SAMHSA State/Tribal/Adolescents at Risk Suicide Prevention Grantee Technical Assistance Meeting H. Westley Clark, MD, JD, MPH, CAS, FASAM Director Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration Why Are We Here? In 2004, there were over 15,000 emergency department (ED) visits made by adolescents aged 12 to 17 whose suicide attempts involved drugs. Almost three quarters of these drug-related suicide attempts were serious enough to merit the patient s admission to the same hospital or transfer to another health care facility Source: Drug Abuse Warning Network (DAWN), 2004 1
2 Why Are We Here? Pain medications were involved in about half of the suicide attempts Antidepressants or other psychotherapeutic medications were involved in over 40 percent of the suicide attempts by adolescents who were admitted to the hospital. DAWN data do not distinguish which of the patients had been prescribed antidepressants to treat a preexisting condition. Source: Drug Abuse Warning Network (DAWN), 2004 ED Visits Involving Drug-Related Suicide Attempts by Adolescents Age 12-17: 2004 Note: Three dots ( ) indicate that an estimate with and RSE greater than 50% or and estimate less than 30 has been suppressed. *Does not sum to total due to rounding Source: Office of Applied Studies, SAMHSA, Dawn Network, 2004 (9/2005 update).
Patients Treated and Released On average, 1.9 drugs were involved in suicide attempts of adolescent patient who were treated and released Half of these suicide attempts involved at least one pain medication. The pain medication containing opiates (i.e. opioid analgesics), such as hydrocodone and oxycodone, were involved in 36 percent of these visits. Source: Drug Abuse Warning Network (DAWN), 2004 Substances Involved in Adolescent Suicide-Related ED Visits, by Disposition: 2004 Source: Office of Applied Studies, SAMHSA, DAWN, 2004 (9/2005 update). 3
4 Risk Factors for Suicide and Substance Abuse Mental illness and/or substance use disorder Hopelessness, impulsivity, low self-esteem Previous suicide attempt(s) Social withdrawal Aggressive tendencies or history of violent behavior History of trauma or abuse Source: Prevention Resource Center, Suicide Prevention: Community Core Competencies (2006) Substance Use among Youths Aged 12 to 17 by MDE in the Past Year: 2005 Percent Dependent or Abusing in Past Year 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 38.0 18.0 5.3 2.5 3.8 2.2 Illicit Drug Use Daily Cigarette Use Heavy Alcohol Use Had MDE in the Past Year Did Not Have MDE in the Past Year
5 Substance Use among Adults Aged 18 or Older, by MDE: 2005 Percent Using 30.0 26.8 28.0 25.0 20.0 15.0 12.7 16.3 10.0 8.4 7.0 5.0 0.0 Past Year Illicit Drug Use Past Month Cigarette Use Past Month Alcohol Use Had Past Year MDE Source: NSDUH, 2005 Did Not Have Past Year MDE Treatment for Mental Health Problems among Adults Aged 18 or Older, by Type of Treatment: 2002-2005 Percent Receiving Treatment in the Past Year 14.0 13.2 13.0 12.8 13 12.0 2002 2003 2004 2005 10.0 8.0 7.4 7.1 7.1 6.8 6.0 10.9 10.5 10.510.7 4.0 2.0 0.7 0.8 0.9 1 0.0 Any Treatment Inpatient Outpatient Prescription Source: NSDUH, 2005 Medication
6 Substance Use among Youths Aged 12 to 17, by Major Depressive Episode in the Past Year: 2005 Percent Using Substance 40 38.0 Had Major Depressive Episode in the Past Year 35 Did Not Have Major 30 Depressive Episode in the 25.2 25 Past Year 19.3 20 18.0 15 10 5 0 Past Year Illicit Drug Use 12.1 Past Year Marijuana Use 7.2 Past Year Psychotherapeutics Use 5.3 Daily Cigarette Use in Past Month 3.8 2.5 2.2 Past Month Heavy Alcohol Use Substance Use among Adults Aged 18 or Older, by Major Depressive Episode in the Past Year: 2005 30 25 20 15 26.8 12.7 28 16.3 Had Major Depressive Episode in the Past Year Did Not Have Major Depressive Episode in the Past Year 10 5 8.4 7 0 Past Year Illicit Drug Use Daily Cigarette Use in Past Month Past Month Heavy Alcohol Use
7 Co-Occurrence of SPD and Substance Use Disorder in the Past Year among Adults Aged 18 or Older: 2005 Up by 1 million in 2 years 14.9 Million Substance Use Disorder (SUD) Only 5.2 Million 19.4 Million Serious Psychological Distress (SPD) Only Co-Occurring SUD and SPD Past Year Treatment among Adults Aged 18 or Older with Co-Occurring SMI and a Substance Use Disorder: 2005 Treatment Only for Mental Health Problems 39.8% 7.5% Treatment for Both Mental Health and Substance Use Problems 3.7% Substance Use Treatment Only No Treatment 49.0% 4.2 Million Adults with Co-Occurring SMI and Substance Use Disorder
21.1 million Adults 8 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12+ Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2005 Did Not Feel They Needed Treatment 94.4% 4.1% Felt They Needed Treatment and Did Not Make an Effort (865,000) 1.4% Felt They Needed Treatment and Did Make an Effort (296,000) 20.9 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use Note: Due to rounding, these percentages do not add to 100 percent. (5.2 million Adults) Substance Use Disorder Co-Occurring Disorders Serious Psychological Distress 60% 24.6 million Adults General Population Survey (NSDUH) Drug Use Disorder Treatment Seeking Population (NESARC Study) Mood Disorders 18% 9% (16.4 million adults untreated for alcohol ) 8% 3% Felt Need for TX, but did not receive Treatment Received TX (5.2 million adults needing care for illicit drug use untreated) 89% 73% Felt No Need for TX Illicit Drugs Alcohol 2005 NSDUH
