Substance abuse in Michigan

Ann Arbor, Sterling Heights and Madison Heights, Michigan
Michigan Departaments of Health and Human Services Page 1 of 26
Substance abuse in Michigan,
August 2015
ALCOHOL/SUBSTANCE ABUSE
EPIDEMIOLOGY PROGRAM
The Michigan Department of Health and Human Services (MDHHS) recei-ves
federal funding to conduct public health surveillance on the effects of alcohol and
drug abuse on Michigan's population. The Bureau of Disease Control, Prevention,
and Epidemiology provides epidemiological support to programmatic efforts
related to alcohol and drugs provided by other Michi-gan and National agencies.
ALCOHOL
Excessive alcohol use, either in the form of heavy drinking (drinking more than
drinks containing alcohol two drinks per day on average for men or more than
one drink per day on average for women), or binge drinking (drinking 5 or more
drinks during a single occasion for men or 4 or more drinks during a single
occasion for women), can lead to increased risk of health problems such as liver
disease or unintentional injuries.
While most adults consume alcohol responsibly, there is a growing need to
understand the relationship between alcohol use, particularly excessive use and
its harmful effects in Michigan.
The MDHHS, Bureau of Disease
Control, Prevention, and
Epidemiology receives su-pport
from the Centers for Dise-ase
Control and Prevention (CDC) to
conduct public health surveillance
on how alcohol affects Michigan's
population. Our focus consists of
moni-toring alcohol-related
disease and negative societal
outcomes with a special interest
in youth to develop
environmental and policy
indicators for Michigan.

Violence & Mental Distress in
Current & Binge Drinking MI Youth
Each year, approximately 5,000 young Americans under the age of 21 die as a
result of underage drinking; which includes about 1,900 deaths from motor
vehicle crashes, 1,600 as a result of homicides, 300 from suicide, as well as
hundreds from other injuries such as falls, burns, and drownings.
In 2003, the average age of first use of alcohol was about 14, compared to about
17 1/2 in 1965. People who reported starting to drink before the age of 15 were
four times more likely to also report meeting the criteria for alcohol dependence
at some point in their lives. In fact, new research shows that serious drinking
problems (including alcoholism) typically associated with middle age, actually
begin to appear much earlier, during young adulthood and even adolescence.
Other research shows that the younger children and adolescents are when they
start to drink, the more likely they will be to engage in behaviors that harm
themselves and others. For example, frequent binge drinkers (nearly 1 million
high school students nationwide) are more likely to engage in risky behaviors,
including using other drugs such as marijuana and cocaine, having sex with six or
more partners, and earning grades that are mostly Ds and Fs in school.
Data from the 2009 Michigan’s Youth Risk Behavior Survey (MiYRBS) can be used
to examine the prevalence of violent behaviors & mental distress in Michigan’s
teenagers that drink alcohol. Among MiYRBS respondents, the overall proportion
of non-drinkers was 63.0%, while 37.0% of respondents reported being current
drinkers and 23.2% reported binge drinking. Overall, high school males and
females had similar prevalence of current (36.0% of males and 37.0% of females)
& binge (23.8% of males and 22.4% of females) drinking. Generally, binge and
current drinkers reported more violence and mental distress than non-drinkers,
regardless of sex. Among males, MiYRBS data demonstrate that drinkers were
more likely to engage in dangerous, violent behavior and exhibit more symptoms
of mental distress than non-drinkers.
While binge drinkers had slightly higher prevalence estimates than current
drinkers, the difference was not found to be significant. When comparing current
and binge drinkers to non-drinkers there was a substantial difference, indicating
significance between these two groups. Among male students, violent behaviors
were more frequent, while females had more frequent indicators of mental
distress. As shown in the table below, current and binge drinking males had
higher prevalence estimates of carrying a gun or other weapon and being
threatened or injured with a weapon on school property in the previous 12
months. Male drinkers were more likely to be in a physical fight and treated by
either a doctor or nurse for fighting compared to male non-drinkers. Male

