SUD PREVENTION FOR YOUNG ADULTS (18-25 YEAR OLD) NASADAD Annual Meeting Presentation Indianapolis, Indiana May 25, 2017, 1:45p.m.

A bit about Washington 6.8 Million People Approx. 4 million of them in 4 largest counties 71,362quare Miles Largest ferry system in the US and 4th largest in the world Includes Desert, Coast, Glaciers, Rain Forest, 15 National Parks, Home to Starbucks and Microsoft

Surveillance Prevention Intervention Challenges Recommendations Overview Surveillance Prevention Intervention Challenges Recommendations Surveillance will cover the Young Adult Survey process topics key findings Prevention summarizes two things: College Coalition for Substance Abuse Prevention Campus health center SBIRT efforts through carryover WASBIRT funds SPE Young Adults & Pregnant Women Alcohol & Marijuana Misuse/Abuse Prevention workgroup efforts Intervention summarizes one thing: Challenges covers systemic challenges to addressing young adult SUD prevention needs in general for WA Recommendations are for what would help WA meet the needs of young adult population SUD prevention needs

Surveillance Young Adult Survey Methodology Key Topics Key Findings

Young Adult Survey Overview Surveillance Young Adult Survey Overview Annual convenience sample survey of Young Adults starting in 2014 Initiated to get baseline data prior to recreational marijuana retail stores opening in WA. Note: Marijuana had been legalized for over a year prior to the first survey, but no retail stores had opened. Able to follow cohorts from 2014 through 2016 so far 2014 = 2101 responses 2015 = 1677 new respondents; 1203 cohort 1 follow-up 2016 = 2493 new respondents; 1005 cohort 1 follow-up; 1180 cohort 2 follow-up; Young adult survey respondents are 18-24 year olds and are convenience sampled. Recruitment was via online and direct mail. Online was via social media, Facebook, Amazon Mechanical Turk, and craigslist across all counties in WA. Direct mail was via DOL random sampling. Brief screening criteria preceded a baseline survey. All surveys were conducted with DatStat Illume survey software using a secure server and 128-bit encryption

Young Adult Survey Key Topics Surveillance Young Adult Survey Key Topics Marijuana use Perceived risk of harm Where people get marijuana Medical vs. recreational use Age of initiation Alcohol and cigarette use and combined use Also asks about opioids and a few health related behaviors such as seeing a doctor etc.

Young Adult Survey Key Findings Surveillance Young Adult Survey Key Findings Frequency of use is increasing significantly within cohorts. Perceived peer recreational marijuana use has remained largely stable across cohorts, but continues to be grossly misaligned with actual use rates. Perceived physical and psychological risk of harm continues to decrease across cohorts. This generally precedes increased use in national studies. Among those who used at least once in the last 30-days, driving within 3 hours of marijuana use is decreasing across cohorts, but remains high: in 2014, 49% drove at least once in the past month after using marijuana. This decreased to 42% in 2016. No significant difference between cohorts (different individuals interviewed in 2014, 2015, 2016) in percentage reporting they used marijuana in past year. 2016 was 45%

Young Adult Survey Key Findings Continued Surveillance Young Adult Survey Key Findings Continued Among those age 21-25, an increasing number are obtaining marijuana from retailers There is an increasing number of underage (18-20) users who are obtaining marijuana from their parents with permission. Data shows that there are an increasing number of first time users.

