Drug and alcohol abuse present a compelling threat to public health. According to the Lewin Group, a leading health policy and consulting firm, the total economic cost of drug and alcohol abuse is about $417 billion annually. Of this, $193 billion can be attributed to illicit drug abuse. Economic costs of drug and alcohol abuse include health care, prevention costs, abuse treatment, reduced work productivity, social welfare, crime, and court-related costs.
The American work ethic suffers directly from drug use, particularly with methamphetamine. The Center for Substance Abuse Prevention estimates 9.4 million Americans have used the drug at least once. Most users are workers, high school students, and truck drivers. Lost work productivity costs the economy billions of dollars each year.
National Drug Abuse Trends by Age
Drug abuse doesn’t discriminate by race, ethnicity, age, or gender. According to the World Health Organization’s Program on Substance Abuse, up to 30 million children worldwide are orphaned and must care for themselves. Up to 90% of street children use an illicit substance, and many traffic drugs to support themselves. The start of drug addiction in street children can be as early as age five.
Unfortunately, the number of young people using drugs and drinking is increasing. In the 1960s, the National Household Survey on Drug Abuse found the number of new female drinkers between the age of 10 and 14 was 7%. Today, that number has surged to 31%.
These numbers aren’t exclusive to drinking. Inhalant use is the most prevalent amongst young people; the most common activities are huffing household items like shoe polish and paint thinner. There are more than 1,000 products widely available in today’s homes with abuse potential, according to the National Inhalant Prevention Coalition.
Young Children and Smoking
Even with the money spent on intervention and prevention, the Center for Substance Abuse estimates that 3,000 children become smokers each day. A third of them will eventually die from complications directly related to tobacco use. In the meantime, 66% of 12-17-year-olds who used cigarettes in the past year already show signs of addiction. However, data from the National Center on Drug Abuse indicates that tobacco use among teenagers in declining.
Drug Use Increasing Nationally
In spite of efforts to prevent and rehabilitate substance abuse and addiction, statistics show drug use continues to increase. In 1999, there were 14.8 million Americans who admitted to using illicit drugs. Of those, 3.5 million were dependent on drugs, and an additional 8.2 were dependent on alcohol. In 2013, 24.6 million Americans aged 12 and older admitted to using an illicit drug in the past month, according to the National Institute on Drug Abuse. This represents 9.4% of the nation’s population.
How Placer County Stacks Up
In the mid-1990s, the California Department of Alcohol and Drug Programs (ADP) made a commitment to improving the state’s prevention and intervention systems. As part of this systematic effort, planners needed a way to identify trends and prioritize levels of need for programming readily. As a result, the ADP, in collaboration with the Center of Applied Research Solutions (CARS), began compiling and publishing data from each county in California. Placer County is not excluded from the substantial costs associated with drug and alcohol abuse.
Tracking Drug and Alcohol Abuse in Placer County
Current best practices and research frameworks regarding community intervention planning identify the following four major risk factor domains related to drug and alcohol abuse:
- Community Factors – include things like availability of substances, societal norms regarding use, community-specific laws, and social disorganization.
- Family Factors – may involve the family history of drug abuse, support network, parental drug use, favorable perception on drug use, and levels of family conflict.
- School Factors – such as academic failure, school-related problematic behavior, and commitment to schooling endeavors.
- Individual and Peer Factors – may include rejection, alienation, rebelliousness, friends who use illicit substances and early introduction to drug use.
Let’s take a closer look at each of these domains and how they influence drug use and abuse in Placer County.
Community Risk Factors and Drug Use
Community risk factors in Placer County include unemployment, crime rate, number of reported drug violations, and even the number of liquor licenses. Here’s how the County compares to the state of California as a whole regarding a sample of community-level risk indicators:
The unemployment rate in Placer increased from 1997 to 2002, from 5,100 to 6,300. The annual unemployment rate in 1996 was 4.6%, and in 2002 it was 4.5%. In April 2015, the unemployment rate was 4.8%, according to the Bureau of Labor Statistics. The statewide ranking for unemployment in Placer County in 2002 was 9th. According to the Auburn Journal, Placer currently ranks 11th in the state, and it has among the lowest number of unemployed people in the region. The unemployment rate in Nevada County is 5%, and in Sacramento County, 5.5%.
Placer historically has a lower unemployment rate than California as a whole. In 2002, the unemployment rate in the state was 6.7%. Today, the statewide unemployment rate hovers around 5.7%, one of the lowest in the nation.
