Substance abuse and its related problems are among society’s
most pervasive health and social concerns. Each year, about 100,000 deaths in
the United States are related toalcohol consumption.1
Illicit drug abuse and related acquired immunodeficiency syndrome (AIDS) deaths
account for at least another 12,000 deaths. In 1995, the economic cost of
alcohol and drug abuse was $276 billion.2 This
represents more than $1,000 for every man, woman, and child in the United States
to cover the costs of health care, motor vehicle crashes, crime, lost
productivity, and other adverse outcomes of alcohol and drug abuse.
A substantial proportion of the population drinks alcohol.
Forty-four percent of adults aged 18 years and older (more than 82 million
persons) report having consumed 12 or more alcoholic drinks in the past year.3
Among these current drinkers, 46 percent report having been intoxicated at
least once in the past year—nearly 4 percent report having been intoxicated
weekly. More than 55 percent of current drinkers report having consumed five or
more drinks on a single day at least once in the past year—more than 12 percent
did so at least once a week. Nearly 20 percent of current drinkers report
having consumed an average of more than two drinks per day. Nearly 10 percent
of current drinkers (about 8 million persons) meet diagnostic criteria for
alcohol dependence. An additional 7 percent (more than 5.6 million persons)
meet diagnostic criteria for alcohol abuse.4
Alcohol use and alcohol-related problems also are common
among adolescents.5 Age at onset of drinking strongly
predicts development of alcohol dependence over the course of the lifespan.
About 40 percent of those who start drinking at age 14 years or under develop
alcohol dependence at some point in their lives; for those who start drinking
at age 21 years or older, about 10 percent develop alcohol dependence at some
point in their lives.6 Persons with a family history of
alcoholism have a higher prevalence of lifetime dependence than those without
such a history.7
Excessive drinking has consequences for virtually every part
of the body. The wide range of alcohol-induced disorders is due (among other
factors) to differences in the amount, duration, and patterns of alcohol
consumption, as well as differences in genetic vulnerability to particular
alcohol-related consequences.
Light-to-moderate drinking can have beneficial effects on the heart, particularly among those at greatest risk for
heart attacks, such as men over age 45 years and women after menopause.9
Moderate drinking generally refers to consuming one or two drinks per day. Moderate
drinking, however, cannot be achieved by simply averaging the number of drinks.
For example, consuming seven drinks on a single occasion will not have the same
effects as consuming one drink each day of the week.
Long-term heavy drinking increases
risk for high blood pressure, heart rhythm irregularities (arrhythmias), heart
muscle disorders (cardiomyopathy), and stroke. Long-term heavy drinking also
increases the risk of developing certain forms of cancer, especially of the
esophagus, mouth, throat, and larynx.10 Heavy
alcohol use also increases risk for cirrhosis and other liver disorders11
and worsens the outcome for patients with hepatitis C.12
Drinking also may increase the risk for developing cancer of the colon and
rectum.10 Women’s risk of developing breast cancer increases
slightly if they drink two or more drinks per day.13
Alcohol use has been linked with a substantial proportion of
injuries and deaths from traffic crashes, falls, fires, and drownings.11
It also is a factor in homicide, suicide, marital violence, and
child abuse14 and has been associated with high-risk sexual
behavior.11,15,16
Persons who drink even relatively small amounts of alcoholic beverages may
contribute to alcohol-related death and injury in occupational incidents or if
they drink before operating a vehicle.11 In 1996,
alcohol use was associated with 41 percent of all motor vehicle crash
fatalities, a significantly lower percentage than in the 1980s.17
Although there has been a long-term drop in overall use,
many Americans still use illicit drugs. In 1997, there were 13.9 million
current users of any illicit drug in the total household population aged 12
years and older, representing 6.4 percent of the total population.18
Marijuana is the most commonly used illicit drug, and 60 percent of users abuse
marijuana only.18 Thirty-six percent of persons aged
12 years and older have used an illegal drug in their lifetime. Of these, more
than 90 percent used marijuana or hashish, and approximately 30 percent tried
cocaine.18 Relatively rare in 1996, methamphetamine use began
spreading in 1997.18,19
Estimated rates of chronic drug use also are significant. Of
the estimated 4.4 million chronic drug users in the United States in 1995, 3.6
million were chronic cocaine users (primarily crack cocaine), and 810,000 were
chronic heroin users.20
Drug dependence is a chronic, relapsing disorder. Addicted
persons frequently engage in self-destructive and criminal behavior. Research
has confirmed that treatment can help end dependence on addictive drugs and
reduce the consequences of addictive drug use on society. While no single
approach for substance abuse and addiction treatment exists, comprehensive and
carefully tailored treatment works.21
Drug use among adolescents aged 12 to 17 years doubled
between 1992 and 1997, from 5.3 percent to 11.4 percent.18
Youth marijuana use has been associated with a number of dangerous behaviors.
Nearly 1 million youth aged 16 to 18 years (11 percent of the total) have
reported driving in the past year at least once within 2 hours of using an
illegal drug (most often marijuana).22 Adolescents
aged 12 to 17 years who smoke marijuana were more than twice as likely to cut
class, steal, attack persons, and destroy property than those who did not smoke
marijuana.23 Drug and alcohol use by youth also is associated with
other forms of unhealthy and unproductive behavior, including delinquency and
high-risk sexual activity.
Illegal use of drugs, such as heroin, marijuana, cocaine,
and methamphetamine is associated with other serious consequences, including
injury, illness, disability, and death as well as crime, domestic violence, and
lost workplace productivity. Drug users and persons with whom they have sexual
contact run high risks of contracting gonorrhea, syphilis, hepatitis, tuberculosis,
and human immunodeficiency virus (HIV). The relationship between injection drug
use and HIV/AIDS transmission is well-known. Injection drug use also is
associated with hepatitis B and C infections.24 The use of
cocaine, nitrates, and other substances can produce cardiac irregularities and
heart failure, convulsions, and seizures. Cocaine use temporarily narrows blood
vessels in the brain, contributing to the risk of strokes (bleeding within the
brain) and cognitive and memory deficits.25 Long-term
consequences, such as chronic depression, sexual dysfunction, and psychosis,
may result from drug use.
Substance abuse, including tobacco use and nicotine
dependence, is associated with a variety of other serious health and social
problems. An analysis of the epidemiological evidence reveals that 72
conditions requiring hospitalization are wholly or partially attributable to
substance abuse.26
Substance abuse contributes to cancers that, until recently,
were thought to be unrelated. Advances in research techniques since the 1980s,
including advanced brain imaging and the study of the effects of alcohol and
drug abuse on individual cells, have helped to document the alteration of
healthy systems by all forms of substance abuse, including marijuana use. Researchers
have identified lasting brain and nervous system damage from drugs, including
changes in nerve cell structure associated with alcohol and drug dependence.
Other research has focused on the long-term effects of alcohol and drug abuse
on the immune system as well as the effects of prenatal alcohol and drug
exposure on the behavior and development of children.
Research confirms that a substantial number of frequent
users of cocaine, heroin, and illicit drugs other than marijuana have co-occurring
chronic mental health disorders. Some of these persons can be identified by
their behavior problems at the time of their entry into elementary school.27
Such youth tend to use substances at a young age and exhibit sensation-seeking
(or “novelty-seeking”) behaviors. These youth benefit from more intensive
preventive interventions, including family therapy and parent training
programs.28,29
The stigma attached to substance abuse increases the
severity of the problem. The hiding of substance abuse, for example, can
prevent persons from seeking and continuing treatment and from having a
productive attitude toward treatment. Compounding the problem is the gap
between the number of available treatment slots and the number of persons
seeking treatment for illicit drug use or problem alcohol use.
Substance abuse affects all racial, cultural, and economic
groups. Alcohol is the most commonly used substance, regardless of race or
ethnicity, and there are far more persons who smoke cigarettes than persons who
use illicit drugs. Usage rates for an array of substances reveal that, for
adolescents aged 12 to 17 years:
Whites and Hispanics are more likely than African Americans to use alcohol.
Whites are more likely than African Americans and Hispanics to use tobacco.
Whites are more likely than African Americans and Hispanics to use illicit drugs.
Additional findings include the following:
Substance Use in the Past Year, 1997
White
Hispanic
African American
Substance
All Ages
Aged 12 to 17 Years
All Ages
Aged 12 to
17 Years
All Ages
Aged 12 to 17
Years
Percent
Alcohol
67.8
36.0
55.6
32.5
52.7
27.3
Cigarette
33.7
29.1
30.4
20.8
32.5
18.2
Any illicit drug
11.3
19.6
9.9
16.5
12.1
15.7
Marijuana
9.1
16.3
7.5
13.8
9.9
13.4
Cocaine
1.9
2.5
2.0
2.3
2.4
0.2
Inhalants
1.2
5.2
1.1
3.7
0.4
1.0
Heroin
0.2
*
0.6
*
0.5
*
*Not available
Source: National Household Survey on Drug Abuse: Population Estimates 1997, SAMHSA
Older adolescents and adults with co-occurring substance
abuse and mental health disorders need explicit and appropriate treatment for
their disorders. Those who suffer from co-occurring disorders, however, are
frequently turned away from treatment designed for one or the other problem but
not for both. (See Focus Area 18. Mental Health and Mental Disorders).
The population aged 65 years and older faces risks for
alcohol-related problems, although this group consumes comparatively low
amounts of alcoholic beverages.30 Adverse
alcohol-drug interaction can put older people in the hospital, since many take
multiple medications. In addition, many cases of memory deficits and dementia
now are understood to result from alcoholism.31
The direct application of prevention and treatment research
knowledge is particularly important in solving substance abuse problems.
Developing adaptations of research-proven programs for diverse racial and
ethnic populations, field testing them with high-quality process and outcome
evaluations, and providing them where they are most needed are critical.
Interventions appropriate to the population to be served, including
interventions to address gaps in substance abuse treatment capacity, must be
identified and implemented by Federal, Tribal, regional, State, and community-based
providers in a variety of settings.
Scientific research has identified many opportunities to
prevent alcohol-related problems. For example, studies indicate that school-based
programs focused on altering perceived peer-group norms about alcohol use32,33
and developing skills in resisting peer pressures to drink34,35,36
reduce alcohol use among participating students.
Communitywide programs involving school curricula, peer leadership, parental
involvement and education, and community task forces also have reduced alcohol
use among adolescents.37
Raising the minimum legal drinking age to 21 years was
accompanied by reduced alcohol consumption, traffic crashes, and related
fatalities among young persons under age 21 years38 Reductions
in alcohol-related traffic crashes are associated with many policy and program
measures39—among them, administrative revocation of licenses for
drinking and driving40 and lower legal blood alcohol
limits for youth41 and adults.42
Community programs involving multiple city departments and private citizens
have reduced driving after drinking and traffic deaths and injuries.43
In addition, a combination of community mobilization, media advocacy, and
enhanced law enforcement has been shown to reduce alcohol-related traffic
crashes and sales of alcohol to minors.44
Higher prices or taxes for alcoholic beverages are
associated with lower alcohol consumption and lower levels of a wide variety of
adverse outcomes—including the probability of frequent beer consumption by
young persons,45 the probability of adults drinking
five or more drinks on a single occasion,46 death rates
from cirrhosis47 and motor vehicle crashes,48,
49 frequency of drinking and driving,50 and some
categories of violent crime.51 One study suggests that,
among adults, the effect of alcoholic beverage prices on frequency of heavy
drinking varies with knowledge of the health consequences of heavy drinking:
better informed heavy drinkers are more responsive to price changes.52
In college settings, brief one-on-one motivational
counseling has proved effective in reducing alcohol-related problems among high-risk
drinkers.53 Research on the effect of the density of alcohol
outlets on violence is inconclusive.54, 55
Many opportunities to prevent drug-related problems have
been identified. Core strategies for preventing drug abuse among youth include
raising awareness, educating and training parents and others, strengthening
families, providing alternative activities, building skills and confidence,
mobilizing and empowering communities, and environmental approaches. Studies
indicate that making youth and others aware of the health, social, and legal
consequences associated with drug abuse has an impact on use. Parents also play
a primary role in helping their children understand the dangers of substance
abuse and in communicating their expectation that drug and alcohol use will not
be tolerated. Research suggests that improving parent/child attachment and
supervision and monitoring also protects youth from substance abuse.
Alternative activities for youth teach social skills and provide an alternative
to substance abuse. According to one study, programs that help young persons
develop psycho social and peer resistance skills are more successful than other
programs in preventing drug abuse.21 Findings
suggest that having community partnerships in place for sustained periods of
time produces significant results in decreasing alcohol and drug use in males.
Literature shows that having “buy-in” from local participants greatly enhances
the success of any endeavor. Studies also show that changing norms is extremely
effective in reducing substance abuse and related problems.21
For substance abuse prevention to be effective, people need
access to culturally, linguistically, and age-appropriate services; job
training and employment; parenting training; general education; more behavioral
research; and programs for women, dually diagnosed patients, and persons with
learning disabilities. Particular attention must be given to young persons
under age 18 years who have an addicted parent, since these youth are at
increased risk for substance abuse. Because alcoholism and drug abuse continue
to affect lesbians, gay men, and transgendered persons at two to three times
the rate of the general population,56 programs
that address the special risks and needs of these population groups also are
needed. Government, employers, the faith community, and other organizations in
the private and nonprofit sectors must increase their level of cooperation and
coordination to ensure that multiple service needs are met.
The prevention and treatment of substance abuse require that
all abused substances be addressed—from tobacco and alcohol to marijuana and
other illicit drugs. Tobacco prevention and treatment are equally important
parts of a comprehensive substance abuse prevention program. (See Focus Area
27. Tobacco Use.)
Of the 20 substance abuse objectives in Healthy People 2000,
2 have met or surpassed their targets. More than 90 percent of worksites with
50 or more employees have adopted policies on alcohol and drugs (1995),
exceeding the Healthy People 2000 target of 60 percent. One additional target
has been met—monitoring access to treatment programs by the under served
(1996).
Progress has been made toward other objectives. Alcohol-related
motor vehicle crash deaths declined to 6.5 per 100,000 population (1996),
attributed in part to passage of State laws mandating administrative license
revocation, setting maximum blood alcohol concentration levels of 0.08 percent
for drivers aged 21 years and older, and establishing zero tolerance for
alcohol in the blood of drivers under age 21 years. The cirrhosis death rate
declined to 7.4 per 100,000 population, although the rate for American Indians
or Alaska Natives remains significantly higher than that of other groups.
Average age of first use of harmful substances by adolescents aged 12 to 17
years has increased. In addition, past-month use of alcohol by adolescents aged
12 to 17 years has declined, as has steroid use by high school seniors.
Less progress has been made toward other targets. Past-month
use of marijuana and cigarettes among adolescents aged 12 to 17 years has
increased since 1994. Among high school seniors, both perception of harm and
perception of social disapproval of substance abuse have declined. For the
total population, rates of drug-related deaths and drug-abuse-related emergency
department visits have increased.
Note: Unless otherwise noted, data are from Centers for
Disease Control and Prevention, National Center for Health Statistics, Healthy
People 2000 Review, 1998-99.
Goal: Reduce substance abuse to protect the health,
safety, and quality of life for all, especially children.
Number
Objective
Adverse Consequences of Substance Use
and Abuse
26-1 26-2 26-3 26-4 26-5 26-6 26-7 26-8
Motor vehicle crash deaths and injuries Cirrhosis deaths Drug-induced deaths Drug-related hospital emergency department visits Alcohol-related hospital emergency department visits Adolescents riding with a driver who has been drinking Alcohol- and drug-related violence Lost productivity
Substance Use and Abuse
26-9 26-10 26-11 26-12 26-13 26-14 26-15
Substance-free youth Adolescent and adult use of illicit substances Binge drinking Average annual alcohol consumption Low-risk drinking among adults Steroid use among adolescents Inhalant use among adolescents
Risk of Substance Use and Abuse
26-16 26-17
Peer disapproval of substance abuse Perception of risk associated with substance abuse
Treatment for Substance Abuse
26-18 26-19 26-20 26-21
Treatment gap for illicit drugs Treatment in correctional institutions Treatment for injection drug use Treatment gap for problem alcohol use
State and Local Efforts
26-22 26-23 26-24 26-25
Hospital emergency department referrals Community partnerships and coalitions Administrative license revocation laws Blood alcohol concentration (BAC) levels for motor vehicle drivers
26-1. Reduce deaths and injuries caused by alcohol- and drug-related motor vehicle crashes.
Target and baseline:
Objective
Reduction in Consequences
of Motor Vehicle Crashes
1997
Baseline
2010
Target
Per 100,000 Population
26-1a.
Alcohol-related deaths
6.1
4
26-1b.
Alcohol-related injuries
122
65
26-1c.
Drug-related deaths
Developmental
26-1d.
Drug-related injuries
Developmental
Target setting
method: Consistent withthe U.S.
Department of Transportation for 26-1a; 47 percent improvement for 26-1b.
Data source:
Fatality Analysis Reporting System (FARS), DOT, National Highway Traffic Safety
Administration (NHTSA); General Estimates System (GES), DOT.
Total Population, 1997
(unless noted)
Alcohol-Related Motor
Vehicle Crashes
26-1a.
Deaths
26-1b.
Injuries
Rate per 100,000
TOTAL
6.1
122
Race and ethnicity
American Indian or Alaska Native
19.2
(1995)
DNC
Asian or Pacific Islander
2.4
(1995)
DNC
Asian
DNC
DNC
Native Hawaiian and other Pacific
Islander
DNC
DNC
Black or African American
6.4
(1995)
DNC
White
6.0
(1995)
DNC
Hispanic or Latino
DNA
DNC
Not Hispanic or Latino
DNA
DNC
Black or African American
DNA
DNC
White
DNA
DNC
Gender
Female
2.9
DNA
Male
9.4
DNA
Age
All persons aged 15 to 24 years
11.7
DNA
Education level
Less than high school
DNC
DNC
High school graduate
DNC
DNC
At least some college
DNC
DNC
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
Progress
has been achieved in reducing the rate of alcohol-related driving fatalities,
which declined from 9.8 deaths per 100,000 population in 1987 to 6.1 deaths per
100,000 in 1997. However, fatal injuries caused by motor vehicle crashes in
which either a driver or nonoccupant (that is, pedestrian or bicyclist) was
under the influence of alcohol or drugs remain a serious problem in the United
States.
Of
particular concern is the fatality rate among Native Americans and persons aged
15 to 24 years. In 1994, the alcohol involvement rate in fatal traffic crashes
for American Indian or Alaska Native men was four times higher (28 per 100,000
population) than for the general population. For persons aged 15 to 24 years,
the rate was 11.7 per 100,000 population in 1997. Based on these rates, about 3
in every 10 persons in the United States will be involved in an alcohol-related
crash sometime in their lives. The alcohol-related traffic fatality rate for
youth, however, has decreased by more than 50 percent since 1982, from 22
deaths per 100,000 population to 10 deaths per 100,000 population in 1996.57
The National Highway Traffic Safety Administration estimates that since 1975,
over 17,300 lives have been saved by enforcement of minimum drinking age laws.57
The
number of children who are victims of alcohol- and drug-related traffic crashes
also is significant. In 1997, of traffic crashes in which 3,157 children under
age 16 years were killed,nearly 21 percent were alcohol related.
Crash-related
injuries also are a serious problem. In 1997, crash-related injuries totaled
3,399,000, compared to 41,967 crash-related deaths.58 A reduction
in all injuries resulting from alcohol- and drug-related driving is needed.
