NEW DATA SHOW SIGNIFICANT DISRUPTIONS IN U.S. METHAMPHETAMINE, COCAINE MARKETS
PRICE OF METH SOARS 73 PERCENT;PURITY DOWN BY NEARLY A THIRD
(Washington, D.C.)—Today, the U.S. Drug Czar, John Walters, released new data signaling significant progress against methamphetamine. According to the Drug Enforcement Administration's (DEA) System to Retrieve Information on Drug Evidence (STRIDE) database, the average price per pure gram of methamphetamine increased 73 percent from January 2007 through September of this year, from $141.42 to $244.53. During the same period, the purity of meth dropped 31 percent.
Director Walters credited State and local law enforcement officials, as well as the Mexican government, with much of the progress. “The intense pressure placed on meth producers and traffickers has significantly disrupted the market for this devastating drug. New disruptions in the supply of meth are a result of the collective efforts of thousands of individuals here in the U.S. and in Mexico . But it is not time to declare victory; it is time to bolster gains against the supply of meth with further progress against demand. Meth is still on the streets in too many communities, ruining too many lives. The continued pursuit of a balanced strategy, here at home and in cooperation with our international partners, will help us sustain and extend our progress.”
More than 40 States have enacted restrictions on the retail distribution of products containing pseudoephedrine, a key ingredient in the production of methamphetamine. In 2006, President Bush signed the Combat Methamphetamine Epidemic Act into law, supporting existing State efforts and setting a national standard for retail distribution of products containing precursor chemicals. These controls contributed to a dramatic 42 percent drop in the number of domestic meth lab incidents. Mexican drug trafficking organizations soon sought to fill the supply void created by these domestic U.S. controls, and began exporting finished meth into the United States.
Under the leadership of President Felipe Calderon, Mexico has initiated unprecedented controls in the supply of pseudoephedrine. Effective January 2008, Mexico will no longer allow the importation of pseudoephedrine and ephedrine, and all use of the precursor chemicals will be banned throughout the nation by January of 2009 – further reducing the ability of methamphetamine manufacturers to produce and traffic the drug into the United States. Additionally, President Calderon has overseen an aggressive crackdown on drug traffickers and drug-related violence, particularly along the U.S.–Mexico border. More than 12,000 Mexican troops have participated in enforcement operations.
“Increasing purchase prices for cocaine and methamphetamine in the U.S. market and decreasing purity mean one thing – these drugs are less available on the streets of America,” said DEA Administrator Karen P. Tandy. “Drug kingpins are having a harder time moving illegal drugs and chemicals and pocketing the illicit proceeds because they are up against the full court press of sustained, joint initiatives by a historic three-way partnership among Colombia, Mexico, and the United States. This rock solid, international lineup has disrupted the world's highest level narco-traffickers, made illegal drugs costlier and less pure, forced traffickers into an uncertain reactive mode, and formed the linchpin to greater stability throughout the Western Hemisphere.”
While youth meth use has decreased by 50 percent since 2001, the Bush Administration is continuing efforts to drive down the demand for methamphetamine. The National Youth Anti-Drug Media Campaign launched a $10 million public awareness campaign in September, which includes television, print, radio, and Web advertising. An additional advertising effort targeted to American Indian and Alaska Native communities will launch later this month.
Director Walters joined DEA Administrator Karen Tandy, Mexican Attorney General Eduardo Medina Mora Icaza, and Colombian Minister of Defense Juan Manuel Santos in Bogota, Colombia, to release the new STRIDE data, which also support reports of regional U.S. cocaine shortages. From January 2007 through September 2007, there was a 44 percent increase in the average price per pure gram of cocaine in the United States (from $95.35 to $136.93) and a corresponding 15 percent decrease in cocaine purity in the illegal drug market in the United States. These findings support earlier indicators of reductions in cocaine availability in 37 U.S. cities, based on law enforcement intelligence reports and unprecedented reductions in the number of employees testing positive for cocaine in workplace drug tests.
STRIDE is a forensic inventory of evidence acquired by the DEA. It is widely considered a real-time authority of drug intelligence and market trends.
Sources:
http://www.whitehousedrugpolicy.gov/news/press07/110807.html
Tuesday, December 2, 2008
U.S. HIGHLIGHTS LATEST INTERNATIONAL PROGRESSAGAINST METHAMPHETAMINE;URGES VULNERABLE NATIONS TO INCREASE EFFORTS TOCURB TRAFFICKING OF PRECURSOR CHEM
PRESS RELEASE:
THURSDAY, MARCH 6, 2008
CONTACT:
Jennifer de Vallance(202) 395–6648 / (202) 368–8422
U.S. HIGHLIGHTS LATEST INTERNATIONAL PROGRESSAGAINST METHAMPHETAMINE;URGES VULNERABLE NATIONS TO INCREASE EFFORTS TOCURB TRAFFICKING OF PRECURSOR CHEMICALS
(Washington, D.C.)—The U.S. Deputy Drug Czar, Scott Burns, announced today that Mexico has made monumental strides to disrupt the methamphetamine precursor chemical trade, and is making a direct and significant impact on trafficking of finished meth into the United States. Mexico, under the leadership of President Calderon, has drastically reduced the amount of imports of methamphetamine precursors in 2007, and has ceased to issue import permits for key meth precursor chemicals. Sellers of products containing meth precursors must deplete their remaining supplies by 2009. Estimates indicate that the Mexican precursor control efforts have already contributed to a nearly 50 percent decrease in meth seizures along the U.S. Southwest border.
"Mexico's bold action to eliminate the flow of meth precursor chemicals benefits all nations and is helping to safeguard millions of people from the pain and social consequences that meth brings," said Deputy Director Burns. "But there is still more that can be done internationally. Many nations remain vulnerable to exploitation and trafficking of meth chemicals. We must act collaboratively to continue to disrupt the methamphetamine market and to put the violent drug trafficking organizations that profit from the misery of addiction out of business."
Despite the widespread cooperation of most nations, many countries do not have sufficient controls in place to prevent chemical diversion, or have yet to provide sufficient reporting on legitimate commercial requirements and transactions to multilateral institutions. Many countries, such as Iran, Burma, and Syria, have not reported legitimate trade data to allow international bodies to measure licit national requirements for precursor chemicals against actual imports. This comparison can be very useful to determine potential illicit diversion. The United States urges these countries to support the efforts of the International Narcotics Control Board (INCB) to monitor global trade activity for pseudoephedrine and ephedrine.
To date, 105 countries have supplied the INCB with estimates of their national licit need, which has, in turn, been used to investigate and stop suspicious or excessive shipments of precursors. Provision of legitimate trade estimates can help identify nations with imbalances in licit need versus precursor imports. For example, though they do no provide trade information, Iran and Syria report a licit need estimate for pseudoephedrine that could rank them among the top five global importers of the product.
The United States, at the Commission on Narcotic Drugs meeting in Vienna, Austria on March 10th, will call on all nations to refine their estimates of precursor chemicals licit need and to support transparency by providing import and export data for these products to international trade databases.
Source:
http://www.whitehousedrugpolicy.gov/news/press08/030608.html
THURSDAY, MARCH 6, 2008
CONTACT:
Jennifer de Vallance(202) 395–6648 / (202) 368–8422
U.S. HIGHLIGHTS LATEST INTERNATIONAL PROGRESSAGAINST METHAMPHETAMINE;URGES VULNERABLE NATIONS TO INCREASE EFFORTS TOCURB TRAFFICKING OF PRECURSOR CHEMICALS
(Washington, D.C.)—The U.S. Deputy Drug Czar, Scott Burns, announced today that Mexico has made monumental strides to disrupt the methamphetamine precursor chemical trade, and is making a direct and significant impact on trafficking of finished meth into the United States. Mexico, under the leadership of President Calderon, has drastically reduced the amount of imports of methamphetamine precursors in 2007, and has ceased to issue import permits for key meth precursor chemicals. Sellers of products containing meth precursors must deplete their remaining supplies by 2009. Estimates indicate that the Mexican precursor control efforts have already contributed to a nearly 50 percent decrease in meth seizures along the U.S. Southwest border.
"Mexico's bold action to eliminate the flow of meth precursor chemicals benefits all nations and is helping to safeguard millions of people from the pain and social consequences that meth brings," said Deputy Director Burns. "But there is still more that can be done internationally. Many nations remain vulnerable to exploitation and trafficking of meth chemicals. We must act collaboratively to continue to disrupt the methamphetamine market and to put the violent drug trafficking organizations that profit from the misery of addiction out of business."
Despite the widespread cooperation of most nations, many countries do not have sufficient controls in place to prevent chemical diversion, or have yet to provide sufficient reporting on legitimate commercial requirements and transactions to multilateral institutions. Many countries, such as Iran, Burma, and Syria, have not reported legitimate trade data to allow international bodies to measure licit national requirements for precursor chemicals against actual imports. This comparison can be very useful to determine potential illicit diversion. The United States urges these countries to support the efforts of the International Narcotics Control Board (INCB) to monitor global trade activity for pseudoephedrine and ephedrine.
To date, 105 countries have supplied the INCB with estimates of their national licit need, which has, in turn, been used to investigate and stop suspicious or excessive shipments of precursors. Provision of legitimate trade estimates can help identify nations with imbalances in licit need versus precursor imports. For example, though they do no provide trade information, Iran and Syria report a licit need estimate for pseudoephedrine that could rank them among the top five global importers of the product.
The United States, at the Commission on Narcotic Drugs meeting in Vienna, Austria on March 10th, will call on all nations to refine their estimates of precursor chemicals licit need and to support transparency by providing import and export data for these products to international trade databases.
Source:
http://www.whitehousedrugpolicy.gov/news/press08/030608.html
NIDA InfoFacts: Prescription and Over-the-Counter Medications
Prescription medications such as pain relievers, central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants are highly beneficial treatments for a variety of health conditions. Pain relievers enable individuals with chronic pain to lead productive lives; tranquilizers can reduce anxiety and help patients with sleep disorders; and stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their attention. Most people who take prescription medications use them responsibly. But, when abused—that is, taken by someone other than the patient for whom the medication was prescribed, or taken in a manner or dosage other than what was prescribed—prescription medications can produce serious adverse health effects and can lead to addiction.
Patients, healthcare professionals, and pharmacists all have roles in preventing the abuse1 of and addiction to prescription medications. For example, patients should follow the directions for use carefully, learn what effects and side effects the medication could have, and inform their doctor/pharmacist whether they are taking other medications [including over-the-counter (OTC) medications or health supplements], since these could potentially interact with the prescribed medication. The patient should read all information provided by the pharmacist. Physicians and other healthcare providers should screen for past or current substance abuse in the patient during routine examination, including asking questions about what other medications the patient is taking and why. Providers should note any rapid increases in the amount of a medication needed or frequent requests for refills before the quantity prescribed should have been finished, as these may be indicators of abuse.1
Similarly, some OTC medications, such as cough and cold medicines containing dextromethorphan, have beneficial effects when taken as recommended, but they can also be abused and lead to serious adverse health consequences. Parents should be aware of the potential for abuse of these medications, especially when consumed in large quantities, which should signal concern and the possible need for intervention.
Commonly Abused Prescription Medications
Although many prescription medications can be abused, the following three classes are most commonly abused:
Opioids—usually prescribed to treat pain.
CNS Depressants—used to treat anxiety and sleep disorders.
Stimulants—prescribed to treat ADHD and narcolepsy.
Opioids
What are Opioids? Opioids are commonly prescribed because of their effective analgesic, or pain-relieving, properties. Studies have shown that properly managed medical use of opioid analgesic compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction.
