It cannot be overstated that substance use disorders are important in our
country, state, and the Travis County community. It is a serious problem
impacting all members of the community. Each health and human service issue
area of the Community Action Network is affected by substance abuse and dependence.
Health
There are over 72 medical conditions that have risk factors related to
substance use disorders (Join Together, 2000, October 17). The four
leading causes of death in Travis County, the Metropolitan Statistical
Area (MSA), and the State of Texas are heart disease, some forms of cancer,
stroke, and unintentional injury (Epigram Population and Mortality Data
Analysis, Online). These leading causes of death are significantly correlated
to substance abuse and are addressed in the Physical Health Section. In
addition, alcohol and drug related deaths and auto crashes, spreading of
infectious diseases, drug-related medical emergencies, and HIV/AIDS negatively
impact the health of our community.
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Co-Occurring Mental Disorders
From 30 to 60 percent of persons with an addictive disorder have a co-occurring
mental disorder i.e., substance use disorder and a mental illness at the
same time. Over 80 percent of the time mental disorders precede substance
abuse by five to ten years (Office of National Drug Control Policy, 1999,
p. 60) Thirty-seven percent of people who have a mental health disorder are
also affected with an alcohol disorder. Of those with a drug disorder, the
co-morbidity rate is 53 percent (Bassuk, 1994, p.1-4).
Psychiatric hospitals have a 39.6 percent prevalence rate for substance
abuse. People with a lifetime mental disorder are twice as likely to have
an alcohol disorder and four times as likely to have a lifetime drug disorder
compared to the general population (Bassuk, 1994).
- An estimated three percent of the population (18 and over) have co-occurring
addictive and a mental health disorder within a given year; 15 percent
for those with a serious mental illness; and 27 percent for those with
severe and persistent mental illness (USDHHS, 2000).
- Ninety percent of inmates with mental disorders have an addiction disorder
(Regier, 1990).
- Dual diagnosis occurs in 28-60 percent of the mental health target population
(Central Texas Partnership, 1996).
- Children and adolescents (especially boys) diagnosed with conduct disorders
appear to be at special risk to abuse substances (USDHHS, 2000).
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Dependence in the Workplace
The myth that substance abuse, dependence, and addiction are issues limited
to those who are homeless or destitute is erroneous. The Office of National
Drug Control Policy (1999) reports that over seventy-three percent of those
who abuse substances are employed. In 1997, an estimated 60 percent of current
illegal substance abusers were of working age. An estimated 13.8 percent
of unemployed Americans are current drug users compared to 6 percent of the
general population (National Institute on Drug Abuse [NIDA], Workplace Trends).
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Public Safety, Crime Prevention, & Victimization
Studies show that substance use, especially at a young age, is a predictor
of future criminal behavior. The Community Action Network's assessment, Public
Safety, Crime Prevention, & Victimization discusses the relationship between
substance dependence, incarceration and the lack of treatment. Although the
majority of adult offenders are under the influence of drugs or alcohol at
the time of their arrest, the assessment highlights the lack of substance
dependence treatment for offenders and those at-risk of offending (Supervile,
1998). Although drug treatment and case management capacity in Travis County
Community Corrections has been expanded in recent years through programs
like the Drug Court, SMART and specialized substance dependence caseloads
for probation, waiting lists for treatment still exist. "The system does
very little to treat the addiction that often led them to commit the crime
in the first place...addiction is a chronic condition that jailing alone
will not cure" (Join Together, 2000, October 27).
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Housing
The lack of affordable housing in Austin coupled with the growing population,
accelerated rental costs, high occupancy rates, employment growth, imbalance
between wages and cost of living, and decline in federal resources are some
of the factors causing serious housing problems. Additional complicating
factors related to housing and substance disorders are:
- Stigma related to substance disorders;
- Difficulty qualifying for housing with prior drug conviction;
- Lack of sufficient transitional and permanent housing for offenders
with substance abuse and dependence histories;
- Lack of community transition programming for incarcerated offenders
with substance abuse and dependence histories; and
- Decreasing property values in drug traffic neighborhoods.
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Homelessness
The supply of substance dependence treatment services available to homeless
persons is inadequate. Locally, providers estimate that up to 40 percent of
homeless adults need substance abuse treatment. Data collected by ACCESS, a
local program providing outreach to homeless persons with severe and persistent
mental illness, indicate that over one-third (34 percent) of these individuals
are dually diagnosed with mental illness and substance dependence.
- Nearly two-thirds of persons receiving services from homeless assistance
programs in the U.S. have had either alcohol, drug abuse or dependence problems
in their lifetime (Center for Substance Abuse Treatment [CSAT], 2000).
- Over half of single, homeless adults need substance dependence treatment
(Bassuk, 1994).
- Thirty to 40 percent of the homeless population abuse alcohol and 10-20
percent abuse drugs as compared to 13.5 percent alcohol abuse and 6 percent
drug abuse in the general population (Bassuk, 1994, p. 1-5).
- An undetermined number of youth are homeless as a result of family rejection/abandonment
or their family's inability to provide a home due to mental illness and/or
substance use disorders.
The Austin and Travis County, Texas 2000 consolidated application for the
HUD Super NOFA Continuum of Care Homeless Assistance application (Table 8-2)
identifies the estimated need, current inventory and unmet need/gap for individuals,
persons in families with children and special populations of chronic substance
abuse and dual diagnosis. The table below reports this information.
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