Substance Use Trends in the Military, Veteran and Family Population Prepared by: Shana Malone Arizona Criminal Justice Commission Statistical Analysis Center
National Illicit Drug Use 1 in 10 individuals ages 12+ years in the general population have used illicit drugs in the past 30 days 1 in 8 active duty military personnel are current users of illicit drugs Sources: NSDUH; ONDCP
20 Arizona Adult Marijuana Use in the Past 30 Days by Veteran Status (2010) 18 16 14 Percent (%) Reporting 12 10 8 6 58-64% Higher 4 2 5.8 3.2 3.0 0 Iraq/Afghanistan Veteran Other Veteran Non-Veteran Note: Scale reduced for visual purposes; accurate depiction is out of 100% Source: 2010 Arizona Health Survey
National Alcohol Misuse Occurs in 11.5%-36% of our active duty forces returning from Afghanistan and Iraq Veterans who screen positive for post traumatic stress disorder (PTSD) or depression are two times more likely to have an associated alcohol problem Binge drinking: Occurs monthly in 43% of active duty (particularly in those 17-25 years of age) Rates increase dramatically after a deployment Sources: NEJM; Addictive Behaviors; AJPM
100 Arizona Adult Alcohol Use in the Past 12 Months by Veteran Status: 5+ drinks in a single day (2010) 90 80 70 Percent (%) Reporting 60 50 40 30 20 65-80% Higher 43.8 10 18.9 22.3 0 Iraq/Afghanistan Veteran Other Veteran Non-Veteran Source: 2010 Arizona Health Survey
100 Arizona Adult Alcohol Use in the Past 12 Months by Veteran Status: Number of Days Engaging in 5+ drinks in a single day (2010) 90 80 70 Percent (%) Reporting 60 50 40 30 56.2 112% Higher 81.1 77.7 20 10 0 23.9 19.8 13.4 16.7 5.5 5.6 Iraq/Afghanistan Veteran Other Veteran Non-Veteran 0 days 1-12 days 13 or more days Source: 2010 Arizona Health Survey
National Rx Drug Misuse The Opioid Influx A 4 fold increase in the quantity of Rx Pain Relievers sold in the U.S. in the last decade The United States makes up 4.6% of the world s population, but consumes 80% of its Rx opioids 46 people a day are dying! Source: CDC
Arizona The Rx Drug Problem? Availability Percentage of Pills by Drug Type in Arizona (2014) ~ 579 million Class II-IV pills were prescribed in Arizona in 2014 Pain Relievers accounted for 60.0% of all pills prescribed Hydrocodone and Oxycodone accounted for 81.4% of all pain relievers prescribed in Arizona Why it matters = probability and access! Benzodiazepine 21.8% All Other Rx Drugs 14.9% Other Rx Pain Relievers 11.1% Oxycodone 27.9% Hydrocodone 20.9%
Volume:Access Ratio Enough Rx pain relievers are dispensed every year to medicate every adult in Arizona around-the-clock for 2 weeks straight!!!
Opioids and SMVF Populations Over 50% of VA patients seen in primary care settings report chronic pain Prescription drug abuse among service members and veterans has more than doubled since 2002 In veterans aged 18 25 the risk for prescription drug abuse is at an all time high Opioid use in the military is twice that of use in the general population Sources: VA; DOD
20.0 Arizona Adult Rx Drug Misuse in the Past 30 Days by Veteran Status 18.0 16.0 14.0 Percent (%) Reporting 12.0 10.0 8.0 6.0 107-121% Higher 4.0 2.0 0.0 5.3 1.6 1.3 Iraq/Afghanistan Veteran Other Veteran Non-Veteran Note: Scale reduced for visual purposes; accurate depiction is out of 100% Source: 2010 Arizona Health Survey
Number of Drug Overdose Deaths Involving Selected Drugs in Arizona 2003-2014 500 450 Number of drug poisoning deaths 400 350 300 250 200 150 100 50 Opioid pain relievers* (T40.2-T40.4) Cocaine (T40.5) Heroin (T40.1) Source: ADHS 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year *Includes methadone
Number of Heroin Overdose Deaths in Arizona 2003-2014 180 160 Number of drug poisoning deaths 140 120 100 80 60 40 184.5% Increase 20 Source: ADHS 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year
Heroin and Other Substances
50 45 Arizona Mental Health and Substance Abuse Problems by Veteran Status (2010) 70-92% Higher 40 35 Percent (%) Reporting 30 25 20 15 35.2 27.9 26.0 10 5 13.1 14.9 16.9 0 Iraq/Afghanistan Veteran Other Veteran Non-Veteran Mental Health Condition Substance Abuse Risk Note: Scale reduced for visual purposes; accurate depiction is out of 100% Source: 2010 Arizona Health Survey
PTSD 14-22 percent who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) 1. Has levels of severity Often a delayed presentation from 6 months to 1 year 17 percent with PTSD had an increased probability of an alcohol use disorder 2. Females who serve in combat are more at risk 1.
