HaZeLDeN Research Update is published bythe ButlerCenter for Researchto share significantscientificfindings from the field ofaddiction treatment research. BUTLER CENTER FOR RESEARCH APRIL2001 Monitoring Substance Abuse THEHAZELOEN EXPERIENCE TheHazelden Foundation,withtreatmentfacilitieslocated The use and abuseofalcohol arid otheraddictiveand mood alteringdrugs is partof modern inMinnesota,Illinois,NewYork, and Florida, iswell awareof American culture. In 1999, an estimated 105 million Americansover age 12 used alcohol, 14.8 regional differences indrugabusepatternsandtrends.The million used illegal drugs, and 10.3 million were dependenton eitheralcohol or drugs. ButlerCenterforResearchparticipatesintheongoingdrug abusemonitoringeffortsoftheNational Instituteon Drug Yet howdo we measure the changing magnitude ofthe problem and its consequences in an Abusethroughthetwice-annual meetingsofthe Community ongoing, systematicway? Whattypes of research methodsaccurately capture the extentof EpidemiologyWorkGroup(CEWG).Established in 1976, it substanceabuse?With new drugs ofabuse emergingon a regular basis and the variability isanearlywarning, nationalsurveillancenetworkthat acrosscommunities, how dowe know ifthe overall situation is improving? How do we gauge detects newdrugsofabuse, newpatternsofuse, and new the impact ofsubstanceabuse on our criminal justice and health care systems? populationsatrisk.r How Do We Measure Drug Abuse? CONTROVERSIES& QUESTIONS In reality there is no single, uniformlyaccepted measure ofwhat is looselycalled the drug Eachongoingmeasurementsystem haslimitations. abuse problem,” because it is notjust a single, homogeneous behavior or problem. Multiple Regardingpopulation surveys,peoplemaybereluctant individual, cultural, and economic factors fosterthe developmentofaddiction. Multiple systems toreadilyadmitillegal behaviorsuch asdrugabuse,or are affected by itand respond to the consequences itgenerates. illnesssuchasaddictiontoanyone, includingresearchers. Ofequal importance is the variability in drug use and abuse patterns and trendsacross Asa result, surveydataareseen asunderestimatesofthe communities. The natureand extentof the problem’ can be quite different in one region or actualextentofdruguseandabuse.Inaddition, student communitywhen compared with others. surveysdonotcaptureadolescentswhohavedroppedout ofschool and may,infact, bemorelikelytobesubstance Measuringand monitoringthe drLigabuse problem involves multipledata collection systems, abusers.Similarly,treatmentdata mayunderestimatethe each measuringa uniqueaspect. When viewed collectively, they presenta multi-dimensional, totalactualnumberofpeoplewhorecoverfromaddiction quantitative snapshot. becausetheyincludeonlythosepersonsenrolled informal This Research Updatesummarizesthe majordata collection systems used to measure the programs, notthosewhorecoverwithoutformaltreatment prevalenceand consequences ofdrug use and abuse in the United States, and provides links throughself-helpgroupssuch asAlcoholicsAnonymousand to additional information. NarcoticsAnonymous. Whilethere are data based systems and research studies in addition to those discussed here, HOWTO USETHISINFORMATION the systems described beloware the majorcornerstones around which otherfocused, locally- Accurate, reliable,and up-to-dateinformation aboutthe based, quantitative, qualitative, or ethnographic research activitiescurrentlyoccur. All ofthese natureandextentofdrugabuseassistsintheplanningand evaluationofprograms,theallocationofpublicresources, RatesofDrug-RelatedHospitalEmergenciesVaryAcrossCities andthedeliveryofservices.Itcan beusedtobetterinform