Arizona Profile 1997

Drug Strategies

Impact on Health

Alcohol, tobacco and illicit drugs threaten the health of individuals who do not even use them. They also add significantly to Arizona's health care costs. Substance abuse is a major factor in chronic illness, the spread of infectious diseases, hospital emergency room visits, newborn health problems, violence and auto fatalities.

Deaths from Substance Abuse

Between 1990 and 1994, the number of drug-related deaths in Arizona rose 36 percent, and the number of alcohol-related deaths rose 25 percent. Although the rising state population could account for some of the increase, the alcohol mortality rate also increased during this period and the drug-related mortality rate nearly doubled. Thus, a larger proportion of the total population now dies from alcohol and drugs. Methamphetamine casts a long shadow; in Phoenix, the number of methamphetamine-related deaths jumped nearly fourfold.

One key to Arizona's escalating alcohol mortality rate may be found among Native Americans, who comprise 6 percent of the state's population. Native American alcoholism mortality rates for the Tucson, Phoenix and Navajo reporting sites are seven times those for all other races combined, according to the Indian Health Service. Across the country, Native Americans die of alcoholism at five times the national rate.

On a positive note, alcohol is causing fewer problems on Arizona highways. Driving fatalities now account for just half of all alcohol-related deaths, compared to 82 percent in 1990. While 25 percent of driving fatalities test positive for alcohol, only 18 percent violate the legal blood alcohol limit (.1 percent).

Smoking remains a lethal problem in Arizona. Causing more than 400,000 deaths in the United States annually, according to the American Cancer Society, smoking-related illnesses kill an estimated 6,000 people in Arizona each year-more than motor vehicle crashes, AIDS and homicides combined.

Emergency Room Drug Cases

The impact of substance abuse is felt in Arizona's hospitals as well. Between 1990 and 1995, the Drug Abuse Warning Network reported a 41 percent increase in emergency room drug mentions in Phoenix. The 1995 figures also include 33 percent more heroin mentions, 72 percent more cocaine mentions, and more than triple the number of marijuana mentions. Methamphetamine cases are also increasingly pervasive in Phoenix emergency rooms.

Impact on Newborns

According to the Arizona Needs Assessment Study, 3.3 percent of pregnant women in the state are addicted to alcohol, .5 percent are addicted to drugs, and 1.3 percent are addicted to both. Based on these percentages, as many as 3,692 of the 72,386 babies born in 1995 may have suffered adverse effects in utero from their mothers' substance abuse.

But Arizona's birth records do not begin to capture the problem. Consider fetal alcohol syndrome (FAS), a condition caused by heavy alcohol use during pregnancy and characterized by birth defects, low birth weight and developmental delays. Physicians diagnose FAS at birth, but in Arizona this system is evidently not very reliable; 1995 state records show only 10 babies with FAS (out of more than 72,000 births).

Similar problems prevail in identifying newborns exposed to drugs in utero. In Arizona, newborns are tested at the hospital's discretion, whenever drug exposure is suspected. However, these efforts do not provide an accurate count of drug-exposed infants. Until Arizona implements more effective measures of drug and alcohol exposure at birth, the state cannot anticipate related health care, foster care and social services needs, or effectively target prevention efforts.

When necessary medical care is provided, the babies of drug addicts are born drug-free. For example, with prenatal care, medically supervised detoxification and substance abuse treatment, the Pregnancy Addiction Program in Maricopa County has great success: 80 percent of babies born to participants are drug-free and 85 percent are normal birth weight.

HIV and AIDS

With fewer than 4,500 AIDS cases, Arizona has not experienced the epidemic seen in other parts of the country. Nonetheless, HIV and AIDS cases are increasing quickly in some groups, particularly among Hispanics in the Southern part of the state.

Although prevention messages have effectively reached homosexuals and hemophiliacs, more education and outreach are needed for drug users. Injection drug users account for 22 percent of Arizona's AIDS cases, and half of the state's female AIDS cases are injection drug users or their sex partners.

One promising intervention: The Community Outreach Project on AIDS in Southern Arizona (COPASA) has reduced high-risk behaviors among drug users in Tucson through education about using condoms and clean needles to prevent the spread of HIV.

Treatment for Substance Abuse

Arizona's substance abuse treatment caseload in 1994 was up 35 percent over 1993, and the 10,527 people treated for drug addiction in 1994 represented the state's highest drug caseload on record. Nonetheless, most treatment in Arizona is for alcohol addiction. Fortunately, Arizona has a well-developed treatment infrastructure, and at least part of the caseload increase has been due to better case finding and more effective referrals.

The foundation for Arizona's treatment system was laid back in the 1960's, when the state began funding treatment for substance abuse. Today, services include comprehensive case management; residential, outpatient and group therapy; and special programs for pregnant women, minorities and HIV-positive drug users.

Funds are distributed to local treatment providers through subcontracts with Arizona's five Regional Behavioral Health Authorities (RBHAs), which promote prevention and treatment services tailored to meet local needs in distinct areas of the state. For ex-ample, while Maricopa County's RBHA, ComCare, reimburses treatment providers for services as they are rendered, the RBHA for Arizona's southern counties uses a risk-based, managed behavioral care model.

Access to treatment is a continuing challenge. Treatment facilities in rural areas are centrally located to draw clients from broad geographic regions. The large staffing requirements of these all-purpose facilities make it very difficult to provide a full continuum of care to rural residents. Lack of long-term treatment and transportation are also primary barriers to service delivery in remote parts of the state.

Over the years, coverage for impoverished citizens has improved dramatically. In 1982, Arizona became the first state to provide Medicaid services through a managed care system. In 1995, managed care coverage was extended to substance abuse and mental health services for all Medicaid recipients. And in November 1996, the system's chief limitation-that few indigent residents were eligible for federal matching funds-was eliminated by ballot initiative. Health services for many more poor Arizonans will now be covered in part by federal dollars.

Currently, 80 percent of alcohol and drug treatment is funded by the Arizona Department of Health Services, including block grant funds from the Federal Center for Substance Abuse Treatment. While total treatment spending increased 42 percent between 1991 and 1995, more than half of the increase came from local funds or federal demonstration grants to local organizations. There has been virtually no increase in state dollars in recent years. Consequently, in real, inflation-adjusted dollars, Arizona's total treatment funds have declined since the late 1980's.

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