The Arizona Substance Abuse Partnership, A Strategic, Data-Driven, Driven, and Collaborative Approach to Arizona s Substance Abuse Prevention, Treatment, and Recovery Efforts Jeanne Blackburn Governor Janice Brewer s Office for Children, Youth, and Families Division for Substance Abuse Policy Shana Malone Arizona Criminal Justice Commission Statistical Analysis Center The Arizona Substance Abuse Partnership serves as the single statewide council on substance abuse issues. ASAP brings together stakeholders at the federal, state, tribal and local level to utilize data and practical expertise to develop effective methods to integrate and expand services across the state by maximizing available resources. ASAP, with three subcommittees and a Community Advisory Board, works on five Strategic Focus Areas. 1
Governor Janice K. Brewer ASAP Community Advisory Board Meth Task Force UAD Prevention Committee Epi Work Group Mission Ensure community-driven, agency-supported outcomes to prevent and reduce the negative impacts of alcohol, tobacco and other drugs by building and sustaining partnerships between prevention, treatment, recovery and enforcement professionals. Goals Integrate effective substance abuse prevention, education, early intervention, enforcement, treatment and aftercare strategies to achieve the most favorable outcomes for all Arizonans. Enhance the ability of public, private and community-based organizations to engage diverse and underserved populations to participate in planning strategies and activities for reducing the consensus of substance abuse behaviors. 2
Goals Enhance the capacity of families and communities to reduce the causes and effects of substance abuse and associated behaviors. Establish and sustain a state-wide prevention and enforcement substance abuse infrastructure that incorporates: a common purpose/planning efforts, on-going examination and development of policy, mechanism for effective state and local partnerships, data infrastructure and evaluation systems to assess and improve outcomes. Strategic Focus Areas Child Welfare / Drug-Endangered Children / Children of Incarcerated Parents Law Enforcement and Drug Trafficking Prescription Drug Abuse Prevention and Community Partnerships Underage Drinking 3
Child Welfare / Drug Endangered Children / Children of Incarcerated Parents Systematically identify families in the child welfare and juvenile justice systems and prioritize them for treatment and prevention services. Increase capacity to provide substance abuse and mental health services. Seek funding for a DEC staff person and website. Expand the DEC Alliance to include a focus on children of incarcerated parents. Child Welfare / Drug-Endangered Children / Children of Incarcerated Parents Executive Order 2008-01 required state agencies administering substance abuse treatment funding to prioritize treatment services for families involved with CPS. As a result, agencies are leveraging existing resources and working together to prioritize CPS families, while ensuring that federal funds are maximized before state funds are expended. Child Welfare / Drug-Endangered Children / Children of Incarcerated Parents The first Arizona Drug-Endangered Children (DEC) Tribal Training Workshop was held in January 2009 as a collaborative effort between the Governor s Office and federal and tribal entities. Since then, seven additional tribal communities have partnered with the Arizona Alliance for Drug Endangered Children to receive training. The Workshops educate tribal communities about DEC and work with tribal leaders to establish multidisciplinary DEC teams and develop DEC protocols in their communities. 4
Child Welfare / Drug-Endangered Children / Children of Incarcerated Parents A DEC Coordinator provided by the National Guard has begun to work with the Arizona Alliance for Drug Endangered Children full time to further its efforts. The group is meeting on a monthly basis, and its membership has been expanded. The Arizona Alliance is working on: An MOU between partner agencies; A risk assessment tool to be used by law enforcement personnel when responding to environments that expose children to drugs; Amending the 2003 DEC Protocols to include Level II cases and situations in which a child is home when a parent / caretaker is arrested; and Integrating