Among the compounds that fall within this class are hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin—an oral, controlled-release form of the drug), morphine, fentanyl, codeine, and related medications. Morphine and fentanyl are often used to alleviate severe pain, while codeine is used for milder pain. Other examples of opioids that can be prescribed to relieve pain include propoxyphene (Darvon); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of its side effects. In addition to their effective pain-relieving properties, some of these medications can be used to relieve severe diarrhea (for example, Lomotil, also known as diphenoxylate) or severe coughs (codeine).
How are Opioids Abused?Opioids can be taken orally, or the pills may be crushed and the powder snorted or injected. A number of overdose deaths have resulted from the latter routes of administration, particularly with the drug OxyContin, which was designed to be a slow-release formulation. Snorting or injecting opioids results in a rapid release of the drug into the bloodstream, exposing the person to high doses and causing many of the reported overdose reactions.
How do Opioids Affect the Brain?Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these compounds attach to certain opioid receptors in the brain and spinal cord, they can effectively change the way a person experiences pain.
In addition, opioid medications can affect regions of the brain that mediate what one perceives as pleasure, resulting in the initial euphoria or sense of well-being that many opioids produce. Repeated abuse of opioids can lead to addiction—a chronic, relapsing disease, characterized by compulsive drug seeking and abuse despite its known harmful consequences.What Adverse Effects Can be Associated with Opioids? Opioids can produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death.
These medications are only safe to use with other substances under a physician’s supervision. Typically, they should not be used with alcohol, antihistamines, barbiturates, or benzodiazepines. Because these substances slow breathing, their combined effects could lead to life-threatening respiratory depression. What Happens When you Stop Taking Opioids? Patients who are prescribed opioids for a period of time may develop a physical dependence on them, which is not the same as addiction. Repeated exposure to opioids causes the body to adapt, sometimes resulting in tolerance (that is, more of the drug is needed to achieve the desired effect compared to when it was first prescribed) and withdrawal symptoms upon abrupt cessation of drug use. Thus, individuals taking prescribed opioid medications should not only be given these medications under appropriate medical supervision, but should also be medically supervised when stopping use in order to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements.
Are there Treatments for Opioid Addiction? Individuals who abuse or are addicted to prescription opioid medications can be treated. Initially, they may need to undergo medically supervised detoxification to help reduce withdrawal symptoms—however, that is just the first step. Options for effectively treating addiction to prescription opioids are drawn from research on treating heroin addiction. Behavioral treatments combined with medications have proven effective. Currently used medications are:
Methadone, a synthetic opioid that eliminates withdrawal symptoms and relieves craving, has been used for more than 30 years to successfully treat people addicted to heroin.
Buprenorphine, another synthetic opioid, is a more recently approved medication for treating addiction to heroin and other opiates. It can be prescribed in a physician’s office and has a better safety profile than methadone.
Naltrexone is a long-acting opioid receptor blocker that can be employed to help prevent relapse. It is not widely used, however, because of poor compliance, except in highly motivated individuals (e.g., physicians at risk of losing their medical license). It should be noted that this medication can only be used for someone who has already been detoxified, since it can produce severe withdrawal symptoms in a person continuing to abuse opioids.
Naloxone is a short-acting opioid receptor blocker that counteracts the effects of opioids and can be used to treat overdoses.
CNS Depressants
What are CNS Depressants?CNS depressants (e.g., tranquilizers, sedatives) slow normal brain function. In higher doses, some CNS depressants can be used as general anesthetics or pre-anesthetics.
CNS depressants can be divided into three groups, based on their chemistry and pharmacology:
Barbiturates, such as mephobarbital (Mebaral) and sodium pentobarbital (Nembutal), are used as preanesthetics, promoting sleep.
Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), and estazolam (ProSom), can be prescribed to treat anxiety, acute stress reactions, panic attacks, convulsions, and sleep disorders. For the latter, benzodiazepines are usually prescribed only for short-term relief of sleep problems because of the development of tolerance and risk of addiction.
Newer sleep medications, such as zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), are now more commonly prescribed to treat sleep disorders. These medications are non-benzodiazepines that act at a subset of the benzodiazepine receptors and appear to have a lower risk for abuse and addiction.
How are CNS Depressants abused? CNS depressants are usually taken orally, sometimes in combination with other drugs or to counteract the effects of other licit or illicit drugs (e.g., stimulants).
How do CNS Depressants Affect the Brain? Most of the CNS depressants have similar actions in the brain—they enhance the actions of the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. Although different classes of CNS depressants work in unique ways, it is ultimately their ability to increase GABA activity that produces a drowsy or calming effect.
What Adverse Effects Can Be Associated with CNS Depressants?Despite their beneficial effects for people suffering from anxiety or sleep disorders, barbiturates and benzodiazepines can be addictive and should be used only as prescribed.
CNS depressants should not be combined with any medication or substance that causes drowsiness, including prescription pain medicines, certain OTC cold and allergy medications, or alcohol. If combined, they can slow both the heart and respiration, which can be fatal.
What Happens When you Stop Taking CNS Depressants? Discontinuing prolonged use or abuse of high doses of CNS depressants can lead to serious withdrawal symptoms. Because it works by slowing the brain’s activity, when one stops taking a CNS depressant, this activity can rebound to the point that seizures can occur. Someone who is either thinking about ending their use of a CNS depressant, or who has stopped and is suffering withdrawal, should seek medical treatment.
Are there Treatments for Addiction to CNS Depressants? In addition to medical supervision during withdrawal, counseling in an inpatient or outpatient setting can help people who are overcoming addiction to CNS depressants. For example, cognitive-behavioral therapy has been used successfully to help individuals in treatment for abuse of benzodiazepines. This type of therapy focuses on modifying a patient’s thinking, expectations, and behaviors while simultaneously increasing their skills for coping with various life stressors.
Stimulants
What are Stimulants?Stimulants such as amphetamines (Adderal, Dexedrine) and methylphenidate (Concerta, Ritalin) have chemical structures that are similar to key brain neurotransmitters called monoamines, which include dopamine and norepinephrine—stimulants increase the levels of these chemicals in the brain and body. This, in turn, increases blood pressure and heart rate, constricts blood vessels, increases blood glucose, and opens up the pathways of the respiratory system. Stimulants increase alertness, attention, and energy; and because they increase dopamine, they can produce a sense of euphoria.
Historically, stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the use of stimulants began to wane. Now, stimulants are prescribed for treating only a few health conditions, most notably ADHD, narcolepsy, and, in some instances, depression that has not responded to other treatments.
How are Stimulants Abused?Stimulants may be taken orally, but some abusers crush the tablets, dissolve them in water, and inject the mixture; complications can arise from this because insoluble fillers in the tablets can block small blood vessels. Stimulants have been abused for both “performance enhancement” and recreational purposes (i.e., to get high).
How Do Prescription Stimulants Affect the Brain?All stimulants work by increasing dopamine levels in the brain. Dopamine is a brain chemical (neurotransmitter) associated with pleasure, movement, and attention. The therapeutic effect of stimulants is achieved by slow and steady increases of dopamine that are similar to the natural production of this chemical by the brain. The doses prescribed by physicians start low and increase gradually until a therapeutic effect is reached. However, when taken in doses and routes other than those prescribed, stimulants can increase brain dopamine in a rapid and highly amplified manner—as do most other drugs of abuse—disrupting normal communication between brain cells, producing euphoria, and increasing the risk of addiction.
What Adverse Effects Can Be Associated with Stimulant Abuse?The consequences of stimulant abuse can be extremely dangerous. Taking high doses of a stimulant can result in an irregular heartbeat, dangerously high body temperatures, and/or the potential for cardiovascular failure or seizures. Taking high doses of some stimulants repeatedly over a short period of time can lead to hostility or feelings of paranoia in some individuals.
Stimulants should not be mixed with antidepressants, which may enhance the effects of a stimulant, or OTC cold medicines containing decongestants, which may cause blood pressure to become dangerously high or lead to irregular heart rhythms.
Are there Treatments for Stimulant Addiction? Treatment of addiction to prescription stimulants is based on behavioral therapies proven effective for treating cocaine or methamphetamine addiction. At this time, there are no proven medications for the treatment of stimulant addiction.
Depending on the patient’s situation, the first step in treating prescription stimulant addiction may be to slowly decrease the drug’s dose and attempt to treat withdrawal symptoms. This process of detoxification could then be followed with one of many behavioral therapies. Contingency management, for example, improves treatment outcomes by enabling patients to earn vouchers for drug-free urine tests; the vouchers can be exchanged for items that promote healthy living. Cognitive-behavioral therapies—which teach patients skills to recognize risky situations, avoid drug use, and cope more effectively with problems—are proving beneficial. Recovery support groups may also be effective in conjunction with a behavioral therapy.
Dextromethorphan (DXM)
What is DXM?Dextromethorphan is the active cough suppressant found in OTC cough and cold medications. When taken in recommended doses, these medications are safe and effective.
How is DXM Abused?DXM is taken orally. In order to experience the mind-altering effects of DXM, excessive amounts of liquid or gelcaps must be consumed. The availability and accessibility of these products make them a serious concern, particularly for youth, who tend to be their primary abusers.
What are the Consequences Associated with the Abuse of DXM?In very large quantities, DXM can cause effects similar to that of ketamine and PCP by affecting similar sites in the brain. These effects can include impaired motor function, numbness, nausea/vomiting, and increased heart rate and blood pressure. On rare occasions, hypoxic brain damage has occurred due to the combination of DXM with decongestants often found in these medications.
What are the Trends in the Abuse of Prescription Drugs and Cough Medicine?
Monitoring the Future (MTF) Survey2Each year, the Monitoring the Future (MTF) survey assesses the extent of drug use among 8th-, 10th-, and 12th-graders nationwide. Nonmedical use of any prescription drug is reported only for 12th-graders. In 2007, 21.7 percent reported lifetime3 use (down significantly from 2006); 15.4 percent reported past-year use; and 7.6 percent reported past-month use. Prescription and OTC medications were the most commonly abused drugs by high school students after marijuana. They represent 6 of the top 10 illicit drugs reported by 12th-graders.
Prescription Painkillers. In 2002, MTF added questions to the survey about past-year nonmedical use of Vicodin and OxyContin. For Vicodin, past-year nonmedical use has remained stable at high levels for each grade since its inclusion in the survey.
Rates of abuse in 2007 (%)
8th-Grade
10th-Grade
12th-Grade
Vicodin
2.7
7.2
9.6
OxyContin
1.8
3.9
5.2
CNS Depressants. Nonmedical use of tranquilizers (benzodiazepines and others) has remained stable for all three grades in all prevalence periods (lifetime, past-year, and past-month use). For sedatives (barbiturates), data are collected only from 12th-graders.
Rates of abuse in 2007 (%)
8th-Grade
10th-Grade
12th-Grade
Tranquilizers
2.4
5.3
6.2
Sedatives
--
--
6.2
Stimulants. Nonmedical use of stimulants is broken up by the type of stimulant used: amphetamines, methamphetamine, and Ritalin. Amphetamine and methamphetamine abuse have been decreasing among 8th-, 10th-, and 12th-graders over the past 6 years; nonmedical use of Ritalin has decreased in 10th-graders during the same time period.
Rates of abuse in 2007 (%)
8th-Grade
10th-Grade
12th-Grade
Amphetamines
4.2
8.0
7.5
Methamphetamine
1.1
1.6
1.7
Ritalin
2.1
2.8
3.8
Cough Medicine. In 2006, a question about the use of cough and cold medicines to get high was asked for the first time.