Baltimore Phiiadeiphia policymakingatall levels.Yetbecausethenatureand Chicago Miamiiflaaieah extentofdrugabusevariesconsiderablyfromcommunity Atiania D,trr.t tocommunity, local data arenecessarytoaddress local — — Sea, YakCity issues.Additionaltipsabouthowtoobtain local dataare —— Seattie availablefromtheNationalInstituteon DrugAbuseand San Francisco uuffaio JoinTogether. SaintLouis I Boston Phoenix Denver •‘ Oaiias Washrgtcn DC ‘ LosAnge,esLoxrgueach San Diego MinneapslSt.Paui 50 100 150 200 250 300 Thistabiepresentsthepopuiatron-basedratesipertuo,000ptpuiationiothospitaiemergencydeparti ‘mt EDimeniirrsnicocaineint999forthenretropnhtarareasthat participateintheDrtgShoneY’ari.rgNetwankanditttraothehighdegreeofoariab.:ltyacrosscities.SuunCE.DragAbaseOcri igN—workmAcNi Dii ofAppEed Studies,SubstanceAbuseandCentSHeahhS,iuicesAdministrationiSAMHSAi.2000. ‘CONTiNUEDONBACK <CONTINUEDFROMFRONT Monitoring Substance Abuse HZLDN data systemsare operated by the federal government. Some involve nationwide samples, and others involve the colectiun oflocal data. None is without limitation. Yet each represents a valuabletool that enables sound epidemiological monitoring, promotes informed policymaking. <CONTINUEDFROMLEFT and assists in the evaluation ofvarious programs and initiatives. Additional Data Sources Population Surveys — The National Clearinghouseon Alcohol and Drug Information. This isthe mostcomprehensivedata Monitoring the Future Survey. This survey, also known as The High School SeniorSurvey baseand starting pointforfindingdrugand alcohol- measuresthe attitudes and behaviors regarding substanceabuse usinga national sample of related information. Onlineat: w’w.health.crg 50,000 students in grades8, 10, and 12. The survey has been conducted annually bythe — The National Instituteon DrugAbuse. Onlineat: Universityof Michigan with National Institute on DrugAbusefunding since 1975. See the www.nida.nih.gov earlier Research Update Prevalence ofAdolescentSubstanceAbuse, January2000. — The National Instituteon Alcohol Abuseand vsws’a.monitoriugtbefuture.org Alcoholism. At: cir,w.niaaa.nih.gov NationalHouseholdSurveyon DrugAbuse. This survey is administered to a national sample — SubstanceAbuseand Metal Health Services Administration. Onlineat: err’iw.samhsa.gov of people age 12 and older living in households, dormitories, and civilianson military bases. Information is obtained regarding demographics, health, and frequencyofdrug and alcohol — TheOfficeofNational DrugControl Policy, Officeofthe President. Onlineat: wvvw.whitehousedrugpolicy.gov Use, age offirst use, and consequences. Online at: wwsv.samhsa.gov. Seethe earlier Researcfi Update: Current Trends in Substance Abuse, February2000. — The Centers for DiseaseControland Prevention, (CDC), maintains ongoing epidemiological surveillancedata. Online at: wwss.cdc.gov Youth RiskBehaviorSurvey. Conducted by the Centersfor DiseaseControl and Prevention, the 1999 Youth Risk Behavior Surveywas administered to 15,000 students in 41 statesat 144 schools. Itcollects health risk information about injuries (intentional and unintentional), tobacco use, alcohol and other drug use, sexual behaviors, unhealthy dietary practices, and physical activity. Onlineat: www.cdc.gov References Systems that Track Drug-Related Consequences 1. U.s DepartmeetofHealthandHoinanServices.120001Suniniaiyof Arrestee DrugAbuse MonitoringProgram (ADAM) This is a system operated bythe National SFuinbdsitoagnsce[toArnbutsireea1n9d99MNenattailonHaelaHlthouSseerhvoilcdesSuAisd’omyinonistDrartuigonA,bDuHseHS Institute ofJusticeto examinethe relationship between drug use and crime. It