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Substance Abuse
Vision
Travis County will reduce substance abuse and its impact on the community.
Summary
The cost of substance abuse to society is substantial. Numerous studies have measured the impact of substance abuse on our community. Substance abuse is correlated with many social problems and critical conditions including crimes, emergency room admissions, domestic violence, child abuse, disabilities, homelessness, truancy and school dropout rates, illness, deaths, motor vehicle accidents, problem births, decreased worker productivity and related costs to local industry, HIV/AIDS cases, psychiatric admissions, and economic viability of neighborhoods. In 1990 alone, an estimated 166 billion dollars were spent or lost due to alcohol and drug problems nationwide. About 37% of these costs were related to crime, criminal justice costs, and property damage; 27% of these costs came from the loss of productivity due to injury or illness; 22% from loss of productivity due to premature death; 8% due to health care costs for treatment and their medical consequences; and 5% due to AIDS and Fetal Alcohol Syndrome. (SAMHSA, 1995)
According to a survey conducted by Seton, over 65% of Travis County residents drink alcohol. Of those Travis County residents who drink, approximately 46% binge drink, that is they have 5 or more drinks on one occasion. About 28% of residents reported that they binge drink 1 to 3 times per month and another 18% binge drink at least once a week. Furthermore, findings from school surveys administered by the Austin Independent School District indicate that alcohol is the most commonly used substance across all grade levels. Tobacco is the second most used substance in all grades; other drugs are third. For example, in 1995, 54% of 12th graders used alcohol, 36% used tobacco, and 29% used drugs in the month prior to being surveyed. Nationwide trends parallel those in Travis County. Nationwide the most used substances are alcohol, cigarettes, and marijuana respectively. Results from a 1993 national household survey revealed that the greatest proportion, 50% of persons age 12 and older, used alcohol in the month prior to being surveyed, 24% smoked cigarettes, 4% used marijuana, 1% used psychotherapeutics for non-medical uses, and 1% used cocaine, inhalants, and hallucinogens. (SAMHSA, 1994) Of those being treated by facilities funded by the Texas Commission on Alcohol and Drug Abuse (TCADA) in Travis County, alcohol is the primary drug presented upon admission by adults and marijuana is the primary drug presented upon admission by youth. A breakdown of drugs presented as the primary problem upon admission by adults in 1995 indicates that 43% of adults used alcohol, 30% cocaine, 13% opiates, 11% marijuana, 2% amphetamines, and 2% other drugs such as inhalants, ecstasy, hallucinogens, and depressants. The breakdown of drugs presented by youth in the same year was as follows: 61% of youth used marijuana hash, 20% alcohol, 8% inhalants, and 4% cocaine/powder. (TCADA, 1996)
This section of the Community Plan addresses the abuse of tobacco, alcohol, and other drugs including legal, over-the-counter, and prescriptions drugs as well as illicit drugs such as marijuana, cocaine/crack, inhalants, and hallucinogens.
Risk factors of substance abuse include:
- economic deprivation and instability brought on, for example, by poverty, homelessness, and loss of job;
- poor family management including poor role modeling by parents and siblings, lack of bonding, history of abuse or drug behavior in the family, conflict, and poor family management skills;
- community laws and norms favorable to drug use including advertising and cultural trends favorable to drug use and taxes, costs, and regulations leading to increased availability and accessibility to alcohol, tobacco, and other drugs.
- environmental and social stressors such as alienation and peer rejection; isolation of the elderly after retirement, for example, made even more critical when family members live in other parts of the country and cannot monitor alcohol/medication use; drug-using peers which can lead to drug use by those unable to cope with peer pressure; and living in neighborhoods which are disorganized, disenfranchised, densely populated, and have high crime rates, continuous shifts in populations due to highly mobile residents, and physical deterioration.
