current trends in drug abuse · effective treatment for addiction exists. source: principles of...

Current Trends in Drug Abuse

Carol FalkowskiDirector, Research Communications

Author, Dangerous DrugsAugust 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

SOURCE: 2003 National Survey on Drug Use and Health, SAMHSA. Respondents = age 12 and older.

83.172.7

46.440.6

20.114.7 14.5

9.7 5.2 1.6

alcohol

tobacco

ANY illici

t MJ

non-med

Rx

coca

inehall

uc

inhalants

methhero

in0

20

40

60

80

100

Past Month Alcohol, Tobacco, and Illcit Drug Use by Age Group

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.

16.4 15.69.7

7.24.6

56.8

42.9

15.9 13.6

5.9

49

28.9

4.2 3 1.7

Alcohol Tobacco ANY Illicit Drug MJ Illicit other than MJ0

10

20

30

40

50

60

70

80

90

100% reporting

12 to 17 18 to 25 26 and older

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

Current alcohol use – 2004(any alcohol use in past 30 days)

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 = 67.8%MA = 67.4%RI = 66.3%MN = 66.2%IKY – 31.7%WVA = 30.2%UT = 28.7%

National56.8%

Binge drinking - 2004(having five or more alcoholic

drinks on one occasion)

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

WI = 21.8%ND = 20.4%MN = 19.8%IUT = 9.2%TN = 8.2 %

National14.9%

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.

Consequences of High-risk College Drinking

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

0

10

20

30

40

50

60

70

8th 10th 12th

ever usedcurrent use

Smoking contributes to more deaths than other substances.

Comparative causes of annual deaths in the United States

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

418

105

46

31

30

25

9

4

smoking

alcohol

motor vehicle

suicide

AIDS

homicide

illicit drugs

fires

0 50 100 150 200 250 300 350 400 450 500# of deaths (in thousands)

YOUTH TOBACCO USE and use of alcohol and other drugs

Adolescents who smoke are much MORE LIKELY

to use alcohol & other drugs

0

10

20

30

40

50

60

Alcohol Any illegal drug

NONsmokerSmoker

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

0.40.70.91.21.41.4

2.43.0

5.05.8

11.325.5

0 5 10 15 20 25 30

HeroinLSD

SedativesOxyContin®

CrackMethamphetamine

EcstasyStimulants

TranquilizersCocaine

Pain RelieversMarijuana

Numbers in MillionsEstimates for OxyContin® are based on 2004 only.

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

Drug Facilitated Rape

• Predatory use of drugs to incapacitate victims

• Most are stranger-to-stranger encounters• Prevalence difficult to measure• Samantha Reid, Hilary Farias

GHB (“G” “Liquid X” “Scoop”)

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

Heroin

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

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

METH BASICS

Route of administration: 1992-2002

Past Year Methamphetamine Use by Age and Gender: Average of 2002, 2003 and 2004

0.7

1.6

0.4

0.70.5

0.0

0.5

1.0

1.5

2.0

12 to 17 18 to 25 26 orOlder

Male Female

Percent Using in Past Year

Meth addiction can produce profound changes in physical appearance.

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.

“Meth Mouth”

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.

Changing the landscape of rural AND

urban areas

METH LABS

Source: El Paso Intelligence Center (EPIC), U.S. DEA, 2004

Number of Methamphetamine Laboratory Seizures: 1997-2005

2,8063,802

6,750 7,021

8,5429,282

10,199 9,895

5,249

0

2,000

4,000

6,000

8,000

10,000

12,000

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

Adult Male Arrestees Testing Positive for METHAMPHETAMINE -- 2003

SOURCE: National Institute of Justice, Arrestee Drug Abuse Monitoring (ADAM) Program, 2004.

40.338.3

37.636.9

36.232.1

28.728.6

27.925.625.4

21.417.4

1614.3

12.312.1

10.15.8

4.73.53.3

2.82.6

2.121.9

1.61.41.2

0.70.70.60.60.40.3

000

HonoluluPhoenix

SacramentoSan Jose

San DiegoSpokane

Los AngelesLas Vegas

Des MoinesSalt Lake CityPortland, OR

OmahaTulsa

TucsonWoodbury, IA

Oklahoma CitySeattle

AlbuquerqueDallas

DenverSan Antonio

MINNEAPOLISRio Arriba, NM

New OrleansHouston

AtlantaIndianapolis

TampaChicago

BirminghamAnchorage

Washington DCCharlotte

PhiladelphiaMiami

ClevelandAlbanyBoston

New York City

0 10 20 30 40 50 60

% testing positive

exhibit 11

Upper Midwest67%

Southeast26%

Lower Midwest57%

Southwest76%

Northwest 75%

Northeast4%

County law enforcement agencies reporting meth as biggest problem in their county - 2005

SOURCE: N=500 county law enforcement agencies. Survey conducted by the National Associationof 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, 2005Hazelden 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.


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).

Every dollar spent on addiction treatment saves $12 in averted health, criminal justice, and social costs.

Treatment is cost effective.

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 consideredcritical to recovery from addiction:

Detoxification Rehabilitation Aftercare


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 groupsalso 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 counselorsLicensed psychologists and psychiatristsMedical personnelWellness 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)

1993

Alcohol57%

Opiates13% Cocaine

17%

Marijuana7%

Stimulants2%

Other4%

2003

Alcohol41%

Opiates18%

Cocaine14%Marijuana

16%

Stimulants7%

Other4%

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.

Primary Substance of Abuse at U.S. Substance Abuse Treatment Facilities - 1993 and 2003

> 5835 - 58

< 1212 - 35

No data

Primary Amphetamine/MethamphetamineTEDS Admission Rates: 1992

(per 100,000 aged 12 and over)

> 5835 - 58

< 1212 - 35

No data



Meth addicted patients:

EVALUATION of Psychosis – stabilize it Cognitive damage – assess it Protracted dysphoria Persistent psychosis Lingering paranoiaIn 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 lossAvailable/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 3/9/2006part 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

In bookstores or online at: www.hazelden.org

www.drugabuse.gov

The National Institute on Drug AbuseNational Institutes of Health

US Department of Health and Human Services

www.hazelden.org

current trends in drug abuse · effective treatment for addiction exists. source: principles of...

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