Rates of abuse in 2007 (%)
8th-Grade
10th-Grade
12th-Grade
Cough Medicine
4.0
5.4
5.8
National Survey on Drug Use and Health (NSDUH)4According to the 2006 NSDUH, an estimated 7 million persons, or 2.8 percent of the population, age 12 or older had used prescription psychotherapeutic medications nonmedically in the month prior to being surveyed. This includes 5.2 million using pain relievers (an increase from 4.7 million in 2005), 1.8 million using tranquilizers, 1.2 million using stimulants, and 0.39 million using sedatives.
Past-month nonmedical use of prescription-type drugs among young adults aged 18 to 25 increased from 5.4 percent in 2002 to 6.4 percent in 2006. This was primarily due to an increase in pain reliever use, which was 4.1 percent in 2002 and 4.9 percent in 2006. However, nonmedical use of tranquilizers also increased over the 5-year period, from 1.6 to 2.0 percent.
Among persons aged 12 or older who used pain relievers nonmedically in the past 12 months, 55.7 percent reported that they got the drug most recently used from someone they knew and that they did not pay for it. Another 19.1 percent reported that they obtained the drug from one doctor. Only 3.9 percent purchased the pain reliever from a drug dealer or other stranger, and only 0.1 percent reported buying the drug on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 80.7 percent reported in a followup question that the friend or relative had obtained the drug from just one doctor.
Sources:
http://www.nida.nih.gov/Infofacts/Painmed.html
Patients, healthcare professionals, and pharmacists all have roles in preventing the abuse1 of and addiction to prescription medications. For example, patients should follow the directions for use carefully, learn what effects and side effects the medication could have, and inform their doctor/pharmacist whether they are taking other medications [including over-the-counter (OTC) medications or health supplements], since these could potentially interact with the prescribed medication. The patient should read all information provided by the pharmacist. Physicians and other healthcare providers should screen for past or current substance abuse in the patient during routine examination, including asking questions about what other medications the patient is taking and why. Providers should note any rapid increases in the amount of a medication needed or frequent requests for refills before the quantity prescribed should have been finished, as these may be indicators of abuse.1
Similarly, some OTC medications, such as cough and cold medicines containing dextromethorphan, have beneficial effects when taken as recommended, but they can also be abused and lead to serious adverse health consequences. Parents should be aware of the potential for abuse of these medications, especially when consumed in large quantities, which should signal concern and the possible need for intervention.
Commonly Abused Prescription Medications
Although many prescription medications can be abused, the following three classes are most commonly abused:
Opioids—usually prescribed to treat pain.
CNS Depressants—used to treat anxiety and sleep disorders.
Stimulants—prescribed to treat ADHD and narcolepsy.
Opioids
What are Opioids? Opioids are commonly prescribed because of their effective analgesic, or pain-relieving, properties. Studies have shown that properly managed medical use of opioid analgesic compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction.
Among the compounds that fall within this class are hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin—an oral, controlled-release form of the drug), morphine, fentanyl, codeine, and related medications. Morphine and fentanyl are often used to alleviate severe pain, while codeine is used for milder pain. Other examples of opioids that can be prescribed to relieve pain include propoxyphene (Darvon); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of its side effects. In addition to their effective pain-relieving properties, some of these medications can be used to relieve severe diarrhea (for example, Lomotil, also known as diphenoxylate) or severe coughs (codeine).
How are Opioids Abused?Opioids can be taken orally, or the pills may be crushed and the powder snorted or injected. A number of overdose deaths have resulted from the latter routes of administration, particularly with the drug OxyContin, which was designed to be a slow-release formulation. Snorting or injecting opioids results in a rapid release of the drug into the bloodstream, exposing the person to high doses and causing many of the reported overdose reactions.
How do Opioids Affect the Brain?Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these compounds attach to certain opioid receptors in the brain and spinal cord, they can effectively change the way a person experiences pain.
In addition, opioid medications can affect regions of the brain that mediate what one perceives as pleasure, resulting in the initial euphoria or sense of well-being that many opioids produce. Repeated abuse of opioids can lead to addiction—a chronic, relapsing disease, characterized by compulsive drug seeking and abuse despite its known harmful consequences.What Adverse Effects Can be Associated with Opioids? Opioids can produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death.
These medications are only safe to use with other substances under a physician’s supervision. Typically, they should not be used with alcohol, antihistamines, barbiturates, or benzodiazepines. Because these substances slow breathing, their combined effects could lead to life-threatening respiratory depression. What Happens When you Stop Taking Opioids? Patients who are prescribed opioids for a period of time may develop a physical dependence on them, which is not the same as addiction. Repeated exposure to opioids causes the body to adapt, sometimes resulting in tolerance (that is, more of the drug is needed to achieve the desired effect compared to when it was first prescribed) and withdrawal symptoms upon abrupt cessation of drug use. Thus, individuals taking prescribed opioid medications should not only be given these medications under appropriate medical supervision, but should also be medically supervised when stopping use in order to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements.
Are there Treatments for Opioid Addiction? Individuals who abuse or are addicted to prescription opioid medications can be treated. Initially, they may need to undergo medically supervised detoxification to help reduce withdrawal symptoms—however, that is just the first step. Options for effectively treating addiction to prescription opioids are drawn from research on treating heroin addiction. Behavioral treatments combined with medications have proven effective. Currently used medications are:
Methadone, a synthetic opioid that eliminates withdrawal symptoms and relieves craving, has been used for more than 30 years to successfully treat people addicted to heroin.
Buprenorphine, another synthetic opioid, is a more recently approved medication for treating addiction to heroin and other opiates. It can be prescribed in a physician’s office and has a better safety profile than methadone.
Naltrexone is a long-acting opioid receptor blocker that can be employed to help prevent relapse. It is not widely used, however, because of poor compliance, except in highly motivated individuals (e.g., physicians at risk of losing their medical license). It should be noted that this medication can only be used for someone who has already been detoxified, since it can produce severe withdrawal symptoms in a person continuing to abuse opioids.
Naloxone is a short-acting opioid receptor blocker that counteracts the effects of opioids and can be used to treat overdoses.
CNS Depressants
What are CNS Depressants?CNS depressants (e.g., tranquilizers, sedatives) slow normal brain function. In higher doses, some CNS depressants can be used as general anesthetics or pre-anesthetics.
CNS depressants can be divided into three groups, based on their chemistry and pharmacology:
Barbiturates, such as mephobarbital (Mebaral) and sodium pentobarbital (Nembutal), are used as preanesthetics, promoting sleep.
Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), and estazolam (ProSom), can be prescribed to treat anxiety, acute stress reactions, panic attacks, convulsions, and sleep disorders. For the latter, benzodiazepines are usually prescribed only for short-term relief of sleep problems because of the development of tolerance and risk of addiction.
Newer sleep medications, such as zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), are now more commonly prescribed to treat sleep disorders. These medications are non-benzodiazepines that act at a subset of the benzodiazepine receptors and appear to have a lower risk for abuse and addiction.
How are CNS Depressants abused? CNS depressants are usually taken orally, sometimes in combination with other drugs or to counteract the effects of other licit or illicit drugs (e.g., stimulants).
How do CNS Depressants Affect the Brain? Most of the CNS depressants have similar actions in the brain—they enhance the actions of the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. Although different classes of CNS depressants work in unique ways, it is ultimately their ability to increase GABA activity that produces a drowsy or calming effect.
What Adverse Effects Can Be Associated with CNS Depressants?Despite their beneficial effects for people suffering from anxiety or sleep disorders, barbiturates and benzodiazepines can be addictive and should be used only as prescribed.
CNS depressants should not be combined with any medication or substance that causes drowsiness, including prescription pain medicines, certain OTC cold and allergy medications, or alcohol. If combined, they can slow both the heart and respiration, which can be fatal.
What Happens When you Stop Taking CNS Depressants? Discontinuing prolonged use or abuse of high doses of CNS depressants can lead to serious withdrawal symptoms. Because it works by slowing the brain’s activity, when one stops taking a CNS depressant, this activity can rebound to the point that seizures can occur. Someone who is either thinking about ending their use of a CNS depressant, or who has stopped and is suffering withdrawal, should seek medical treatment.
Are there Treatments for Addiction to CNS Depressants? In addition to medical supervision during withdrawal, counseling in an inpatient or outpatient setting can help people who are overcoming addiction to CNS depressants. For example, cognitive-behavioral therapy has been used successfully to help individuals in treatment for abuse of benzodiazepines. This type of therapy focuses on modifying a patient’s thinking, expectations, and behaviors while simultaneously increasing their skills for coping with various life stressors.
Stimulants
What are Stimulants?Stimulants such as amphetamines (Adderal, Dexedrine) and methylphenidate (Concerta, Ritalin) have chemical structures that are similar to key brain neurotransmitters called monoamines, which include dopamine and norepinephrine—stimulants increase the levels of these chemicals in the brain and body. This, in turn, increases blood pressure and heart rate, constricts blood vessels, increases blood glucose, and opens up the pathways of the respiratory system. Stimulants increase alertness, attention, and energy; and because they increase dopamine, they can produce a sense of euphoria.
Historically, stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the use of stimulants began to wane. Now, stimulants are prescribed for treating only a few health conditions, most notably ADHD, narcolepsy, and, in some instances, depression that has not responded to other treatments.
How are Stimulants Abused?Stimulants may be taken orally, but some abusers crush the tablets, dissolve them in water, and inject the mixture; complications can arise from this because insoluble fillers in the tablets can block small blood vessels. Stimulants have been abused for both “performance enhancement” and recreational purposes (i.e., to get high).
How Do Prescription Stimulants Affect the Brain?All stimulants work by increasing dopamine levels in the brain. Dopamine is a brain chemical (neurotransmitter) associated with pleasure, movement, and attention. The therapeutic effect of stimulants is achieved by slow and steady increases of dopamine that are similar to the natural production of this chemical by the brain. The doses prescribed by physicians start low and increase gradually until a therapeutic effect is reached. However, when taken in doses and routes other than those prescribed, stimulants can increase brain dopamine in a rapid and highly amplified manner—as do most other drugs of abuse—disrupting normal communication between brain cells, producing euphoria, and increasing the risk of addiction.
What Adverse Effects Can Be Associated with Stimulant Abuse?The consequences of stimulant abuse can be extremely dangerous. Taking high doses of a stimulant can result in an irregular heartbeat, dangerously high body temperatures, and/or the potential for cardiovascular failure or seizures. Taking high doses of some stimulants repeatedly over a short period of time can lead to hostility or feelings of paranoia in some individuals.
Stimulants should not be mixed with antidepressants, which may enhance the effects of a stimulant, or OTC cold medicines containing decongestants, which may cause blood pressure to become dangerously high or lead to irregular heart rhythms.
Are there Treatments for Stimulant Addiction? Treatment of addiction to prescription stimulants is based on behavioral therapies proven effective for treating cocaine or methamphetamine addiction. At this time, there are no proven medications for the treatment of stimulant addiction.
Depending on the patient’s situation, the first step in treating prescription stimulant addiction may be to slowly decrease the drug’s dose and attempt to treat withdrawal symptoms. This process of detoxification could then be followed with one of many behavioral therapies. Contingency management, for example, improves treatment outcomes by enabling patients to earn vouchers for drug-free urine tests; the vouchers can be exchanged for items that promote healthy living. Cognitive-behavioral therapies—which teach patients skills to recognize risky situations, avoid drug use, and cope more effectively with problems—are proving beneficial. Recovery support groups may also be effective in conjunction with a behavioral therapy.
Dextromethorphan (DXM)
What is DXM?Dextromethorphan is the active cough suppressant found in OTC cough and cold medications. When taken in recommended doses, these medications are safe and effective.
