Substance Abuse -- A National Challenge
Prevention, Treatment and Research at HHS
January 13, 2006
Table of Contents
Overview: In 2004, nearly 19 million Americans ages 12 and older were using illicit drugs -- about 8 percent of the population. Each year, drug and alcohol abuse contributes to the death of more than 120,000 Americans. According to the Office of National Drug Control Policy, drugs and alcohol cost taxpayers more than $328 billion annually in preventable health care costs, extra law enforcement, auto crashes, crime and lost productivity. The Department of Health and Human Services (HHS) plays a key role in the Administration's substance abuse strategy, leading the Federal government's programs in drug abuse research and funding programs, and in campaigns aimed at prevention and treatment, particularly programs for youth. While overall use of drugs in the United States fell by more than 50 percent between 1979 and 1992, drug use among adolescents increased during the early 1990s. Since 1996, drug use by youth has leveled off, but in 2004 there were still nearly 1.4 million youth under age 18 who had tried marijuana for the first time within the past year.
The fiscal year 2006 budget includes $2.4 billion for substance abuse treatment and prevention programs. In addition, the 2006 budget includes $1 billion for substance abuse treatment and prevention research.
Recent Findings From HHS Substance Abuse Surveys
HHS tracks the nation's substance abuse patterns through six major surveys: the Drug Abuse Warning Network (DAWN), the Drug and Alcohol Services Information System (DASIS), the National Survey on Drug Use and Health (NSDUH), the Monitoring the Future Survey (MTF), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the Youth Risk Behavior Survey (YRBS). Information from these surveys helps the nation to identify potential drug problem areas and ensure that resources are targeted to areas of greatest need.
Drug and Alcohol Services Information System (DASIS). DASIS is one of the three major substance abuse data collections conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). DASIS provides national and state-level information on the substance abuse treatment system through the annual National Survey of Substance Abuse Treatment Services (N-SSATS) and through reports by states and localities to the Treatment Episode Data Set (TEDS). The N-SSATS includes all known specialty substance abuse treatment providers and gives data on the number of persons in treatment and the characteristics of treatment facilities. The TEDS is a client-level data set on the demographic and drug use characteristics of persons admitted to and discharged from treatment. TEDS also provides information on duration of treatment episodes and completion rates. Findings from the most recent N-SSATS and TEDS are available at http://oas.samhsa.gov/dasis.htm.
Drug Abuse Warning Network (DAWN). DAWN is one of three major substance abuse surveys conducted by SAMHSA. DAWN provides annual estimates of drug-related emergency department visits for the nation and for selected metropolitan areas. Estimates are based on a national probability sample of hospitals, with oversampling in key metropolitan areas. DAWN also provides annual profiles of drug-related deaths investigated by medical examiners and coroners in selected metropolitan areas and states. Recent findings from DAWN are available at DAWNinfo.samhsa.gov.
The National Survey on Drug Use and Health (NSDUH). The NSDUH is HHS's largest survey of drug use behavior in which approximately 70,000 people are surveyed in their homes on drug use, alcohol abuse, tobacco use and mental illness. The SAMHSA survey is based on a representative sample of the U.S. population ages 12 and older. Findings of the recently released 2004 NSDUH are available at www.oas.samhsa.gov.
Monitoring the Future (MTF). The MTF survey, funded by the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH), tracks illicit drug use trends and attitudes by 8th, 10th and 12th grade students. The 2005 study surveyed more than 49,000 students in some 400 public and private schools across the Nation about lifetime use, past year use, past month use and daily use of drugs, alcohol, cigarettes and smokeless tobacco. Findings of the 2004 MTF survey are available at www.drugabuse.gov/DrugPages/MTF.html. Findings for 2005 will be online as of December 19, 2005.
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). NESARC is conducted and sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). NESARC was designed as a longitudinal survey with its first wave of interviews fielded in 2001-2002. The second wave of interviews was fielded in 2004-2005. NESARC is a representative sample of the U.S. population, and 43,093 Americans participated in the first wave of the survey. The target population of NESARC is the non-institutionalized household population, ages 18 years and older, residing in the United States. The sample provides estimates for the nation as a whole on topics related to alcohol and drug use, abuse and dependence, and their associated disabilities. The survey is available at http://niaaa.census.gov.
