Epidemiology of Substance Abuse

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Epidemiology of Substance Abuse

• September 9, 2005
• Cathy Callahan, MD, MPH
• Community and Rural Preventive Medicine
• Virginia College of Osteopathic Medicine

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Drug
Any chemical, other than food or water, which
brings about significant psychological or
physiological changes in the user.
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Categories of drugs of abuse

• Alcohol
• Marijuana
• Cocaine
• Heroin
• Hallucinogens
• Inhalants
• Non-medical use of prescription drugs pain
  relievers, tranquilizers, stimulants, and
  sedatives

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What percent of the population currently uses
illicit drugs?
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What percent of the population currently uses
illicit drugs?

• 8.3 or 1/12 people over the age of 12

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Dependence

• gt3 of the following
• Tolerance
• Withdrawal
• Significant time spent to obtain substance
• Other activities decreased or stopped
• Use despite recurrent social or interpersonal
  problems
• Unsuccessful desire to cut down
• Substance taken in larger amounts or longer
  duration than intended

American Psychiatric Association Diagnostic and
Statistical Manual of Mental Disorders, ed 4.
(DSM IV)
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Substance abuse

• gt1 or more of the following
• Use causing failures at work, school or home
• Use despite situations in which it is physically
  hazardous
• Use despite recurrent social or interpersonal
  problems as a result of use
• Recurrent legal problems

American Psychiatric Association Diagnostic and
Statistical Manual of Mental Disorders, ed 4.
(DSM IV)
8
Why do people use drugs?

• Social interaction
• Euphoria
• Religious/ceremonial
• Medical
• Stress
• Self-medication
• Dependence

• Rebelliousness
• Increase Confidence
• Curiosity
• Coping skill
• Experimentation
• Recreation
• Early use

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• SAMHSA
• Federal Government's lead agency for improving
  the quality and availability of substance abuse
  prevention, addiction treatment, and mental
  health services

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National Survey on Drug Use Health

• Prevalence, patterns and consequences of the use
  and abuse of
• Alcohol
• Tobacco
• Illicit drugs

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Monitoring the Future Survey funded by the
National Institute on Drug Abuse (NIDA), at the
National Institutes of Health (NIH)

• Conducted by the University of Michigan
• Tracks 8th and 12th graders' illicit drug use and
  attitudes towards drugs
• 2001 surveyed 44,000 students in 424 schools
  across the nation

http//www.ncadi.samhsa.gov/newsroom/abuseInformat
ion/default.aspx?smonitor
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Epidemiology of Substance Abuse

• Early Use and initiation of use
• Alcohol abuse

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Early drug use

• Why does it matter?

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Prediction of future abuse

• Early drinkers are 4x more likely to develop
  alcoholism than those who begin to consume
  alcohol at age 21
• 85 of current adult smokers, began smoking
  before age 21
• Substance use progression

National Council on Alcoholism and Drug
Dependence. Alcoholism and alcohol-related
problems a sobering look. NCADD Fact Sheet.
Available online http//ncadd.org/pubs/fsproblems
.html
Epps RP et al. Tobacco use among
adolescentsstrategies for prevention. Pediatr
Clin North Am 199542(2)389-399
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Increased risk

• Homicide
• Suicide
• Motor vehicle crashes
• Fatal motor vehicle crashes
• Poor school performance

Summary of findings from the 2000 National
Household Survey on Drug Abuse (NHSDA Series
H-13, DHHS Publication No. SMA 01-3549). Rockville
, MD Author.
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Primary prevention is more effective than
substance abuse recovery

• 40-45 of patients are compliant in substance
  abuse treatment
• Compliance with other chronic diseases is similar
• Behavioral changes are necessary in addition to
  use of medications and counseling
• Often patients require multiple episodes of
  treatment
• Long term management with physician involvement
  is optimum
• Patient more likely to be successful in treatment
• Less psychiatric problems
• More social supports
• Access to cognitive and financial resources
• Legal and employment motivators/consequences

American Society of Addiction Medicine,
Principles of Addiction Medicine, 2001.
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Adolescent drugs of abuse
Partnership attitude tracking survey, 2004.
www.drugfree.org
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Any Illicit Drug Use in Past Month among Youths
Aged 12 to 17, by State
Percentages, Annual Averages Based on 2002 and
2003 NSDUHs
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Adolescent drugs of abuse
Partnership attitude tracking survey, 2004.
www.drugfree.org
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Annual Number of New Marijuana Users
2002 and 2003 National Survey on Drug Use and
Health (NSDUH
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Marijuana

