Tennessee Department of Mental Health and Substance Abuse Services Anthony Jackson & Karen Edwards Office of Research 11/5/2014

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1 Substance Abuse Patterns for Different Age Groups in Tennessee and the United States Tennessee Department of Mental Health and Substance Abuse Services Anthony Jackson & Karen Edwards Office of Research 11/5/2014 1

of Mental Health and Substance Abuse Services Anthony

2 Overview Purpose To compare the patterns of substance of abuse for different age groups in Tennessee and the United States Who Youth (ages 12-17) Young adults (ages 18-24) Adults (ages 25+) Measures of substance abuse Admissions to substance abuse treatment programs The primary substance of abuse named at admission to treatment Time period

Adults (ages 25+) Measures of substance abuse Admissions to substance abuse treatment

3 Data source: Treatment Episode Data Set Admissions (TEDS-A) Maintained by the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA). Contains data on 1.9 million substance abuse treatment admissions annually. Reflects treatment admissions funded by state alcohol and/or drug agencies, including federal Substance Abuse Treatment Block Grant funds. Includes 13,000 substance abuse treatment admissions from Tennessee reported to the TEDS-A system through quarterly reports generated from the Tennessee substance abuse services administrative data system: TN- WITS. 3

Reflects treatment admissions funded by state alcohol and/or drug agencies, including federal Substance Abuse Treatment Block Grant funds.

4 Data notes and limitations TEDS-A: Does not reflect the total national demand for substance abuse treatment. Is a significant proportion of all admissions to substance abuse treatment. Reflects differences in state systems of licensure, certification, accreditation, and disbursement of public funds. Charts reflect the primary substance of abuse at admission to substance abuse treatment. Data represent the percent of substance abuse treatment admissions for each age group by primary substance of abuse at admission. 4

Reflects differences in state systems of licensure, certification, accreditation, and disbursement of public funds.

5 Drug categories included in this study: Alcohol Cocaine/crack Marijuana: Includes THC and any other cannabis sativa preparations Heroin Prescription opioids: hydrocodone (Vicodin), oxycodone (OxyContin), hydromorphone (Dilaudid), propoxyphene (Darvon), meperidine (Demerol), codeine, tramadol (Ultram), pentazocine (Talwin), other opiates or synthetics, and any other drug with morphine-like effects Other drugs: LSD, non-prescription methadone, other hallucinogens, aerosols, PCP or PCP combination, solvents, ketamine (Special K), diphenhydramine, nitrites, other drugs, other over-thecounter drugs, other inhalants, unknown drugs, methamphetamine, speed, methylenedioxymethamphetamine (MDMA, Ecstasy), methylphenidate (Ritalin), other amphetamines, other stimulants, clonazepam (Klonopin, Rivotril), alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), other barbiturate sedatives, other tranquilizers, ethchlorvynol (Placidyl), chordiazepoxide (Librium), secobarbital/amobarbital (Tuinal), phenobarbital, clorazepate (Tranxene), triazolam (Halcion), or flunitrazepam (Rohypnol) other non-barbiturate sedatives, other sedatives, or other benzodiazepines 5

morphine-like effects Other drugs: LSD, non-prescription methadone, other hallucinogens, aerosols, PCP or PCP combination, solvents, ketamine (Special K), diphenhydramine, nitrites, other drugs,

6 Tennessee and United States, PATTERNS OF YOUTH SUBSTANCE ABUSE 6

7 Over the past 10 years, both the growth in youth opioid abuse and the decline in alcohol abuse in Tennessee have outpaced the United States. Chart 1. Substance abuse treatment admissions among youth, ages 12-17, by primary substance of abuse: Tennessee and the United States, (Data source: TEDS-A) 100% 75% 6.4% 0.5% 1.0% United States 4.8% 2.1% 1.1% 100% 75% 16.5% 1.0% Tennessee 6.8% 8.1% 50% 68.0% 77.1% 50% 58.5% 76.2% 25% 2.0% 0.8% 22.2% 13.9% 0% % 25% 0.6% 21.2% 8.3% 0%

Substance abuse treatment admissions among youth, ages 12-17, by primary substance of abuse: Tennessee and the United States, 2002-2011 (Data

8 Chart 2. Top substances of abuse for youth, ages 12-17: Tennessee and the United States, 2011 Tennessee and United States: Substance abuse treatment admissions for youth in 2011 Substance U.S. TN TN Rank Marijuana 77.1% 76.2% 1 Alcohol 13.9% 8.3% 2 Prescription opioids 2.1% 8.1% 3 Other drugs 4.8% 6.8% 4 Cocaine/crack 0.8% 0.6% 5 Heroin 1.1% 0.0% 6 Total 100% 100% - Tennessee s percentage of youth prescription opioid admissions (8.1%) was 4x times the United States rate (2.1%). Tennessee s percentage of youth alcohol admissions was almost 50% lower than the national rate. Tennessee s percentage of youth treatment admissions (76.2%) for marijuana abuse was slightly lower than the United States (77.1%) in

1% 76.2% 1 Alcohol 13.9% 8.3% 2 Prescription opioids 2.1% 8.1% 3 Other drugs 4.8% 6.8% 4 Cocaine/crack 0.8% 0.6% 5 Heroin 1.1% 0.

