mohave county needs assessment

 MOHAVE COUNTY NEEDS ASSESSMENT 31 DECEMBER 2010 Prepared By MSTEPP Mohave Substance Treatment, Education and Prevention Partnership 1660 Lakeside Drive #388 Bullhead City, Arizona 86442‐6544 e‐mail: [email protected] website: http://www.mstepp.com This document may be copied and transmitted freely. No deletions, additions or alterations of contents are permitted without the expressed, written consent of MSTEPP. Table of Contents Acknowledgements ………………………………………………………………………………………………. Sponsors & Supporters ……….………………………………………………………………………………… 2010 MSTEPP Board of Directors ………………………………………………………………………….. Forward by Sheriff Tom Sheahan ………………………………………………………………………….. Executive Summary ………………………………………………………………………………………………. 1.0 Introduction………………………………………………………………………………………………… 1.1 Mohave County Characteristic s and Demographics ..………………………. 1.2 Closing Remarks ……………………………………………………………………………… 2.0 Law Enforcement ……………………………………………………………………………………….. 2.1 Bullhead City Police Department …………………………………………………….. 2.2 Lake Havasu City Police Department ……………………………………………….. 2.3 Kingman Police Department ……………………………………………………………. 2.4 MAGNET ………………………………………………………………………………………….. 2.5 Hualapai Nation Police Department …………………………………………………. 2.6 Fort Mojave Tribe Police Department ………………………………………………. 2.7 Mohave County Sheriff’s Office ………………………………………………………… 2.8 Crime in Arizona Report (2006, 2007, 2008, 2009) ……………………………. 2.9 Arizona Motor Vehicle Crash Facts (2006, 2007, 2008) …………………….. 2.10 Closing Remarks ……………………………………………………………………………….. 3.0 Courts, Child Welfare and Probation ……………………………………………………………. 3.1 Courts ………………………………………………………………………………………………. 3.2 Arizona Criminal Justice Commission ……………………………………………….. 3.3 Mohave County Child Dependency Statistics ……………………………………. 3.4 Child Welfare Reports (Oct 2005 – Sep 2009) …………………………………… 3.5 Probation …………………………………………………………………………………………. 3.6 Closing Remarks ……………………………………………………………………………….. 4.0 Mohave County Treatment Services and Substance Abuse Surveys ………………. 4.1 SAMHSA ……………………………………………………………………………………………. 4.1.1 NSDUH ………………………………………………………………………………….. 4.1.2 N‐SSATS …………………………………………………………………………………. 4.2 Arizona Families F.I.R.S.T. ………………………………………………………………….. 4.3 Arizona Dept of Health Services – Division of Behavioral Health Services (ADHS DBHS) ……………………………………………………………… 4.3.1 Performance Audit, Substance Abuse Treatment Programs, Report No. 09‐07, July 2009…………………………………………………….. 4.3.2 Annual Report of Substance Abuse Treatment Programs, i iii iii v 1 2 2 6 7 8 11 16 23 26 27 29 33 35 36 38 38 43 45 49 53 55 57 57 58 69 80 82 82 State Fiscal Years 2009 and 2010 …………………………………………….. 4.3.3 Substance Abuse Treatment Capacity Report, April 2008 ………. 4.4 Substance Abuse Prevention and Treatment Block Grant (SAPT) ………. 4.5 Arizona Substance Abuse Epidemiology Profile …………………………………. 4.5.1 Tobacco …………………………………………………………………………………. 4.5.2 Alcohol …………………………………………………………………………………… 4.5.3 Illicit Drugs ……………………………………………………………………………… 4.5.4 Substance Abuse in Critical Populations …………………………………. 4.6 Mohave County Treatment Services …………………………………………………. 4.6.1 Mohave Mental Health Clinic (MMHC) …………………………………… 4.6.2 Treatment Assessment Screening Center (TASC) ……………………. 4.6.3 Hospital Discharge Data …………………………………………………………. 4.6.4 Fort Mojave Tribe Behavioral Health ……………………………………… 4.6.5 Mohave County Tobacco Use Prevention Program ………………… 4.7 Closing Remarks ……………………………………………………………………………….. Discussion and Recommendations ……………………………………………………………….. 5.1 Discussion …………………………………………………………………………………………. 5.2 Recommendations ……………………………………………………………………………. Bibliography …………………………………………………………………………………………………. 5.0 6.0 83 86 89 92 92 93 93 94 94 94 95 96 97 100 106 109 109 112 113 List of Appendices A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Monthly AHCCCS Enrollment by County Bullhead City Police Department Statistics Lake Havasu City Police Department Statistics Mohave County Sheriff’s Office Data Mohave County Courts Data Mohave County Dependency Statistics N‐SSATS Data Sets Letters from Arizona Department of Health Services TASC Drug Test Results Kingman Needs Assessment Bullhead City Needs Assessment Lake Havasu City Needs Assessment List of Tables Chapter One 1‐1
2008 Projected Populations in Mohave County …………………………………………… 2 1‐2
Arizona Commerce Population Projections …………………………………………………. 1‐3
Ethnic Break Down, 2009 …………………………………………………………………………….. 1‐4
Arizona Median Household Income by County ……………………………………………. 1‐5
Arizona Persons Below Poverty Level by County ………………………………………….. 1‐6
AHCCCS Enrollment by County …………………………………………………………………….. Chapter Two 2‐1 Bullhead City Police Arrests …………………………………………………………………………. 2‐2 Bullhead City Drug Arrests by Drug Type ……………………………………………………… 2‐3 UCR Drug Related Arrests – Lake Havasu City Police Dept ……………………………. 2‐4 Lake Havasu City UCR Drug Arrests by Drug Type ………………………………………… 2‐5 Lake Havasu City Police Department Drug Arrest Charges …………………………… 2‐6 Lake Havasu City Police Department DUI Charges ……………………………………….. 2‐7 Kingman Police Department Calls for Service ………………………………………………. 2‐8 Kingman School Resource Officer Activity ……………………………………………………. 2‐9 Kingman Flex Squad Drug Arrests ………………………………………………………………… 2‐10 Kingman Flex Squad Drug Seizures ………………………………………………………………. 2‐11 Kingman Police Department UCR Drug Arrests …………………………………………….. 2‐12 KPD UCR Drug Arrests by Drug Type (Adult & Juvenile) ………………………………… 2‐13 MAGNET Drug Related Arrests ……………………………………………………………………. 2‐14 MAGNET Drug Seizures ……………………………………………………………………………….. 2‐15 Hualapai Law Enforcement Drug Related Incidents ……………………………………… 2‐16 Fort Mojave Tribe Drug Related Charges ……………………………………………………… 2‐17 Mohave County Jail Drug Related Bookings by Agency (not including MCSO).. 2‐18 Drug Related Bookings as a Percentage of Total Jail Bookings ………………………. 2‐19 Arrests per 10,000 Residents – Synthetic Narcotics (includes meth) …………….. 2‐20 Arrests per 10,000 Residents – Other Dangerous Drugs ……………………………….. 2‐21 Arrests per 10,000 Residents – Marijuana ……………………………………………………. 2‐22 Arrests per 10,000 Residents – Opium Cocaine, Derivatives …………………………. 2‐23 2006 Alcohol Related Crashes ………………………………………………………………………. 2‐24 2007 Alcohol Related Crashes ………………………………………………………………………. 2‐25 2008 Alcohol Related Crashes ………………………………………………………………………. 2‐26 Percentage of Drug Related Crashes ……………………………………………………………... Chapter Three 3‐1 Drug Cases Filed in Municipal Courts ……………………………………………………………… 3‐2 Drug Cases Filed in Justice Courts ………………………………………………………………….. 3‐3 Drug Cases Filed in Superior Court …………………………………………………………………. 3 4 4 5 6 9 10 11 13 14 16 16 18 19 19 20 22 24 25 26 27 29 30 33 34 34 35 35 35 36 36 40 40 41 3‐4 Guilty Drug Convictions in Municipal Courts …………………………………………………... 3‐5 Guilty Drug Convictions in Justice Courts ……………………………………………………….. 3‐6 Guilty Drug Convictions in Superior Court ……………………………………………………… 3‐7 Drug Cases per 1000 Residents ……………………………………………………………………… 3‐8 Conviction by Drug Type in Mohave County ………………………………………………….. 3‐9 Mohave County Dependency Statistics ………………………………………………………….. 3‐10 Child Welfare Reports per 10,000 County Residents ……………………………………… 3‐11 Investigations per 10,000 County Residents ………………………………………………….. 3‐12 Children in Voluntary Out‐of‐Home Placement per 10,000 County Residents… 3‐13 Mohave County Probation Drug Test Results ………………………………………………… Chapter Four 4‐1 Illicit Drug Use in Past Month, Ages 12‐17 …………………………………………………….. 4‐2 Illicit Drug Use Other Than Marijuana in Past Month, Ages 12‐17 ………………….. 4‐3 Cocaine Use in Past Year, Ages 12‐17 …………………………………………………………….. 4‐4 Nonmedical Use of Pain Relievers in Past Year, Ages 12‐17 ……………………………. 4‐5 Marijuana Use in Past Month, Ages 12‐17 ……………………………………………………… 4‐6 Perceptions of Risk of Substance Use in Rural North, Ages 12‐17 …………………… 4‐7 Dependence On or Abuse of Illicit Drugs or Alcohol in Past Year, Ages 12‐17 …. 4‐8 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year, Ages 12‐17 …………………………………………………………………………………………………….. 4‐9 Illicit Drug Use Other Than Marijuana in Past Month, Ages 18‐25 ………………… 4‐10 Nonmedical Use of Pain Relievers in Past Year, Ages 18‐25 …………………………. 4‐11 Alcohol Dependence in Past Year, Ages 18‐25 ……………………………………………… 4‐12 Illicit Drug Dependence or Abuse in Past Year, Ages 18‐25 …………………………… 4‐13 Needing But Not Receiving Treatment for Alcohol Use in Past Year, Ages 18‐25 ……………………………………………………………………………………………………. 4‐14 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year, Ages 18‐25 ……………………………………………………………………………………………………. 4‐15 Cocaine Use in Past Year, Ages 18‐25 …………………………………………………………… 4‐16 Illicit Drug Dependence in Past Year, Ages 18‐25 ………………………………………….. 4‐17 Alcohol Dependence in Past Year, Ages 18‐25 ………………………………………………. 4‐18 Perceptions of Risk of Substance Use, Ages 18‐25 …………………………………………. 4‐19 Illicit Drug Use in Past Month, Ages 26 or Older …………………………………………….. 4‐20 Illicit Drug Use Other Than Marijuana in Past Month, Ages 26 or Older …………. 4‐21 Cocaine Use in Past Year, Ages 26 or Older ……………………………………………………. 4‐22 Nonmedical Use of Pain Relievers in Past Year, Ages 26 or Older …………………… 4‐23 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year, 42 42 43 44 45 46 50 51 52 54 60 60 60 61 61 61 62 62 63 63 63 63 64 64 64 65 65 65 66 66 66 66 4‐24 4‐25 4‐26 4‐27 4‐28 4‐29 4‐30 4‐31 4‐32 4‐33 4‐34 4‐35 4‐36 4‐37 4‐38 4‐39 4‐40 4‐41 4‐42 4‐43 4‐44 4‐45 4‐46 4‐47 4‐48 4‐49 4‐50 Ages 26 or Older ……………………………………………………………………………………………. Alcohol Dependence or Abuse in Past Year, Ages 26 or Older ……………………….. Dependence On or Abuse of Illicit Drugs or Alcohol in Past Year, Ages 26 or Older …………………………………………………………………………………………………………….. Needing But Not Receiving Treatment for Alcohol Use in Past Year, Ages 26 or Older ………………………………………………………………………………………………………… Perceptions of Risk of Substance Use, Ages 26 or Older ……………………………….. 2009 Clients in Outpatient Treatment Services …………………………………………….. 2008 Clients in Outpatient Treatment Services …………………………………………….. 2007 Clients in Outpatient Treatment Services …………………………………………….. 2006 Clients in Outpatient Treatment Services …………………………………………….. 2009 Clients in Inpatient Treatment Services ……………………………………………….. 2008 Clients in Inpatient Treatment Services ……………………………………………….. 2007 Clients in Inpatient Treatment Services ……………………………………………….. 2006 Clients in Inpatient Treatment Services ……………………………………………….. Utilization Rate of Designated Substance Abuse Treatment Beds ………………… Mohave County Referrals to AFF …………………………………………………………………. Number of Referrals to AFF Program …………………………………………………………… Number of Referrals to AFF Program Per 1000 Residents …………………………….. 2008 Substance Abuse Treatment Enrollees ………………………………………………… 2009 Substance Abuse Treatment Enrollees ………………………………………………… 2009 Involuntary Substance Abuse Participants ………………………………………….... Statewide Availability of Adult Substance Abuse Treatment Service Providers By Type and GSA, March 2008 ……………………………………………………………………….. Statewide Availability of Adult Substance Abuse Treatment Service Providers By Type and GSA per 100,000 Adults, March 2008 …………………………………………. TASC Client Drug Test Results …………………………………………………………………………. Admissions Due To Alcohol or Drug Related Disorders …………………………………… Substance Abused by Adults ………………………………………………………………………….. Substance Abuse by Juveniles ………………………………………………………………………… Type of Treatment for Adults …………………………………………………………………………. Type o Treatment for Juveniles ………………………………………………………………………. 67 67 67 68 68 70 71 72 73 75 76 77 78 79 80 81 81 84 84 85 87 88 96 97 98 99 99 100 List of Figures Chapter Two 2‐1 2‐2 Bullhead City Drug Arrests as a Percentage of Total Criminal Arrests ……………… Bullhead City Percentage of Drug Arrests by Category ……………………………………. 9 10 2‐3 Bullhead City Police Department DUI Arrests …………………………………………………. 2‐4 Lake Havasu City UCR Drug Related Juvenile Arrests ………………………………………. 2‐5 Lake Havasu City UCR Drug Related Adult Arrests ………………………………………….. 2‐6 Lake Havasu City Percentage of UCR Drug Arrests by Drug …………………………….. 2‐7 Lake Havasu Police Department Juvenile Drug Related Charges …………………….. 2‐8 Lake Havasu Police Department Adult Drug Related Charges …………………………. 2‐9 Lake Havasu City Police Department DUI Charges …………………………………………... 2‐10 Kingman Police Department Drug Related Calls for Service …………………………….. 2‐11 Kingman Police Department Calls for Service ………………………………………………….. 2‐12 Kingman SRO Drug Related Arrests …………………………………………………………………. 2‐13 Kingman Police Department % Drug Arrests/Total Arrests ……………………………… 2‐14 Kingman Flex Squad Drug Seizures ………………………………………………………………….. 2‐15 KPD UCR Drug Arrests ……………………………………………………………………………………… 2‐16 KPD UCR Drug Arrests by Gender ……………………………………………………………………. 2‐17 Percentage UCR Drug Arrests by Drug Type (Adult & Juvenile) ……………………….. 2‐18 Kingman Police Department DUI Calls for Service …………………………………………… 2‐19 MAGNET Drug Related Arrests ……………………………………………………………………….. 2‐20 Arizona County Comparison – Meth Seizures (grams) …………………………………….. 2‐21 Arizona County Comparison – 2009 Meth Seizures (grams) …………………………… 2‐22 Hualapai Law Enforcement Drug Related Incidents ……………………………………….. 2‐23 Fort Mojave Tribe Drug Related Charges ……………………………………………………….. 2‐24 Fort Mojave Drug Arrests by Gender and Age ……………………………………………….. 2‐25 Mohave County Jail Drug Related Bookings …………………………………………………… 2‐26 MCSO Drug Related Arrests …………………………………………………………………………… 2‐27 MCSO Adult Percentage of Drug Arrests ………………………………………………………… 2‐28 Mohave County Sheriff Juvenile Percentage of Drug Arrests ………………………….. 2‐29 Mohave County Sheriff’s Department DUI Jail Bookings ………………………………… Chapter Three 3‐1 Drug Cases Filed in Mohave County Court System …………………………………………. 3‐2 Guilty Drug Convictions in Mohave County ……………………………………………………. 3‐3 Guilty Drug Convictions in Justice Courts ……………………………………………………….. 3‐4 Drug Cases per 1000 Residents ………………………………………………………………………. 3‐5 Mohave County Dependency Statistics ………………………………………………………….. 3‐6 Bullhead City Dependency Statistics ………………………………………………………………. 3‐7 Lake Havasu City Dependency Statistics …………………………………………………………. 3‐8 Kingman Dependency Statistics ………………………………………………………………………. 3‐9 Child Welfare Reports Per 10,000 County Residents ……………………………………….. 11 12 12 13 14 15 15 17 17 18 19 20 21 21 22 23 24 25 26 27 28 28 30 31 31 32 32 39 41 43 44 47 48 48 49 50 3‐10 Child Welfare Investigations Per 10,000 County Residents ……………………………… 3‐11 Children in Voluntary Out‐of‐Home Placement per 10,000 County Residents …. 3‐12 Mohave County Probationers on Drug Charges ………………………………………………. 3‐13 Mohave County Probation Drug Test Results ………………………………………………….. Chapter Four 4‐1 Treatment Planning Areas within Arizona ………………………………………………………. 4‐2 Adults Receiving Substance Abuse Treatment ………………………………………………… 4‐3 Juveniles Receiving Substance Abuse Treatment …………………………………………... 4‐4 Adult Smoking Prevalence (with 95% CI) – Mohave & Maricopa County, 2000‐2008 ……………………………………………………………………………………………………… 4‐5 Adult Smoking Rates – Mohave & Maricopa County, 1997‐2008 ……………………. 4‐6 Percentage of Youth Indicating Smoking Past 30 Days …………………………………… 4‐7 Use Tobacco in Last 30 Days – 2008 Mohave County Arizona Youth Survey ….. 4‐8 Prevalence of Cigarette Smoking & Smokeless Tobacco Use …………………………. 51 52 54 55 58 97 98 101 102 103 103 105 ACKNOWLEDGMENTS This document is the result of the diligent efforts of volunteers who gave up weekends and evenings to find, collect, review and analyze raw data, read reports, create tables and figures, and write the report itself. Many people stepped forward to assist in preparing this document. MSTEPP is grateful for all who shared in this endeavor. Our respect and thanks go to Sheriff Tom Sheahan who wrote the forward for this Needs Assessment and has supported MSTEPP and its efforts to develop a residential treatment center in Mohave County since day one. He has offered assistance and advice, attended meetings, and strengthened the board of directors by appointing a Deputy Sheriff to work with MSTEPP. The value of Sheriff Sheahan’s help and encouragement cannot be overstated. Captain Scott Wright of the Kingman Police Department deserves a special note of appreciation, not only for providing valuable data and insight on the Law Enforcement chapter, but also for being the driving force in the creation of MSTEPP itself. Captain Wright, along with Kingman Police Chief Robert DeVries, was among the first to recognize the need for a county wide substance abuse coalition. It is largely through Captain Wright’s efforts, and Chief DeVries encouragement, that MSTEPP exists today. The Law Enforcement chapter assembled raw data from departments throughout Mohave County. MSTEPP is indebted to the following individuals who worked closely with us to provide the data we requested and helped verify our presentation was correct: Chief Rodney Head and Angie Abbott of Bullhead City Police Department, Jill Pellaton and Captain Carl Pederson of Lake Havasu City Police Department, Jennifer Sochocki of Kingman Police Department, Chief Francis Bradley of Hualapai Nation Police Department, Leslie DeSantis of Mohave County Sheriff’s Office, Karen Shaw of Kingman Unified School District and Collette Lewis of Fort Mojave Indian Tribe Behavioral Health. A heartfelt thanks goes to Judge John Taylor who provided critical assistance and insight in developing the Courts, Child Welfare and Probation chapter, as well as Judge Richard Weiss for his contribution to the discussion on child welfare in Mohave County. MSTEPP is also grateful to the following people who provided valuable assistance and content to this chapter: Susan Hensler, Assistant Program Manager for District IV, DES Division of Children, Youth and Families, Lorraine Back and Kyle Rimel of Mohave County Superior Court, Jon Potts of Arizona Department of Economic Security, Bridget Long from Mohave County Probation, and Nancy McBride from Mohave County’s Court Appointed Special Advocates program. The chapter on Treatment Services and Substance Abuse Surveys was substantially improved with the help of Ron French of Mohave Mental Health Clinics, Lauren Lauder of NARBHA, Susan Williams of Mohave County Tobacco Use Prevention Program, and Dr. Cathie Alderks, SAMHSA’s N‐SSATS Specialist. Their contributions to this chapter were exceptional. A number of people have our deepest appreciation for assisting with and providing valuable data for this comprehensive chapter. They include: Tom Baughman of TASC, Jamie Taylor and Erma Lorion of Kingman Regional Medical Center (KRMC), Lance Ross of Valley View Medical Center, Susan Chamberlain of Lake Havasu City Medical i Center, Collette Lewis of Fort Mojave Indian Tribe Behavioral Health, Kim Mitchell of Westcare Arizona, Shana Malone of the Arizona Criminal Justice Commission, and Tammany McDaniel of Arizona Youth Partnership. Within MSTEPP, people who made special efforts in organizing and leading the effort to prepare this document include Jon Longoria, Annie Meredith and Laura Jackson. Mohave Community College faculty member Lori Howell had the great idea of getting MCC’s chemical dependency interns, Debbie Jennings and Joshua Wyatt, involved with the report as part of their internship. The remaining MSTEPP board of directors provided the valuable role of conducting the final review of the document. ii MSTEPP Thanks Our Sponsors & Supporters! MSTEPP NEEDS ASSESSMENT SPONSORS Mr. Robert Phelps Kingman Regional Medical Center MSTEPP NEEDS ASSESSMENT SUPPORTERS Lake Havasu City Medical Center Dr. Barbara Dorf, D.C. Westcare Arizona H & H Printers, Inc. Jackson Digital Imaging Corp. Aaction Automotive Carpenters Local 897 Mohave State Bank MSTEPP 2010 BOARD OF DIRECTORS Jon Longoria, Chairperson Debby Jennings Lori Howell Annie Meredith Diane Pelzer John Slaughter Larry Tunforss Laurie DeVries Melissa Temple Kelli Truver iii iv FORWARD One of the biggest challenges a parent faces today is preventing their children from beginning a life of substance abuse. We all know, either directly or indirectly, someone who is facing these challenges. Substance abuse destroys not only the lives of the abusers, but also the lives of family members, with little hope of treatment or rehabilitation unless you are living in or near a metropolitan area where help is available. Substance abuse is generational. Over the years I have observed that parents who were involved in substance abuse in the 1980’s were also, many times, involved in acts of domestic violence. These acts occurred in the presence of their children. With little to no availability of treatment in Mohave County, this trait has been passed on to their children. Now, in 2010, those who grew up with parents as substance abusers are substance abusers themselves. Almost weekly I recognize the names of the young arrestees who are the children of those we in law enforcement arrested in the 1980’s. There will be no end to this cycle of tragedy unless residential substance abuse treatment becomes readily available in Mohave County. Many hardworking individuals are trying their best to bring the badly needed services to our county to break this cycle. Unless we move forward and finally obtain a residential treatment facility that will handle the substance abuse problem in Mohave County, the problem will most certainly get worse. This is not a problem that will disappear if ignored. In fact, the problem has been ignored too long. It is time for all of us to do what is necessary in all of our communities to make a much needed substance abuse treatment facility a reality. Within this document are the facts that tell the story. Tom Sheahan Sheriff Mohave County, Arizona 16 November 2010 v Executive Summary This document evaluates the severity of substance abuse in Mohave County and assesses the chemical dependency treatment resources available to those people who must rely on publicly funded services. An objective review of statistics, empirical data, SAMHSA surveys and relevant reports indicates Mohave County has a need for additional treatment resources; specifically, residential treatment services and detoxification services. Mohave County is the largest county in Arizona in both size and population which does not offer any type of publicly funded residential treatment or detoxification/stabilization services within the county limits. Substance abuse indicators suggest Mohave County has one of the worst substance abuse problems in the state, particularly with respect to methamphetamines. The Arizona Criminal Justice Commission reports Mohave County had more methamphetamine related arrests than any other Arizona County from 2006 to 2008. Arrest records from local law enforcement agencies indicate marijuana and methamphetamine are the two drugs most often associated with drug related arrests. The number of children in the child welfare system has increased steadily for four years with methamphetamine being the predominate drug associated with dependency cases. From 2006 through 2008, Mohave County had the highest percentage of alcohol related crashes in the state. These indicators, and many others reviewed in this report, imply there is a substantial chemical dependency problem in Mohave County. Furthermore, in light of Mohave County having the largest population in northern Arizona on AHCCCS (Arizona’s Medicare program), it is clear that the need for timely, comprehensive, publicly funded treatment services is substantial. The current availability of residential and detoxification services in Mohave County is inadequate. Using the state average utilization rate for residential treatment, at least 137 Mohave County residents are estimated to have needed publicly funded residential treatment in 2008. Due, in large part, to the lack of availability of residential beds, approximately 60 people actually received residential treatment. This disparity, which is a conservative estimate, is unacceptable. Moreover, evidence‐based treatment practices require family involvement in the recovery process. Due to the large geographic size of the county and the lower economic status of the clientele, a residential treatment program needs to be within the county to realistically expect family participation. The wait time of up to two weeks for Mohave County residents to enter a residential facility is also unacceptable. A local facility would create an environment where local clients could have timely access to a residential bed. Furthermore, with the current residential facility roughly 200 miles away from their home, many people in need of residential treatment are hesitant, or simply refuse, to enter into a facility due to the great distance from home. A facility within familiar territory, close to family and friends, would relieve people from the anxiety of travelling great distances to receive the treatment they need. Prior to entering residential treatment, all clients must first undergo detoxification. Just as residential treatment services need to be developed within Mohave County, so do detoxification services. These treatment interventions operate in tandem and are essential to a comprehensive treatment program. 