The number of reported crimes in Placer has decreased in recent years. In 1996, there were 8,336 reported crimes with a population of 209,200, representing a rate of 39.8 crimes per 1,000 people. In 2001, there were 7,533 reported crimes with a population of 261,500, with an average rate of 28.8 per 1,000 people.
Using a three-year average model, Placer County has a reported crime rate of 28.7 crimes per 1,000 people. The average for the state of California is 38.0, lowering Placer and giving them a rank of 23.
For the purposes of research, “crime rate” refers to documented incidents of select crimes, including homicide, sexual assault and rape, burglary, larceny, theft, aggravated assault, and motor vehicle theft.
Placer County Reported Drug Violations
The number of drug and alcohol-related arrests has increased slightly in Placer County. In 1996, there were 1,161 drug violation arrests in individuals aged 18-69, a rate of 8.3 per 1,000. In 2001, there were 1,405, a rate of 8.4 per 1000. A three-year average ranks Placer 18th in the state for drug violation arrests, with a rate of 7.9 per 1,000. Statewide, the average rate of drug violation arrests per 1,000 is 10.3.
While the County ranks below the statewide average concerning drug violation arrests, a recent case-processing study commissioned by the local government tells another story. According to the case report, 62% of all misdemeanor bookings were for drug and alcohol-related offenses. Statewide, that number was 44%. For the study, drug and alcohol-related offenses included drunk driving offenses and possession of narcotics.
Additionally, high percentages were intoxicated at booking: in Placer County, 19% of felony offenders were intoxicated. For misdemeanor offenders, that number was 31%.
Reported Drug Violations and Drug Court
Interestingly, the case-processing study found that the Drug Court in Placer County is underutilized, with only 44 active participants in 2 years. Over the same period, there were over 1,100 bookings for narcotics use that went to local jails. The report also found there were ineffective screening processes for participation. In an eight month period, there were only 32 screenings for the Drug Court program, yet there were 1,085 narcotics-related admissions to area jails.
Drug Courts help hold individuals accountable through a series of drug tests – the study found the average participant faced 55 routine tests and screenings. Nearly a fifth of Drug Court participants also had a mental health diagnosis, suggesting comorbidities play a role in Placer County drug abuse and addiction.
Number of Retail Liquor Licenses
Placer County has more liquor licenses per capita than the statewide average. In the state of California, there is an average of 191.6 retail liquor outlets per 100,000 people, but in Placer, there are 242.2. Placer is ranked 26th statewide for the number of retail liquor stores.
While Placer has more liquor access than a typical California county, the number of available liquor outlets has decreased slightly, from 271.3 in 1996 to 238.3 in 2002. However, the data could be skewed by the fact that retail establishments may be required to have multiple licenses (on-sale, off-sale, etc.).
Adult Arrests for DUI and Other Alcohol-Related Offenses
Placer County has more adult arrests for driving under the influence than the average population. Placer had an overall DUI arrest rate of 10.2 per 1,000 using a three-year average model, while the state averaged 8.4. Overall, the county ranked 19th statewide.
Placer also ranks higher than the state average concerning alcohol-related violations that exclude DUI (for example, disorderly conduct). In adults aged 18 to 69, there were 1,185 total arrests in Placer County for alcohol-related offenses excluding DUI in 2001, for an average rate of 7.1 per 1,000. The same year, the statewide average was 5.5. This earns Placer a rank of 25th in the state.
Lastly, there are slightly more alcohol-related motor vehicle accidents in the County than the rest of the state. There were an average 98.5 alcohol-related motor vehicle accidents per 100,000 over three years, while the state average was 98.1. These rates are based on accidents that caused injury or fatality – incidents that were labeled ‘Property Damage Only’ were excluded from the data.
Placer County Risk Factors
For some risk factors, Placer County scores well below the statewide average – for example, the county’s low unemployment rate is a protective factor for drug and substance abuse. Similarly, a lower-than-average reported crime rate helps. On the other hand, Placer ranks higher than the national average for DUI and alcohol-related arrests, as well as alcohol-related motor vehicle accidents leading to death or injury. That, combined with an underutilized Drug Court, suggests the direction for community-level intervention.
Family Risk Factors
Family risk factors include a variety of mechanisms, from incidences of domestic violence, child abuse, a number of children in foster care, and reliance on federal programs such as Temporary Assistance for Needy Families (TANF). Let’s take a closer look at each.
TANF Utilization Rates
TANF is a federal program that provides temporary financial assistance to families living in extreme poverty, for a period up to 6 months. This provides cash assistance beyond the Supplemental Nutrition Assistance Program (SNAP, or food stamps). Families may use TANF to cover a list of approved expenses. Since TANF is an indicator of extreme poverty, utilization may be a risk factor for drug or substance abuse.
