug Use and Health (NSDUH) data show California s sub-state region 2, which includes Nevada County, as having the third highest rate of illicit drug use in the past month in the State. Further, our region demonstrates the highest average in the State for those needing but not receiving treatment for alcohol and illicit drug use (Office of Applied Studies, SAMHSA). Figure 11. Nevada County, Placer County, CA Comparison of AOD Hospitalization Rates (County 1 is Nevada County (circles), County 2 is Placer County (squares) and All Counties is all counties in California (diamonds)) (Source: Nevada County hospitalization rates due to alcohol or other drugs are higher than neighboring Placer County, and more similar to State rates. Compare County/State Hospitalizations Placer Population 290, , , , ,388 Rate per 100, Nevada Population 97,151 98,994 99,303 99, ,219 Rate per 100, Hospitalizations California Total 77,521 77,424 75,579 75,136 77,679 Population California Total (10-69) 35,989,853 36,505,465 36,957,436 37,380,870 37,810,582 Rate per 100, (Source: 13

14 Adult Alcohol Data, Trends and Analysis Nevada County residents reported the second highest rate of binge drinking in the region at 17.6 percent. In comparison, the regional binge drinking rate was 14.7 percent. (2003 California Health Interview Survey) Arrests (and bookings) for Driving Under the Influence (DUI) have remained fairly steady over the last ten years, following data from local law enforcement arrests and bookings as well as California State Department of Justice felony and misdemeanor data. Arrests are consistent between 1200 and 1400 between 2002 and (See fig. 12 below) Drunk in public arrests show a similar pattern; a fairly consistent trend of between arrests per year for the past 8 years. Figure 14, shown below, shows Nevada County to have a much higher rate of alcohol involved motor vehicle accidents than Placer County or the State as a whole. Alcohol-related offenses are a persistent and consistent challenge, with indicators demonstrating ongoing abuse of this substance in Nevada County similar to national averages. Figure 12. Number of Arrests for Driving Under the Influence Nevada County, Number of Arrests 1,600 1,400 1,200 1, Year (Source: Nevada County Sheriff s data, ) Arrests (and bookings) for Driving Under the Influence (DUI) have remained fairly steady over the last ten years. 14

15 Figure 13. Nevada County, Placer County, California Comparison of Alcohol Involved Motor Vehicle Accidents (County 1 is Nevada County (circles), County 2 is Placer County (squares) and All Counties is all counties in California (diamonds) (Source: Nevada County has a much higher rate of alcohol involved motor vehicle accidents than Placer County or the State as a whole County/State Nevada Population 98,994 99,303 99, , ,012 Rate per 100, Placer Population 303, , , , ,998 Rate per 100, California 50,492 50,862 52,769 53,083 50,143 Population Total 36,505,465 36,957,436 37,380,870 37,810,582 38,246,598 Rate per 100, (Source: 15

16 Adult Marijuana Use -Data, Trends, and Analysis National Survey on Drug Use and Health data show our region has the highest rate of marijuana use in 2009 in California, and correspondingly, one of the lowest perceptions of risk. Data representing the number of arrests for marijuana possession in NC shows a steady increase over time. Figure 14. Number of Arrests for Possession Marijuana Nevada County, # of Arrests Year (Source: Nevada County Sheriff s booking data, ) -# of Arrests Number of arrests for marijuana possession in Nevada County shows a steady increase over time and a threefold increase over the past decade. Adult Methamphetamine Use- Data, Trends, and Analysis Data representing number of arrests for possession of methamphetamine looks similar to a bell curve over the last decade, with slightly higher rates of arrest currently than there were ten years ago. There were nearly 150 arrests in 2000, which then nearly tripled in the following 5 years to peak of nearly 400 arrests in The trend then reversed, with about 190 arrests in Figure 15. Number of Arrests for Possession Methamphetamines Nevada County, Year (Source: Nevada County Sheriff s booking data, ) Indicators around methamphetamine in NC in the last decade are interesting, because all indicators demonstrate a rise, a peak, and a subsequent decline. 16