training for DEC and children of incarcerated parents to ensure consistency. Law Enforcement and Drug Trafficking Improve Intelligence sharing between law enforcement agencies/tribes. Reduce the trafficking of illegal drugs in Arizona. Law Enforcement and Drug Trafficking ACJC has compiled a list of U.S. Department of Justice (DOJ) and U.S. Department of Homeland Security (DHS) grant awards to Arizona law enforcement agencies. Arizona developed the capacity to analyze purity and price levels of all illegal narcotics and distribute results to all state law enforcement agencies. Arizona has established effective, model intelligence centers in the state (e.g., ACTIC and HIDTA). DPS and HIDTA have used these centers to more effectively coordinate intelligence and enforcement strategies. 5
Prescription Drug Abuse Strengthen the prescription drug monitoring infrastructure. Educate the public and practitioners about the risks of prescription drug abuse. Prescription Drug Abuse ASAP member agencies developed a prevention and public awareness campaign around prescription drug abuse and the proper disposal of prescriptions and OTC medications. The informational pamphlet was distributed by Fry s pharmacies in December 2009. It is estimated that the campaign reached 100,000 citizens. This brochure will be distributed at Target pharmacies later this summer, with brochures distributed through all pharmacies in Arizona, both chain and small Mom and Pop pharmacies, later this year. Prescription Drug Abuse The HIDTA NMPI hosted a Prescription Drug Abuse Training Conference on December 1-2, 2009. Over 240 participants attended and learned current trends and diversion methods, which will enhance the state s response to prescription abuse. The DEA developed a protocol for law enforcement personnel to follow when collecting prescription drugs. Substance abuse coalitions, in partnership with law enforcement, have collected over 3,000 pounds of prescription drugs at community take back events. 6
Prevention and Community Partnerships Increase awareness about the benefits of prevention efforts. Increase and promote the use of cost-effective prevention strategies. Improve collaboration between federal / state / community partners. Prevention and Community Partnerships Implementation of environmental prevention strategies by funded community coalitions has increased substance abuse prevention activities in 53 communities in 12 Arizona counties, reaching 32% of the state s population. In communities with an active substance abuse prevention coalition, AZ has seen decreases in juvenile alcohol consumption, binge drinking, drug arrests, marijuana and meth use, and adult drug arrests. Underage Drinking Strengthen youth perceptions about the risks of underage drinking. Build the capacity of families, communities, schools, and tribes to reduce UAD. Use data to enhance underage drinking strategies. 7
Underage Drinking Several communities in Arizona passed local social host ordinances in 2009. A youth screening guide for Substance Abuse, Alcohol and Problem Gambling was developed by ADHS, ADE and the Arizona Office of Problem Gambling. The ADHS established an IGA with ASU to expand the SYNAR database to include tracking mechanisms for alcohol. Methamphetamine Task Force Reduce trafficking of methamphetamine and its precursor chemicals. Improve access to treatment services for adult and juvenile methamphetamine-related offenders. Implement evidence-based prevention strategies to prevent high-risk populations from using methamphetamine. Methamphetamine Task Force ATR grant was expanded to provide treatment and recovery support services to the adult general population in Maricopa and Pima County with methamphetamine addiction. Arizona was selected to participate in Methamphetamine: The National Summit to Promote Public Health, Partnerships and Safety for Critically Affected Populations. Following the summit a state plan was developed to expand the states response to critical populations. 8
