Alcohol and Substance Use

Definition

Excessive alcohol consumption, including binge drinking (drinking five or more drinks on an occasion for men or four or more drinks for women) and underage drinking, is harmful to health and well-being, potentially leading to increased risk of health issues such as injuries, violence, liver diseases and cancer (1, 2). Prescription drug misuse and illicit drug use, also have significant health, economic and social consequences (3).

Every year, the abuse of alcohol and illicit and prescription drugs contributes to the deaths of over 90,000 Americans. Additionally, the use, misuse and addiction to alcohol, nicotine and illicit and prescription drugs, costs the U.S. more than $700 billion a year in increased health care costs, crime and lost productivity (4). From 1999 to 2016, overdose deaths related to prescription opioids increased 500 percent (3).

The consequences of drug and alcohol addiction and abuse are very harmful and can affect nearly everyone. Substance related addiction disorders are chronic, relapsing brain diseases which trigger compulsive, drug-seeking behavior and use — despite negative consequences (4). The impacts of substance use can be seen across the lifespan.

• Babies who are exposed to alcohol or drugs while in the womb may be born premature, underweight or with developmental or cognitive impairments. They may also be born with birth defects.

• Adolescents who misuse drugs or alcohol often exhibit behavior problems and have a higher likelihood of dropping out of school. They are also at risk for unplanned pregnancies, infectious diseases and physical violence.

• Adults who misuse drugs or alcohol are more likely to encounter difficulties with memory recall, thinking clearly and attention span. These adults are more prone to develop poor social behaviors, have unstable employment, be unemployed or have negatively impacted personal relationships.

• Over time, excessive alcohol consumption has been linked to hypertension, heart disease, fetal alcohol syndrome, liver disease and certain cancers (3).

The chart to the right shows the number of deaths, due to drug overdose, from 2000 to 2016 in the United States. The largest number of deaths has been due to synthetic opioids, such as tramadol and fentanyl. This is followed by heroin and then natural and semi-synthetic opioids such as hydrocodone, oxycodone and morphine.

Source: National Institute of Drug Abuse (2018), available at https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Marijuana is the most commonly used drug in the U.S. With more than 11 million young adults — ages 18 to 25 — using marijuana in 2015, the use among young people has become widespread (5). When marijuana is smoked, tetrahydrocannabinol (THC), and other chemicals contained in the plant, pass from the lungs into the bloodstream and the brain. Effects vary by individual. Many people experience euphoria and a sense of relaxation, while others may experience anxiety, fear, distrust or panic. A person who takes too much, or the marijuana is of an unexpected high dosage, may experience acute psychosis — which includes hallucinations, delusions and a loss of personal identity. Since the legalization of marijuana in Colorado, the overall use rates among adults and adolescents have not changed in terms of number of users or the frequency with which they use (6). However, with 13 percent of adults reporting use in the past month compared to five percent nationally, the overall rate of adult marijuana use continues to be above the national average (5). Use of marijuana has been linked to issues such as depression, anxiety and suicidal thoughts among teens. Still, more than five percent of Colorado high school students use marijuana daily or near daily. This rate has remained constant since 2005 (6).

The use, and dependence, of illicit drugs and alcohol also has significant harmful effects to individual health and society at large. Individuals who are diagnosed with substance-misuse disorders are known to have higher rates of suicide attempts, higher health care expenses and significant disability (6).

Health Disparities and Inequities

Certain subpopulations in the United States are disproportionately affected by substance misuse disorders. They experience negative health impacts such as elevated rates of suicide, poverty, domestic violence, childhood and adult trauma and involvement in foster care and criminal justice systems. These disparities are most prevalent among racial and ethnic minorities, LGBTQ populations, persons with disabilities, transition-age youth and young adults. These subpopulations are historically underserved and have experienced barriers in access to care, lack of information and a need for culturally and linguistically-competent care and programming (7). In terms of alcohol use, Hispanic/Latino and black individuals have higher rates of complete abstinence from alcohol than white, non-Hispanic individuals. However, among Hispanics/Latino and black individuals who do drink, they consume more alcohol and have higher rates of binge drinking than white, non-Hispanic individuals (8).

The table below shows demographic differences in drinking habits among Jefferson County adults (18+). Those listed were more likely to participate in the drinking activity than their counterparts.

Summary of demographic disparities related to the drinking habits by those most likely to participate, Jefferson County (2013-2014)

Source: Colorado BRFSS, Jefferson County (2013-2014)

The maps below highlight areas (census tracts) within Jefferson County with more (darker areas) or less (lighter area) adults who binge drink or drink heavily (2011-2015).

Percent of adults who binge drink (past 30 days) (2014-2017)

Source: CDPHE BRFSS Small Area Estimates (2014-2017)

Percent of adults who drink heavily (past 30 days) (2014-2017)

Source: CDPHE BRFSS Small Area Estimates (2014-2017)

Implications and Data for Jefferson County

Community Health Needs Assessment Focus Group Findings

Few focus group participants noted concerns regarding substance use and/or abuse, though some did note that it is closely related to mental illness.

Community Health Needs Assessment Key Informant Findings

Alcohol and Substance Use

Driving under the influence was reported as on the rise by an informant in the law enforcement community, especially more cases of driving under the influence of multiple substances.

Adult substance misuse and abuse issues with alcohol, marijuana and heroin or opioids, was stated as a significant concern among some informants. Informants with both the treatment and law enforcement experience noted that they have seen increases in opioid and heroin use and overdoses in their intake over the last three years. These individuals who use tend to have more than one additional medical disease related to mental illness. First responders in Jefferson County often carry Narcan, which is used to reverse an opioid overdose.

Youth substance use/abuse issues regarding marijuana was a concern with some informants.

The closure of a large substance misuse and dependency treatment program was a recurring theme across informants working in substance use prevention and treatment. It was pointed out as a substantial loss to the community’s inpatient treatment capacity. Many informants stated that prior to the closure they were already struggling with ability to provide treatment referrals due to low Medicaid reimbursement rates for substance misuse and other behavioral health treatment. In response, many informants working in substance use treatment are exploring expansions to outpatient options as well as pooling resources with other nonprofits to develop community mental health centers. 

Access to Care- Mental Health and Substance Treatment

Another recurring theme across informants who noted concerns with alcohol and drug use was the interconnection to mental illness and how the frequencies of clients with both addiction and mental health issues are rising across the county. Substance misuse treatment needs to occur together with mental health treatment. These clients often suffer from both of these issues, as well as struggling to meet basic needs around housing, clothing, employment assistance and other services. Groups affected include individuals experiencing homelessness or near homelessness, housing instability, older adults, veterans, unemployed, pregnant women and others. Click here to learn more about Access to Care - Mental Health and Substance Use Treatment.

Communities That Care Youth Focus Group Findings

Why youth use drugs and alcohol:

According to Jefferson County youth, youth use alcohol and drugs for two main reasons:

1. It's a big part of their social environments. The substances that were discussed most often were marijuana, alcohol, and cocaine. Youth talked about how substance use is a way to fit in with their peers and avoid social isolation. Rather than experiencing overt peer pressure, most of the youth discussed using drugs and alcohol as a way to socialize. Making the choice to abstain from substance use was identified as a way to be excluded from social groups and even lose friends.

In addition to fitting in with their peers, youth social environments also included using these substances for fun and experimentation and the accessibility of these substances at school and at home. Alcohol and drugs were said to be easily available at parties, where fitting in, having fun, and accessibility were mentioned together as part of youth social environments. In addition, social norms around substance use were said to make it an acceptable activity for youth.

One of the comments about substance use as a part of youth social environments is shown below:

"I’ve noticed that if someone chooses to be sober, like, they lose a lot of friends. People want to be your friend to do drugs with you or drink with you. As soon as you’re not doing that anymore you lose friends. That makes it harder for people to stop."

2. To cope/self-medicate from stress and trauma experienced at home and at school. The youth often said that their peers don’t know healthier ways of handling stress. Most of the time, stress and trauma were identified as coming from school life, home life, or a combination of both.

One of the comments about substance use to cope/self-medicate is shown below:

"We all know life isn’t fair. We all know life will hit you in the face with a spiked bat, spit on you, and not even help you up. But I think for some people, drugs are the only thing that’s not gonna leave you."

Why youth don't use drugs and alcohol:

According to Jefferson County youth, youth abstain from using alcohol and drugs for two main reasons:

1. They have have a strong sense of who they are, and they don't feel the need to use. One of the comments about having a stable sense of self is shown below:

"From what I’ve seen, it seems like those who don’t abuse substances know where they belong. Like they feel like they belong somewhere. And they feel secure at where they are in life. And they know who they are. Whereas those who do drugs are very confused – not really confused. But like, they feel like they don’t belong anywhere, like they’re sort of floating. Floating in between groups of people. Like they have no real close friends, but they have acquaintances."

2. They have plans and hope for the future, like going to college. One of the comments about future plans is shown below:

"In the individual, something just clicks, or they just see that end result, and that’s what they want."

Alcohol Use

Adults in Jefferson County are more likely to binge drink, drink heavily and drive intoxicated, compared to adults in Colorado and the United States. 

- Colorado Behavioral Risk Factor Surveillance Survey data

Heavy drinking = 15 drinks/week for men and 8 drinks/week for women.

Binge drinking = 5 or more drinks for men and 4 or more drinks for women at the same time or within a couple of hours of each other.

Note: In 2011, the BRFSS methodology changed to include calls to cell phones. Changes between 2010 and 2011 should be interpreted with caution.

Marijuana  Use

Marijuana use in the past 30 days in Colorado is significantly higher than the United States, across all age groups, as shown in the chart to the right.

"Colorado ranked 1st among percent of marijuana users in the 12-17 and 26+ age groups, and 2nd (behind Vermont) in the 18-25 age group."

- Substance Abuse and Mental Health Services Association - National Survey on Drug Use and Health data

Percent of adults who used marijuana or hashish in the past 30 days (2014-2017)

Source: CDPHE BRFSS Small Area Estimates (2014-2017)

Use Among High School Students

Percent of high school students, currently using or lifetime use, by substance, Colorado and United States (2015)

Source: HKCS (2015) & YRBS (2015)

*Binge drinking = 5 or more alcoholic beverages on an occasion.

