1. A New Era for Prevention: Integration is the Future Richard Lucey, Special Assistant to the Director SAMHSA’s Center for Substance Abuse Prevention 2012 MAPPA Annual Conference Moving Toward a Credentialed Workforce Ocean City, MD November 15, 2012

2. SAMHSA’s Vision Behavioral health is essential to health. Prevention works. Treatment is effective. People recover. America is a nation that understands and acts on the knowledge that …

3. What the Vision Looks Like Primary care providers monitor: – Blood pressure, body mass index, vaccines – Depression, alcohol/tobacco use School/community presentations focus on: – Academic success and health – Physical health, substance use, and emotional health Partnering at all levels

4. Daily Disaster of Unprevented and Untreated Mental and Substance Use Disorders Any Mental Illness 45.9 million Substance Use Disorder 21.6 million Diabetes 25.8 million Heart Disease 81.1 million Hypertension 74.5 million 39.2 % receiving treatment 10.8 % receiving treatment 84 % receiving treatment 74.6 % receiving screenings 70.4 % receiving treatment

5. A National Call to Action

6. SAMHSA’s Strategic Initiative #1: Prevention of Substance Abuse and Mental Illness Top Priorities Prevent substance abuse and improve well- being in states, territories, tribes Establish prevention of underage drinking as a priority issue for states, territories, tribal entities, colleges and universities, and communities. Reduce prescription drug misuse and abuse. Increase public knowledge of the warning signs for suicide and actions to take in response. – Surgeon General’s National Strategy on Suicide Prevention

7. Underage Drinking Alcohol use—and, importantly, occasions of heavy drinking— continued a long-term gradual decline among teens, reaching historically low levels in 2011. (Source: 2011 Monitoring the Future Survey) HOWEVER 19.6 percent of drivers ages 16 to 25 drive while impaired. (Source: State Estimates of Drunk and Drugged Driving, SAMHSA) Hospital emergency department visits related to underage drinking increased more than 250 percent on New Year’s Day. (Source: SAMHSA, 2009 Drug Abuse Warning Network Report)

8. Binge Alcohol Use among Adults Aged 18 to 22, by College Enrollment: 2002-2011 + Difference between this estimate and the 2010 estimate is statistically significant at the.05 level. 2011 NSDUH survey.

9. SAMHSA’s Underage Drinking Prevention Efforts – Public Awareness Times Square Coming soon State videos

10. 2011 National Survey on Drug Use and Health – Illicit Drugs In 2011, the rate of current use of illicit drugs was 22 percent among full-time college students aged 18 to 22. This was similar to the rate among other persons aged 18 to 22 (23.4 percent), which included part-time college students, students in other grades or types of institutions, and nonstudents. In 2010, among full-time college students aged 18 to 22, there was a decrease from 2009 to 2010 in the rate of nonmedical use of psychotherapeutic drugs (from 6.3 to 5.0 percent).

11. 2011 National Survey on Drug Use and Health – Tobacco Use Among 18 to 22 year olds, full-time college students were less likely to be current cigarette smokers than their peers who were not enrolled full time in college. Past month cigarette use was reported by 23.8 percent of full- time college students, less than the rate of 39.2 percent for those not enrolled full time. Among male full-time college students in 2010 aged 18 to 22, cigarette use declined from 31.7 percent in 2009 to 26.6 percent in 2011.

12. National Prescription Drug Abuse Prevention Strategy Prescriber and consumer education/awareness – More than half, 55 percent, of people 12 and older using prescription pain relievers non- medically got them from a friend or relative for free. Expanded and enhanced use of prescription drug monitoring programs Education/awareness about safe disposal of unused medicines

13. National Action Alliance for Suicide Prevention Priorities: 2012-2014 Integrating suicide prevention into health care reform and encouraging the adoption of similar measures in the private sector. Transforming health care systems to significantly reduce suicide. Changing the public conversation around suicide and suicide prevention. Increasing the quality, timeliness, and usefulness of surveillance data regarding suicidal behaviors.

14. Suicide among Youth Suicide is the third leading cause of death among 15 to 24 year olds. Suicides account for 1.4 percent of all deaths in the U.S. annually, but they comprise 12 percent of all deaths among 15 to 24 year olds. For every youth who dies by suicide, 100 to 200 attempts are made. LGBT youth are 2 to 3 times more likely to commit suicide than other youth.

15. Mental Health of College Students 44 percent of college students have severe psychological disorders and 24 percent take psychiatric medication. Source: American College Counseling Association In the past 12 months: 46 percent of college students felt things were hopeless. Nearly a third reported that they felt so depressed it was difficult to function. 48 percent felt overwhelming anxiety. 56 percent felt very lonely. 48 percent felt overwhelming anger. 6 percent seriously considered suicide. Source: American College Health Association

16. Strategic Prevention Framework Guides Practice SAMHSA’s Strategic Prevention Framework Defines and prioritizes core prevention principles, enabling the alignment and allocation of available resources Community behavioral health practices must be “locally grown and tested”

17. What Do Americans Believe About Addiction? … and about one in three think less of someone currently addicted … and three-quarters think recovery is possible Yet, two-thirds think addiction can be prevented … One in five think less of a friend/relative in recovery from an addiction …

18. What Do Americans Believe About Mental Illness? The majority, two out of three, think treatment and support can help people with mental illness lead normal lives. And, Only one in five think people with a mental illness are dangerous to others.

19. Up to half of people with a serious mental illness will develop a substance use disorder at some time in their lives. Alcohol dependence is four times more likely to occur among adults with mental illness than among adults with no mental illness. Many health care systems that treat substance abuse and mental illness are disconnected: a missed opportunity. Substance Abuse and Mental Illness Are Linked Substance abuse and mental illness share risk and protective factors.

20. Changing the Conversation: Behavioral Health Is Part of Overall Health Americans know risk factors for chronic conditions such as diabetes, hypertension, and cardiovascular disease. However, many people do not know the warning signs for suicide, addiction, or mental illness. … Nor do they know what to do to help themselves or others.

21. People with mental health problems are at higher risk for non- communicable diseases. – Diabetes – Cardiovascular disease – Obesity – Substance use (tobacco, alcohol, drugs) People with non-communicable diseases are at risk for mental health problems. Mental Health Affects Physical Health and Vice Versa 21

22. Mental health problems increase risk for physical health problems. Substance use disorders increase risks for chronic diseases, HIV/AIDS, STDs. Cost of treating common diseases is higher with untreated behavioral health problems. –Hypertension – 2X the cost –Coronary heart disease – 3X the cost –Diabetes – More than 4X the cost Impact of Behavioral Health on Physical Health

23. Everyone Has a Part: Communities Embrace health reform prevention opportunities Partner Work with other states Focus on recovery support ― help people get well and stay well

24. Everyone Has a Part: Health Systems, Insurers, Physicians ID and screen patients for excessive drinking. ID patients for depression, other mental illness. ID, track, and prevent inappropriate patterns of prescribing. Develop and adopt evidence- based guidelines for prescribing opiates. –State prescription drug monitoring plans.

25. Maryland: Progress! Promoting the Maryland Strategic Prevention Framework across the state Strengthening the foundation for an integrated behavioral health care system Developing a strategic plan to deal with the prescription drug overdose problem

26. Maryland: Challenges and Opportunities Tough economic climate – Maintaining momentum will be hard. – Strategic approach is vital. – Keep prevention in the spotlight. – Opportunity for new collaborations.

27. A Bold Vision: Can We Imagine a Generation… Without a death by suicide? Of youth without substance abuse? Without one young person being bullied because they are LGBT? In which no one in recovery struggles to find a job? … in which behavioral health is truly an essential part of primary care.

28. Collaboration Is Key! Center for Substance Abuse Prevention Center for Mental Health Services Center for Substance Abuse Treatment Center for Behavioral Health Statistics and Quality http://www.samhsa.gov