1.0 INTRODUCTION Mohave County residents recognize the detrimental consequences of alcohol and drug abuse throughout their communities. The impact of substance abuse is seen within the family, the workplace, and the neighborhood. Many believe substance abuse is worse in Mohave County than in other areas of the state. They believe drugs are readily available for those who seek them and that getting high or drunk is more socially acceptable here than elsewhere. Furthermore, they believe the lack of a local residential treatment center, particularly for those who can’t afford a private treatment facility, results in addicts not getting the treatment they need to become sober. To date, these beliefs have never been empirically tested. Is the problem worse here? How does Mohave County rank against other Arizona counties in the severity of our substance abuse problem and our available treatment options? Would a residential treatment center be viable in Mohave County? For the health of our families, our neighbors and our work force, it is time to answer these questions. The purpose of this report was to: 1) define the scope and severity of the county’s substance abuse problem using statistical data from local, state‐wide, and federal sources, 2) assess the county’s treatment resources, and 3) use this data to identify treatment objectives based on true need. The primary focus of this report is substance abuse and treatment resources for the adult population. However, youth are considered throughout the report and addressed alongside the statistics for adults. Likewise, data on the tribes is considered throughout the report along with the other county data. 1.1 Mohave County Characteristics and Demographics At 13,479 square miles, Mohave County is geographically larger than nine U.S. states and is the fifth largest county in the contiguous United States. It has three incorporated cities: Kingman, Bullhead City and Lake Havasu City. The majority of the county’s population resides in or near these cities, but lesser populations exist throughout Mohave County in unincorporated towns and outlaying areas (Table 1‐1). Three tribes reside within Mohave County: the Hualapai, Fort Mohave and Kaibab‐Pauite Tribes. Vast areas of sparsely populated desert accurately describe most of the county. Several of the smaller desert communities have reputations of heavy substance abuse within their population. Providing substance abuse education and locally convenient treatment services to these remote locations is challenging and results in many of Mohave County’s rural populations being underserved in this capacity. Table 1‐1: 2008 Projected Populations in Mohave County (Arizona Commerce Projections) Arizona Mohave County Lake Havasu City Bullhead City Kingman 6,500,194 208,372 55,263 41,000 28,635 [2] In the northeast, the Grand Canyon cuts through Mohave County. This feature creates a physical barrier through the land which effectively separates the (Colorado Strip) communities north of the canyon, such as Colorado City and the Kaibab‐Pauite Tribe, from the rest of the county’s population. Due to the isolated nature of the Colorado Strip and the relatively small population of this region compared to the rest of Mohave County, the treatment resources used in this area are different than the rest of Mohave County. Consequently, their concerns regarding treatment resources are fundamentally different than the rest of the county. Albeit important, these concerns will not be addressed in this Needs Assessment. Within Arizona, Mohave County competes with Yuma County as the fifth largest population in the state. Arizona Commerce projections estimate Mohave County surpassing Yuma County in population in 2007. Table 1‐2 presents the population projections from 2006 through 2009. These are the population figures used throughout this report when determining per capita figures and presenting data in terms of the percentage of population. Table 1‐2: Arizona Commerce Population Projections (Arizona Commerce Authority) Arizona Commerce Population Projections Greenlee County
La Paz County
Graham County
Santa Cruz County
Gila County
Apache County
2006
8,281
21,489
35,873
45,303
55,102
74,691
2007
8,259
21,779
36,271
46,545
55,769
75,597
2008
8,238
22,062
36,666
47,777
56,427
76,486
2009
8,220
22,347
37,054
48,998
57,092
77,361
% Change
-0.74%
3.99%
3.29%
8.16%
3.61%
3.57%
Navajo County
112,672
115,331
117,971
120,591
7.03%
132,826
134,789
194,920
195,499
212,722
269,892
980,977
3,764,446
6,239,482
135,070
137,708
201,693
201,435
220,170
293,312
1,003,918
3,879,150
6,432,007
137,261
140,560
208,372
207,305
227,468
316,899
1,026,506
3,992,887
6,622,885
139,388
143,346
214,949
213,086
234,626
340,660
1,048,796
4,105,623
6,812,137
4.94%
6.35%
10.28%
9.00%
10.30%
26.22%
6.91%
9.06%
9.18%
Coconino County
Conchise County
Mohave County
Yuma County
Yavapai County
Pinal County
Pima County
Maricopa County
TOTAL
Eighty percent of Mohave County residents consider themselves white persons of non Hispanic origin. Those of Hispanic origin constitute 14.1% of the population. Native Americans are 2.6%, African Americans are 1.5% and Asian Americans are 1.2% of the population (Table 1‐3). [3] Table 1‐3: Ethnic Break Down, 2009 (U.S. Census Bureau) White Hispanic Native American African American Asian American Other 80% 14.1% 2.6% 1.5% 1.2% 0.6% In 2009, persons under 18 years of age consisted of 21.8% of the population. Persons 65 years and older were 22.4% of the population. High school graduates were 77.5% of the population and those persons having a bachelor’s degree or higher were 9.9% of the population. Mohave County ranks fifth lowest in the state in Median Household Income. All counties ranking lower than Mohave County have significantly smaller populations. Mohave County was one of four Arizona counties to suffer a drop in Median Household Income between 2007 and 2008. Table 1‐4: Arizona Median Household Income by County (U.S. Census Bureau) Arizona Median Household Income by County Apache County
La Paz County
Santa Cruz County
2005
$26,308
$29,015
$33,491
2006
$27,600
$29,534
$34,620
2007
$29,976
$29,912
$35,661
2008
$31,728
$32,973
$38,490
% Change
20.60%
13.64%
14.93%
Gila County
$33,862
$35,716
$34,761
$38,405
13.42%
Mohave County
$35,320
$36,320
$39,669
$38,641
9.40%
Yuma County
$35,739
$37,154
$39,781
$39,063
9.30%
Navajo County
Graham County
Yavapai County
Conchise County
$31,532
$33,558
$40,382
$36,296
$35,824
$34,618
$40,923
$38,825
$38,871
$38,798
$44,268
$42,995
$39,416
$40,902
$42,311
$44,000
25.00%
21.88%
4.78%
21.23%
Pima County
$41,484
$43,002
$43,721
$46,653
12.46%
Coconino County
$41,446
$43,683
$48,549
$47,933
15.65%
Pinal County
$41,177
$43,627
$49,906
$50,208
21.93%
Greenlee County
Maricopa County
$43,338
$48,752
$46,728
$52,522
$50,195
$54,733
$53,654
$56,511
State Average
$44,402
$47,315
$49,923
$51,009
23.80%
15.92%
14.88%
Mohave County is one of six Arizona counties which had an increase in level of poverty since 2005 (Table 1‐5). Its 2008 poverty level was 16.8%, which is the seventh highest level of poverty in the state. With the exception of Greenlee County, poverty appears to be less prevalent in the counties which have large [4] urban populations. The Federal Poverty Thresholds for 2008 which were used to determine the percentage of people in poverty considered one person to be in poverty if their annual earnings was under $10,991; two persons (in a family unit) were considered to be at poverty level if their combined annual income was under $14,051. Table 1‐5: Arizona Persons Below Poverty Level by County (U.S. Census Bureau) Arizona In Poverty by County 2005
2006
2007
2008
% Change
Apache County
41.7%
34.5%
33.4%
33.2%
-20.38%
La Paz County
21.6%
21.0%
23.8%
26.1%
20.83%
Navajo County
28.8%
24.4%
23.4%
23.1%
-19.79%
Yuma County
Graham County
Santa Cruz County
19.1%
23.7%
20.4%
19.0%
23.4%
21.8%
17.8%
22.4%
20.1%
21.5%
21.4%
18.5%
12.57%
-9.70%
-9.31%
Mohave County
15.6%
16.0%
13.5%
16.8%
7.69%
Gila County
19.9%
20.0%
18.2%
16.1%
-19.10%
Coconino County
18.0%
16.8%
16.2%
16.0%
-11.11%
Conchise County
Pinal County
Pima County
Maricopa County
16.9%
15.7%
14.9%
12.6%
18.0%
15.2%
15.3%
12.5%
16.3%
12.5%
14.9%
12.9%
16.0%
14.0%
15.4%
13.4%
-5.33%
-10.83%
3.36%
6.35%
Yavapai County
12.8%
12.4%
12.6%
12.9%
0.78%
Greenlee County
12.8%
10.9%
11.2%
11.3%
TOTAL
14.4%
14.2%
14.1%
14.7%
-11.72%
2.08%
In light of the population figures and the county‐level economic data, it is not surprising to find that Mohave County has the largest number of people enrolled in AHCCCS in northern Arizona (Table 1‐6). AHCCCS is Arizona’s Medicaid program. In 2009, twenty‐two percent of Mohave County’s population was enrolled in AHCCCS. Similar to every county in Arizona, AHCCCS enrollment in Mohave County increased between 2008 and 2009. A monthly breakdown of AHCCCS enrollment by county is provided in Appendix A. [5] Table 1‐6: AHCCCS Enrollment by County (Arizona Health Care Cost Containment System) AHCCCS ENROLLMENT BY COUNTY 2006 Average Monthly Enrollment 2007 Average Monthly Enrollment 2008 Average Monthly Enrollment 2009 Average Monthly Enrollment Number Percent of Population Number Percent of Population Number Percent of Population Number Percent of Population
APACHE 31,648 42% 30,867 41% 30,656 40% 32,354 42% NAVAHO SANTA CRUZ 36,251 32% 35,920 31% 37,026 31% 40,765 34% 14,029 31% 13,643 29% 13,888 29% 15,406 31% GILA 13,659 25% 13,280 24% 13,674 24% 14,950 26% GRAHAM 8,455 24% 7,818 22% 7,811 21% 8,929 24% YUMA 45,250 23% 46,104 23% 46,903 23% 50,224 24% MOHAVE 37,950 19% 38,081 19% 41,311 20% 46,399 22% LA PAZ County 4,470 21% 4,527 21% 4,565 21% 4,802 21% COCONINO 27,105 20% 25,795 19% 26,512 19% 29,455 21% COCHISE 25,871 19% 24,668 18% 25,091 18% 26,664 19% PIMA 168,700 17% 170,045 17% 179,453 17% 197,508 19% MARICOPA 567,775 15% 572,418 15% 611,579 15% 706,585 17% GREENLEE 1,385 17% 1,061 13% 965 12% 1,283 16% YAVAPAI 30,125 14% 30,117 14% 31,740 14% 36,781 16% PINAL 37,202 14% 39,481 13% 42,005 13% 48,254 14% ARIZONA 1,049,874 17% 1,053,824 16% 1,113,178 17% 1,260,359 19% 1.2 Closing Remarks on Characteristics and Demographics of Mohave County It is important to consider the characteristics and demographics of Mohave County when assessing the scope of the county’s substance abuse problem and its treatment resources. Although low income levels aren’t necessarily associated with higher levels of substance abuse, a lack of education/prevention programs and resources in outlaying areas results in populations less informed of the dangers of substance abuse than populations in the cities. Low income families also frequently have limited accessibility and affordability for psychological and family support services. In addition, travel to the cities where treatment services are available may be prohibitively expensive, or otherwise impractical, for low income families living in rural areas. In fact, many people in Mohave County rarely leave the county, or even their local area, due to the driving distances and the costs associated with travel. [6] 2.0 LAW ENFORCEMENT An examination of law enforcement statistics provides useful information about how much criminal activity is associated with substance abuse as well as providing an indicator of the drugs types being used in the community. When statistical data is considered within an agency, an increase/decrease in drug arrests or drug related incidents or calls is commonly considered an indicator of an increase/decrease in illegal drug use within a community. Local law enforcement agencies in Mohave County that provided data for this report include: Bullhead City Police Department, Lake Havasu City Police Department, Kingman Police Department, M.A.G.N.E.T. (Mohave Area General Narcotics Enforcement Team) Hualapai Nation Police Department, Fort Mojave Police Department, Mohave County Sheriff’s Office. These agencies provided three or more years of historical data through 2009. Each agency or department collects arrest and charge data according to inner‐department methodology, therefore the data from each source should be considered stand alone and should not be compared against each other. Arrest data compiled as part of the FBI’s Uniform Crime Reporting (UCR) Program was also provided by Bullhead, Lake Havasu and Kingman Police Departments. The UCR Program is a voluntary nationwide program which collects data from local city, county, and state law enforcement agencies to serve as a national clearinghouse for statistical information on crime. Federal agencies and tribal police agencies do not report to the UCR program. This program classifies each arrest by the charge which is considered most serious per UCR guidelines (some exceptions exist but are not relevant for this report). Consequently, if a person was arrested for a drug related offense in addition to a more serious charge (such as murder, rape, assault, burglary, arson, etc.), the drug related offense would not be the primary reason for arrest and therefore this charge would not be included in the UCR data. For this reason, UCR data should be considered incomplete. The UCR Program defines “Drug‐Related Arrests” as an arrest due to the sale, manufacturing or possession of illegal drugs. [7] It should be kept in mind that variations in the number of arrests and/or charges may be influenced by factors unrelated to the volume of crime actually occurring. Many factors affect the volume and type of crime occurring from place to place, among which are: Population density and degree of urbanization. Number of officers on the street. Crime reporting practices of the citizenry. Citizens’ attitudes toward crime. Economic conditions, including median income, poverty level, and job availability. Stability of population with respect to residents’ mobility, commuting patterns, and transient factors. Administrative and investigative emphases of the law enforcement agency. A very important factor which may directly impact the number of arrests in a given year is an increase or decrease in funding within a law enforcement agency. Cuts in funding may result in cuts in manpower and consequently a reduction in arrests. These community specific influences should be considered along with an understanding that the total number of arrests does not represent the total number of people being arrested since the same person may be arrested more than once in any given year. Likewise, multiple charges are commonly applied to a single person so charge data is an inappropriate indicator of the number of people being charged with a crime. Valid conclusions based on the data presented herein are possible only with careful study and analysis of the range of unique conditions affecting each local law enforcement jurisdiction. In addition to local law enforcement statistics, MSTEPP reviewed the Crime in Arizona Reports and Arizona Motor Vehicle Crash Facts Reports back through 2006. The relevant data from these reports is presented here. 2.1 Bullhead City Police Department Bullhead City Police Department provided enhanced UCR data for 2004 through 2009 (Appendix B). The data was enhanced by including not only arrests in which the primary charge was drug related, but also arrests where any drug related offense was charged. Therefore, the Bullhead City Police Department data presented here is a complete listing of all drug related arrests. Table 2‐1 and Figure 2‐1 present this data. [8] Table 2‐1: Bullhead City Police Arrests Bullhead City Police Arrests Year Drug‐Related Arrests Total Criminal Arrests 2004 2005 2006 2007 2008 2009 737 778 715 520 459 398 3398 3546 3735 3213 2768 2674 % Drug Arrests 22% 22% 19% 16% 17% 15% Drug‐related arrests compared to total criminal arrests ranged from 22% to 15% over the five year span. A decreasing trend in the percentage of drug‐related arrests began in 2006 with 2009 being a six year low. Figure 2‐1: Bullhead City Drug Arrests as a Percentage of Total Criminal Arrests A comparison of drug‐related arrests according to the type of illegal drug involved indicates marijuana related arrests were more freqent than all other drugs, except for the year 2005 which had methamphetamine as the drug most often involved in drug‐related arrests. [9] Table 2‐2: Bullhead City Drug Arrests by Drug Type Drug Arrests by Drug Type Year Meth Marijuana Other 2004 2005 2006 2007 2008 2009 43.00% 48.00% 37.90% 20.00% 37.00% 33.00% 50.00% 46.00% 52.60% 69.00% 57.00% 60.00% 7.00% 6.00% 9.50% 11.00% 6.00% 7.00% Figure 2‐2 suggests marijuana and methamphetamine have remained the illegal drugs of choice over the past five years in Bullhead City. Figure 2‐2: Bullhead City Percentage of Drug Arrests by Catagory DUI arrests for the past six years have remained fairly steady in Bullhead City with an 18% variation across this time span and showing no decisive trends. [10] Figure 2‐3: Bullhead City Police Department DUI Arrests 2.2 Lake Havasu City Police Department Lake Havasu City Police Department (LHCPD) provided UCR drug‐related arrest data and all records of drug related charges for 2004 through 2009 (Appendix C). The UCR data strictly follows the UCR guidelines and therefore only includes arrests where the drug‐related offense was the primary charge. Table 2‐3: UCR Drug Related Arrests ‐ Lake Havasu City Police Dept. UCR Drug Related Arrests ‐ Lake Havasu City P.D. Year Juvenile Adult Drug‐Related Arrests 2004 2005 2006 2007 2008 2009 63 55 68 75 34 61 322 266 300 360 277 227 385 321 368 435 311 288 Figure 2‐4 shows that UCR juvenile arrests have been variable since 2004, with a low in 2008 which rebounded in 2009. [11] Figure 2‐4: Lake Havasu City UCR Drug Related Juvenile Arrests Figure 2‐5 shows UCR adult arrest data fluctuating over the past six years with arrests declining over the past two years. Figure 2‐5: Lake Havasu City UCR Drug Related Adult Arrests [12] LHCPD provided arrest data by drug type for 2004 through 2008. A comparison of drug‐related arrests according to the type of illegal drug involved indicates there is normally two to three times the number of marijuana related arrests compared to synthetics/meth related arrests. Likewise, synthetics/meth arrests are two to four times more freqent than arrests due to all remaining illegals drugs. Table 2‐4: Lake Havasu City UCR Drug Arrests by Drug Type UCR Drug Arrests by Drug Type Year Synthetics i.e. Meth Marijuana Other 2004 28.00% 65.00% 7.00% 2005 31.00% 58.00% 11.00% 2006 24.00% 68.00% 8.00% 2007 27.00% 62.00% 11.00% 2008 32.00% 57.00% 11.00% The following graph illustrates the disparity between marijuana related arrests, synthetics/meth related arrests and all other drug related arrests. Figure 2‐6: Lake Havasu City Percentage of UCR Drug Arrests by Drug [13] In a review of records of drug related charges by the LHCPD, adult and juvenile trends are different than the UCR data trends. Table 2‐5 lists all drug related charges associated with arrests for the years 2004‐
2009. Multiple charges may be applied in a single arrest. These statistics are more comprehensive than the UCR arrest data so provide a better picture of drug related crime occurring in Lake Havasu City. Table 2‐5: Lake Havasu P.D. Drug Charges Lake Havasu P.D. Drug Arrest Charges Year 2004 2005 2006 2007 2008 2009 Adult 755 674 685 782 544 464 Juvenile 107 88 119 127 62 106 Total 862 762 804 909 606 570 Figures 2‐7 and 2‐8 graphically illustrate the data in Table 2‐5. For juveniles, the trend mirrors the UCR data quite well. There were 106 charges in 2009 which is midrange for juvenile charges over the past six years. Figure 2‐7: Lake Havasu P.D. Juvenile Drug Related Charges [14] For adults, there is a steady reduction in drug related charges since 2007 with 2009 having the lowest number of adult drug related charges in the six year historical record. As with juveniles, the trend for charge data mirrors the trend for UCR data. Figure 2‐8: Lake Havasu P.D. Adult Drug Related Charges A bar graph of DUI charges in Lake Havasu City show DUIs peaking in 2006, declining for two years and bumping up again in 2009. Figure 2‐9: Lake Havasu City P.D. DUI Charges [15] Table 2‐6 shows the breakdown of DUI charges according to charges applied to adults and juveniles. It should be kept in mind these are total charges and not the total arrests. Table 2‐6: Lake Havasu City PD DUI Charges LHCPD DUI Arrests (Charges) Year 2004 2005 2006 2007 2008 2009 Total DUI Charges 410 505 729 533 473 505 Adult
407 503 720 523 468 496 Juvenile 3 2 9 10 5 9 2.3 Kingman Police Department Kingman Police Department (KPD) publishes an Annual Report each year which is posted on‐line (www.kingmanpolice.com) and provides statistics on law enforcement activities. Reports from 2005 through 2009 were reviewed for this document and relevant drug related data include Calls for Service, School Resource Officer arrests, and Flex Squad activity. Mohave Area General Narcotics Enforcement Team (MAGNET) statistics are also presented in KPD’s Annual Report since KPD is the “lead agency” for MAGNET. Table 2‐7 lists for the years 2002 through 2009 KPD’s Calls for Service related to Drugs, DUIs, Domestic Violence and Burglary. A call for service is a call which an officer or KPD employee responds to. Table 2‐7: Kingman Police Department Calls For Service CALLS FOR SERVICE Year 2002 2003 2004 2005 2006 2007 2008 2009 Drugs 313 305 399 405 390 306 287 289 DUIs 100 61 86 116 68 144 148 125 [16] Domestic Violence 1000 1009 1143 1259 1231 1053 940 946 Burglary 753 737 555 810 879 750 529 695 A bar graph of all Drug Related Calls depicts a bell curve that peaked in 2005 (Figure 2‐10). The last two years, 2008 and 2009, had the lowest number of Drug Related Calls for Service in this time frame. Figure 2‐10: Kingman Police Department Drug Related Calls for Service Figure 2‐11 charts the Calls for Service in a line graph. A review of this chart shows a rough correspondence between the number of Drug Related Calls for Service and the number of Domestic Violence and Burglary Calls for Service. A distinct hump is observed between 2003 and 2008 for all three of these call types. This suggests a direct relationship between the amount of substance abuse, burglary and domestic violence. DUI Calls for Service are also plotted in this graph. Figure 2‐11: Kingman Police Department Calls for Service [17] School Resource Officers (SRO’s) handle calls at the nine (9) local Kingman school campuses. The past five years of drug related arrests by SRO’s are listed in Table 2‐8 and plotted in Figure 2‐12. Table 2‐8: Kingman School Resource Officer Activity Kingman SRO Drug Related Arrests Year 2005 2006 2007 2008 2009 Drug Related Arrests 18 21 19 13 38 Drug Related Arrests as a Percentage of Total Arrests 18.37% 20.79% 14.50% 12.87% 39.58% According to KPD’s annual report, the striking increase in drug related arrests in 2009 is largely attributed to a dramatic increase in prescription drug abuse in the schools and the involvement of multiple students in association with these investigations. The school district superintendent has publically recognized that prescription drug abuse became a significant problem in 2009 and continued in 2010. Figure 2‐12: Kingman SRO Drug Related Arrests The KPD Flex Team was created to combat street level narcotics and other issues affecting quality of life in the City of Kingman. The data provided in Table 2‐9 and plotted in Figure 2‐13 show that drug arrests were between 42% and 67% of total arrests made by the Flex Team in the last four years. [18] Table 2‐9: Kingman Flex Squad Drug Arrests FLEX SQUAD DRUG ARRESTS Year 2006 2007 2008 2009 Drug Arrests 192 55 50 107 Total Arrests 289 130 96 208 % Drug/Total Arrests 66.44 42.31 52.08 51.44 Figure 2‐13: Kingman Police Department % Drug Arrests/Total Arrests The Flex Team has seized marijuana and methamphetamine annually since 2006. Table 2‐10 lists the quantities of marijuana and methamphetamine seized. The amount of marijuana seized in the past two years increased significantly from previous years. More methamphetamine was seized by the Flex Team in 2009 than any other year reviewed. Table 2‐10: Kingman Flex Squad Drug Seizures FLEX SQUAD DRUG SEIZURES Year 2006 2007 2008 2009 Marijuana Seized (lbs) 1 0.5 11 18 Methamphetamine Seized (lbs) 2 1 0.5 2.5 [19] Figure 2‐14: Kingman Flex Squad Drug Seizures Table 2‐11 and Figure 2‐15 provide KPD’s UCR drug arrest data for 2005 through 2009. Table 2‐11: KPD UCR Drug Arrests UCR Drug Arrests Year Adult Juvenile Total 2005 2006 2007 2008 2009 152 151 106 115 91 26 21 22 33 26 178 172 128 148 117 The number of adult UCR drug arrests have declined since 2005 to a five year low in 2009. Juvenile UCR drug arrests have remained fairly level for the past five years. It is interesting to note the UCR juvenile data does not look anything like the SRO data, which shows a sharp increase in drug related arrests for 2009. [20] Figure 2‐15: KPD UCR Drug Arrests An analysis of the drug arrests by gender (Figure 2‐16) generally reflect the drug arrest data (Figure 2‐