The rate of TANF usage in Placer County is remarkably small. In 2002, only 1.1% of the county’s 270,700 citizens used TANF. In California, the average rate of TANF recipients is 4.1% of the total population.
Domestic violence and drug abuse often go hand-in-hand. Those who abuse drugs may come from families with a history of abuse and may be more likely to become abusers, themselves. Since domestic abuse is a high-risk factor for drug addiction, and vice-versa, intervention planners must pay close attention to these metrics on a community-wide scale.
Placer County ranks lower than the statewide average for incidences of domestic abuse with an average rate of 4.6 per 100,000, compared to the statewide rate of 8.7. The rate is calculated by tracking the number of domestic violence calls throughout the county. However, there is widespread underreporting for domestic violence due to fear, so the actual incidence rate of domestic violence is likely underrepresented.
Like domestic violence, child abuse, and drug abuse are often comorbid conditions. According to the National Center on Drug Abuse, as many as 2/3rds of individuals admitted to a facility for treatment report physical, mental, or sexual abuse as a child. A study from the University of South Carolina found that children who were victims of rape were three times more likely to smoke marijuana, six times more likely to use cocaine, and ten times more likely to have tried other drugs, such as heroin and methamphetamine.
In Placer County, child abuse rates are far above the statewide average, with a reported rate of 106.9 reported emergency room dispositions per 1,000 in 2002. The state average for the same time period was 68.6. Additionally, the incidence of child abuse increased markedly from 1998 to 2002, from 88.2 to 106.9 per 1,000.
These figures do not account for unreported cases of child abuse, nor is the data adjusted for repeat violations. As a result, the numbers may be underrepresented. The data also excludes data from claims that could not be sufficiently substantiated.
Children in Foster Care
Foster care metrics are important in the examination of drug addiction for a couple of reasons. Firstly, maternal drug and alcohol abuse is described as a critical factor in the abuse, neglect, and abandonment of children. Secondly, children in foster care are more likely to use and abuse drugs. According to a study in Addiction Behavior, 45% of foster children surveyed had used illicit drugs in the past six months, 49% had tried drugs in their lifetime, and 35% met the criteria for a substance abuse disorder.
Placer County has fewer children in foster care than the statewide average. In 2002, there were 443 foster care placements in a youth population (under 18) of 67,605 (6.7 per 1,000). The state average for the same year was 9.7 per 1,000.
Unpacking Family Risk Factors
In terms of poverty, Placer County fares better than the state average, and it has lower domestic abuse rates than the state average. However, child abuse rates in Placer are far above the state average. Intervention planners must address the rates of local child abuse, which may be rooted in parental drug abuse and addiction. Additionally, addressing child abuse may help prevent future cases of addiction.
School Risk Factors
School risk factors include such cases as school dropouts, expulsions, and alternative education options. Each plays a unique role in drug abuse and addiction.
School Dropout Rates
Drug and alcohol abuse is more common among those who drop out of high school. According to Partnership for Drug-Free Kids, dropouts between the ages of 16 and 18 are more likely to be current users of drugs, alcohol, and other illicit substances. According to the report, 31.4 % of dropouts use illegal drugs, compared to 18.2 percent of teens enrolled in school. They are also more likely to abuse alcohol (41.6%, compared to 35.3%), and binge drink (32.3% versus 23.8%). Nationally, 1 in 7 students drops out of school, which has long-reaching public health implications.
While the national dropout rate is around 14%, in California the rates are much lower, only 2.7% in 2002. In Placer County, the rate was slightly lower at 2.4%. In 2015, the County Community Schools reported a 91% graduation rate.
School expulsions are a compelling metric for determining the prevalence of drug abuse in teens because of an increase in zero-tolerance policies. Though students may be expelled for many reasons, drug and alcohol abuse is the most common, according to the California State Parent-Teacher Association (PTA). However, the State PTA has recently taken the position of dismantling zero-tolerance policies for prevention, education, and rehabilitation, in light of research that shows mandatory expulsions do nothing to deter drug abusive behavior.
The National Longitudinal Study on Adolescent Health found students who are in “connected school districts” with a comprehensive intervention and prevention strategy were less likely to engage in risky health behaviors. The overall connectedness in schools that use temporary expulsion for relatively minor infractions was lower than schools with more lenient policies. This suggests schools with a focus on rehabilitation, treatment, and intervention, as opposed to punishment, is more likely to produce healthy students.
