It cannot be overstated that substance use disorders are important in our country, state, and the Travis County community. It is a serious problem impacting all members of the community. Each health and human service issue area of the Community Action Network is affected by substance abuse and dependence.
Health
There are over 72 medical conditions that have risk factors related to substance use disorders (Join Together, 2000, October 17). 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 auto crashes, spreading of infectious diseases, drug-related medical emergencies, and HIV/AIDS negatively impact the health of our community.
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Co-Occurring Mental Disorders
From 30 to 60 percent of persons with an addictive disorder have a co-occurring mental disorder i.e., substance use 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 (Office of National Drug Control Policy, 1999, p. 60) 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 is 53 percent (Bassuk, 1994, p.1-4).
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 lifetime drug disorder compared to the general population (Bassuk, 1994).
- An estimated three percent of the population (18 and over) have co-occurring addictive and a mental health disorder within a given year; 15 percent for those with a serious mental illness; and 27 percent for those with severe and persistent mental illness (USDHHS, 2000).
- Ninety percent of inmates with mental disorders have an addiction disorder (Regier, 1990).
- Dual diagnosis occurs in 28-60 percent of the mental health target population (Central Texas Partnership, 1996).
- Children and adolescents (especially boys) diagnosed with conduct disorders appear to be at special risk to abuse substances (USDHHS, 2000).
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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 Office of National Drug Control Policy (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 are current drug users compared to 6 percent of the general population (National Institute on Drug Abuse [NIDA], Workplace Trends).
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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 dependence, 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 dependence treatment for offenders and those at-risk of offending (Supervile, 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 dependence 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 a chronic condition that jailing alone will not cure" (Join Together, 2000, October 27).
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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 disorders are:
- Stigma related to substance disorders;
- Difficulty qualifying for housing with prior drug conviction;
- Lack of sufficient transitional and permanent housing for offenders with substance abuse and dependence histories;
- Lack of community transition programming for incarcerated offenders with substance abuse and dependence histories; and
- Decreasing property values in drug traffic neighborhoods.
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Homelessness
The supply of substance dependence 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 dependence.
- Nearly two-thirds of persons receiving services from homeless assistance programs in the U.S. have had either alcohol, drug abuse or dependence problems in their lifetime (Center for Substance Abuse Treatment [CSAT], 2000).
- Over half of single, homeless adults need substance dependence treatment (Bassuk, 1994).
- Thirty to 40 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 (Bassuk, 1994, p. 1-5).
- 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 and/or substance use disorders.
The Austin and Travis County, Texas 2000 consolidated application for the HUD Super NOFA Continuum of Care Homeless Assistance application (Table 8-2) 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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