15), with highs and lows for both males and females increasing and decreasing in kind. The UCR data for 2005 – 2009 is similar to the calls for service data with highs in 2005 and 2006 followed by lower numbers in 2007 through 2009. Figure 2‐16: KPD UCR Drug Arrests by Gender When arrests are classified according to drug type, marijuana related arrests are most common followed by methamphetamine related arrests. The UCR data by drug type is modified from the data submitted to the state and FBI by the KPD. KPD originally submitted their statistics with methamphetamine arrests [21] classified under “Other Dangerous Nonnarcotics”. Other law enforcement agencies submitted methamphetamine arrests under the “Synthetic Narcotics” classification. The KPD statistics have been adjusted in this report so methamphetamine arrests are classified as “Synthetic Narcotics”. Table 2‐12: KPD UCR Drug Arrests by Drug Type (Adult & Juvenile) UCR Drug Arrests by Drug Type (Adult & Juvenile) Year 2005 2006 2007 2008 2009 Synthetics i.e. Meth 81 68 44 44 40 Marijuana Other 93 100 75 89 68 4 4 9 15 9 If we look at the percentage of arrests according to drug type (Figure 2‐17), we see that marijuana has been the drug most often related to arrests throughout the past five years, consistently constituting 58% to 60% of arrests in recent years. Synthetic drugs, which includes methamphetamine, is secondary. The percentage of synthetic drug‐related arrests had been decreasing since 2005, but an increasing percentage was observed in 2009 despite the total number of arrests being lower. Arrests associated with other drugs have increased in recent years. Although these arrest figures are at 10% or under, there exists a concern in Kingman law enforcement that heroin related criminal activity is on the rise. Figure 2‐17: Percentage UCR Drug Arrests by Drug Type (Adult & Juvenile) [22] Kingman DUI Calls for Service shows no discernable trends over the past six years, although the last two years, 2008 and 2009, had the highest number DUI Calls for Service within this time frame. Figure 2‐18: Kingman P.D. DUI Calls for Service 2.4 MAGNET MAGNET (Mohave Area General Narcotics Enforcement Team) is a specialized team of narcotics enforcement officers who conduct drug searches, seizures and arrests in the Mohave County area. In addition to inner county activities, MAGNET also collaborates with outside law enforcement agencies investigating interstate and international drug trafficking operations. MAGNET is composed of seven agencies: Kingman Police Department, Bullhead City Police Department, Lake Havasu City Police Department, Mohave County Sheriff’s Office, Arizona Department of Public Safety, U.S. Department of Drug Enforcement Administration, and the Mohave County Attorney’s Office. Their mission is to facilitate federal, state and local multi‐agency partnerships to substantially reduce drug related crime and violence. MAGNET’s arrest statistics presented in Table 2‐13 and Figure 2‐19 are for the fiscal years (July 31 – June 30) from 2005 through 2009. These figures were obtained from Arizona Criminal Justice Commission’s Enhanced Drug and Gang Enforcement (EDGE) Report. MAGNET Drug Related Arrests have increased each year since FY2007. FY2009 had the highest number of arrests since 2005. [23] Table 2‐13: MAGNET Drug Related Arrests MAGNET Drug Arrests Year FY2005 FY2006 FY2007 FY2008 FY2009 Drug Related Arrests 425 415 357 399 445 Figure 2‐19: MAGNET Drug Related Arrests Table 2‐14 shows MAGNET’s drug seizures from FY2005 through FY2009. The quantity of methamphetamine seized in FY2009 was nearly double the amount seized in FY2008 and the highest quantity since FY2005 (Figure 2‐20). When evaluating methamphetamine seizures in Mohave County, it should be kept in mind that most methamphetamine seized by MAGNET is a result of highway interdictions. The large quantity of methamphetamine seized in FY2009 is contributed to one such interdiction; in this case the drug was being transported to Hawaii. For heroin and cocaine, FY2009 was a five year low in quantities seized. Marijuana seizures dropped significantly in FY2009, however it remained above the FY2005 and FY2006 levels. [24] Table 2‐14: MAGNET Drug Seizures MAGNET DRUG SEIZURES Year FY2005 FY2006 FY2007 FY2008 FY2009 Methamphetamine Heroin Seizures Seizures (grams) (grams) 24,550 10 16,637 1,002 14,180 2,356 8,625 48 16,813 2 Marijuana Seizures (lbs.) Cocaine (grams) 296 373,406 325 12,069 413 197,891 692 37,278 381 6,514 Other Drugs (dosage units) 178,328 179 85,764 37,276 1,894 Figure 2‐20: Arizona County Comparison – Meth Seizures (grams) Figure 2‐21 shows a comparison of meth seized by MAGNET in 2009 to six other Arizona Counties. Among this group MAGNET ranks second in quantity seized. [25] Figure 2‐21: Arizona County Comparison – 2009 Meth Seizures (grams) 2.5 Hualapai Nation Police Department The Hualapai Nation Police Department provided a listing of drug related incidents which occurred for the years 2004 through 2009. The data is presented in Table 2‐15 and Figure 2‐22, which shows an increase in drug related incidents since 2007. Table 2‐15: Hualapai Law Enforcement Drug Related Incidents Hualapai Law Enforcement Drug Related Incidents Year 2004 2005 2006 2007 2008 2009 Adult 15 15 7 8 10 12 Juvenile 5 2 4 1 2 1 [26] Total 20 17 11 9 12 13 Figure 2‐22: Hualapai Law Enforcement Drug Related Incidents 2.6 Fort Mojave Tribe Police Department The Fort Mojave Tribe Police Department provided a listing of drug related incidents which occurred for the years 2006 through 2009. However, the format of their drug report changed in 2009 so that information on the type of drugs associated with the charges was not presented. The data for 2006 – 2008 presented in Table 2‐16 and Figure 2‐23 is consistent with other agency statistics indicating marijuana is the most common illegal drug associated with crime, followed by methamphetamine. Table 2‐16: Fort Mojave Tribe Drug Related Charges Fort Mohave Tribe Drug Arrests Meth Marijuana Other Drugs Total Drug Arrests Paraphenalia 2006 76 87 14 177 105 [27] 2007 24 44 8 76 68 2008 12 24 6 42 39 Figure 2‐23: Fort Mojave Tribe Drug Related Charges Figure 2‐24 shows a significant decrease in the number of drug related incidents since 2006, although in 2009 they saw a bump in arrests of all demographics except juvenile males. Arrests of juvenile males dropped from eleven (11) to two (2) in 2009. Figure 2‐24: Fort Mojave Drug Arrests by Gender and Age [28] 2.7 Mohave County Sheriff’s Office Mohave County Sheriff’s Office (MCSO) provided arrest data for 2005 through 2009. This data included drug related jail bookings for all agencies as well as arrests made by MCSO. Table 2‐17 presents the number of jail bookings made by each agency (excluding MCSO) and the total drug related bookings for those agencies. Overall drug related arrests have decreased over the past five years. The exception to this is bookings due to court commitments which increased through 2008 and then dropped in 2009. Table 2‐17: Mohave County Jail Drug Related Bookings by Agency (not including MCSO) Mohave County Jail Drug Related Bookings by Agency Year 2005 2006 2007 2008 2009 Total Drug Related Arrests 1189 1165 1106 900 833 KPD 241 256 250 180 166 Bullhead PD 394 410 264 252 226 Lake Havasu PD 297 255 273 203 173 Court Commitments 109 116 166 171 153 DPS 148 128 153 94 115 Not every arrest in Mohave County results in a jail booking. Arrests may be a summons to court or a citation rather than a booking into jail. After that person appears in court (on a summons or a citation) the court may then order them to report to jail for fingerprints and photo. Figure 2‐25 is a line graph representing the data from Table 2‐17 which depicts the number of drug related bookings through time for each agency. MAGNET is not differentiated because the MAGNET officer who does the booking normally uses his or her agency of employment as the arresting agency for purposes of the jail booking. [29] Figure 2‐25: Mohave County Jail Drug Related Bookings A view of drug related bookings as a percentage of total bookings (by agency) shows that the number of drug related bookings as compared to total jail bookings have decreased through time for all agencies, except for Court Commitments, which have increased since 2005. Table 2‐18: Drug Related Bookings as a Percentage of Total Jail Bookings Drug Related Bookings as a Percentage of Total Jail Bookings Year 2005 2006 2007 2008 2009 TOTAL 12% 11% 10% 8% 8% Kingman PD 17% 16% 13% 11% 10% Bullhead PD 25% 23% 15% 18% 15% Lake Havasu PD 18% 16% 20% 16% 13% Court Commitments 7% 9% 11% 11% 10% DPS
31%
25%
25%
16%
20%
For drug related arrests by MCSO, we were provided with arrest data which included custody arrests, cite and release arrests, and long form complaint charges. The arrest data was subdivided into adult male, adult female, juvenile male and juvenile female. The total number of drug related arrests by MCSO peaked in 2006 with 647 arrests. Year 2008 had the lowest number of arrests. This is graphically illustrated in Figure 2‐26. [30] Figure 2‐26: MCSO Drug Related Arrests Figure 2‐27 illustrates the trends of male and female adult drug arrests. We see that male drug arrests have gradually declined in five years with 2009 having the lowest percentage of adult drug related male arrests in a five year history. The percentage of female adult drug arrests increased in 2006, stabilized for two years, and dropped again in 2009. Figure 2‐27: MCSO Adult Percentage of Drug Arrests [31] Drug arrests for youth show a different trend than adults. Arrests of juvenile males increased gradually since 2005 and sharply increased in 2009. Juvenile female arrests have been generally consistent over the five years reviewed. Figure 2‐28: Mohave County Sheriff Juvenile Percentage of Drug Arrests Mohave County jail bookings for DUI’s steadily increased between 2005 and 2008, then dropped in 2009 (Figure 2‐29). Figure 2‐29: Mohave County Sheriff’s Department DUI Jail Bookings [32] 2.8 Crime in Arizona Report (2006, 2007, 2008, 2009) The “Crime in Arizona” Reports include all UCR data which is reported throughout the state of Arizona. This compilation is produced by the Arizona Department of Public Safety each year and is available to the public online at www.azdps.gov. This report facilitates assessment of Mohave County as a whole as well as providing a convenient way to compare Mohave County’s drug arrest data to other counties. As discussed previously, UCR data is incomplete and does not include all drug related arrests. Therefore, the data should be reviewed as an indicator only. All UCR data includes both adults and juveniles. The UCR program classifies drugs into four categories: Opium, Cocaine, Derivatives Marijuana Synthetic Narcotics (includes Methamphetamine) Other Dangerous Nonnarcotics We organized the UCR arrest data by dividing the number of arrests in a county by each county’s population to provide per capita data. The figures in Tables 2‐19 through 2‐21 show the number of arrests per 10,000 county residents. Therefore, it may be inferred that the higher the number is; the more serious the problem is. For example, in Mohave County in 2008, there were 17.85 synthetic narcotics arrests for every 10,000 Mohave County residents. In contrast, in Maricopa County in 2008, there were 3.66 synthetic narcotics arrests for every 10,000 Maricopa County residents. Therefore, according to UCR data, Mohave County had 4.9 times the arrests of Maricopa County per capita for synthetic narcotics that year. This database has been adjusted to reflect the corrections to KPD’s UCR drug arrest records (previously discussed). Table 2‐19: Arrests Per 10,000 Residents – Synthetic Narcotics (includes Methamphetamine) Arrests Per Capita ‐ Synthetic Narcotics 2009 2008 2007 2006 Mohave 12.61 17.85 16.46 25.09 Coconino 1.79 0.95 2.00 1.81 Yuma 4.41 2.22 5.56 7.77 [33] Yavapai 9.38 13.89 6.31 8.27 Pinal 1.35 2.05 2.52 3.89 Pima 12.99 13.93 13.43 14.88 Maricopa 3.43 3.66 5.37 7.23 When compared to six of the most populous counties in Arizona, UCR arrest data indicates Mohave County consistently ranked first for arrests related to synthetic narcotics (i.e. methamphetamines) until 2009 when Pima County surpassed Mohave County in arrests. For UCR arrests related to other dangerous narcotics, Mohave County ranked 2nd for having the most arrests per capita for 2009. Table 2‐20: Arizona Counties Arrests Per 10,000 Residents – Other Dangerous Nonnarcotics Arrests Per Capita ‐ Other Dangerous Narcotics 2009 2008 2007 2006 Mohave 11.16 4.46 7.44 7.23 Coconino 4.16 3.93 4.00 6.47 Yuma 2.16 1.74 3.77 3.43 Yavapai 7.07 6.95 13.99 17.53 Pinal 3.4 4.29 3.82 6.08 Pima 31.46 34.14 40.47 44.63 Maricopa 4.6 4.53 6.23 6.83 Table 2‐21 shows per capita arrests for marijuana related offenses in seven of the most populous counties in Arizona. Although this table shows Mohave County ranks 5th among these counties for the years reviewed, it’s important to note there were more than twice as many arrests related to marijuana in Mohave County than arrests related to synthetic narcotics. Table 2‐21: Arizona Counties Arrests Per 10,000 Residents ‐ Marijuana Arrests Per Capita ‐ Marijuana 2009 2008 2007 2006 Mohave 24.66 24.86 28.56 30.06 Coconino 62.34 64.84 66.85 69.72 Yuma 23.46 21.66 29.44 32.12 Yavapai 50.93 47.26 38.61 33.89 Pinal 18.55 20.42 20.01 20.97 Pima 51.26 47.33 46.76 44.04 Maricopa 27.11 25.83 25.96 24.90 For UCR arrests related to opium, cocaine and their derivatives, Mohave County ranked 6th for 2007 through 2009, with the exception of 2006 in which it ranked 7th. Based on UCR arrest data alone, it appears that use of opium, cocaine and their derivatives in Mohave County may not be as prevalent as marijuana, synthetic narcotics and other dangerous nonnarcotics. [34] Table 2‐22: Arizona Counties Arrests Per 10,000 Residents – Opium, Cocaine, Derivatives Arrests Per Capita ‐ Opium, Cocaine, Derivatives 2009 2008 2007 2006 Mohave 0.98 1.54 1.69 0.92 Coconino 3.51 4.74 4.29 3.16 Yuma 1.03 0.53 1.24 1.48 Yavapai 2.51 3.69 4.68 4.32 Pinal Pima 0.94 6.43 2.15 6.59 3.34 7.00 3.26 6.51 Maricopa 7.17 8.37 9.60 8.65 2.9 Arizona Motor Vehicle Crash Facts Each year the Arizona Department of Transportation releases a report on Motor Vehicle Crash Facts for the State of Arizona. Included among this information are statistics on crashes involving alcohol and drugs. Tables 2‐23 through 2‐25 show the percentage of alcohol related crashes in seven of the most populous counties in Arizona, including Mohave County, for the years 2006 through 2008. Among these counties Mohave County has the consistently highest percentage of alcohol related crashes for all years. Table 2‐23: 2006 Alcohol Related Crashes 2006 Alcohol Related Crashes Total # of Crashes MARICOPA PIMA MOHAVE YAVAPAI PINAL
COCONINO YUMA
94,159 20,353
3,656 4,082 3,948 4,295 3,130 # Alcohol Rel. Crashes 5,048 957 292 269 232 248 176 % Alcohol Rel. Crashes 5.36% 4.70% 7.99% 6.59% 5.88%
5.77% 5.62% Table 2‐24: 2007 Alcohol Related Crashes 2007 Alcohol Related Crashes Total # of Crashes MARICOPA PIMA MOHAVE YAVAPAI PINAL COCONINO YUMA 93,734 20767 3517 3974 3755 4277 3117 # Alcohol Rel. Crashes 5,055 1047 307 299 235 226 201 % Alcohol Rel. Crashes 5.39% 5.04% 8.73% 7.52% 6.26% 5.28% 6.45% [35] Table 2‐25: 2008 Alcohol Related Crashes 2008 Alcohol Related Crashes MARICOPA PIMA MOHAVE YAVAPAI PINAL COCONINO YUMA Total # of Crashes 78,034 18218 3025 3479 3249 4211 2879 # Alcohol Rel. Crashes 4,240 984 257 223 201 197 197 % Alcohol Rel. Crashes 5.43% 5.40% 8.50% 6.41% 6.19% 4.68% 6.84% Table 2‐26 shows the percentage of drug related crashes for Mohave County and five other Arizona counties for 2006 through 2008. Mohave County ranks between 3rd through 5th for drug related crashes for the counties considered. In Mohave County, testing for drugs at crash sites occurs only if alcohol is ruled out as a cause of impairment or another indicator is present that suggests drugs may be a factor. Table 2‐26: Percentage of Drug Related Crashes Percentage of Drug Related Crashes Year 2006 2007 Maricopa 0.37% 0.36% Pima 0.30%
0.32%
Mohave 0.46%
0.33%
Yavapai 0.78%
0.93%
Pinal 0.61%
0.91%
Coconino 0.35%
0.42%
2008 0.27% 0.32%
0.38%
0.71%
0.79%
0.40%
2.10 Closing Remarks on Law Enforcement Mohave County has been a focus for drug control and enforcement on the national stage since 1990 when the federal government established it would be part of the High‐Intensity Drug Trafficking Area Program (HIDTA). Several attributes of the county combine to make it a hot spot for drug trafficking; it is a rural region, geographically located between Phoenix, Las Vegas and Los Angeles, and a major interstate highway, I‐40, traverses through it. As a nexus for drug trafficking, it is unsurprising that a significant percentage of Mohave County’s criminal activity is related to or involved with illegal drugs. Throughout all the statistics, two drugs rise to the top as being ubiquitous in Mohave County arrests; marijuana and methamphetamine. Marijuana‐related arrests are the most common of the drug‐related arrests for all law enforcement agencies followed by methamphetamine‐related arrests. A notable exception occurred in 2005 when methamphetamine related arrests surpassed marijuana related arrests in Bullhead City. According to UCR data from 2006 through 2009, Mohave County ranks first in [36] Arizona (among the seven most populous counties) in arrests per capita for synthetic narcotics (which include methamphetamine). The Kingman Flex Squad reported seizures of marijuana and methamphetamine in 2009 which are their largest quantities seized in four years. MAGNET also seized large quantities of methamphetamine in 2009. Mohave County Jail reports several years of decline in drug related jail bookings for all law enforcement agencies with the exception of court commitments which has had a modest increase since 2005. Adult males are arrested most often on drug related charges, followed by adult females and juvenile males. MCSO reports the percentage of juvenile male drug arrests has doubled in the past five years. Kingman observed a striking increase in drug related arrest activity in their schools in 2009 which was attributed to an increase in prescription drug abuse among students. The Hualapai Nation Police Department reported an increase in drug related incidents since 2007 although the amount of juvenile involvement has generally decreased since then. The Fort Mojave Police Department saw an increase in drug related charges between 2008 and 2009 after a three year decline. In contrast to the increasing number of drug related arrests for adults and juvenile females, arrests of juvenile males in drug related incidents declined significantly between 2008 and 2009. Although DUI bookings at Mohave County jail decreased in 2009 after increasing for four straight years, it is important to note that Mohave County had the highest percentage of alcohol related crashes from 2006 through 2008 among seven of the most populous counties in Arizona. In summary, it should be noted that due to the economic climate, budgets have decreased for most, if not all, local law enforcement agencies in the past few years. This decrease in funding may have impacted levels in manpower which resulted in fewer arrests. Two observations support this hypothesis. First, MAGNET, which has supplemental funding provided by the state as well as grants, had a record number of arrests in 2009. Second, a review of arrests per capita in other counties, as observed in the Crime in Arizona Reports, shows that all the counties have generally decreased their arrest rates in the past four years. We can therefore conclude that the decline in drug related arrests observed throughout Mohave County probably has more to do with a decline in funding than with a decline in drug related criminal activity. [37] 3.0 COURTS, CHILD WELFARE AND PROBATION The Mohave County court system deals with drug‐related violations regularly. Considering the high number of drug related arrests (see Law Enforcement chapter), it is unsurprising that drug related court cases are common. The court data discussed here includes all drug related cases for 2004 through 2009 for Mohave County Superior Court, Justice Courts and Municipal Courts for Bullhead City, Lake Havasu City and Kingman. Drug related cases in Mohave County were compared to other Arizona counties to provide an understanding of where Mohave County ranks within the state for prosecution of drug related crimes. Statewide statistics were only available for cases which were prosecuted using funds from the Drug and Gang Enforcement Account. The Drug and Gang Enforcement Account is administered through the Arizona Criminal Justice Commission (ACJC) who releases an annual report on activities funded by this account. In Mohave County, these cases are for arrests conducted by MAGNET. A summary of drug test results was provided by the Probation Department for this report. These test results provide a useful indicator of the types of drugs being used in Mohave County. In addition to cases brought about by drug related arrests, the court also oversees child welfare cases. When children are removed from their home by the Department of Economic Services (DES) due to abuse and neglect concerns, these children may become wards of the state. These dependency cases are managed by Child Protective Services and under the jurisdiction of Mohave County Family Court. It is estimated that approximately 90% of all children removed from their homes by the court come from families having substance abuse problems. For this reason, a review of child welfare reports and child dependency cases is valuable in assessing substance abuse in families in Mohave County. 