Transcript Public Health: Alcohol and Rural Courts

Epidemics in the Justice System:
Alcohol and Rural Courts
Linda L. Chezem, JD
Purdue University
Indiana Alcohol Research Center at
Indiana University School of Medicine
Public Health
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United States 2001
Alcohol Harmful Effects
2500000
2000000
1500000
Harmful
Effects
Chronic
1000000
Acute
500000
0
Total
Alcohol Attributable Death
Total for All Causes
Minnesota 2001
Chronic Causes
1200
Acute pancreatitis
Alcohol abuse
Alcohol cardiomyopathy
1000
Alcohol dependence syndrome
Alcohol polyneuropathy
800
Alcohol-induced chronic pancreatitis
Alcoholic gastritis
600
Alcoholic liver disease
Alcoholic myopathy
Alcoholic psychosis
400
Breast cancer (females only)
Cholelithiases
200
Chronic hepatitis
Chronic pancreatitis
Degeneration of nervous system due to alcohol
0
Male
Female
Total
Epilepsy
Esophageal cancer
Past-Year DSM-IV Alcohol Dependence Among 12-to-17
Year-Olds by Sex, Race-Ethnicity and Urbanicity
8
7.4
7
Urban
Rural
6
5.9
Prevalence (%)
5.4
4.8
5
4
2.8
3
2.3
2
1.9
2.3
1.9
2.1
1.6
1.1
1
0.7
0.2
0
Male
Female
White
Native
American
Hispanic
Black
Asian
Past-Year Binge Drinkers Among 12-to-17 YearOlds by Sex, Race-Ethnicity and Urbanicity
16
14
13.5
12.5
10.8
Prevalence (%)
13.3
12.3 12.4
12
10
13.9
10.0
Urban
Rural
9.2
8.0
8
6.0
6
4.8
4
3.4
2.7
2
0
Male
Female
White
Native
Hispanic
American
Black
Asian
Past-Year Drinkers Among 12-to-17 Year-Olds
by Sex, Race-Ethnicity and Urbanicity
40
36.5 37.1
36.9
34.2
35
33.5
31.5
30.4
Urban
Rural
30
Prevalence (%)
37.2
36.7
35.2
28.5
25
22.9
21.7
18.9
20
15
10
5
0
Male
Female
White
Native
Hispanic
American
Black
Asian
Public Health Core Functions
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Assessment
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Surveillance (how many alcohol related cases in the
courts?)
Detection of alcohol use in underage or other at risk
population
Policy Development
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Inform, educate, and empower people about alcohol in the
justice system and the health issues
Mobilize community partnerships and action to identify and
solve health problems (e.g., convening and facilitating
community groups to promote health about alcohol).
Assurance
(about alcohol and health)
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Enforce alcohol laws and regulations that protect health and
ensure safety.
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Evaluate effectiveness, accessibility, and quality of personal and
population-based health services (e.g., continuous evaluation of
public alcohol health programs).
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Research for new insights and innovative solutions to alcohol
problems (e.g., links with academic institutions and capacity for
epidemiologic and economic analyses).
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Evaluate impact of alcohol response in the justice system
First Step
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Articulate the public health impact of alcohol.
Determine the impact of alcohol in the
community.
Seek to better understand the public health
role of courts when alcohol is involved.
Justice System
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More than 20,000 Courts in US have jurisdiction
over alcohol related cases.
Fewer than 2000 drug
courts in US
Civil
Civil
Criminal
Dissolutions
Juvenile
Probate
Rural Courts
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Cannot stand alone
"The life of the law has not been logic: it has
been experience." Oliver Wendell Holmes
from The Common Law, 1881
Research that applies to rural communities is
essential
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Utilize
Help set agenda
All courts are alcohol courts.
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Courts are the RURAL Community Agents
for INTERVENTION AND TREATMENT.
Should people have to go to court for alcohol
health services?
Do rural populations have geographical and
economic access to honest EVIDENCE
BASED TREATMENT?
Can Drug Courts Go Country ?
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Debatable (approximately 1700 courts)
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GAO report
Only as good as the treatment provider?
Not easily transportable
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Limited number of judges
Extremely limited justice resources
Evidence based assessment and treatment
services
Community dynamics
Alcohol fuels the justice system.
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Alcohol
Alcohol plus other drugs
Alcohol plus mental illness
All of the above add up to an overwhelming
impact on justice.
What Research is Rural?
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Not enough studies are conducted in rural
communities.
Federal research dollars and foundation
grants do not adequately include rural
targets.
Rural and non urban communities are
invisible in much research.
CAN community based urban research apply
to rural?
Alcohol Law
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Enforcing Underage
Drinking Laws
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Prosecution of under 21
for possession or
consumption of alcohol.
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Under 18 go to juvenile
court.
Over 21 go to adult
court.
Underage Drinking
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Alcohol is the most commonly used drug by
children and adolescents.
Teens who use alcohol and drugs are more
likely to be involved in violent behaviors.
Is the violence connection true for rural
children and adolescents?
Supporting Research
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NESARC Data.
