Substance Abuse Epidemiology Profile Report - Executive Summary
Consequences of Substance Abuse
IntroductionEight of the ten leading causes of death in New Mexico are, at least partially, caused by the abuse of alcohol, tobacco, or other drugs. In 2015, the ten leading causes of death in New Mexico were malignant neoplasms, diseases of the heart, unintentional injuries, chronic lower respiratory diseases, cerebrovascular diseases, diabetes, chronic liver disease and cirrhosis, suicide, Alzheimer's disease, and influenza and pneumonia. Of these, chronic liver disease, unintentional injuries, and suicide are associated with alcohol use; chronic lower respiratory diseases and influenza and pneumonia are associated with tobacco use; heart disease, malignant neoplasms, and cerebrovascular diseases are associated with both alcohol and tobacco use; and unintentional injuries and suicide are associated with the use of other drugs.
Alcohol-Related Deaths and HospitalizationsOver the past 30 years, New Mexico has consistently had among the highest alcohol-related death rates in the United States, and it has had the highest alcohol-related death rate since 1997. The negative consequences of excessive alcohol use in NM are not limited to death, but also include domestic violence, crime, poverty, and unemployment, as well as chronic liver disease, motor vehicle crash and other injuries, mental illness, and a variety of other medical problems. In 2010, the economic cost of excessive alcohol consumption in New Mexico was $2.2 billion ($2.77 per drink or an average of $1,084 per person) (Sacks, Jeffrey J., et al. "2010 national and state costs of excessive alcohol consumption." American Journal of Preventive Medicine 49.5 (2015): e73-e79.
Death rates from alcohol-related causes increase with age. However, one in six deaths among working age adults (20-64) in NM is attributable to alcohol. Male rates are substantially higher than female rates. American Indians have higher alcohol-related death rates than other race/ethnicities. Rio Arriba and McKinley counties have extremely high alcohol-related death rates, driven by high rates in the American Indian and Hispanic male populations, respectively. The counties with the most deaths for the five-year period, of 2012-2016, were Bernalillo, McKinley, San Juan, Santa Fe, and Dona Ana. New Mexico has extremely high death rates due to both alcohol-related chronic diseases and alcohol-related injuries.
- Alcohol-Related Chronic Disease Death.. NM's rate of death due to alcohol-related chronic diseases
is more than twice the national rate. Death rates increase with age. American Indians, both male and
female, and Hispanic males have extremely high rates. As with total alcohol-related death, Rio Arriba
and McKinley counties have the highest rates in the state.
Alcohol-related chronic liver disease (AR-CLD) is the disease that accounts for the most deaths due to alcohol-related chronic disease. AR-CLD death rates are extremely high among American Indians, both male and female, and Hispanic males. The high rates among American Indians and Hispanic males between the ages of 35 and 64 represent a tremendous burden in terms of years of potential life lost (YPLL). While Bernalillo County has the highest number of deaths due to AR-CLD (643 for the years 2012-2016), two counties that stand out for their very high rates are Rio Arriba and McKinley, which have rates that are more than five times the national rate.
Chronic liver disease hospitalizations (CLD-HIDD) can provide information on CLD risk at an earlier time point in the disease's development then AR-CLD mortality and number of visits can be used as a measure of the impact of CLD on the medical system. Women are at lower risk than men. Women who identify as Asian or Pacific Islander have the lowest rates whereas men who identify as American Indian have the highest rates. McKinley County has the highest rate of CLD-HIDD, followed by Cibola, Rio Arriba and Sierra. Eddy County had the lowest rate. It is important to note that hospitalizations from federal facilities (e.g. Indian Health Services and Veterans Administration) are not included in these results.
- Alcohol-Related Injury Death. NM's rate of alcohol-related injury death is 1.6 times the national rate. In
the current reporting period (2012-2016), drug overdose surpassed alcohol-related motor vehicle traffic
crashes and falls as the leading cause of alcohol-related injury death; and numerous other types of injury
death are also associated with excessive alcohol use (particularly binge drinking). Deaths from drug
overdose, a portion of which are partially attributable to alcohol, have increased substantially in recent
years. Males are more at risk for alcohol-related injury death than females, with American Indian males at
particularly elevated risk.