3.1 Courts For the purpose of this report, court cases for Bullhead City, Lake Havasu City and Kingman courts were reviewed. Moccasin Justice Court and Colorado City Municipal Court were not considered since these courts are located in the Colorado Strip area which is not a target area for this Needs Assessment. The original court data which was used to create the following tables and figures is included in Appendix E. Figure 3‐1 presents a line graph of all drug cases filed in the municipal courts, justice courts and superior courts. Misdemeanors are filed in either municipal court or justice court; municipal court handling cases within city limits and justice court handling cases which occur in county jurisdiction. All felony cases are filed in superior court. However, drug cases can originally be charged as misdemeanors or felonies, depending upon the discretion of law enforcement or the charging agency. When charged as a felony, all defendants have a right to a preliminary hearing before a case goes to superior court. The practice in Mohave County has been to charge a felony case into justice court. Then, if the case merits felony [38] prosecution, the matter is presented to the Grand Jury in lieu of a preliminary hearing. These cases pass through the justice court to superior court without a determination of guilt at the justice court level. This may explain the differing trends in justice court for the number of cases filed and number of convictions (presented below in Figures 3‐1 and 3‐2). The justice courts handle the majority of the cases and superior court handles the fewest. However, the felony cases handled in superior court would typically be more complex than the misdemeanor cases handled in the lower courts. Drug case filings have decreased in both the justice courts and municipal courts over the past several years. Though superior court has observed a decrease in drug case filings since a peak in 2006, its six year trend is more stable than the other courts. Figure 3‐1: Drug Cases Filed in Mohave County Court System A six year review of drug cases filed in the municipal courts (Table 3‐1) reveals Bullhead City filed the most cases, followed by Lake Havasu City and lastly, Kingman. During this time span, the case load for all municipal courts decreased substantially; Kingman by 68%, Lake Havasu City by 56% and Bullhead City by 54%. [39] Table 3‐1: Drug Cases Filed in Municipal Courts DRUG CASES FILED IN MUNICIPAL COURTS COURT Bullhead City Municipal Court 2004 2005 2006 2007 2008 2009 439 405 263 285 233 203 Kingman Municipal Court 253 243 168 66 108 81 Lake Havasu City Municipal Court 433 389 380 318 227 189 TOTAL 1125 1037 811 669 568 473 With respect to justice court, Bullhead City receives the most filings for drug related cases followed by Kingman and then Lake Havasu City (Table 3‐2). It is likely that one factor which contributes to Bullhead City’s high number of drug related case filings (in both municipal and justice court) is the city is a vacation destination where recreational drug use by tourists is common. Lake Havasu City is also a popular vacation destination where a significant amount of recreational drug use by a transient population occurs. However, the Lake Havasu City Justice Court is a much smaller court which may account for its smaller case load. As with the municipal courts, the case load in justice courts have also declined. Lake Havasu City had the largest decline at 56%, followed by Bullhead City at 35% and Kingman at 26%. Table 3‐2: Drug Cases Filed in Justice Courts DRUG CASES FILED IN JUSTICE COURTS COURT Bullhead City Justice Court 2004 2005 2006 2007 2008 2009 1130 1326 1351 745 845 738 Kingman Justice Court 898 887 684 740 672 665 Lake Havasu City Justice Court 433 389 380 318 227 189 TOTAL 2461 2602 2415 1803 1744 1592 [40] The number of felony cases filed in Mohave County experienced a six year low in 2008 following a six year peak in 2006. Though felony case filings increased again in 2009 (Table 3‐3), it remained below the number of filings received in any given year from 2004 through 2007. Table 3‐3: Drug Cases Filed in Superior Court DRUG CASES FILED IN SUPERIOR COURT COURT 2004 2005 2006 2007 2008 2009 Superior Court 612 576 755 607 432 513 As with drug related case filings, guilty drug convictions in all courts have shown an overall decline since 2004. Whereas convictions in the justice courts and superior court peaked in 2006 and have declined since then, municipal court convictions had a steady six year reduction. Figure 3‐2: Guilty Drug Convictions in Mohave County Guilty drug convictions in municipal courts have reduced substantially in the past six years (Table 3‐4). Kingman had the biggest drop with 2009 guilty drug convictions only 23% of what they were in 2004. Bullhead City and Lake Havasu City are 29% and 36%, respectively, of what they were in 2004. [41] Table 3‐4: Guilty Drug Convictions in Municipal Courts GUILTY DRUG CONVICTIONS IN MUNICIPAL COURTS COURT Bullhead City Municipal Court 2004 2005 2006 2007 2008 2009 223 190 134 118 94 64 Kingman Municipal Court 169 153 95 35 63 39 Lake Havasu City Municipal Court 338 299 277 221 149 123 TOTAL 730 642 506 374 306 226 The three justice courts each have their own distinct trends in guilty drug convictions over time. The statistics for each justice court are shown in Table 3‐5 and illustrated in a line graph in Figure 3‐3. With some variation which is unique to each court, Bullhead City and Kingman Justice Courts have had an overall decrease in convictions whereas Lake Havasu City Justice Court has had an increase in convictions. Table 3‐5: Guilty Drug Convictions in Justice Courts GUILTY DRUG CONVICTIONS IN JUSTICE COURTS COURT Bullhead City Justice Court 2004 2005 2006 2007 2008 2009 249 266 327 177 189 179 Kingman Justice Court 439 424 381 397 345 342 Lake Havasu City Justice Court 98 128 180 181 146 145 TOTAL 786 818 888 755 680 666 [42] Figure 3‐3: Guilty Drug Convictions in Justice Courts Guilty felony (i.e. superior court) convictions for drug cases have decreased by 25% since 2004 (Table 3‐
6), whereas the number of felony drug case filings have decreased by only 16% (Table 3‐3) in the same time span. Superior court was the only court in Mohave County that had an increase in the number of convictions from 2008 and 2009, in accord with the increased number of felony drug case filings. Table 3‐6: Guilty Drug Convictions in Superior Court GUILTY DRUG CONVICTIONS IN SUPERIOR COURT COURT 2004 2005 2006 2007 2008 2009 Superior Court 364 369 445 378 246 271 3.2 Arizona Criminal Justice Commission The Arizona Criminal Justice Commission (ACJC) distributes funds for fifty four programs throughout the state which are able to operate in large part due to the Drug and Gang Enforcement Account. This account provides funding for the implementation of the statewide enhanced drug enforcement strategy; a strategy which depends on narcotics enforcement agencies in operation throughout the state. In Mohave County, this agency is MAGNET. In addition to drug apprehension, records improvement, drug offender adjudication and detention, drug analysis and drug abuse education/prevention, the Drug and Gang Enforcement Account also compensates for prosecution costs for criminals that are apprehended through efforts resulting from this program. [43] Prosecution data from this program is summarized in the Enhanced Drug and Gang Enforcement Report (EDGE) each year. This report may be accessed at www. azcjc.gov. The prosecution data was reviewed for fiscal years 2006 through 2009. Mohave County was compared against the seven most populous counties in Arizona. The number of drug cases was divided by the population to derive per capita statistics. Table 3‐7 provides these figures. Among the counties analyzed, Mohave County ranks among the highest in per capita drug cases for all years reviewed. Mohave County’s data is reported at the time the case is closed out so each case is counted only once. Reporting procedures for other counties may differ and therefore have an impact on the statistics presented here. Table 3‐7: Drug Cases Per 1000 Residents DRUG CASES PER 1000 RESIDENTS COUNTY Coconino Maricopa Mohave Yavapai Pima Pinal Yuma FY2006 3.5 4.5 5.5 4.2 6.9 1.9 4.6 FY2007 4.3 4.4 7.9 2.8 6.9 1.7 7.9 FY2008 3.0 3.9 5.2 3.6 4.0 1.5 8.3 FY2009 2.6 2.6 3.9 4.0 3.7 1.2 10.0 A line graph of the data in Table 3‐7 clearly illustrates Mohave County’s high ranking in per capita drug cases (Figure 3‐4). Figure 3‐4: Drug Cases per 1000 Residents [44] ACJC also reports on the type of drug(s) affiliated with each conviction. Table 3‐8 lists the distribution of drug types for convictions from FY2007 to FY2009. Marijuana and methamphetamine stand out as the substances most often related to convictions in Mohave County. Table 3‐8: Conviction by Drug Type in Mohave County CONVICTION BY DRUG TYPE IN MOHAVE COUNTY Year FY2007 FY2008 FY2009 Paraphernalia Methamphetamine
64% 15% 74% 12% 74% 11% Marijuana 18% 11% 11% Cocaine 1% 1% 1% Heroin 0% 0% 0% Other/Unknown 2% 2% 3% 3.3 Mohave County Child Dependency Statistics Substance abuse in families which are investigated by Child Protective Services is very common. In fact, the accepted statistic for substance abuse in families of dependent children is usually somewhere between 85% and 95%. In 2006, a survey was done for all active Mohave County dependency cases and it was determined that 85% of cases had homes with confirmed substance abuse problems and at least another 5% of cases had suspected substance abuse problems in the home. At that time, the distribution of known drugs involved in these cases was 63.5% methamphetamine, 17.3% marijuana, 5.8% alcohol and 1.9% heroin. On 29 July 2009, the Honorable Richard Weiss, the Presiding Juvenile Judge in Mohave County Superior Court (at that time) issued the following statement in response to a question about the prevalence of substance abuse in dependency cases. My response is not based upon any collected statistics, rather general perceptions from the bench. I would estimate that virtually all of our dependency cases involve the abuse of some substance. Perhaps we have 5% of all cases where the issues are only mental health or destitution without substance abuse issues. Mohave County has experienced a substantial increase in filings of dependency cases during the last three years. Approximately 40% of the cases involve infants and toddlers (0‐5). Of this group of cases a large proportion are substance exposed newborns (SEN). Unfortunately for the parents of these children, most children achieve permanence in an adoptive home as the impact of the substances controlling many of these parent’s lives is greater than their ability to achieve behavioral change during the first six to twelve months of the infant’s life. We may also be seeing inconsistent protocols at the county’s hospitals in effectively determining whether a child is born substance exposed. We are aware that proper identification at birth, regardless of whether a dependency action is filed, is critically important to understand and when needed develop appropriate mental health [45] interventions for these children. The study of prenatal effects of parental substance abuse is starting to identify areas of concern where early interventions may environmentally assist a child’s development. In my view this is the area where a community may have its greatest impact in addressing the detrimental influence of substance abuse. For the older children of substance abusing parents in foster care we tend to see the environmental impacts of these abuses on the children, whether it is educational delays or adolescent maturity issues. Dealing with these issues tend to be more costly compared to earlier interventions. Mohave County Family Court provided dependency statistics for 2006 through 2009 (Appendix F). This data included the number of children and the number of case filings for the entire county as well as the individual cities of Kingman, Bullhead City and Lake Havasu City. Each city area includes not only the city itself but the surrounding county areas as well. As Table 3‐9 and Figure 3‐5 show, the number of dependency case filings and the number of children in dependencies have steadily increased in the past four years. According to Su Hensler, Assistant Program Manager for District IV, DES Division of Children, Youth and Families, several reasons account for the increase in dependency filings in recent years. Two factors she pointed out as probably being among the most important are 1) the growing population in Mohave County and 2) the use of enhanced assessment tools to better evaluate the safety and security of the home environment. Ms. Hensler pointed out that the increased number of dependencies should be considered a good thing for Mohave County since it is likely more children are being kept out of harm’s way. Table 3‐9: Mohave County Dependency Statistics MOHAVE COUNTY DEPENDENCY STATISTICS Year 2006 2007 2008 2009 Total Case Filings 43 59 76 87 Total Children 72 105 134 147 [46] Figure 3‐5: Mohave County Dependency Statistics Figures 3‐6 through 3‐8 presents the dependency data for each city area. Case filings are normally equivalent to households, so we shall consider the trends of case filings herein. Since 2006, all communities have observed an increase in cases (i.e. dependent households) with Bullhead City and Lake Havasu City having the greatest increase at 59% and 58%, respectively. Though Kingman has a lower rate of increase, at 39%, it has significantly more case filings than the other two cities. In fact, in any given year, Kingman has more case filings than the other two cities combined. The reasons for Kingman’s larger number of case filings are not well defined, but are probably related to the very large rural area which the Kingman Child Protective Services (CPS) office oversees. Another factor is related to Kingman’s location on Highway I‐40 at the intersection of Highway 93 to Las Vegas. This geographic location draws a larger transient population than observed in Bullhead City and Lake Havasu City. Much of this transient population is not considered in census counts, but children in transient families are at high risk for dependencies. [47] Figure 3‐6: Bullhead City Dependency Statistics Figure 3‐7: Lake Havasu City Dependency Statistics [48] Figure 3‐8: Kingman Dependency Statistics 3.4 Child Welfare Reports Child Welfare Reports are prepared biannually by DES Division of Children, Youth and Families (the Division). Through the Division, the state of Arizona works to ensure safety and promote permanency for abused and neglected children. DES recognizes the prevalence of substance abuse among families of children in state custody. In fact, they consider the provision of substance abuse treatment critical to supporting Child Protective Services in making reasonable efforts, as required by federal and state law, to reunify families impacted by substance abuse. The Child Welfare Reports are posted on DES’s web site, www.azdes.gov. These reports provide statistical information on child abuse and neglect, investigations, shelter and receiving home services, foster homes, length of care, and adoptions. MSTEPP reviewed the reports from October 2005 through September 2009. The per capita statistics for Mohave County were compared to six other of the most populous counties in Arizona as well as the state as a whole. The annual reporting time period is 1 October through 30 September. Statistical information presented here from these reports include the total number of reports received, the total number of reports assigned for investigation, and the total number of children entering out‐of‐home care who do so under Voluntary Placement Agreements. Reports of child abuse and neglect are made to the Child Abuse Hotline. A report must meet DES’s criteria for abuse or neglect. In 2009, Mohave County received 56 reports per 10,000 residents (living in Mohave County). This is 15% lower than the number of reports received in 2006, when 66 reports were received per 10,000 residents. Collating this data for four years with the six selected Arizona Counties [49] (Table 3‐10), indicates Mohave County has ranked among the three highest counties in the number of reports received per capita since 2006. Table 3‐10: Child Welfare Reports per 10,000 County Residents Reports Per 10,000 Residents County MARICOPA PIMA MOHAVE YAVAPAI PINAL YUMA STATE 2006 52 66 66 55 66 45 2007 51 62 61 51 68 41 2008 51 63 58 46 63 39 2009 49 61 56 46 59 35 55 54 53 51 Figure 3‐9 charts the county and state reporting data in a line graph. The state statistics include all county statistics in Arizona (not just the seven counties listed). The line graph clearly shows that the number of reports per capita in Mohave County (solid red line) is well above the state average (solid black line). Figure 3‐9: Child Welfare Reports Per 10,000 County Residents [50] Each report received by the Child Abuse Hotline must meet the statutory criteria for it to be assigned for investigation. Table 3‐11 lists investigations per 10,000 county residents for Mohave County as well as the other selected Arizona counties and the state. Table 3‐11: Investigations per 10,000 County Residents Investigations Per 10,000 Residents MARICOPA PIMA MOHAVE YAVAPAI PINAL COCONINO YUMA STATE 2006 52 65 66 55 64 55 45 2007 51 61 60 51 67 51 41 2008 51 62 57 45 61 48 39 2009 49 60 56 46 57 46 35 55 53 52 50 The pattern for Mohave County investigations is similar to the pattern for Mohave County reports. As with reports, Mohave County has observed a decrease in investigations over time, but remains well above the state average. Among the selected counties, Mohave County ranked 3rd highest in the number of investigations per capita for 2007 through 2009, and ranked highest in 2006, equal with two other counties. Figure 3‐10: Investigation Per 10,000 County Residents [51] The number of children entering out‐of‐home foster care through Voluntary Placement Agreements increased in Mohave County between 2006 and 2007 and has been decreasing since that time (Table 3‐
12). Voluntary placements into foster care are not entered into the court system and are not considered dependencies (which were discussed in the prior section). Voluntary Placement Agreements are offered to parents who willingly place their children into a foster home and grant CPS legal custody of their children. Voluntary Placement Agreements are only offered to families whom CPS believes can remedy their situation within 90 days. Table 3‐12: Children in Voluntary Out‐of‐Home Placement per 100,000 County Residents Kids in Out‐of‐Home Care per 100K Residents County MARICOPA PIMA MOHAVE YAVAPAI PINAL COCONINO YUMA 2006 105 179 77 145 179 114 95 2007 103 175 104 117 169 105 95 2008 118 204 98 112 124 82 55 2009 107 191 81 86 109 74 47 STATE 121 118 125 113 A review of the line graph for children in out‐of‐home placements reveals that Mohave County is below the state average in out‐of‐home placements; ranking 3rd from the bottom (among the selected Arizona counties) in 2008 and 2009, 2nd from bottom in 2007, and ranking the lowest in 2006. Figure 3‐11: Children in Voluntary Out‐of‐Home Placement per 10,000 County Residents [52] This last graph appears to show an anomaly for Mohave County. Upon examination of the graphs presented above, a pattern is discernable when reports, investigations and out‐of‐home placements are compared. Counties ranking above the state average in reports and investigations also rank above the state average in out‐of‐home placements (i.e. Pima, Pinal). Likewise, counties ranking below the state average in reports and investigations, also rank below the state average in out‐of‐home placements (i.e. Yuma). Counties ranking in the mid‐range for reports and investigations were roughly in the mid‐range for out‐of‐home placements (Maricopa, Yavapai). Contrary to this pattern, Mohave County ranks consistently above the state average in reports and investigations, but ranks consistently below the state average in out‐of‐home placements. In fact, in 2006 Mohave County was the highest ranking county in reports and investigations (among the selected counties reviewed) yet ranked the lowest in out‐of‐home placements. The Division explains there are multiple reasons for Mohave County’s unusually low out‐of‐home placement statistics. For instance, there are frequently multiple reports on a single family which may result in only a single removal. Also, children may be placed with family members who are not considered in DES’s out‐of‐home care statistics. It was noted that extended families are more likely to be available in rural areas like Mohave County than in urban areas. Another reason for the discrepancy may be that Mohave County has more children re‐entering voluntary placement which isn’t reflected in the statistics. DES assures that regardless of the statistics, children will be removed if there is a safety risk in the home. The Division acknowledges it faces a number of challenges in its efforts to ensure safety and promote permanency for abused and neglected children. These challenges include: 1. Retention of trained and qualified staff. 2. Increased expectations for staff to implement new practices and meet new federal requirements without adequate funding. 3. Economic factors which create additional stress upon families and increases factors that place children at risk of maltreatment. 4. Funding cuts to the Division have had devastating impacts on services. These impacts have been felt through reduced staffing, severe reductions in the preventative and family support services provided by the Division and large decreases in the amount of in‐home services provided to clients. They also indicate that as the economic crisis continues, the prospect of further funding cuts will yield yet greater impacts to clients and services. 3.5 Probation Mohave County Probation provided statistics for probationers on drug charges and drug testing results. Figure 3‐12 is a bar graph showing the number of probationers on drug charges each year for 2007 through 2009. This graph shows that 2009 had the highest number of people on probation due to drug charges. There was a total variation of 5.7% over this three year span. [53] Figure 3‐12: Mohave County Probationers on Drug Charges Drug testing of probationers revealed positive drug test results of 15% to 17% for those tested. This percentage of positive drug tests held steady despite a significant increase in the number of drug tests conducted between 2007 and 2009 (from 2866 tests to 5246 tests). Table 3‐13 and Figure 3‐13 shows the percentage and type of drugs with positive test results in 2008 and 2009. The drug most commonly detected was marijuana (34.4% ‐ 36.4%) followed by amphetamine (24.1% ‐ 26.1%) and alcohol (23.0% 0 25.0%). Table 3‐13: Mohave County Probation Drug Test Results DRUG TEST RESULTS Drug Amphetamine Alcohol THC Opiates Cocaine 2008 24.1% 25.0% 34.4% 15.2% 0.9% [54] 2009 26.1% 23.0% 36.4% 13.2% 1.3% Figure 3‐13: Mohave County Probation Drug Test Results 3.6 Closing Remarks on Courts, Child Welfare and Probation When assessing the number of drug case filings in the court system, it should be kept in mind that the volume of cases filed is related to the number of arrests made by law enforcement. Therefore, it is unsurprising that we observe a decrease in drug related case filings since we also have experienced a decrease in drug related arrests (as reported by Mohave County jail) since 2005. A comparison of drug related cases filed in the municipal and justice courts reveals that Bullhead City courts have a greater number of cases filed than either of the other communities. This is consistent with the higher number of arrests out of Bullhead City Police Department. One likely reason for this is that Bullhead City is a vacation destination where recreational drug use by tourists is common. Though the case load in both Bullhead City Municipal and Justice Courts is largest, the number of guilty drug convictions in these courts is below Lake Havasu City Municipal Court and Kingman Justice Court. In Mohave County Superior Court the number of felony convictions increased between 2008 and 2009. This is the only court in Mohave County that observed an increase in convictions since 2006. The per capita number of drug related cases prosecuted under the Drug and Gang Enforcement Account in Mohave County (i.e. crimes prosecuted by MAGNET) for the years FY2006 through FY2009 is among the highest in Arizona. Among the seven counties assessed (Coconino, Maricopa, Mohave, Yavapai, Pima, Pinal, Yuma) Mohave County has among the highest per capita number of prosecuted drug cases, occasionally ranking above both Pima and Yuma County. This is striking considering that Pima and Yuma Counties border Mexico and are the front line against drug trafficking from Mexico. The drugs most often related to convictions in Mohave County are marijuana and methamphetamine. [55] A steady increase in the number of dependency case filings has occurred throughout Mohave County since 2006. Reasons for this increase are many, but include a growing population and the use of improved assessment tools at CPS. The city of Kingman has the lowest rate of increase in case filings although, in any given year, it files more dependency cases than Bullhead City and Lake Havasu City combined. The large rural area administered by the Kingman CPS office and the transient population of the city help account for Kingman’s high number of dependencies. Statistics on dependency case filings from other Arizona counties were not available for review. Although Mohave County ranks above the statewide average in the per capita number of reports and investigations, it ranks below the statewide average in per capita number of Voluntary Placement Agreements. This is anomalous with the rest of the state which maintains a fairly consistent ranking in number of reports, investigations and Voluntary Placement Agreements. The reasons for Mohave County’s anomaly are not well defined, but DES acknowledges that Mohave County has a long, hard history of substance abuse, and agrees there is a strong relationship between substance abuse and child abuse and neglect. In their view, recreational drug use spirals into addiction quickly in Mohave County due to the high availability of drugs and the lack of residential and intensive out‐patient treatment services. Drug tests on Mohave County probationers show that positive test results are most often attributed to marijuana, amphetamine and alcohol. This is consistent with other drug data collected by the courts. [56] 4.0 MOHAVE COUNTY TREATMENT SERVICES AND SUBSTANCE ABUSE SURVEYS A review of the treatment services and substance abuse surveys in Mohave County and Arizona is important to identify the types of substances of concern for the region as well as assessing the needs and service gaps for treatment. State level data, sub‐state level data and community data were all reviewed. The state and county level data was retrieved from reports and data sets prepared by SAMHSA (Substance Abuse and Mental Health Services Administration), Arizona Families First, Arizona Department of Health Services and Arizona’s Substance Abuse Epidemiology Work Group. Data from local health service providers, such as Fort Mojave Behavioral Health, TASC, and area hospitals, is also presented. It is common that reports and data sets present their data by Regional Behavioral Health Areas rather than County. Mohave County is included in the Northern Arizona region or NARBHA (Northern Arizona Regional Behavioral Health Authority) area. NARBHA is a private, not‐for‐profit agency responsible for funding, monitoring and administering publicly funded behavioral health services in Northern Arizona. NARBHA serves over 700,000 people in 62,000 square miles which includes the entire northern half of Arizona. 