Substance Use Disorder
The standard term "Substance Abuse" refers to the overindulgence in or dependence on an addictive substance, especially alcohol or drugs. In 2013, the American Psychiatric Association (APA) updated the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), replacing the categories of substance abuse and substance dependence with a single category: substance use disorder. The symptoms associated with a substance use disorder fall into four major groupings: impaired control, social impairment, risk use, and pharmacological criteria (i.e., tolerance and withdrawal).1
1. The Science of Drug Abuse and Addition: The Basics. National Institute on Drug Abuse. Accessed: 1/6/2016.
Abuse of and addiction to alcohol, nicotine, and illicit and prescription drugs cost Americans more than $700 billion a year in increased health care costs, crime, and lost productivity. Every year, illicit and prescription drugs and alcohol contribute to the death of more than 90,000 Americans, while tobacco is linked to an estimated 480,000 deaths per year. (Hereafter, unless otherwise specified, drugs refers to all of these substances.)1
Eight of the ten leading causes of death in Alaska are at least partially caused by the abuse of
alcohol, tobacco, or other drugs. In 2013, the ten leading causes of death in Alaska were malignant neoplasms, diseases of the heart, unintentional injuries, chronic lower respiratory disease, cerebrovascular
disease, suicide, diabetes, chronic liver disease, Alzheimer's disease, and influenza and pneumonia. Of
these, chronic liver disease, unintentional injuries, and suicide are associated with alcohol use; chronic
lower respiratory disease and influenza and pneumonia are associated with tobacco use; heart disease, malignant
neoplasms, and cerebrovascular disease are associated with both alcohol and tobacco use.2
2. Top Ten Leading Causes of Death for Alaska 2013 Alaska Bureau of Vital Statistics. Accessed: 1/6/2016.
The economic cost to the Alaska economy from substance use disorders in 2010 was estimated at $1.2 billion. Costs by category include3:
- $673.2 million in productivity losses (56%),
- $50.5 million in traffic crash costs (4%),
- $217.7 million in criminal justice and protective services (18%)
- $237.3 million in heath care (20%), and
- $13.2 million in public assistance and social services (1%).
3. The Economic Costs of Alcohol and Other Drug Abuse in Alaska, 2012 Update McDowell Group. Accessed: 1/6/2016.
Alaska's pattern of substance use disorder generally follows national trends. Below are some of the situations where they differ4:
- About 4 in 10 (42.4%) adolescents (aged 12-17) in Alaska in 2013-2014 perceived no great risk from smoking one or more packs of cigarettes a day-a percentage higher than the national percentage.
- About 8 in 10 (82.9%) adolescents (aged 12-17) in Alaska in 2013-2014 perceived no great risk from smoking marijuana once a month-a percentage higher than the national percentage.
- In Alaska, about 6,000 adolescents (9.8% of all adolescents) per year in 2013-2014 reported using illicit drugs within the month prior to being surveyed.
- In Alaska, about 4,000 adolescents (6.2% of all adolescents) per year in 2013-2014 reported using cigarettes within the month prior to being surveyed.
- In Alaska, about 12,000 people aged 12-20 (13.0% of all people in this age group) per year in 2013-2014 reported binge alcohol use within the month prior to being surveyed.
- In Alaska, about 39,000 individuals aged 12 or older (6.7% of all individuals in this age group) per year in 2013-2014 were dependent on or abused alcohol within the year prior to being surveyed. The percentage did not change significantly from 2010-2011 to 2013-2014.
- In Alaska, about 19,000 individuals aged 12 or older (3.2% of all individuals in this age group) per year in 2013-2014 were dependent on or abused illicit drugs within the year prior to being surveyed. The percentage did not change significantly from 2010-2011 to 2013-2014.
- In Alaska, about 35,000 adults aged 21 or older (7.2% of all adults in this age group) per year in 2010-2014 reported heavy alcohol use within the month prior to being surveyed.
- In Alaska, among individuals aged 12 or older with alcohol dependence or abuse, about 5,000 individuals (10.6%) per year in 2010-2014 received treatment for their alcohol use within the year prior to being surveyed.
- In Alaska, among individuals aged 12 or older with illicit drug dependence or abuse, about 2,000 individuals (11.8%) per year in 2010-2014 received treatment for their illicit drug use within the year prior to being surveyed.
4. Substance Abuse and Mental Health Services Administration.Behavioral Health Barometer Alaska, 2015. HHS Publication No. SMA-16-Baro-2015-AK. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015. Accessed: 1/28/2016.
In almost thirty years of research for the best methods to offer prevention and early intervention services to youth and families, a number of key issues have been identified for Alaska5:
Nationally, the most common reasons that people who need and seek treatment do not receive it are because: they have no health insurance and cannot afford the cost; they are concerned about the possible negative effect on their job; or they are not ready to stop using.6
- Environmental and educational strategies help communities take an active role in addressing local issues of substance abuse.
- Culturally appropriate services promote greater success in our Alaska Native communities by implementing programs that incorporate traditional cultural values.
- Identification of a community's risk and protective factors has led to the use of the resiliency model that builds upon positive life skills and experiences, helping youth succeed despite growing up in a high-risk family or environment.
- More aggressive underage purchasing enforcement laws for both alcohol and tobacco reduce teen usage and adult purchasing for youth.
- Greater emphasis on local option laws assist in giving communities more control of access to alcohol and drugs.
Nationally, the most common reasons that people who need and seek treatment do not receive it are because: they have no health insurance and cannot afford the cost; they are concerned about the possible negative effect on their job; or they are not ready to stop using.6
5.