- lack of resiliency and coping skills which can result from or be related to physiological and psychological problems such as genetic predisposition, prenatal exposure, pain, hunger, and biochemical conditions, mental illness, unresolved trauma, and poor self-esteem; poor adjustment to developmental stages related to early and persistent problem behavior, attention deficit disorder (ADD), hyperactivity, withdrawn or antisocial behavior; and early onset of drug use.
- poor learning associated with low academic performance, poor life skills, or low commitment to school which may be associated with truancy, not doing homework, not desiring further education, or having a high IQ but not being engaged in school.
Effective prevention, intervention, and treatment services minimize critical conditions associated with substance abuse while saving lives and money. With the vision of reducing substance abuse in Travis County, this Plan calls for a client-focused continuum of care which includes prevention, assessment, intervention, detoxification, treatment, and continuing care services that are:
- Delivered with a holistic approach to care whereby the physical, mental, and spiritual health needs of individuals and families are addressed;
- Culturally and linguistically appropriate;
- Age appropriate;
- Family focused;
- Consumer driven (with special needs of clients and families considered); and
- Provided while respecting clients' rights and capacities.
Beyond maintaining a continuum of care, this community must ensure that persons with substance abuse problems have their basic needs addressed. For example, people need jobs, housing, transportation, child care, education, and insurance that covers mental and physical services to support and stabilize their lives. This can only be realized through continued collaboration among private and public partners; consumers and family members; and other community stakeholders working in the areas of substance abuse, health, public safety, education, workforce development, mental health, etc.
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Critical Conditions
- About 27% of persons ages 15 to 54, experience substance abuse/dependence in their lifetime. (Kessler et al, 1994)
- With few exceptions, the percent of students using alcohol, tobacco, and other drugs in the month prior to being surveyed increased in all grade levels (seven through 12) from 1994 to 1995. (AISD, 1995) According to statewide school surveys, binge drinking or having five or more drinks on one occasion rose from 1992 to 1994. Illicit drug use among adolescents in Texas, especially marijuana, has risen since 1992. Consequently, arrests are also on the rise. Approximately nine out of ten youths entering Texas Youth Commission facilities use illegal drugs. (TCADA, 1996)
- Co-occurrence of substance abuse and mental disorders is well documented. Over one-third of the population, age 15 to 54 years old, have had a mental disorder in their lifetime; 30% of these people also had substance abuse/dependence. Almost 50% of persons ages 15 to 54 who had substance/abuse dependence in their lifetime, had a mental disorder. (Kessler, 1994)
- The Austin-Travis County Homeless Coalition estimates that there are 6,000 homeless in Travis County. Over half of all single homeless adults are estimated to need substance abuse treatment. (ATCMHMR)
- Females within the Texas Department of Criminal Justice were almost four times as likely to report any illicit drug use in their lifetimes than females outside the criminal justice system, five times more likely to report lifetime use of inhalants, 14 times more likely to report lifetime use of cocaine, and 55 times more likely to have ever used crack. (TCADA, 1994)
- Five to ten percent of older adults misuse, abuse, or have a dependence on alcohol or medications and between 20 to 30% of elderly psychiatric clients have problems with alcohol use. (Griffin, Andrew W., 1994)
- In 1990, TCADA estimated that approximately 2,940 of 14,464 (20%) of pregnant women in Travis County used legal or illegal substances during pregnancy. (Snapshot, 1995) Nationally, an estimated 5.5% of all women delivering live births used illicit drugs during their pregnancy while 19% used alcohol and 20 % smoked cigarettes during pregnancy. (NIDA, 1996)
- In Texas each year, an estimated 600 children are born with Fetal Alcohol Syndrome. The lifetime health-related cost per child with FAS is estimated at $240,000. (Texas Department of Health, 1996)
- In more than 40% of confirmed cases of child abuse by the Texas Department of Protective and Regulatory Services (Child Protective Services), parental substance abuse was a contributing factor.
