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II. Substance Abuse in Maine
Extent of Alcohol and Other Drug Use in Maine
Broad Impact of Alcoholism
Alcohol is so pervasive that we need to rebuild society. Observation from Biddeford Study Circle.11
It’s everywhere. It’s in all of these subtle things. It’s in child neglect, it’s in child abuse, it’s in domestic violence, it’s in depression, it’s in thought disorders, it’s in people who are losing their jobs. It’s in people who can’t keep their marriages, it’s in people who are in legal trouble. It’s in sexual predators. Dr. George L. Higgins, III, Chief of Emergency Medicine, Maine Medical Center12
Alcohol is the unreported story in homicides and accidental deaths in Maine. If, on a daily basis, we put several people in a plane and crashed them into a mountainside because the pilot was drunk, there’d be an outrage. We’d hop right on that problem. But because alcohol-related deaths are spread out geographically and chronologically, we don’t grasp the full dimension of it. We see the boating accident, the car crash, the bitter spouse, the shooting incident, but we miss the booze...It’s hard for us to grasp the fact that something we all do on a regular basis can kill people and cause so much destruction. Administrator of Emergency Trauma Services, Eastern Maine Medical Center.13
This is a major public health crisis for this state. It’s an absolute scourge, a crisis. Dr. David Stuchiner, Director of Emergency Medicine, Central Maine Medical Center.14
The annual cost of substance abuse in Maine is estimated to be $1.2+ billion—$916 for every man, woman, and child in Maine.15 This hidden “tax” on the people of Maine is two-thirds the size of the State’s annual budget. This does not begin to account for the suffering and burden on those whose well-being is affected directly or indirectly by substance abuse. In “The Deadliest Drug: Maineís Addiction to Alcohol,” The Portland Newspapers made the case for the general public that alcohol abuse contributes to every social problem (e.g. unemployment, family violence, crimes against people and property, fires, poor health, and suicide.)
Substance Abuse by Adults
OSA’s 1997 Alcohol and Other Drugs Household Estimates Study estimates that there are 647,000 adults in Maine who use alcohol over the course of a year, including approximately 88,000 heavy alcohol users.16 Among pregnant women, it is estimated that 5.7% are heavy alcohol users, while two-thirds report some alcohol use.
Marijuana is the most commonly used illicit drug, used by an estimated 94,757 adults. Maine has a higher rate of marijuana use among adults age 18-24, when compared to the rates in the Northeast and the nation. There is a low prevalence of other illicit drug use in Maine, though this is increasing. However, it is likely that this is under-estimated (crack/cocaine and heroin users are not likely to participate in a telephone survey.)17
Substance Abuse by Youth
Aimee drank "obsessively" by age 10, but she began drinking much earlier. Her childhood slipped away in a downward spiral of blackouts and drunken driving.18
Throughout Maine, alcohol and other drugs are used by children and youth at an alarming rate. Substance abuse begins at an early age. In 1997, high school students in Maine reported that 29% had their first drink before age thirteen, 30% had smoked before age thirteen, and 12% had used marijuana before age thirteen. They also reported that19:
Information about the use of alcohol, marijuana, and cigarettes by Maine’s 8th, 10th, and 12th grade students indicates that they exceed most regional and national rates.20 For example, in 1995-96:
Increases in the rate of youth suicide have been sufficiently alarming that in 1997 Governor King commissioned a task force to study the problem. Adolescents who had attempted suicide unsuccessfully said alcohol and drug use were one of the significant factors contributing to suicide, which is the second leading cause of death of 15 to 24-year olds and the third leading cause of death for 10 to 14-year olds in Maine.
Characteristics of Maine People Receiving OSA Services
OSA gathers information about people served by the agencies it funds (including all substance abuse clients of those agencies whether or not they are supported by OSA funds), people receiving treatment as the result of an Operating-Under-the-Influence conviction, people receiving Medicaid-funded substance abuse services, and people receiving methadone treatment. The OSA data system does not include information from non-Medicaid private practices or from major hospitals (for example, Jackson Brook Institute, Maine Medical Center—other than data about methadone detoxification, and St. Mary’s.)
During fiscal year 1997, the total, unduplicated number of Maine people receiving substance abuse services from OSA was 10,607, including 6% (634) who were admitted as “affected others”. While 52% of the State's population is female21, women accounted for 26.6% of people entering treatment.