Such injuries significantly contribute to emergency department use and overall
health care costs and cause personal tragedies for families.
Although
alcohol and its relationship to motor vehicle crashes has been studied more
extensively than other substances, tracking drug-related fatalities and
injuries is needed. This extension will promote the understanding that driving
while under the influence of drugs is a serious problem and will help reduce
drug-related fatalities.
Reductions
in traffic crashes are the result, in part, of many policy and program
measures—among them, raising the minimum legal drinking age to 21 years,59
administrative revocation of licenses for drinking and driving,60
lower legal blood alcohol limits for youth41 and adults,42
and higher prices through increased taxation of alcoholic beverages.48,
49 Higher prices for alcoholic beverages also are associated with
reduced frequency of drinking and driving.50 In addition,
community programs involving multiple city departments and private citizens
have reduced both driving after drinking and traffic deaths and injuries.43
Baseline: 9.4
cirrhosis deaths per 100,000 population in 1998 (preliminary data; age adjusted
to the year 2000 standard population).
Target setting
method: Better than the best.
Data source:
National Vital Statistics System (NVSS), CDC, NCHS.
Total Population, 1997*
Cirrhosis Deaths
Rate per 100,000
TOTAL
9.6
Race and ethnicity
American Indian or Alaska Native
24.2
Asian or Pacific Islander
3.4
Asian
DNC
Native Hawaiian and other Pacific
Islander
DNC
Black or African American
10.7
White
9.6
Hispanic or Latino
15.9
Not Hispanic or Latino
9.6
Black or African American
10.9
White
8.9
Gender
Female
6.2
Male
13.6
Education level (aged 25 to 64 years)
Less than high school
20.1
High school graduate
14.0
At least some college
5.8
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.
*New data for population groups will be added when
available.
Sustained heavy alcohol
consumption is the leading cause of cirrhosis, 1 of the 10 leading causes of
death in the United States.61, 62, 63, 64, 65 Cirrhosis
occurs when healthy liver tissue is replaced with scarred tissue until the
liver is unable to function effectively. Changes in alcohol consumption patterns
over time are associated with changes in the death rate from cirrhosis.
Improvements in disease management and in the availability of treatment for
alcoholism, however, also may have contributed to a decline in cirrhosis deaths
since 1973. In addition, higher State excise tax rates on distilled spirits are
associated with lower death rates from cirrhosis.47
Baseline: 5.1
drug-induced deaths per 100,000 population in 1998 (preliminary data; age
adjusted to the year 2000 standard population).
Target setting
method: Better than the best.
Data source:
National Vital Statistics System (NVSS), CDC, NCHS.
Total Population, 1997*
Drug-Induced Deaths
Rate per 100,000
TOTAL
6.0
Race and ethnicity
American Indian or Alaska Native
6.6
Asian or Pacific Islander
1.6
Asian
DNC
Native Hawaiian and other Pacific
Islander
DNC
Black or African American
9.0
White
5.7
Hispanic or Latino
6.0
Not Hispanic or Latino
6.0
Black or African American
9.2
White
5.6
Gender
Female
3.6
Male
8.3
Education level (aged 25 to 64 years)
Less than high school
18.4
High school graduate
13.9
At least some college
5.8
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.
*New data for population groups will be added when
available.
Causes of drug-induced
deaths include drug psychosis, drug dependence, suicide, and intentional and
accidental poisoning that result from illicit drug use. Declining initiation,
number of cases, and intensity of drug abuse should be reflected in fewer drug-induced
deaths. However, the prevention of suicide, accidental poisoning, and fatal
interaction among medications contributes to changes in the statistics measured
in this objective.
Baseline:
542,544 drug-related hospital emergency department visits in 1998.
Target setting
method: 35 percent improvement.
Data source:
Drug Abuse Warning Network (DAWN), SAMHSA.
Drug-related
hospital emergency department (ED) visits are another major indicator of the
harmful effects of drugs. In hospital EDs, a “drug-related episode” is defined
as one resulting from the nonmedical use of a drug. This includes the unprescribed
use of prescription drugs, use of drugs contrary to approved labeling, and use
of illicit drugs. Episodes are abstracted from medical records by hospital
staff or hired clerks. To be counted as having a drug-related episode, the ED
patient must be aged 6 years or older and meet four criteria: the patient was
treated in the hospital’s ED; the presenting problem was induced by or related
to drug use; the case involved the nonmedical use of a legal drug or any use of
an illegal drug; and the patient’s reason for taking the substance(s) included
dependence, suicide attempt or gesture, or psychic effects.
“Suicide
attempt or gesture” and dependence were the most frequently cited motives for
taking a substance that resulted in an ED episode, with each accounting for 35
percent of all episodes in 1998. In 1998, 55 percent of the drug-related ED
episodes occurred among adolescents and adults aged 16 to 34 years and 44
percent among persons aged 35 years and older. Whites accounted for 54 percent
of drug-related ED episodes. African Americans and Hispanics accounted for 25
percent and 11 percent, respecitively.66
Potential data
source: National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC,
NCHS.
