PREVENTIVE MEDICINE 22, 598-603 (1993) Alcohol and Other Drug Use’ Vivian L. Smit, M.S.W. Department of Health and Human Services, Substance Abuse and Mental Health Services ‘Administration, Center for Substance Abuse Prevention, Rockwall I1, 600 Fishers Lane, Rockville, Maryland 20857 The focus of my report is alcohol and other drug abuse among youth and adolescents. However, because, we are a new agency, I would like to give you a brief overview of the Substance Abuse and Mental Health Services Administra- tion, On July 10, 1993, President Bush signed into legislation P.L.102-321, the Alco- hol, Drug Abuse and Mental Health Reorganization Act. What that act did in effect was to separate prevention and treatment services from research. The three existing institutes, i.c., the National Institute of Mental Health, the National Institute of Drug Abuse, and the National Institute of Alcohol Abuse and Alco- holism, were reorganized and placed within the National Institutes of Health. Effective October I, the Alcohol, Drug Abuse and Mental Health Administration became the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office for Substance Abuse Prevention (OSAP) became the Center for Substance Abuse Prevention (CSAP). SAMHSA has three compo- nents: the Center for Substance Abuse Treatment, the Center for Substance Abuse Prevention, and the newly created Center for Mental Health Services. The first two centers carry over duties from the Office for Treatment Improvement and the Office for Substance Abuse Prevention. The Center for Mental Health Services will administer programs to prevent mental illness and provide mental health services. There are very few of us who have not been touched directly or indirectly by the problem of alcohol and/or other drug (AOD) abuse, particularly in relation to our young people. We face the problem in the workplace, as parents, and as members of our communities. Even young people themselves perceive a problem Accord- ing to a poll conducted by the National Association of Student Councils in the summer of 1991, 46% of its members cited alcohol as their school's leading prob- Jem (1). Furthermore, in a comparison among four different groups (Fig. 1), we find that nearly 60% of students in a rural New Hampshire elementary school have tried alcohol, in comparison with over 40% of youth from the 1990 National Household Survey of 12- to 17-year-olds (2). The 1990 Adolescent Student Health Survey (3) indicated that 80% of eighth graders had tried alcohol. Among high school seniors, the survey reveals that approximately 9 of every 10 students nationwide have tried alcohol. Of these, 6 of 10 are regular—that is, monthly— alcohol users. About one-third of 12th graders engaged in binge drinking at least * This is a summary of a talk presented at the conference The Health Status of American Children and Youth, October 5, 1993, American Health Foundation, New York. 598 (0091-7435195 $5.00 Copyright © 1983 by Academic Press All ne of reprodcton in any formPROCEEDINGS: THE HEALTH STATUS OF AMERICAN CHILDREN 599 % Who have tried alcohol 0 20 40 60 80 100 Elementary School (ural Now Hampshire) 12-17 Year Olds (Household Survey) Eighth-Grade Students (Adolescent Student Health Survey) High School Seniors (igh Schoo! Senior Survey) Use alcohol monthly {High School Senior Survey) Binge drink at least once every two weeks (High School Senior Survey) Fic. 1. Too many young people drink. ‘once every 2 weeks. Of these, 4% drink on a daily basis (4). These statistics and their corollaries are alarming. Too many young people drink and know too little about the consequences, e.g.: © Alcohol-related highway deaths are the number one killer of teen and young adults (5); young adults ages 15~24 constitute 8,000 of the 20,000-25,000 lives a year lost through impaired driving, making motor vehicle crashes the leading cause of death among this age group. © Alcohol use is associated with homicides, suicides, and drownings, the three other leading causes of death among youth (6). © 16% of all teens who drink use condoms less often after drinking, placing them at greater risk for HIV infection (7). © 2.6 million teenagers do not know that a person can die from an overdose of alcohol (8) The National High School Senior Survey (4), a comprehensive, sophisticated, statistical instrument used to measure the nation’s progress in reducing AOD problems, has been used for many years to measure high school seniors’ attitudes and behaviors toward AOD. The 1991 study also included for the first time a cohort of 8th and 10th graders. If one compares the prevalence of alcohol abuse among seniors over a 10-year period, it is easy to track the downward trend ( 2). Although these decreases are not dramatic, they are statistically significant for “past month" and “past year” use. “‘Lifetime’’ use is not subject to as rapid a change. Therefore, we should focus our efforts on decreasing the more immediate “past month” and “past year”” use.600 VIVIAN L. SMITH _s4_| | Mlever | © | past Year | Past month | | 20 0 1981 1991 Fic. 2. Percentage of high school seniors who have used alcohol. Even with progress in the desired direction, concerns remain about alcohol abuse among underage youth. In addition, even though binge drinking, i.c., con- suming five or more drinks once or twice every weekend, has decreased from 1981, when it was 41.4%, to 29.8% in 1991, it has remained perilously high (Fig. 2). All of the percentages cited indicate that alcohol and, of course, cigarettes are still the substances of choice among youth. Figure 3 shows the percentage of high school seniors who have ever used an illicit drug (e.g., marijuana, hallucinogens, cocaine, heroin, opiates, stimulants, barbituates, methaqualone, tranquilizers). Again, we see in this 10-year compar- ison a dramatic decrease in overall use in all categories by high school seniors. In terms of national goals, we have been using as our frame of reference the National Health Promotion and Disease Prevention objectives from Healthy Peo- ple 2000, which are health promotion, health protection, and preventive services. These goals aim to increase the span of healthy life and to reduce existing dis- parities in access to health care. Healthy People 2000 addresses the prevention of major chronic illnesse: inju- 1981 Fic. 3. Percentage of high school seniors who have used any