Of the people entering treatment, 80.2% reported alcohol as the primary drug abused, 44% reported a secondary drug problem, and 16.8% reported a problem with a third drug. Marijuana/hashish was the primary drug of choice for 13.4% of those admitted to treatment other than emergency shelter/detoxification and for 4.0% of those admitted for detoxification/ emergency shelter.
The average age was 35.2 for persons reporting alcohol or a drug other than alcohol as a primary problem. Of the people entering treatment, 77.7% reported using alcohol before age eighteen, 10.1% were youth under the age of 20, and 34.8% completed less than 12th grade. Over 40% of Maine people receive at least some college education22, compared with only 19.6% of people entering treatment.
At the time of admission, 29.4% of the people were unemployed, of whom 12.9% were not looking for employment. Others described themselves as not in the labor force (34.6%) or being unable to work or get work for physical or psychological reasons (25%). Others described themselves as homemakers (4.3%), students (7.3%), retired (1.2%), and incarcerated (5.4%).
Of the people reporting household incomes, 43% had a yearly income of $7,992 or less. This is less than half the 1995 estimated average per capita income for Maine of $20,105. Of people reporting household incomes, 11.7% reported welfare (Food Stamps, Temporary Assistance for Needy Families, town welfare) as their primary source of income and 12.7% reported Supplemental Security Income and Social Security Disability Income as their primary source.
Six out of ten people (60.2%) were involved in the legal system (probation, awaiting trial, incarcerated, driving under the influence). During the 12 months prior to admission, 67.5% were arrested at least once; 37.6% were arrested for substance abuse related offenses; and 44.8% were arrested for Operating-Under-the-Influence.
Of those admitted to detoxification/emergency shelters, 30.9% had a concurrent psychiatric problem, compared with 26.1% of those admitted to other services. During the 12 months prior to admission, 40.1% were treated in a hospital emergency room at least once and 11.8% were treated in a psychiatric hospital. Of those admitted, 65% had a prior treatment episode.
Of those admitted to detoxification/emergency shelter, 57.9% reported self referral to treatment and 11.4% reported being referred by the court/correctional system. For clients in all other service settings, 18.4% referred themselves to treatment; 15% were referred by the court/correctional system; 27.1% were in treatment to fulfill the requirements of the Driver Education and Evaluation Program; and 11.8% were referred by another substance abuse treatment agency.
Substance Abuse and Criminal Behavior
Relationship between Substance Abuse and Criminal Behavior
It’s the first question you ask [when investigating a homicide]: ‘Anyone been drinking?’ The likelihood alcohol is going to be involved is the general rule....Alcohol is the thing that breaks down the last barrier. The drunk knows he’s about to shoot a person, not a pumpkin, but what they lack is a sense of judgment, reason. They lack the ability to say to themselves, ‘You’re about to do something really stupid and life-changing.’ William Stokes, Maine Department of Attorney General23
I’d estimate that 75 to 85 % of all our cases have an overlay of alcohol abuse. Michael Cantara, York County District Attorney24
Alcohol [is] present in 90% of the cases we handle. Everybody worries about street drugs, yet alcohol is the biggest problem we face in this state. It’s rare that the victim, defendant, or both aren’t drinking. Meg Elam, Cumberland County Deputy District Attorney25
Studies have documented the relationship between criminal behavior and substance abuse among both juvenile and adult offenders.26 This also has been observed by professionals involved in the criminal justice system.
Substance Abuse by Juvenile Offenders
Many of Maine's juvenile offenders are substance abusers and need substance abuse treatment. Research has shown that the correlation for criminal conduct and substance abuse ranges from .45 to .60 for adolescents.27
Both nationally and in Maine, studies report that marijuana and alcohol are the most frequently used substances by juvenile offenders.28 Studies also have shown that the cost savings for providing substance abuse treatment to juvenile offenders can be significant compared to the costs of incarceration (up to 16 to 1 in financial savings alone).
OSA provides substance abuse screening and comprehensive assessment for all adolescents committed to the Maine Youth Center. Based on eight years of statistics, the data has shown that substance abuse is clearly a dominant problem for juvenile offenders at the Center:
Over the past two years, OSA has screened 1,300 offenders referred by Department of Corrections caseworkers and substance abuse treatment providers. Of the juvenile offenders screened, 72% required further substance abuse intervention; yet, during this same time period, only about 20% of all adolescent offenders were referred for screening.
