Understanding Substance Use Disorder in Greater Nashua
The City of Nashua Division of Public Health and Community Services (DPHCS) conducted a community based research project to assess the extent to which substance use occurs in Nashua. Substance use includes the use of alcohol, cannabis, stimulants, hallucinogens, opioids, and other drugs. The purpose of this research was to estimate the prevalence and define the degree of substance use disorder in Nashua and the Greater Nashua Public Health Region in order to identify improvements in the continuum of care. Data for this research was collected in 2019 and analyzed in 2020 and included both an online survey (222 participants) and in-person interviews (50 participants) with people that were actively using, in recovery, or had never used substances.
A 10-15 minute, online survey was distributed widely throughout the Greater Nashua community via social media, community networks and physical posted flyers. There were 222 community members that participated in the survey, about 56% of which had never used substances.
Fifty 1-hour, in person interviews were conducted with people that were actively using substances or in substance use recovery. Interviews were semi-structured and allowed for back and forth conversation between the interviewer and the interviewee. After the interview, participants were provided with a $25.00 gift certificate for their time and travel. All participants were read and provided written consent forms that described the details of their participation in the research.
Qualitative data was transcribed, coded, and analyzed using SAS 9.4. Quantitative data was collected via SurveyMonkey and analyzed using SAS 9.4.
About 44% of our survey participants had ever used substances (in recovery or actively using) and 56% of our survey participants had never used substances. 100% of our in-person interview participants were either in recovery or actively using. Having a large population of participants that never used substances was essential in order to determine any risks associated with substance use.
"My brother went into a convenience store, helped himself to a pack of cigarettes, grabbed a beer out of the cooler, and sat on the floor in front of the register and smoked a butt and drank his beer. And then he says to the cashier "I'm waiting for you to call the cops, I want to go to jail. It's too cold outside. I want to go to jail.""
About 60% of participants were residents of Nashua, and the remaining 40% were from across the Greater Nashua Public Health Region and the state. In regards to living situation, the vast majority owned their own home or rented their own apartment, including those that were actively using. The majority of participants were female, including those that were actively using or in recovery. This number may be survey bias, as we know that the majority of people who use(d) substances are male. The majority of participants had a 2-year college degree or higher, and were between the ages of 25 and 44.
Participant Adverse Childhood Experiences (ACEs)
Traumatic childhood events such as abuse, neglect, and witnessing experiences like crime, parental conflict, mental illness, and substance abuse can result in long-term negative effects on physical, social, emotional, and cognitive development. Often referred to as ACEs, these types of events create dangerous levels of stress that can derail healthy brain development and increase risk for smoking, alcoholism, depression, heart disease, and other illnesses and unhealthy behaviors throughout life. ACEs affect children and families across all communities, and have consequences that affect our whole society.
ACEs Questions Asked to Participants
1. As a child did anyone in your household have a problem with drinking alcohol or using drugs?
2. As a child was anyone in your household mentally ill, depressed, or attempt suicide?
3. As a child did anyone in your household spend time in jail or prison?
4. As a child did you ever hear or witness household members hurt or threaten to hurt each other?
5. As a child were you ever hurt or threatened by someone in your household?
6. As a child did you often feel unloved, unsupported, and/or unprotected?
7. As a child were your parents ever separated or divorced?
8. Has a doctor, nurse, or health professional ever asked you about your experiences during childhood?
Odds of Ever Using by ACE
The graph below shows the risk of ever using associated with the specific ACE. For example, those who experienced domestic violence as a child were 2.36 times as likely to ever used substances compared to those that did not experience domestic violence as a child. This result was statistically significant and not likely due to chance (OR 2.36, 95% Confidence Interval = 1.36 - 4.08). The wider the confidence interval, the more data is needed to clarify the result. The tighter the confidence interval, the more confidence we can have that the odds ratio is good representation of reality.
Stories from Research Participants
"They went to church and I wouldn’t go with them. So they locked me in a closet and didn’t let me out until hours later when they got back. He would come and whip me with a belt. And he would tell me that my mother didn’t love me and that she left me."
"I don’t know much about my biological father. He was convicted of child rape when I was 9 months old and then again when I was 4 years old. He abused me, apparently, I guess. "
"A bottle of vodka raised me and my brother more than anyone. We just waited until my mother got drunk and then we did whatever we wanted to."
"My mom was pretty violent when she was high, she hit my dad a lot. My brothers and I were just hanging around like as if it wasn’t happening."
"My grandfather was raping me from at least ages 4 to 9. I think that’s why he offed himself... because he couldn’t live with it anymore."
Participants Actively Using Substances
Substance Use Disorder (SUD) is a medical illness caused by repeated misuse of a substance or substances. SUDs are characterized by clinically significant impairments in health, social function, and impaired control over substance use and are diagnosed through assessing cognitive, behavioral, and psychological symptoms. The term substance use includes the use of alcohol, cannabis, stimulants, hallucinogens, opioids, and other drugs. SUDs affect a person's brain and behavior, leading to the inability to control the use of substances.
"I just want to be numb, especially with what's happening in my life."
"We were doing 'blood shots'. This guy couldn’t get himself high anymore. So we had 8 rigs [syringes] set up in the car, all just full of his blood. You can get more high off of his blood shot than you can off your own bag. So we would."
"I love Groups. Amazing place. The staff, the doctors, everybody is incredible there. But because I don’t have NH Medicaid, it's 65 dollars a week for me. I can't afford it. I can afford my bag, but I can't afford Groups."
Participants in Recovery
Substance misuse can cause lifelong health effects and is mostly preventable. Treatment for substance use disorder can lead to sustained recovery. Long term recovery is possible. People can recover and live productive lives.
"If you don’t have a lot of money, you can't get medication. So you can't be assisted with the medication to get off of things and stay off of things."
"I died about a month ago, and the person I was with Narcaned me twice. I didn’t come back and she was dumping, dumping buckets of water on me, to try to bring me back. I came back."