Youth Risk Behavior Survey. The Centers for Disease Control and Prevention's (CDC) National Youth Risk Behavior Survey is a biennial school-based survey that collects data from a representative sample of students in grades 9-12 on health-related risks. In addition to surveying tobacco, alcohol and other drug use, the survey covers other injury-related behaviors such as carrying weapons and attempted suicide, sexual and dietary behaviors and physical activity. Findings of the 2001 YRBS are available at www.cdc.gov/YRBS.
HHS Programs and Services to Prevent and Treat Substance Abuse
Increasing Treatment Capacity. According to SAMHSA's 2004 National Survey on Drug Use and Health, an estimated 8.1 million persons ages 12 or older needed treatment for an illicit drug problem. Of them, 1.4 million received treatment at a specialty substance abuse facility. Of those not getting needed treatment, an estimated 598,000 reported they knew they needed treatment -- among them, approximately 194,000 who had sought but were unable to get the treatment they needed.
The fiscal year 2006 budget includes a total of $2.4 billion for SAMHSA's substance abuse treatment and prevention programs, including $1.76 billion for the Substance Abuse Prevention and Treatment Block Grant and $399 million for competitive drug treatment grants -- Programs of Regional and National Significance (PRNS). The 2006 budget includes $98 million for the Access to Recovery initiative, SAMHSA's primary funding mechanism to complement the Block Grant and the PRNS to help those in need of substance abuse treatment receive it.
Programs through the Administration for Children and Families (ACF). ACF's Community-Based Resource Centers serve as comprehensive family service centers that can provide referrals to treatment programs for parents and other family members. The Head Start program, also administered by ACF, helps families access substance abuse services and provides training for Head Start workers in substance abuse issues. In addition, ACF provides counseling, education, referral and other services to high-risk, runaway and homeless youth. More information on ACF programs is available at http://www.acf.hhs.gov/.
Programs Serving American Indians and Alaska Natives. Substance abuse continues to be a leading contributor to health problems among American Indians and Alaska Natives. The Indian Health Service (IHS) funds approximately 400 alcoholism and substance abuse programs and establishes cooperative agreements with other Federal and private programs to provide a number of treatment and prevention services to rural and urban communities. More information on IHS programs is available at www.ihs.gov/MedicalPrograms/Behavioral.
Inpatient/Outpatient Benefits. The Medicaid program helps thousands of Americans each year overcome drug addiction. Medicaid may cover some emergency treatment of drug-related symptoms, detoxification and rehabilitation as well as some outpatient services. Many states have also used Medicaid waivers to implement managed care programs targeted at substance abuse. Information on Medicaid is available at www.cms.hhs.gov/medicaid/.
Recovery Community Service Programs. Twenty-nine community-based organizations with new or ongoing involvement in substance abuse treatment activities have received SAMHSA grants -- totaling $7.9 million in FY 2005 -- to foster participation of people in recovery and their family members in the program's dialogue about addiction, treatment and recovery. Grantees are expected to develop, design, deliver and document peer-driven recovery support services that help prevent relapse and promote long-term recovery from alcohol and drug use disorders.
Workplace Programs. This SAMHSA program deals with substance abuse prevention, early identification and intervention, and drug testing programs for 120 Federal agencies and over 600,000 regulated industries within the Department of Transportation, Nuclear Power Generation and the Department of Energy. In addition, by working with non-Federal, public and other private employers and managed care organizations, SAMHSA helps improve substance abuse prevention and education programs in the workplace. A SAMHSA-supported Workplace Helpline, 1-800-967-5752 (WORKPLACE), also provides assistance to employers who are developing and implementing substance abuse prevention programs. More information on workplace programs is available at www.drugfreeworkplace.gov.