drinkers also reported higher estimates of fighting on school property and being
slapped by a boyfriend or girlfriend within the past 12 months than non-drinking
males. Males that consumed alcohol were more likely to display feelings of
mental distress, such as having felt sad for two continuous weeks, considering
suicide, making a suicide plan and attempting suicide in the previous 12 months
compared to non-drinkers. Female binge and current drinkers had similar
patterns of risky violent behavior and mental distress characteristics as male
binge and current drinkers compared to non-drinkers. Similar to male drinkers,
female binge drinkers reported slightly higher prevalence estimates than current
drinkers.
Prevalence of Violence & Mental Distress Characteristics by Alcohol
Consumption among 9th-12th grade students - 2009 MiYRBS
Female drinkers reported higher prevalence estimates of carrying a gun or other
weapon in the past 30 days and being threatened or injured by a weapon on
school property, being in a physical fight and being treated for fighting by a
doctor or nurse in the past 12 months. Female drinkers were more likely to have
fought on school property, been slapped by their boyfriend or girlfriend, felt sad
for two continuous weeks, considered suicide, made a suicide plan and attempted
suicide in the past 12 months.
Figures 1 and 2 illustrate that current and binge drinking males and females were
more likely to engage in violent and aggressive behavior than non-drinkers, while
Figures 3 and 4 indicate that females and males who consumed alcohol reported
more mental distress and mental health concerns compared to non-drinkers.
Results from the 2009 MiYRBS reflect previous findings that current and binge
drinkers engage in riskier, violent behavior and experience greater levels of
mental distress than non-drinkers, regardless of sex. Binge drinkers tend to have
the highest prevalence estimates of violent and mental distress indicators,
followed by current drinkers and non-drinkers. Prevalence estimates for binge
drinking male and females were generally higher than in current drinkers, but the
differences between binge and current drinkers were not statistically significant.
Alcohol use, violence and mental distress appear to co-occur in a significant

proportion of Michigan teenagers of both sexes. Prevention and intervention
efforts should be targeted at this high risk group. Michigan youth with evidence of
violence or depression should be screened and treated for alcohol misuse.
Sexual Behavior & the Impact of Drinking in MI Youth
Scientific evidence states that among youth, drinking is strongly related to the
decision making process of having sex and to indiscriminate forms of risky sex
(e.g., having multiple or casual sex partners), but is inconsistently and often
negatively related to protective behaviors (e.g., condom use). Research on
adolescent risk behaviors documents the co-occurrence of alcohol use, sexual risk
taking, and other problem behaviors. Youth who drink, for example, are more
likely to report multiple sexual partners and inconsistent condom use later risk
taking.
Studies of early adolescents through young adults have demonstrated a
connection between early patterns of use (e.g., binge drinking) and subsequent
sexual risks also reported links between early drinking and problem behaviors,
including pregnancy and parenthood by 12th grade. Early drinking may shape
subsequent decision making through multiple pathways, for example, by affecting
judgment, school performance, peer selection, and exposure to environments
that reward risk taking. Although other substances (e.g., marijuana, cocaine) have

been associated with sexual risk taking, drinking may be especially relevant for
younger adolescents, who are more likely to be using alcohol than other drugs.
to examine the prevalence of risky sexual behavior in Michigan’s teenagers that
drink alcohol.
Among MiYRBS respondents, the overall proportion of non-drinkers was 63.0%,
while 37.0% of respondents reported being current drinkers and 23.2% reported
binge drinking. Overall, high school males and females had similar prevalence of
current (36.0% of males and 37.0% of females) & binge (23.8% of males and
22.4% of females) drinking. Risky sexual behavior is reported at a greater
frequency among male and female drinkers than non-drinkers. Patterns of sexual
behavior in Michigan youth appear to support previous studies’ findings and do
not vary considerably by gender.
The table below illustrates the overall trend in increasing risky sexual behavior by
drinking category. While not statistically significant, binge drinkers were more
likely to report engaging in risky sexual behavior compared to current drinkers.
The difference between both binge and current drinkers and non-drinkers was in
most instances significant. Non-drinkers tend to report higher percentages of
protective factors, such as using a condom or birth control before a participant’s
last sexual experience. Among males, these estimates indicate that binge and
current drinkers were more likely to have had sex, been physically forced to have
sex, to have their first sexual partner be three or more years older and to have
ever caused a pregnancy than male non-drinkers.
Prevalence of Sexual Behavior by Alcohol Consumption
among 9th-12th grade students- 2009 MiYRBS
As seen in Figure 1, males that consumed alcohol in the last month also reported
higher prevalence estimates of having sex with four or more partners in their
lifetime, having sex before 13 years old, having sex in the past three months and
to have used alcohol or drugs before their last sexual act as compared to male
non-drinkers. Male non-drinkers were more likely to report using a condom
before their last sexual encounter and having a conversation about sex with their