How is DXM Abused?DXM is taken orally. In order to experience the mind-altering effects of DXM, excessive amounts of liquid or gelcaps must be consumed. The availability and accessibility of these products make them a serious concern, particularly for youth, who tend to be their primary abusers.
What are the Consequences Associated with the Abuse of DXM?In very large quantities, DXM can cause effects similar to that of ketamine and PCP by affecting similar sites in the brain. These effects can include impaired motor function, numbness, nausea/vomiting, and increased heart rate and blood pressure. On rare occasions, hypoxic brain damage has occurred due to the combination of DXM with decongestants often found in these medications.
What are the Trends in the Abuse of Prescription Drugs and Cough Medicine?
Monitoring the Future (MTF) Survey2Each year, the Monitoring the Future (MTF) survey assesses the extent of drug use among 8th-, 10th-, and 12th-graders nationwide. Nonmedical use of any prescription drug is reported only for 12th-graders. In 2007, 21.7 percent reported lifetime3 use (down significantly from 2006); 15.4 percent reported past-year use; and 7.6 percent reported past-month use. Prescription and OTC medications were the most commonly abused drugs by high school students after marijuana. They represent 6 of the top 10 illicit drugs reported by 12th-graders.
Prescription Painkillers. In 2002, MTF added questions to the survey about past-year nonmedical use of Vicodin and OxyContin. For Vicodin, past-year nonmedical use has remained stable at high levels for each grade since its inclusion in the survey.
Rates of abuse in 2007 (%)
8th-Grade
10th-Grade
12th-Grade
Vicodin
2.7
7.2
9.6
OxyContin
1.8
3.9
5.2
CNS Depressants. Nonmedical use of tranquilizers (benzodiazepines and others) has remained stable for all three grades in all prevalence periods (lifetime, past-year, and past-month use). For sedatives (barbiturates), data are collected only from 12th-graders.
Rates of abuse in 2007 (%)
8th-Grade
10th-Grade
12th-Grade
Tranquilizers
2.4
5.3
6.2
Sedatives
--
--
6.2
Stimulants. Nonmedical use of stimulants is broken up by the type of stimulant used: amphetamines, methamphetamine, and Ritalin. Amphetamine and methamphetamine abuse have been decreasing among 8th-, 10th-, and 12th-graders over the past 6 years; nonmedical use of Ritalin has decreased in 10th-graders during the same time period.
Rates of abuse in 2007 (%)
8th-Grade
10th-Grade
12th-Grade
Amphetamines
4.2
8.0
7.5
Methamphetamine
1.1
1.6
1.7
Ritalin
2.1
2.8
3.8
Cough Medicine. In 2006, a question about the use of cough and cold medicines to get high was asked for the first time.
Rates of abuse in 2007 (%)
8th-Grade
10th-Grade
12th-Grade
Cough Medicine
4.0
5.4
5.8
National Survey on Drug Use and Health (NSDUH)4According to the 2006 NSDUH, an estimated 7 million persons, or 2.8 percent of the population, age 12 or older had used prescription psychotherapeutic medications nonmedically in the month prior to being surveyed. This includes 5.2 million using pain relievers (an increase from 4.7 million in 2005), 1.8 million using tranquilizers, 1.2 million using stimulants, and 0.39 million using sedatives.
Past-month nonmedical use of prescription-type drugs among young adults aged 18 to 25 increased from 5.4 percent in 2002 to 6.4 percent in 2006. This was primarily due to an increase in pain reliever use, which was 4.1 percent in 2002 and 4.9 percent in 2006. However, nonmedical use of tranquilizers also increased over the 5-year period, from 1.6 to 2.0 percent.
Among persons aged 12 or older who used pain relievers nonmedically in the past 12 months, 55.7 percent reported that they got the drug most recently used from someone they knew and that they did not pay for it. Another 19.1 percent reported that they obtained the drug from one doctor. Only 3.9 percent purchased the pain reliever from a drug dealer or other stranger, and only 0.1 percent reported buying the drug on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 80.7 percent reported in a followup question that the friend or relative had obtained the drug from just one doctor.
Sources:
http://www.nida.nih.gov/Infofacts/Painmed.html
A Guide to Action
To Prevent and Reduce
Underage Drinking
A Guide to Action
for Families
·
The Surgeon General’s Call to Action
What It Means to YOU
·
About This
Surgeon General’s
Call to Action
The Surgeon General is the Nation’s top doctor and public health officer. The President
of the United States appoints the Surgeon General to help protect and promote the
health of the Nation.
The Surgeon General lets people across the country know the latest news on how to get
healthy and stay healthy. He explains how to avoid illness and injury.
When a health topic needs special attention, the Surgeon General issues a national call to action
to everyone in America. The Surgeon General’s Call to Action To Prevent and Reduce Underage
Drinking explains why underage alcohol use is a major public health and safety issue.
It asks everyone to take action.
About This Guide to Action for Families
When it comes to tackling public health problems, knowledge is power. When people have
the facts and the right tools, they can take action. This guide gives you the knowledge and
tools you need to take action against underage drinking. It tells you about underage alcohol
use and the damage it can do. And, it suggests ways you can end underage drinking in your
home, family, community, and across the country.
Suggested Citation: U.S. Department of Health and Human Services. The Surgeon General’s Call to Action To
Prevent and Reduce Underage Drinking: A Guide to Action for Families. U.S. Department of Health and Human
Services, Office of the Surgeon General, 2007.
All material in this report is in the public domain and may be reproduced or copied without permission from the
Federal government. Citation of the source is appreciated.
Drinking alcohol can harm the growing body and brain. That’s why it’s important for young people
to grow up alcohol-free. And it takes everyone to help young people choose not to drink alcohol.
It takes you.
What Is Underage Drinking?
When anyone under age 21 drinks alcohol, we call it underage drinking. And underage drinking
is against the law, except in special cases, such as when it is part of a religious ceremony. Underage
drinking is also dangerous. It can harm the mind and body of a growing teen in ways many
people don’t realize.
Yet, children and teens still drink, even though it can harm them. Underage drinking is a serious
problem, with roots deep in our culture. It is time to change that picture. It’s time to take action. It’s
time to stop looking the other way. It’s time to tell children and teens that underage drinking is not
okay. It will take a lot of work over time to change how people think about underage drinking. It’s a
long-term project for parents, schools, local groups, community leaders, and other concerned adults.
And it’s a project that should start when children are young and continue through the teen years.
u In any month, more youth are drinking than are smoking cigarettes or using marijuana.
TODA Y, NEARLY 10.8 MILLION YOUTH,
AGE S 12-20, ARE UNDERAGE DRINKERS
More teens
drink alcohol
than smoke
or use drugs.
0
5
10
15
20
25
30
35
40
45
50
Grade
Percent Alcohol Cigarettes Marijuana
Past Month Substance Use by Grade
8th 10th 12th
—Johnston, et al. 2006 Monitoring the Future National Survey Results on Drug Use.
As they grow older, the chance
that young people will use
alcohol grows. Approximately
10% of 12-year-olds say they have
used alcohol at least once. By age 13
that number doubles. And by age 15,
approximately 50% have had at least one drink.
Alcohol dependence is a term doctors use when
people have trouble controlling their drinking, and
when their consumption of, or preoccupation with, alcohol
occurs to the extent that it interferes with normal personal,
family, social, or work life. Alcohol dependence rates are highest
among young people between ages 18 and 20. And they’re not even
old enough to drink legally.
Did You Know?
The greatest influence on young people’s decisions to begin drinking is the world
they live in, which includes their families, friends, schools, the larger community,
and society as a whole.
Alcohol use by young people often is made possible by adults. After all, teens can’t
legally get alcohol on their own.
THE FAC TS
FASTFACT
Most young people who start drinking before age 21 do so when
they are about 13-14 years old. That’s why it’s important to start
talking early and keep talking about underage drinking. And
that’s why ALL adults working with young people should send
the same message that underage drinking is not okay.
WHAT IS “A DRINK,”
ANYWAY?
A drink can come in many forms. It can be a shot of hard
liquor or a mixed drink containing vodka, rum, tequila, gin,
scotch, etc. It can also be wine, a wine cooler, beer, or malt liquor.
A standard drink is any drink that contains about 14 grams of pure
alcohol (about 0.6 fluid ounces or 1.2 tablespoons). This is the amount of
alcohol usually found in—
One 12-ounce beer
One 4- to 5-ounce glass of wine
One 1.5-ounce shot of 80 proof liquor
What’s a Standard Drink?
But not all drinks are standard drinks. In fact, different drinks often have different amounts
of alcohol. Mixed drinks may contain more than one shot of liquor, and different beers or
wines may not have the same amount of alcohol in them, even when the drinks are the same
size. For example, some beers and beer products, like “ice” beers, and malt liquors, and some
wines, have more alcohol than others.
Remember, the legal drinking age is 21 and underage
drinking can be a threat to health and development.
So many young people drink.
Many more young people use alcohol than
tobacco or illegal drugs. By age 18, more
than 70% of teens have had at least one drink.
When young people drink, they
drink a lot at one time. Teens drink
less often than adults. But when teens do
drink, they drink more than adults. On
average, young people have about 5 drinks
on a single occasion. This is called
binge drinking, a very dangerous way of
drinking that can lead to serious problems
and even death.
Early drinking can cause later
alcohol problems. Of adults who
started drinking before age 15, around 40%
say they have the signs of alcohol dependence.
That rate is four times higher than for adults
who didn’t drink until they were age 21.
Alcohol may have a special appeal
for young people. The teen years are a time
of adventure, challenges, and taking risks.
Alcohol is often one of the risks young people
take. But most people don’t know how
alcohol affects a teen’s body and behavior. They
don’t realize that alcohol can affect young people
in different ways from adults. And they don’t
realize that underage drinkers can also harm
people other than themselves.
FASTFACT
Rates of death and injury
nearly triple between
the early teen years
and early adult life.
Dangerous activities like
underage drinking play
a large role. That’s why
ending teen alcohol use
can help save lives.
Why Is Underage Drinking
A Problem?
0
10
20
30
40
50
60
70
80
90
100
Age
Percent
male female
—SAMHSA, 2005 National Survey on Drug Use & Health (NSDUH)
12 13 14 15 16 17 18 19 20
Percent of Youth Who Have Used Alcohol by Age and Gender
Many people don’t know that underage
alcohol use—
Is a major cause of death from injuries among young people. Each year,
approximately 5,000 people under the age of 21 die as a result of underage drinking;
this includes about 1,900 deaths from motor vehicle crashes, 1,600 as a result of
homicides, 300 from suicide, as well as hundreds from other injuries such as falls,
burns, and drownings.
Increases the risk of carrying out, or being a victim of, a physical or sexual assault.
Can affect the body in many ways. The effects of alcohol range from hangovers to
death from alcohol poisoning.
Can lead to other problems. These may include bad grades in school, run-ins with
the law, and drug use.
Affects how well a young person judges risk and makes sound decisions.
For example, after drinking, a teen may see nothing wrong with driving a car or
riding with a driver who has been drinking.
Plays a role in risky sexual activity.
This can increase the chance of teen
pregnancy and sexually transmitted
diseases (STDs), including HIV, the
virus that causes AIDS.
Can harm the growing brain,
especially when teens drink a lot.
Today we know that the brain
continues to develop from birth
through the teen years into the
mid-20s.
The results of underage
drinking can be grave
The Teen Years Are a Time of Many Changes
Boys physically become young men and girls become young women.
Young people move from elementary to middle to high school. Responsibilities
increase. For example, teens learn to drive, may get a job, and have more chores and
more homework.
Teens spend less time with their parents. They spend more time alone or with friends.
They also like to stay up later and sleep in.
Teens search for who they really are and who they want to be. They worry about
friendships and social groups. And they have growing romantic and sexual interests.
