PREVENTION PRIORITIES, OPPORTUNITIES, CHALLENGES & THE NUMBERS THAT DRIVE THEM Pamela S. Hyde, J.D. SAMHSA Administrator SAMHSA CSAP Prevention Day National Harbor, MD February 4, 2013

PREVENTING...  To avoid doing; to stay away from dangerous or risky things  Measures taken to prevent diseases or injuries rather than curing them or treating their symptoms

PROMOTING...  To present information to consumers as well as others  To increase demand  To differentiate a product

PROMOTING...  Attitudes  Beliefs and Values  Skills  Policies  Environmental Factors  Actions/Behaviors

SAMHSA PREVENTION PRIORITIES  Substance Abuse and Mental Illness; Build Emotional & Behavioral Health  Suicide Prevention  Prevent Underage Drinking  Prescription Drug Abuse/Misuse 5

PROGRESS MADE AMONG YOUTH/YOUNG PEOPLE  Tobacco use is   Cocaine use is   Methamphetamine use is   Abuse/Misuse of prescription drugs is  (depending on age group)  Underage Drinking is  (except yr olds)  Use of hallucinogens is  6

YET, FOR 12 AND OLDER... STAGNANT OR SLIGHTLY ↑  Current illicit drug users 8.7 percent of pop. (22.5 million) in 2011 from 8.1 percent in 2008  Marijuana 7.0 percent of pop. (18.1 million) in 2011 from 5.8 percent in 2007  Heroin 620,000 people in 2011 from 373,000 in

FIRST TIME USE/INITIATES & OLDER – INITIATED USE BEFORE AGE 18  ~2.9 M used alcohol for the first time; ~7,900 new users/day  ~1.5 M used marijuana for the first time; ~4,100 new users/day  ~1.3 M smoked cigarettes for first time; ~3,700 new users/day  ~800,000 used prescription pain relievers non-medically for the first time; ~2,100 new users/day  ~500,000 used inhalants for the first time; ~1,300 new users/day  ~500,000 used hallucinogens for first time; ~1,400 new users/day  ~200,000 used cocaine for the first time; ~500 new users/day 8

WHEN PREVENTION FALLS SHORT…  Untreated Substance Abuse/Misuse/Addiction 21.6 M adults needing specialized treatment for an illicit drug or alcohol use problem in 2011 – only 10.8 percent received needed treatment (2.3 M)  Long Time Elapses Before Treatment Among 669,000 adults admitted for SA treatment for the first time, an average of 15.6 years had elapsed since the first time they started using the substance (2010 TEDS) Longer for males than females (16.5 years versus 13.8 years) and longest for alcohol (20.2 years) while shortest for prescription painkillers (7.8 years) 9

 Suicide: 2,286 ages 12 to 20  Homicide: 2,930 ages 12 to 20 years PREVENTABLE DEATHS CDC WISQARS, 2011  Motor Vehicle Crashes: 2,739 ages 15 to 20 10

ALCOHOL ABUSE/UNDERAGE DRINKING: DEADLY REACH All ages combined: ~ One-third (31.5 percent) of homicides and ~ one-quarter (22.7 percent) of suicides were alcohol attributable, occurring when decedent had a BAC ≥ 0.10 g/dL 11

MISSED OPPORTUNITIES TO SAVE LIVES Of 2,739 young drivers ages killed in MVCs, 694 (25 percent) had a BAC ≥.08 g/dL Among 16 to 20 years old at 0.08 percent BAC, male drivers were 52 times more likely than sober male drivers the same age to die in a single-vehicle fatal crash 12

UNDERAGE DRINKING – DESPITE PROGRESS...  Remains unacceptably high  Alcohol remains most widely used substance of abuse among our Nation’s young people  When youth drink, they tend to drink in extreme ways/binge  Two-thirds (> 67 percent) of young people who start drinking before age 15 will try an illicit drug  > 4 in 10 who begin drinking before age 15 eventually become dependent on alcohol 13

SUICIDE – DEATHS AND ATTEMPTS  Annually, 11 M+ Americans seriously consider taking their own lives 8 M make a plan 2.5 M > 14 years attempt 38,000+ died from suicide in 2010  America loses ~ 100 people every 24 hours Not to battles of war, acts of terrorism, or natural disasters, but to suicide 14

PRESCRIPTION DRUGS  Nation's most prevalent illicit drug problem after marijuana ~22 M persons initiated nonmedical pain reliever use since 2002 ~1 in 22 (4.6 percent) reported misuse/abuse of prescription pain relievers (2010 & 2011) US represents 4.5% of world’s population, yet consumes 99% of world’s hydrocodone (Internat’l Narcotics Control Bd)  Emergency room visits Non-medical use of ADHD stimulant medications nearly tripled from 5,212 to 15,585 visits; about one-fifth involved illicit drugs (21 percent) or alcohol (19 percent) 2005 – 2010  SU treatment admissions Benzodiazepine and narcotic pain reliever abuse ↑ percent (from 5,032 admissions in 2000 to 33,701 admissions in 2010) 15

SOME FAMILY AND FRIENDS AREN’T HELPING  Marijuana – ~ 70 percent of 523,000 teens aged received the drug for free the last time they used – Over half (55.6-percent) received from friends – Over 10 percent received from someone in their family  Prescription Pain Relievers – 54 percent of persons 12 and ↑ who used non-medically received them from a friend or relative for free  Alcohol – ~20 percent of the time, parents, guardians, or other adult family members provided alcohol for underage drinkers 16

PREVENTION’S POWER: PERCEPTION OF RISK Percentage of adolescents (12 to 17) who perceived great risk from having five or more alcoholic drinks once or twice a week ↑ (38.2 percent in 2002 to 40.7 percent in 2011) – During same period, the rate of binge alcohol use among adolescents  (10.7 to 7.4 percent) COMPARED TO Percentage of adolescents who perceived great risk from smoking marijuana once or twice a week  from 54.6 to 44.8 percent – During same period ( ), rate of past month marijuana use among adolescents ↑ from 6.7 to 7.9 percent 17

ON PREVENTION’S HORIZON – OPPORTUNITIES  ACA Implementation New opportunities for selective (screening) and indicated prevention (brief intervention) Parity  National Prevention Strategy & National Prevention Council Action Plan (part of ACA) Tobacco Alcohol Substance Abuse Depression/MI screening 18

ON PREVENTION’S HORIZON – OPPORTUNITIES  National Suicide Prevention Strategy & Pres’ Exec Order re MH for Military & Vets SA & MH – Prevention, treatment, research, workforce Suicide screening in MU2 (ACA)  Anti-Bullying Efforts – WH/ED/HHS  National Dialogue on Mental Health Secretaries of Dept of Ed and HHS will soon launch, to help change the conversation and galvanize action Violence – MI is the focus; SA a bigger problem

ON PREVENTION’S HORIZON – CHALLENGES  Marijuana – attitudes and laws  Synthetic Drugs of Abuse  Prescription Drugs  Weight Control Medications  Deficits/Sequester/State & Local Funding  Immigration and Gun Safety  PREVENTION NOT A PRIORITY SA /MH still seen as a social or moral issue rather than a public health issue!

COMMUNITIES AND GRANTEES  Make your voices heard in health reform  Stay current with National Strategies  Join or Lead Local Dialogues  Partner  Send the message every chance you get... PREVENTION WORKS! 21