17 This trend of declining prevalence occurs despite data showing that methamphetamine availability and production has increased in California and nationally. (USDOJ, National Drug Threat Assessment 2010). An interesting corollary is that in 2005 the Nevada County Board of Supervisors released a Grand Jury study on the deleterious effects of the methamphetamine epidemic on this county (What You Don t Know Can Hurt You, 2005) and in 2006, the Coalition for a Drug Free Nevada County became funded by a SAMHSA Drug Free Communities grant to focus on methamphetamine abuse. This decline is consistent with California State statistics that show a decline in treatment admissions for methamphetamine (ADP FactSheet, Methamphetamine Uses in Treatment). Given the fact that methamphetamine production has not decreased nationwide, it may be reasonable to correlate declining methamphetamine problem in Nevada County and California with focused efforts of law enforcement, education, prevention and treatment strategies employed over the last five years. Adult Prescription, Opiates, and Other Drug Use Data, Trends, and Analysis Arrests rates of persons possessing a controlled substance (e.g. cocaine, cocaine base, heroin, and prescription drugs such as codeine or hydrocodone without lawful prescription) have increased dramatically since the turn of the century. Although patterns are somewhat erratic, there is a clear upward trend with an approximate sevenfold increase over the past decade. Similarly, possessing or purchasing a controlled substance for sale increased over the same period. Figure 16. Number of Arrests for Possession of a Controlled Substance Nevada County, # of Arrests Year (Source: Nevada County Sheriff s data, ) Above: Although patterns are somewhat erratic, there is a clear upward trend of arrests for possession of a controlled substance with an approximate sevenfold increase over the past decade. 17

18 Figure 17. Arrest by Possession Type Nevada County, ,600 Number of Arrests 1,400 1,200 1, Controlled Substances Marijuana Possession Meth Possession DUI Drunk in Public Year (Source: Nevada County Sheriff s Data, ) Alcohol related arrest rates (DUI and Drunk in Public) are over 10 times higher than rates for the 2 nd most prevalent offense: methamphetamine possession. Figure 18. Nevada County, Placer County, California Comparison of AOD Arrest Rates Compare County/State Arrests Nevada 1,933 1,947 1,886 1,746 1,753 Population (10-69) 78,405 78,140 78,495 79,332 79,972 Rate per 100,000 2, , , , , Placer 4,786 5,355 5,950 6,175 5,986 Population (10-69) 236, , , , ,741 Rate per 100,000 2, , , , , California 599, , , , ,171 Population Total (10-69) 28,395,122 28,775,905 29,183,297 29,558,540 29,910,167 Rate per 100,000 2, , , , , (Source: 18

19 Figure 18. County/State Comparison of Alcohol/Drug Arrests Rates per 100,00 (County 1 is Nevada County (circles), County 2 is Placer County (squares) and All Counties is all counties in California (diamonds) (Source: Drug and alcohol arrest rates have dropped in Nevada County, but remain higher than the state. Figure 19. Drug Induced Deaths Nevada County, Year Suicide Undetermined Accidental Total (Source: Nevada County Sheriff s Department Coroner Report) Drug induced death rates in Nevada County are higher than state averages, but have improved from local peaks in 2006 and (CA Department of Public Health 2007, 2010). 19