parents at higher frequencies than male binge and current drinkers. Females that
consumed alcohol had similar patterns of sexual behavior as male drinkers.
Current and binge drinkers almost always had higher frequencies of the variables
measured, compared to non-drinkers. Female binge and current drinkers were
more likely to have had sex, to have had their first sexual partner be three or
more years older and to have ever been physically forced to have sex than female
non-drinkers, as evidenced in Figure 2.
Female drinkers also reported higher frequencies of having four or more sexual
partners, having sex in the last three months and having used alcohol or drugs
before their last sexual experience (Figure 2). Non-drinkers had higher prevalence
estimates of condom use during their last sexual encounter and ever having a
conversation about sex with their parents compared to current and binge
drinkers.
A greater percentage of males reported a condom was used than females, while
birth control use varied by the alcohol categories and by gender, illustrated in
Figures 3 and 4. Results from the 2009 MiYRBS indicate that alcohol consumption
and sexual behavior in Michigan’s youth are a real cause for concern. Data
demonstrate that both male and female binge and current drinkers are more
likely to engage in risky sexual activity compared to non-drinkers. Having multiple
sexual partners, using alcohol and/or drugs before sexual activity and teen
pregnancy are all issues that require immediate attention in Michigan teenagers.

Non-drinkers were more likely to report protective behavior than binge and
current drinkers. The impact of alcohol consumption on decision making related
to sexual behavior needs to be addressed in Michigan youth because these
teenagers are at a critical period when their behavior can develop into lifelong
habits. Possible strategies to address this issue could include having discussions
about alcohol use in sexual education at school and in conversations at home.
Weight Control Behavior of
Current & Binge Drinking MI Youth
Obesity among adolescents is of public health concern given its high prevalence
and potential adverse medical consequences. The use of disordered eating
behaviors, such as binge eating and unhealthy weight control behaviors, is also a
serious problem given that these behaviors are commonly used by adolescents.
These behaviors are associated with poor eating patterns and dietary quality,
eating disorders, depression, and have been found to longitudinally increase risk
for weight gain and besity. In previous analyses of the Project EAT (Eating Among
Teens) study population, the co-occurrence of overweight status and use of
disordered eating behaviors was found to be high, particularly among female
adolescents. Thus, while an important public health goal is to prevent obesity in
adolescents, it may be even more important to prevent the co-occurrence of
obesity and disordered eating in youth.
to examine the prevalence of weight loss behaviors in Michigan teenagers that
drink alcohol. Among MiYRBS respondents, the overall proportion of non-drinkers
was 63.0%, while 37.0% of respondents reported being current drinkers and
23.2% reported binge drinking. Overall, high school males and females had similar
prevalence of current (36.0% of males and 37.0% of females) & binge (23.8% of
males and 22.4% of females) drinking. Regardless of sex or drinking status, a
higher percentage of students reported themselves as “overweight” than were
overweight based on their body mass index (BMI*), as calculated from their
reported height and weight. Current and binge drinkers were more likely to
report trying to lose weight, eating less and exercising to lose weight than non-
drinkers. Female drinkers were significantly more likely to report these behaviors
than males, as seen in Table 1. While there was not a significant difference
between drinking category, males were more likely to be physically active for 60
or more minutes on five or more days during the past week than females.
The table below demonstrates that current and binge drinkers were more likely to
report using extreme and unhealthy methods of weight control than non-
drinkers. All current drinkers and female binge drinkers were more likely to report
fasting for 24 hours or longer in the past 30 days compared to non-drinkers. For

current and binge drinkers of both sexes, the reported use of diet pills was
significantly higher compared to non-drinkers. There was also a greater trend of
vomiting and/or using laxatives as a method of weight control in the past 30 days
in both male and female binge drinkers and female current drinkers than non-
drinkers. While a significant difference does not exist between being overweight
and describing one’s self as overweight by drinking category, (see Figures 1 & 2),
the behavior to control weight is significantly different between drinkers and non-
drinkers. Males were more likely to be overweight or obese, by calculated BMI,
compared to females, (see Figures 1 & 2) regardless of drinking category.
Females, on the other hand, were more likely than males to describe themselves
as overweight, despite reporting lower frequencies of being overweight or obese
by BMI status. As seen in Figures 3 and 4, female drinkers have higher prevalence
estimates of fasting, vomiting and laxative use compared to male drinkers, while
the frequency of diet pill use was similar across drinking status and sex.
Prevalence of Weight Control Behavior by Alcohol Consumption
among 9th-12th grade students- 2009 MiYRBS
Overall, 2009 MiYRBS data demonstrate that current and binge drinkers are more
likely to report unhealthy weight control behaviors and trying to lose weight
compared to non-drinkers. Drinkers were more likely to report higher
percentages of vomiting and/or laxative use, fasting and diet pill use than non-
drinkers.