9 Only an estimated 1.1 million adults received treatment for illicit drug use disorders and 1.5 million adults received treatment for alcohol use disorders in 2005 5.2 million adults needed treatment for illicit drug use disorders but did not receive it 18% 9% 16.4 million adults needed treatment for alcohol use disorders but did not receive it 8% 3% Felt Need for TX, but did not receive it. Received TX 73% Felt No Need for TX 89% Illicit Drugs Alcohol 2005 NSDUH Reasons for Not Receiving Treatment in the Past Year among Persons Aged 18 or Older with an Unmet Need for Treatment: 2005 Cost/Insurance Barriers Did Not Feel Need for Treatment/ Could Handle the Problem without Treatment Did Not Know Where to Go for Services Stigma Did Not Have Time Treatment Would Not Help Fear of Being Committed/ Have to Take Medicine Other Access Barriers 3.3 8.8 8.1 14.4 18.5 23.4 36.7 46.8 Source: NSDUH, 2005 0.0 10.0 20.0 30.0 40.0 50.0 Percent
Intervention is Necessary 10
11 SAMHSA: Building the Nation s Demand Reduction Infrastructure Strategic Prevention Framework State Incentive Grants Mental Health System Transformation Drug Free Communities Support Program Substance Abuse & HIV Prevention Grants Methamphetamine & Inhalants Grants Underage Drinking Initiatives Center for the Application of Prevention Technologies (CAPTs) National Coalition Institute Prevention Fellows State Prevention Directors (NPNs) Leadership Academy Fetal Alcohol Spectrum Disorders Center for Excellence National Outcome Measures (NOMs) Substance Abuse Prevention and Treatment (SAPT) Block Grant National Survey of Drug Use and Health Drug Abuse Warning Network (DAWN) Access to Recovery (ATR) Targeted Capacity Expansion Grants Screening, Brief Intervention, Referral & Treatment State Infrastructure Grants for Treatment of Persons with Co-Occurring Substance & Mental Health Disorders (COSIG) Recovery Community Services Program (RCSP) Addiction Technology Transfer Centers (ATTCs) Treatment Leadership Institute Family & Juvenile Drug Courts Target Capacity Expansion Programs for Substance Abuse Treatment & HIV/AIDS Services (TCE/HIV) Pregnant & Postpartum Women (PPW) Grants to Benefit Homeless Individuals Resilience Prevention Treatment RECOVERY Protective Factors for Suicide and Substance Abuse Resiliency, self-esteem, direction, perseverance Coping and problem-solving skills Cultural and religious beliefs that discourage suicide Source: Prevention Resource Center, Suicide Prevention: Community Core Competencies (2006)
Labor Business 12 Child Welfare Faith Housing Substance Abuse Treatment Prevention Education People in Recovery Criminal & Juvenile Justice Primary Care Mental Health People in Recovery Substance Abuse Treatment Capacity Strategic Prevention Framework Mental Health System Transformation Primary healthcare Child welfare Criminal & Juvenile justice system Housing Education Business Labor Community & Faith-based organizations
13 Community Outreach Enlisting the vectors of values in a community to promote interventions and to facilitate Recovery Community Based Organizations Faith Based Organizations Self Help Groups Families Employers/Business/Labor Recovery Community/Peer Support Law Enforcement Child Welfare Implications for the Substance Abuse Treatment Community Given the high prevalence of co-occurring mood and anxiety disorders among treatment seeking clients, it is clear that the substance abuse treatment community must be able to assess, diagnose and treat those conditions. Treatment strategies must be developed to accommodate different modalities of intervention such as medications, cognitive behavioral strategies and other strategies Without a clear entry assessment of co-occurring conditions proper care and treatment cannot be rendered
14 Implications for the Mental Health Treatment Community Approximately 7% of individuals with a mood disorder have a co-occurring drug use disorder Approximately 8% of individuals with a mood disorder who present for treatment for that mood disorder also have a drug use disorder This is about 4 times the general 12- month prevalence rate for drug use disorders. Implications for the Mental Health Treatment Community Approximately 17.3% of individuals with a mood disorder have a co-occurring alcohol use disorder Approximately 17. 5% of individuals with a mood disorder who present for treatment for that mood disorder also have an alcohol use disorder This is about twice the general 12-month prevalence rate for alcohol use disorders
15 Approaches to Reaching the Untreated Patient Address State laws that translate serious emotional illness into serious and persistent emotional illness Thus, limiting access for those with milder forms of mental illness. Promote screening and brief intervention for those suffering from substance use disorders Thus, reaching those with both mild mental illness and substance use disorders BEFORE conditions grow more severe Seek Answers How do we increase treatment seeking behavior among those with substance use disorders? What can be done to strengthen the system to accommodate the increased demand?
16 There is no single road to Recovery. No absolute path. Each person must identify that which works. Some roads are paved, some are rough, and others are ill defined. No matter. Recovery works, but the burden rests on the individual, the family, the community, and or the tribe.