1. Wisconsin Department of Health Services January 2014 P-00522D Healthiest Wisconsin 2020 Baseline and Health Disparities Report Alcohol and Other Drug Use

2. ALCOHOL AND OTHER DRUG USE Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthiest Wisconsin 2020 objectives and indicators Rationale Key points Data Risk behaviors among youth Risk behaviors among adults Alcohol consumption and availability Adverse health outcomes Consequences of substance abuse References Links to additional reports and resources Contacts Chapter Outline 2 Chapter outline

3. ALCOHOL AND OTHER DRUG USE Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf Report overview 3

4. ALCOHOL AND OTHER DRUG USE Report Format Full Report Format: PDF Intended use: reference document Chapters Format: Annotated PowerPoint slide set Intended uses: presentations to –Decision-makers –Service providers –Community leaders –The public Sample annotated slide Report overview 4

5. ALCOHOL AND OTHER DRUG USE Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes Report overview 5

6. ALCOHOL AND OTHER DRUG USE Report Outline: Detail Section 3: Health focus areas Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas Access to health care Report overview 6

7. ALCOHOL AND OTHER DRUG USE Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

8. ALCOHOL AND OTHER DRUG USE Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non- Hispanic. Report overview 8

9. ALCOHOL AND OTHER DRUG USE Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach Report overview 9

10. ALCOHOL AND OTHER DRUG USE Healthiest Wisconsin 2020 objectives and indicators Objective 1 By 2020, reduce unhealthy and risky alcohol and other drug use by changing attitudes, knowledge, and policies, and by supporting services for prevention, screening, intervention, treatment and recovery. Objective 1 Indicators State rates and rankings of selected youth and adult behaviors related to unhealthy and risky alcohol and other drug use. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Alcohol and Other Drug Use Focus Area Profile. 10 HW2020 objectives

11. ALCOHOL AND OTHER DRUG USE Healthiest Wisconsin 2020 objectives and indicators Objective 2 By 2020, assure access to culturally appropriate and comprehensive prevention, intervention, treatment, recovery support and ancillary services for underserved and socially disadvantaged populations who are at higher risk for unhealthy and risky alcohol and other drug use. Objective 2 Indicators Periodic inventory of the proportion of counties with local capacity to provide alcohol and other drug abuse prevention, intervention (including criminal justice diversion), treatment, recovery support and ancillary services across all revenue streams for underserved and socially disadvantaged populations. Periodic inventory of the proportion of counties with services specific to racial and ethnic minorities; women; and lesbian, gay, bisexual and transgender populations. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Alcohol and Other Drug Use Focus Area Profile. 11 HW2020 objectives

12. ALCOHOL AND OTHER DRUG USE Healthiest Wisconsin 2020 objectives and indicators Objective 3 By 2020, reduce the disparities in unhealthy and risky alcohol and other drug use among populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status. Objective 3 Indicators Unhealthy and risky alcohol and other drug use by race, ethnicity, sexual identity and orientation, gender identity, and educational or economic status. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Alcohol and Other Drug Use Focus Area Profile. 12 HW2020 objectives

13. ALCOHOL AND OTHER DRUG USE Rationale Alcohol and other drug abuse is any use of one or more mood-altering, habit-forming substances that results in negative consequences. Adverse health outcomes associated with excessive alcohol consumption include cirrhosis of the liver and other chronic diseases, alcohol dependence, and fetal alcohol spectrum disorder. Individuals who abuse alcohol and other drugs are more likely to engage in risky behaviors that may result in motor vehicle accidents and fatalities, employment problems, relationship problems, unplanned pregnancies and sexually transmitted diseases, birth abnormalities, child abuse, and crime. The abuse of illicit drugs, like heroin, cocaine, marijuana, and including the non-medical use of mood-altering prescribed drugs, inflicts harm upon individuals, families, and communities. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Alcohol and Other Drug Use Focus Area Profile. 13 Rationale

14. ALCOHOL AND OTHER DRUG USE Key points Adult risk behaviors In 2011, Wisconsin ranked first in the nation for both heavy drinking and binge drinking among adults. Significant disparities exist in the prevalence of adult risk behaviors. For example: o Binge drinking rates were significantly higher among males and younger age groups. o Binge drinking rates were significantly lower for Black adults compared to Whites; people in the lowest income and education levels; and in Milwaukee County compared to smaller metropolitan and non- metropolitan counties. 14 Key points