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Teenagers who begin drinking before age 15
have four times the risk of developing alcohol
dependence later in life.
Adolescents with histories of extensive alcohol
use have noticeable changes in brain function
that impair learning, memory, and problem
solving; smaller hippocampal volume.
EUDL: What Works?
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Law is to prevent youthful
consumption.
Office of Juvenile Justice
and Delinquency Prevention
program.
360,000 to each state and
discretionary grants of $1
million.
Required to have justice
system participate in
community coalition
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Research Response
 NIAAA is evaluating the
EUDL program in rural
communities of 7 states
to determine the
effectiveness of
programs.
 The “National Evaluation”
Excluded communities of
under 50,000.
Why Do We Need Research?
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Difficult to enforce
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Uneven
Lack of police resources
Legal process is
expensive
Results can be harsh
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Community programs
have limited resources.
Communities have
limited attention spans.
Rural Research Needed
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What prevention programs can be effective in
rural settings?
Who needs intervention and treatment in
rural communities?
How can service delivery be economically
accessible?
What are barriers to research?
Can methodologies be developed to
compensate for small numbers?
Fetal Alcohol
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Law and policy not supported by research.
Punitive laws used to prevent mother from
drinking may be more harmful.
Laws are unenforceable.
Research about rural and small town
attitudes indicates need for more studies.
Rural Questions about FASD
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Purpose: This 2-part study examines gender differences in attitudes
and perceived barriers to intervention in a large community sample of
persons living in rural and small-town environments in Kentucky (n =
3,346). The study also examines rural/small-town prenatal service
providers' perceptions of barriers to assessment and intervention with
pregnant substance abusers (n = 138).
Findings: Overall results of the community sample suggest that neither
males nor females were knowledgeable about the harmful effects of
alcohol use during pregnancy. Results also indicate substantial gender
differences in alcohol attitudes, knowledge, and perceived barriers.
Further, prenatal care providers identified several barriers in
assessment and treatment of pregnant women with alcohol use
problems in rural and small-town communities, including lack of
knowledge and comfort with assessment as well as a lack of available
and accessible treatment for referrals.
Cite
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Rural and small-town attitudes about alcohol use during pregnancy: A community and provider sample
Logan TK, Walker R, Nagle L, Lewis J, Wiesenhahn D
JOURNAL OF RURAL HEALTH 19 (4): 497-505 FAL 2003
Abstract:
Context: While there has been considerable research on prenatal alcohol use, there have been limited studies focused on
women in rural and small-town environments.
Purpose: This 2-part study examines gender differences in attitudes and perceived barriers to intervention in a large
community sample of persons living in rural and small-town environments in Kentucky (n = 3,346). The study also examines
rural/small-town prenatal service providers' perceptions of barriers to assessment and intervention with pregnant substance
abusers (n = 138).
Methods: Surveys were administered to a convenience sample of employees and customers from 16 rural and small-town
community outlets. There were 1503 males (45%) and 1843 females (55%) ranging in age from under 18 years old to over
66 years old. Surveys also were mailed to prenatal providers in county health departments of the 13-county study area, with
138 of 149 responding.
Findings: Overall results of the community sample suggest that neither males nor females were knowledgeable about the
harmful effects of alcohol use during pregnancy. Results also indicate substantial gender differences in alcohol attitudes,
knowledge, and perceived barriers. Further, prenatal care providers identified several barriers in assessment and treatment
of pregnant women with alcohol use problems in rural and small-town communities, including lack of knowledge and comfort
with assessment as well as a lack of available and accessible treatment for referrals.
KeyWords Plus:LOW-BIRTH-WEIGHT, SUBSTANCE-ABUSE, DRINKING, LIFE, RISK, CONSEQUENCES, PREVENTION,
BEHAVIOR, CHILDREN, GROWTH
Addresses:
Logan TK, Univ Kentucky, Ctr Drug & Alcohol Res, Dept Behav Sci, 1151 Red Mile Rd,Suite 1-A, Lexington, KY 40504 USA
Univ Kentucky, Ctr Drug & Alcohol Res, Dept Behav Sci, Lexington, KY 40504 USA
Bluegrass Reg Mental Hlth Mental Retardat Board I, Lexington, KY USA
NCJFCJ
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SPRING 2004 – VOLUME 55 – NO. 2
FETAL ALCOHOL SPECTRUM DISORDERS
(FASD) AND THE ROLE OF FAMILY COURT
JUDGES IN IMPROVING OUTCOMES FOR
CHILDREN AND FAMILIES
by Diane V. Malbin
Abstract: Fetal Alcohol Spectrum Disorder (FASD) is
a physical disability that is 95% under diagnosed
and 40 times over-represented in juvenile justice.
My Suggestions
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DEMAND research that is relevant and
applicable to the rural communities.
Consider the appropriate role of the courts
around alcohol abuse and dependence and
the unique circumstances of the rural courts.
Promote a better understanding of rural
alcohol issues as systemic public health
concerns.
Alcohol use disorders are an
epidemic that the justice system
cannot prevent nor cure.
….
But the community can