New Mexico's alcohol-related motor vehicle traffic crash (AR-MVTC) death rate has decreased dramatically over the past 30 years. After substantial declines during the 1980's and 1990's, NM's rate stagnated for almost ten years. However, a comprehensive program to prevent driving while intoxicated (DWI), initiated in 2004, resulted in substantial rate declines, particularly during the period 2005-2008. Nonetheless, rate disparities remain: both male and female American Indians have elevated rates, especially among middle age males (age 25-64). Catron, Harding, Mora, McKinley, and Sandoval, are the counties with the highest alcohol-impaired motor vehicle traffic crash (AI-MVTC) death rates. However, Catron, Harding, Mora, and Union have low numbers of deaths, whereas McKinley and Sandoval are second and seventh in number of deaths, respectively.
Smoking-Related DeathHistorically, New Mexico has had one of the lowest smoking-related death rates in the nation. Nonetheless, New Mexico's burden of death associated with smoking is considerably greater than the burden associated with alcohol and other drugs. Among all racial/ethnic groups, males have higher smoking-related death rates than females. Among males, Blacks have the highest rates, followed by Whites. Among females, Whites have the highest rates, followed by Blacks. The counties with the highest rates and relatively heavy burdens of smoking-related death (i.e., 20 or more deaths a year) are Sierra, Luna, Lea, Quay, Curry, Eddy, and Torrance. The high rates in most of these counties, and in the state overall, are driven by high rates among Whites.
Drug Overdose DeathIn 2015, New Mexico had the eighth highest drug overdose death rate in the nation. The consequences of drug use continue to burden New Mexico communities. Drug overdose death rates remained higher for males than for females. The highest drug overdose death rate was among Hispanic males, followed by Whites. Rio Arriba County had the highest drug overdose death rate in the state. Bernalillo County continued to bear the highest burden of drug overdose death in terms of total numbers of deaths. Unintentional drug overdoses account for almost 86% of drug overdose deaths. The most common drugs causing unintentional overdose death for the period covered in this report were prescription opioids (i.e., methadone, oxycodone, morphine; 49%), heroin (33%), benzodiazepines (25%), cocaine (13%), and methamphetamine (21%) (not mutually exclusive). In New Mexico and nationally, overdose death from opioids has become an issue of enormous concern as these potent drugs are widely available.
Opioid overdose related emergency Department (OOR-ED) visits have increased 98.4% in the US between 2004 and 2009. In NM, between 2010 and 2015, ED visits increased 9.8%. Male rates of OOR-ED visits were higher compared to female rates. For both groups, Whites had the highest rates. Rio Arriba County had the highest rate of OOR-ED visits during 2012-2016 with 207.8 OOR-ED visits per 100,000 population.
Suicide and Mental HealthSuicide is a serious and persistent public health problem in New Mexico. Over the period 1981 through 2010, New Mexico's suicide rate has consistently been among the highest in the nation, at 1.5 to 1.9 times the US rate. Male suicide rates are around three times higher those of females, across all racial/ethnic groups, except Asian/Pacific Islanders. For the five-year period 2012-2016, all but eight counties had suicide rates that were one and a half times higher than the most recent available US rate.
Indicators in this report also document the prevalence of frequent mental distress and current depression among New Mexico adults; persistent sadness or hopelessness, suicidal ideation, and suicide attempt among New Mexico youth; and the association between risk and resiliency factors and substance abuse and mental health indicators, among New Mexico youth.
Alcohol, Tobacco, and Other Drug Consumption BehaviorSubstance abuse behaviors are important to examine not only because substance abuse can lead to very negative consequences in the short-term, but also because substance abuse can have long-term negative consequences. For example, while drinking by youth is a behavior that can lead directly to alcohol-related injury or death, it can also lead to very serious consequences in adulthood, ranging from alcohol abuse or dependence to a variety of diseases associated with chronic heavy drinking.
Substance Use Indicators included in this Report
- Adult Binge Drinking. Binge drinking (defined as drinking five or more drinks on a single occasion for men, or four or more drinks on a single occasion for women) is associated with numerous types of injury death, including motor vehicle traffic crash fatalities, drug overdose, falls, suicide, and homicide. Among adults (age 18 or over) of all ethnicities, binge drinking was more commonly reported by males than females, mirroring higher rates of alcohol-related injury death among males. Among males, Hispanics were more likely to report binge drinking than other race/ethnicities. Young adults (age 18-24) were more likely than other age groups to report binge drinking.
