Current Trends in Drug Abuse

Current Trends in Drug Abuse Carol Falkowski Director, Research Communications Author, Dangerous Drugs August 2006 www.hazelden.org

National Institute on Drug Abuse: Community Epidemiology Work Group (CEWG) Provides community-level, epidemiological surveillance of drug abuse through ongoing analysis of quantitative research data in 20 US cities since 1976.

Percent of population reporting lifetime use of selected substances 100 83.1 80 72.7 60 46.4 40 40.6 20.1 20 14.7 14.5 9.7 5.2 1.6 0 co l a l o h o cc t a b o A NY il i lic t M J no m n- ed Rx c co n ai e h c lu l a h s t an in l a h m et h oi r e n SOURCE: 2003 National Survey on Drug Use and Health, SAMHSA. Respondents = age 12 and older.

Past Month Alcohol, Tobacco, and Illcit Drug Use by Age Group 100 % reporting 12 to 17 90 18 to 25 26 and older 80 70 60 56.8 49 50 42.9 40 28.9 30 20 16.4 13.6 9.7 10 0 15.9 15.6 4.2 Alcohol Tobacco ANY Illicit Drug 7.2 3 MJ 4.6 5.9 1.7 Illicit other than MJ SOURCE: Substance Abuse and Mental Health Services Administration, Summary of Findings from the 2000 National Household Survey on Drug Abuse, NHSDA Series H-13, Rockville, MD.

ALCOHOL 75% drink before graduation, 60 % have been drunk. 20 % of 8th graders and 42 % of 10th graders have been drunk at least once. SOURCE: Johnston LD, O'Malley PM, Bachman JG. Data tables from the 2003 Monitoring the Future Survey. Ann Arbor MI: University of Michigan News and Information Services.

ALCOHOL TREND - drink as much as possible as quickly as possible Beer bongs, power hour, drinking games

WI = 67.8% MA = 67.4% RI = 66.3% MN = 66.2% I KY 31.7% WVA = 30.2% UT = 28.7% Current alcohol use 2004 (any alcohol use in past 30 days) National 56.8% Percent SOURCE: Percent of respondents age 18 and older who reported having at least one drink of alcohol in past 30 days. National Center for Chronic Disease Prevention and Health Promotion, 2004 Behavioral Risk Factor Surveillance System, online at: www.cdc.gov/brfss

WI = 21.8% ND = 20.4% MN = 19.8% I UT = 9.2% TN = 8.2 % Binge drinking - 2004 (having five or more alcoholic drinks on one occasion) National 14.9% Percent SOURCE: All respondents 18 and older who reported having five or more drinks on an occasion, one or more times in the past 30 days. National Center for Chronic Disease Prevention and Health Promotion, 2004 Behavioral Risk Factor Surveillance System, online at: www.cdc.gov/brfss

Consequences of High-risk College Drinking Source: Hingson, R. et al. Magnitude of Alcohol-Related Mortality and Morbidity Among U.S. College Students Ages 18-24: Changes from 1998 to 2001. Annual Review of Public Health, vol. 26, 259-79; 2005.

National Longitudinal Epidemiological Study People who 1st drank before age 15 40% developed alcoholism People who 1st drank at age 21, 22 10% developed alcoholism

Youth Tobacco Use 70 60 50 40 ever used current use 30 20 10 0 8th 10th 12th

Smoking contributes to more deaths than other substances. Comparative causes of annual deaths in the United States smoking 418 alcohol 105 motor vehicle 46 suicide 31 AIDS 30 homicide 25 illicit drugs 9 fires 4 0 50 100 150 200 250 300 350 400 450 500 # of deaths (in thousands) SOURCE: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Tobacco Information and Prevention Source: at http://www.cdc.gov/tobacco/andths.htm

YOUTH TOBACCO USE and use of alcohol and other drugs 60 Adolescents who smoke are much MORE LIKELY to use alcohol & other drugs 50 40 30 NONsmoker Smoker 20 10 0 Alcohol Any illegal drug SOURCE: Household Survey on Drug Abuse, U.S. Dept of Health and Human Services, 1998, USE = any past month use

8.1 percent of the population aged 12 or older had used an illicit drug in the past month Based on 2003 and 2004 NSDUHs

Estimated Number of Persons Using Drugs Illicitly in Past Year: Average of 2002, 2003 & 2004 Marijuana 25.5 Pain Relievers 11.3 Cocaine 5.8 Tranquilizers 5.0 Stimulants 3.0 Ecstasy 2.4 Methamphetamine 1.4 Crack 1.4 OxyContin 1.2 Sedatives 0.9 LSD 0.7 Heroin 0.4 0 5 10 15 20 Numbers in Millions Estimates for OxyContin are based on 2004 only. 25 30

MARIJUANA Almost 1 out of 2 students use marijuana before graduation from high school. SOURCE: Johnston LD, O'Malley PM, Bachman JG. Data tables from the 2003 Monitoring the Future Survey. Ann Arbor MI: University of Michigan News and Information Services.