- Nearly 30% of all AIDS cases reported in a 10 county area in 1995 were associated with intravenous (injecting) drug use; 93% of these cases are in Travis County. (Austin Area Comp. HIV Planning Council)
- The Austin Police Department reported that 30% of arrests were drug/alcohol related in 1995. About 19% of arrests involved public intoxication, driving while intoxicated or under the influence of drugs, and other liquor violations and another 11% involved inhalant abuse and possession or delivery of controlled substances/marijuana. (APD, 1996)
- Approximately 36% of all fatal injuries resulting from motor vehicle accidents in Travis County in 1995 were related to alcohol or other drug use. (TCADA, 1995)
- Illegal drugs and alcohol together account for 11.3% of preventable deaths nationwide. (McGinnis & Foege, 1993) Nationally, 57% of deaths related to excessive alcohol consumption result from cancer, stroke, cirrhosis of the liver, and other illnesses. Homicides and suicides comprise 19% of deaths related to excessive alcohol consumption. (Doyle, 1996)
- There were 396 deaths directly or indirectly related to alcohol or other drug use in Travis County in 1994. (TCADA, 1995)
- Smoking accounted for 38% of preventable deaths nationwide in 1990. (McGinnis & Foege, 1993) The smoking related death rate in Travis County was 284.9 per 100,000 in 1993. (Snapshot)
- There were 279,100 drug-related hospital emergency department episodes nationwide in the first 6 months of 1995, an increase of ten percent from 1994. (SAMHSA, 1995)
- Findings from a study of 6,400 employees using an Employee Assistance Program indicated that persons with alcohol problems were more likely to have attendance problems and accidents on and off-the-job. For example, while about 19% of persons without alcohol problems dealt with absenteeism or lateness to the job, 34% of persons with alcohol problems had these attendance issues. (Blum & Roman, 1992)
- About 39% of persons treated for drug abuse with family incomes below $10,000 lack health insurance. (SAMHSA, 1993)
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Desired Community Impacts
A. Increase the number of community members who access appropriate substance abuse services.
B. Increase people's development of a range of coping skills and resources to enable them to deal constructively with life.
C. Increase the capability of all families to meet their members' needs.
D. Increase the number of persons who can achieve their full learning potential.
E. Increase the number of persons with safe, supportive communities (schools, churches, neighborhoods, and businesses).
F. Increase the number of persons who have resources to meet their basic needs.
G. Increase the number of persons who support responsible community laws and norms for use of alcohol, tobacco, and other drugs.
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Strategies
A. Community-wide Commitment, Development, and Empowerment
Foster community-wide involvement by establishing an ongoing representative planning, development, and funding consortium which serves as a resource for diverse community representatives. (based on HIV Planning Council model)
B. Community-wide Education to Increase Awareness
Increase community knowledge of the broad impact of substance abuse and the benefits of prevention, intervention, and treatment resources and services by disseminating information through community networking and a multi-media campaign.
C. Comprehensive Continuum of Care
Develop a client-focused continuum of care which includes prevention, assessment, intervention, detoxification, treatment, and continuing care.
D. Evaluation and Assessment
Develop an evaluation process that measures progress toward achievement of goals and provides feedback to the community.
E. Community-wide Prevention
- Develop an ongoing, coordinated approach to community substance abuse education that is family-focused and provides age and culturally appropriate information needed to make healthy decisions and decrease risky behavior. Key components include education about:
- the mental and physiological risks associated with substance use and dependence;
- the onset of use and recognition of signs and symptoms of substance use and abuse;
- protective factors;
- resiliency and coping skills; and
- accessing appropriate interventions, support systems and resources.
- Work with schools to implement a pre-Kindergarten through 12th grade planned, sequential, comprehensive substance abuse curriculum that meets the above criteria; and enhances the ability of educators to deliver and reinforce age appropriate information to students.
- Provide community-based services and activities based on risk and resiliency concepts targeting risk factors for individuals, families and the broader community.