- Youth Current Drinking. Any alcohol consumption by a person under the age of 21 is considered to be excessive drinking. Alcohol is the most commonly used drug among youth in New Mexico, more than tobacco or other drugs. However, contrary to common perception, most high school students do not drink. In 2015, 26.1% of high school students reported that they were current drinkers. This is a significant decrease from 43.3% in 2005.
- Youth Binge Drinking. Youth binge drinking has significantly decreased over the last decade. In 2015, New Mexico public high school students were less likely to report binge drinking than US high school students. Among New Mexico high school students, binge drinking was more commonly reported by upper grade students than lower grade students. There was no significant difference in the binge drinking rate between male and female high school students. Binge drinking rates were lower among American Indian youth than other racial/ethnic groups.
- Youth Having Ten or More Drinks. On average, underage drinkers consume more drinks per drinking occasion than adult drinkers and risk of harm increases as the number of drinks consumed on an occasion increases. Students in the 12th grade are more likely to drink ten or more drinks on an occasion than 9th grade students. Although boys and girls are equally likely to drink (see current drinking indicator), boys are almost twice as likely to drink ten or more drinks on an occasion than girls.
- Adult Heavy Drinking. In NM, between 2014-2016, adult heavy drinking (defined as drinking, on average, more than two drinks per day, for men; or more than one drink per day, for women) was less commonly reported (5.2%) than in the rest of the nation in 2016 (6.9%). Heavy drinking was more prevalent among middle-aged (age 25-64) adults, with 5.8% reporting past-month heavy drinking. New Mexico men were almost 1.5 times more likely to report chronic drinking than women (6.3% v. 4.3%).
- Adult Drinking and Driving. In 2016, adult past-30-day drinking and driving was reported in New Mexico by 1.0% of adults aged 18 and over. Past-30-day drinking and driving was more prevalent among young (age 18-24) and middle-age (age 25-64) adults than among older adults (age 65+). New Mexico men were almost three times more likely to report drinking and driving than women (1.6% v. 0.5%). Hispanic males (2.1%) were more likely to report drinking and driving than American Indian (1.4%) and White (1.2%) males.
- Youth Drinking and Driving. In 2015, New Mexico high school students were less likely to report driving after drinking alcohol than other US students. Driving after drinking was more common among boys than girls, and was less common among White and American Indian youth than among other racial/ethnic groups. Twelfth grade students were more likely to report drinking and driving than ninth and tenth grade students.
- Youth Drug Use. In 2015, past-30-day marijuana and methamphetamine use were more prevalent among New Mexico students than among US students. The use of marijuana was more commonly reported by American Indian than by students in other racial/ethnic groups. Asian or Pacific Islander students were more likely to report past-30-day use of cocaine, heroin, methamphetamine, and inhalants than students of other racial/ethnic groups.
- Adult Tobacco Use. Between 2014-2016, the prevalence of adult smoking was a bit higher for New Mexico compared to the 2016 US estimates (17.8% vs. 17.0% respectively). Smoking was most prevalent among middle-aged groups, and was more common among men than women for all age categories.
- Youth Tobacco Use. In 2015, smoking was more prevalent among New Mexico high school students (11.4%) than in the nation overall (10.8%). New Mexico boys were more likely than girls to report current smoking (12.8% vs. 9.8). American Indian high school students (17.0%) were more likely to report current cigarette smoking than Black (9.5%) and White (10.5%) students.
- National/New Mexico population data, 1981-1989: U.S. Census Bureau. Estimates of the Population of States by Age, Sex, Race, and Hispanic Origin: 1981 to 1989. Available from http://www.census.gov/popest/archives/1980s/80s_st_detail.html as of January 31, 2017.
- National/New Mexico population data, 1990-1999: U.S. Census Bureau. Estimates of the Population of States by Age, Sex, Race and Hispanic Origin: 1990 to 1999, Internet Release Date August 30, 2000. http://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm#july1999 as of January 31, 2017.
- National population data, 2000-2010: National Center for Health Statistics (NCHS). Intercensal estimates of the resident population of the United States for July 1, 2000-July 1, 2010, by year, county, age, bridged race, Hispanic origin, and sex. Available from: http://www.census.gov/programs-surveys/popest/data/data-sets.2000.html http://www.census.gov/programs-surveys/popest/data/data-sets.2000.html as of January 31, 2017.
