Alcohol, tobacco and other drugs impair the health and well-being of individuals who use them as well as those who do not, adding substantially to health care costs. Drug abuse plays a significant role in chronic illness, fatal automobile accidents, new-born health problems, the spread of infectious diseases and emergency room visits. Heroin is the drug of choice for one in four adults in treatment in Wayne County-more than twice the statewide rate. More than half of the Michigan residents who need alcohol and other drug treatment reside in the Detroit metropolitan area. However, just 7 percent of Detroit residents needing treatment receive it.
Deaths from Substance Abuse. Tobacco-related deaths are not tracked by state or city health departments in Michigan. However, according to mortality figures from the Centers for Disease Control and Prevention, in 1995, more than 1,500 people in Wayne County died from lung cancer, bronchial cancer or emphysema alone. Total tobacco-related deaths are almost certainly higher since they also include a portion of deaths from heart disease, stroke and other chronic diseases. Between 1990 and 1995, 1,451 deaths investigated by the Wayne County medical examiner were attributed directly to alcohol, and 1,046 deaths were attributed to other drugs. In 1995, a total of 231 drug-related deaths occurred in the city of Detroit; more than half were among adults aged 35 to 54. Deaths attributed directly to cocaine use increased by a third from 1992 to 1996. Many treatment and prevention programs in Detroit incorporate specialized services for clients addicted to crack and powder cocaine. Heroin-related deaths more than doubled from 118 in 1992 to 242 in 1996-one of many indications of the re-emergence of heroin in Detroit.
Drinking continues to compromise safety on Michigan roads. In 1995, more than a third of fatal crashes in the state involved drinking, and almost half of alcohol-related crashes in Michigan resulted in injury or death. In 1997, alcohol was involved in 42 percent of fatal crashes in the city of Detroit-twice the rate in 1994.
Emergency Room Visits. Data from emergency rooms (ER) can illustrate drug use trends within a community. Drug-related ER visits in the seven county region that includes the city of Detroit rose 29 percent between 1988 and 1996, when 20,822 people visited hospital emergency rooms for drug-overdoses or drug-induced medical conditions. This trend not only reflects the need for increased alcohol and other drug abuse education, prevention and treatment, but also indicates a growing economic burden on area medical resources needed to treat drugrelated health problems.
Alcohol-Related Fatal Crashes Rise in Detroit 20 21 Dexter Boulevard Between 1988 and 1996, emergency room cocaine mentions in the region increased by 57 percent. Heroin is also a growing concern to health experts. Between 1990 and 1996, heroin ER visits more than doubled in the Detroit area. During the same period, ER visits for marijuana rose seven fold, with more than 4,200 such vis-its in 1996. Data regarding alcohol-related ER visits in Detroit are not available. However, alcohol- related health problems and injuries comprise a significant portion of hospital visits across the country. Sixty percent of fatal burns nationally involve alcohol use, and up to 38 per-cent of ER patients are legally intoxicated at the time of their visit.
HIV and AIDS. One in three AIDS cases in the Detroit metropolitan area is attributable to injection drug use (IDU). In 1996, 10 percent of the estimated 35,000 Detroit metropolitan area injection drug users were HIV positive, with about 315 new IDU-related HIV cases that year. The city itself does not record new HIV infections. Wayne County, including the city of Detroit, accounts for 57 percent of cumulative AIDS cases in the state.
Alcohol and other drug use increase the risk of contracting sexually transmitted diseases (STDs). Findings from a 1995 study by the Michigan Department of Community Health indicate that 44 percent of Detroit residents with STDs used illicit drugs in the past year and 31 percent used in the past month. In 1997, 18 percent of sexually active 12th graders in Detroit said they used alcohol or other drugs at the time of their last sexual intercourse.
