Transcript Overview of Epidemiology

Foundations of Addictions
Unit 1
Glenn Maynard M.Ed., NCC, MAC,
LPC
Overview of Addictions
• Debate in US continues on whether
addiction is a disease, poor behavioral
decision making or a moral failing
• Prior to Prohibition, Temperance Movement
placed the cause in the substance and then
in the user
• AA- moved the cause to the user and
formed the basis of the disease model and
behavioral model
Addictions Counseling
• Full cycle from mental health orientation to
separate field and back to mental health
under the name behavioral health
• Long history of people in recovery working
as lay counselors
• Standards for addictions counselors began
to evolve in the 1970’s
Addictions Certification
• 1972 JCAH developed accreditation
standards that brought addictions into the
mainstream
• NIDA and NIAAA developed standards for
training including 2 years recovery; one
year counseling experience and written
examination
• Current certifications- CADC, NCADC,
MAC
Reuniting Addictions and Mental
Health
• Increased Federal and State interest in dual
dx
• Behavioral health includes addictions as a
focus of interest
• Administrative for AOD acknowledge
licensed professionals as providers
Brickman Schema
Is the person responsible for
changing the Addictive
Behavior?
Is the person responsible for
the development of the
Addictive Behavior?
Yes
No
Yes
Moral Model (War on
Drugs)
Lack of willpower
No
Compensatory Model
(Cognitive)
Errors in judgement
Spiritual Model (AA and
12-Step)
Loss of contact with higher
power
Disease Model (Heredity
and Physiology)
Activation of disease state
Characteristics of Effective
Counselors
• Meta analysis of tx
outcomes show
stronger therapist than
tx effects
• Therapist attributesfew gross effects
• Recovery status does
not predict tx outcome
• Positive relationship r
with positive
outcomes
• Adherence to a manual
or technique improves
outcomes
• Mixed research
outcomes on
confrontational tx
Overview of Epidemiology
• Study of disease in populations
• Groups studied in order to understand the
etiology and prevention of disease
• Web of causation- agent (vector), host,
environment
Prevalence and Incidence
• Prevalence= # of persons with a disease
total number in population
• Incidence= # of persons developing disease
total population at risk
Lifetime Prevalence Rates for
Substance Use Disorders
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Any Substance Use Disorder
Alcohol Abuse
Alcohol Dependence
Drug Abuse
Drug Dependence
Marijuana Dependence/Abuse
Cocaine Dependence/Abuse
Opiate Dependence/Abuse
Barbiturate Dependence/Abuse
Amphetamine Dependence/Abuse
Hallucinogen Dependence/Abuse
16.7%
5.6%
7.9%
2.6%
3.5%
4.3%
0.2%
0.7%
1.2%
1.7%
0.3%
Co-Morbidity Between Mental Disorders and
Substance Use Disorders
• Any Substance Use Disorder and:
– Schizophrenia
– Anxiety Disorder
– Antisocial Personality Disorder
47%
23.7%
83.6%
Co-Morbidity Between Mental Disorders and
Substance Use Disorders
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Any Mental Disorder and:
– Any Alcohol
36.6%
– Any Drug
53.1%
Schizophrenia and:
– Any Alcohol
3.8%
– Any Drug
6.8%
Affective Disorder and:
– Any Alcohol
13.4%
– Any Drug
26.4%
Anxiety Disorder and:
– Any Alcohol
19.4%
– Any Drug
28.3%
Alcohol Surveillance Data
• Per capita alcohol
consumption in 1997
lowest in 35 years
• Consumption by state
shows a consistent
pattern of decreased
consumption except
for AR and MS
• Regional patterns:
NE- decrease 0.5%
South- decrease 0.9%
Midwest- no change
West- decrease 0.4%
• NIAAA goal for 2000
was annual
consumption of 2
gals/capita
Trends in Alcohol Use
• 105 million Americans older that 12
reported current use of alcohol (30 day
prevalence)
• 45 million engaged in binge drinking (30
day prevalence)
• 10.4 million are age 12-20
• 6.8 million of 12-20 engaged in binge
drinking
•
1999 National Household Survey on Drug Abuse
Epidemiologic Trends in Drug
Abuse
• Data collection differs from alcohol due to
all non-prescribed drugs being illegal
• Drug use more variable than alcohol use
based on location and local customs about
drug use
• 14.8 million 30-day prevalence in 1999
• Peak use of illicit drugs in 1979 was 25
million
Cocaine
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Peak use of 5.8 million in 1985
1.75 million users in 1996
1995 estimated incidence was 652,000
Profile- most users are inner-city crack
users, older users
• New trend- teenagers using crack and MJ
(blunts)
Cocaine
• Decrease since 1985 has stabilized and may
be on the rise for teenagers
• Women users are exceeding male users
according to arrest records in some areas
• As m-amphetamine used declines, cocaine
use may increase
Heroin
• Two types- Black Tar and White Powder
• Black Tar- used primarily in West and SW;
injected; has more impurities
• White Powder- East Coast and SE;
intranasal and smoked; appealing to teens
• Increasingly popular with college students
• Increasing use with other drugs
• Most CEWG cities report increased use
DAWN Heroin Data
• Seattle
97.5% IV
• San Francisco
96.6%
IV
• Newark
43.6% IV
• Philadelphia
66.8%
• Los Angeles
95.0%
IV
• San Diego
93.3%
• Boston
73.3% IV
• New York City
74.6%
IV
IV
IV
Marijuana
• Incidence in 1995 was
2.5 million
• Drop in prevalence
rate for 12th graders
from 50.8% in 1979 to
23%
• Young adult use may
account for incidence
• Considered less risky
than other drugs
• MJ is being mixed
with other drugs
• DAWN data for MJ
have increased. See
chart
M-Amphetamine
• DAWN data report sharp declines in mamphetamine admissions from 1994-1998
• May be due to community prevention
programs
• Aggressive legal action
• Precursor laws
• Decreased potency and purity
Developing Trends
• Rave or club drugs
• Ecstasy (MDMA)- 1996-7 14% of male and
7% of female 12th graders reported using
MDMA at least once
• GHB (-hydroxybutrate)- too early to
evaluate DAWN data
• Ketamine- as above
Epidemiological Correlates
• AOD abuse more
common among men
than women (note
higher recent
incidence of alcohol
and cocaine use
among young women
• Alcohol and drug
prevalence decreases
with age
• African-Americans
begin abusive drinking
later than Whites
• A-A have more health
consequences than
Whites
• Hispanics have higher
life time prevalence
for alcohol, lower for
drugs
Epidemiological Correlates
• Twins typically show a • Prevalence rates for
40-50% concordance
alcohol disorders
for alcohol abuse
increase for people
unemployed for six
• Alcoholic are 6X more
months in 5 years
likely to come from
homes with parental
• Higher rates of
alcoholism
alcoholism in entry
level and blue collar
• 1/3 to 2/3 of people
jobs
with alcohol disorders
report no parental risk
Epidemiological Correlates
• ECA data do not show • Marital status- lifeappreciable drug effect
time prevalence for
on employment
stable marriages is
8.9%; cohabitating is
• Drug use among
29.2%
employed men is
higher on low income • For drug use- married
jobs
men at 3.6% and
women at 1.8%;
• Leaving school r with
cohabitating men at
increased risk
30.2% and women
19.9%