StateState ofof HawaiiHawaii 20042004 TreatmentTreatment NeedsNeeds AssessmentAssessment State of Hawaii Department of Health Alcohol and Drug Abuse Division State of Hawaii 2004 Treatment Needs Assessment Department of Health Alcohol and Drug Abuse Division 2007 Page 1 Acknowledgement This report would not have been possible without the efforts and patience of a great many people. While the list is far too long to present here, most notable are Ms. Elaine Wilson, former Director of the Alcohol and Drug Abuse Division (ADAD) who had the vision to realize that the Division not only required a new assessment of treatment needs but also that there was a need for perspective in this report and a need to place the treatment needs of Hawaii’s residents in a context both temporally and nationally. Her successor, Mr. Keith Yamamoto carried that vision into this report and his unswerving support for the project and his limitless patience in its production are appreciated. Ms. Virginia J. Jackson (VJ) was the glue that held all of this together and will hopefully be one of the prime beneficiaries of the product as she helps the Division move ahead with its planning and implementation. Dr. Victor Yee provided the fidelity check point questioning and examining the details of the report to assure that what was promised was delivered. Closer to the report, my wife, Sandie provided a great deal of the editing of the report and along with Dr. Jin Young Choi created the envelope of assurance around the data and their explanation and the conclusions that emerged. Finally, the people of the State, at least the 5050 who responded to the survey in 2004 made this all possible and it is to them that I extend my most warm Aloha and the hope that this report will in some way make their lives better. D. William Wood Kailua, Hawaii 2007 Page i ABSTRACT In the spring of 2004 the Hawaii State Department of Health, Alcohol and Drug Abuse Division contracted for a Treatment Needs Assessment of the State. That contract was to collect data from a Stratified Random Sample of residents sufficiently large enough to allow within-county analyses of data. The core data collection instrument for this study was the questionnaire from the previous treatment needs assessment of 1998. In addition, the study was to compare its results with those of previous surveys of drug use, treatment need and behavioral health in the State of Hawaii and with those of national surveys. Data collection began in the spring of 2004 and was completed by the autumn of that year. Datasets were cleaned and tested for accuracy and then reweighted to produce statewide and county level estimates of the nature and extent of drug use in 2004 in the State of Hawaii. In early 2005, data from previous surveys in the State of Hawaii and data from national surveys were assembled and examined for their structure and the ability to perform additional analyses. The primary contractor produced the technical report on the project in the spring of 2005 and submitted it to ADAD. In addition a series of unanalyzed table were provided to ADAD in late spring 2005 and the contract with that vendor was declared complete later that year. Errors in the reweighted data were discovered during the late spring and were corrected to align the data with a more accurate view of Hawaii as it was in the 2000-2004 time period. A new contract for the reanalysis of the data and production of a narrative report was signed April 2006 and the current report is the result of that contract. In examining the data generated from the 2004 survey the two most frequently used mood altering substances were tobacco and alcohol. These substances are also legal to use for those of certain specific ages. The data revealed that Hawaii was not the lowest State in terms of tobacco use but that it was consistently lowering its rates of tobacco consumption and in 2005 ranked fourth lowest in the nation. However, concern was expressed over the relative lack of success in having young people not start smoking. In terms of alcohol use, the data revealed that for those classified as “social drinkers” women outnumbered men by far. Men were represented as the highest proportion of “heavy drinkers”, “binge drinkers” and “chronic drinkers.” It was also pointed out that as the age of the drinker increased the absolute and relative proportions found in the heavier drinking categories decreased and the proportion in the social drinker group increased. As an additional finding, the number of DUI cases peaked in 1991 (about 6,500 cases) and then decreased dramatically (about 2,200 cases in 2004). Finally, it was a point of concern that there were so many (nearly one-third) underage drinkers across most of the 25 years of surveys. Stimulants are the subject of the middle chapters of the report with cocaine and then methamphetamine as the specific drugs examined. Given the proclivity of residents to smoke rather than to snort or inject their drugs, the relative shortage of powder cocaine in Hawaii is not surprising. In fact, cocaine did not become a popular drug of choice until after ‘crack cocaine’ became readily available. Smoking “rock” or “crack” became much more common place in the 1980s and 1990s with the “peak” in cocaine use occurring in the 1995-1997 period. Rates of “crack” smoking in Hawaii have tended, over the past 30 years, to be lower Page ii than on the mainland. Methamphetamine was first reported in Hawaii in 1985 and as of 2003, Hawaii had among the highest rates of use across a wide variety of measures, However, according to NSDUH data, Hawaii ranks 13th for self-reported lifetime use of the drug, tied for 9th ranking with three other states for past year use, and tied for 7th ranking with 6 other states for past month (current) use. Regardless of those data, the presence of crystal methamphetamine in the State of Hawaii has had a profound effect on the population and the systems of control and care that are in place as a safety net for the people. Almost 50% of alcohol and drug treatment spaces are devoted to people reporting methamphetamine as their primary drug of abuse, nearly 1,000 police cases associated with methamphetamine use were filed in 2005, an increase from about 300 cases in 1991. Deaths with positive toxicology screens for methamphetamine increased twofold over the same time period and use of treatment services increased at least tenfold. Except for a short period following the Vietnam conflict, heroin has never been a drug of major concern in the State. Immediately following the return of Vietnam veterans, heroin was available in the State by prescription for those who may have become addicted during their deployment. The use of the drug in this way was of very short duration as veterans returned home and rejoined their families and their pre-enlistment lives. Recent reports of youth “trying” the drug have been noted but the proportion of youth participating in this activity seems very small. Marijuana, on the other hand, has been a “drug of choice” in Hawaii for decades. The rates of lifetime use among youth in grade 12 approach 50% both in the State and nationally. Current use rates for the same population are also very comparable at just over 20%. Rates of lifetime use of marijuana remain almost the same for Hawaii and national 18-25 year olds at just over 50% while for past year use of the drug the use rate for the same age group drops to fewer than 30%. Current use of the drug by this age group (defined as use in the past 30 days) is between 16% and 17%. In 1979, one-third of all state residents between 12 and 65 years used marijuana, 14% were current users. In 1991 the lifetime use rates were higher with 48% of 18-14 year olds, 52.7% of those 25-44 years of age, and 11.9% of those 45-91 years of age reporting use at some point in their lives. In 1995 those rates dropped to 23% of 18-24 year olds, 37.1% of 25-44 year olds, and 13.7% of 45- 95 year olds reporting lifetime use. The proportions reporting lifetime use remained stable through the 1998 survey in Hawaii and in 2004 were 28.8% of 18-24 year olds, 30.2% of 25- 44 year olds, and 25.9 of 65 year olds report use at some point in their lives. It would seem fair to suggest that marijuana use in Hawaii has a long and relatively stable use pattern with about one-third of the population having experience use of the drug at some point in their lives. Concern was expressed regarding the relatively high numbers of treatment spaces being use by persons reporting marijuana as their primary drug over the past 15 years because of the extreme shortage of treatment spaces for those abusing and dependent on other more dangerous drugs. The need for treatment was the overall topic of this report and the final substantive chapter focuses on that issue from two separate perspectives – by drug and by county. The overwhelming conclusion to the entire report is that there are not, nor could the ever be, enough treatment slots for all the people diagnosed as either dependent or abusing drugs and in need of treatment services. This conclusion is substantiated in the needs analyses by drug in which polydrug use was seen as the dominant mode of substance use in the State.