4.1 SAMHSA SAMHSA is the lead Federal Agency which works to promote substance abuse prevention and improve access to addiction treatment and mental health services in the United States. Within SAMHSA, the Office of Applied Studies (OAS) collects, analyses and disseminates critical substance abuse health data to the public. A quick web search on the OAS web site provides a tremendous amount of valuable information regarding illicit drug and alcohol abuse, treatment, emergency department episodes, and medical examiner cases. However, with a couple of exceptions, most of this information is presented at a national and state level so that trends within a state cannot be analyzed. The exceptions to this are two annual surveys conducted by OAS called NSDUH and N‐SSATS. NSDUH (National Survey on Drug Use and Health) is a nationwide survey which collects information on alcohol, tobacco, marijuana and other drug abuse. The NSDUH data is made available in sub‐state areas for the express purpose of illustrating the geographic distribution of substance use prevalence so that states may appropriately plan for treatment services. The other survey which provides data at a sub‐
state level is the N‐SSATS (National Survey of Substance Abuse Treatment Services). This annual survey collects information from substance abuse treatment facilities, both public and private, that provide outpatient, residential and hospital treatment services. [57] 4.1.1 NSDUH The National Survey on Drug Use and Health is an annual survey which has been conducted on the civilian, non‐institutionalized population aged 12 or older at a sub‐state level since 1999. Approximately 362 sub‐state regions, also called Treatment Planning Areas, are evaluated in the 50 States plus the District of Columbia (there are minor variations in the number of sub‐state regions from year to year). The results of this survey provide estimates of substance dependence, abuse, and treatment. All estimates available to the public meet the criteria for statistical reliability (defined in SAMSHA’s full reports on the survey results accessible at http://oas.samhsa.gov). Estimates that do not meet these criteria are suppressed. Treatment Planning Areas are defined by officials from each State. In Arizona, four areas have been defined by the Arizona Division of Behavioral Health Services: Maricopa, Pima, Rural North, and Rural South (Figure 4‐1). Figure 4‐1: Treatment Planning Areas within Arizona Rural North is equivalent to the area of Arizona covered by NARBHA and includes Mohave, Apache, Coconino, Navajo and Yavapai Counties . The sampling size for each state and Treatment Planning Area varies based on the population. Arizona’s sample size is about nine hundred. Youths and young adults [58] are oversampled so that the sampling is approximately equally distributed among three age groups: 12 to 17 years, 18 to 25 years, and 26 years or older. Respondents are selected randomly. Surveys are conducted in person using an audio computer‐assisted self‐interviewing (ACASI) method. The respondent wears headphones, listens to the questions, and answers using a laptop computer. This highly private and confidential mode for responding to questions increases the level of honest reporting of illicit drug use and other sensitive behaviors. Answers are non‐traceable. Less sensitive items are administered by interviewers using an computer‐assisted personal interviewing (CAPI) method. Three NSDUH data sets were reviewed for this report. The first data set was an annual average based on surveys conducted in 2002, 2003 and 2004. The second data set was an annual average based on surveys conducted in 2004, 2005 and 2006. The last data set was an annual average based on surveys conducted in 2006, 2007 and 2008. Each data set was reviewed according to age groups: 12‐17, 18‐25, 26 or older. NSDUH measures substance use in five broad areas: illicit drug use, alcohol use, tobacco use, substance dependence and abuse, substance use treatment need, and serious psychological distress (SPD). Marijuana is the most commonly used illicit drug in the U.S. and its use in Northern Arizona ranks in the medium to high range in the United States. Illicit drugs other than marijuana include cocaine (and crack), heroin, hallucinogens, inhalants, or any prescription‐type psychotherapeutic used nonmedically. Explanation of Ranking/Tables For this report, the rate of substance use or perception of risk for the Rural North (NARBHA) was compared to the other Treatment Planning Areas in Arizona and given a rank within the state. The ranking range is from one through four (for each of the Treatment Planning Areas in Arizona). A rank of one indicates that the Rural North is estimated as having the highest rate of substance use in the state. A rank of four is the lowest rate in the state. In the case of perceptions of risk, a rank of one indicates that sub‐state region has the lowest perception of risk, meaning that it may be most likely to participate in the risky behavior. When considering the relative ranking within the state, it should be kept in mind that differences in rank may be a very small difference, such as a fraction of a percent. The original NSDUH data sets (www.oas.samhsa.gov) should be evaluated for more detailed information on the inner‐state survey results. In addition to showing the rank of the Rural North substance use/dependence within the state, we have also shown substance use/dependence as an estimated percentage of the population. We show this for the Rural North, the state, and the country. We believe this provides the most straight forward assessment of how the Rural North’s substance abuse problem compares to the state as whole as well as the country as a whole. [59] Ages 12‐17 NSDUH estimates for ages 12 through 17 indicate illicit drug use among youth in the Rural North has decreased steadily between 2002 and 2008 (Tables 4‐1 and 4‐2). Estimates from earlier years showed the Rural North as having among the highest rates of use in the entire country. Though the percentage of illicit drug use among youth in the Rural North have decreased substantially, it is still above the national average. Table 4‐1: Illicit Drug Use in Past Month, Ages 12‐17 Table 4‐1 Illicit Drug Use in Past Month 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 1 1 3 % in Rural North 16.12 12.43 10.22 % in AZ 11.97 11.02 10.43 % in U.S.A. 11.19 10.08 9.54 Table 4‐2: Illicit Drug Use Other Than Marijuana in Past Month, Ages 12‐17 Table 4‐2 Illicit Drug Use Other Than Marijuana in Past Month 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 1 1 2 % in Rural North 8.09 6.69 5.71 % in AZ 6.67 5.54 6.1 % in U.S.A. 5.57 5.03 4.66 The use of cocaine among youth has demonstrated the same decrease over time as other illicit drugs (Table 4‐3). Likewise, the percentage of youth using cocaine in the Rural North is also above the national average. Table 4‐3: Cocaine Use in Past Year, Ages 12‐17 Table 4‐3 Cocaine Use in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 1 3 4 % in Rural North 3.44 2.11 1.91 % in AZ 2.87 2.37 2.31 % in U.S.A. 1.81 1.64 1.45 Nonmedical use of pain relievers by youth took a dip in 2004‐2006 throughout Arizona, but resurged in 2006‐2008. The country as a whole has shown a steady decline between 2002 and 2008. The Rural North ranks second within Arizona and is well above the national average. [60] Table 4‐4: Nonmedical Use of Pain Relievers in Past Year, Ages 12‐17 Table 4‐4 Nonmedical Use of Pain Relievers in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 1 3 2 % in Rural North 10.07 7.49 8.96 % in AZ 8.73 7.78 8.93 % in U.S.A. 7.53 7.14 6.75 Within the state, marijuana use in the past month for the Rural North consistently ranks first or second (Table 4‐5). However, there is a decreasing trend in this category for all areas, the Rural North, the state, as well as the country. The 2006‐2008 survey shows the percentage of use in the Rural North equal to the national average. The state of Arizona is below the national average. Table 4‐5: Marijuana Use in Past Month, Ages 12‐17 Table 4‐5 Marijuana Use in Past Month 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 1 2 2 % in Rural North 10.61 8.33 6.68 % in AZ 7.73 7.6 6.55 % in U.S.A. 7.89 6.99 6.68 A review of Rural North youth on their perception of the risk associated with smoking marijuana, drinking alcohol and smoking cigarettes shows a poorer perception of risk in 2008 than in 2002. Within Arizona, the Rural North ranks first or second in the state in NSDUH’s most recent “Perceptions of Risk” surveys (Table 4‐6) Table 4‐6: Perceptions of Risk of Substance Use in Rural North, Ages 12‐17 Table 4‐6 Perceptions of Risk of Substance Use 2002‐2004 2004‐2006 2006‐2008 Perceptions of Great Risk of Smoking Marijuana Once Per Month Perceptions of Great Risk of Having Five or More Drinks of an Alcoholic Beverage Once or Twice a Week 1 1 * 4 3 2 Perceptions of Great Risk of Smoking One or More Packs of Cigarettes Per Day 3 2 1 [61] In the past, youth in the Rural North have ranked among the highest in the country for “Dependence On or Abuse Of Alcohol And Illicit Drugs In The Past Year”, as well as “Needing and Not Receiving Treatment for Alcohol and Illicit Drug Use In The Past Year”. However, the most recent surveys indicate improvements in these areas have occurred (Tables 4‐7 and 4‐8). Table 4‐7: Dependence On or Abuse of Illicit Drugs or Alcohol in Past Year, Ages 12‐17 Table 4‐7 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year Rank in AZ % in Rural North % in AZ % in U.S.A. 2002‐2004 1 12.63 10.7 8.87 2004‐2006 4 9.74 9.27 8.27 2006‐2008 3 7.92 8.27 7.78 Table 4‐8: Needing But Not Receiving Treatment for Illicit Drug Use in Past Year, Ages 12‐17 Table 4‐8 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year Rank in AZ % in Rural North % in AZ % in U.S.A. 2002‐2004 2 6.75 6.76 5.01 2004‐2006 4 4.81 5.46 4.53 2006‐2008 4 4.04 4.36 4.21 Though the survey question of “Having at Least One Major Depressive Episode in Past Year” was only asked for the first time to this age group in the last NSDUH report, the results are noteworthy. Rural North youth ranked among the highest in the country. They also ranked first in Arizona. Ages 18‐25 For all NSDUH reports reviewed, the age group of 18‐25 in the Rural North has consistently ranked first or second in Arizona for illicit drug use and dependence, nonmedical use of pain relievers, alcohol dependence and abuse, and needing but not receiving treatment for drugs and/or alcohol. Though several years worth of surveys on various questions were not statistically reliable enough to be [62] presented in the data sets, those that were reliable clearly show that substance use for this age group in the Rural North is significantly higher than the state as a whole or the country (Table 4‐9 through 4‐14). Table 4‐9: Illicit Drug Use Other Than Marijuana in Past Month, Ages 18‐25 Table 4‐9 Illicit Drug Use Other Than Marijuana in Past Month 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 2 1 1 % in Rural North 8.49 9.04 10.58 % in AZ 7.93 8.10 10.25 % in U.S.A. 8.15 8.53 8.25 % in AZ 12.48 15.03 14.16 % in U.S.A. 11.76 13.64 12.21 % in AZ 8.59 8.1 7.41 % in U.S.A. 6.92 7.28 7.37 Table 4‐10: Nonmedical Use of Pain Relievers in Past Year, Ages 18‐25 Table 4‐10 Nonmedical Use of Pain Relievers in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 2 2 1 % in Rural North 12.19 * 15.82 Table 4‐11: Alcohol Dependence in Past Year, Ages 18‐25 Table 4‐11 Alcohol Dependence in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 2 1 2 % in Rural North 9.07 10.1 7.93 Table 4‐12: Illicit Drug Dependence or Abuse in Past Year, Ages 18‐25 Table 4‐12 Illicit Drug Dependence or Abuse in Past Year Rank in AZ % in Rural North % in AZ % in U.S.A. 2002‐2004 2004‐2006 2006‐2008 2 1 2 8.5 8.45 8.85 7.73 6.91 8.17 8.1 8.17 7.88 [63] Table 4‐13: Needing But Not Receiving Treatment for Alcohol Use in Past Year, Ages 18‐25 Table 4‐13 Needing But Not Receiving Treatment for Alcohol Use in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ % in Rural North % in AZ % in U.S.A. 1 2 2 19.59 18.19 17.22 18.75 16.81 16.31 16.74 16.79 16.58 Table 4‐14: Needing But Not Receiving Treatment for Illicit Drug Use in Past Year, Ages 18‐25 Table 4‐14 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ % in Rural North % in AZ % in U.S.A. 1 1 2 8.18 7.48 7.7 7.25 6.44 7.32 7.52 7.55 7.32 When compared to the rest of the country, the Rural North and Arizona is consistently at or above the national average for substance use and dependence for ages 18‐25. For cocaine use in the past year, Arizona has among the highest rates in the country (Table 4‐15). For illicit drug dependence in the past year, Arizona is pretty close to the national average, but the rates in the Rural North are among the United States’ highest figures in this category (Table 4‐16). The same is true for alcohol dependence in the past year (Table 4‐17). Table 4‐15: Cocaine Use in Past Year, Ages 18‐25 Table 4‐15 Cocaine Use in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 3 3 4 [64] % in Rural North 8.12 7.65 7.43 % in AZ 8.59 8.35 8.55 % in U.S.A. 6.66 6.75 6.26 Table 4‐16: Illicit Drug Dependence in Past Year, Ages 18‐25 Table 4‐16 Rank in AZ 1 1 2 Illicit Drug Dependence in Past Year 2002‐2004 2004‐2006 2006‐2008 % in Rural North 6.5 6.58 6.27 % in AZ 5.74 4.84 5.62 % in U.S.A. 5.42 5.58 5.51 Table 4‐17: Alcohol Dependence in Past Year, Ages 18‐25 Table 4‐17 Alcohol Dependence or Abuse in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ * 1 1 % in Rural North * 20.71 19.14 % in AZ 19.18 17.18 17 % in U.S.A. 17.31 17.34 17.19 As with the youth, perceptions of the risk associated with smoking marijuana, smoking cigarettes and drinking alcohol were among the worst in the state (Table 4‐18). Table 4‐18: Perceptions of Risk of Substance Use Table 4‐18 2002‐
2004 2004‐
2006 2006‐
2008 Perceptions of Great Risk of Smoking Marijuana Once Per Month 2 2 2 Perceptions of Great Risk of Having Five or More Drinks of an Alcoholic Beverage Once or Twice a Week 2 2 1 Perceptions of Great Risk of Smoking One or More Packs of Cigarettes Per Day 1 1 1 Perceptions of Risk of Substance Use Ages 26 or Older Estimates for ages 26 and older in Arizona (and consequently, the Rural North) rank well above the national average for “Illicit Drug Use in Past Month”, “Illicit Drug Use Other Than Marijuana in Past Month”, “Cocaine Use in Past Year”, “Nonmedical Use of Pain Relievers in Past Year” and “Needing but Not Receiving Treatment for Illicit Drug Use in Past Year” (Tables 4‐19 through 4‐23). [65] Table 4‐19: Illicit Drug Use in Past Month, Ages 26 or Older Table 4‐19 Illicit Drug Use in Past Month 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 1 3 3 % in Rural North 7.01 5.91 6.81 % in AZ 6.27 5.95 7.09 % in U.S.A. 5.67 5.87 5.96 Table 4‐20: Illicit Drug Use Other Than Marijuana in Past Month, Ages 26 or Older Table 4‐20 Illicit Drug Use Other Than Marijuana in Past Month 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 3 3 3 % in Rural North 3.21 3.17 3.49 % in AZ 3.45 3.37 4.03 % in U.S.A. 2.59 2.65 2.81 % in Az 2.64 2 2.44 % in U.S.A. 1.82 1.71 1.75 % in AZ 3.94 3.73 4.72 % in U.S.A. 3.16 3.31 3.53 Table 4‐21: Cocaine Use in Past Year, Ages 26 or Older Table 4‐21 Cocaine Use in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 3 3 3 % in Rural North 2.06 1.83 1.95 Table 4‐22: Nonmedical Use of Pain Relievers in Past Year, Ages 26 or Older Table 4‐22 Nonmedical Use of Pain Relievers in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in Az 4 3 2 [66] % in Rural North 3.67 3.67 4.91 Table 4‐23: Needing But Not Receiving Treatment for Illicit Drug Use in Past Year, Ages 26 or Older Table 4‐23 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ % in Rural North % in AZ % in U.S.A. 2 1 3 1.8 1.59 1.57 1.79 1.49 1.78 1.53 1.49 1.48 Other estimates which still rank the Rural North above the national average but show recent improvements which have brought the region more in‐line with the rest of the country include “Alcohol Dependence or Abuse in Past Year”, “Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year” and “Needing But Not Receiving Treatment for Alcohol Use in Past Year” (Tables 4‐24 through 4‐26). Table 4‐24: Alcohol Dependence or Abuse in Past Year, Ages 26 or Older Table 4‐24 Alcohol Dependence or Abuse in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ 3 2 3 % in Rural North 6.88 7.88 6.21 % in AZ 8.02 7.54 6.62 % in U.S.A. 6.22 6.29 6.18 Table 4‐25: Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year, Ages 26 or Older Table 4‐25 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year Rank in AZ % in Rural North % in AZ % in U.S.A. 2002‐2004 2004‐2006 2006‐2008 4 2 3 7.6 8.68 7.32 8.97 8.43 7.75 7.26 7.27 7.2 [67] Table 4‐26: Needing But Not Receiving Treatment for Alcohol Use in Past Year, Ages 26 or Older Table 4‐26 Needing But Not Receiving Treatment for Alcohol Use in Past Year 2002‐2004 2004‐2006 2006‐2008 Rank in AZ % in Rural North % in AZ % in U.S.A. 3 1 3 6.58 7.38 5.95 7.8 7.13 6.36 5.84 5.95 5.82 Perception of risk for Rural North adults 26 and over are the worst in the state for smoking cigarettes, smoking marijuana, and drinking alcohol (Table 4‐27). In every data set reviewed and for all ages, the understanding of perceived risk for substance use is either maintaining at the same level through the years or getting worse in the Rural North. Table 4‐27: Perceptions of Risk of Substance Use, Ages 26 or Older Table 4‐27 Perceptions of Risk of Substance Use Perceptions of Great Risk of Smoking Marijuana Once Per Month 2002‐04 4 2004‐06 2 2006‐08 1 Perceptions of Great Risk of Having Five or More Drinks of an Alcoholic Beverage Once or Twice a Week 3 1 1 Perceptions of Great Risk of Smoking One or More Packs of Cigarettes Per Day 1 1 1 Approximately 94% of the estimates collected in the Rural North for 2002‐2008 are above the national average. The good news is that the percentage of the population using, or depending on, illicit drugs and alcohol has decreased for many substances in recent years. However, there are notable exceptions. For instance, increases have occurred in nonmedical use of pain relievers and illicit drug use and/or dependence. All age groups in the Rural North rank well above the national average for abuse of pain relievers and illicit drugs, particular illicit drugs other than marijuana. The age group 18‐25 appears to have the biggest problem according the NSDUH. This age group also has an exceptionally high percentage of people having alcohol dependence and needing, but not receiving, treatment services. It is extremely important to note that “Perceptions of Risk” for all ages in the Rural North became progressively poorer between 2002 and 2008 for all substances surveyed. This implies the population as a whole does not properly understand the dangers of using cigarettes, marijuana and alcohol. [68] 4.1.2 N‐SSATS The National Survey of Substance Abuse Treatment Services (N‐SSATS) is an annual census of facilities which provide substance abuse treatment in the United States. Data collected in this survey includes the location, characteristics, and use of alcohol and drug abuse treatment facilities and services throughout the country. An analysis of this data is important to see how treatment services in Mohave County and NARBHA compare to the rest of the state and country. At a nationwide level, the 2009 survey results indicate outpatient treatment was offered by 81% of all facilities and accounted for 90% of all clients in treatment. Residential (non‐hospital) treatment was offered by 26% of all facilities and accounted for 9% of all clients in treatment. Hospital inpatient treatment was offered by 6% of all facilities and accounted for 1% of all clients in treatment. The N‐SSATS data differentiate between three major types of care – outpatient, residential (non‐