15. ALCOHOL AND OTHER DRUG USE Key findings Adult health outcomes and consequences of substance abuse In 2011, the estimated annual costs associated with excessive alcohol use in Wisconsin totaled $6.8 billion. From 2002 to 2010, both alcohol- and drug-related hospitalization rates increased in Wisconsin. Significant disparities exist in the prevalence of adverse consequences associated with substance abuse. For example: o The death rate from alcoholic liver disease among American Indians in Wisconsin was much greater than the rate for Whites, similar to national differences. Drug-related deaths involving heroin or other opioids increased nearly four- fold during 2000-2011 15 Key points

16. ALCOHOL AND OTHER DRUG USE Key findings: Youth risk behaviors Youth In Wisconsin, more than one-third of high school students drank alcohol within the past 30 days. Significant disparities exist in the prevalence of youth risk behaviors. For example: o White students were significantly more likely to binge drink than were Black, Hispanic, and Asian students. o Current marijuana use among Black students was significantly higher than among White, and Asian students. o Early initiation of alcohol use (before age 13) was most prevalent among Latino and Black students; early initiation of marijuana use was most prevalent among Black and American Indian students. o Sexual minority students had much higher rates of marijuana, cocaine, inhalants, and heroin use compared to sexual majority students. o Sexual minority students had higher rates of early initiation of both alcohol and marijuana use than sexual majority students. 16 Key points

17. ALCOHOL AND OTHER DRUG USE Risk behaviors among youth 17

18. ALCOHOL AND OTHER DRUG USE Rates of current drinking, binge drinking, and marijuana use among Wisconsin high school students, by race/ethnicity, 2007-2011 Risk behaviors among youth Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. 18

19. ALCOHOL AND OTHER DRUG USE Rates of current drinking, binge drinking, and marijuana use among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Risk behaviors among youth 19

20. ALCOHOL AND OTHER DRUG USE Rates of lifetime use of cocaine, inhalants, and heroin among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Risk behaviors among youth 20

21. ALCOHOL AND OTHER DRUG USE Lifetime use of cocaine, inhalants, and heroin among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Risk behaviors among youth 21

22. ALCOHOL AND OTHER DRUG USE Rates of early initiation of alcohol and marijuana use among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Risk behaviors among youth 22

23. ALCOHOL AND OTHER DRUG USE Early initiation of alcohol and marijuana use among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Risk behaviors among youth 23

24. ALCOHOL AND OTHER DRUG USE Risk behaviors among adults 24

25. ALCOHOL AND OTHER DRUG USE Rates of binge drinking and heavy drinking among Wisconsin adults, by sex, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset. Risk behaviors among adults 25

26. ALCOHOL AND OTHER DRUG USE Rates of binge drinking and heavy drinking among Wisconsin adults, by age group, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset. Risk behaviors among adults 26

27. ALCOHOL AND OTHER DRUG USE Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Risk behaviors among adults 27

28. ALCOHOL AND OTHER DRUG USE Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by household income level, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Risk behaviors among adults 28

29. ALCOHOL AND OTHER DRUG USE Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by education level, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Risk behaviors among adults 29

30. ALCOHOL AND OTHER DRUG USE Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by level of urbanization, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Risk behaviors among adults 30

31. ALCOHOL AND OTHER DRUG USE Rates of binge drinking and heavy drinking among Wisconsin adults ages 18-64, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Risk behaviors among adults 31

32. ALCOHOL AND OTHER DRUG USE Binge drinking among Wisconsin adults, by sexual orientation, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. 32 Risk behaviors among adults

33. ALCOHOL AND OTHER DRUG USE Alcohol consumption and availability 33

34. ALCOHOL AND OTHER DRUG USE Alcohol consumption by state, gallons per capita, 2009 Source: National Institute on Alcoholism and Alcohol Abuse, Alcohol Epidemiologic Data System. Gallons per capita Alcohol consumption and availability U.S. average: 2.3 gallons per capita Wisconsin: 3.0 gallons per capita 34

35. ALCOHOL AND OTHER DRUG USE Alcohol outlet density, people per license, Wisconsin, 2011-2012 Source: Wisconsin Department of Health Services, Division of Mental Health and Substance Abuse Services, Bureau of Prevention, Treatment and Recovery; and the University of Wisconsin Law School, Resource Center on Impaired Driving, Wisconsin Alcohol Policy Project. Alcohol consumption and availability 35

36. ALCOHOL AND OTHER DRUG USE Adverse health outcomes and costs 36

37. ALCOHOL AND OTHER DRUG USE Alcoholic liver disease deaths by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines; this means a rate may not be presented for every population group. Adverse health outcomes 37

38. ALCOHOL AND OTHER DRUG USE Alcoholic liver disease deaths by county, age-adjusted rate per 100,000, Wisconsin, 2006-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines; this means a rate may not be presented for every population county. Adverse health outcomes 38

39. ALCOHOL AND OTHER DRUG USE Total motor vehicle crash fatalities and alcohol-related motor vehicle crash fatalities, Wisconsin, 2006-2011 Source: Wisconsin Department of Transportation, final year crash statistics (June 2012). Note: These figures represent final statistics for crashes that occurred on public roads in Wisconsin. Adverse health outcomes 39

40. ALCOHOL AND OTHER DRUG USE Alcohol- and drug-related hospitalizations, rate per 100,000, Wisconsin 2002-2010 Source: Wisconsin Department of Health Services: Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012. Adverse health outcomes 40

41. ALCOHOL AND OTHER DRUG USE Alcohol-related hospitalizations by county, rate per 100,000,Wisconsin, 2009-2010 Source: Wisconsin Department of Health Services: Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012. Adverse health outcomes 41

42. ALCOHOL AND OTHER DRUG USE Source: Wisconsin Department of Health Services, Office of Health Informatics, Wisconsin death certificates. Note: Includes all deaths to Wisconsin residents or occurring in Wisconsin. Opiate-related deaths, rate per 100,000, Wisconsin, 2000-2011 Adverse health outcomes 42

43. ALCOHOL AND OTHER DRUG USE Source: Wisconsin Department of Health Services, Wisconsin Electronic Disease Surveillance System. Note: Reflects cases reported as of September 2013. Reported hepatitis C virus infections among people ages 15-29, rate per 100,000, Wisconsin, 2003-2012 Adverse health outcomes 43

44. ALCOHOL AND OTHER DRUG USE Estimated annual economic costs of excessive alcohol use in Wisconsin, 2011 Source: University of Wisconsin Population Health Institute: The Burden of Excessive Alcohol Use in Wisconsin, March 2013. Total annual cost: $6.8 billion Consequences of substance abuse 44

45. ALCOHOL AND OTHER DRUG USE References 1.University of Wisconsin Population Health Institute. County Health Rankings 2013. http://www.countyhealthrankings.org/our-approach http://www.countyhealthrankings.org/our-approach 2.Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 3.LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic% 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic% 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 4.Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ 5.Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf 6.National Institute on Drug Abuse. Drug Facts: Alcohol. http://www.drugabuse.gov/drugs-abuse/alcohol http://www.drugabuse.gov/drugs-abuse/alcohol 7.National Institute on Drug Abuse. Drug Facts: Marijuana. http://www.drugabuse.gov/publications/drugfacts/marijuana http://www.drugabuse.gov/publications/drugfacts/marijuana 8.National Institute on Drug Abuse. Drug Facts: Cocaine. http://www.drugabuse.gov/publications/drugfacts/cocaine http://www.drugabuse.gov/publications/drugfacts/cocaine 45 References

46. ALCOHOL AND OTHER DRUG USE 9.National Institute on Drug Abuse. Drug Facts: Inhalants. http://www.drugabuse.gov/publications/drugfacts/inhalants http://www.drugabuse.gov/publications/drugfacts/inhalants 10.National Institute on Drug Abuse. Drug Facts: Heroin. http://www.drugabuse.gov/publications/drugfacts/heroin http://www.drugabuse.gov/publications/drugfacts/heroin 11.CDC. Fact sheets - Underage drinking. http://www.cdc.gov/alcohol/fact- sheets/underage-drinking.htmhttp://www.cdc.gov/alcohol/fact- sheets/underage-drinking.htm 12.National Institute on Drug Abuse. Marijuana’s Lasting Effects on the Brain. http://www.drugabuse.gov/about-nida/directors-page/messages- director/2013/01/marijuanas-lasting-effects-brain http://www.drugabuse.gov/about-nida/directors-page/messages- director/2013/01/marijuanas-lasting-effects-brain 13.CDC. Alcohol Use and Health. http://www.cdc.gov/alcohol/fact-sheets/alcohol- use.htmhttp://www.cdc.gov/alcohol/fact-sheets/alcohol- use.htm 14.CDC. BRFS Prevalence and Trends Data. http://apps.nccd.cdc.gov/brfss/http://apps.nccd.cdc.gov/brfss/ 15.National Institute on Alcoholism and Alcohol Abuse. Surveillance Report #92, Apparent per Capita Alcohol Consumption: National, State, and Regional Trends. http://pubs.niaaa.nih.gov/publications/Surveillance92/CONS09.htm#top http://pubs.niaaa.nih.gov/publications/Surveillance92/CONS09.htm#top 16.CDC. Preventing Excessive Alcohol Consumption: Regulation of Alcohol Outlet Density. http://www.thecommunityguide.org/alcohol/outletdensity.html 17.Wisconsin Department of Health Services (DHS). Alcohol License Overview for Wisconsin, 2012. http://www.dhs.wisconsin.gov/substabuse/docs/AlcDensity/AlcoholOutletReport- Wisconsin.pdf http://www.dhs.wisconsin.gov/substabuse/docs/AlcDensity/AlcoholOutletReport- Wisconsin.pdf 46 References

47. ALCOHOL AND OTHER DRUG USE 18.National Institutes of Medicine, Medline Plus. Alcoholic Liver Disease. http://www.nlm.nih.gov/medlineplus/ency/article/000281.htm 19.CDC. CDC WONDER. http://wonder.cdc.gov/http://wonder.cdc.gov/ 20.National Highway Traffic Safety Administration. An Analysis of the Significant Decline in Motor Vehicle Traffic Fatalities in 2008. http://www- nrd.nhtsa.dot.gov/Pubs/811346.pdfhttp://www- nrd.nhtsa.dot.gov/Pubs/811346.pdf 21.Alcohol-Related Disease Impact (ARDI). http://apps.nccd.cdc.gov/ARDI/HomePage.aspx 22.DHS. Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012. http://www.dhs.wisconsin.gov/publications/P4/P45718-12.pdf http://www.dhs.wisconsin.gov/publications/P4/P45718-12.pdf 23.Wisconsin State Council on Alcohol and Other Drug Abuse: 911 Good Samaritan Recommendations: Analysis and Recommendations for Reducing Drug-related Overdoses in Wisconsin, 2013. http://www.scaoda.state.wi.us/docs/911GSL/GoodSamFINAL081213.pdf http://www.scaoda.state.wi.us/docs/911GSL/GoodSamFINAL081213.pdf 24.Page, K. et al. Injection Drug Use and Hepatitis C Virus Infection in Young Adult Injectors: Using Evidence to Inform Comprehensive Prevention, Clinical Infectious Diseases, 2013:57 (Suppl 2). 25.University of Wisconsin Population Health Institute. The Burden of Excessive Alcohol Use in Wisconsin, March 2013. http://uwphi.pophealth.wisc.edu/publications/other/burden-of-excessive-alcohol-use- in-wi.pdf http://uwphi.pophealth.wisc.edu/publications/other/burden-of-excessive-alcohol-use- in-wi.pdf 47 References

48. ALCOHOL AND OTHER DRUG USE Links to additional reports and resources Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2012: http://www.dhs.wisconsin.gov/publications/P4/P45718-12.pdf Alcohol License Overview for Wisconsin, 2012: http://www.dhs.wisconsin.gov/substabuse/docs/AlcDensity/AlcoholOutletRe port-Wisconsin.pdf Wisconsin State Council On Alcohol and other Drug Abuse: http://www.scaoda.state.wi.us/ http://www.scaoda.state.wi.us/ University of Wisconsin Population Health Institute: The Burden of Excessive Alcohol Use in Wisconsin, March 2013. http://uwphi.pophealth.wisc.edu/publications/other/burden-of-excessive- alcohol-use-in-wi.pdf http://uwphi.pophealth.wisc.edu/publications/other/burden-of-excessive- alcohol-use-in-wi.pdf 48

49. ALCOHOL AND OTHER DRUG USE Contact Mike Quirke Wisconsin Division of Mental Health and Substance Abuse Services Wisconsin Department of Health Services Email: Michael.Quirke@dhs.wisconsin.govMichael.Quirke@dhs.wisconsin.gov 49