• Average age of marijuana initiates 17
• 1.7 million new users under age 18 (thats 2/3 of
  all users)
• 53 were female

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Adolescent drugs of abuse
Partnership attitude tracking survey, 2004.
www.drugfree.org
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Inhalant use
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Percentages of Youths Aged 12 to 17Reporting
Lifetime Use of Inhalants, by Inhalant, 2002
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Inhalants

• Estimated 10.5 percent of youths aged 12 to 17,
  (2.6 million youths) had used one or more
  inhalants in their lifetime
• More likely to use marijuana, hallucinogens,
  cocaine, and prescription drugs non-medically

2002 NSDUH
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Adolescent drugs of abuse
Partnership attitude tracking survey, 2004.
www.drugfree.org
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Generation Rx

• Prescription drug abuse

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Generation Rx
Partnership attitude tracking survey, 2004.
www.drugfree.org
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Common prescription drugs of abuse

• Opoids
• Oxycontin, Darvon, Vicodin, Dilaudid)
• Depressants
• Valium, Xanax
• Stimulants
• Dexedrine, Ritalin

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Annual Numbers of New Non-medical Users of Pain
Relievers 19652002
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Prescription drug use

• 43 of new users were younger than 18
• One in 5 adolescents has used hydrocodone
  (Vicodin ) in the past year
• One in 10 has used stimulants (Ritalin and/or
  Adderall

NIDA's 2003 Monitoring the Future
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Complications of prescription drug abuse

• Physical dependence and addiction
• Paranoia
• Death
• Dangerously high body temperatures
• Irregular heartbeat

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Adolescent drugs of abuse
Partnership attitude tracking survey, 2004.
www.drugfree.org
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Hallucinogens

• "MDMA" or methylenedioxymethamphetamine

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Annual Numbers of New Users of Ecstasy, LSD, and
PCP 19652002
2002 and 2003 National Survey on Drug Use and
Health (NSDUH
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What is it?

• Chemical made in home labs
• Chemicals such as caffeine, dextromethorphan
  (cough syrup), amphetamines, and even cocaine
  combined
• Can cause addiction.

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Hallucinogens

• Initiation of ectasy peaked in 2001 and is
  declining (from 1.8 million in 2001 to 1.1
  million)
• 2/3 of new ectasy users are gt age 18
• LSD use has also declined

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Other illicit drugs

• Cocaine
• Average age of first use 20 years.
• In 2002, 1.1 million persons used cocaine for the
  first time.
• Heroin
• Average age of first use gt18 years

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Youth Prevention-Related Measures

• Perceptions of risk
• Availability of substances
• Perceived parental disapproval
• Attitudes about school
• Involvement in delinquent behavior
• Participation in religious and other activities
• Exposure to substance prevention messages

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Relationship of religious beliefs and illicit
substance abuse
Percent who used illicit drugs
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Relationship between parental disapproval and
drug abuse
Percent who used illicit drugs
42
Relationship between school and activity
participation and illicit drug use
Percent who used illicit drugs
43
What about drug prevention programs?
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Relationship between drug prevention programs and
illicit drug use
Percent who used illicit drugs
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Does adolescent drug use mirror trends in the US?
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Past Month Illicit Drug Use, by Age 2002
Substance Abuse and Mental Health Services
Administration. (2004). Results from the 2003
National Survey on Drug Use and Health National
Findings (Office of Applied Studies, NSDUH Series
H25, DHHS Publication No. SMA 043964).
Rockville, MD.
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Past Month Use of Selected Illicit Drugs among
Persons Aged 12 or Older 2002
Substance Abuse and Mental Health Services
Administration. (2004). Results from the 2003
National Survey on Drug Use and Health National
Findings (Office of Applied Studies, NSDUH Series
H25, DHHS Publication No. SMA 043964).
Rockville, MD.
48
Summary

• Adolescents are more likely than older adults to
  initiate use of
• Alcohol
• Tobacco
• Marijuana
• Prescription drug abuse among adolescents is
  prevalent

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Summary

• Youth prevention measures that may impact
  adolescent drug use are
• Parental disapproval
• Importance of religious beliefs
• Involvement in school
• Drug prevention programs

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What is the third leading cause of preventable
death in the U.S.?
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Alcohol
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Alcohol

• In 2001, an estimated 4.7 million Americans under
  age 21 used alcohol for the first time including
  3.8 million (73 percent) under age 18.