Statistics show that juvenile offenders have more severe substance abuse problems and require greater amounts of treatment than non-offending adolescents. Between July 1, 1996 and June 30, 1997, substance abuse treatment providers reported on 962 adolescents (338 adolescents were in the juvenile justice system and 624 were not) who received treatment. In every category, juvenile offenders faired worse than their non-offending peers:
Substance Abuse by Adult Offenders
An estimated 68% of Maine’s incarcerated adult offenders will require intervention strategies for substance abuse, with 6% of the inmates likely to be assessed as the most severely addicted. Eighty-seven percent of crimes committed by the most severely addicted inmates are substance abuse related. Fewer than 8% of Maine's state prison population needing substance abuse treatment is receiving such treatment. Yet, studies in California, Illinois, and Missouri have shown that criminal activity of adult offenders is reduced after substance abuse treatment.29
National statistics indicate that 3.5 million adults were sentenced to probation in 1996, 50% of whom previously had been on probation and 30% had served at least one prior period of incarceration. Of the felony population, 31% were convicted of a drug offense. Of adults on probation, 41% were ordered to participate in drug or alcohol treatment as a condition of probation, 38% had orders requiring use of mandated drug testing, and 37% received treatment which included crisis/emergency care, self help groups, counseling, outpatient and inpatient care.
A special report on adult probationers, prepared by the Bureau of Justice Assistance in 1995, revealed that an estimated 47% were under the influence of drugs or alcohol at the time of their offenses. The chart below categorizes the offenses and the type of substance used.
Substance Abuse by Adult Probationers at Time of Offenses
| Offense | Alcohol |
Drugs |
Alcohol/Drugs |
|---|---|---|---|
| Sexual Assault | 31.8% |
10.9% |
33.0% |
| Assault | 45.5% |
9.3% |
47.5% |
| Burglary | 38.5% |
23.3% |
49.4% |
| Larceny/Theft | 16.3% |
9.6% |
20.8% |
| Fraud | 9.7% |
8.2% |
13.3% |
| Drug Possession | 14.4% |
26.6% |
33.5% |
| Trafficking | 16.2% |
36.6% |
42.2% |
Overview of Substance Abuse Services in Maine
OSA Funding and Services
The State collects $64 million in annual taxes from alcohol, but spends only $7.4 million on OSA’s budget. In 1997, OSA spent $14.3 million in state and federal dollars. State dollars included $742,438 for the Driver Education and Evaluation Program; $5.62 million for prevention, intervention, and treatment services; and $780,000 in Medicaid matching funds. Federal dollars included $4.39 million in substance abuse block grant funding, $1.78 million in Safe and Drug Free Schools and Communities Act (SDFSCA) funding, and $886,184 in other federal categorical funding. OSA also received $137,148 from other sources.
Funding Streams
There are at least 19 funding streams which pay for substance abuse services and prevention activities in Maine, only some of which flow through OSA. At least 15 federal funding streams flow from seven federal agencies (U.S. Departments of Health and Human Services, Education, Housing and Urban Development, Justice, Transportation, and Veterans Affairs, as well as the National Guard.) Maine’s major funding stream—the General Fund—flows through several state departments that are involved in substance abuse prevention and treatment activities (Departments of Mental Health, Mental Retardation and Substance Abuse Services; Human Services; Education; Corrections; and Inland Fisheries and Wildlife, as well as the Maine Arts Commission.) Maine has a major new source of funding—the excise tax on tobacco—that is available for school and community prevention activities. Finally, there are unknown amounts of county, municipal, and private funds that support substance abuse services and prevention activities in Maine.
Coordination
A great deal of coordination exists among agencies involved with substance abuse services. One example of coordination is pooled funding. Maine began pooling funding for substance abuse prevention projects in 1995 when funds from the Substance Abuse Prevention Block Grant, SDFSCA Governor’s Portion, and Title V of the Juvenile Justice and Delinquency Prevention Act were distributed through a collaborative request for proposals (RFP) process coordinated by OSA. In 1996, there was a second round of pooled funding, which also included the Maine Arts Commission. Forty-two programs throughout Maine have received funding for primary prevention projects through this integrated RFP process.
Another example of coordination is the Dirigo Prevention Coalition, a coalition of eight partners and twenty Executive Committee members representing diverse perspectives. Funded by a federal grant from the Center for Substance Abuse Prevention, Dirigo was created to better coordinate substance abuse prevention efforts and to make accessible what already exists. The partners include OSA, Communities for Children, the Bureau of Health, the Juvenile Justice Advisory Group, the Maine Arts Commission, the Maine State Health Education Coalition, the Maine Commission on Community Service, and the National Guard.
There also are a number of other cooperative efforts between agencies, including the following: