Alcohol & Substance Use

Background

The results of substance use manifest on the individual, family, and community levels. It can cause premature death, unemployment, and childhood trauma. It is often used as a coping mechanism for mental disorders, and stigma for both conditions as well as other barriers leave many without access to appropriate treatment.

Addiction is a complex disease that requires a diagnosis, treatment, and behavioral therapy from a medical professional. The National Institute on Drug Abuse defines addiction as a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her [1]. Substance abuse is not a self-control issue, but a symptom of a chemical imbalance in the brain that can become worse the first time you use and/or anytime you use drugs or alcohol afterward.

Many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa. Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa [2].

The DC Healthy People 2020 goals on this topic include:

1. Coping for mental health disorders occurs through healthy treatment and not substance use.

2. Alcohol and legally prescribed medications are used responsibly.

3. The growth, manufacture, transport, and use of illicit drugs is prevented.

Alcohol

In 2016, an estimated 20.1 million Americans aged 12 years and older had a substance use disorder related to their use of alcohol or illicit drugs in the past year [3]. However, only about 1 in 10 people who needed substance use treatment in this same year received treatment at a specialty facility.

Each year in the US excessive alcohol use causes 88,000 deaths [4]. In 2017, 25.6% of District adults and 8.2% of high school students were binge drinkers, or had more than 4-5 drinks at one time in the past month [5,6]. Among students in the District, 20.5% of high school students and 9% of middle school students reported using alcohol during the past month [6]. While LGB youth made up 15.1% of the District high school population in 2017, they accounted for 23.2% who drink alcohol [6].

Excessive alcohol use accounts for 10% of deaths among adults in the US. Over time, excessive alcohol consumption is a risk factor for high blood pressure, heart disease, liver disease, memory problems, stroke, and certain cancers [7]. 

In the short-term, excessive drinking is also associated to alcohol poisoning, intimate partner violence, risky sexual behaviors, and motor vehicle crashes [4]. The number of arrests for impaired driving in the District has decreased between 2012-2017 [8].

The Youth District of Columbia Prevention Survey found that in 2017, 43% of youth believe their close friends would strongly disapprove of them drinking alcohol nearly every day and nearly 80% believe their parents would disapprove of the same [9]. 

District-wide, 10.2% of youth indicated that it would be very easy to get alcohol if they wanted to,  however, this varied greatly by ward. 

Youth who reported having easy access to alcohol if they wanted ranged from a high of 18.9% of youth in Ward 6, to a low of 7.6% of youth in Ward 8.

Illicit Drugs

In 2017, the District had a higher percentage of residents reporting use of illicit drugs in the past month, 20.4% vs. 11.2% nationally among adults and 11.2% vs 7.8% among adolescents [10]. While LGB youth made up 15.1% of the District high school population in 2017, they accounted for 29% of youth who ever used cocaine [6]. Overall, the rates of adolescents using illicit drugs has decreased from 2010-2017.

As opioid-related deaths continue to rise across the nation, DC has also experienced an alarming increase in fatal opioid overdoses. Overdoses hit a peak in 2017, with 279 overdoses total, and has since trended downward with a 24.2% decrease in 2018 [13]. National trends largely reflect new opioid users who are White (non-Hispanic) younger adults who begin their addiction by experimenting with prescription drugs, with the potential of progressing to heroin usage. However, the District’s epidemic affects a unique demographic and presents different trends in use [11]. 

Overall, 81% of all deaths were among African-Americans, and 74% of all deaths were males. Approximately 80% of all overdoses due to opioid drug use happened among adults between the ages of 40–69, and such deaths were most prevalent among people ages 50- 59. From 2014 to 2017, opioid-related fatal overdoses were most prevalent in Ward 7 and Ward 8. Among all overdose victims, 22% had been using heroin (primary used opioid in Washington, DC) for more than 40 years, 59% for more than 25 years, and 88% for more than 10 years [11].

In 2019, the District government and stakeholders developed the Live. Long. DC strategic plan to reduce opioid use, misuse and related deaths. In 2019, there were a total of 44 opioid overdose deaths in the District.

Opioid Dependency Treatment Centers, Narcan Locations and Needle Exchange Programs

Marijuana

In 2015, the District of Columbia decriminalized possession of small amounts of marijuana for residents 21 and over. Additionally, the District allows residents the use of medical marijuana recommended by a physician, dentist, . As of 2019, there are 6,061 patients registered in the DC medical marijuana program across all 8 wards [12]. There are 8 cultivation centers and 6 dispensaries across the city.

Among young people in the District, 9.8% of middle school students and 33% of high school students report they currently use marijuana in 2017 [6]. According to the 2019 Youth District of Columbia Prevention Survey, 36% of young people (12-17 years old) indicated that they believe adults in their neighborhood would think it’s very wrong for young people to use marijuana. While nearly 79% believe that their parents would strongly disapprove of them using marijuana regularly once or twice a week, 32% indicate that they perceive a great risk from using marijuana regularly once or twice a week [9].

Despite similar rates of marijuana use, communities of color have been disproportionately harmed by the criminalization of cannabis. The new status of marijuana will bring additional legislation, regulation, treatment, and prevention strategies for a new legal substance, and may change usage patterns moving forward.

For far too long, the possession of marijuana has been a pipeline to prison, and we're taking bold steps to replace that pipeline with a pathway to prosperity. 

—Mayor Muriel Bowser

Promising Practices & Policies

• SU-I Limit alcohol outlet density and restrict hours/days when sale is permitted.

• SU-II Improve population-level data infrastructure around non-medical use of prescription drugs.