When Utah tallies the damage done to its residents by drugs, alcohol and co-occurring mental health issues, a complex picture emerges. There is much to celebrate in its prevention, treatment and enforcement efforts and much work still to do.
On the plus side, Utah has the fewest alcohol-related driving deaths in the nation — 17 percent of total traffic fatalities in 2013. (No. 1 South Carolina, by comparison, had a 44 percent rate.) That’s to do in part, of course, with Utah’s heavily Mormon population, whose religious beliefs eschew alcohol. But it also reflects enforcement and education efforts. MADD lauds the state as “a leader in the fight to end drunk driving,” noting in particular its ignition interlock laws, which help prevent impaired drivers from operating vehicles, use of sobriety checkpoints, and laws that mandate all convicted offenders undergo an assessment and participate in treatment as needed.
On the negative side, though, the state hasn’t been immune to drug use trends, especially the prescription drug epidemic sweeping the nation. Utah, in fact, has seen deaths related to prescription drug misuse and abuse increase more than 400 percent in the past decade, according to the Utah Department of Health. A 2013 report ranked the state eighth in the nation in drug overdose mortality rates, a majority of those from prescription drugs.
In 2007, the state responded to the crisis with the creation of the Prescription Pain Medication Program, which educated both clinicians and the public through its Use Only As Directed campaign. Though the program missed its goal of reducing deaths by 15 percent, it did help achieve a 12.6 percent decline. The program was funded for only two years, however, and by 2010, deaths had begun to edge up.
Fresh efforts to fight harm from prescription drugs are underway. The Utah Pharmaceutical Drug Community Project, established in 2009, recently created a strategic plan to monitor trends, identify risks and get help where needed. And Utah is one of only five states to receive more than $1 million over the next three years from the Centers for Disease Control and Prevention to tackle prescription drug issues. Part of the money will help the state evaluate two new laws, passed in 2014, that are poised to prevent drug deaths: a Good Samaritan law, which allows bystanders to report an overdose without fear of criminal prosecution, and a naloxone law, which allows caregivers and bystanders to obtain and administer the drug, which can reverse overdose from prescription opioids or heroin.
Prescription drugs aren’t the only risk to the state’s residents, of course. Those seeking help at Utah’s treatment facilities most commonly cite stimulants such as methamphetamine as their drug of choice (after alcohol), followed by marijuana, heroin, other opioids and cocaine.
Meth use peeked in the state around 2006, but has declined to levels seen around the year 2000 as the result of aggressive efforts to find and dismantle meth labs, punish those involved, and limit the sale of over-the-counter drugs that could be used to make meth. While use of the drug remains a problem for the state, its manufacture is now largely limited to Mexico.
Where Is Utah Headed?
Clues to Utah’s future are provided through the 2014 Utah Behavioral Health Barometer, a collection of 2009-2013 survey data compiled by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report examines Utah residents’ drug and alcohol use, as well as their mental health issues, which often play a role in substance use. What the barometer shows is that the state hovers around or below the national average in many key areas, but that it rises above it in several worrisome ways. Among the findings:
Alcohol and Drug Use by Adolescents
- 3 percent of the youths surveyed in 2012-2013 reported using illicit drugs within the previous month. While that’s lower than the national average of 9.2 percent, it’s up slightly from Utah’s five-year low of 5.9 percent in 2010-2011.
- From 2009 to 2013, a total of 5.2 percent of adolescents began drinking alcohol within the year prior to being surveyed, 3.4 percent began using marijuana, and 2.5 percent began nonmedical use of prescription drugs.
- More than half of adolescents surveyed in 2012-2013 saw no risk from having five or more drinks once or twice a week. The number has edged up slightly since 2009-2010 but remains below the national average. Even more — close to 64.7 percent — saw no great risk from smoking marijuana once a month. That’s lower than the national average of 74.7 percent.
- 2 percent reported binge drinking — defined as five or more drinks within a couple of hours of each other — in the previous month. It’s up just slightly from the previous year’s survey but below the national average of 14.7 percent
Substance Use and Dependence
- In those 12 and older, Utah is below the 2012-2013 national numbers for alcohol abuse or dependence — 5.4 percent compared to 6.7 percent — but it’s slightly above the national figures for illicit drug abuse or dependence — 2.9 percent compared to 2.7 percent.
- In terms of heavy drinking, an even more dramatic gap is seen. In Utah, 3.8 percent of those 21 and older reported heavy alcohol use in the month prior to being surveyed from 2009-2013. The national figures were almost double: 6.8 percent.
- Enrollment in substance use treatment centers has declined since 2009. A single day count in 2009 showed 13,492 enrolled, while a similar count in 2013 showed 12,586, an almost 8 percent decrease. Of the 2013 group, 40.5 percent were in treatment for drug use only, 13.4 percent were in treatment for alcohol use only, and 46.1 percent were in treatment for both drug and alcohol use.
- From 2009-2013, the vast majority of those 12 and older with alcohol abuse or dependence — 90.6 percent — did not receive treatment within the year prior to being surveyed. The numbers weren’t much better for those struggling with illicit drugs: 82.9 percent received no treatment.
- Methadone and buprenorphine use as part of treatment has increased in Utah since 2009 — up more than 21 percent and 13 percent respectively. Both can be used to help with detoxification and as part of opioid maintenance therapy. In a single-day count in 2013, 2,629 people were receiving methadone and 345 were receiving buprenorphine.
Adolescent Mental Health and Treatment
- 5 percent of the adolescents surveyed in 2012-2013 had at least one major depressive episode in the previous year. That’s above the national average of 9.9 percent. It also represents a jump from 2009-2010, when the number stood at 8.1 percent for both Utah and the nation.
- Of those who reported depression from 2009-2013, only 44.6 percent received treatment, which is similar to the national percentage.
Adult Mental Health and Treatment
18 or older
- Adults with serious thoughts of suicide numbered 4.8 percent in 2012-2013, above the national figure of 3.9 percent.
- 4 percent reported a serious mental illness in the previous year, up slightly from the previous five years. The national figure was 4.1 percent.
- From 2009-2013, only 42.7 percent received mental health treatment and counseling within the year prior to being surveyed, a figure that’s on par with the national numbers.
In the final analysis, the report paints a picture of a state with greater drug than alcohol issues, but which hasn’t escaped the ravages of either. It also highlights growing mental health concerns for adolescents and adults alike, especially suicide and suicidal thoughts. Most tellingly, it demonstrates that much more help is needed to get treatment to all of those who are suffering.
Hope for Utah’s Future
Hope is on the horizon in the form of the Affordable Care Act (ACA) and mental health parity laws, which together require most insurers to provide addiction and mental health treatment at the same levels as medical benefits. It remains a work in progress, however. Utah, for example, did not avail itself of federal subsidies for Medicaid expansion that came with the law and is now struggling to find ways to fill a coverage gap for many of its low-income residents. But the goal is that eventually all those struggling with mental health issues such as depression or with a dependence on alcohol or drugs can quickly find the help they need and, by doing so, minimize the damage to themselves and to their communities.
Utah’s Department of Human Services is working to build on these laws by emphasizing strategies that focus on prevention, early intervention and recovery-oriented systems of care. In the department’s 2013 annual report, Doug Thomas, director of the department’s Division of Substance Abuse and Mental Health, expressed optimism that the new laws and the department’s work will help reduce stigma and increase understanding, leading more into treatment. “We know the earlier people receive help, the better the outcomes people have, at less cost, with less disability.”