20 The following table demonstrates an increase in overall treatment admissions for the past five years. The County s population has increased by approximately 6% (U.S. Census Bureau) while treatment admissions have increased by 75% (CalOmsTx data, below). Figure 20. Treatment Admissions, All Ages Nevada County, Fiscal Years through Year Male Female Total (Source: CalOmsTx Data, December 2010 extraction. CalOMS Treatment (CalOMS Tx) is California s data collection and reporting system for alcohol and other drug treatment services.) Countywide treatment admissions have increased by 75% between 2005 and Although overall adult felony arrests in Nevada County have decreased in years by nearly one-third, drug-related felonies have increased from 161 to 205. Drug-related arrests compose onethird of all felony arrests. Similar patterns exist for misdemeanors, with men s rates slightly down, women s up, and misdemeanor arrests for other drugs up by 130% (62 to 152) (Office of the Attorney General The following table summarizes treatment admissions for all ages in Nevada County for the four primary substance categories this report focuses on, which comprise 97% of all admissions. Figure 21. Treatment Admissions by Four Major Categories, All Ages Nevada County, Fiscal Years through Year Methamphetamine Opiates* Marijuana Alcohol % of total admissions % % % % % * Opiates = heroin, oxycodone/oxycontin, other opiates or synthetics (Source: CalOmsTx Data, December 2010 extraction.) The data demonstrates in increase overall in total admissions in each category except methamphetamine. Increase in admissions for opiates is exponential, with an over 700% increase in the 5-year period. 20

21 4. Current Strategies to Address Substance Abuse 4.1 Strategy: PREVENTION Research on adolescent brain development shows the value of focusing prevention on young people: those who reach the age of 21 without developing an addiction are very unlikely to do so afterward. (2010 National Drug Control Strategy.) Recently (2009), an intensive community assessment involving numerous stakeholders from diverse public and private sectors identified high levels of alcohol, tobacco and drug use/abuse as the most pressing problem facing Nevada County schools and youth. (SS/HS needs assessments prior to proposal writing and program implementation.) During this process, student problem behaviors and community risk and protective factors were identified. The following is a succinct summary of student, parent, and school personnel input: Figure 22. AOD-related Problem Behaviors, Risk Factor, and Protective Factors Nevada County Student Problem Behaviors Community Risk Factors Protective Factors ATOD use/abuse, overdoses Truancy Selling drugs on campus Using drugs on campus/ attending school on a substance Campus drug use by some harmful to other students Insufficient ATOD progs. supporting entire family Insufficient ATOD curricula Lack of affordable, accessible activities Easy access to ATOD ATOD abuse/use by parents Establishment of Coalition for a Drug-Free NC in 2006 Recent growth/funding of mentoring programs Some evening/ afterschool activities for youth (Source: Development of SS/HS Proposal) Implementation of many of these key prevention strategies began in Since then, other important steps have been taken. In 2009, on behalf of the Coalition for a Drug-Free Nevada County (CDFNC), Community Recovery Resources (CoRR) received a grant from the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, for a Sober Truth on Preventing Underage Drinking Act (STOP Act) project. Later in 2009, collaboration between Nevada County Superintendent of Schools and Nevada County Health and Human Services Agency, Nevada County Probation, and multiple non-profit partners secured a federal Safe Schools/Healthy Students grant. These funding sources support components of most of Nevada County s current prevention initiatives. Below is a summary of current local prevention strategies. a) 40 Assets Trainings The 40 Developmental Assets is a framework for helping parents and others build assets in all children, infant through teen. Over the last 4 years, nearly 25 volunteers have been trained to present 40 Asset Workshops for community members. Currently, a 40 Asset Committee is in the process of developing a training video in cooperation with Sierra Mentoring Partnership to present 40 Asset workshops in the Family Resource Centers. b) Drug Free Workplace Policies (DFW) Multiple local businesses have instituted drug-free workplace policies. Activities implemented through various partner efforts facilitate peer-to-peer discussion of the positive effects of a drug-free workplace and policy implementation. Workshops were held on drug-free workplaces (DFW) through a collaborative effort of Coalition for a Drug Free Nevada County and CoRR, with partners 21