hospital), and hospital inpatient. This data includes all treatment services provided regardless of method of payment (private, public, donations or insurance) or if the facility is gender restricted. SAMSHA’s N‐SSATS Specialist, Dr. Cathie Alderks, prepared data sets specifically for this Needs Assessment that separated the data out for Mohave County, the NARBHA region, and the State of Arizona less the NARBHA region. This enables a comparison of services provided in these areas and helps assess treatment service gaps for NARBHA as well as Mohave County (within NARBHA). Dr. Alderks provided annual records since 2000 (2001 was excluded) for treatment services and residential utilization rates. The complete tables provided by Dr. Alderks are included in Appendix G. Outpatient Services ‐ The N‐SSATS recognize five different types of outpatient treatment services: Regular Outpatient, Intensive Outpatient, Day Treatment/Partial Hospitalization, Detoxification, and Methadone/ Buprenorphone. The number of clients served for each of these outpatient services from 2006 through 2009 is provided in Tables 4‐28 through 4‐31. For each outpatient service type, the number of clients served per area is compared to its estimated population (Arizona Department of Commerce Estimates) and shown as clients per 1000 people. The data reveal that for all years reviewed the proportion of the population receiving Outpatient Treatment Services in the NARBHA Region exceed the proportion of the population receiving these services in the rest of Arizona. Furthermore, the proportion of Mohave County residents receiving Outpatient Treatment Services is significantly higher than the statistic for the NARBHA Region. Likewise the Median Number of Clients per Facility for Mohave County is significantly higher than the rest of the state and NARBHA (see Appendix G). The data indicate that Outpatient Treatment Services in Mohave County is probably the most heavily utilized in Arizona. An analysis of 2009 data for clients receiving outpatient treatment services (Table 4‐28) shows that regular outpatient services in Mohave County are utilized 73% higher than NARBHA as a whole and 100% higher than the rest of Arizona (all counties in Arizona not in NARBHA). Intensive outpatient services are utilized far less in Mohave County than they are used throughout the rest of NARBHA or the state. This trend holds true for all years reviewed. It is interesting to note that NARBHA utilizes [69] intensive outpatient treatment far more than it is used in southern Arizona (approximately 52% higher utilization rate). Methadone/ buprenorphone services are well utilized in Mohave County; in 2009 these services were used 47% more than NARBHA in its entirety. Outpatient services unavailable in Mohave County include Daytime Treatment/Partial Hospitalization and Detoxification. This gap in services is reflected in all data for years 2006 through 2009. Table 4‐28: 2009 Clients in Outpatient Treatment Services 2009 CLIENTS IN OUTPATIENT TREATMENT SERVICES TYPE OF SERVICE Regular Outpatient Intensive Outpatient Day TX/Partial Hosp. Detoxification Methadone/Bupren. ANY OUTPATIENT Population Mohave County Number 1,125 85 ‐ ‐ 150 1,360 214,949 Per 1000 Residents
5.23 0.40 0.00 0.00 0.70 6.33 NARBHA Region (all counties including Mohave) Number 2,835 930 108 14 289 4,176 786,915 [70] Per 1000 Residents
3.60 1.18 0.14 0.02 0.37 5.31 Rest of AZ (All counties in AZ NOT in NARBHA) Number 15,562 3,458 159 352 4,788 24,319 6,027,231 Per 1000 Residents
2.58 0.57 0.03 0.06 0.79 4.03 An analysis of 2008 data for clients receiving outpatient treatment services shows that regular outpatient services in Mohave County are utilized 160% higher than NARBHA and 97% higher than the rest Southern Arizona. These records indicate regular outpatient service utilization decreased between 2008 and 2009 from 6.5 persons per thousand to 5.23 persons per thousand. This is a 19.5% drop in utilization. In contrast, NARBHA had only a 0.5% drop in utilization and Southern Arizona had a 22.7% drop on utilization. Meanwhile, intensive outpatient services and methadone/buprenorphone services in Mohave County remained fairly consistent between 2008 and 2009. Table 4‐29: 2008 Clients in Outpatient Treatment Services 2008 CLIENTS IN OUTPATIENT TREATMENT SERVICES TYPE OF SERVICE Regular Outpatient Intensive Outpatient Day TX/Partial Hosp. Detoxification Methadone/Bupren. ANY OUTPATIENT Population Mohave County Number 1,354 85 ‐ 1 151 1,591 208,352 Per 1000 Residents
6.50 0.41 0.00 0.00 0.72 7.64 NARBHA Region (all counties including Mohave) Number 2,779 659 60 3 274 3,775 767,558 [71] Per 1000 Residents
3.62 0.86 0.08 0.00 0.36 4.92 Rest of AZ (All counties in AZ NOT in NARBHA) Number 19,543 2,217 225 64 3,902 25,951 5,855,327 Per 1000 Residents
3.34 0.38 0.04 0.01 0.67 4.43 The number of outpatient clients in 2007 is unusually low with only 38% the number of the outpatient clients in 2006 and 55% the number of outpatient clients in 2008. The striking contrast to the years on either side implies a disparity in data for the number of regular outpatient clients in 2007. It’s noteworthy to point out that despite abnormally low figures for regular outpatient clients in Mohave County, it still has a significantly higher utilization rate than NARBHA and the State; 23% higher than NARBHA and 54% higher than Southern Arizona. The number of intensive outpatient clients in 2007 is also very low at 42 clients for the entire year. Methadone/buprenorphone clients are consistent with later years. Table 4‐30: 2007 Clients in Outpatient Treatment Services 2007 CLIENTS IN OUTPATIENT TREATMENT SERVICES TYPE OF SERVICE Number 748* Intensive Outpatient 42 Day TX/Partial Hosp. ‐ Detoxification 2 154 Methadone/Bupren. 946 ANY OUTPATIENT 201,693 Population *Adjusted value = 1361 Regular Outpatient Mohave County Per 1000 Residents
3.71 0.21 0.00 0.01 0.76 4.69 NARBHA Region (all counties including Mohave) Number 2,370 878 72 12 269 3,601 747,861 [72] Per 1000 Residents
3.17 1.17 0.10 0.02 0.36 4.82 Rest of AZ (All counties in AZ NOT in NARBHA) Number 13,750 2,179 188 257 4,804 21,178 5,684,146 Per 1000 Residents
2.42 0.38 0.03 0.05 0.85 3.73 An analysis of 2006 data for clients receiving outpatient treatment services shows that regular outpatient services in Mohave County are utilized 152% higher than NARBHA and 359% higher than Southern Arizona. The unusually high number of outpatient clients served in Mohave County in 2007 followed by the unusually low number of outpatient clients served in Mohave County in 2008 suggests a possible solution to the discrepancy in the data noted in 2007. It appears that a portion of the clients served in 2007 may have accidentally been placed with the 2006 client total. If we add the number of regular outpatient clients from 2006 and 2007 together and divide that by two years, we derive an average of 1361 clients for each year. This adjusted number is only slightly higher than the 2008 value and appears to be a more reasonable estimate for 2006 and 2007 than the original values provided by SAMHSA. With just 57 clients, the utilization of intensive outpatient treatment in Mohave County remains far lower than the utilization in NARBHA and southern Arizona. The utilization of methaodone/buprenorphone in Mohave County was slightly lower in 2006, but remained at more than twice the utilization rate of NARBHA and consistent with the rate for southern Arizona. Table 4‐31: 2006 Clients in Outpatient Treatment Services 2006 CLIENTS IN OUTPATIENT TREATMENT SERVICES TYPE OF SERVICE Number 1,975* 57 ‐ Day TX/Partial Hosp. 3 Detoxification 145 Methadone/Bupren. ANY OUTPATIENT 2,180 Population 194,920 *Adjusted value = 1361 Regular Outpatient Intensive Outpatient Mohave County Per 1000 Residents
10.13 0.29 0.00 0.02 0.74 11.18 NARBHA Region (all counties including Mohave) Number 4,108 719 63 82 243 5,215 727,831 [73] Per 1000 Residents
5.64 0.99 0.09 0.11 0.33 7.17 Rest of AZ (All counties in AZ NOT in NARBHA) Number 12,402 2,680 95 428 4,138 19,743 5,511,651 Per 1000 Residents
2.25 0.49 0.02 0.08 0.75 3.58 If we use the adjusted values for 2006 and 2007, we observe the number of regular outpatient clients in Mohave County decreased between 2006 and 2009. In contrast, the number of intensive outpatient clients has increased and the number of methadone/buprenorphone clients has remained relatively steady. Elsewhere in the state, both in NARBHA and southern Arizona, the utilization rates of outpatient services are a bit more erratic through the years, fluctuating up and down (NARBHA values should be adjusted for the 2007 Mohave County discrepancy). Overall, rates between 2006 and 2009 have slightly increased in southern Arizona for intensive outpatient and methadone/ buprenorphone. For regular outpatient services, NARBHA rates have decreased while rates in the rest of Arizona have increased. Inpatient Services – Inpatient Treatment Services are divided into two broad categories, Residential and Hospital, which each have subcategories. Residential is divided into Short Term, Long Term and Detoxification. Hospital is divided into Rehabilitation and Detoxification. The number of clients served for each of these outpatient services from 2006 through 2009 is provided in Tables 4‐32 through 4‐35. As with the Outpatient Treatment Tables, the number of clients served per area is compared to its estimated population (Arizona Department of Commerce Estimates) and shown as clients per 1000 people. The data reveal the same trends as the Outpatient data. For all years reviewed the proportion of the population receiving Inpatient Treatment Services in the NARBHA Region exceed the proportion of the population receiving these services in the rest of Arizona. Mohave County does not have any chemical dependency (CD) residential facilities. People needing residential treatment in Mohave County are normally sent a NARBHA location elsewhere in Northern Arizona if they require public funding for their treatment. In general, the number of people receiving residential treatment throughout Arizona has been decreasing since 2007. However, it is important to note the statistics provided in Tables 4‐32 through 4‐
35 are not exclusive to publicly funded facilities. Therefore, no conclusions can be made from this data regarding publicly funded residential beds. In fact, private residential treatment facilities in Arizona have been closing down in recent times as a result of the difficult economic environment and lack of clients who could afford their services. In addition, it should be kept in mind that clients to private pay facilities may live outside the region where they are receiving residential treatment service. [74] An analysis of 2009 data for clients receiving inpatient treatment services on a per capita basis shows that in patient treatment services are used more often in the NARBHA region than in the rest of Arizona. For example, as the data in Table 4‐32 illustrates, residential detoxification and hospital detoxification in the NARBHA Region were used 30% more often than these services were used in the rest of Arizona (all counties in Arizona not in NARBHA). For short term residential, long term residential and hospital rehabilitation services, NARBHA’s population used services 104% more often than the rest of Arizona. It should be noted that hospital rehabilitation was not offered in the NARBHA region during 2009. Table 4‐32: 2009 Clients in Inpatient Treatment Services 2009 CLIENTS IN INPATIENT TREATMENT SERVICES TYPE OF SERVICE Short Term Res. Long Term Res. Detoxification ANY RESIDENTIAL Hospital Rehab Hospital Detox ANY HOSPITAL Population Mohave County NARBHA Region Number Per 1000 Residents Number Per 1000 Residents Number Per 1000 Residents
0 0 0 0 0 0 105 173 10 0.13 0.22 0.01 195 707 76 0.03 0.12 0.01 0 0 0 0 214,949 0 0 0 0 0.37 0.00 0.02 0.02 978 140 77 217 6,027,231 0.16 0.02 0.01 0.04 288 0 16 16 786,915 [75] Rest of AZ (All counties in AZ NOT in NARBHA) An analysis of 2008 data for clients receiving inpatient treatment services shows that rates of use for residential and hospital detoxification in the NARBHA Region were 597% higher than the rest of Arizona. For residential and hospital rehabilitation services, the utilization was 63% higher in the NARBHA Region than the rest of Arizona. Table 4‐33: 2008 Clients in Inpatient Treatment Services 2008 CLIENTS IN INPATIENT TREATMENT SERVICES TYPE OF SERVICE Mohave County Number Per 1000 Residents Short Term Res. 0 0 Long Term Res. 0 0 Detoxification ANY RESIDENTIAL 0 0 0 0 Hospital Rehab 0 0 Hospital Detox 0 0 ANY HOSPITAL 0 208,352 0 Population Rest of AZ (All counties in AZ NOT in NARBHA) Per 1000 Per 1000 Number Number Residents Residents
55 272 0.07 0.05 193 782 0.25 0.13 58 0.08 51 0.01 306 0.40 1,105 0.19 9 0.01 145 0.02 112 0.15 135 0.02 121 0.16 280 0.05 767,558 5,855,327 NARBHA Region [76] An analysis of 2007 data for clients receiving inpatient treatment services shows that NARBHA’s rate of use for detoxification services were 96% below than the rest of Arizona. The rates of use for residential and hospital rehabilitation services were 69% higher in the NARBHA Region than the rest of Arizona. Table 4‐34: 2007 Clients in Inpatient Treatment Services 2007 CLIENTS IN INPATIENT TREATMENT SERVICES TYPE OF SERVICE Mohave County NARBHA Region Number Per 1000 Residents Number Per 1000 Residents Short Term Res. 0 0 46 0.06 Long Term Res. 0 0 264 0.35 Detoxification ANY RESIDENTIAL 0 0 9 0.01 0 0 319 0.43 Hospital Rehab 0 0 0 0.00 Hospital Detox 0 0 12 0.02 ANY HOSPITAL 0 201,693 0 12 747,861 0.02 Population [77] Rest of AZ (All counties in AZ NOT in NARBHA) Number 310 846 43 1,199 237 270 507 5,684,146 Per 1000 Residents
0.05 0.15 0.01 0.21 0.04 0.05 0.09 An analysis of 2006 data for clients receiving inpatient treatment services shows that the rate of use for residential and hospital detoxification in the NARBHA Region was 323% below than the rest of Arizona. For residential and hospital rehabilitation services, NARBHA’s rate of use was 67% higher in the NARBHA Region than the rest of Arizona. Table 4‐35: 2006 Clients in Inpatient Treatment Services 2006 CLIENTS IN INPATIENT TREATMENT SERVICES TYPE OF SERVICE Mohave County Number Per 1000 Residents Short Term Res. 0 0 Long Term Res. 0 0 Detoxification ANY RESIDENTIAL 0 0 0 0 Hospital Rehab 0 0 Hospital Detox 0 0 ANY HOSPITAL 0 194,920 0 Population NARBHA Region Number 40 259 1 300 13 6 19 727,831 Per 1000 Residents 0.05 0.36 0.00 0.41 0.02 0.01 0.03 Rest of AZ (All counties in AZ NOT in NARBHA) Number 280 928 91 1,299 204 133 337 5,511,651 Per 1000 Residents
0.05 0.17 0.02 0.24 0.04 0.02 0.06 Between 2006 and 2008, NARBHA experienced a significant increase in the number of people using residential and hospital detoxification services. This high use rate for detoxification services decreased in 2009 but remained significantly above southern Arizona’s rate. NARBHA’s hospital rehabilitation and residential services have maintained consistently high rates of use throughout the four years reviewed, outpacing southern Arizona’s use rate for these services by 63% to 104%. [78] Residential Bed Utilization In analyzing statistics for residential bed utilization rates, it should be noted that some data may be missing if facilities incorrectly responded to the survey. In order for a facility to be included, they were required to respond to all the appropriate questions and respond to client count queries for themselves only. It is possible for some facilities to report combined client counts with another facility, or to have their client counts reported by another facility—as in networks. In these cases, the data from those facilities are not considered. For 2009, the utilization rate for all residential (non‐hospital) beds in the country was 89%. In Arizona, the residential bed utilization rate was 79.7%. For hospital inpatient beds designated for substance abuse treatment the utilization rate is 84% countrywide and 79.7% in Arizona. Table 4‐36 presents the statistics for utilization rates over the past five years. Table 4‐36: Utilization Rate of Designated Substance Abuse Treatment Beds Utilization Rate of Designated Beds Year 2005 2006 2007 2008 2009 Location Residential Hospital Inpatient Arizona U.S. Arizona U.S. Arizona U.S. Arizona U.S. Arizona U.S. 89% 92% 84% 91% 79% 92% 87% 92% 80% 89% 80% 90% 121% 90% 139% 85% 126% 85% 80% 84% This table shows that, on average, Arizona utilizes their existing residential beds less than the national average. However, since the beds in Table 4‐36 include beds available at for‐profit treatment facilities, this table does not accurately portray the utilization rate of publicly funded residential beds, which is the concern of this Needs Assessment. The number of publicly funded residential treatment beds allocated to Mohave County residents is approximately five beds. None of these beds are exclusive to Mohave County and may be used by others if they are available. Likewise, Mohave County may use more than its allotted five beds if they are available when the need is present. Mohave County keeps its five allocated beds fully occupied and often has the need for additional beds. [79] The wait time for a publicly funded residential bed is up to two weeks for Mohave County clients. Two weeks is an unacceptably long waiting period. NARBHA indicates the delay for Mohave County residents is likely a lack of availability. For example, NARBHA reported the utilization rate for the first quarter of 2010 at West Yavapai Guidance Clinic was 108%. This is the location where nearly all Mohave County clients go to for Chemical Dependency (CD) Residential Treatment. This rate of utilization for CD Residential beds at this facility is considered normal by NARBHA. 4.2 Arizona Families F.I.R.S.T. Arizona Family F.I.R.S.T. (Families in Recovery Succeeding Together – AFF) is a community substance abuse prevention and treatment program established by the Arizona Legislature in 2000. AFF provides contracted family‐centered, strengths‐based, substance abuse treatment and recovery support services to parents or caregivers whose substance abuse is a significant barrier to maintaining or reunifying the family or achieving self‐sufficiency. AFF emphasizes face‐to‐face outreach and engagement at the beginning of treatment, concrete supportive services, transportation, housing, and aftercare services to manage relapse occurrences. AFF contracts providers locally for treatment services. All services are either provided through the local RBHA (Regional Behavioral Health Authority) if the client is AHCCCS eligible, or via an AFF contracted provider who is paid by DES. In Mohave County, the RBHA is NARBHA and the contracted DES provider is Westcare Arizona. To join the AFF program, clients must either be referred by Child Protective Services or the DES Jobs program. In Mohave County every client is referred to Westcare Arizona who then determines if services are to be provided by them or NARBHA. Westcare was able to provide the following summary of the total number of AFF clients in Mohave County for calendar years 2007, 2008 and 2009 (Table 4‐37). Table 4‐37: Mohave County Referrals to AFF (Westcare Arizona) Mohave County Referrals to AFF Calendar Year 2007 2008 2009 No. of Referrals 180 173 127 No. of Referrals per 1,000 residents 0.89 0.83 0.59 An annual report on the AFF program is prepared by the Center for Applied Behavioral Health Policy (CABHP) at Arizona State University. Up until the 2008‐2009 report when budget cuts precluded the presentation of much of the detailed geographical data, the annual report provided much of their data per county or DES provider district. Since Mohave County and La Paz County share the same DES Provider, their statistics were presented together. A request was made to extract the data for Mohave [80] County out from La Paz County for analysis purposes. Unfortunately, cuts in AFF’s budget has resulted in reduced available manpower and MSTEPP’s request could not be granted. The number of referrals to AFF in Mohave and La Paz counties were compared to Yuma County, Yavapai County, Coconino County and the entire state (Table 4‐38). Table 4‐39 compares these figures per capita. These figures are for the state fiscal year, beginning July 1st and ending June 30th. Table 4‐38: Number of Referrals to AFF Program Number of Referrals to AFF Program Fiscal Year 2004‐05 2005‐06 2006‐07 2007‐08 2008‐09 Mohave & La Paz Yuma Yavapai Coconino State 145 186 163 147 unavailable 69 70 116 72 unavailable 247 232 240 205 unavailable 68 78 84 70 unavailable 3851 4705 5087 4691 3944 Table 4‐39: Number of Referrals to AFF Program Per 1000 Residents Number of Referrals to AFF Program Per 1000 Residents 2004‐05* 2005‐06 2006‐07 2007‐08 2008‐09 Mohave & La Paz Yuma Yavapai Coconino State
0.67 0.86 0.73 0.64 Unavailable 0.35 0.36 0.58 0.35 Unavailable 1.16 1.09 1.09 0.90 unavailable 0.51 0.59 0.62 0.51 unavailable 0.62 0.75 0.79 0.71 0.58 Since the program began in 2001, approximately 99% of the referrals have been provided by CPS caseworkers. Very few referrals come from the DES Jobs Program which is a program for individuals who face challenges getting back in the work force. The decrease in referrals which occurred throughout the state between SFY08 and SFY09 was 15.9% according to the AFF report. This decrease was a continued decline in referrals since SFY07. It was noted in the AFF report that the decrease in referrals is concomitant with budget reductions in the AFF program. A comparison of the per capita figures for Mohave County alone (Table 4‐37) and Mohave County combined with La Paz County (Table 4‐39) shows that Mohave County alone has a higher number of [81] referrals per capita than the two counties combined. Moreover, the per capita referral data for Mohave County’s calendar years are consistently above the state averages derived from the CABHP Report. 4.3 Arizona Dept of Health Services – Division of Behavioral Health Services (ADHS DBHS) 4.3.1 Performance Audit, Substance Abuse Treatment Programs, Report No. 09‐07, July 2009 A performance audit was conducted in response to an October 5, 2006, resolution of the Joint Legislative Audit Committee. The audit analyzed three years of data related to four National Outcome Measures (NOMs) which were developed by the federal government and believed to evaluate treatment program effectiveness – extent of continuing alcohol or drug use, employment, criminal activity, and homelessness. The analysis found that two factors were strongly associated with successful treatment: 1) deciding to abstain from using alcohol or drugs before treatment started, and 2) completing treatment. The factors which showed only slight association with treatment outcome were lack of recent arrests, employment, and stable housing. The report pointed out that drug and alcohol abuse is associated with some of society’s most serious and expensive problems. The costs of these nation‐wide problems are significant and borne by taxpayers. They include: o
o
o
o
More than half of all state prison inmates were under the influence of alcohol or drugs when they were arrested. Nearly one in six state inmates committed crimes to support a drug addiction. About 20 percent of acute care Medicaid expenditures pay for alcohol‐ or drug‐related medical costs. Drunk driving is a major expense for the police, courts, and emergency medical systems. Furthermore, SAMHSA reports that people with substance use disorders rely on public sources of financing far more than people with other diseases. Unfortunately, within the past year the most severe budget reductions in the history of Arizona’s behavioral health system have been implemented (See Appendix H). The consequence of these reductions is that fewer people will be able to receive publicly funded treatment services. This occurs at a time when the need is increasing. In fact, from SFY 2001 to STY 2008, the number of people receiving some type of state‐provided substance abuse treatment increased by nearly 300 percent. This increase is attributed primarily to expansion in AHCCCS eligibility requirements. The Audit acknowledged substance abuse is a chronic, relapsing condition that may require multiple episodes of care over many years. Successful treatment retention relies upon an individual’s ability to [82] change his/her behavior, and ability and motivation to integrate techniques for disease management into his/her lifestyle. Personal, social and cultural factors such as socio‐economic, legal, family and employment situations all factor into a person’s ability to manage their symptoms. Although reduced criminal activity and finding gainful employment were determined to be poor indicators in Arizona for successful treatment, the report noted NARBHA as the REBA which showed the greatest improvement in these areas. Overall, auditors compared Arizona’s NOMs with those reported by other states and found that Arizona’s performance is below that of substance abuse programs in other states. In addition to improvements in oversight of substance abuse programs, the Audit also made several recommendations for improvement in treatment outcomes. These are: o
o
o