illicit drug.PROCEEDINGS: THE HEALTH STATUS OF AMERICAN CHILDREN 601 ries, and infectious diseases. And it maintains that our nation can no longer afford not to invest in prevention. AOD-related problems are central to this endeavor since they permeate nearly every other health and social issue. Healthy People 2000 contains precise objectives to reduce the risks associated with AOD prob- lems among youths and adolescents. A brief outline of these objectives will help to define CSAP’s role in their implementation and realization 1. Increase the age of first time alcohol and marijuana use by I year from the 1988 baseline of 13.1 years to 14.1 years by the year 2000. The importance of this goal cannot be overestimated. Youth who begin to use alcohol within the criti 14- to 16-year-old period are more inclined to become frequent abusers of alcohol, cigarettes, and marijuana than those who begin drinking when they are older (4) Alcohol and marijuana use, as well as tobacco use, is associated with other health problems, including adolescent suicide, homicide, academic failure, delinquency, motor vehicle crashes, early sexual activity, sexually transmitted diseases, and teenage pregnancy which carries with it a whole array of health and social prob- lems. Delaying the age of first use of alcoho! beyond childhood and adolescence reduces the risk of AOD becoming problems later in life (5) 2. Reduce “past month” use for alcohol, marijuana, and cocaine. Mind alter- ing and addictive substances have been shown to jeopardize physical, mental, and social development during the formative years. Their use also poses a threat to successful transition from school to the workplace. Of particular concern is drug use among schoo! dropouts, lower income inner city youths for whom rates do not seem to have declined as much as they have for the overall population of youth. Also of concern is the increasing rate of use among pregnant teenagers, whose pregnancies must be considered as high risk even if they are not involved in drug use (If, 12). 3. To reduce the number of seniors reporting heavy drinking in the previous 2-week period. Binge drinking is linked to property damage, poor academic per- formance, disruptive/violent behavior, to name just a few (4). About 4% of high school seniors still report daily drinking—and this does not seem to be decreasing very rapidly. In recent years binge drinking has declined only in modest incre- ments, but the declining overall pattern of alcohol use among high school seniors indicates the feasibility of this goal We can account for this decline, in part, because of the school- and community- based prevention programs and the increased awareness through media or other communications. The possibility of serious medical and economic consequences for individuals, families, and society makes prevention and early intervention essential. 4. To increase the number of high school seniors reporting risk associated with heavy alcohol use, regular marijuana use, and trying cocaine once or twice. Again, this is a critical goal for prevention. The 10-year decline in marijuana use among seniors from 1978 to 1987 can be directly attributed to the dramatic in- crease in the perceived risk of psychological and physical harm and the increased perception of social disapproval associated with regular marijuana use. A similar pattern appears to exist for the perceived risk for cocaine use. Emphasizing pre-602 VIVIAN L. SMITH vention of marijuana and cocaine use may also be instrumental in the future prevention of tobacco and alcohol use by adolescents. 5. To increase the proportion of high school seniors who perceive social dis- approval associated with heavy use of alcohol, occasional marijuana use, and experimentation with cocaine. Once again this illustrates the link between social norms and their effect upon behavior. In summary, I would like to repeat that we are going in right direction to achieve the goals outlined in Healthy People 2000. We expect the downward trends to continue, but this can be done only if we are vigilant in our efforts to keep prevention the number one priority in our work CSAP’s role in the realization of these goals is to lead the government preven- tion effort. We work with state and local agencies to develop prevention programs at all levels of society, with an emphasis on special populations. When CSAP was legislated in 1986, our commitment was to youth and families. In more recent years this commitment has also embraced pregnant and postpartum women and their infants and a broad-based community prevention program that emphasizes septems development. CSAP currently supports a vast array of programs that include nearly 700 demonstration grants (Table 1). Promising prevention programs take a comprehensive, community-based ap- proach that responds to the multiple problems in young people's lives rather than the narrower approach of combatting AOD problems in isolation. The most prom- ising programs focus not only on AOD prevention, but also help youth respond to the multiple challenges at home, school, and in the neighborhood. TABLE CSAP Procrams Prevention/intervention demonstrations Client oriented (HRY, PPWI) Systems oriented (CP) Workplace prevention program (EAP) ‘Training: National Training Systems (NTS) ‘Communcation: NCADI/RADAR Media campaigns Cooperative agreements Field development Learning community Conference grants Perinatal resource center Technical assistance Foundation initiative Evaluation Individual grant programs Program-wide evaluation National evaluation National Prevention Evaluation Resource NetworkPROCEEDINGS: THE HEALTH STATUS OF AMERICAN CHILDREN 603 REFERENCES USA Today, June 25, 1991 pp. National Household Survey. 1990. Adolescent Student Health Survey, 1990. National High Schoo! Senior Survey, 1990. National Highway Traffic Safety Administration, 1988, National Commission on Drug-Free Schools, 1990. Hingson RW, Strunin L, Berlin BM, Heeren T. Beliefs about AIDS. Use of Alcohol, and Drugs and Unprotected Sex and Massachusetts Adolescents, 1990; 80:295-299. 8. Office of the Inspector General Survey, 1991 9. Yu. Williford. Too many young people drink and know too little about the consequences. 10. Robins, Prybeck 1985 1. Clayton, Voss 1982. In: Healthy People 2000, 12. Kandel. 1975 In: Healthy People 2000. Received January 1993 Accepted February 1993