The data suggest that Michigan youth engaging in unhealthy weight control
behaviors are at risk for inadequate dietary intakes. While the obesity epidemic
continues to be an issue of concern, especially in adolescents, interventions
aimed at preventing unhealthy weight control behaviors should include both
educational and environmental components that also address alcohol use, social
norms and perceptions.
Self-reported Experience with
Drinking & Driving in MI Youth
Motor-vehicle crashes are the leading cause of death in the United States for
persons aged 16-24 years, and a substantial proportion of these crashes are
alcohol-related. Alcohol has been identified as one of the most important
preventable causes of motor vehicle collisions for more than 4 decades. In 2006
alone, 38,588 fatal collisions led to 42,642 fatalities, of which 41 percent occurred
while at least one of the drivers or non-motorists involved in the fatal crash had a
blood alcohol concentration (BAC) above the legal limit. However, not all drivers
are equally at risk of alcohol-related motor vehicle crashes. Younger drivers have
reported a higher rate of driving under the influence and male drivers have a
twofold higher chance of being under the influence of alcohol in a fatal crash. Not
only are drivers aged less than 21 years more likely than older drivers to be
involved in fatal crashes, but their added risk for fatal crash involvement increases
more sharply at all levels of alcohol use.
to examine the prevalence of Michigan teenagers riding in a vehicle with a
drinking driver & driving after drinking alcohol. Among MiYRBS respondents, the
overall proportion of non-drinkers was 63.0%, while 37.0% of respondents
reported being current drinkers and 23.2% reported binge drinking. Overall, high
school males and females had similar prevalence of current (36.0% of males and
37.0% of females) & binge (23.8% of males and 22.4% of females) drinking.

Compared to youth who didn’t drink alcohol, youth who drank in the past 30 days
were significantly more likely to ride with a driver that had been drinking.
Current and binge drinkers had higher prevalence estimates of both riding in a
vehicle with a drinking driver and driving a vehicle after drinking in the past 30
days compared to non-drinkers. While binge drinkers reported a slightly larger
percentage of riding in a vehicle with a driver that had been drinking than current
drinkers, there was not a significant difference between the two groups. A
statistically significant difference existed between drinkers, (both current & binge)
and non-drinkers (see Table below). In the past 30 days, most current and non-
drinking youth did not ride with a driver who had been drinking.
Youth who drank were four to five times more likely to ride with a driver who had
been drinking than non-drinkers. While not statistically different, females tended
to ride more frequently with drivers who had been drinking, while males tended
to drive after drinking (Figures 1&2). Among those who consumed alcohol, binge
drinkers reported higher frequencies of getting a ride from a drinking driver than
current drinkers. Binge and current drinkers reported riding with a drinking driver
two to three times in the past 30 days with the highest frequency, as evidenced in
Figures 3 and 4. Most female youth who rode with a drinking driver did so less
than four times in the previous 30 days. Male youth did not report this pattern.
Although the majority of youth who drank alcohol did not drive afterwards,
approximately one in four current & binge drinkers drank and drove at least once
in the past month.
Riding with a Drinking Driver and Driving after Drinking Reported by
Alcohol Consumption among 9th-12th grade students- 2009 MiYRBS
When asked about driving after drinking alcohol, binge drinkers were more likely
to report a higher prevalence than current drinkers. Male and female current
drinkers reported higher frequencies of never driving after drinking than male and
female binge drinkers. Binge drinkers had higher prevalence estimates of driving
multiple times after consuming alcohol. Males reported higher percentages of
driving after drinking when compared to females (Figures 1 & 2). For both sexes,
Michigan adolescents were more likely to drive one time after drinking, with less

reporting multiple episodes of drinking and driving in the past month for both
current and binge drinkers.
Addressing the issue of drinking and driving among Michigan youth is of critical
importance. High school students may be at a greater risk of motor vehicle crash
injury and death because they have less driving experience and may become
more easily distracted by their peers compared to adult drivers. Data from the
MiYRBS are especially alarming because they demonstrate increasing and similar
trends of binge drinking and driving observed in adults (data not shown).
Appropriate interventions are needed to prevent Michigan adolescents from
establishing unsafe patterns of drinking and driving that may continue into
adulthood.
Type of Alcohol Consumed by MI Youth
Excessive alcohol consumption contributes to an average of approximately 4,700
deaths among underage youth in the United States each year (e.g., from
homicides, motor-vehicle crashes, and suicides) and an average of 60 years of life
lost per death. Although drinking by underage persons (<21 years) is illegal in
every state, youth aged 12-20 years drink nearly 20% of all the alcohol consumed