22 including the Chamber of Commerce, Nevada County Contractors Association, and the Economic Resource Council (ERC). CoRR offered free DFW trainings to local businesses on DFW policies and benefits to employer and employee, also providing DFW resource and training manual. The Coalition is invigorating this campaign in c) Safe Schools/Healthy Students (SS/HS) School-based prevention activities SS/HS is a comprehensive initiative funded for four years to promote safe, healthy, drug-free schools. Prevention strategies include increasing access to resources, including parenting classes and mental health services, through school-based Family Resource Centers. SS/HS implements evidenced-based prevention initiatives at each grade level K-12. These include delivering the following AOD prevention curricula: Second Step, Steps to Respect, and Project Alert as well as after-school and summer programs delivering AOD curriculum and enrichments. d) Friday Night Live Nevada County Friday Night Live Partnership, ATOD (Alcohol Tobacco and Other Drugs) Prevention and Youth Development programs currently serve about 200 middle school and high school aged youth, and provide 13 school and community based chapters. Initiatives include: Peer to Peer Mentoring programs Social Host Ordinance Campaign (SHO), to reduce alcohol-related problem associated with social access to alcohol; Develop and implement social marketing campaign, known as "Adults Committed to Youth". Tobacco Retail License Ordinance for the Town of Truckee Smoke-Free Movies, pushing for legislation at the state level to regulate PG and PG-13 movies. TEEN Health education and awareness projects (Peer Advocates). e) The New Generation (NEO) The name "NEO" came from the prefix defined as "new". What it means is "a new choice", or "a new way of thinking" around living a drug free lifestyle. NEO, the youth-sector of CDFNC, provides youth with the opportunity to take on leadership roles, support local young bands and artists, and implement strategies to positively change the youth perceptions of AOD use. Accomplishments in recent years include: forming two active clubs at Nevada Union High School implementing multiple well-attended ongoing activities, including BMX bicycle events; performance; dances, etc. providing music (bands) at Thursday Night Market for youth creating the Big Buddy program at Lyman Gilmore collaborating with the Nevada County Fair Board and Law enforcement to discourage youth-binge drinking and social hosting providing a collaborative space for youth leaders to meet working with Grass Valley businesses to provide a discount to youth that wear NEO shirts on Fridays advocating for smoke free parks and trails 22

23 f) Mentoring Initiatives Mentoring is identified by the US Department of Justice as a primary prevention strategy. The Sierra Mentoring Partnership (SMP) was founded to create a bridge between a caring community and youth in need through the development and support of safe, effective mentoring programs. SMP acts as an advocacy and umbrella organization for mentoring, assuring that there is no duplication of services, identifying gaps in services, and working to insure each program reaches its potential. SMP supports the efforts of youth serving programs resulting in improved efficiency and increased capacity to provide services for Nevada County children who are considered at-risk or high-risk. In total, these programs serve 325 youth in Nevada County with excellent outcomes. g) Clean Out Your Cabinets Prescription Drug collection The Coalition developed prescription drug disposal plan in partnership with Nevada County Recycles, local pharmacies, and law enforcement (GVPD). To date nearly 2500 pounds of prescription drugs have been collected through this initiative. As a result of this effort, disposal bins are available at Grass Valley Police Department, Behavioral Health, and Kmart Pharmacy in Grass Valley. h) Social Hosting ordinances (future effort) Friday Night Live, law enforcement, schools and parent groups have partnered to plan to disseminate social hosting laws information. The goal of this is to change a pervasive perception in the County that adult hosting of drinking parties for minors is acceptable. i) Screening, brief intervention and referral to treatment (SBIRT) In partnership with UCLA s Integrated Substance Abuse programs and Community Recovery Resources, the Coalition for a Drug Free Nevada County has provided training for healthcare professionals (and has more trainings scheduled). In past studies, similar interventions have been shown to reduce future re-injury and/or re-hospitalization. The goal is to teach providers how to screen their patients for alcohol and other drug problems. For those in need of treatment, brief intervention skills can facilitate improved understanding of and follow-through with referrals to treatment services. 23