The desire for adventure, excitement, and action increases. That’s why many young
people want to take more chances, try new things, and be more independent.
These changes are important steps on the road to adult life. However, these changes also
increase the chance that some young people may turn to alcohol.
Did You Know?
The different “worlds” teens live in can have a big effect on their drinking. Some young
people are more involved with family than others. Others turn to their friends first. Still
others turn to social groups like sports teams and clubs, faith-based groups, or groups of
like-minded youth. The Internet, media, music, and videos are also an important part of the
world of most teens. All of these affect a young person’s choices about using alcohol.
FASTFACT
Factors in an adolescent’s environment affect both the appeal
of alcohol and its availability. Among these factors are the social
systems within which teens function and with which they interact.
Examples of these social systems are parents, friends, family, schools,
and the community. The media and the larger social culture,
including how alcohol is marketed and portrayed, also contribute to
alcohol’s appeal to young people.
Why Teens May Choose
to Drink
Many things affect a young person’s decisions about
drinking—
The different “worlds” in which teens live, including
family, friends, school, and community
A greater desire to take risks
Less connection to parents and more independence
More time spent with friends and by themselves
Increased stress
Greater attention to what teens see and hear about alcohol
Did You Know?
Teens with behavior or family problems are at higher risk for alcohol use. And if
anyone in the family has a drinking problem, it can affect the entire family. It also may
affect a teen’s choices about drinking.
FASTFACT
Youth with histories of behavior problems (for example,
delinquent activity, impulsive actions, and difficulty controlling
responses) are more likely to use alcohol than are other young
people. The same is true for youth who have an unusually strong
desire for new experiences and sensations, and for those with
histories of family conflict and stress, and/or alcohol problems.
Underage drinking can affect anyone,
including people who don’t drink.
Underage alcohol use can lead to dangerous behavior, property damage,
and violence.
The results can be injury and even death for the drinker, and for other people nearby.
About 45% of people who die in car crashes involving a drinking driver under age 21
are people other than the driver.
The effects of underage drinking can be felt by everyone. That makes underage alcohol use
everyone’s problem.
Underage Drinking Is
Everyone’s Problem
FASTFACT
Most 6-year-olds know that alcohol is
only for adults. Between ages 9 and 13,
youth begin to think that alcohol use is
okay. That’s why it’s never too early to
start talking with young people about
the dangers of underage drinking.
Teens say that they rely on adults in
their lives more than anyone else to
help them make tough decisions and to
provide good advice.
There is a role for
everyone.
Everyone can work together to create
a community where young people can
grow up and feel good about themselves
without drinking.
Everyone in the community should deliver
the message that underage drinking is not
okay. The message should be the same whether youth hear it in school, at home, in
places of worship, on the sports field, in youth programs, or in other places where
young people gather.
It is important for families to pay attention to what’s happening with their teens.
Young people can learn about the dangers of alcohol use. They can change how they
and others think about drinking.
It’s time to change how we all think, talk, and act when it
comes to underage drinking. We need to stop accepting it
and to start discouraging it. It’s time to help young people
understand that it is not okay for them to drink alcohol. The
discussion needs to start long before youth start thinking
about drinking.
Ending underage drinking is
everyone’s job
While many teens drink alcohol, underage alcohol use is not inevitable. Families are not
helpless to prevent it. Focus your efforts on the factors that protect teens from alcohol use. At
the same time, you can work to reduce the factors that increase the chance that they will drink.
Support your teens and give them space to grow.
Be involved in your teens’ lives. Be loving and caring.
Encourage your teens’ growing independence, but set appropriate limits.
Make it easy for your teens to share information about their lives.
Know where your teens are, what they’re doing, who they’re with, and who their
friends are.
Find ways for your teens to be involved in family life, such as doing chores or caring
for a younger brother or sister.
Set clear rules, including rules about alcohol use. Enforce the rules you set.
Talk with your teens about alcohol use.
When you talk with your teens about drinking, listen to them and respect what they say.
Make clear your expectation that your teens will not drink.
Teach your children about the dangers of underage drinking.
Discuss laws about underage drinking, including the age 21 law.
Help your teens make good decisions about alcohol.
Help your teens know how to resist alcohol.
Help them find ways to have fun without alcohol.
Do not give alcohol to your teens. Tell them that any alcohol in your home is off
limits to them and to their friends.
Don’t let your teens attend parties where alcohol is served. Make sure alcohol isn’t
available at teen parties in your own home.
Set clear rules about not drinking and enforce them consistently.
Help your teens avoid dangerous situations such as riding in a car driven by someone
who has been drinking.
Help your teens get professional help if you’re worried about their involvement
with alcohol.
What families can do about
underage alcohol use
Be aware of factors that may
increase the risk of teen
alcohol use.
Significant social transitions
such as graduating to middle
or high school, or getting a
driver’s license
A history of conduct problems
Depression and other serious emotional problems
A family history of alcoholism
Contact with peers involved in deviant activities
Be a positive adult role model.
If you drink yourself, drink responsibly. That means not drinking too much or too often.
Stay away from alcohol in high-risk situations. For example, don’t drive or go
boating when you’ve been drinking.
Get help if you think you have an alcohol-related problem.
Work with others.
No matter how close you and your teens are, it may not be enough to prevent them from
drinking. It’s hard for families to do this alone. It’s important to reach out to schools,
communities, and government. You can help protect teens from underage alcohol use by
working to see to it that—
Schools and the community support and reward young people’s decisions not to drink.
Rules about underage drinking are in place at home, at school, and in your community.
Penalties for breaking the rules are well known. Rules are enforced the same way
for everyone.
All laws about underage alcohol use are well known and enforced.
Parties and social events at home and elsewhere don’t permit underage drinking.
The Surgeon General’s Call to Action To Prevent and Reduce Underage Drinking was written
to improve public knowledge about underage drinking. It encourages action by people and
groups nationwide. Each person in America has a role to play to help prevent and reduce
underage alcohol use. This Call to Action helps adults across the country rethink underage
drinking as we know it today. It provides the tools to get the word out in discussions around
the dinner table, in school or campus-based programs, and in communities. It can also
inform local, Tribal, State, and national programs and policies.
By learning more about how underage drinking affects a teen’s growing body and brain,
family and other adults in the community can better help protect youth from the dangers of
underage drinking. Family and caring adults in the community can help teens choose not to
drink. Finally, communities can help create a safer environment for young people by working
together with parents and with schools, health care professionals, local organizations, and
policymakers to prevent and reduce underage drinking.
This Call To Action is exactly that. It calls on every adult in the country to join with the
Surgeon General in a national effort to address underage drinking early and often.
Underage alcohol use is everyone’s problem—and its solutions are everyone’s responsibility.
References for “A Guide to Action for Families”
The data, facts, and suggestions presented here come primarily from the Surgeon General’s Call to Action To Prevent
and Reduce Underage Drinking, cited on the inside front cover. Other sources of some data presented in this
document include:
Grant BF, Dawson DA, Stinson FS, Chou SP, Dufour MC, Pickering RP. The 12-month prevalence and trends
in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug and Alcohol
Dependence 74:223-234, 2004.
Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. (December 21, 2006). Teen drug use continues down
in 2006, particularly among older teens; but use of prescription-type drugs remains high. University of Michigan
News and Information Services: Ann Arbor, MI. [On-line]. Available: www.monitoringthefuture.org; accessed
01/03/07.
Substance Abuse and Mental Health Services Administration. Results from the 2005 National Survey on Drug Use
and Health: National Findings. Rockville (MD): U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration; 2006. Available: www.oas.samhsa.gov/nsduh.htm;
accessed 01/03/07.
Advancing the
call to action
13
Acknowledgements
This public document was prepared by the U.S. Department of Health and Human Services (DHHS) under
the direction of the Office of the Surgeon General. Its purpose is to make information contained in the Surgeon
General’s Call to Action To Prevent and Reduce Underage Drinking available in a brief, accessible format to
improve public knowledge on this topic.
Rear Admiral Kenneth P. Moritsugu, M.D., M.P.H., Acting Surgeon General, U.S. Public Health Service,
Office of the Surgeon General, Office of the Secretary, DHHS, Washington, D.C.
Richard H. Carmona, M.D., M.P.H., F.A.C.S., former Surgeon General, U.S. Public Health Service,
Office of the Surgeon General, Office of the Secretary, DHHS, Washington, D.C.
Commander Karen A. Near, M.D., M.S., Senior Science Advisor, Office of the Surgeon General,
U.S. Public Health Service, Office of the Secretary, DHHS, Washington, D.C.
Ron Schoenfeld, Ph.D., former Senior Science Advisor, Office of the Surgeon General,
U.S. Public Health Service, Office of the Secretary, DHHS, Washington, D.C.
Ting-Kai Li, M.D., Director, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.
Rear Admiral Eric B. Broderick, D.D.S., M.P.H., Acting Deputy Administrator, Assistant Surgeon General,
Substance Abuse and Mental Health Services Administration, DHHS, Rockville, MD.
Editors and Writers
Patricia A. Powell, Ph.D., Senior Scientific Editor, Acting Chief, Science Policy Branch, Office of Science Policy
and Communications, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.
Vivian B. Faden, Ph.D., Senior Scientific Editor, Deputy Director, Division of Epidemiology and Prevention
Research, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.
Stephen Wing, M.S.W., Associate Administrator for Alcohol Policy, Substance Abuse and Mental Health
Services Administration, DHHS, Rockville, MD.
Science Writers
Hamilton Beazley, Ph.D. Scholar-in-Residence, St. Edward’s University, Austin, TX.
Theodora Fine, M.A., A.B.D., Executive Officer, Fine WordCrafters: Communications and Editing Alchemy,
Ellicott City, MD.
Underage drinking is a public health and safety problem that results in serious personal, social,
and economic consequences for adolescents, their families, communities, and the Nation as a
whole. Your involvement can make a difference.
Many free sources of information are available to help you take action to prevent and reduce
underage drinking. Some of the materials can help better educate youth and their families,
your colleagues, and your community about the dangers of underage drinking and how to
help stop it before it starts.
To read the entire Surgeon General’s Call to Action To Prevent and Reduce Underage
Drinking, be sure to log on to the Surgeon General’s Web site at www.surgeongeneral.gov.
For more information about ways you can help to prevent and reduce underage
drinking in your community, please check out www.stopalcoholabuse.gov, a
comprehensive portal of Federal resources for information on underage drinking
and ideas for combating the problem.
Another excellent source of information is the Web site of the National Institute on
Alcohol Abuse and Alcoholism at http://www.niaaa.nih.gov.
General information about underage drinking, its effects on adolescents, families
and communities, and what you can do to help stop underage drinking is available
through the National Clearinghouse on Alcohol and Drug Information (NCADI),
on the Internet at http://ncadi.samhsa.gov/ or by calling (800) 729-6686.
The words and images in this Guide to Action were designed to reach a broad audience.
Copies of this booklet and the Surgeon General’s Call to Action To Prevent and Reduce
Underage Drinking can be downloaded from both of the Web sites noted. To order copies by
mail, please contact the National Clearinghouse on Alcohol and Drug Information (NCADI)
http://ncadi.samhsa.gov/ or by calling (800) 729-6686.
for more information
References:
http://www.surgeongeneral.gov/topics/underagedrinking/FamilyGuide.pdf
Underage Drinking
A Guide to Action
for Families
·
The Surgeon General’s Call to Action
What It Means to YOU
·
About This
Surgeon General’s
Call to Action
The Surgeon General is the Nation’s top doctor and public health officer. The President
of the United States appoints the Surgeon General to help protect and promote the
health of the Nation.