Methamphetamine Task Force Fifteen Anti-Meth Coalitions implemented environmental prevention strategies to reduce methamphetamine use/abuse reaching 34% of the state s population. GIS Maps depicting youth methamphetamine hot spots by Community Health Analysis Areas from the Substance Abuse Epidemiology Work Group will be used to target prevention, treatment and enforcement resources. Methamphetamine Task Force Awarded Rural Law Enforcement Initiative Grant by the Department of Justice to provide training and increase intelligence-led policing in rural and tribal communities. Continue to track progress on the Arizona Action Plan to expand the state s response to critical populations. Developing a plan to notify prevention and treatment partners of upcoming targeted enforcement activities in their communities. Arizona Criminal Justice Commission with funding from The Governor s Office for Children, Youth and Families 9
Goals and Objectives Currently sponsored by the GOCYF, the primary goal of the project is to create a central repository for Arizona s substance abuse and crime data in an effort to enhance data-for-decision-making, programmatic monitoring, and reporting consistency. Through a user-friendly website, individuals will be able to access the type of data and the geographic level of interest with just a few clicks of a mouse. Where available, data will be displayed at multiple levels, across demographics, and over time. Geographic levels will include state, county, city, and defined community coalitions, depending on data availability and the appropriate level of reporting. Output options will include tables, graphs, and maps to cover a variety of reporting and visualization needs. Indicators and Their Utility Consumption A system for assessing the current problem and/or tracking the prevalence of the problem over time. Consequences A system for determining the correlative outcomes of the substanceuse problem; can be used as one proxy for return on investment. Context A system for identifying factors that influence (amplify or deter) decision-making about substance use. Other A set of useful resources related to substance use 10
Variables CONSUMPTION CONSEQUENCES CONTEXT Prescription Drug scripts & doses Average Daily Public School Attendance Rates Protective Factors Adult Binge Drinking (18-25 years) Drug & Alcohol School Violations Disapprove of Peers Using Illicit Drugs (LSD, cocaine, meth, other) 30 Day Cigarette Use (Current Use) Alcohol & Drug-Related ER visits Perceive Moderate/Great Risks of 1-2 Drinks Every Day Lifetime Cigarette Use Alcohol & Drug Tx Admissions Perceive Moderate/Great Risks of Smoking 1+ Packs of Cigarettes Daily Age of 1st Cigarette Use Alcohol-Related Crashes - Injuries Perceive Moderate/Great Risks of Trying Marijuana Once or Twice 30 Day Alcohol Use Alcohol-Related Crashes - Fatalities Perceive Moderate/Great Risks of Smoking Marijuana Regularly Lifetime Alcohol Use Alcohol & Drug-Related Deaths Exposure to Prevention Messgaes Binge Drinking DUI Communication with Parents About Dangers of Tobacco, Alcohol, Drugs Age of 1st Alcohol Use Liquor Law Violations Adult Perception of Youth Alcohol Consumption & Availability Age of 1st Regular Alcohol Use Drug Arrests 30 Day Marijuana Use Alcohol & Drug-Related Violent Crime Arrests Risk Factors Lifetime Marijuana Use Alcohol & Drug-Related Property Crime Arrests Low Neighborhood Attachment Age of 1st Marijuana Use Drunk or High at School Laws and Norms Favorable to Drugs 30 Day Hallucinogen Use Sold Illegal Drugs Perceived Availability of Handguns Lifetime Hallucinogen Use Drinking and Driving Perceived Availability of Drugs 30 Day Cocaine Use Riding With Driver Who Has Been Drinking Poor Family Management Lifetime Cocaine Use High Family Conflict 30 Day Methamphetamine Use Parental Attitudes Favor Antisocial Behavior Lifetime Methamphetamine Use CONTEXT Family History of Antisocial Behavior Age of 1st Methamphetamine Use School Academic Failure 30 Day Inhalent Use Protective Factors Low School Commitment Lifetime Inhalent Use Community Opportunity for Prosocial Involvement Peer-Individual: Rebelliousness 30 Day Ecstasy Use Community Rewards for Prosocial Involvement Peer-Individual: Early Initiation of Antisocial Behavior Lifetime Ecstasy Use Family Attachment Peer-Individual: Early Initiation of Drug Use 30 Day Heroin Use Family Opportunity for Prosocial Involvement Peer-Individual: Attitudes Favorable to Antisocial Behavior Lifetime Heroin Use Family Rewards for Prosocial Involvement Peer-Individual: Antisocial Peers 30 Day Steroid Use School Opportunity for Prosocial Involvement Peer-Individual: Peer's Drug Use Lifetime Steroid Use School Rewards for Prosocial Involvement Peer-Individual: Rewards for Antisocial Involvement 30 Day Prescription Stimulant Use Peer-Individual: Belief in Moral Order Peer-Individual: Gang Involvement Lifetime Prescription Stimulant Use Peer-Individual: Interaction with Prosocial Peers 30 Day Prescription Sedative Use Peer-Individual: Prosocial Involvement Other Factors Lifetime Prescription Sedative Use Peer-Individual: Rewards for Prosocial Involvement Where Alcohol Was Obtained 30 Day Prescription Pain Reliever Use Parents Disapprove of Alcohol Use Treatment Capacity Lifetime Prescription Pain Reliever Use Parents Disapprove of Cigarette Use 30 Day Total Prescription Use Parents Disapprove of Marijuana Use Color Codes Lifetime Total Prescription Use Disapprove of Peers Drinking Alcohol Regularly Matched SAMHSA NOM 30 Day Over The Counter Drug Use Disapprove of Peers Smoking Cigarettes Proxy for a SAMHSA NOM Lifetime Over The Counter Drug Use Disapprove of Peers Smoking Marijuana Non-SAMHSA NOM, direct relationship to substance use 30 Day Illegal Drugs Except Marijuana Disapproval from Peers for Smoking Non-SAMHSA NOM, strong correlation to substance use Consumption Example In 2008, 3.1% of 12th graders in Arizona reported having tried heroin in their lifetime, compared to 1.3% nationally. 2.9% of 12 graders reported lifetime heroin use in Coconino county. For coalition 1 (serving the Flagstaff area), 3.6% of 12 th graders reported lifetime heroin use. Looking within subpopulations, white males had the highest % of lifetime heroin use, indicating a potential target population for prevention efforts. For coalition 2 (serving the Williams area), there was no reported lifetime heroin use for 12 th graders. However, 25.0% reported lifetime inhalant use and 33.3% reported lifetime Rx sedative use. These rates are substantially higher than the state rates for inhalants (9.2%) and Rx sedatives (13.2%), indicating that while heroin use is not a problem for this area, there are other critical target areas for this specific coalition. Consequences Example In 2008, 3.5% of all emergency room visits for Arizona youth ages 12-17 years were drug- or alcohol-related; 72.1% of these cases involved substance abuse and 5.5% involved substance dependency. For Greenlee County, 4.1% of all youth ER visits were drug- or alcohol-related; 49.0% of these cases involved abuse and 17.6% involved dependency. In the town of Duncan, 3.9% of all youth ER visits were drug- or alcoho- related; 43.0% of these cases involved abuse and 26.7% involved dependency. To date, there are no drug prevention coalitions in Greenlee County; intervention efforts might be considered given the following: The rate of dependency is much higher than the state average. Greenlee County received the highest score on the Drug Severity Index. There are no substance abuse treatment facilities serving youth in the county. 11
Context Example Risk Factors Marijuana Perceptions Users State Non-Users County Coalition 1 Coalition 2 Users Non- Users Non- Users Non- Users Users Users Easy To Get 94.6% 47.1% 95.0% 52.8% 94.9% 53.5% 89.3% 46.2% Cool If You Use 82.2% 37.2% 79.1% 41.1% 80.0% 42.2% 75.9% 34.0% No Risk Trying 67.0% 18.9% 69.7% 24.2% 70.3% 23.3% 39.3% 23.4% No Risk Regular Use 30.4% 7.8% 30.7% 10.1% 30.3% 9.2% 10.7% 6.6% Output Example 1 Percentage of Youth Reporting Current Substance Use by Gender In the past 30 days, on how many occasions (if any) have you: (One or more occasions) Male Coaltion Coalition Coalition County 2004 2006 2008 2008 State 2008 Female Coalition Coaltion Coalition County 2004 2006 2008 2008 State 2008 Alcohol Alcohol Heavy Use*** had alcoholic beverages (beer, wine or hard liquor) to drink - more than just a few sips? how many times have you had 5 or more alcoholic drinks in a row in the past 2 weeks? 47.8 38.7 36.3 35.4 31.3 44.2 36.4 26.5 28.1 34.7 32.0 26.3 25.2 23.9 19.3 27.5 18.8 11.2 14.8 20.5 Cigarettes smoked cigarettes? 24.6 18.9 22.2 20.4 15.3 23.7 15.8 12.1 12.5 14.1 Chewing Tobacco used smokeless tobacco (chew, snuff, plug, dipping tobacco, chewing tobacco)? 7.8 8.5 8.7 9.4 6.2 1.3 2.5 2.7 2.1 2.4 Marijuana used marijuana? 22.7 20.9 20.6 18.7 13.6 17.2 14.8 12.3 13.5 11.4 Hallucinogens** used LSD or other hallucinogens? 