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Alcohol

• The average age when youth first try alcohol is
  11 years for boys and 13 years for girls.  The
  average age at which Americans begin drinking
  regularly is 15.9 years old.

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Alcohol

• Alcohol contributes to 100,000 deaths annually,
  making it the third leading cause of preventable
  mortality in the US, after tobacco and
  diet/activity patterns.

Alcohol-attributable deaths and years of
potential life lost--United States, 2001.SO -
MMWR Morb Mortal Wkly Rep 2004 Sep
2453(37)866-70.
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Alcohol abuse

• Current use at least one drink in last 30 days
• Binge use at least 5 or more drinks on one
  occasion in last 30 days
• Heavy use at least 5 or more drinks on the same
  occasion on at least 5 different days in the last
  30 days

Substance Abuse and Mental Health Services
Administration. (2004). Results from the 2003
National Survey on Drug Use and Health National
Findings (Office of Applied Studies, NSDUH Series
H25, DHHS Publication No. SMA 043964).
Rockville, MD.
56
What are the health risks?

• Oncologic aerodigestive, liver and breast
• Cardiovascular Hypertension, cardiomyopathy
• Hematologic anemia, thrombocytopenia
• Neurologic Wernickes encephalopathy, peripheral
  neuropathy, dementia
• Gastrointestinal cirrhosis, pancreatitis,
  esophago-gastritis, peptic ulcers
• Fetal alcohol syndrome
• Malnutrition thiamine and folate deficiency

• http//ncadd.org/pubs/fsproblems.html, NCADD fact
  sheet

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Alcohol is associated with.

• Illicit drug use
• Tobacco use
• Homicide
• Suicide
• Motor vehicle crashes and fatalities

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Alcohol and motor vehicles

• 40 percent of all traffic fatalities were
  alcohol-related 16,653 fatalities
• 3 out of every 10 people will at some point be
  involved in an alcohol-related crash
• Alcohol use was associated with 20 to 37 percent
  of emergency room trauma cases in 1998.

National Highway Traffic Safety Administration
(NHTSA). Traffic Safety Facts 2000 Alcohol.
http//www.nhtsa.dot.gov (Accessed 3/7/05
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Costs of alcohol use 185 billion (1998)

• 2.3 million years of productive life lost
• Drug abuse treatment
• Associated diseases and comorbidities
• Crime
• Maternal abuse and neglect
• Food stamps and other federal/state benefits
• Foster care
• Loss of work time

Alcohol-attributable deaths and years of
potential life lost--United States, 2001.SO -
MMWR Morb Mortal Wkly Rep 2004 Sep
2453(37)866-70.Department of Health and Human
Services (DHHS). Healthy People 2010 Conference
Edition. DHHS, 2000
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Current, Binge, and Heavy Alcohol Use, by Age
2003
Substance Abuse and Mental Health Services
Administration. (2004). Results from the 2003
National Survey on Drug Use and Health National
Findings (Office of Applied Studies, NSDUH Series
H25, DHHS Publication No. SMA 043964).
Rockville, MD.
61
Current, Binge, and Heavy Alcohol Use among
Persons Aged 12 or Older, by Race/Ethnicity
Substance Abuse and Mental Health Services
Administration. (2004). Results from the 2003
National Survey on Drug Use and Health National
Findings (Office of Applied Studies, NSDUH Series
H25, DHHS Publication No. SMA 043964).
Rockville, MD.
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Alcohol Use in Past Month among Persons Aged 12
or Older, by State

• Percentages, Annual Averages Based on 2002 and
  2003 NSDUHs

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Binge Alcohol Use in Past Month among Persons
Aged 18 to 25, by State
Percentages, Annual Averages Based on 2002 and
2003 NSDUHs
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Heavy Alcohol Use, by College Attendance and Age
2003
Substance Abuse and Mental Health Services
Administration. (2004). Results from the 2003
National Survey on Drug Use and Health National
Findings (Office of Applied Studies, NSDUH Series
H25, DHHS Publication No. SMA 043964).
Rockville, MD.
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Summary

• Alcoholism is the third leading cause of
  preventable death (after obesity and tobacco) in
  the US
• Binge and heavy alcohol use is most prevalent
  among white, young adults
• Alcohol increases a persons risk for multiple
  health and social problems

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Questions??