tracks the PublicationNo.ISS1Ai00-3466. prevalenceand types ofdrugs in recently booked arrestees in 35 urban areas by performing 2. U.S.DepartmentofHealthaedHumanServices.120801Monitoring theFutureSurrey.NationalSun’evResultsonDrugUse, 1975-1999. urinalysis and collecting information from questionnaires. Online at: ww.ADAM-nij.net VolumelrSecondarySchoolStudents.NationalInstituteonDrug Abase,NIHPublicationAu 00-4802. DrugAbuse Warning Network (DAWN) Drug AbuseWarning Network, operated outofthe 3. U.S.DepartmentofHealthandHumanServices.12000)Suininaiyof FindingsfronithejyyNationalHooseholdSius’eyonDrugAbuse. Office of Applied Studies, Substance Abuse and Mental Health Services Administration, U.S. SubstanceAbuseandMentalHealthServicesAdmnvstration,DHHS Public Health Service, generatesweighted estimatesofall drug abuse-related emergency PublicationNo,ISMA)00-3466. 4. YouthRiskBehaviorSurvey.CentersforDiseaseCnntrnland department (ED) mentions in non-Federal, short-term general hospitals in the Standard Preventinis.Onlineut:sswss.cdc.gos. Metropoiitan Statistical Areas. Included are incidents related to illegal drug use and those 5. U.S.DepartnientofJustice.120001ArresteeDrugAbuseMonitnring Prograni(ADAMI, 1999AnnualReportonDrugUseAmongAdultand related tothe non-medical use of prescribed drugs. A single drug abuse-related ED episode JuvenileArrestees.OfficeofinsticePrograms.NatinnalInstituteof can involvethe mention” ofuptofour drugs and alcohol-used-in-combination. Onlineat: justice.NCI 181426. 6. U.S.DepartnientofHealthandHumanServices.12000) Year-End1999 vswsv.samhsa.gov EniergencyDepartmentData[reintheDrugAbuseWarningNetcoik Substuur.eAbuseandMentalHealthServicesAdnministratinn DHHS Treatment Episode Data Set (TEDS) Operated out ofthe Office ofApplied Studies, Substance Publication Na.lStiA)00-3462. Abuseand Mental Health Services Administration, U.S. Public Health Service, this data set 7. U.S.OepartnientofHealthandHumanServices,120001Treatment EpisndeDataSot(TEDS).SubstairceAbuseandl,lentalHealth collects demographic, drug-specific, sourceof referral, and treatment historydata on persons ServicesAdministration,Dt)HSPublicationNs.ISMA)99-3324. who receivetreatmentfor addiction. Data are reported to each state alcohol and drugabuse 8. U.S.DepartmentofHealthandHumanSercicus.120001Epidemiologic TrendsinDrugAbuse. VolumeOrProceedingsnftheConnimmuvity authority. which in turn reports ittothe Office ofApplied Studies. Online at: www.samhsa.gov EpidemiologyltbrkGroup-December1999.NatiurnlInstituteon DrugAbase.NIHPublicationAu.00-4740.Availablenirlineat: <CONTINUED www.nida.niti.goviCETiG!CECGH0me.html 9. U.S.DepartnientofHealthandHumanServices.(19981Assessiimg DrugAbuseWitbinandAcrossCommunities.NationalInstituteoe DrugAbuse.NIHPublicationNo.98-3614. hazelden.org 10. joinTogether,BostonUniversityScheelofPublicHealthandInstitute ofHealthPolicy,BrandeisUniversity119971.Ho;rDoWeKnorWe BUTLER CENTER FOR RESEARCH APRIL2001 AreMakingADifference?ACommunitySvbstanceAbuseIndicators Handbook. Tlsr Boilet Ceiirer (or Research intornisanii I nprox’cs i’ecrr’ery services,ind prodoccrs i’esearcli Ni: s-ncIiis ih’ held ofsiddicnon I ‘citmrnr.\\‘e sicdecticared noconchocm rigdin cal research, col)ahorsi npv.lilT exir—rnal i’cseam’clser<,and coinmuiricariligsi.’iciinificfsimchinp’. PatriciaOwen,Ph.D.,Director IfyouhavequRstians,orcouldliketorequestcopiesofResearchUpdate, pleasecall800-257-7800ext.4405,emailbstlerresearch9Thozelden.erg, or“citeDC4.P.O.Box11,CenterCity,MN 55012-0011. ‘52.iC3..i.rz<:de,nFr’s’eisi:orr 0,z8’.rendodtireHozdiderrIrgo regrr<red ucR-Ruo5 ..Tr.rroO’SatireHozSder,Fourrdrt’Or: 081220 to.r‘Or