**Prescription drugs =  Using/taking prescription drugs when they have not been prescribed by a doctor.

"16.5 percent of Colorado students were offered, sold or given drugs at school in the past year (U.S.=21.7 percent; HP 2020 Goal=20.4 percent)."

- Healthy Kids Colorado Survey data (2015)

Alcohol and Drug Related Emergency Department Visits

The chart below distinguish between emergency department (ED) visits for pharmaceutical opioid overdoses, excluding heroin, and heroin overdoses for Jefferson County and Colorado. In Jefferson County, the rates of visits to the ED for pharmaceutical opioids has decreased from 2012 to 2016, but increased again in 2017. Rates of ED visits for heroin in Jefferson County have been increasing, but stabilized between 2015 to 2017. Overall, our ED rates for these substances has been slightly higher than Colorado.

The change in these rates over time has not been uniform across all age groups. For example, the rates for alcohol-related emergency department visits have decreased in those under 25 years of age, but have increased in those 25 years and older. 

In 2015, the following number of Jefferson County residents visited the emergency department: 
68 persons for pharmaceutical opioid-related poisonings
80 persons for heroin-related poisonings
51 persons for marijuana-related poisonings
6,507 persons for alcohol-related poisonings


- Colorado Hospital Association data via Colorado Department of Public Health and Environment 

Get Involved!

The Jefferson County Communities That Care (CTC) coalition is using a structured, evidence-based community change process to increase protective factors and decrease risk factors related to youth substance misuse, with a specific focus on alcohol, marijuana and prescription drug misuse. 

Risk factors for youth substance misuse include: 

• Community laws and norms favorable toward substance use
• Including price & promotion of substance
• Community norms & social rules, and laws & law enforcement
• Extreme economic deprivation
• Transitions and mobility
• Availability of substances
• Low neighborhood attachment and community disorganization
• Lack of commitment to school
• Academic failure beginning in late elementary school
• Family history of substance abuse
• Family management problems
• Favorable parental attitudes and involvement in substance use
• Early initiation of substance use
• Favorable attitudes toward substance use among individuals
• Perceived low risk of substance abuse among individuals

Protective Factors include: 

• Opportunities for prosocial involvement
• Recognition for prosocial involvement
• School rewards for prosocial involvement 
• Family opportunities for prosocial involvement.

Many of these risk & protective factors also known to influence prevalence of violence and hopelessness among youth. More information regarding youth substance misuse and risk & protective factors can be found in the Jefferson County CTC community assessment (link available soon). 

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Reference List

1. Centers for Disease Control and Prevention. (2018, March 27). Alcohol and Public Health. Retrieved from: https://www.cdc.gov/alcohol/index.htm

2. Centers for Disease Control and Prevention. (2018, March 29). Alcohol and Public Health: FAQs. Retrieved from: https://www.cdc.gov/alcohol/faqs.htm

3. Robert Wood Johnson Foundation. (2018). Alcohol and Drug Use. Retrieved from: http://www.countyhealthrankings.org/explore-health-rankings/what-and-why-we-rank/health-factors/health-behaviors/alcohol-and-drug-use

4. National Institute of Drug Abuse. (2014, July). Drugs, Brains, and Behavior: The Science of Addiction. Retrieved from: https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/introduction

5. Substance Abuse Center for Behavioral Health Statistics and Quality. (2016, September). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Retrieved from: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf

6. Colorado Department of Public Health & Environment. (2016). Monitoring changes in marijuana use patterns. Retrieved from: https://drive.google.com/file/d/0B0tmPQ67k3NVc2lFeDFoMUJ1N2c/view

7. Substance Abuse and Mental Health Administration. (2018). Health Disparities. Retrieved from: https://www.samhsa.gov/health-disparities

8. National Institute on Alcohol Abuse and Alcoholism. (2018). Minority Health and Health Disparities. Retrieved from: https://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/diversity-health-disparities 

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Data Sources

Colorado BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey: http://www.chd.dphe.state.co.us/cohid/

CDC BRFSS: Behavioral Risk Factor Surveillance Survey: https://www.cdc.gov/brfss/data_tools.htm

CO BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey: http://www.chd.dphe.state.co.us/cohid/

SAMHSA NSDUH: Substance Abuse and Mental Health Services Association - National Survey on Drug Use and Health: https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health

HKCS: Healthy Kids Colorado Survey: https://www.colorado.gov/pacific/cdphe/hkcs

YRBS: Youth Risk Behavior Surveillance System: https://www.cdc.gov/healthyyouth/data/yrbs/results.htm

Colorado Hospital Association via CDPHE: Colorado Department of Public Health and Environment: Alcohol and Marijuana data - direct request; Opioid and Heroin via the Colorado Consortium for Prescription Drug Abuse Prevention Data Dashboard:  https://public.tableau.com/profile/omni#!/vizhome/ConsortiumDashboardTESTING/Readmefirst

Click the logos below to return to the assessment home page.

Published on July 17, 2018

Updated on May 13, 2019