The Surgeon General lets people across the country know the latest news on how to get
healthy and stay healthy. He explains how to avoid illness and injury.
When a health topic needs special attention, the Surgeon General issues a national call to action
to everyone in America. The Surgeon General’s Call to Action To Prevent and Reduce Underage
Drinking explains why underage alcohol use is a major public health and safety issue.
It asks everyone to take action.
About This Guide to Action for Families
When it comes to tackling public health problems, knowledge is power. When people have
the facts and the right tools, they can take action. This guide gives you the knowledge and
tools you need to take action against underage drinking. It tells you about underage alcohol
use and the damage it can do. And, it suggests ways you can end underage drinking in your
home, family, community, and across the country.
Suggested Citation: U.S. Department of Health and Human Services. The Surgeon General’s Call to Action To
Prevent and Reduce Underage Drinking: A Guide to Action for Families. U.S. Department of Health and Human
Services, Office of the Surgeon General, 2007.
All material in this report is in the public domain and may be reproduced or copied without permission from the
Federal government. Citation of the source is appreciated.
Drinking alcohol can harm the growing body and brain. That’s why it’s important for young people
to grow up alcohol-free. And it takes everyone to help young people choose not to drink alcohol.
It takes you.
What Is Underage Drinking?
When anyone under age 21 drinks alcohol, we call it underage drinking. And underage drinking
is against the law, except in special cases, such as when it is part of a religious ceremony. Underage
drinking is also dangerous. It can harm the mind and body of a growing teen in ways many
people don’t realize.
Yet, children and teens still drink, even though it can harm them. Underage drinking is a serious
problem, with roots deep in our culture. It is time to change that picture. It’s time to take action. It’s
time to stop looking the other way. It’s time to tell children and teens that underage drinking is not
okay. It will take a lot of work over time to change how people think about underage drinking. It’s a
long-term project for parents, schools, local groups, community leaders, and other concerned adults.
And it’s a project that should start when children are young and continue through the teen years.
u In any month, more youth are drinking than are smoking cigarettes or using marijuana.
TODA Y, NEARLY 10.8 MILLION YOUTH,
AGE S 12-20, ARE UNDERAGE DRINKERS
More teens
drink alcohol
than smoke
or use drugs.
0
5
10
15
20
25
30
35
40
45
50
Grade
Percent Alcohol Cigarettes Marijuana
Past Month Substance Use by Grade
8th 10th 12th
—Johnston, et al. 2006 Monitoring the Future National Survey Results on Drug Use.
As they grow older, the chance
that young people will use
alcohol grows. Approximately
10% of 12-year-olds say they have
used alcohol at least once. By age 13
that number doubles. And by age 15,
approximately 50% have had at least one drink.
Alcohol dependence is a term doctors use when
people have trouble controlling their drinking, and
when their consumption of, or preoccupation with, alcohol
occurs to the extent that it interferes with normal personal,
family, social, or work life. Alcohol dependence rates are highest
among young people between ages 18 and 20. And they’re not even
old enough to drink legally.
Did You Know?
The greatest influence on young people’s decisions to begin drinking is the world
they live in, which includes their families, friends, schools, the larger community,
and society as a whole.
Alcohol use by young people often is made possible by adults. After all, teens can’t
legally get alcohol on their own.
THE FAC TS
FASTFACT
Most young people who start drinking before age 21 do so when
they are about 13-14 years old. That’s why it’s important to start
talking early and keep talking about underage drinking. And
that’s why ALL adults working with young people should send
the same message that underage drinking is not okay.
WHAT IS “A DRINK,”
ANYWAY?
A drink can come in many forms. It can be a shot of hard
liquor or a mixed drink containing vodka, rum, tequila, gin,
scotch, etc. It can also be wine, a wine cooler, beer, or malt liquor.
A standard drink is any drink that contains about 14 grams of pure
alcohol (about 0.6 fluid ounces or 1.2 tablespoons). This is the amount of
alcohol usually found in—
One 12-ounce beer
One 4- to 5-ounce glass of wine
One 1.5-ounce shot of 80 proof liquor
What’s a Standard Drink?
But not all drinks are standard drinks. In fact, different drinks often have different amounts
of alcohol. Mixed drinks may contain more than one shot of liquor, and different beers or
wines may not have the same amount of alcohol in them, even when the drinks are the same
size. For example, some beers and beer products, like “ice” beers, and malt liquors, and some
wines, have more alcohol than others.
Remember, the legal drinking age is 21 and underage
drinking can be a threat to health and development.
So many young people drink.
Many more young people use alcohol than
tobacco or illegal drugs. By age 18, more
than 70% of teens have had at least one drink.
When young people drink, they
drink a lot at one time. Teens drink
less often than adults. But when teens do
drink, they drink more than adults. On
average, young people have about 5 drinks
on a single occasion. This is called
binge drinking, a very dangerous way of
drinking that can lead to serious problems
and even death.
Early drinking can cause later
alcohol problems. Of adults who
started drinking before age 15, around 40%
say they have the signs of alcohol dependence.
That rate is four times higher than for adults
who didn’t drink until they were age 21.
Alcohol may have a special appeal
for young people. The teen years are a time
of adventure, challenges, and taking risks.
Alcohol is often one of the risks young people
take. But most people don’t know how
alcohol affects a teen’s body and behavior. They
don’t realize that alcohol can affect young people
in different ways from adults. And they don’t
realize that underage drinkers can also harm
people other than themselves.
FASTFACT
Rates of death and injury
nearly triple between
the early teen years
and early adult life.
Dangerous activities like
underage drinking play
a large role. That’s why
ending teen alcohol use
can help save lives.
Why Is Underage Drinking
A Problem?
0
10
20
30
40
50
60
70
80
90
100
Age
Percent
male female
—SAMHSA, 2005 National Survey on Drug Use & Health (NSDUH)
12 13 14 15 16 17 18 19 20
Percent of Youth Who Have Used Alcohol by Age and Gender
Many people don’t know that underage
alcohol use—
Is a major cause of death from injuries among young people. Each year,
approximately 5,000 people under the age of 21 die as a result of underage drinking;
this includes about 1,900 deaths from motor vehicle crashes, 1,600 as a result of
homicides, 300 from suicide, as well as hundreds from other injuries such as falls,
burns, and drownings.
Increases the risk of carrying out, or being a victim of, a physical or sexual assault.
Can affect the body in many ways. The effects of alcohol range from hangovers to
death from alcohol poisoning.
Can lead to other problems. These may include bad grades in school, run-ins with
the law, and drug use.
Affects how well a young person judges risk and makes sound decisions.
For example, after drinking, a teen may see nothing wrong with driving a car or
riding with a driver who has been drinking.
Plays a role in risky sexual activity.
This can increase the chance of teen
pregnancy and sexually transmitted
diseases (STDs), including HIV, the
virus that causes AIDS.
Can harm the growing brain,
especially when teens drink a lot.
Today we know that the brain
continues to develop from birth
through the teen years into the
mid-20s.
The results of underage
drinking can be grave
The Teen Years Are a Time of Many Changes
Boys physically become young men and girls become young women.
Young people move from elementary to middle to high school. Responsibilities
increase. For example, teens learn to drive, may get a job, and have more chores and
more homework.
Teens spend less time with their parents. They spend more time alone or with friends.
They also like to stay up later and sleep in.
Teens search for who they really are and who they want to be. They worry about
friendships and social groups. And they have growing romantic and sexual interests.
The desire for adventure, excitement, and action increases. That’s why many young
people want to take more chances, try new things, and be more independent.
These changes are important steps on the road to adult life. However, these changes also
increase the chance that some young people may turn to alcohol.
Did You Know?
The different “worlds” teens live in can have a big effect on their drinking. Some young
people are more involved with family than others. Others turn to their friends first. Still
others turn to social groups like sports teams and clubs, faith-based groups, or groups of
like-minded youth. The Internet, media, music, and videos are also an important part of the
world of most teens. All of these affect a young person’s choices about using alcohol.
FASTFACT
Factors in an adolescent’s environment affect both the appeal
of alcohol and its availability. Among these factors are the social
systems within which teens function and with which they interact.
Examples of these social systems are parents, friends, family, schools,
and the community. The media and the larger social culture,
including how alcohol is marketed and portrayed, also contribute to
alcohol’s appeal to young people.
Why Teens May Choose
to Drink
Many things affect a young person’s decisions about
drinking—
The different “worlds” in which teens live, including
family, friends, school, and community
A greater desire to take risks
Less connection to parents and more independence
More time spent with friends and by themselves
Increased stress
Greater attention to what teens see and hear about alcohol
Did You Know?
Teens with behavior or family problems are at higher risk for alcohol use. And if
anyone in the family has a drinking problem, it can affect the entire family. It also may
affect a teen’s choices about drinking.
FASTFACT
Youth with histories of behavior problems (for example,
delinquent activity, impulsive actions, and difficulty controlling
responses) are more likely to use alcohol than are other young
people. The same is true for youth who have an unusually strong
desire for new experiences and sensations, and for those with
histories of family conflict and stress, and/or alcohol problems.
Underage drinking can affect anyone,
including people who don’t drink.
Underage alcohol use can lead to dangerous behavior, property damage,
and violence.
The results can be injury and even death for the drinker, and for other people nearby.
About 45% of people who die in car crashes involving a drinking driver under age 21
are people other than the driver.
The effects of underage drinking can be felt by everyone. That makes underage alcohol use
everyone’s problem.
Underage Drinking Is
Everyone’s Problem
FASTFACT
Most 6-year-olds know that alcohol is
only for adults. Between ages 9 and 13,
youth begin to think that alcohol use is
okay. That’s why it’s never too early to
start talking with young people about
the dangers of underage drinking.
Teens say that they rely on adults in
their lives more than anyone else to
help them make tough decisions and to
provide good advice.
There is a role for
everyone.
Everyone can work together to create
a community where young people can
grow up and feel good about themselves
without drinking.
Everyone in the community should deliver
the message that underage drinking is not
okay. The message should be the same whether youth hear it in school, at home, in
places of worship, on the sports field, in youth programs, or in other places where
young people gather.
It is important for families to pay attention to what’s happening with their teens.
Young people can learn about the dangers of alcohol use. They can change how they
and others think about drinking.
It’s time to change how we all think, talk, and act when it
comes to underage drinking. We need to stop accepting it
and to start discouraging it. It’s time to help young people
understand that it is not okay for them to drink alcohol. The
discussion needs to start long before youth start thinking
about drinking.
Ending underage drinking is
everyone’s job
While many teens drink alcohol, underage alcohol use is not inevitable. Families are not
helpless to prevent it. Focus your efforts on the factors that protect teens from alcohol use. At
the same time, you can work to reduce the factors that increase the chance that they will drink.
Support your teens and give them space to grow.
Be involved in your teens’ lives. Be loving and caring.
Encourage your teens’ growing independence, but set appropriate limits.
Make it easy for your teens to share information about their lives.
Know where your teens are, what they’re doing, who they’re with, and who their
friends are.
Find ways for your teens to be involved in family life, such as doing chores or caring
for a younger brother or sister.
Set clear rules, including rules about alcohol use. Enforce the rules you set.
Talk with your teens about alcohol use.
When you talk with your teens about drinking, listen to them and respect what they say.
Make clear your expectation that your teens will not drink.
Teach your children about the dangers of underage drinking.
Discuss laws about underage drinking, including the age 21 law.
Help your teens make good decisions about alcohol.
Help your teens know how to resist alcohol.
Help them find ways to have fun without alcohol.
Do not give alcohol to your teens. Tell them that any alcohol in your home is off
limits to them and to their friends.
Don’t let your teens attend parties where alcohol is served. Make sure alcohol isn’t
available at teen parties in your own home.