in the United States. In 2005, a preliminary series of questions assessing the type
of alcohol usually consumed were added to the Youth Risk Behavior Survey in
Arkansas, Nebraska, New Mexico & Wyoming to obtain information on underage
drinking. However, little is known about the specific types of alcoholic beverages
currently consumed by Michigan youth. These data are important because
numerous evidence-based strategies for reducing underage drinking rates are
beverage-specific, including increasing alcohol excise taxes and increasing
restrictions on the distribution and sale of alcoholic beverages.
Data from the 2007 Michigan Youth Tobacco Survey (MiYTS) can be used to
determine the type of alcohol consumed in Michigan’s teenagers. Among YTS
respondents, the overall proportion of non-drinkers was 59.0%, while 41.0% of
respondents reported being current drinkers and 31.3% reporting binge drinking.
Overall, high school males and females had similar prevalence of current (40.8%
of males and 41.3% of females) & binge (32.1% of males and 30.4% of females)
drinkers. The table below indicates that alcohol consumption increases by grade
level and is most common in non-Hispanic White students. Among current
drinkers, liquor was the most widely used type of alcohol (38.1%) in the past 30
days for all sexes, grades and racial/ethnic groups. Beer was the next most
commonly consumed type of alcoholic beverage (19.4%), followed by no usual
type (15.5%) and malt beverages (15%). Wine coolers, wine and other types of
alcohol were consumed at much lower frequencies in the past month compared
to the alcoholic beverages listed above.
As seen in Figure 1, liquor was the most frequently consumed type of alcohol for
both sexes. Beer was second most frequently consumed for males and malt
beverages for females. More males than females reported ‘no usual type of
alcohol’ consumed. Figure 2 demonstrates that liquor was the most frequent
beverage consumed for all grades and increased in prevalence with grade level.
9th graders reported more beer and malt beverage than older students.
Prevalence of Type of Alcohol Usually Consumed Among
Current Drinkers in 9th-12th grade - 2007 MiYTS

Liquor was the most frequently consumed type of alcohol for all racial/ethnic
groups. Hispanics reported higher liquor consumption prevalence than non-
Hispanic Whites and Blacks.
Beer was the second most
commonly consumed beverage for
non-Hispanic Whites and Hispanics,
while for non-Hispanic Blacks, ‘no
usual type’ was second most
frequent. Сonsumption of wine and
other types of alcohol were repor-
ted at very small frequencies for all
sexes, grades and racial/ethnic gro-
ups. In 2007, liquor was the most
prevalent type of alcohol usually
consumed by students in 9th-12th
grades reporting current alcohol
use in Michigan. It also was the
most prevalent type across sex,
grade and racial/ethnic groups.
Binge drinkers reported the same
preference in types of alcoholic
beverages as current drinkers.
Liquor use was reported at higher
percentages by binge drinkers than
current drinkers (data not shown.)
This report provides convincing
evidence of the need for policies
and interventions to reduce the
accessibility of alcohol by Michigan
youth and the excessive
consumption of alcohol.
Understanding beverage type and
brand consumption preferences
are crucial in developing targeted
interventions for youth. This report’s findings are similar to the 2005 MMWR
“Types of Alcoholic Beverages Usually Consumed by Students in 9th--12th Grades
--- Four States”. Previousstudies provide consistent evidence that increases in
alcohol prices and alcohol taxes are associated with decreases in both excessive
alcohol consumption and related harms, such as alcohol-impaired driving, non–
motor vehicle mortality outcomes, and violence outcomes. Alcohol excise taxes
and greater enforcement of laws prohibiting sales to minors and prohibiting

adults from supplying alcohol to underage youth would help to reduce the
excessive alcohol consumption patterns reported in Michigan high school
students.
Cancer & Alcohol Use
The good news is that persons can reduce their risk for some types of cancers,
such as mouth, esophagus, breast, liver and colon, by reducing their alcohol use.
If you choose to drink, follow the U.S. Dietary Guidelines, which recommend up to
1 drink per day for women and up to 2 drinks per day for men.
People who shouldn’t drink alcohol include:
 Children and adolescents
 Women who are pregnant or may become pregnant
 Persons with certain medical conditions
 Individuals taking prescription or over-the-counter medications that can
interact with alcohol
 Persons recovering from alcoholism
 Individuals who cannot limit their drinking to low levels
 Persons who plan to drive, operate machinery, or other activities that require
skill & attention
The Relationship Between Alcohol Use & Cancer
 In 1988, alcohol was declared a cancer causing agent by the World Health
Organization.
 Alcohol consumption has been shown to contribute to cancers of the mouth,
pharynx, larynx, esophagus, colon-rectum, liver, and female breast.
 Alcohol intake has also been significantly associated with pancreatic cancer.
 In 2009, alcohol consumption resulted in an estimated 18,200 to 21,300
cancer deaths, or 3.2% to 3.7% of all US cancer deaths. Alcohol-attributable
cancers resulted in 17.0 to 19.1 years of potential life lost for each death.
 In 2014, the WHO reported that when it comes to cancer, no amount of
alcohol is safe to drink.
Alcohol as a Risk Factor
 The more alcohol that a person drinks, the higher their cancer risk.
 Smoking tobacco and drinking alcohol is particularly dangerous. It increases
the risk for cancers of the oral cavity, pharynx, larynx, and esophagus.
Individuals who are both heavy drinkers and heavy smokers have the highest
risks of these cancers.