3.1 2.1 3.6 3.1 1.8 2.1 1.1 1.4 1.2 1.2 Cocaine used cocaine or crack? 4.5 2.4 2.2 2.5 2.0 2.7 2.7 3.1 2.5 1.8 Inhalants sniffed glue, breathed the contents of an aerosol spray can, or inhaled other gases or sprays, in order to get high? 2.6 3.0 1.4 1.9 3.0 1.8 5.2 3.7 3.5 4.6 Methamphetamines** used methamphetamines (meth, crystal, crank)? n/a 1.4 0.0 0.2 0.5 n/a 0.8 0.7 0.5 0.6 Heroin or Other Opiates used heroin or other opiates? 1.2 0.7 1.1 0.6 0.7 0.5 0.8 0.0 0.0 0.5 Ecstasy** used Ecstasy ( X, E, or MDMA)? 1.0 1.8 1.1 1.2 1.5 0.5 0.4 0.7 1.1 1.2 Steroids* Prescription Pain Relievers* Stimulants (2004 only)** Prescription Stimulants** Prescription Sedatives** Prescription Drugs** used steroids or anabolic steroids (such as Anadrol, Oxandrin, Durabolin, Equipoise or Depotesterone)? used prescription pain relievers (such as Vicodin, OxyContin, Percocet or Codeine) without a doctor telling you to take them? used stimulants ( amphetamines, meth, crystal, crank ) without a doctor telling you to take them? used prescription stimulants (such as Ritalin, Adderall, or Dexedrine) without a doctor telling you to take them? used prescription sedatives (tranquilizers, such as Valium or Xanax, barbiturates, or sleeping pills)? combined results of prescription stimulant, sedative and pain reliever questions (see appendix for details) n/a 0.4 1.5 1.2 1.2 n/a 0.0 0.3 0.2 0.5 n/a n/a 10.5 10.0 7.5 n/a n/a 7.5 7.7 8.7 2.1 n/a n/a n/a n/a 3.9 n/a n/a n/a n/a n/a 2.7 1.4 0.8 2.0 n/a 3.0 0.3 0.7 2.2 9.0 5.6 4.4 3.5 3.2 12.8 9.5 2.7 2.5 5.1 n/a 8.3 12.7 11.5 9.5 n/a 9.1 9.6 9.2 11.9 used over-the-counter drugs (such Over-the-Counter as cough syrup, cold medicine, or diet n/a n/a 6.1 4.2 5.3 n/a n/a 4.8 6.6 6.5 Drugs* pills) for the purposes of getting high? * Substance categories that were not measured and reported in one or more survey administrations prior to 2008 (also denoted by 'n/a' in the data column). ** Denotes a change in the wording of the question between 2008 and prior administrations. Consult appendix for a detailed explanation. ***Note: Heavy Drinking is in reference to consumption in the past 2 weeks vs. 30 days. Output Example 2 Youth Current Substance Use by Grade 100 8th Grade 10th Grade 12th Grade 90 80 70 Percent (%) Use 60 50 40 30 20 10 0 *Over-the-Counter Drugs **Total Rx Drugs **Rx Sedatives **Rx Stimulants *Rx Pain Relievers Steroids **Ecstasy Heroin or Other Opiates **Methamphetamines Inhalants Cocaine **Hallucinogens Marijuana Chewing Tobacco Cigarettes Heavy Alcohol Alcohol *Over-the-Counter Drugs **Total Rx Drugs **Rx Sedatives **Rx Stimulants *Rx Pain Relievers Steroids **Ecstasy Heroin or Other Opiates **Methamphetamines Inhalants Cocaine **Hallucinogens Marijuana Chewing Tobacco Cigarettes Heavy Alcohol Alcohol *Over-the-Counter Drugs **Total Rx Drugs **Rx Sedatives **Rx Stimulants *Rx Pain Relievers Steroids **Ecstasy Heroin or Other Opiates **Methamphetamines Inhalants Cocaine **Hallucinogens Marijuana Chewing Tobacco Cigarettes Heavy Alcohol Alcohol Coalition 2004 Coalition 2006 Coaltion 2008 County 2008 State 2008 12
Output Example 3 Percentage of Youth Drug-Related ER Visits Involving Abuse and Dependency 100% 80% 60% 40% 20% 0% 5.5% 17.6% 26.7% 72.1% 49.0% 43.0% State Greenlee Duncan Abuse Dependency Output Example 4 Drug Severity Index Scores Per Substance in Greenlee County Alcohol Tobacco Marijuana Rx Pain Relievers 15.74 10.19 5.56 Inhalants 1.2 3 4.3 2 Rx Sedatives 1.2 3 Hallucinogens 0.9 3 2 5.6 2 0.6 2 Cocaine Steroids Rx Stimulants 3 9.2 0 Meth Heroin None Low High Extreme (50-100) Ecstasy Output Example 5 13
Take Home Message One size does not fit all. Local Information is the key to making the bestinformed decisions and maximizing return on investment. Coupling various types of information across multiple levels provides the most comprehensive picture. The Demo Version Bach Harrison Demo The Arizona Website www.bach-harrison.com/arizonadataproject Currently under construction; limited use availability in August and full use by September. Links to the site and update information will also be posted on the Arizona Criminal Justice Commission webpage: http://www.azcjc.gov/acjc.web/default.aspx 14
For additional information, please contact: Jeanne Blackburn jblackburn@az.gov Shana Malone smalone@azcjc.gov 15
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