Alcohol consumption is associated
with a wide range of events that can result in ED visits—among them, traffic
crashes, violence, and alcohol poisoning. In 1996, alcohol-related hospital ED
visits (2.2 million) accounted for 2.4 percent of all ED visits.67
Visits related to both alcohol and drugs accounted for an additional 0.4
percent. However, these figures, based on a national probability survey of hospital
EDs, are probably underestimates since information on alcohol involvement often
is missing from ED medical records.67
An analysis of 1995 data from the
same survey found that alcohol-related visits are 1.6 times as likely as other
ED visits to be injury related; in 20 percent of alcohol-related visits, the
principal diagnosis is alcohol abuse or alcohol dependence.68
Other studies, based on smaller samples and different measures of alcohol
involvement, suggest a large proportion of young persons and trauma victims are
intoxicated when they visit the ED.69, 70, 71
Screening for alcohol problems in
the ED offers an opportunity for early intervention and appropriate referral of
patients and may reduce subsequent illness, injury, and death.72
Policy measures that reduce specific alcohol-related problems11—for
example, traffic crashes or violence—also may help reduce alcohol-related ED
visits.
Baseline: 37
percent of students in grades 9 through 12 reported riding with a driver who
had been drinking alcohol in 1997.
Target setting
method: Better than the best.
Data source:
Youth Risk Behavior Survey (YRBS), CDC, NCCDPHP.
Students in Grades 9
Through 12, 1997
Rode
With Drinking Driver During
Previous 30 Days
Percent
TOTAL
37
Race and ethnicity
American Indian or Alaska Native
DSU
Asian or Pacific Islander
DSU
Asian
DNC
Native Hawaiian and other Pacific
Islander
DNC
Black or African American
DNC
White
DNC
Hispanic or Latino
43
Not Hispanic or Latino
DNC
Black or African American
34
White
37
Gender
Female
35
Male
38
Family income level
Poor
DNC
Near poor
DNC
Middle/high income
DNC
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
Health risk behaviors that
contribute to the leading causes of illness, death, and social problems among
youth and adults often are established during youth, extend into adulthood, and
are interrelated. In the United States, 72 percent of all deaths among school-aged
youth and young adults result from four causes: motor vehicle crashes, other
unintentional injuries, homicide, and suicide. Many high school students
practice behaviors that may increase their likelihood of death from these four
causes. Hispanic students are more likely than African American or white
students to ride with a driver who has been drinking.
Rates of drinking across
State surveys ranged from 19.4 percent to 52.5 percent (median: 36.0 percent).
Across the local surveys, the rates ranged from 20.7 percent to 43.1 percent
(median: 32.1 percent).73 Reducing the number of adolescents
who ride in a motor vehicle with another adolescent driver who has been
drinking is an important step to lower motor-vehicle related deaths and
injuries.
Potential data
source: National Crime Victimization Survey (NCVS), U.S. Department of
Justice, Bureau of Justice Statistics.
A
review of the literature found that the percentage of homicide offenders who
were drinking when they committed the offense ranged from 7 to 85 percent, with
most studies finding the figure greater than 60 percent.74
Drugs, and most commonly alcohol, also are a factor in a significant number of
firearm-related deaths.75 In 1996, juvenile and adult
arrestees testing positive for drugs had been frequently arrested for violent
offenses, such as robbery, assault, and weapons offenses.Two-thirds of
victims who experienced violence by an intimate (a current or former spouse,
boyfriend, or girlfriend) reported that alcohol had been involved. Among
spousal victims, three out of four incidents involved an offender who was
drinking. Thirty-one percent of strangers who were victimized believed that the
offender was using alcohol.76 Efforts are underway to
establish targeted prevention and treatment programs aimed at reducing violence
related to or caused by alcohol and drug use.77, 78 Efforts
are underway to develop surveillance systems aimed at reinforcing local
community activities.79
Potential data
source: Periodic estimates of economic costs of alcohol and drug use, NIH,
NIAAA and NIDA.
The
economic cost of alcohol and drug abuse in the United States was estimated at
$276 billion for 1995,2 with $167 billion attributed to
alcohol abuse and $110 billion to drug abuse. Productivity losses accounted for
$119 billion of the costs of alcohol abuse and $77 billion of the costs of drug
abuse.
The
majority of alcohol-related productivity losses (62 percent) were attributed to
alcohol-related illness. These costs, measured as impaired earnings among those
with a history of alcohol dependence, may result from increased unemployment,
poor job performance, and limited career advancement. The adverse effects of
early alcohol use on educational attainment may underlie these effects.
Productivity losses were greatest for males who started drinking before age 15
years.
For
drug abuse, most (56 percent) of the estimated productivity losses were
associated with crime, including lost earnings of victims (3 percent) and
incarcerated perpetrators (26 percent) of drug-related crime and foregone
legitimate earnings because of participation in the drug trade (28 percent).