Alcohol Consumption and Teen Pregnancy
Teen births in Michigan have declined to
the lowest level ever recorded, howe-
ver, in 2012, there were almost 9,000
live births among teens aged 15 to 19. A
strong association exists between alco-
hol use an risky sexual behavior, such as
having unprotected sex, multiple sexual
partners, transmission of sexually trans-
mitted infections and unintended preg-
nancy. Preventing excessive alcohol use
among high school students may reduce
risky sexual behaviors and outcomes,
such as teen pregnancy.
Among Michigan high school students
who binge drink:
 3 out of every 4 report having sex in
their lifetime
 1 in 5 report having 6 or more sexual
partners
 Almost half report using alcohol or drugs the last time they had sex
 Significantly more report having sex before the age of 13, being forced to do
sexual things, including being forced to have sex, compared to nondrinkers.
To reduce excessive alcohol consumption
among youth, the Community Preventive
Services Task Force recommends the
following evidence-based strategies:
 Enhance enforcement of laws prohibiting
sales to minors
 Regulate alcohol outlet density
 Increase alcohol taxes
 Maintain limits on days and hours of
alcoholic sales
 Enforce commercial host liability

To prevent teen pregnancies, Doctors, nurses & health care providers can:
 Encourage teens to delay sexual activity
 Encourage sexually active teens to consider the most effective reversible
methods of birth control.
 Talk about using condoms correctly every time during sex to prevent sexually
transmitted diseases, including HIV/AIDS, even if another birth control
method is used.
Parents, guardians, and caregivers can:
 Talk with teens about normal sexual development, and how and when to say
"no" to sex.
 Talk about using birth control and a condom every time they have sex.
 Know where their teens are and what they are doing, particularly after school.
 Be aware of their teen's use of social media and digital technology (e.g., cell
phones, computers, tablets).
Drinking & Driving
Of Michigan youth, females were more likely to ride with a drinking driver, while
males were more likely to drive after drinking (data not shown)
Driving After Drinking in the
previous 30 days:
 23% of current drinkers
reported driving after drinking.
 11% of current drinkers
reported driving after drinking
one time.
 7% drove two to three times
after drinking.
Riding with a Drinking Driver in the previous 30 days:
 46% of current drinkers rode with a driver that had been drinking compared
to 13% of nondrinkers.
 16% of current drinkers rode with a drinking driver one time. 19% rode two to
three times and 11% rode four or more times.
 6% of nondrinkers rode with a drinking driver one time. 4% rode two to three
times and 3% rode four or more times.

SUBSTANCE ABUSE
Substance abuse is defined as the continued usage of drugs or alcohol to the
extent that it results in significant impairment including interference with one's
work, home, social relationships, or health in the previous 12 months. The
nonmedical use of prescription type-drugs, defined by the usage of drugs without
a prescription or only for the intention of experiencing the drug's effect, has
increased dramatically across the nation. The effects of substance abuse are far-
reaching, extending beyond individuals to families and society. Therefore, there is
an urgency to monitor the burden of substance and prescription drug abuse in
Michigan.
The Bureau of Disease Control, Preven-
tion, and Epidemiology monitors the
abuse of illegal, prescription and over-
the-counter drugs to support agencies
and communities in their actions to
reduce the burden associated with
drugs and other substances in
Michigan and improve the overall
quality of life of Michigan's residents.
Because there is large overlap between
substance abuse and mental health,
the Bureau of Disease Control,
Prevention, and Epidemiology is also
interested in monitoring the co-
occurrence of these public health
issues.
Unintentional Drug Poisoning Deaths in Michigan
In 2010, there were 973 deaths due to unintentional drug poisonings in Michigan.
Of these deaths, 22.7% involved opioid analgesics. Opioid analgesics are narcotic
drugs that are usually prescribed to relieve pain (ex. oxycodone, hydrocodone,
methadone).
From 1999-2010:
 The total number of unintentional poisoning deaths rose from 235 to 973.
 Poisoning deaths involving opioid analgesics increased by 8.3 fold, more
rapidly than those from any other drug.
 The number of prescriptions filled in Michigan for opioid analgesics also
increased substantially over this time period.