Addiction and Suicide Approximately 18 22 veterans are dying each day by suicide 1. Alcohol and drug abuse are contributing factors 2. Nearly 6,000 military veterans take their own lives each year Highest age group 30-64 years of age Higher prevalence in men than women Higher rate of women veterans than women in general population
Barriers to Access Veterans struggling with addiction are being discharged to local communities and VA Centers where a capacity for treatment exists for only 20 percent of the existing total population Nearly 2.7 million veterans have enrolled in the VA health care since 2009 54,000 of these will likely need substance use screening and treatment Source: ONDCP
Homelessness Disability as a Reason for Homelessness by Veteran Population (2013) 25.0% 20.0% 15.0% 10.0% 5.0% 23.0% 15.0% 0.0% Veteran Not a Veteran Alcohol Use as a Reason for Homelessness by Veteran Population (2013) 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 16.0% 6.0% 4.0% 8.0% Source: ASU, Morrison Institute 2.0% 0.0% Veteran Not a Veteran
Arizona Youth Living in Military and Veteran Families Source: Arizona Youth Survey, Arizona Criminal Justice Commission
CONSUMPTION Identifying the severity of the problem and who is most affected
Percentage of Arizona Youth Reporting Past 30 Day Substance Use (2014) 100 90 80 70 60 50 40 30 20 10 0 24.0 13.5 9.3 6.6 6.3 3.4 2.1 1.2 1.0 0.8 0.6 0.3 0.3 Alcohol Marijuana Cigarettes Chewing Tobacco Prescription Drugs OTC Inhalants Hallucinogens Ecstasy Synthetics Steroids Heroin Meth Percent (%) Reporting Use
Percentage of Arizona Youth Reporting Past 30 Day Use of the Most Common Substance Types 40 35 30 Percent (%) Reporting Use 25 20 15 30.2% Decrease 3.1% Increase 10 5 39.2% Decrease 41.1% Decrease 0 2006 2008 2010 2012 2014 Alcohol Cigarettes Marijuana Rx Drugs Note: scale reduced for visibility; accurate depiction is out of 100%
30 Percentage of Youth Reporting the Most Common Substances Used in Past 30 Days (2014) 25 Percentage (%) of Use 20 15 10 24.3 24.0 5 14.0 13.5 11.3 8.9 7.0 6.1 0 Alcohol Marijuana Cigarettes Rx Drugs Youth with Military Parent/Guardian Youth with Non-Military Parent/Guardian Note: Scale reduced for visual purposes; accurate depiction is out of 100%
50 Percentage of Youth with Military Parent/Guardian Reporting Current Substance Use (2014) 45 40-57% Higher 40 35 Percentage (%) of Use 30 25 20 38.0 43-63% Higher 60-92% Higher 55-83% Higher 15 10 25.4 24.6 21.2 23.1 22.0 5 15.0 12.4 12.0 11.9 10.0 8.1 14.3 7.1 8.1 5.9 0 Alcohol Marijuana Cigarettes Rx Drugs Deceased Military Parent/Guardian Active Duty Parent/Guardian Veteran Parent/Guardian Reservist Parent/ Guardian Note: Scale reduced for visual purposes; accurate depiction is out of 100%
CONSEQUENCES Identifying the Costs of Substance Use and Markers of Return on Investment for Prevention
35 Percentage of Youth Reporting Public Safety Consequences by Military Status (2014) 30 Percent (%) Reporting Consequences 25 20 15 10 5 0 10.8 8.3 6.8 7.0 5.2 5.8 Got into fights Arrested Sold Drugs Drinking & Driving Driving while misusing Rx drugs 5.8 4.9 3.8 2.9 21.0 21.1 Passenger to imparied driver Youth with Military Parent/Guardian Youth with Non-Military Parent/Guardian Note: Scale reduced for visual purposes; accurate depiction is out of 100%
45 Percentage of Youth Reporting School-Related Consequences by Military Status (2014) 40 35 Percent (%) Reporting Consequences 30 25 20 15 10 5 14.3 13.2 14.2 13.1 10.3 10.8 35.0 30.4 22.5 19.8 12.3 8.4 0 Drunk/high at school In fights at school Suspended from school Bullied at school Bullied another student Threatened at school Youth with Military Parent/Guardian Youth with Non-Military Parent/Guardian Note: Scale reduced for visual purposes; accurate depiction is out of 100%
CONTEXTUAL FACTORS Identifying What Can Be Changed
100 Notable Risk Factors among Youth with a Military Parent/Guardian (2014) 90 80 Percentage (%) at High Risk 70 60 50 40 30 20 10 0 24.5 54.6 Perceived Availability of Drugs 8.2 51.8 Early Initiation of Drug Use 31.8 55.2 Poor Family Management 18.3 48.5 Parental Attitudes Favor Drug Use 12.5 53.8 Attitudes Favor Drug Use 16.5 62.1 Peer Drug Use No Substance Use Any Substance Use
Alcohol
Most Common Source of Alcohol for Youth with a Military Parent/Guardian 43%
Parents 1 out of 5 got alcohol from their parents 23% higher rate than youth with non-military parent/guardian
Marijuana & Rx Drugs
Easy Access 78.9% of Arizona youth who have misused prescription drugs in the past 30 days report getting them from friends, family or right out of the home
Where Arizona Youth Obtained Marijuana* 100 90 80 Percent (%) Youth Reporting Each Source 70 60 50 40 30 78.6 75.7 20 10 0 28.6 27.1 14.8 14.3 11.6 14.3 13.4 Friends Parties Family/Relative Someone with a medical mj card 11.3 School 6.1 Home 5.7 2012 2014 *Students could pick more than one source; will not sum to 100%
Why Does Age of Initiation Matter?