F. Access
Ensure equitable, readily accessible, available, and comprehensive services for all persons by creating strong linkages among providers and disseminating information so that at-risk and underserved populations have the knowledge and skills to access services.
G. Advocacy
Carry out effective and coordinated advocacy efforts for:
- Non-discriminatory, equal enforcement of current laws;
- High quality standards of care that promote family and community involvement;
- Early detection of at-risk individuals to prevent incarceration and/or criminal behavior due to substance use;
- Publicized information regarding pending legislation to enable the community to make informed decisions and increase voter participation;
- Community input into policy development;
- Community support of responsible laws and norms for use of alcohol, tobacco and other drugs;
- Adequate funding;
- Involvement of business community as a collaborative partner;
- Community empowerment to directly address problems in the community associated with substance use;
- Increased coverage of alcohol/drug treatment by private/public health insurance; and
- Increased licensure and availability to grass-roots service providers and advocates.
H. Collaboration
Establish a multi-disciplinary provider network to maximize resource use by jointly establishing and achieving goals and objectives based on a community-wide needs assessment; pooling resources; and integrating services. This will be accomplished by:
- Building consensus on a foundation of knowledge, understanding, and trust;
- Identifying and addressing barriers to collaboration;
- Establishing and consistently utilizing clear channels of communication; and
- Developing local, state, and federal linkages.
I. Best Practices
Promote innovation and best practices by:
- Researching best practices and identifying effective models of service delivery in this and other communities;
- Identifying and inviting qualified professionals to conduct community training regarding best practices;
- Collaboratively sharing information among community stakeholders and ensuring continued networking opportunities; and
- Establishing a clearinghouse to collect and disseminate information.
J. Training and Credentialling
Ensure practitioners have the state-of-the-art skills and abilities to provide quality services by:
- Developing a curriculum or guidelines to communicate best practices to professional groups and providers;
- Promoting assessment and validation of credentials to ensure that services are provided by competent professionals;
- Providing multi-disciplinary cross-training regarding identification of abuse and risk factors for abuse;
- Cross-training service providers in substance abuse, mental health, HIV, etc.; and
- Providing linkages with community grass-roots resources to promote training and certification and thus continued service.
K. Community-based, Alternative Drug-Free Activities
Promote and develop a range of community-based activities that offer high risk populations alternatives to those associated with substance use.
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Outcomes
A. Decreased rate of persons reporting alcohol, tobacco, and other drug abuse.
B. Decreased rate of persons relapsing after completion of treatment.
C. Increased rate of persons accessing the substance abuse continuum including appropriate interventions, support systems, and resources.
D. Increased service coordination to facilitate transition within the continuum.
E. Increased effectiveness of the continuum of care.
F. Increased effective family involvement in the continuum of care.
G. Increased rate of persons engaged in productive daily activities, including employment.
H. Decreased impact of substance use on critical conditions and other systems of care, e.g. HIV cases, emergency room visits resulting from motor vehicle accidents, disabilities resulting from babies prenatally exposed to substances, etc.
I. Increased rate of persons securing and maintaining meaningful employment at a living wage.
J. Increased rate of persons securing decent, safe, and affordable housing.
K. Decreased rate of persons with criminal charges or arrests linked to substance use.
L. Increased percentage of youth showing improved school attendance and academic performance.
M. Increased rate of persons able to make healthy decisions resulting from life skills training.
N. Increased percentage of youth who participate in training activities and demonstrate increased knowledge and use of resiliency and coping skills.
O. Increased percentage of parents utilizing effective parenting skills resulting in improved family relationships.
P. Increased percentage of children/youth and young parents with positive role models.
Q. Increased active community involvement in reinforcing and supporting laws and norms, e.g. restricting availability and access to substances by children/youth and advertising favorable to drug use.
R. Increased participation of community members, especially children/youth/elderly, in constructive, drug-free, peer group activities based in the community.
S. Increased community-wide education and awareness about substance use and abuse.
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