Opioid-Related Hospitalizations in Michigan, 2000-2011
The number of hospitalizations involving opioids increased 120 percent between
2000 and 2011, from 9,157 to 20,191 hospitalizations, respectively.
From 2000-2011:
 The rate of hospitalizations involving opioids rose from 9.2 to 20.4 per 10,000
population.
 The rate of hospitalizations involving cocaine peaked in 2006 with a rate of
19.7 per 10,000 population, decreasing to a rate of 13.7 per 10,000
population in 2011.

 The rate of hospitalizations involving amphetamines and/or psychostimulants
remained stable during this time period.
What can be done to reduce opioid-related hospitalizations?
Individuals
 Use prescription painkillers only as directed by a health care provider.
 Never sell or share unused medications with others.
Health Care Providers
 Prescribe painkillers only for the expected length of pain.
 Screen patients for potential substance abuse problems.
State of Michigan
 Use the Michigan Automated Prescription
 System to identify improper prescribing of painkillers.
 Increase access to substance abuse treatment.
Depressive Feelings & Illicit Drug
Use Among Michigan Youth
When youth have both substance abuse problems and mental illnesses such as
depression, they are at increased risk for poor parental and friend relationships,
school dropout, suicide, and homelessness.
In 2009 (data not shown):
 15.2% of Michigan youth reported depressive feelings over the last year and
illicit drug use at some point during their lifetime.
 9.4% of Michigan youth reported depressive feelings over the last year and
illicit drug use in the past 30 days.

Youth with depressive feelings were 1.5 times more likely to report illicit drug
use at some point during their lifetime.
 56% of youth with depressive feelings reported using illicit drugs during their
lifetime compared to 37% of youth without depressive feelings.
Youth with depressive feelings were 2 times more likely to report illicit drug use
in the past 30 days.
 35% of youth with depressive feelings reported using illicit drugs in the past
30 days compared to 15% of youth without depressive feelings.

STATISTICS
Alcohol
60% of Michigan adults, aged 18 and older, used alcohol in the past month, while
16% of youth aged 12-17 consumed alcohol. 27% of adults and 10% of youth
binge drank in the past month (1). Excessive alcohol use is the 3rd leading
lifestyle-related cause of death for people in the United States each year. From
2001-2005, there were approximately 79,000 deaths annually attributable to
excessive alcohol use in the United States.
In 2008, there were approximately 190,000 emergency rooms visits by persons
under age 21 for injuries and other conditions linked to alcohol in the United
States.
Substance Abuse
According to data from the National Survey on Drug Use and Health (NSDUH)
from 2010-2011, 10.7% of Michigan residents aged 12 years and older reported
using illicit drugs in the past month. When marijuana was excluded, the estimated
dropped to 3.6%.
In 2008, poisoning surpassed motor vehicle crashes to become the leading cause
of injury death in the United States. Since 2003, over 90% of all poisonings have
involved drugs, with the largest increase in poisonings related to opioid analgesics
(pain relievers). A similar national pattern has also been seen in Michigan with
poisonings exceeding motor vehicle crashes to become the leading cause of injury
death in Michigan in 2009.
Drug Withdrawal in Newborns
The number of U.S. newborns diagnosed with symptoms of drug withdrawal
nearly tripled in 10 years due to increasing opiate use among pregnant women.
These newborns with Neonatal Withdrawal Syndrome (NWS, also know as
Neonatal Abstinence Syndrome, NAS) are more likely to have trouble breathing,
low birth weight, feeding difficulties and seizures. A recent study by MDHHS
documents this problem in Michigan and highlights the increased costs due to
their longer hospital stays.

Neonatal Drug Withdrawal among Michigan Infants
 When mothers use illicit or prescription drugs during the pregnancy, infants
can present with drug withdrawal symptoms after birth, called neonatal
withdrawal syndrome (NWS).
 The risk for NWS is greatest when the mother uses prescription pain relievers
known as opioids analgesics or heroin during the pregnancy.
 Between 2000 and 2009, there were a total of 1,509 infants in Michigan
hospitalized with a diagnosis of NWS*.