HHS Campaigns to Prevent and Treat Substance Abuse
In addition to the programs and services that the department supports, HHS has joined with numerous private and public partners to establish comprehensive prevention campaigns to educate the public about the dangers of illicit drug use, particularly among youth. Following are just a few examples of those initiatives:
Marijuana. To reduce marijuana use among American youth, HHS maintains a comprehensive marijuana initiative including support for new research on the effects of marijuana and the launch of campaigns to help parents educate children about the dangers of drugs. The"NIDA Goes Back to School" initiative was launched in 2003 to keep teachers and parents informed of current scientific findings on drug abuse. Information about NIDA's campaign may be obtained at www.backtoschool.drugabuse.gov or by calling 1-800-729-6686. NIDA also collaborates with Scholastic Publishing to place articles in several of their magazines that go to classrooms for use in lessons. The special series, "Heads Up: Real News about Drugs and Your Body," has appeared in print and online since 2002. SAMHSA has been working with ONDCP to promote its educational programs about marijuana use and recently published a 4-volume education and training series for health professionals focusing on cannabis use among youth. Information about SAMHSA's activities may be obtained at www.samhsa.gov.
Club Drugs. In 1999, NIDA launched a new national education, prevention and research initiative to combat the increased use of club drugs such as ecstasy. More information is available at www.clubdrugs.gov. In 2003, NIDA launched a site designed especially for teens that includes information on drugs of abuse and shares stories from teens who have struggled with addiction. Information about that site can be found at www.teens.drugabuse.gov. This year, SAMHSA is making $4 million in grant funds available to states and communities to expand prevention activities related to use of ecstasy and other club drugs, including GHB, ketamine, Rohypnol, and LSD. SAMHSA also focuses on the dangers of club drugs in its national drug abuse data collection efforts, its substance abuse publications and in other awareness programs. Information from SAMHSA -- including the latest data on club drug use -- is available at www.samhsa.gov.
Steroids. Recognizing several years ago from MTF data that steroid abuse may be on the rise, NIDA joined with seven national partners in 2000 to launch an initiative to alert the public about the risks associated with anabolic steroid use. NIDA's public service ads on steroid abuse -- Game Plan -- were reissued in Spring 2005 to television stations around the country. More information is available at www.steroidabuse.gov.
Alcohol. At the request of the Secretary of Health and Human Services, the Administrator of SAMHSA, Charles G. Curie, M.A., A.C.S.W., convened the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) in 2004. The Committee is made up of representatives from the Department of Health and Human Services' Office of the Surgeon General (OSG), Centers for Disease Control and Prevention (CDC), Administration for Children and Families (ACF), Office of the Assistant Secretary for Planning and Evaluation (ASPE), National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism (NIH/NIAAA); the Department of Justice/Office of Juvenile Justice and Delinquency Prevention (DOJ/OJJDP); the Department of Education/Office of Safe and Drug Free Schools (ED/OSDFS); the Department of Transportation/National Highway Traffic Safety Administration (DOT/NHTSA); the White House Office of National Drug Control Policy (ONDCP); the Department of the Treasury; the Department of Defense (DOD); and, ex officio, the Federal Trade Commission (FTC). In the fall of 2005, the ICCPUD and SAMHSA held a national meeting of states on the prevention of underage alcohol use. This meeting provided an opportunity for teams from the states to consider how their state could strengthen its efforts to address the problem based on the most recent research, and to plan participation in a nationwide series of town hall meetings in March 2006. SAMHSA will provide stipends of $1,000 to 1500 communities across the country to assist them in holding town hall meetings addressing the prevention of underage drinking.
ICCPUD is intended to serve as a mechanism for coordinating Federal efforts aimed at reducing underage drinking and to serve as a resource for the development of a comprehensive plan for combating underage drinking. HHS made ICCPUD a standing committee to provide ongoing, high-level leadership on this issue and to serve as a mechanism for coordinating federal efforts aimed at preventing and reducing underage drinking.
One of NIAAA's research priorities is addressing the major public health problem of underage drinking. As part of its initiative, NIAAA has convened an expert panel to help stimulate research on underage drinking. The 18-member panel consists of experts in adolescent development, child health, brain imaging, genetics, neuroscience, prevention research, and other research fields as well as individuals with public policy and communications expertise. The expert panels' mission is to advise NIAAA on future research to improve the prevention and treatment of underage drinking by including a developmental perspective. Other NIAAA underage drinking prevention activities include the following.