In Placer County, there were 124 students recommended for expulsion during the 2001-02 school year (2.1 students per 1,000). This ranks lower than the statewide average, which was 3.6 per 1,000.
Alternative education can be a protective factor for drug abuse, since alternative education programs may include substance abuse intervention. Enrollment in alternative education programs may be the substitution for mandatory expulsion or a requirement for anyone expelled who still wishes to graduate. Some alternative education programs are designated as “recovery high schools,” and allow teens safe spaces for rehabilitation.
On the other hand, alternative education enrollment may be a predictive factor for drug abuse, since those enrolled in these programs have been expelled from other institutions. In the 2002-03 school year, there were 678 placements in alternative education programs in a student population of 60,716 (an estimated 1.1 student per 1,000). The state average for the same year was 1.9.
Unpacking School Factors
In general, Placer County fares better than the state as a whole when it comes to school-related risk factors for drug abuse. They have fewer school dropout rates, fewer expulsions, and fewer enrolled in alternative education programs. Intervention planners should still look at school tolerance policies and ensure the focus of drug abuse in schools is based on rehabilitation, not punishment.
Individual and Peer Factors
The last set of risk factors that influence drug and alcohol abuse and addiction pertain to the individual and their network of peers. Indicators of these kinds of risk factors include juvenile arrests, adolescent admissions to drug and alcohol treatment facilities, youth runaways, births to teen mothers, and teen suicides. Each of these factors shapes substance abuse behavior in a unique way.
Juvenile Arrests for Drug and Alcohol-Related Offenses
Juvenile substance abuse and delinquency are inextricably linked. According to the Drug Use Forecasting System, involvement with the juvenile justice system is highly correlated with drug addiction.
Placer County ranks higher than the statewide average in terms of juvenile arrests for drug and alcohol-related offenses. A three-year average between 1999 and 2002 found the County averaged 12.5 arrests per 1,000 juveniles, compared to California’s average of 9.1.
Adolescent Admission to Drug and Treatment Facilities
Interestingly, Placer County has fewer admissions to treatment centers than the state average, at 0.6 individuals per 1,000 under 18 years. The average rate statewide is 1.8. Given the numbers of juvenile arrests in the county, this perhaps suggests that community leaders should focus intervention efforts on effectively identifying adolescents at risk for substance abuse and funneling them through treatment facilities, instead of through the juvenile court system.
Children who run away are more likely to abuse drugs and alcohol. The World Health Organization says that homeless children are also more likely to deal drugs, and may use illicit substances as early as age five.
Placer County has fewer youth runaways compared to the California average, with 627 reported runaways in 2002, given a population of 67,605 under 18 (equaling an average rate of 8.5 per 1,000). Statewide, the average is 9.3.
Teen Mother Births
Teen motherhood is a compelling metric for many reasons – firstly, teen mothers are more likely to come from families with histories of domestic violence or drug abuse. Secondly, the rate of drug addiction is much higher among pregnant teens than non-pregnant ones. Nearly 60% of pregnant teens admit to having used illicit substances within the past year, according to by Partnership for Drug-Free Kids.
Those habits are more likely to continue during pregnancy, especially among younger teens – over 1/3rd of pregnant teens aged 12 to 14 admitted to using drugs within the past month. Children born to drug addicted mothers are more likely to be neglected, abused, and abandoned – more risk factors for drug addiction.
Placer County fares better than the state average when it comes to births to teen mothers. Between 2000 and 2002, there was an average of 20.2 births per 1,000 girls aged 15-19. The statewide average was 44.8.
Adolescent suicides may indicate a drug abuse problem since substance abuse and depression are inextricably linked. In Placer County, there was an average of one adolescent suicide per 100,000 juveniles between 2000 and 2002. Statewide, there were 0.9.
Unpacking Individual and Peer Risk Factors
Placer County fares better than the state average in several areas, such as births to teen mothers and the number of youth runaways. However, the disparate number between the juvenile arrest rate for drug and alcohol-related offenses and admission to treatment facilities merits further discussion.
Conclusion and Future Directions
Examining the data on risk factors for abuse in Placer County helps inform further directions for intervention. While Placer fares better than the state as a whole in several areas, it is in need of work in others. By addressing such issues as child abuse, admission to treatment facilities, and effective utilization of the Drug Court, the county will be better prepared to prevent further incidence of drug abuse and hasten rehabilitation.
These trends will also serve to guide further research and discover why some of these discrepancies exist within the community. With a holistic and integrated approach based on rehabilitation and prevention, not punishment, public health planners will be able to address substance abuse in this vibrant community more effectively.