USE OF SYNTHETIC MARIJUANA
(KNOWN AS "SPICE"/"K2")
Since the increase in popularity of synthetic marijuana in 2010, new forms of
synthetic marijuana have appeared. These substances contain ingredients that
act in the same way as THC, the active ingredient in marijuana. Legislation
making ingredients in synthetic marijuana illegal in Michigan went into effect in
October 2010; since then, synthetic cannabinoids are added to the list of
Schedule l controlled substances as discovery and investigation continues.
The Michigan Regional Poison Control Center at DMC Children's Hospital of
Michigan (PCC) monitors the number of cases called in by the general public and
health care providers due to synthetic marijuana exposure. The PCC reports the
number of cases increased between January 1, 2010 through June 2012 in
Michigan; with a total of 533 emergency department visits involving THC
homologs reported. Subsequently, the number of cases involving THC use
reported to the Poison Control Center has decreased, even as more synthetic
cannabinoids have been placed onto Schedule l.
Although there is no mandated reporting requirements, PCC conducts ongoing
surveillance. Hospitals are encouraged to report cases even if advice is not
needed, as PCC is an agent of MDCH for designer drugs. The PCC encourages
hospitals to contact them by calling 1-800-222-1222.
Emergency department visits using cathinones, or "bath salts," became
increasingly prevalent in 2010 and 2011. These "bath salts" are part of the
substituted phenethylamine class of chemicals, of which several others are also
emerging. Such phenethylamines include MDMA, MDA, and other hallucinogenic
amphetamines. From January 2012 through March 2013, 70 emergency
department visits involved substituted phenethylamines.
A complete report of Michigan cases between November 2010 and March 2011
was published in the Centers for Disease Control and Prevention (CDC) Morbidity
and Mortality Weely Report (MMWR).

MEASURING THE BURDEN OF EXCESSIVE ALCOHOL
CONSUMPTION AMONG MICHIGAN RESIDENTS: ALCOHOL-
ATTRIBUTABLE HOSPITALIZATIONS, 2001-2010
Background
 Excessive alcohol consumption is associated with multiple adverse health and
social consequences, including liver cirrhosis, certain cancers, unintentional
injuries, violence, and fetal alcohol spectrum disorder.
 In 2006, 4.4 million U.S. outpatient visits were attributable to excessive
drinking and alcohol-attributable hospitalizations cost $5.1 million dollars.
 This is the first comprehensive analysis and summary of hospitalizations for a
wide variety of conditions attributable to alcohol among Michigan residents.
Methods
Data were obtained from the Michigan Inpatient Database.
 A case was defined as:
 Michigan resident
 Admitted to one of Michigan’s 142 acute care hospitals
 Discharged between 1/1/2001-12/31/2010
 Primary diagnosis = alcohol-attributable condition (Table 1)
 Prevalence of alcohol-attributable hospitalizations by patient demographics,
source of admission, discharge disposition, insurance type and total hospital
charges were generated.
 Characteristics of alcohol-attributable hospitalizations were compared to all
other hospitalizations using. Pearson’s chi-square tests. Differences were
statistically significant when p<0.05.
Table 1. Alcohol-attributable conditions and corresponding ICD-9-CM codes
Alcohol-Attributable Condition ICD-9-CM Code
Alcohol psychoses 291.0-291.5, 291.81, 291.89, 291.9
Acute alcohol intoxication 303.00-303.03, 303.90- 303.93
Alcohol abuse 305.00-305.03
Alcoholic polyneuropathy 357.5
Alcoholic cardiomyopathy 425.5
Alcoholic gastritis 535.30, 535.31
Alcoholic liver diseases 571.0-571.3
Fetal alcohol syndrome 760.71
Excessive blood level of alcohol 790.3
Toxic effect of ethyl alcohol 980
Accidental poisoning by alcoholic beverages E860.0, E860.1

Results
Figure 1. Alcohol-attributable (A-A) and non alcohol-attributable (Non A-A)
hospitalization rates among Michigan residents, by age and sex, 2001-2010

Conclusions
For alcohol-attributable hospitalizations:
• The high proportion of admission via emergency department may be an
indication that these patients lack primary and/or managed care. Previous
research has concluded that these conditions are often more progressed and
more expensive to treat.
• Individuals are more likely to leave without a discharge plan, suggesting
limited follow-up opportunities and resources for medical interventions and
treatment.
• Self-payment implies a lack of health insurance coverage and these individuals
represent an at-risk population that is less likely to have access to and afford
healthcare resources and more likely to delay seeking treatment.
Limitations:
• The true burden of alcohol on Michigan’s health care system is not captured
because alcohol-attributable emergency department data are currently not
available; this analysis was limited to primary diagnoses and treatment data
were excluded.
• These data may understate the incidence of alcoholattributable
hospitalizations due to the perceived stigma related to these diagnoses and
incomplete identification of these conditions.
Recommendations:
• Extend screening and behavioral counseling interventions beyond primary
care settings to all hospitalized individuals.
• Implement Community Guide recommendations which may reduce excessive
alcohol consumption and related harms, including hospitalizations.

Substance abuse in Michigan

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