- New Mexico population data, 2000-2016: University of New Mexico, Bureau of Business and Economic Research. Annual Estimates of the Population of New Mexico by County, Age, Sex, Race and Hispanic Origin, 2000 to 2016 (10/21/2016 update).
- National death data: National Center for Health Statistics (NCHS). Multiple Cause-of-Death files, 1981-2010, machine readable data files and documentation. National Center for Health Statistics, Hyattsville, Maryland. Available from: http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm#Mortality_Multiple. Death rates were calculated by the New Mexico Department of Health (NMDOH), Epidemiology and Response Division (ERD), Injury and Behavioral Epidemiology Bureau (IBEB), Substance Abuse Epidemiology Section (SAES).
- New Mexico death data: New Mexico Department of Health, Epidemiology and Response Division, Bureau of Vital Records and Health Statistics (BVRHS). Death rates were calculated by the New Mexico Department of Health, Epidemiology and Response Division, Injury and Behavioral Epidemiology Bureau, Substance Abuse Epidemiology Section.
- National/New Mexico motor vehicle traffic crash fatality data: National Highway Traffic Safety Administration
(NHTSA), Fatality Analysis Reporting System (FARS).
(1) VMT reporting: Fatalities, Fatalities in Crashes by Driver Alcohol Involvement, Vehicle Miles Traveled (VMT), and Fatality Rate per 100 Million VMT, by State, 1982-2012. Report provided by NHTSA National Center for Statistics and Analysis, Information Services Team. 2008-2012 death rates per 100 Million VMT calculated by the New Mexico Department of Health, Epidemiology and Response Division, Injury and Behavioral Epidemiology Bureau, Substance Abuse Epidemiology Section.
(2) Per 100,000 population reporting: Persons Killed, by STATE and Highest Driver Blood Alcohol Concentration (BAC) in Crash - State : USA, Year. Available from: http://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm#july1999 Death rates were calculated by the New Mexico Department of Health, Epidemiology and Response Division, Injury and Behavioral Epidemiology Bureau, Substance Abuse Epidemiology Section.
- New Mexico Emergency Department Visits: New Mexico Department of Health, Epidemiology and Response Division, Health Systems Epidemiology Unit. Visit rates were calculated by the New Mexico Department of Health, Epidemiology and Response Division, Injury and Behavioral Epidemiology Bureau, Substance Abuse Epidemiology Section according to methodology described in: http://nmhealth.org/data/view/newsletter/1729/
- New Mexico Hospital Inpatient Discharges: New Mexico Department of Health, Epidemiology and Response Division, Health Systems Epidemiology Unit. Discharge rates were calculated by the New Mexico Department of Health, Epidemiology and Response Division, Injury and Behavioral Epidemiology Bureau, Substance Abuse Epidemiology Section.
- National adult behavioral data: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health. Behavioral Risk Factor Surveillance System Online Prevalence Data, 1995-2015. Available from: http://www.cdc.gov/brfss/data_tools.htm as of January 31, 2016.
- New Mexico adult behavioral data: New Mexico Department of Health, Epidemiology and Response Division, Injury and Behavioral Epidemiology Bureau, Survey Unit. New Mexico Behavioral Risk Factor Surveillance System (BRFSS). More reporting available from: https://nmhealth.org/about/erd/ibeb/brfss/ as of January 31, 2016.
- National youth behavioral data: Centers for Disease Control and Prevention (CDC). Surveillance Summaries, June 8, 2012. MMWR. 201:61(SS-4). More reporting available from: http://www.cdc.gov/HealthyYouth/yrbs/index.htm as of January 31, 2016.
- New Mexico youth behavioral data: New Mexico Department of Health, Epidemiology and Response Division, Injury and Behavioral Epidemiology Bureau, Survey Unit; and the New Mexico Public Education Department, School and Family Support Bureau. New Mexico Youth Risk and Resiliency Survey (YRRS). More reporting available from: http://youthrisk.org as of January 31, 2016
- New Mexico substance use disorder and mental health data: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Sub-state Estimates from the 2008-2010 National Surveys on Drug Use and Health and Statewide Estimates from 2011-2012. Available from: http://www.samhsa.gov/data/NSDUH/substate2k10/toc.aspx, http://www.samhsa.gov/data/NSDUH/2k12State/Tables/NSDUHsaeTables2012.pdf More reporting available from: http://www.samhsa.gov/data/population-data-nsduh as of January 31. 2016.