9 Changes in Tennessee substance abuse treatment admissions for youth from 2002 to 2011 Chart 3. Percent of Tennessee treatment admissions for youth, ages 12-17, for primary substances of abuse, 2002 and From , for youth: Marijuana abuse increased 30.3%. Marijuana 58.5% 76.2% Alcohol abuse decreased 60.8%. Alcohol Prescription opioids 8.3% 8.1% 1.0% 21.2% Prescription opioids were among the top three substances of abuse in Other drugs Cocaine/crack Heroin 6.8% 16.5% 0.6% 2.8% 0.0% 0.0% Heroin abuse was minimal among children admitted to treatment. 9

youth: Marijuana abuse increased 30.3%. Marijuana 58.5% 76.2% Alcohol abuse decreased 60.8%. Alcohol Prescription opioids 8.3% 8.1% 1.0% 21.

10 Tennessee and United States, PATTERNS OF YOUNG ADULT SUBSTANCE ABUSE Tennessee Department of Mental Health and Substance Abuse Services 10

11 The percent of young adult treatment admissions for prescription opioid abuse in Tennessee was almost 3x greater than the United States in Chart 4. Substance abuse treatment admissions among young adults, ages 18-24, by primary substance of abuse: Tennessee and the United States from 2002 to 2011 (Data source: TEDS-A) 100% United States 11.9% 8.9% 2.4% 14.6% 100% Tennessee 14.5% 10.9% 75% 13.5% 75% 15.5% 17.6% 0.0% 41.4% 30.3% 24.7% 50% 50% 2.3% 29.7% 7.4% 16.8% 25.8% 25% 3.2% 25% 34.6% 26.0% 28.5% 4.4% 15.3% 0% 0% *NOTE: Tennessee began disaggregating heroin admissions from prescription opioids in July

United States 11.9% 8.9% 2.4% 14.6% 100% Tennessee 14.5% 10.9% 75% 13.5% 75% 15.5% 17.6% 0.0% 41.4% 30.3% 24.7% 50% 50% 2.3% 29.7% 7.4% 16.8% 25.8% 25% 3.2% 25% 34.6% 26.0% 28.5% 4.

12 Chart 5. Top substances of abuse for young adults, ages 18-24: Tennessee and the United States, 2011 Substance use among young adults in Tennessee and the United States Substance U.S TN 2011 TN Rank Prescription opioids 14.6% 41.4% 1 Marijuana 29.7% 25.8% 2 Alcohol 26.0% 15.3% 3 Other drugs 8.9% 10.9% 4 Cocaine/crack 3.2% 4.4% 5 Heroin 17.6% 2.3% 6 Total 100% 100% - The percent of Tennessee young adult prescription opioid admissions was almost 3x higher than the United States. The percent of Tennessee young adult alcohol abuse admissions was 40% lower than the United States. While heroin ranked #3 among substances of abuse in the United States, heroin ranked #6 in Tennessee. 12

S. 2011 TN 2011 TN Rank Prescription opioids 14.6% 41.4% 1 Marijuana 29.7% 25.8% 2 Alcohol 26.0% 15.3% 3 Other drugs 8.9% 10.9% 4 Cocaine/crack 3.2% 4.4% 5 Heroin 17.6% 2.

13 Changes in Tennessee substance abuse treatment admissions for young adults from 2002 to 2011 Chart 6. Percent of Tennessee treatment admissions for young adults, ages 18-24, by primary substance of abuse, 2002 and From , for young adults: Opioid abuse increased 167%. Prescription opioids 15.5% 41.4% Alcohol abuse decreased almost 50%. Marijuana Alcohol Other drugs 15.3% 10.9% 14.5% 25.8% 24.7% 28.5% The identification of cocaine/crack and other drugs as primary substances of abuse decreased by 73.8%, and 24.8%, respectively. Cocaine/crack Heroin 2.3% 4.4% 16.8% Marijuana abuse showed little change as a primary substance of abuse from 2002 (24.7%) to 2011 (25.8%). 13

increased 167%. Prescription opioids 15.5% 41.4% Alcohol abuse decreased almost 50%. Marijuana Alcohol Other drugs 15.3% 10.9% 14.5% 25.8% 24.7% 28.