24 4.2 Strategy: TREATMENT Increasingly, nationwide studies demonstrate the efficacy of substance abuse treatment from a public safety and public cost perspective. This includes studies demonstrating that increases in substance abuse treatment admissions are associated with decreases in crime rates and reduced incarceration rates. In fact, California has been an important case study, experiencing decreased incarceration rates when the number of people sent to drug treatment programs increased (primarily through Proposition 36). Violent crime fell as well. Some were concerned that the decrease in incarceration resulting from Prop 36 would lead to an increase in violent crime. In fact, from 2000 to 2004 California s violent crime rate decreased by 11.2 percent. Substance abuse treatment also appears to be more cost-effective than prison or other punitive measures. Independent analysis of Prop 36 by the University of California and The Justice Policy Institute both found considerable fiscal savings; JPI estimates that California saved a total of $412 million on prison and jail operating costs alone over six and a half years, and the UC shows a total of $173.3 million in savings to the California government in the first year alone. The Washington State Institute for Public Policy (WSIPP) found that drug treatment conducted within the community is extremely beneficial in terms of cost, especially compared to prison. Every dollar spent on drug treatment in the community is estimated to return $18.52 in benefits to society. Like other specialized areas of healthcare, substance abuse treatment research and practice are developing rapidly. Current best-practice trends include: 1) Recovery oriented approach: A recovery oriented system of care identifies and builds upon each individual s assets, strengths, and areas of health and competence to support achieving a sense of mastery over his or her condition while regaining a meaningful, constructive, sense of membership in the broader community. This approach involves a no wrong door perspective and encourages entry at any time. It emphasizes a collaborative, strengths-based treatment process using evidence-based curriculum. 2) Addressing co-occurring disorders: Based on SAMHSA s Blueprint for Change, it is estimated that over 50% of those with a substance use disorder also have other complicating mental health disorders. It is further estimated that over 70% of those with mental health disorders also have substance abuse disorders. This drives a need to create services that can identify and support dually diagnosed patients. 3) Integrated health model: Utilizing an approach that integrates primary healthcare with comprehensive substance abuse and mental health services. Statistics addressed above concerning the prevalence of dually diagnosed patients are compounded by the reality that both mental health clients and substance abuse clients have a greater risk of multiple physical health problems. Research shows substance abuse to be an underlying cause of many health problems, leading to increased risk of cardiovascular disease, cancer, liver problems, and even osteoporosis and damage to the nervous system. Very frequently, people with substance abuse and mental health issues have not maintained preventive health screenings and have un-treated primary health and dental conditions. Nevada County Providers/Services: Strengths: Nevada County providers offer a range of effective treatment services, including adolescent prevention and treatment, residential treatment for women, transitional housing, schoolbased interventions, criminal justice system programs, and various types of group and individual counseling and therapy at multiple sites. Principal providers of drug and alcohol treatment in Nevada County include Nevada County Behavioral Health Department (county government), 24