Do more to increase retention, such as adopting goals and incentives related to retention and treatment completion. Do more to ensure continuum of care, such as establishing standards to assess the severity of consumers’ substance abuse problems and provide case management with a clear definition of consumers’ expectations. Do more to encourage use of evidence‐based practices, such as more extensive monitoring and improved guidance for implementing specific evidence‐based practices. The Department of Health Services, Division of Behavioral Health Services (ADHS/DBHS) agreed with all recommendations of the Auditor General and is currently implementing them. 4.3.2 Annual Report of Substance Abuse Treatment Programs, State Fiscal Years 2008 & 2009 Each year the ADHS/DBHS conducts an assessment of its substance abuse treatment programs in accordance with Arizona Revised Statutes 36‐2023. This report includes information related to service types and geographic locations, funding sources and expenditures, numbers of clients served and their corresponding demographic information, and substance use patterns. Throughout the report information is presented by Geographical Service Areas (GSAs). Mohave County is included in GSA 1, which consists of the five Counties whose behavioral health services are provided through NARBHA. In SFY 2008, more than $121 million was spent on substance abuse treatment for more than 63,000 eligible enrollees. In SFY 2009, approximately $128.5 million was spent providing treatment for over 69,000 eligible adults and children. The reports indicated the majority of funding (62%‐69%) is provided through Medicaid funding (Title XIX & Proposition 204) and approximately 19% is provided from the Federal Block Grant for Substance Abuse Prevention and Treatment (SAPT Grant). The remaining funding is from State appropriated monies, County and City programs, the Arizona Department of Corrections and liquor fees. The distribution of enrollment into treatment programs throughout the state for both 2008 and 2009 shows Maricopa County has the highest enrollment, followed by Pima County and GSA 1 (Tables 4‐40 and 4‐41). However, when the enrollment figures are compared to the population of these areas, it is [83] shown that although Maricopa County contains approximately 60% of the states’ population, they only have about 39% of the treatment services enrollees. In contrast, Pima County contains 15% of the states’ population but about 26 to 28.5% of the enrollees. GSA 1 contains 11.6% of the population and 15 to 16% of the enrollees. The report does not provide how funds are distributed throughout the state. Table 4‐40: 2008 Substance Abuse Treatment Enrollees 2008 Substance Abuse Treatment Enrollees Area GSA 1: NARBHA GSA 2: La Paz/Yuma GSA 3: Conchise/Graham/ Greenlee/Santa Cruz GSA 4: Gila/Pinal GSA 5: Pima GSA 6: Maricopa % Population 11.6% 3.5% % of Enrollees 14.8% 4.9% 3.5% 5.8% 5.6% 15.5% 60.3% 7.3% 26.3% 38.0% Table 4‐41: 2009 Substance Abuse Treatment Enrollees 2009 Substance Abuse Treatment Enrollees Area GSA 1: NARBHA GSA 2: La Paz/Yuma GSA 3: Conchise/Graham/ Greenlee/Santa Cruz GSA 4: Gila/Pinal GSA 5: Pima GSA 6: Maricopa % Population 11.6% 3.5% % of Enrollees 15.9% 4.9% 3.5% 5.6% 5.8% 15.4% 60.3% 6.6% 28.5% 39.5% For both years, over 90% of all individuals receiving substance abuse treatment services were adults. The age group receiving the majority of services was 25‐44 (49‐50% of enrollees) followed by 45‐64 (27‐
28% of enrollees) and 21‐24 (10.5% of enrollees). In 2009, more males (56.2%) received substance abuse treatment in Arizona than females (43.8%). Approximately 86% of enrollees were White, 7% African American, 5% Native American and 2% Asian, Pacific Islander or Multi‐racial. [84] In SFY2008, the majority of consumers’ received outpatient treatment (79% of enrollees) which is significantly less costly than inpatient services. Brief or long term residential treatment services were provided to 8.6% of the enrollees for that year. Detoxification services was provided to 2.8% of enrollees. In SFY2009, these services were provided to 78.6% for outpatient treatment, 9.5% for residential treatment, and 2.6% for detoxification services. In SFY2009, a total of 10,762 individuals received court ordered substance abuse treatment. Approximately 19.6% of court ordered enrollees (roughly 2,109 people) were in GSA 1. Per capita, this is 2.7 people for every 1,000 persons in GSA 1. A review of the SFY 2009 figures throughout Arizona indicates rural areas tend to have a higher number of involuntary substance abuse treatment participants per capita than areas containing large urban populations (Table 4‐42). Table 4‐42: 2009 Involuntary Substance Abuse Participants 2009 Involuntary Substance Abuse Participants Area Population Approx No. of Participants GSA 1: NARBHA GSA 2: La Paz/Yuma GSA 3: Conchise/Graham/ Greenlee/Santa Cruz GSA 4: Gila/Pinal GSA 5: Pima GSA 6: Maricopa 786,915 235,433 2109 1022 Participants Per 1000 People 2.7 4.3 237,618 1205 5.1 397,752 1,048,796 1453 1840 3.7 1.8 4,105,623 3132 0.8 Types of substances abused differ between children/adolescents and adults. DBHS reports in 2009 that alcohol was the leading substance abused by adults with serious mental illness (41%); this is consistent with findings from previous years which shows alcohol abuse ranging from 51% to 39% between 2006 and 2009. However, in 2009, marijuana overtook stimulants as the second most commonly abused substance among adults at 25%. The use of marijuana among adults in Arizona has shown a steady increase since 2006 at which time it was used by 17% of adults. The use of stimulants among adults peaked in 2007 at 28% and has since decreased to 24% in 2009. Between 2006 and 2009, the use of narcotics has steadily increased from 4% to 6% and other substances have steadily decreased from 6% to 3%. Children and adolescents receiving treatment report that marijuana is the substance most commonly used, followed by alcohol. Marijuana use among children/adolescents increased from 59% in 2006 to [85] 73% in 2009. Meanwhile, alcohol use decreased from 27% in 2006 to 20% in 2009. Stimulants use has also decreased from 11% in 2006 to 3% in 2009. Narcotics and other substances are reported to be minimally abused by children and adolescents with usage between 1% and 2% for years 2006‐2009. ADHS/DBHS highlights several programs and specific initiatives using evidenced‐based models in their report. These include: Methamphetamine Centers of Excellence (COE), Addiction Reduction and Recovery Fund, Enhancing Treatment Effectiveness through Peer Support and Family Support Services, Services for Families Involved with Child Protective Services, Adolescent Alcohol/Drug Treatment Projects, and Substance Abuse Prevention and Treatment (SAPT) Block Grant. The program which has the most visible impact in Mohave County is the Arizona Families F.I.R.S.T. (AFF) program which is part of the Services for Families Involved with Child Protective Services. None of the other programs or initiatives are identified as being offered with Mohave County. The Addiction Reduction and Recovery Fund (HB2554) passed in 2006 and provided funding for the development of several Substance Abuse Stabilization Centers in rural areas of Arizona. Mohave County was not one of these areas. 4.3.3 Substance Abuse Treatment Services Capacity Report, April 2008 This report was prepared in accordance with Executive Order 2008‐01 and is intended to provide Arizona’s capacity to provide substance abuse treatment services to those in need of such treatment. This order prioritizes families involved in the child welfare system for access to substance abuse treatment services. Child Protective Services (CPS) reports that when a child is in danger, substance abuse is almost always a factor. They estimate nearly 80% of Arizona families referred to CPS have substance abuse issues. Executive Order 2008‐01 seeks to ensure that the funds spent on treatment in Arizona are being spent in the most efficient and coordinated manner, providing treatment first to those in great need. It is intended that the information provided in this report will allow the state of Arizona to target substance abuse treatment funding where it is most needed. The report highlights a number of findings which it says points to the fact that the need for treatment may in some situations exceed the state’s capacity to provide treatment. These findings include: o
o
o
o
In FY2006, Arizona had the second highest rate of individuals 25 years or older who were in need of, but did not receive, treatment for alcohol abuse. In FY2006, Arizona had the second highest rate of individuals ages 12 to 17 who needed, but did not receive, treatment for illicit drugs. The 2005 NSDUH estimated that 2.67% of individuals in Arizona needed treatment services for illicit drug use but did not receive such treatment. The 2005 NSDUH revealed that approximately one in twelve people in Arizona needed, but did not receive, treatment for alcohol abuse. To assess where the treatment service gaps in Arizona are, ADHS/DBHS surveyed the state agencies on their substance abuse treatment capacity. This report provided the results and interpretation of the survey. The same geographic service areas (GSAs) that were described in the Annual Report on [86] Substance Abuse Treatment Programs were utilized here. The service provider network within each of the GSAs was described. NARBHA’s description included the following, “Despite enormous geographic distances and sparsely‐populated communities, NARBHA has established, and continues to expand and enhance, a full continuum of covered behavioral health services to meet members’ needs in a timely, culturally‐relevant, and clinically‐appropriate manner.” The survey divided Adult Substance Abuse Treatment Service Providers into eight categories: Contracted Providers, Outpatient Clinics, Specialty Providers, Residential Substance Abuse Beds, Detox Inpatient Beds, Detox Sub‐Acute Beds, Stabilization Services and Methadone Clinics. Although the number beds for each residential facility was reported, the capacity of the non residential facilities was not reported. This is relevant since a facility with a staff of five would have a smaller treatment capacity than a facility with a staff of fifty. Table 4‐43 presents the number of providers per GSA. According to the table, GSA 1 is listed as having the highest number of stabilization services, and the second highest number of contracted providers, specialty providers and outpatient clinics. In contrast, GSA 1 is listed as having the lowest number of residential substance abuse beds and detoxification sub‐acute beds, and the second lowest number of detoxification inpatient beds. Table 4‐43: Statewide Availability of Adult Substance Abuse Treatment Service Providers by Type and GSA, March 2008 Statewide Availability of Adult Substance Abuse Treatment Service Providers by Type and GSA, March 2008 1 42 71 53 Residential Substance Abuse Beds 38 2 11 30 13 60 101 32 16 1 3 17 23 10 328 8 36 0 1 4 17 50 42 57 101 30 0 1 5 36 55 53 551 225 36 0 3 6 92 179 80 218 44 38 0 10 Total 215 408 251 1252 518 200 40 18 GSA Contracted Outpatient Providers Clinics Specialty Providers Detox Inpatient Beds Detox Sub‐Acute Beds 39 28 24 2 Stabilization Methadone Services Clinics Table 4‐43 is amended from a table (Table 3) in the Substance Abuse Treatment Services Capacity Report which totals the number of services provided as something other than the sum of services provided for each category. Furthermore, it should be noted that a single provider may be licensed to provide more than one type of service. Lastly, the report advises that the total number of beds does not equal the sum of residential substance abuse beds, detox [87] inpatient beds, and detox sub‐acute beds. They explain that duplicate beds have been identified across GSAs. Table 4‐44 presents the data in Table 4‐43 per 100,000. This per capita data is important in that it provides a better picture of service capacity for each GSA. When the availability of each service is viewed per capita, the availability of services in GSA 1 differs from the availability shown in Table 4‐43. The bottom line of the table ranks NARBHA against the other GSAs for service need. A rank of one indicates having the highest need in the state, a rank of six indicates having the lowest need in the state. NARBHA has a rank of one for residential substance abuse beds and two for methadone clinics. Table 4‐44: Statewide Availability of Adult Substance Abuse Treatment Service Providers by Type and GSA per 100,000 Adults, March 2008 Statewide Availability of Adult Substance Abuse Treatment Service Providers by Type and GSA per 100,000 Adults, March 2008 GSA 2008 Population Contracted Providers Outpatient Clinics Specialty Providers Residential Substance Abuse Beds Detox Inpatient Beds Detox Sub‐
Acute Beds Stabilization Services Methadone Clinics 1 767558 5.47 9.25 6.91 4.95 5.08 3.65 3.13 0.26 2 229397 4.80 13.08 5.67 26.16 44.03 13.95 6.97 0.44 3 233241 7.29 9.86 4.29 140.63 3.43 15.43 ‐ 0.43 4 373326 4.55 13.39 11.25 15.27 27.05 8.04 ‐ 0.27 5 1026506 3.51 5.36 5.16 53.68 21.92 3.51 ‐ 0.29 6 3992887 2.30 4.48 2.00 5.46 1.10 0.95 ‐ 0.25 Average 3.25 6.16 3.79 18.90 7.82 3.02 0.60 0.27 5 3 5 1 3 3 5 2 GSA 1 Ranking Table 4‐44 was also amended from the Substance Abuse Treatment Services Capacity Report in the population figures used to derive the per capita values. In that report, 2006 population figures were used against 2008 data to derive the per capita data. The population figures used in Table 4‐44 (pulled from Table 1‐2) are for 2008 and have been used consistently throughout this Needs Assessment. For youth, the availability of residential substance abuse facilities is lower in GSA 1 than the rest of the state. Availability of general outpatient and intensive outpatient services for youth are reported as low to average. The report does not go into detail for youth substance abuse treatment services. A review of the AFF Program found that AFF providers are either over or at‐capacity with no waiting list. However, AFF providers report that due to “capacity limitations at treatment facilities”, some clients receive a less‐intensive level of service than is needed while waiting for [88] the availability of a more appropriate, higher level of care. Clearly, an assessment of the treatment services which lack the capacity to provide timely service to AFF clients is needed. Unfortunately, this has not been done to date. The Capacity Report concluded that for AFF clients the number of treatment providers per 100,000 adults was highest in GSA 4 and GSA 1. GSA 6 was assessed as having the greatest need in the state for additional treatment resources. Unfortunately, this assessment does not differentiate between the types of treatment services which are able to provide timely treatment versus those that do not. Nor does it accurately consider the true need for treatment since it uses the population of a region instead of the actual rates of enrollment for either the AFF program or state funded treatment programs. If these considerations were taken into account it would provide a more accurate assessment of the treatment needs throughout the state. 4.4 Substance Abuse Prevention and Treatment Block Grant (SAPT) The Substance Abuse Prevention and Treatment (SAPT) Block Grant represents a significant Federal contribution to the States’ substance abuse prevention and treatment service budgets. On 30 September 2010, the SAPT Block Grant Application for Arizona was filed. The application required submission of a 3‐year plan (FY2011 – FY2013) for intended use of the funds with information on needs assessment, resource availability and State’s priorities. Prevention The prevention component of the plan required the state to describe their existing mechanisms to support sub‐recipients and community coalitions in implementing data‐driven and evidence‐based preventative interventions. The state relied heavily on data from the Arizona Youth Survey to describe the substance abuse concerns for youth as well as the Arizona Statewide Substance Abuse Epidemiology Profile. It stated the overall direction of prevention services for Arizona is established by the Arizona Substance Abuse Partnership (ASAP). The application explained that capacity to plan and implement effective substance abuse prevention strategies were inconsistent across the state with rural areas lacking the capacity that urban areas enjoyed. When state substance abuse prevention funds were eliminated in January 2010, ADHS and the RBHAs reviewed the needs and resources of each community to determine where reductions in funds would be least likely to negatively impact rates of substance abuse and substance abuse related consequences. Programs identified in Mohave County eligible for funding included: 

Mohave County Projects by Stop Teen Underage Drinking Coalition, Arizona Youth Partnership & the Coalition for Successful Youth Development KUSD Elementary Prevention Project for grades 3, 4 and 5 [89] 
MethSmart by the Boys and Girls Club – a youth statewide program SAPT prevention funds are allocated from ADHS to RBHAs. Prevention providers who receive funds are required to plan, implement, and evaluate all prevention services in collaboration with a community substance abuse prevention coalition. Treatment The application states, “ADHS/DBHS endorses a comprehensive, person/family supportive, and recovery oriented system of care for people in need of publicly funded behavioral health treatment. To ensure this vision of recovery is achieved, the Department of Health Services maintains a firm commitment to increasing access to care and reducing barriers to treatment; collaboration with the greater community; cultural competency; effective innovation and program evaluation, and; emphasizing consumer and family involvement in an individual’s treatment program.” Furthermore, ADHS/DBHS makes clear that it encourages data‐driven decision making at all levels of the provider network to improve the quality and timeliness of service delivery. Data used to assist in understanding the statewide distribution of need, demand and capacity for substance abuse treatment found: 1. there is little geographic variation in the prevalence of need for substance abuse treatment (Household Survey); 2. demand for treatment varies most by population size, with denser areas of the state experiencing the highest demand for treatment (Household Survey, Jail Studies); 3. certain high‐risk groups do exist, including young adults, women in the northern Arizona region (Household Survey) and Tribal nations (Tribal Study); 4. statewide, treatment capacity is insufficient to meet needs identified in the general population. In evaluating treatment needs throughout Arizona, the population of each region was multiplied by 9.2 percent which is the approximate percentage of the population, nationally, in need of treatment for an illicit drug or alcohol use problem (2008 NSDUH). Likewise, estimations for women in need of treatment were determined by multiplying each region by 6.4 percent, which according to the 2008 NSDUH, is the national average for women in need of treatment for an illicit drug or alcohol use problem. Estimates for Arizona’s population that needs treatment but not receiving treatment are also estimated using national averages as reported by NSDUH. This methodology for assessing treatment needs relies entirely on population and disregards local variables. Considering that NSDUH provides state level and sub‐state level data on treatment needs (see above section on NSDUH), the use of a national average is not the most accurate method to evaluate Arizona’s need. In general, Arizona’s treatment needs are [90] higher than the national average. Consequently, the SAPT application appears to be underestimating the treatment needs of the state. The state lists twelve priorities as part of the SAPT application. The number one priority is to “ensure that consumers with a substance use disorder/dependence are referred and placed into the most appropriate treatment modality based on their clinical need by contractually mandating and implementing the statewide use of the American Society of Addiction Medicine’s Patient Placement Criteria (ASAM‐PPC)”. In total, six priorities (including the top two) are treatment related, four are prevention related, and two are administrative. NARBHA’s existing substance abuse treatment resources were reviewed as part of its Assessment of Need, which is a requirement of the SAPT application. With respect to detoxification/stabilization and residential treatment facilities, the following services were listed as available through NARBHA: o
o
o
o
o
o
o
o
Winslow ‐ Sixteen bed Rural Substance Abuse Transitional Agency (Navaho County). Holbrook – Sixteen bed Rural Substance Abuse Transitional Agency (Navaho County). Winslow ‐ Ten bed transitional sober living beds (Navaho County). Flagstaff – Twelve bed Intake Triage Unit (ITU), licensed as a Rural Substance Abuse Transitional Agency (Coconino County). Flagstaff – Sixteen bed Residential Substance Abuse Treatment Center (Coconino County). Prescott – Twenty four bed Residential Substance Abuse Treatment Center (Yavapai County). Cottonwood – Twelve bed facility for women with co‐occurring diagnosis (Yavapai County). Cottonwood – Approximately twelve bed Residential Treatment – separate cost (not block purchased) (Yavapai County). In Mohave County, no inpatient or detoxification services were listed but it was noted that outpatient treatment is available in Kingman, Bullhead City and Lake Havasu City by Southwest Behavioral Health Service (SBHS) and Mohave Mental Health Clinics (MMHC). Other services available at these locations include counseling, peer support, and methadone service. It was noted that outreach efforts had been made to the Hualapai and Fort Mojave Tribes. The needs NARBHA identified include: o
o
o
o