Set clear rules about not drinking and enforce them consistently.
Help your teens avoid dangerous situations such as riding in a car driven by someone
who has been drinking.
Help your teens get professional help if you’re worried about their involvement
with alcohol.
What families can do about
underage alcohol use
Be aware of factors that may
increase the risk of teen
alcohol use.
Significant social transitions
such as graduating to middle
or high school, or getting a
driver’s license
A history of conduct problems
Depression and other serious emotional problems
A family history of alcoholism
Contact with peers involved in deviant activities
Be a positive adult role model.
If you drink yourself, drink responsibly. That means not drinking too much or too often.
Stay away from alcohol in high-risk situations. For example, don’t drive or go
boating when you’ve been drinking.
Get help if you think you have an alcohol-related problem.
Work with others.
No matter how close you and your teens are, it may not be enough to prevent them from
drinking. It’s hard for families to do this alone. It’s important to reach out to schools,
communities, and government. You can help protect teens from underage alcohol use by
working to see to it that—
Schools and the community support and reward young people’s decisions not to drink.
Rules about underage drinking are in place at home, at school, and in your community.
Penalties for breaking the rules are well known. Rules are enforced the same way
for everyone.
All laws about underage alcohol use are well known and enforced.
Parties and social events at home and elsewhere don’t permit underage drinking.
The Surgeon General’s Call to Action To Prevent and Reduce Underage Drinking was written
to improve public knowledge about underage drinking. It encourages action by people and
groups nationwide. Each person in America has a role to play to help prevent and reduce
underage alcohol use. This Call to Action helps adults across the country rethink underage
drinking as we know it today. It provides the tools to get the word out in discussions around
the dinner table, in school or campus-based programs, and in communities. It can also
inform local, Tribal, State, and national programs and policies.
By learning more about how underage drinking affects a teen’s growing body and brain,
family and other adults in the community can better help protect youth from the dangers of
underage drinking. Family and caring adults in the community can help teens choose not to
drink. Finally, communities can help create a safer environment for young people by working
together with parents and with schools, health care professionals, local organizations, and
policymakers to prevent and reduce underage drinking.
This Call To Action is exactly that. It calls on every adult in the country to join with the
Surgeon General in a national effort to address underage drinking early and often.
Underage alcohol use is everyone’s problem—and its solutions are everyone’s responsibility.
References for “A Guide to Action for Families”
The data, facts, and suggestions presented here come primarily from the Surgeon General’s Call to Action To Prevent
and Reduce Underage Drinking, cited on the inside front cover. Other sources of some data presented in this
document include:
Grant BF, Dawson DA, Stinson FS, Chou SP, Dufour MC, Pickering RP. The 12-month prevalence and trends
in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug and Alcohol
Dependence 74:223-234, 2004.
Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. (December 21, 2006). Teen drug use continues down
in 2006, particularly among older teens; but use of prescription-type drugs remains high. University of Michigan
News and Information Services: Ann Arbor, MI. [On-line]. Available: www.monitoringthefuture.org; accessed
01/03/07.
Substance Abuse and Mental Health Services Administration. Results from the 2005 National Survey on Drug Use
and Health: National Findings. Rockville (MD): U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration; 2006. Available: www.oas.samhsa.gov/nsduh.htm;
accessed 01/03/07.
Advancing the
call to action
13
Acknowledgements
This public document was prepared by the U.S. Department of Health and Human Services (DHHS) under
the direction of the Office of the Surgeon General. Its purpose is to make information contained in the Surgeon
General’s Call to Action To Prevent and Reduce Underage Drinking available in a brief, accessible format to
improve public knowledge on this topic.
Rear Admiral Kenneth P. Moritsugu, M.D., M.P.H., Acting Surgeon General, U.S. Public Health Service,
Office of the Surgeon General, Office of the Secretary, DHHS, Washington, D.C.
Richard H. Carmona, M.D., M.P.H., F.A.C.S., former Surgeon General, U.S. Public Health Service,
Office of the Surgeon General, Office of the Secretary, DHHS, Washington, D.C.
Commander Karen A. Near, M.D., M.S., Senior Science Advisor, Office of the Surgeon General,
U.S. Public Health Service, Office of the Secretary, DHHS, Washington, D.C.
Ron Schoenfeld, Ph.D., former Senior Science Advisor, Office of the Surgeon General,
U.S. Public Health Service, Office of the Secretary, DHHS, Washington, D.C.
Ting-Kai Li, M.D., Director, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.
Rear Admiral Eric B. Broderick, D.D.S., M.P.H., Acting Deputy Administrator, Assistant Surgeon General,
Substance Abuse and Mental Health Services Administration, DHHS, Rockville, MD.
Editors and Writers
Patricia A. Powell, Ph.D., Senior Scientific Editor, Acting Chief, Science Policy Branch, Office of Science Policy
and Communications, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.
Vivian B. Faden, Ph.D., Senior Scientific Editor, Deputy Director, Division of Epidemiology and Prevention
Research, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.
Stephen Wing, M.S.W., Associate Administrator for Alcohol Policy, Substance Abuse and Mental Health
Services Administration, DHHS, Rockville, MD.
Science Writers
Hamilton Beazley, Ph.D. Scholar-in-Residence, St. Edward’s University, Austin, TX.
Theodora Fine, M.A., A.B.D., Executive Officer, Fine WordCrafters: Communications and Editing Alchemy,
Ellicott City, MD.
Underage drinking is a public health and safety problem that results in serious personal, social,
and economic consequences for adolescents, their families, communities, and the Nation as a
whole. Your involvement can make a difference.
Many free sources of information are available to help you take action to prevent and reduce
underage drinking. Some of the materials can help better educate youth and their families,
your colleagues, and your community about the dangers of underage drinking and how to
help stop it before it starts.
To read the entire Surgeon General’s Call to Action To Prevent and Reduce Underage
Drinking, be sure to log on to the Surgeon General’s Web site at www.surgeongeneral.gov.
For more information about ways you can help to prevent and reduce underage
drinking in your community, please check out www.stopalcoholabuse.gov, a
comprehensive portal of Federal resources for information on underage drinking
and ideas for combating the problem.
Another excellent source of information is the Web site of the National Institute on
Alcohol Abuse and Alcoholism at http://www.niaaa.nih.gov.
General information about underage drinking, its effects on adolescents, families
and communities, and what you can do to help stop underage drinking is available
through the National Clearinghouse on Alcohol and Drug Information (NCADI),
on the Internet at http://ncadi.samhsa.gov/ or by calling (800) 729-6686.
The words and images in this Guide to Action were designed to reach a broad audience.
Copies of this booklet and the Surgeon General’s Call to Action To Prevent and Reduce
Underage Drinking can be downloaded from both of the Web sites noted. To order copies by
mail, please contact the National Clearinghouse on Alcohol and Drug Information (NCADI)
http://ncadi.samhsa.gov/ or by calling (800) 729-6686.
for more information
References:
http://www.surgeongeneral.gov/topics/underagedrinking/FamilyGuide.pdf
Tuesday, November 25, 2008
Raising a Community
Lack of insurance, increase in drug abuse put youths' health in danger
By Susie Bodman and Stefanie Knowlton • Statesman Journal
November 24, 2008
While a lack of health insurance and burgeoning substance abuse are threatening the health of youth in the Mid-Willamette Valley, area agencies and lawmakers continue to look for ways to develop or expand programs to address these problems.
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Expanding insurance
Access to and the costs of health care are increasingly weighing on the minds of the public, health officials and policy makers.
How do you provide insurance coverage and care to the more than 150,000 uninsured adults and children in the Marion, Polk, Benton, Lane and Linn county region?
Local, state and national efforts are under way to answer that question and provide help to those uninsured.
The main focus in providing health insurance coverage — locally and nationally — is on uninsured children younger than 18.
"The dollars are best spent when we spend them on children," said Andy Walker, public health manger for the Polk County Public Health Department. "Prevention dollars spent on children provide that child with better health for the rest of their lives."
Expanding coverage to all of Oregon's children is at the top of a list of recommendations presented in a recent draft report by the Oregon Health Fund Board, which was formed last year to map out ideas for reforming Oregon's health-care system.
In covering children, the reform may mean an expansion of the Oregon Health Plan to bring more kids under its umbrella. However, the board also recommended extending OHP coverage to more adults, using a combination of taxes to health-care providers and federal funds.
"A lot of data suggests it's really hard to recruit one without the other," said Sean Kolmer, research manager for the state Office of Health Policy and Research.
The target among adults, Kolmer said, would be those with incomes at 100 percent of the federal poverty line. For individuals, that income level is $10,400 a year. If a funding source could be found, the goal would be to enroll another 100,000 adults, he said.
And Oregon Senate President Peter Courtney has said legislators are still working out their health care proposal for the coming 2009 legislative session, which may or may not include a request for a tobacco tax or other increase to expand insurance coverage.
Meanwhile, the Health Fund Board's report warns that unless change is made to the system soon, premiums for family health insurance policies will reach a point where they equal the average family wage.
Likely that means the ranks of the uninsured will increase as individuals and families on the edge financially are forced to choose between health care, food, housing and other basic needs.
Nationwide, a federal push is encouraging states to expand health-care access, especially to children. In some states, that's meant efforts to identify and enroll more young people in public health insurance plans.
Policy analysts and lawmakers also are looking to the new Congress with anticipation. The State Children's Health Insurance Program, which helps get children covered, is due to expire in March. An attempt to pass a bill last year that would have expanded the program met with a presidential veto.
Senator-elect Jeff Merkeley has said he expects the new Congress will pass a similar bill.
Locally, Northwest Human Services, which provides low-cost clinics in West Salem and Monmouth and serves many patients enrolled in the Oregon Health Plan and other public insurance plans, has focused its effort on remodeling and expanding its clinics and services, such as adding more health practitioners.
Opening more clinics also may be on the agenda — provided funding can be found to run them, said Paul Logan, executive director of Northwest Human Services. While federal support is there to go out and establish new clinics, funding to staff and operate them is in short supply.
"It's valuable but not sufficient," he said of the support.
The issue, however, is not only about finding more funding to provide more clinics, services and coverage to those who need it, it also means more outreach to those who are eligible for public and private insurance but not enrolled.
More than half of all the 100,000 uninsured kids in Oregon are now eligible for public or private insurance, but one of the major reasons that families don't insure kids, aside from cost, is administrative hurdles in the application process.
To address this problem, the Health Fund Board has recommended the state simplify application processes to programs such as OHP, increase application assistance and the number of school-based health centers, and extend coverage periods under its public programs from six to 12 months.
Meanwhile, local health departments, Northwest Human Services, other clinic providers, and Salem Hospital are doing their part to help guide people through finding insurance plans and applying for coverage.
"But it's even bigger than the health department; the whole community has to bond together to help with these services," said Pam Heilman, public health division director at the Marion County Health Department.
There are many other ideas to help the uninsured — from calls for tax breaks to offset the cost of insurance to medical IRAs to holding the insurance industry publicly accountable for rate hikes.
"The Health Fund Board reform plan seems to understand that part of bringing costs down is related to universal coverage," said Joy Margheim, an analyst at the Silverton-based Oregon Center for Public Policy, which conducts research on economic issues.
Regardless of the specific reform that may be adopted or plans used to increase coverage of the uninsured, the need isn't going away any time soon.
"We need to find a way to cover people who aren't insured. If people understood why we need universal care — (that) there is a benefit to everyone involved … probably insurance rates for everyone would go down," Walker said.
"In a society like ours, we have an obligation to look out for more than just ourselves. We should be looking out to care for others as well."