MARIJUANA in cigars = blunts mixed with formaldehyde and PCP, known as fry amp wets

Over 289,000 people enter addiction treatment programs with MJ as the primary drug HALF are under the age of 20

Cocaine - not gone- often forgotten Nationally in 2003-2004, the prevalence rate for the use of cocaine in the past year among all persons aged 12 or older was 2.4 percent 10.6 percent of all persons aged 12 or older reported marijuana use in the past year. 4.8 percent reported nonmedical use of Rx painkillers.

Club Drugs MDMA XTC X e GHB (gamma hydroxybutyrate) Ketamine Special K LSD Rohypnol Upward trends in 2000 now leveling: slowed growth rate Use extends beyond nightclubs and raves

GHB ( G Liquid X Scoop ) Drug Facilitated Rape Predatory use of drugs to incapacitate victims Most are stranger-to-stranger encounters Prevalence difficult to measure Samantha Reid, Hilary Farias

Heroin Normalized in the 1990 s Influx of high purity, low cost heroin Smoked, snorted-eventual IV route of administration NOT just in central cities newer, younger users

Prescription Drug Abuse If it s a pill it must be safe

Pharming

Addiction Psychosis/Paranoia Hallucinations Malnutrition/weight loss Skin lesions Aggression Sleep deprivation Dental problems LONG TERM EFFECTS

METH BASICS Route of administration: 1992-2002 Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

Past Year Methamphetamine Use by Age and Gender: Average of 2002, 2003 and 2004 Percent Using in Past Year 2.0 1.6 1.5 1.0 0.7 0.7 0.5 0.4 0.5 0.0 12 to 17 18 to 25 26 or Older Male Female

Meth addiction can produce profound changes in physical appearance.

Meth Mouth Methamphetamine reduces the amount of a person s saliva - important for neutralizing acids and clearing food from the teeth. Decreased saliva flow allows the build up of bacteria to ten times over normal levels. Without saliva, acids can eat away tooth enamel which in turn causes cavities. Many drink high-sugar containing beverages to alleviate dry mouth. Also Bruxism (tooth clenching and grinding) damage and constriction of the blood vessels to the gums and soft tissues.

Why do people use drugs/alcohol? To feel good. To feel better.

Why do people use meth? To feel good. To feel better. To have more energy. To get more done. To lose weight.

Meth production poses unique environmental hazards unlike those with other drugs of abuse.

METH LABS Changing the landscape of rural AND urban areas Source: El Paso Intelligence Center (EPIC), U.S. DEA, 2004

Number of Methamphetamine Laboratory Seizures: 1997-2005 12,000 10,199 10,000 8,542 8,000 6,750 9,282 9,895 7,021 6,000 4,000 5,249 3,802 2,806 2,000 0 1997 1998 1999 2000 2001 2002 2003 2004 2005* SOURCE: National Drug Intelligence Center; National Clandestine Laboratory Seizure System * Data for 2005 are preliminary.

Risks to children Child endangerment, neglect, abuse HEALTH effects due to environmental exposure: respiratory, liver, blood, neurological problems Pattern of use for meth addicts

exhibit 11 Adult Male Arrestees Testing Positive for METHAMPHETAMINE -- 2003 Honolulu Phoenix Sacramento San Jose San Diego Spokane Los Angeles Las Vegas Des Moines Salt Lake City Portland, OR Omaha Tulsa Tucson Woodbury, IA Oklahoma City Seattle Albuquerque Dallas Denver San Antonio MINNEAPOLIS Rio Arriba, NM New Orleans Houston Atlanta Indianapolis Tampa Chicago Birmingham Anchorage Washington DC Charlotte Philadelphia Miami Cleveland Albany Boston New York City 16 14.3 12.3 12.1 10.1 5.8 4.7 3.5 3.3 2.8 2.6 2.1 2 1.9 1.6 1.4 1.2 0.7 0.7 0.6 0.6 0.4 0.3 0 0 0 0 10 17.4 21.4 20 25.6 25.4 28.7 28.6 27.9 32.1 30 % testing positive SOURCE: National Institute of Justice, Arrestee Drug Abuse Monitoring (ADAM) Program, 2004. 40.3 38.3 37.6 36.9 36.2 40 50 60

County law enforcement agencies reporting meth as biggest problem in their county - 2005 Northwest 75% Upper Midwest 67% Northeast 4% Southeast 26% Southwest 76% Lower Midwest 57% SOURCE: N=500 county law enforcement agencies. Survey conducted by the National Association of Counties, The Meth Epidemic in America: Two Surveys of U.S. Counties, 2005. Online at http://www.naco.org.)

National Drug Threat Survey 2005 Greatest drug threat as reported by state and local agencies.

Congressional Briefing: Meth Treatment Outcomes Washington D.C. - April 6, 2005 Hazelden and CSAT

Addiction is a chronic disorder with behavioral components that requires lifelong management and periodic professional services. SOURCE: Principles of Addiction Treatment: A Research-Based Guide, (1999) US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, NIH Publication No. 99-4180.

Effective treatment for addiction exists. SOURCE: Principles of Addiction Treatment: A Research-Based Guide, (1999) US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, NIH Publication No. 99-4180.