National Alcohol and Drug Addiction Recovery Month. SAMHSA's annual September public education campaign, now in its 17th consecutive year, celebrates the gains made by people in recovery from alcohol or substance abuse and lauds the benefits of substance abuse treatment. The theme for the 2006 observance is "Join the Voices for Recovery: Build a Stronger, Healthier Community." More information on the observance is available at www.recoverymonth.gov.
Prescription Drug Abuse. To raise awareness about and increase research efforts on the misuse and abuse of prescription drugs, NIDA has launched a Prescription Drug Abuse Initiative. A bulletin about prescription drug abuse and misuse will be sent to community leaders, health professionals, parents and other key audiences in the Fall of 2005. More information on the initiative is available at www.drugabuse.gov/DrugPages/Prescription.html. In addition, the Food and Drug Administration and SAMHSA have joined together to increase the knowledge of health care professionals and consumers about this topic. This two-part effort was launched in early 2003 with materials targeting youth and young adults ages 15-25; materials focusing on older Americans were released in May 2004 (ages 60+) and in May 2005 (50-60 year olds) for the Older Americans month observance.
Methamphetamine. Abuse of methamphetamine continues to rise in certain regions of the country. NIDA continues to support research and works to increase public awareness of meth's dangers via publications, media outreach, and its science education programs. In 2005 SAMHSA provided $5.4 million for the first year of three year grants to provide treatment for methamphetamine abuse and other emerging drugs for adults residing in rural communities. The 11 grant three-year program will total $16.2 million. These grants follow six grants awarded in 2004.
Inhalants. When 2004 MTF data showed an increase in inhalant abuse among 8th graders, NIDA arranged to send a bulletin to key audiences and strengthen its collaborative efforts with constituency groups like the Community Anti Drug Coalitions of America, PRIDE, and the National Inhalant Prevention Coalition. More information on inhalants is available at inhalants.drugabuse.gov. SAMHSA sponsors a press conference annually with the National Inhalant Prevention Coalition to bring attention to the dangers of inhalants, a drug of choice among the youngest drug users. SAMHSA also supports a drug treatment program for youth who abuse inhalants in Alaska.
Drug Abuse and HIV. In response to the concern about the HIV infection rate among young people and the disproportionate numbers among African Americans, Hispanics and women, NIDA has launched a public awareness campaign, Drug Abuse and HIV: Learn the Link, in time for World AIDS Day, December 1. In addition to sending ads to television networks and stations around the country, NIDA is building coalitions with appropriate national, state and local organizations such as the United Negro College Fund Special Programs Corporation, AIDS Alliance for Children, Youth & Families, and the American Academy of Child and Adolescent Psychiatry. Information about these activities and the connections between drug abuse and HIV infection can be found at hiv.drugabuse.gov.
HHS Research Into Drug Abuse Prevention and Treatment
Drug Abuse Research. NIDA supports most of the world's research on drug abuse and drug addiction to provide a scientific foundation for prevention and treatment. Examples of recent and ongoing research include: studying the environmental and genetic bases of addiction; developing medications to treat drug addiction; developing new and improving existing behavioral and psychosocial treatments; studying the organization and financing of drug abuse treatment and linkage to primary medical care; studying abused drugs and their health consequences; studying the long-term consequences of prenatal exposure to drugs; applying state-of-the-art neuroimaging and genetics techniques to advance drug abuse prevention and treatment efforts; and designing and testing prevention programs designed for use with adolescents. NIDA's fiscal year 2006 budget is $1 billion. More information about NIDA research is available at www.drugabuse.gov.
Alcohol Research. NIAAA provides leadership and financial support for approximately 90 percent of all alcohol-related research in the United States. NIAAA research priorities include: investigating the diverse factors that influence underage drinking and developing research-based strategies to prevent underage drinking; developing new medications for alcohol use disorders; determining how genetic and environmental factors interact to promote or protect against alcohol problems; understanding the biomedical effects of alcohol, and the biological mechanisms through which these effects occur within the body; understanding positive behavior change among people with alcohol use disorders; identifying disparities in the causes and consequences of alcohol-use disorders and developing treatments and preventions to ameliorate them; evaluating the effects of alcohol in the development of birth defects and identifying prevention approaches; and understanding the role of alcohol in the epidemiology, etiology, and onset and progression of HIV/AIDS. NIAAA's fiscal year 2006 budget is $436 million. More information on NIAAA research is available at www.niaaa.nih.gov/.