—Susie Bodman
Substance abuse
Drug prevention and treatment programs are struggling to keep pace with the rising tide of drug use among teens in Oregon.
Eighth-graders were almost twice as likely to drink in the last month compared to their peers around the country in 2005 and since then the number has only grown.
And about 40 percent of all eighth graders reported using alcohol or drugs in the last month, according to the 2007 Healthy Teens Survey.
The early use often translates to drug abuse and addiction in latter years.
Oregon estimates that nearly 27,000 teens needed drug treatment last year, but only 6,500 were enrolled in state treatment.
One of the biggest hurdles for drug treatment is proving enough beds for in-patient care. There are only 71 beds around the state for teens and none of these are in Marion County, which means local youths are shuttled to surrounding communities to get help.
Every county should have its own in-patient facility, but the funding isn't always available, said Diane Lia, who oversees drug treatment programs for Department of Human Services Addiction and Mental Health Division.
The good news is that teens who receive care enjoy promising recovery rates.
Oregon requires counties to provide treatment programs based on a wide range of research-based models.
Treatment is evaluated on three key targets when serving youth: better academic performance, lower incidence of arrest within 30 days after treatment and lower incidence of arrest for possession.
Lia said 93 to 94 percent of teens in treatment met those benchmarks in Oregon. In fact teens not in treatment are more than twice as likely to get arrested and more likely to get arrested for possession.
"If we can intervene early, we can help these kids so they can lead productive lives," Lia said.
Mike Maryanov also is interested in helping these kids get back on the right path.
Maryanov is the coordinator for the Marion County STAR Court, or Supervised Treatment And Recovery, program for teens.
The yearlong program helps non-violent teen offenders get clean through treatment, counseling and resource referral. In exchange the court clears their record.
But it's not just a matter of getting clean, Maryanov said.
"There is a whole world of confusion and hurt underlying all this," he said.
Most of the teens are dealing with a history of sexual abuse, violence in the home, mental illness and loss, he said.
So once they're clean, he said, they have to deal with all the underlying issues that led to their drug abuse in the first place.
Overall the teens just want what everyone else does, he said.
"They want to be cared for and loved in a normal way, they want to be in school, they like getting good grades, they want to listen to music on their iPods, they want to ride their bikes and have boyfriends and girlfriends…"
Yet it's difficult to piece lives back together after addiction. Out of the 153 kids enrolled in the program, there have been only 30 graduates since it started in 2001. Maryanov said he doesn't see his kids back in the courts, which is good news.
But the best way to treat drug abuse is to prevent it in the first place.
"Prevention is a very complex process," said Rick Cady, manager of prevention programs for addictions and mental health division of DHS.
Oregon tries to tackle prevention with a wide range of programs that work with everyone from first-time parents on early childhood development to entire communities to change local attitudes about drugs and alcohol.
But Oregon programs need to work harder to reach teens sooner, according to the Oregon Community Addiction Services Investment Strategy report.
Prevention services don't start early enough and aren't consistently applied across school districts, the report concluded.
The state also needs to increase exposure to prevention programs and prevention needs to be a much higher priority for teachers, parents, counselors and school administrators.
Cady said one of the key target groups is fifth and sixth graders because that's the typical age kids start experimenting.
One of the new initiatives this year is a parenting program called Strengthening Families 10 -14, which has proven to dramatically reduce the initiation of drug use and increase family harmony.
For every year you can delay the child's first drug experience, they're 2 to 10 times less likely to abuse drugs, Cady said.
"That's why that age group is so important."
—Stefanie Knowlton
References:
http://www.statesmanjournal.com/article/20081124/RAC/811240313/1001/NEWS
Lack of insurance, increase in drug abuse put youths' health in danger
By Susie Bodman and Stefanie Knowlton • Statesman Journal
November 24, 2008
While a lack of health insurance and burgeoning substance abuse are threatening the health of youth in the Mid-Willamette Valley, area agencies and lawmakers continue to look for ways to develop or expand programs to address these problems.
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Expanding insurance
Access to and the costs of health care are increasingly weighing on the minds of the public, health officials and policy makers.
How do you provide insurance coverage and care to the more than 150,000 uninsured adults and children in the Marion, Polk, Benton, Lane and Linn county region?
Local, state and national efforts are under way to answer that question and provide help to those uninsured.
The main focus in providing health insurance coverage — locally and nationally — is on uninsured children younger than 18.
"The dollars are best spent when we spend them on children," said Andy Walker, public health manger for the Polk County Public Health Department. "Prevention dollars spent on children provide that child with better health for the rest of their lives."
Expanding coverage to all of Oregon's children is at the top of a list of recommendations presented in a recent draft report by the Oregon Health Fund Board, which was formed last year to map out ideas for reforming Oregon's health-care system.
In covering children, the reform may mean an expansion of the Oregon Health Plan to bring more kids under its umbrella. However, the board also recommended extending OHP coverage to more adults, using a combination of taxes to health-care providers and federal funds.
"A lot of data suggests it's really hard to recruit one without the other," said Sean Kolmer, research manager for the state Office of Health Policy and Research.
The target among adults, Kolmer said, would be those with incomes at 100 percent of the federal poverty line. For individuals, that income level is $10,400 a year. If a funding source could be found, the goal would be to enroll another 100,000 adults, he said.
And Oregon Senate President Peter Courtney has said legislators are still working out their health care proposal for the coming 2009 legislative session, which may or may not include a request for a tobacco tax or other increase to expand insurance coverage.
Meanwhile, the Health Fund Board's report warns that unless change is made to the system soon, premiums for family health insurance policies will reach a point where they equal the average family wage.
Likely that means the ranks of the uninsured will increase as individuals and families on the edge financially are forced to choose between health care, food, housing and other basic needs.
Nationwide, a federal push is encouraging states to expand health-care access, especially to children. In some states, that's meant efforts to identify and enroll more young people in public health insurance plans.
Policy analysts and lawmakers also are looking to the new Congress with anticipation. The State Children's Health Insurance Program, which helps get children covered, is due to expire in March. An attempt to pass a bill last year that would have expanded the program met with a presidential veto.
Senator-elect Jeff Merkeley has said he expects the new Congress will pass a similar bill.
Locally, Northwest Human Services, which provides low-cost clinics in West Salem and Monmouth and serves many patients enrolled in the Oregon Health Plan and other public insurance plans, has focused its effort on remodeling and expanding its clinics and services, such as adding more health practitioners.
Opening more clinics also may be on the agenda — provided funding can be found to run them, said Paul Logan, executive director of Northwest Human Services. While federal support is there to go out and establish new clinics, funding to staff and operate them is in short supply.
"It's valuable but not sufficient," he said of the support.
The issue, however, is not only about finding more funding to provide more clinics, services and coverage to those who need it, it also means more outreach to those who are eligible for public and private insurance but not enrolled.
More than half of all the 100,000 uninsured kids in Oregon are now eligible for public or private insurance, but one of the major reasons that families don't insure kids, aside from cost, is administrative hurdles in the application process.
To address this problem, the Health Fund Board has recommended the state simplify application processes to programs such as OHP, increase application assistance and the number of school-based health centers, and extend coverage periods under its public programs from six to 12 months.
Meanwhile, local health departments, Northwest Human Services, other clinic providers, and Salem Hospital are doing their part to help guide people through finding insurance plans and applying for coverage.
"But it's even bigger than the health department; the whole community has to bond together to help with these services," said Pam Heilman, public health division director at the Marion County Health Department.
There are many other ideas to help the uninsured — from calls for tax breaks to offset the cost of insurance to medical IRAs to holding the insurance industry publicly accountable for rate hikes.
"The Health Fund Board reform plan seems to understand that part of bringing costs down is related to universal coverage," said Joy Margheim, an analyst at the Silverton-based Oregon Center for Public Policy, which conducts research on economic issues.
Regardless of the specific reform that may be adopted or plans used to increase coverage of the uninsured, the need isn't going away any time soon.
"We need to find a way to cover people who aren't insured. If people understood why we need universal care — (that) there is a benefit to everyone involved … probably insurance rates for everyone would go down," Walker said.
"In a society like ours, we have an obligation to look out for more than just ourselves. We should be looking out to care for others as well."
—Susie Bodman
Substance abuse
Drug prevention and treatment programs are struggling to keep pace with the rising tide of drug use among teens in Oregon.
Eighth-graders were almost twice as likely to drink in the last month compared to their peers around the country in 2005 and since then the number has only grown.
And about 40 percent of all eighth graders reported using alcohol or drugs in the last month, according to the 2007 Healthy Teens Survey.
The early use often translates to drug abuse and addiction in latter years.
Oregon estimates that nearly 27,000 teens needed drug treatment last year, but only 6,500 were enrolled in state treatment.
One of the biggest hurdles for drug treatment is proving enough beds for in-patient care. There are only 71 beds around the state for teens and none of these are in Marion County, which means local youths are shuttled to surrounding communities to get help.
Every county should have its own in-patient facility, but the funding isn't always available, said Diane Lia, who oversees drug treatment programs for Department of Human Services Addiction and Mental Health Division.
The good news is that teens who receive care enjoy promising recovery rates.
Oregon requires counties to provide treatment programs based on a wide range of research-based models.
Treatment is evaluated on three key targets when serving youth: better academic performance, lower incidence of arrest within 30 days after treatment and lower incidence of arrest for possession.
Lia said 93 to 94 percent of teens in treatment met those benchmarks in Oregon. In fact teens not in treatment are more than twice as likely to get arrested and more likely to get arrested for possession.
"If we can intervene early, we can help these kids so they can lead productive lives," Lia said.
Mike Maryanov also is interested in helping these kids get back on the right path.
Maryanov is the coordinator for the Marion County STAR Court, or Supervised Treatment And Recovery, program for teens.
The yearlong program helps non-violent teen offenders get clean through treatment, counseling and resource referral. In exchange the court clears their record.
But it's not just a matter of getting clean, Maryanov said.
"There is a whole world of confusion and hurt underlying all this," he said.
Most of the teens are dealing with a history of sexual abuse, violence in the home, mental illness and loss, he said.
So once they're clean, he said, they have to deal with all the underlying issues that led to their drug abuse in the first place.
Overall the teens just want what everyone else does, he said.
"They want to be cared for and loved in a normal way, they want to be in school, they like getting good grades, they want to listen to music on their iPods, they want to ride their bikes and have boyfriends and girlfriends…"
Yet it's difficult to piece lives back together after addiction. Out of the 153 kids enrolled in the program, there have been only 30 graduates since it started in 2001. Maryanov said he doesn't see his kids back in the courts, which is good news.
But the best way to treat drug abuse is to prevent it in the first place.
"Prevention is a very complex process," said Rick Cady, manager of prevention programs for addictions and mental health division of DHS.
Oregon tries to tackle prevention with a wide range of programs that work with everyone from first-time parents on early childhood development to entire communities to change local attitudes about drugs and alcohol.
But Oregon programs need to work harder to reach teens sooner, according to the Oregon Community Addiction Services Investment Strategy report.
Prevention services don't start early enough and aren't consistently applied across school districts, the report concluded.
The state also needs to increase exposure to prevention programs and prevention needs to be a much higher priority for teachers, parents, counselors and school administrators.
Cady said one of the key target groups is fifth and sixth graders because that's the typical age kids start experimenting.
One of the new initiatives this year is a parenting program called Strengthening Families 10 -14, which has proven to dramatically reduce the initiation of drug use and increase family harmony.
For every year you can delay the child's first drug experience, they're 2 to 10 times less likely to abuse drugs, Cady said.
"That's why that age group is so important."
—Stefanie Knowlton
References:
http://www.statesmanjournal.com/article/20081124/RAC/811240313/1001/NEWS
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