Studies from offender populations have found early onset of drinking and drug
use and high dropout rates; these may reflect causal linkages.2
As
indicators of the adverse consequences of alcohol and drug misuse, estimates of
lost productivity have important limitations, including concerns about
statistical and methodological issues and data quality and completeness. For
example, productivity losses cannot be observed directly, implying some
inherent imprecision in these estimates, so that changes in productivity losses
may not be detected. Also, there is persistent uncertainty in quantifying the
causal roles of alcohol and drugs in generating productivity losses. Finally,
some likely effects on productivity are omitted from current estimates, mainly
because suitable data are lacking. These measurement concerns notwithstanding,
efforts to reduce or delay alcohol and drug use may lead to significant
reductions in productivity losses over the long run.
Increase Average Age of
First Use in Adolescents Aged 12 to 17 Years
1997
Baseline
2010
Target
Average Age in Years
26-9a.
Alcohol
13.1
16.1
26-9b.
Marijuana
13.7
17.4
Target setting
method: Better than the best for alcohol use; consistent with Office of
National Drug Control Policy for marijuana use.
Data source:
National Household Survey on Drug Abuse (NHSDA), SAMHSA.
Adolescents Aged 12 to
17 Years, 1997
26-9a.
First Alcohol Use
26-9b.
First Marijuana Use
Average Age in Years
TOTAL
13.1
13.7
Race and ethnicity
American Indian or Alaska Native
13.3
14.1
Asian or Pacific Islander
12.7
13.8
Asian
DNC
DNC
Native Hawaiian and other Pacific
Islander
DNC
DNC
Black or African American
12.9
13.6
White
13.1
13.7
Hispanic or Latino
13.0
13.5
Not Hispanic or Latino
DNA
DNA
Black or African American
DNA
DNA
White
DNA
DNA
Gender
Female
13.4
14.0
Male
12.7
13.5
Family income level
Poor
12.9
13.2
Near poor
13.0
13.8
Middle/high income
13.1
13.8
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
Target and
baseline:
Objective
Increase in High School
Seniors Never Using Substances
1998
Baseline
2010
Target
Percent
26-9c.
Alcoholic beverages
19
29
26-9d.
Illicit drugs
46
56
Target setting
method: Better than the best.
Data source:
Monitoring the Future Study, NIH, NIDA.
High School Seniors,
1998
26-9c.
Never Used
Alcoholic
Beverages
29-9d.
Never Used Any Illicit Drug
Percent
TOTAL
19
46
Race and ethnicity
American Indian or Alaska Native
DSU
DSU
Asian or Pacific Islander
DNC
DNC
Asian
DSU
DSU
Native Hawaiian and other Pacific Islander
DNC
DNC
Black or African American
28
55
White
16
44
Hispanic or Latino
18
43
Not Hispanic or Latino
DNC
DNC
Black or African American
DNC
DNC
White
DNC
DNC
Gender
Female
19
50
Male
18
43
Family income level
Poor
DNC
DNC
Near poor
DNC
DNC
Middle/high income
DNC
DNC
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
An important goal of U.S.
policy for the prevention of substance abuse among youth is to increase the
percentage of young persons who reach adulthood without using tobacco, illicit
drugs, or alcohol. (See Focus Area 27. Tobacco Use.) Strengthening the ability
of children and teenagers to reject all such substances isan important
and critical element in prevention activities because the required skills and
attitudes can carry over into adulthood, long after family constraints and
other influences have lost their effectiveness.80
From 1985 until 1995, the
percentage of high school seniors who reported they had never used tobacco,
drugs, or alcohol increased dramatically.81
This increase clearly demonstrated the value of the national investment in
prevention because it followed many years of virtually no change in the
percentage of high school seniors who reported they had never used any substance.
To achieve overall
prevention goals, local activities are important. Some of the best prevention
approaches involve comprehensive, multistrategy prevention interventions.
Comprehensive community-based programs include interventions that influence
individual behavior and attitudes through education, for example, and
interventions that change environments through controls on the availability of
substances. Comprehensive programs must be applied universally to the general
population and in a more intensive fashion to selected and indicated groups and
persons known to be at high risk for serious drug problems or to targeted
groups of persons already exhibiting early signs of drug use. The need to
sustain universal preventive interventions, selective preventive interventions,
and indicated preventive interventions requires coordination among schools,
State and local governments, businesses, the faith community, civic groups, and
other elements of the community.
26-10a. Increase
the proportion of adolescents not using alcohol or any illicit drugs during the
past 30 days.
Target: 89
percent.
Baseline: 77
percent of adolescents aged 12 to 17 years reported no alcohol or illicit drug
use in past 30 days in 1997.
Target setting
method: Better than the best.
Data source:
National Household Survey on Drug Abuse (NHSDA), SAMHSA.
Adolescents Aged 12 to
17 Years, 1997
26-10a.
