REDUCING SUBSTANCE ABUSE, AND ITS IMPACT ON THE COMMUNITY.
Substance abuse in Travis County is a critical public health problem that affects the young and elderly, rich and poor, educated and uneducated, and professional and blue-collar workers. Identified by a recent health forum as a root cause of many community concerns, substance abuse is a recurring theme in the Community Action Network health and human service issue areas. Substance abuse imposes high costs on individuals, families, employers, tax payers, and society, and continues to be a primary factor contributing to crime, reduced workforce productivity, and human suffering and loss.
Legislators, community members, policymakers, and providers of services are being called upon to recognize the far-reaching impact of substance abuse and substance dependence on our community. As Travis County's population continues to grow, shortage of funding for substance abuse has become critical, and reduced prevention and treatment services threaten to severely limit the opportunities we have to "reduce substance abuse and its impact on the community" (Community Action Network, 1997, p.105).
Some positive elements do exist. Current prevention and treatment services do work and are reducing some of the overall human and economic impacts of substance abuse on Travis County. Best practice criteria are available and when incorporated into our service system, ensure accountability, efficiency, and effectiveness. The City of Austin and Travis County have piloted a health care delivery system designed to increase access and quality of behavioral health care services while maintaining cost effectiveness. This approach ensures consistent performance measures across providers and increases accountability, decreases administrative overhead, and emphasizes best practices.
Our community has not lost the battle against substance abuse, but we are struggling. It is imperative that strong steps be taken as quickly as possible to identify the critical gaps, educate the community, and stimulate the financial and human investments necessary to shift the trend from loss to gain.
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Substance Abuse and Health
There are over 72 medical conditions that have risk factors attributable to substance abuse. The four leading causes of death in Travis County, the Metropolitan Statistical Area (MSA), and the State of Texas are heart disease, some forms of cancer, stroke, and unintentional injury (Epigram Population and Mortality Data Analysis, Online). These Leading causes of death are significantly correlated to substance abuse and are addressed in the Physical Health Section. In addition, alcohol and drug related deaths and accidents, spreading of infectious diseases, drug-related medical emergencies, and HIV/AIDS play a significant role in the health of our community.
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Co-Occurring Mental Disorders
Over 40 percent of persons with an addictive disorder have a co-occurring mental disorder i.e., substance abuse disorder and a mental illness at the same time. Over 80 percent of the time mental disorders precede substance abuse by five to ten years Thirty-seven percent of people who have a mental health disorder are also affected with an alcohol disorder. Of those with a drug disorder, the co-morbidity rate was 53 percent.
Psychiatric hospitals have a 39.6 percent prevalence rate for substance abuse. People with a lifetime mental disorder are twice as likely to have an alcohol disorder and four times as likely to have a drug disorder compared to the general population.
- Of the 1.3 percent of the population who have schizophrenia, 47 percent meet the criteria for alcohol or other drug abuse.
- Of people with an antisocial personality disorder, 83.6 percent meet the criteria for alcohol or other drug abuse; the percentage for persons with mood disorders is 32.
- For persons with bipolar disorder, the rate is 60.7 percent. Ninety percent of inmates with mental disorders have an addiction disorder
- Dual diagnosis occurs in 28-50 percent of the mental health target population.
- Children and adolescents diagnosed with attention deficit hyperactivity disorders (ADHD) appear to be at special risk to abuse substances.
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Dependence in the Workplace
The myth that substance abuse, dependence, and addiction are issues limited to those who are homeless or destitute is erroneous. The 1999 National Drug Control Strategy (1999) reports that over seventy-three percent of those who abuse substances are employed. In 1997, an estimated 60 percent of current illegal substance abusers were of working age. An estimated 13.8 percent of unemployed Americans were current drug users compared to 6 percent of the general population.
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Public Safety, Crime Prevention, Victimization
Studies show that substance use, especially at a young age, is a predictor of future criminal behavior. The Community Action Network's assessment, Public Safety, Crime Prevention, & Victimization discusses the relationship between substance abuse, incarceration and the lack of treatment. Although the majority of adult offenders are under the influence of drugs or alcohol at the time of their arrest, the assessment highlights the lack of substance abuse treatment for offenders and those at-risk of offending. Although drug treatment and case management capacity in Travis County Community Corrections has been expanded in recent years through programs like the Drug Court, SMART and specialized substance abuse caseloads for probation, waiting lists for treatment still exist. "The system does very little to treat the addiction that often led them to commit the crime in the first place...addiction is chronic condition that jailing alone will not cure."
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Housing
The lack of affordable housing in Austin coupled with the growing population, accelerated rental costs, high occupancy rates, employment growth, imbalance between wages and cost of living, and decline in federal resources are some of the factors causing serious housing problems. Additional complicating factors related to housing and substance abuse are:
- Stigma related to substance abuse
- Difficulty qualifying for housing with prior drug conviction
- Lack of sufficient transitional and permanent housing for offenders with substance abuse histories
- Lack of community transition programming for incarcerated offenders with substance abuse histories
- Decreasing property values in drug traffic neighborhoods
Studies show that substance use, especially at a young age, is a predictor of future criminal behavior. The Community Action Network's assessment, Public Safety, Crime Prevention, & Victimization discusses the relationship between substance abuse, incarceration and the lack of treatment. The assessment highlights the lack of substance abuse treatment for offenders and those at-risk of offending, despite the fact that the majority of adult offenders are under the influence of drugs or alcohol at the time of their arrest (Superville, January 8, 1998). Although drug treatment and case management capacity in Travis County Community Corrections has been expanded in recent years through programs like the Drug Court, SMART and specialized substance abuse caseloads for probation, waiting lists for treatment still exist. "The system does very little to treat the addiction that often led them to commit the crime in the first place...addiction is chronic condition that jailing alone will not cure." (Join Together, Take Action On Five Policies America Must Do to Reduce and Substance Abuse, 2000) The lack of affordable housing in Austin coupled with the growing population, accelerated rental costs, high occupancy rates, employment growth, imbalance between wages and cost of living, and decline in federal resources are some of the factors causing serious housing problems (refer to the Community Action Network's Housing Assessment and the Through the Roof report for more information on larger community housing issues). Additional complicating factors related to housing and substance abuse are:
- decreasing property values in drug traffic neighborhoods
- stigma related to substance abuse difficulty qualifying for housing with prior drug conviction
- lack of sufficient transitional and permanent housing for offenders
- lack of community transition programming for incarcerated offenders
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Homelessness
The supply of substance abuse treatment services available to homeless persons is inadequate. Locally, providers estimate that up to 40 percent of homeless adults need substance abuse treatment. Data collected by ACCESS, a local program providing outreach to homeless persons with severe and persistent mental illness, indicate that over one-third (34 percent) of these individuals are dually diagnosed with mental illness and substance abuse addictions.
- Nearly two-thirds of persons receiving services from homeless assistance programs in the U.S. have had either alcohol abuse or drug abuse problems in their lifetime.
- Over half of single, homeless adults need substance abuse treatment.
- Thirty to forty percent of the homeless population abuse alcohol and 10-20 percent abuse drugs as compared to 13.5 percent alcohol abuse and 6 percent drug abuse in the general population.
- An undetermined number of youth are homeless as a result of family rejection/abandonment or their family's inability to provide a home due to mental illness or substance abuse.
The Austin and Travis County, Texas 2000 consolidated application for the HUD Super NOFA Continuum of Care Homeless Assistance application (Table 7-2) identifies the estimated need, current inventory and unmet need/gap for individuals, persons in families with children and special populations of chronic substance abuse and dual diagnosis. The table below reports this information.
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