Addiction treatment is as effective as treatment for other chronic disorders with behavioral components. (asthma, diabetes, hypertension) SOURCE: McLellan, A.T., Lewis, D.C. and Kleber, H.D. (2000). Drug dependence, a chronic medical illness : Implications for treatment insurance, and outcomes evaluation, Journal of the American Medical Association, 284 (13).

Treatment is cost effective. Every dollar spent on addiction treatment saves $12 in averted health, criminal justice, and social costs. SOURCE: California Department of Alcohol and Drug Programs (1994) Evaluating recovery services: CALDATA and Join Together (1998) Treatment for addiction - Advancing the common good: Recommendations from a Join Together policy panel on treatment and recovery.

Three components considered critical to recovery from addiction: Detoxification Rehabilitation Aftercare SOURCE: Principles of Addiction Treatment: A Research-Based Guide, (1999) US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, NIH Publication No. 99-4180.

INDIVIDUAL assessment

At this time the most effective treatments for methamphetamine addiction are cognitive behavioral interventions... designed to help modify the patient's thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Methamphetamine recovery support groups also appear to be effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery. www.drugabuse.gov

The Hazelden Model The Matrix Model

Hazelden Model Twelve Step philosophy Focus on biopsychosocial disease concept Interdisciplinary team of professionals: Certified counselors Licensed psychologists and psychiatrists Medical personnel Wellness and recreational specialists Spiritual care professionals Individualized assessment and treatment plan Individual and group therapies Incorporation of cognitive behavioral and motivational enhancement approaches Patient education Family education and involvement In residential and out-patient settings

Hazelden Meth Outcomes Study Outcomes among 952 residential patients 14.2% methamphetamine users Meth users were younger, less educated, less likely to be employed at admission No differences in outcomes between meth users and non-meth using patients Similar continuous abstinence rates in year after treatment Similar satisfaction with psychosocial and health functioning

Matrix model Cognitive Behavioral Motivational Enhancement Couples and Family Therapy Relapse Prevention Individual Supportive/ Expressive Psychotherapy and Psychoeducation 12-Step Facilitation Group Therapy and Social Support Out-patient model minimum length of treatment of 16 weeks.

ALSO: Iowa s Division of Behavioral Health 71% meth users abstinent 6 months after discharge Tennesee s Bureau of Alcohol and Drug Abuse 65% meth clients abstinent 6 months after discharge Texas Dept of State Health 66% of meth clients abstinent 60 days after discharge (publicly funded services 2001 2004)

Primary Substance of Abuse at U.S. Substance Abuse Treatment Facilities 1993 and 2003 1993 Other 4% Stimulants 2% Marijuana 7% 2003 Alcohol 57% Alcohol 41% Other 4% Stimulants 7% Opiates 13% Cocaine 17% Marijuana 16% SOURCE: Adapted by CESAR from the Office of Applied Studies, SAMHSA. Trends in Substance Abuse Treatment Admissions: 1993 and 2003, The DASIS Report, 2006. Available online at http://oas.samhsa.gov/2k6/txtrends/txtrends.cfm. Cocaine 14% Opiates 18%

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992 (per 100,000 aged 12 and over) > 58 35-58 12-35 < 12 No data

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997 (per 100,000 aged 12 and over) > 58 35-58 12-35 < 12 No data

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2003 (per 100,000 aged 12 and over) > 58 35-58 12-35 < 12 No data

Meth addicted patients: EVALUATION of Psychosis stabilize it Cognitive damage assess it Protracted dysphoria Persistent psychosis Lingering paranoia In extreme cases consider a longer TERM OF ENGAGEMENT In jail, primary treatment, and/or supported aftercare setting

The LURE of METH among adolescents Long duration of action Get control and stay in control Unbridled confidence Infinite energy Weight loss Available/affordable

The LURE of METH within the gay community The sex never ends Crystal Tina

PREVENTION = Same message Different messengers scare tactics alone are ineffective.

METH Solutions: Education/prevention Treatment in communities and correctional settings with supported aftercare Precursor restrictions (curtail meth labs) Law enforcement (public safety)

The Combat Meth Act: 3) Moves cold medicines containing pseudoephedrine behind the counter, sets a limit of how much one person can buy at 7.5 grams a month, and requires signatures and ID for purchases (the Attorney General will develop regulations to ensure uniformity). 4) Creates alternate procedures for stores without pharmacies and stores in rural areas. 5) Establishes a uniform federal standard that strengthens all existing state laws. 6) Creates a national meth treatment center to research more effective treatments for meth addiction. 7) Authorizes $43 million for enforcement, training, and research into treatment. Passed into Law on 3/9/2006 part of Patriot Act

Current drug abuse risks: More choices Use begins at young ages Greater availability/accessibility More misinformation Fewer urban/suburban/rural differences Nonchalant attitudes re: pills

What professionals can do: Stay up-to-date with accurate information about new drugs/patterns of drug abuse Resist stereotypes about drug abusers (77% of illegal drug abusers are also someone s employee) Help others overcome judgmental attitudes about addicts Learn to recognize symptoms of abuse and where to get help

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www.drugabuse.gov The National Institute on Drug Abuse National Institutes of Health US Department of Health and Human Services

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