No Alcohol or Illicit Drug Use
in Past 30 Days
No
Alcohol Use in Past 30 Days*
No Illicit Drug Use in
Past 30 Days*
Percent
TOTAL
77
80
89
Race and ethnicity
American Indian or Alaska Native
55
DSU
DSU
Asian or Pacific Islander
86
DSU
DSU
Asian
DNC
DNC
DNC
Native Hawaiian and other Pacific
Islander
DNC
DNC
DNC
Black or African American
80
DNA
DNA
White
76
DNA
DNA
Hispanic or Latino
78
81
90
Not Hispanic or Latino
DNA
DNA
DNA
Black or African American
DNA
84
89
White
DNA
78
88
Gender
Female
78
80
89
Male
76
79
88
Family income level
Poor
78
DNA
DNA
Near poor
78
DNA
DNA
Middle/high income
77
DNA
DNA
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
*Data for no alcohol use and no illicit drug use are
displayed to further characterize the issue.
26-10b.
Reduce the proportion of adolescents reporting use of marijuana during the past
30 days.
Target: 0.7
percent.
Baseline: 9.4
percent of adolescents aged 12 to 17 years reported marijuana use in past 30
days in 1997.
Target setting
method: Better than the best (consistent with the Office of National Drug
Control Policy).
Data source:
National Household Survey on Drug Abuse (NHSDA), SAMHSA.
Adolescents Aged 12 to
17 Years, 1997
Use
of Marijuana in Past 30 Days
Percent
TOTAL
9.4
Race and ethnicity
American Indian or Alaska Native
3.8
Asian or Pacific Islander
0.8
Asian
DNC
Native Hawaiian and other Pacific
Islander
DNC
Black or African American
9.2
White
9.5
Hispanic or Latino
8.4
Not Hispanic or Latino
9.5
Black or African American
9.1
White
9.8
Gender
Female
8.4
Male
10.3
Family income level
Poor
DNA
Near poor
DNA
Middle/high income
DNA
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
26-10c.
Reduce the proportion of adults using any illicit drug during the past 30 days.
Target: 3.0
percent.
Baseline: 5.8
percent of adults aged 18 years and older used any illicit drug during the past
30 days in 1997.
Target setting
method: Better than the best (consistent with Office of National Drug
Control Policy).
Data source: National
Household Survey on Drug Abuse (NHSDA), SAMHSA.
Adults Aged 18 Years and
Older, 1997
Illicit Drug Use in Past
30 Days
Percent
TOTAL
5.8
Race and ethnicity
American Indian or Alaska Native
11.3
Asian or Pacific Islander
3.4
Asian
DNC
Native Hawaiian and other Pacific Islander
DNC
Black or African American
7.1
White
5.7
Hispanic or Latino
5.1
Not Hispanic or Latino
DNA
Black or African American
DNA
White
DNA
Gender
Female
3.8
Male
8.1
Education level
Less than high school
6.9
High school graduate
6.0
At least some college
5.4
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
Past-month use of any
illicit drug and marijuana was about the same in 1997 as in 1996 and most of
the 1990s for adults aged 18 years and older.82 But young
adults aged 18 to 25 years continued to be the age group with the highest rates
of use. Past-month use of drugs increased among adolescents aged 12 to 17
years, and the 1997 rates of past month use of any illicit drug (11 percent)
and marijuana (9 percent) were significantly higher than the 1996 rates of use
by this age group (9 percent and 7 percent, respectively). Furthermore, past-month
use of illicit drugs by youths was significantly higher in 1997 than at any
time during the 4 years between 1991 and 1994. Past-month use of alcohol was about
the same in 1997 as in 1996.82
The first goal of the 1998
National Drug Control Strategy is to “educate and enable America’s youth to
reject illegal drugs as well as the underage use of alcohol and tobacco.”83
In response to this goal, specific targets for the reduction of drug use among
adolescents aged 12 to 17 years have been established under the Youth Substance
Abuse Prevention Initiative (YSAPI). These targets, which have a baseline of
1996 and goals for the year 2002(7 years), are as follows:
§Reverse the upward trend and reduce past-month use of
marijuana among adolescents aged 12 to 17 years by 20 percent (1996 baseline:
7.1 percent; target: 5.7 percent in 2002).
§Reduce past-month use of any illicit drugs among
adolescents aged 12 to 17 years by 20 percent (1996 baseline: 9.0 percent;
target: 7.2 percent in 2002).
§Reduce past-month use of alcohol among adolescents aged
12 to 17 years by 10 percent (1996 baseline: 18.8 percent; target: 16.9 percent
in 2002).
These
targets were used as the basis for identifying Healthy People 2010
objectives.
Adopting
a multicomponent approach to youth substance abuse prevention may increase the
long-term effectiveness of prevention efforts. This approach includes focusing
on mobilizing and leveraging resources, raising public awareness, and countering
pro-use messages. Several strategies may be effective, such as increasing the
involvement of parents and parent groups at the local level, increasing the
number of adult volunteers involved in drug prevention at the local level,
changing normative attitudes among youth from “everyone’s usingdrugs”
to “everyone has better things to do than drugs,” and increasing the proportion
of youth participating in positive skill-building activities.
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