Impact on Newborns. In Detroit Area Injection Drug Use Accounts for One-Third of AIDS Cases in Detroit Area Michigan Department of Community Health HIV/AIDS Surveillance Section, 1998 Persons Living with HIV/AIDS Injection Drug Use 33% All Other Types of Exposure Martin Luther King, Jr. Impact on Newborns. Citywide statistics on alcohol, tobacco and other drug use by pregnant women are not available for Detroit. However, research at Detroit's Hutzel Hospital, which specializes in serving pregnant women with alcohol or other drug addiction problems, found that many women underreport their drug use. In an 11 year study of 3,000 live births at Hutzel Hospital, one in ten mothers admitted using illicit drugs during pregnancy; however, half of their newborns had positive urine drug screens and nine in ten had positive meconium drug screens. There were 16,586 live births in the city of Detroit in 1996, 39 percent of which took place at Hutzel Hospital. Estimated medical expenditures for a drug exposed infant exceed $50,000 during the first year of life. A statewide study of pregnant alcohol and other drug abusers by the Michigan Department of Community Health will be released later in 1999.
Treatment. Treatment is one of the most cost-effective ways to reduce drug abuse and related crime. In FY 1998, Detroit spent approximately $16.5 million on publicly- funded alcohol and other drug treatment services. Nearly $10 million was spent on specialized services for pregnant and parenting women, the hearing impaired and addicts with HIV/AIDS.
The Detroit Bureau of Substance Abuse (BSA) funded 55 treatment programs in Detroit in 1998. BSA is struggling to acquire funding to provide treatment on demand; however, the agency is only able to serve a fraction of those who need help. According to the Michigan Department of Community Health, an estimated 155,000 alcohol and other drug abusers in Detroit need treatment. In 1995, 56,000 Detroit residents sought treatment; however, only 7 percent (4,000 residents) received treatment within the previous year. More than one-third of those in treatment are there for alcohol-related problems. In 1997, there were 2,853 residential treatment admissions in the city of Detroit, for a total cost of $6 million dollars. An additional 3,626 individuals were admitted for outpatient services costing $4.4 million. Finally, 788 people were admitted for outpatient methadone maintenance or residential detox services, with costs totaling $4.6 million.
Crack cocaine is a more common treatment focus in Wayne County than elsewhere in the state. In 1997, cocaine was the drug of choice for 31 percent of those receiving treatment in Wayne County, compared to 18 percent of those in treatment statewide. Heroin is the drug of choice for 23 percent of adults in treatment-more than twice the rate among those in treatment statewide (9 percent). Although the admission rate for marijuana in Wayne County reached 9 percent in 1997, it remains below the statewide rate of 15 percent.
According to the Detroit Board of Education, alcohol and other drug treatment referrals for children under age 14 increased by 15 percent between 1992 and 1995.The majority of youth are referred for drinking problems; however, when asked to identify their drug of choice, most responded "none," suggesting they do not consider alcohol a drug.
Treatment and Public Assistance. Statistics regarding treatment needs among welfare and Medicaid participants in Detroit are unavailable due to several factors, including lack of funding for data collection. Nationwide, alcohol and other drug use affects the job security and parenting of up to two in five welfare recipients.
In 1998, Detroit began a program which specifically targets treatment and education to local residents receiving welfare and Medicaid. BSA is working with the Michigan Family Independence Agency (FIA) and the Detroit Department of Employment and Training to assess treatment needs among welfare recipients and refer them to providers.
A new alcohol and other drug abuse treatment plan is also under development for Michigan's Medicaid recipients, including those in the city of Detroit. Under this plan, Medicaid recipients seeking alcohol and other drug abuse treatment will be assessed for appropriate treatment and other necessary health services, and guaranteed access to treatment. Urine testing is generally included as part of the treatment regime. BSA has begun to advertise the availability of publicly-funded treatment services for this population.
Dual Diagnosis. Many people suffer from both drug abuse and other mental health problems. Access to comprehensive treatment is complicated by the fact that services are often administered by separate agencies with different funding streams, professional orientations and areas of expertise. In order to serve Detroit's dually-diag-nosed population, the Detroit Dual-Diagnosis/Mentally Ill Substance Abuse Council was established in 1991. Created by the Detroit/Wayne County Community Mental Health Agency and BSA, the Council helps reduce misdiagnosis and helps dually-diagnosed individuals access comprehensive treatment. However, many clients who need treatment cannot get help because such services are underfunded.
Impact on Families. Alcohol and other drug abuse undermines families and puts children at risk of harm. According to the U.S. General Accounting Office, more than three-quarters of all foster care cases nationwide involve parental alcohol and other drug abuse. Wayne County spent $66 million on foster care in 1997, of which $52 million can be attributed to cases involving alcohol and other drug problems.
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