Young Adult Survey Key Findings Continued Surveillance Young Adult Survey Key Findings Continued There was a substantial increase, among those reporting any use in the past 30-days, in crossfading (simultaneous alcohol and marijuana use) in the past 30 days across cohorts. 2015 = about 40%; 2016 = 62% Cigarette use continues to decline: from 31% in 2014 to 28% in 2015 to 22% in 2016 Within-cohort analyses (following the same individuals over time) reveals that between 2015 and 2016, while rate of any past-year recreational marijuana use has remained stable, use among heavy users (those using at least once a week) has increased

Prevention Efforts WA SPE Consortium College Coalition STR Grant

WA State Prevention Enhancement Policy Consortium (SPE Consortium) Prevention Efforts WA State Prevention Enhancement Policy Consortium (SPE Consortium) Began meeting in 2011, with representation from multiple state agencies and tribal representatives Developed and implements the State’s SUD prevention and Mental Health Promotion Strategic Plan Includes five main workgroups with data informed action plans for each group

Prevention Efforts WA State Prevention Enhancement Policy Consortium (SPE Consortium) Continued The Young Adult & Pregnant Women Alcohol & Marijuana Misuse/Abuse Prevention Workgroup has strategies outlined specifically for young adult populations The University Of Washington is currently under contract to carry out most of these actions and uses the College Coalition to do much of this work

College Coalition for Substance Abuse Prevention Prevention Efforts College Coalition for Substance Abuse Prevention Have been meeting in some capacity since 1985 and as the College Coalition since 2001 Conduct a minimum of 3 webinars per year Past year topics have included: Standards of practice for college campuses, Vaping and e-cigs, Beyond brownies and joints: Product development and legalization, Positive community norms, and Alcohol use and suicide

College Coalition Continued Prevention Efforts College Coalition Continued Annual Conference for college level practitioners and other staff targeting college substance abuse prevention and treatment science and practices The Alcohol E-Checkup To Go program has been directly supported by the coalition and in the 2015/2016 academic year, 8,312 evidence- based check ups were completed across 10 campuses PFS funds have been identified to have the University of Washington work with our community CPWI coalitions to address young adult populations

State Targeted Response to the Opioid Crisis Grant Prevention Efforts State Targeted Response to the Opioid Crisis Grant Grant Awarded May 1, 2017 Includes 18 projects (8 prevention related and 10 treatment related) State Targeted Response (STR) to the opioid crisis grant outlines addressing young adult populations specifically through targeted campaigns addressing appropriate use, storage and disposal of opioid prescriptions as well as other opioid related messaging

Intervention Efforts SBIRT

Intervention Efforts SBIRT Program Summary Contracted with the University of Washington to conduct outreach and SBIRT training to health clinics at higher education institutions throughout the state. An initial training occurred in 2014 to gauge interest. Fully implemented in accordance to the State SPE Workgroup plans during the 2016/2017 academic year. This program was an extension activity as part of a larger Washington SBIRT (WASBIRT) grant that ran in health care facilities across the state from 2012 to 2016.

SBIRT Program in Process Intervention Efforts SBIRT Program in Process 5 institutions have conducted or have scheduled trainings for the 2016/2017 academic year 8 other institutions are in the process of securing dates or confirming availability for trainings for a total of 13. There continues to be very high interest in the program At this time, the program has been capacity building for sustainability and no immediate plans exist to identify how many screenings etc. were conducted at this point. Rather, the goal is to track how many campuses now have the capacity to use the tools at scale in their health clinics.

Challenges Limited fiscal and human resources for SUD prevention make it difficult to meet the needs of all populations including young adults WA Dedicated Marijuana Account for prevention is restricted to middle and high school youth Reaching young adult populations outside of the higher education systems while addressing their unique needs is complex and has proven difficult Context of how colleges operate within changing environments

Recommendations Identify a federal champion to drive efforts at the national level Provide funding streams that allow for states to: Build capacity to better reach young adult populations in their states Collect meaningful data from young adult populations including risk and protective factor data Directly address state identified needs among at-risk young adult populations Continue to support and disseminate research that identifies evidence- based practices for young adult populations with regards to substance use disorder prevention NIAAA – Alcohol Intervention Matrix (AIM) and ACHA standards of Practice

CONTACT Chris Imhoff, LICSW, Director Department of Social and Health Services, Behavioral Health Administration, Division of Behavioral Health and Recovery Chris.Imhoff@dshs.wa.gov (360) 725-3700