25 Community Recovery Resources (CoRR) (non-profit), Progress House, and Common Goals (forprofit entity). Demand exceeds service capacity (described below). Figure 23. Overview of Local Treatment Service Providers Nevada County Local Service Providers: Common Goals (Nevada City): Outpatient services in Grass Valley/Nevada City areas. CoRR s Grass Valley Outpatient Center serving Grass Valley/ Nevada City areas with prevention/outreach services, adult/adolescent outpatient substance abuse/mental health treatment programs, criminal justice programs, co-occurring programs, and complimentary services including medical and psychological. CoRR s Hope House- a residential facility serving 10 women with up to 6 total children. CoRR s Transitional housing 6 different locations throughout Nevada County (including Truckee) provide supported temporary (6-12 months) housing for men, women, and women/with children. CoRR s Truckee Service Center serving Truckee and surrounding areas with a smaller scale of programs offered at the Grass Valley Service Center. CoRR s South County Service Center serving the outer lying areas of southwestern Nevada County with a smaller scale of the programs offered at the Grass Valley Service Center with a steady enrollment of approximately 100 on any given day. Nevada County Behavioral Health Department: Provides treatment to Medi-Cal eligible severely mentally ill and dual-diagnosis clients. Progress House: Male only short-term residential of 19 beds in Nevada City. Court Programs: Drug Courts and Treatment Alternatives to Incarceration programs are popular, widely praised and rapidly expanding alternative approaches of dealing with drug offenders and people charged with nonviolent crimes who are drug users. Drug Courts substitute mandatory treatment for incarceration. They have been in operation nationwide since 1989, and multiple studies demonstrate enduring outcomes of reduced recidivism rates and cost savings, including evaluations specific to Nevada County. Nevada County operates three alternative drug courts: Juvenile Drug Court: Juvenile Drug Court is a voluntary program for persons under the age of 18 who have a drug or alcohol problem. The program requires regular appearances at court, random testing, individual, group, and family counseling and a variety of other recovery activities. Evaluation demonstrates that 94% of program graduates have not had subsequent drug convictions since completing this program in Nevada County. Nevada County Adult Felony Drug Court: Drug Court is a voluntary program for persons who are otherwise committed to prison, whose crimes are related to serious drug addiction, and who want help. Initial inpatient treatment is dependent on their initial assessment. The program includes out-patient treatment, self-help meetings, and witnessed drug testing. The participant will be required to return to Court bi-weekly. The counseling will decrease as they gain recovery. Evaluation demonstrates that 92% of program graduates have not had subsequent drug convictions since completing this program in Nevada County. Prop 36 Drug Court: Under Proposition 36, certain non-violent adult offenders who use or possess illegal drugs will receive drug treatment rather than incarceration. Eligible offenders receive up to one year of drug treatment and six months of aftercare. The court may sanction offenders who are not amenable to treatment or who violate their probation terms. Vocational 25

26 training, family counseling, literacy training, and other services may also be provided. Evaluation demonstrates that 87% of program graduates have not had subsequent drug convictions since completing this program in Nevada County. Figure 24. Nevada County Drug Court 2 Year Re-arrest Rates Percent 80% 70% 60% 50% 40% 30% 20% 10% 0% 18% 20% Drug Court Graduates All Drug Court participants Group 67% Comparison Group (Source: Nevada County Courts Data Collection) An evaluation of Nevada County Drug courts coordinated by the State of California demonstrated them to be highly effective. The total cost of events related to recidivism for the Nevada County Drug Court per drug court graduate was $4,327 and per drug court participant (regardless of graduation status) was $9,429, while the cost per comparison group member was $25,673. The difference between the drug court and comparison group was $16,244 per participant. This amount represents the recidivism cost savings due to participation in drug court over 2 years. If this amount is multiplied by the total number of participants who have entered the program since its inception (approximately 92 offenders) the total amount saved by the program due to positive outcomes for its participants (i.e., lower recidivism related events) is $1,494,448. (California Drug Courts, Costs and Benefits, NPC Research 2009) Treatment Deficits: Gaps and deficits exist in service availability, and stakeholders recognize a need to expand service variety and capacity. Local and regional data substantiate this need. Existing services are over-impacted, and certain services do not exist locally at all. Inpatient treatment for men, women, and youth is insufficient, with burgeoning waiting lists and some treatment options that are simply not available such as adolescent residential treatment and men s detoxification treatment. Significant data was garnered through a local and regional needs assessment conducted in November 2009 that surveyed all treatment providers within a 100-mile radius of Grass Valley to determine availability of services. Primary and compelling findings included: Lack of Existing Comprehensive and Specific Services: Regionally, few treatment providers surveyed offer all services (Prevention, Detoxification, Outpatient, Residential, Criminal Justice, Family, Adolescent, Transitional housing,) and certain services (e.g. adolescent and family services) are offered by fewer than 15% of providers; only 12% of providers offer allmale services and a quarter offer all-female. 26

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