HHS Resources for Consumers and Providers
Treatment Referral Services. SAMHSA's online locator system provides a private, convenient way to find treatment programs for substance abuse problems for substance abuse problems, and the name and location of physicians approved to provide buprenorphine treatment for opioid dependence. Information on more than 11,000 facilities recognized by states as appropriate sources of care can be found through this database at www.findtreatment.samhsa.gov. The service augments the locator services available through SAMHSA's English-Spanish 24-7, National Drug and Alcohol Treatment Referral Hotline at 1-800-662-HELP, which currently receives an average of 26,000 calls per month.
Hablemos en Confianza. This program built around Latino strengths is helping Hispanic families bring critical anti-drug messages home to their pre-teens and young teens. The materials for this initiative were built upon input from key leaders and focus groups from Latino communities across the country. An intergenerational communications book provides parents clear examples of ways to discuss substance abuse with family members. Supplementary products include both a children's healthy behaviors activity book (designed for ages 4-6) and a community action guide to help community leaders organize, enhance and expand local substance abuse prevention activities. Information is available at SAMHSA's website at www.samhsa.gov.
Model Programs for Substance Abuse Prevention. SAMHSA makes available a series of evidence-based programs that have produced consistent, replicable results in substance abuse prevention. To date, over 60 model programs have been identified through a rigorous peer review process. SAMHSA is in the process of expanding and evolving this system to include mental health and substance abuse treatment interventions, as well as prevention strategies and activities successfully employed by community anti-drug coalitions. The information on the current system is available at SAMHSA's website at www.modelprograms.samhsa.gov.
New Clinician's Guide. NIAAA recently released a new guide for health care practitioners to help them identify and care for patients with heavy drinking and alcohol use disorders. The 2005 edition of Helping Patients Who Drink Too Much: A Clinician's Guide provides a research-based approach to alcohol screening and brief intervention for both primary care and mental health clinicians. New and revised materials that support clinicians in conducting alcohol screening, assessments, and brief intervention include: an optional written screening tool, provided in both English and Spanish; patient education charts about US adult drinking patterns; a section about prescribing medications for alcohol dependence; forms for recording patient baseline and progress notes; resources for making referrals to treatment and support groups; and a portable, pocket-sized version of the full Guide. The Guide is available full text on NIAAA's website. For training, a PowerPoint slide show on the Guide will be posted on the website in the near future.
Guides for Treatment Providers. The SAMHSA Treatment Improvement Protocol (TIP) series provides substance abuse treatment professionals with "best practices" in treatment. SAMHSA draws on the experience and knowledge of clinical, research and administrative experts to produce each TIP. Copies of the guides are available through the SAMHSA Web site at www.samhsa.gov. New guides include "Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction"; "Substance Abuse Treatment: Group Therapy"; "Substance Abuse Treatment for Persons with Co-occurring Disorders"; "Medication Assisted Treatment for Opioid Addiction in Opioid Treatment Programs"; and Substance Abuse Treatment for Adults in the Criminal Justice System". NIAAA has developed Alcohol Problems: A Health Practitioner's Guide, a research-based publication, pocket guide and other tools that provide a quick, easy, and effective way to identify and assist patients with drinking problems. It is available online at as a PDF.
National Clearinghouse. SAMHSA maintains the National Clearinghouse for Alcohol and Drug Information, which can be reached at 1-800-729-6686 for assistance in English or Spanish, or at TDD 1-800-487-4889 for hearing-impaired callers. It is estimated that more than 100 million Americans benefit from Clearinghouse services each year. PREVLine (PREVention-on-Line), a 24-hour Web-based prevention information portal and search engine, is maintained by SAMHSA and is accessible at http://ncadi.samhsa.gov.
This article was provided by U.S. Department of Health and Human Services.