14 Tennessee and United States, PATTERNS OF ADULT SUBSTANCE ABUSE 14

15 Alcohol continues to be the top substance of abuse for Tennessee adults, but opioids ranked #2 in 2011, topping cocaine/crack. Chart 7. Substance abuse treatment admissions among adults, ages 25+, by primary substance of abuse: Tennessee and the United States from (Data source: TEDS-A) 100% United States 8.0% 9.3% 100% Tennessee 7.9% 10.0% 2.6% 9.5% 11.4% 75% 17.6% 6.8% 16.1% 75% 0.0% 5.8% 27.6% 1.8% 50% 16.0% 9.5% 9.8% 50% 29.9% 10.2% 14.5% 25% 48.9% 45.8% 25% 45.0% 35.8% 0% 0% *NOTE: Tennessee began disaggregating heroin admissions from prescription opioids in July

States 8.0% 9.3% 100% Tennessee 7.9% 10.0% 2.6% 9.5% 11.4% 75% 17.6% 6.8% 16.1% 75% 0.0% 5.8% 27.6% 1.8% 50% 16.0% 9.5% 9.8% 50% 29.9% 10.2% 14.5% 25% 48.9% 45.8% 25% 45.

16 Chart 8. Top substances of abuse for adults (ages 25+): Tennessee and the United States, 2011 Substance use among adults in Tennessee and the United States, 2011 Adult admissions for prescription opioid abuse in Tennessee were 3x higher than the United States in Substance U.S. TN TN Rank Alcohol 45.8% 35.8% 1 Prescription opioids 9.5% 27.6% 2 Cocaine/crack 9.8% 14.5% 3 Marijuana 9.5% 10.2% 4 Other drugs 9.3% 10.0% 5 Heroin 16.1% 1.8% 6 Total 100% 100% - The percent of treatment admissions for alcohol abuse decreased more in Tennessee from 2002 to 2011 (20.4% decrease) than the United States (6.3% decrease). The national percent of heroin admissions is 9x higher than the Tennessee percent. Tennessee cocaine/crack admissions are 60% higher than the United States. 16

abuse in Tennessee were 3x higher than the United States in 2011. Substance U.S. TN 2011 2011 TN Rank Alcohol 45.8% 35.8% 1 Prescription opioids 9.5% 27.6% 2 Cocaine/crack 9.8% 14.5% 3 Marijuana 9.

17 Changes in Tennessee substance abuse treatment admissions for adults from 2002 to 2011 Chart 9. Percent of Tennessee treatment admissions for adults, ages 25+, by primary substance of abuse, 2002 and From , for adults: Opioid abuse more than doubled. Alcohol Prescription opioids 11.4% 27.6% 35.8% 45.0% Marijuana abuse increased 76%, but accounted for only 10.2% of total adult admissions in Cocaine/crack Marijuana 14.5% 10.2% 5.8% 29.9% Cocaine/crack abuse decreased 51.5%, but represented 14.5% of all adult admissions. Other drugs Heroin 1.8% 10.0% 7.9% While over a third (35.8%) of adult treatment admissions were for alcohol abuse, this represented a 20% decrease from 2002 to

Alcohol Prescription opioids 11.4% 27.6% 35.8% 45.0% Marijuana abuse increased 76%, but accounted for only 10.2% of total adult admissions in 2011. Cocaine/crack Marijuana 14.5% 10.

18 Tennessee and United States, PATTERNS OF SUBSTANCE ABUSE ACROSS AGE GROUPS 18

19 Tennessee had a higher percentage of prescription opioid admissions than the United States for each age group; but a lower percentage of heroin abuse for all age groups. Chart 10. Treatment admissions for youth (ages 12-17), young adults (ages 18-24), and adults (ages 25+) by primary substance of abuse: Tennessee and the United States, 2011 (Data source: TEDS-A) United States Tennessee 100% 4.8% 1.1% 2.1% 8.9% 9.3% 14.6% 9.5% 100% 6.8% 8.1% 10.9% 10.0% 75% 50% 77.1% 17.6% 29.7% 16.1% 9.5% 9.8% 75% 50% 76.2% 41.4% 2.3% 27.6% 1.8% 10.2% 14.5% 25% 0% 3.2% 45.8% 0.8% 26.0% 13.9% % 0% 25.8% 4.4% 35.8% 0.6% 8.3% 15.3%

Treatment admissions for youth (ages 12-17), young adults (ages 18-24), and adults (ages 25+) by primary substance of abuse: Tennessee and the United States, 2011 (Data

20 Cross age trends in Tennessee and the United States Prescription opioid abuse is greatest for young adults, and is greater in Tennessee than the United States. Heroin abuse was lower for all age groups in Tennessee than the United States. The abuse of alcohol and cocaine/crack increases with age in both Tennessee and the United States. The abuse of marijuana in Tennessee and the United States decreases with age. 20

Heroin abuse was lower for all age groups in Tennessee than the United States.

SMART DISCHARGE. Client s Name: Client ID: Partial Hospitalization Clinically Managed Medium Intensity Residential Treatment

SMART DISCHARGE. Client s Name: Client ID: Partial Hospitalization Clinically Managed Medium Intensity Residential Treatment SMART DISCHARGE Client s Name: Client ID: DATE OF DISCHARGE: Reason for Discharge Completed Treatment no further treatment needed Completed Treatment Plan/Referred Incomplete Client Left Before Completing