National Data; Source: SAMHSA
National Data; Source: NIDA
Average Age of 1 st Use for Alcohol, Tobacco, Marijuana and Rx Drugs in Arizona?
Youth Living in Military Families: Age of First Alcohol Use High School 27.4% Elementary 29.4% Middle School 43.1% Youth Living in Non-Military Families: Age of First Alcohol Use High School 31.4% Elementary 25.1% Middle School 43.5%
Youth Living in Military Families: Age of First Marijuana Use High School 34.8% Elementary 15.7% Middle School 49.5% Youth Living in Non-Military Families: Age of First Marijuana Use High School 36.9% Middle School 50.2%
Youth Living in Military Families: Age of First Rx Drug Misuse High School 34.3% Elementary 23.5% Youth Living in Non-Military Families: Age of First Rx Drug Misuse Middle School 42.4% High School 37.2% Elementary 19.8% Middle School 43.0%
50 Reasons Past 30 Day Youth Substance Users Gave for Using (2014) 45 40 Percent (%) Reporting Reason 35 30 25 20 15 38.7 41.8 29.4 28.2 28.7 30.5 10 5 0 Have fun Deal with Stress Get high 22.3 22.2 20.9 21.9 17.9 18.6 Keep from feeling sad 16.6 18.3 Other 12.6 11.6 Stop boredom 9.2 8.8 Try something new 7.9 7.2 Help Focus 6.4 5.9 4.5 4.0 2.9 2.3 2.7 2.3 1.7 1.1 Fit In Feel normal Because I needed it Lose weight Get back at my parents Be more grown up Be like famous person Youth with Military Parent/Guardian Youth with Non-Military Parent/Guardian Note: Scale reduced for visual purposes; accurate depiction is out of 100%
100 Source of Stressors for Youth Indicating Stress as a Reason for Past 30 Day Substance Use (2014) 90 Percent (%) Youth Reporting Stress Source 80 70 60 50 40 30 20 63.5 60.2 45.3 43.9 67.1 65.3 10 20.9 16.1 0 Family Peer/Friend School Community Youth with Military Parent/Guardian Youth with Non-Military Parent/Guardian
100 Reasons Youth Gave for Not Using Substances in the Past 30 Days (2014) 90 80 Percent (%) Who Provided Reason 70 60 50 40 30 20 10 82.3 86.3 56.7 61.1 55.2 60.2 48.8 52.3 44.6 47.4 44.3 48.2 43.8 45.5 43.5 45.8 36.4 39.8 29.6 31.2 21.2 24.2 0 6.5 5.6 Not interested Can hurt me Parent disapproval Could be arrested Other adult disapproval Morally wrong Lose privileges 6.3 6.3 Might get expelled Get bad reputation Friends disapprove Against beliefs Couldn't find any Don't like Youth with Military Parent/Guardian Youth with Non-Military Parent/Guardian
100 Percentage of Arizona Youth Reporting No/Slight Perceived Risk of Substance Use (2014) 90 Percent (%) Youth Reporting Stress Source 80 70 60 50 40 30 20 36.9 33.4 67.1 66.2 48.7 46.6 10 18.4 20.3 15.4 18.7 0 1-2 Drinks Daily Cigarettes Rx Drug Misuse Trying Marijuana Regular Marijuana Use Youth with Military Parent/Guardian Youth with Non-Military Parent/Guardian
Percentage of Arizona Youth Reporting No/Slight Risk of Marijuana Use 100 90 80 Percent (%) Reporting Use 70 60 50 40 30 25.8%% Increase 116.6% Increase 20 10 0 2006 2008 2010 2012 2014 Try Marijuana Regular use of marijuana
Over HALF of Arizona youth have never talked to their parents about alcohol or drugs!
Percentage of Arizona Youth Who Have Never Talked to Their Parents about Drugs and Alcohol (2014) 100 90 Percent (%) Youth Reporting Stress Source 80 70 60 50 40 30 20 49.2 50.7 52.8 58.5 51.0 10 0 Active Duty Parent/Guardian Reservist Parent/ Guardian Veteran Parent/Guardian Deceased Military Parent/Guardian Non-Military
Take Away Message
What Should We Do?
How Do We Get There?
Think BIG! 1. Things to do at a state level? 2. Things the AZCMF could do? 3. Things you could do individually?
For More Information Shana Malone 602-364-1158 smalone@azcjc.gov SAC website: http://www.azcjc.gov/acjc.web/sac/default.aspx Community Data Project website: http://www.azcjc.gov/cdp_site/default.aspx