Prevention and Early Intervention: Substance Abuse Prevention Program Alaska Department of Health and Social Services, Division of Behavioral Health. Accessed on 1/6/2016.
6. Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. Accessed on 6/18/2015.
6. Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. Accessed on 6/18/2015.
Mental Health data can be obtained from both mortality as well as morbidity data sources:
- Mortality data report on 100% alcohol- and drug-induced deaths and drug overdoses.
- The Centers for Disease Control and Prevention (CDC) funded the development of the Alcohol-Related Disease Impact (ARDI) methodology that applies attributable fractions to underlying causes of death to arrive at the estimated number of deaths that were alcohol-related.7
- Adult prevalence data come from Behavioral Risk Factor Surveillance System (BRFSS), U.S. Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services.
- Youth prevalence data come from Youth Risk Behavior Surveillance System (YRBSS), U.S. Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services.
- Health Facilities Data Reporting Program for inpatient and ED visits relating to substance abuse disorders.
7. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Downloaded
from http://apps.nccd.cdc.gov/DACH_ARDI/Default/Default.aspx
on Jan 5, 2015.
- Alaska Behavioral Risk Factor Surveillance System (BRFSS)
- Alaska Childhood Understanding Behaviors Survey (CUBS)
- Alaska Emergency Medical Services (EMS)
- Alaska Pregnancy Risk Assessment Monitoring System (PRAMS)
- Health Facilities Data Reporting (HFDR)
- National Survey on Drug Use and Health (NSDUH)
- Syndromic Surveillance
- Adverse Childhood Experiences: Substance Abuse in Household
- Alcohol: Alcohol-Induced Mortality Rate
- Alcohol: Binge Drinking Among Adults (18+)
- Alcohol: Binge Drinking Among High School Students (Grades 9-12)
- Alcohol: Current Drinking Among High School Students (Grades 9-12)
- Behavioral Risk Factor Surveillance System (BRFSS)
- Drug-induced Mortality Rate
- Drug Use - Cocaine - Adolescents (Grades 9-12)
- Drug Use - Cocaine - Adults (18+) (NSDUH)
- Drug Use - Ecstasy - Adolescents (Grades 9-12)
- Drug Use - Heroin - Adolescents (Grades 9-12)
- Drug Use - Heroin - Adults (18+) (NSDUH)
- Drug Use - Illicit Drugs - Adolescents (Ages 12-17) (NSDUH)
- Drug Use - Illicit Drugs - Adults (Ages 18+) (NSDUH)
- Drug Use - Inhalants - Adolescents (Grades 9-12)
- Drug-use: Marijuana - Adolescents (Grades 9-12)
- Drug-use: Marijuana - Adults (18+)
- Drug Use - Marijuana - Adults (18+) (NSDUH)
- Drug Use - Methamphetamines - Adolescents (Grades 9-12)
- Drug Use - Needed but Not Receiving Treatment - Adults (18+) (NSDUH)
- Drug Use - Nonmedical Use of Pain Relievers - Adolescents (12-17) (NSDUH)
- Drug-use: Prescription Drug Abuse - Adolescents (Grades 9-12)
- Drug use - Prescription Drug Misuse - Adults (Ages 18+) (NSDUH)
- Tobacco Use - Adolescents (Grades 9-12) - No Use
- Tobacco Use - Adults (18+) - Not Cigarette Smoking
- Youth Risk Behavior Surveillance System (YRBSS)
Some of these links will take you to the query where you can select SUBMIT to run the default query. To modify the query criteria, you can use the top left ("MODIFY Query") navigation button on the query results page.
- BRFSS - Behavioral Risk Factor Surveillance System - Selection Menu
- CUBS (Childhood Understanding Behaviors System) - Selection Menu
- PRAMS (Pregnancy Risk Assessment Monitoring System) - Selection Menu
- YRBS (Youth Risk Behavior Survey) - Local Selection Menu
- YRBS (Youth Risk Behavior Survey) - Statewide Selecton Menu
BRFSS (Behavioral Risk Factor Surveillance System) - Examples
Alcohol
Marijuana
Tobacco
- Tobacco - Usage Status (Smoked or Smokeless)
- Tobacco - Current smoking
- Tobacco - Smokeless tobacco status
- Tobacco - Currently use E-cigarettes
- Tobacco - Ever used E-cigarettes
- Tobacco - Past 30 days, someone smoking inside home
CUBS (Childhood Understanding Behaviors System) - Examples
Alcohol
Tobacco
PRAMS (Pregnancy Risk Assessment Monitoring System) - Examples
Alcohol
- Preconception: Binge drinker 3 months before pregnancy
- Binge drinker (4+ drinks in a 2-hour time span) last 3 months of pregnancy
Marijuana
- Preconception: Marijuana use 12 months before pregnancy
- Marijuana use during pregnancy
- Marijuana use since new baby was born
Tobacco
- Smoked 3 months before pregnancy
- Spit tobacco use (chew, iqmik) during pregnancy
- Smoked During Last 3 Months of Pregnancy
- Smoke Now
YRBS (Youth Risk Behavior Survey) - Local Survey Examples
Alcohol
Marijuana
Other Drugs
- Lifetime Cocaine Use
- Lifetime Ecstasy Use
- Lifetime inhalants Use
- Lifetime methamphetamines Use
- Lifetime prescription drug misuse
- Lifetime synthetic marijuana use
Tobacco
YRBS (Youth Risk Behavior Survey) - Statewide Survey Examples
Alcohol
Marijuana
Other Drugs
- Lifetime Cocaine Use
- Lifetime Ecstasy Use
- Lifetime inhalants Use
- Lifetime methamphetamines Use
- Lifetime prescription drug misuse
- Lifetime synthetic marijuana use