Add SBHS as an additional Responsible Agency in Mohave County to assist in the expansion of substance abuse and other services in Mohave County. Increase and expand treatment services, specifically counseling services, throughout the network. Expand housing, peer support services, and employment services. Increase the number and availability of specialty service providers. The application notes that only 2.5% of consumers live outside of a 25 mile radius to a comprehensive service provider. Hualapai Behavioral Health Services is being recruited into the provider network in response to this 2.5% and to provide more convenient access to culturally relevant services for members [91] of the Hualapai Tribe. NARBHA indicates the data does not show a need for additional network expansion based upon geographic accessibility. Interestingly, the need for additional CD residential treatment services was not mentioned. 4.5 Arizona Substance Abuse Epidemiology Profile The Arizona Substance Abuse Epidemiology Profile was first prepared in 2005 to provide data required for the Strategic Prevention Framework State Incentive Grant (SPF SIG) from the federal Center for Substance Abuse Prevention (CSAP) in SAMHSA. The SPF SIG provided $11.75 million over five years to reduce substance use in Arizona. These funds were intended to prevent the onset and reduce the progression of substance abuse, with a special focus on the reduction of underage drinking; to reduce substance abuse and its associated consequences in communities throughout the state; and to build, grow and sustain the state’s prevention capacity and infrastructure. The focus of the Epidemiology Profile is to show the impact of substance abuse on our state and its populace. In addition, it identifies data gaps that exist in our state and discusses the progress made in this area over the past two years. The data used in the Substance Abuse Epidemiology Profile does not include any primary research. It is derived from reports and surveys already discussed elsewhere in this Needs Assessment. Therefore, only a summary of the findings from the Epidemiology Profile as it relates to defining the substance abuse problem in Arizona and specific issues identified within Mohave County will be discussed here. The Profile begins with several facts on the impact of substance abuse in Arizona. Seven of the ten leading causes of death in Arizona are at least partially linked to the abuse of alcohol, tobacco, or other drugs. Between 2000 and 2007 the rate of drug‐induced deaths more than doubled from 6.5 deaths per 100,000 to 18.3 deaths per 100,000. Similarly, the number of alcohol‐induced deaths per 100,000 population almost doubled from 2000 to 2007. A comparison of drug and alcohol‐related deaths by county shows that Mohave County, along with Yavapai County, ranks second in the state in the rate of drug and alcohol‐related deaths per 100,000 population (Gila County ranks first). 4.5.1 Tobacco Mohave County has the highest rate of malignant neoplasm of trachea, bronchus and lung deaths in the state. The number of these tobacco‐related deaths per 100,000 people is 88.1. This is more than twice the overall state rate. Gila and Yavapai Counties have the second and third highest rates at 65.2 and 64.5 per 100,000 people. The rate of cardiovascular disease deaths is also very high in Mohave County at 354.1 deaths per 100,000 people. The highest rates in the state are Gila County at 425.6 and La Paz County at 373.4. The state average rate is 203.0. [92] 4.5.2 Alcohol The percent of adults who currently drink alcohol in the Arizona is similar to the U.S. for all age groups except our state’s oldest residents. In 2009, 49% of Arizonans age 65 and older drank alcohol compared to 41% of this age group nationally. This age group also surpassed national rates in both heavy alcohol use and binge drinking. A breakdown of youth alcohol consumption by state shows that Mohave County youth rank second, at 68.7%, in reporting using alcohol at least once during their lifetime. Mohave County ranks third in Arizona for the rate of youth which report drinking in the past 30 days at 36.4%. Youth reporting binge drinking (5+ drinks on one occasion) in the past two weeks was 22.7% in Mohave County, slightly less than Gila County at 24.7% and Greenlee County at 24.5%. 4.5.3 Illicit Drugs The Epidemiology Profile used the NSDUH as its main source of information about adult consumption of illicit drugs. It does not go into substate‐level detail and only reviews data through 2007. MSTEPP therefore recommends that readers refer to Section 4.1.1 for substate specific data on illicit drugs. Arizona borders Mexico and is a known gateway for trans‐national drug trafficking. Therefore, drug seizures provide useful information on the types of drugs in demand in the U.S. and Arizona. Between 2006 and 2009, there was a significant decrease in the amount of cocaine and methamphetamine seized. Unfortunately, there was almost a 90% increase in the amount of heroin seized. Tucson and Phoenix are primary drug transit areas through which many tons of cocaine, marijuana, methamphetamine and heroin are smuggled into for distribution throughout the country. Consequently, easy access to illicit drugs has generated local community drug abuse problems throughout the state. Marijuana is the most commonly trafficked drug. Illicit drug consumption by youth is assessed based on data from two sources: the Arizona Youth Survey (AYS) and the Youth Risk Behavior Survey (YRBS). Analysis of the age when students begin experimenting with illicit drugs indicates youth in Arizona experiment with drugs earlier than students nationally (34.7% of Arizona students versus 19.6% of students in U.S. in 2008). Likewise, the percentage of Arizona students which report using illicit drugs in the past 30 days was higher than the U.S. for 2004, 2006, and 2008. Historically, the rate of use for marijuana is higher among students than any other illicit drug. Though marijuana remains the drug of choice for youth today, the rate of use decreased slightly in Arizona between 2004 and 2008. A comparison of youth illicit drug use by county was presented. Mohave County leads the state in the percentage of youth indicating they have tried heroin (2.4%) and non‐prescribed prescription drugs (27.7%) in their lifetime. Mohave County also ranks very high in the state (among the top four counties) for youth indicating past 30‐day use of ecstasy, heroin, steroids and hallucinogens. Overall, Mohave [93] County ranks above the state average for percentage of youth indicating they have used an illicit drug in their lifetime for all drugs except cocaine. A review of treatment admissions reported by ADHS DBHS indicates that in 2008 alcohol accounted for the most treatment admissions of any substance type, followed by methamphetamine, marijuana, heroin and cocaine. A review of rates of drug and alcohol treatment admissions by county shows that Mohave County ranks third in the state for admissions for a problem with heroin, sixth for methamphetamine and eighth for all drugs. It should be noted, however, that Mohave County does not have a full range of treatment services within the county so people who need services not available locally (such as residential treatment) must go outside the county for treatment. Property crime is considered an indicator of drug use since approximately 30% of property crimes are attributable to illegal drug use. The rate of reported property crime in Arizona is reported as consistently higher than the national rate since 1994. An analysis of property crime by county shows that Mohave County has the highest rate of property crime in Arizona for youth; it ranks third in the state for adults. 4.5.4 Substance Abuse in Critical Populations Data on substance abuse in the populations which are part of Arizona’s correctional and/or child welfare systems are discussed in the Profile although county specific data is minimal. Detailed data on critical populations in Mohave County is provided in the Courts, Child Welfare, and Probation chapter of this report. 4.6 Mohave County Treatment Services 4.6.1 Mohave Mental Health Clinic (MMHC) MMHC is a private, non‐profit community mental health center servicing Mohave County from three office locations in Kingman, Bullhead City and Lake Havasu City. They contract with NARBHA to provide publicly funded behavioral health services to eligible residents of Mohave County. MMHC’s services include: 1) screening and assessment, 2) substance abuse, intake and assessment and treatment, 3) adult seriously mentally ill (SMI) case management and treatment, and 4) child and adolescent services. Substance abuse treatment services available through MMHC include outpatient individual and group therapy, as well as intensive outpatient treatment (Matrix Model). Buprenorphine services are also available. Methadone services are available through a NARBHA contract with Community Medical Services (CMS) in Bullhead City, Arizona. Medical detoxification services are available through a Level I Subacute Facility on a case by case basis. All residential treatment is provided outside of Mohave County, primarily at West Yavapai Guidance Clinic (Hillside), where MMHC has “block purchased” five CD residential beds. [94] MMHC initiates treatment with a professional clinical assessment including utilizing ASAM Placement Criteria. Recommendations are made based on assessed needs. A medically necessary behavioral health service plan is negotiated in collaboration with the client and his/her natural support system(s). MMHC has sufficient resources and availability for outpatient services. Medical detoxification and CD residential treatment in Mohave County is the most obvious unmet need. The current strategy of providing CD residential treatment for Mohave County residents in Yavapai County does not sufficiently provide this level of care in a timely manner that would optimize recovery. Nevertheless, records indicate that MMHC keeps their allocated CD residential treatment beds fully utilized throughout the year and often has more people in CD residential than they have designated spaces. For instance, in September 2010, Hillside had seven people from Mohave County. Clients may sometimes wait up to two weeks for a CD Residential bed. This is an unacceptable delay in treatment for a client who is assessed to need CD residential treatment. It is generally understood that a client who has a residential treatment facility available locally is more likely to get a residential bed immediately than a client who lives 2 ½ hours from the facility. Furthermore, there are a number of clients that need CD residential treatment but refuse that level of care because it is too far away. Consequently, these clients enter into a locally available outpatient treatment programs rather than the level of care that their assessment recommends. MMHC also recognizes the value of family involvement in the treatment process. When clients enter into residential treatment which is 150 to 200 miles away from their community, the family component of treatment is difficult to facilitate at best and often not possible. This occurs because these families frequently lack the resources to travel this distance to visit their family member in treatment. 4.6.2 Treatment Assessment Screening Center (TASC) TASC provides substance abuse and mental health assessment and treatment services in Mohave County. They have offices in Bullhead City, Kingman and Lake Havasu City. The TASC laboratory is exclusively dedicated to substance abuse oriented testing and they have provided testing services to Mohave County’s criminal justice and court systems, including the child welfare system, for several years. The results of drug testing from TASC provide a fair indication of the preferred substance of use for these critical populations. Table 4‐45 provides the types of substances that tested positive between 1 July 2007 and 30 June 2010. Appendix I includes additional data on the TASC test results from each of its Mohave County locations. [95] Table 4‐45: TASC Client Drug Test Results TASC Client Drug Test Results Drug Type Alcohol Amphetamine Barbiturates Benzo Carisoprodol Cocaine Ecstasy ETG Opiates Propoxyphene THC TOTAL Bullhead City 0.40% 10.80% 0.10% 0.30% 0.00% 0.60% 0.00% 28.10% 9.00% 0.00% 50.70% 100.00% Kingman 2.70% 23.90% 0.10% 0.90% 0.00% 0.30% 0.00% 15.90% 19.80% 0.10% 36.40% 100% Lake Havasu City 5.30% 23.40% 0.10% 0.90% 0.10% 0.40% 0.60% 10.70% 8.00% 0.20% 50.30% 100.00% The majority of positive drug test results showed THC (marijuana) as the primary substance of use. The second most popular drug was amphetamine in Kingman and Lake Havasu City; ETG (alcohol) in Bullhead City. These three drugs, along with opiates, were the most frequently used drugs among the critical populations tested by TASC. 4.6.3 Hospital Discharge Data An assessment was conducted on Mohave County hospitals to determine volume of admissions due to alcohol or drug related disorders. The data is in Table 4‐46. These numbers are believed to be conservative for a couple of reasons. First, they exclude emergency room department discharge volume. Second, data from Kingman Regional Medical Center and Havasu Regional Medical Center are reporting discharge only as primary diagnosis excluding a secondary diagnosis that may be uncovered during treatment and considered an alcohol or other drug disorder (AOD). [96] Table 4‐46: Admissions Due To Alcohol or Drug Related Disorders Reporting Medical Institutions Total Number of Admissions Reporting Period Kingman Regional Medical Center 42 July 2008‐June 2009 Havasu Regional Medical Center 87 January 2008‐July 2009 Valley View Medical Center 895 January –December 2008 Total 1,024 4.6.4 Fort Mojave Tribe Behavioral Health Treatment statistics was provided by Fort Mojave Indian Tribe Behavioral Health for years 2006 through 2009. Figure 4‐2: Adults Receiving Substance Abuse Treatment Figure 4‐1 illustrates the trend of adults receiving substance abuse treatment over the past four years. There was a 40% increase in the number of men receiving treatment and a 51% increase in the number of women receiving treatment during this time. [97] Figure 4‐3: Juveniles Receiving Substance Abuse Treatment The number of juveniles receiving substance abuse treatment is shown in Figure 4‐2. For most years there were more juvenile males than females in treatment. The number of juvenile males in treatment increased between 2007 and 2009. No obvious trends are present for juvenile females. Table 4‐47: Substance Used by Adults Substance Used by Adults Alcohol Amphetamine Cannabis Opioid Poly‐substance 2006 Male Female 23 7 7 9 8 0 1 2 0 1 2007 Male Female 29 9 8 7 5 1 4 3 8 5 2008 Male Female 25 24 5 13 6 4 1 3 7 7 2009 Male Female 34 21 14 8 9 0 0 3 11 9 Table 4‐47 shows the substances used by adults in the Fort Mojave tribe. Alcohol was the most commonly used substance for all years, for both men and women, followed by amphetamine. Cannabis is also a commonly used substance, particularly for males. Opioids are used to a lesser extent but appear to be more popular among women than men. [98] Table 4‐48: Substance Used by Juveniles Substance Used by Juveniles Alcohol Amphetamine Cannabis Cocaine Opioid Poly‐substance Male 1 1 6 0 0 1 2006 Female 2 0 1 0 0 0 Male 1 1 3 0 2 0 2007 Female 1 0 0 0 0 0 Male 3 0 4 0 0 0 2008 Female 2 0 3 0 0 1 Male 4 0 5 0 0 0 2009 Female 1 0 2 1 0 0 Juvenile substance preferences were slightly different from the adults. Male juveniles slightly preferred cannabis over alcohol. Female juveniles appear to use both alcohol and cannabis in equal measure. Amphetamines, cocaine and opioids were used to a lesser extent (Table 4‐48). Table 4‐49: Type of Treatment for Adults Type of Treatment for Adults Individual Family Group Intensive Out‐pt Methadone In‐Patient 2006 Male Female
13 7 0 0 0 0 11 8 1 2 2 1 2007 Male Female
23 19 3 0 4 0 3 1 2 2 3 1 2008 Male Female 18 23 1 2 0 0 10 10 1 2 7 3 2009 Male Female 27 23 0 0 0 0 13 12 0 0 6 3 The majority of treatment used for adults for both men and women was individual outpatient counseling followed by intensive outpatient treatment (Table 4‐49). The number of clients requiring in‐
patient treatment increased between 2007 and 2008, and maintained at a higher level in 2009. [99] Table 4‐50: Type of Treatment for Juveniles Type of Treatment for Juveniles Individual Family Group Intensive Out‐pt Methadone In‐Patient 2006 Male Female 3 0 0 1 4 2 0 0 0 0 0 0 2007 Male Female
3 0 0 1 0 0 0 0 0 0 0 0 2008 Male Female 2 4 1 0 0 0 0 0 0 0 1 0 2009 Male Female
6 2 0 0 0 0 0 0 0 0 1 0 Individual, family and group counseling have all been utilized for juvenile treatment (Table 4‐50). As with adults, individual counseling is used most often. Methadone and intensive outpatient treatment have not been used at all for juveniles in the past four years. In‐patient treatment for juveniles has been used twice since 2006. 4.6.5 Mohave County Tobacco Use Prevention Program Arizona is known to many as the Wild West, a place where citizens make their own lifestyle choices. Do they choose healthy behaviors? Surveying and monitoring surveillance systems allow us to follow trends and determine if people are actually engaging in healthy lifestyles. Arizonans, especially in Mohave County, tend to fall short of making the healthier behavior choices as seen in the national, state and local adult and youth risk behavior surveying. The 2008 Arizona Vital Statistics reports that Mohave County adversely leads the state with high rates of chronic disease: Cancer, Pulmonary Obstruction, and Heart. Further alarming reports show our pre adults and high school youth are at risk too. On average they are more likely than US youth to have ever tried using tobacco, methamphetamine, cocaine, marijuana, and drink alcohol before the age of 13. The seriousness of youth participating in these at risk behaviors in their early years often leads to addictive lifestyles, chronic health diseases and compromised quality of life. For the families, friends and community, these citizens become a societal and financial burden. Tobacco According to research, tobacco use is the single most preventable cause of death in the United States. Each year in the United States, cigarette smoking and exposure to secondhand smoke causes 443,000, or 1 in 5 deaths. Mohave County has the highest smoking rate in the state, 33% (Figure 4‐4) of our adult population smoke in comparison to the 16% state average and 21% US smoking rate. For almost the past ten years, [100] Mohave smoking rates have remained higher than state and national trends. In several of the following graph summaries, Maricopa County serves as a reference point by which other Arizona counties are measure since it drives the state averages (Center for Disease Control, 2008). Figure 4‐4: Adult Smoking Prevalence (with 95% CI) – Mohave & Maricopa County, 2000 ‐ 2008 Research shows that women who smoke during pregnancy have higher rates of pregnancy complication, premature delivery, low birth weight babies and increased risk of sudden infant death. Additional burdens for infants born to mothers who smoke are higher rates of respiratory and ear infections, asthma, and colic. Mohave County has much higher rates of women smoking during pregnancy than state and national trends. On the positive side, the rates have been decreasing over the last several years (Figure 4‐5). [101] Figure 4‐5: Adult Smoking Rates – Mohave & Maricopa County, 1997 ‐ 2008 Children are also negatively affected by the hazards of tobacco through numerous exposures: second and third hand smoke, increased and expensive tobacco companies marketing campaigns targeted towards them, pressure to use tobacco from peers and family. These experiences often promote early tobacco use leading to the increased risk of addiction and premature health problems. Each day in the United States, approximately 3,900 young people between 12 and 17 years of age smoke their first cigarette and an estimated 1,000 youth become daily cigarette smokers. Youth that live with a smoker are 50% more likely to be exposed to second hand smoke. This is a critical adverse factor during the youth’s ongoing physiological development and they are twice as likely to become smokers themselves. Approximately, 57% of Mohave County students 4‐8th grades who received tobacco education report that they live with someone that smokes (Arizona Statewide Substance Abuse Epidemiology Profile, 2007). With the help of tobacco awareness and prevention programming during 2004 and 2008, the U.S. reported a decrease in the number of youth that smoke. However, the decrease was not substantial. “The U.S and Arizona both witnessed decreases between 2004 and 2008 in the percentage of youth indicating smoking in the past 30 days, but the decrease was more significant in the U.S. While the U.S. saw a 4.6 percentage point of decrease in past‐month 12th grade smokers, Arizona only saw a 0.5 percentage point decrease from 2004 to 2008 among these youth.”(Figure 4‐6) (Mohave County Tobacco Youth Survey, 2006). [102] Figure 4‐6: Percentage of Youth Indicating Smoking Past 30 Days (2004)
Percentage of Youth Indicating Smoking in Past 30 Days by Grade,
AZ vs. U.S. (2004-2008)
30
5
Percentage
(2004) (2006) (2008)
.
.S
U
10
.
.S
U
15
AZ
.
.S
U
AZ
.
.S
U
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AZ
.
.S
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.
.S
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AZ
20
(2004) (2006) (2008)
(2004) (2006) (2008)
0
Grade 8
Grade 10
Grade 12
AZ 2004
10.7
17.7
24.4
U.S. 2004
9.2
16
25
AZ 2006
10.5
17.1
21.2
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9.7
14.5
21.6
AZ 2008
9.7
16.6
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6.9
12.3
20.4
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AZ
AZ
AZ
25
.
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U
Whereas, Mohave County youth in grades 8th and 10th observed decreased percentages in 30 day tobacco use, 12th graders were fairly constant. (Figure 4‐7) Figure 4‐7: Use Tobacco in Last 30 Days ‐ 2008 Mohave County Arizona Youth Survey 30
25
20
15
10
5
0
2004
2006
2008
State
8th
10th
[103] 12th
8th graders
10th graders
12th graders
2004 – 10.4
2004 – 18.1
2004 – 29.7
2006 – 13.1
2006 – 19.9
2006 – 20.6
2008 – 7.6
2008 – 17.9
2008 – 20.8
State – 8.7
State – 16.6
State – 23.9
In comparison to Maricopa County, Mohave youth prevalence of cigarette smoking and smokeless tobacco use are similar with the smokeless rates fairly unchanged over time. Cigarette smoking rate is stable overtime despite some erratic changes in grades 8th and 12th (Figure 4‐8). (University of Arizona, Feb 2010) [104] Figure 4‐8: Prevalence of Cigarette Smoking & Smokeless Tobacco Use [105] 4.7 Closing Remarks on Treatment Services and Substance Abuse Surveys The statistics provided by SAMHSA’s annual NSDUH are frequently quoted as a comprehensive and unbiased source of data on the severity of substance abuse in the United States. The Arizona Department of Health Services relies on this information to help assess the behavioral health needs of the state (Arizona Substance Abuse Epidemiology Profile) and make its case for receiving grant funds (Substance Abuse Prevention and Treatment Block Grant). The responses received to NSDUH questions on “Needing but Not Receiving Treatment for” a substance and “Dependence On or Abuse of” a substance are considered by many substance abuse specialists as the best available assessment of the treatment needs for a given community. For all age groups, approximately 94% of the NSDUH estimates collected in the NARBHA area for 2002‐
2008 are above the national average. This fact persists despite the fact that the percentage of the population using, or depending on, illicit drugs and alcohol has decreased for many substances in recent years. For many survey questions NARBHA region ranks first or second in Arizona, particularly in the age range 18‐25. It may be that one of the factors which helps contribute to the high level of substance use and dependence in northern Arizona is the exceptionally poor perception of the understanding of perceived risk for substance use in this region. The data show that northern Arizona has become progressively more naïve with respect to the risks associated with using cigarettes, marijuana and alcohol since 2002. SAMHSA’s N‐SSATS provide a picture of the availability and utilization of treatment services in Mohave County, NARBHA and for southern Arizona (all counties outside of the NARBHA counties). For the past few years Mohave County has enjoyed an increase in regular outpatient treatment services, and based on the number of clients served per capita, Mohave County appears to use outpatient services more heavily than the rest of the state. It may be Mohave County’s high usage of regular outpatient treatment is due to an abundance of availability of this type of treatment service whereas other forms of treatment services, such as residential services, are lacking locally. In fact, MMHC reports that some clients which are assessed as needing residential treatment refuse to leave the county to receive this service. Consequently, they frequently choose to follow a treatment course (i.e. outpatient) they can receive closer to their home. In any case, the availability of outpatient treatment services appears to be sufficient in Mohave County. There are no residential CD treatment services available in Mohave County. It is the only county in Arizona with a population greater than 100,000 people which does not have some type of CD residential facility (long term, short term, stabilization, or substance abuse detoxification). It is the largest county (by land area) in the contiguous United States which does not have some type of a CD residential facility. Mohave County residents who require publicly funded residential treatment must travel approximately 200 miles to receive CD residential treatment (in Prescott, Arizona). These rural Arizonans must travel the longest distances in the state to receive publicly funded CD residential treatment. [106] West Yavapai Guidance Clinic in Prescott has five publicly funded beds allocated to Mohave County residents. These beds are fully utilized at all times. In fact, Mohave County regularly exceeds their allocated number of beds. Clients must sometimes wait up to two weeks to be admitted into CD Residential Treatment. NARBHA indicates this delay is likely due to a lack of bed availability. Treatment professionals are in agreement this wait time is unacceptable. NARBHA recognizes the need for additional beds for Mohave County. They further acknowledge that a residential treatment facility located in Mohave County is needed. An estimate of the number of CD residential beds needed by Mohave County can be derived by using national or statewide average figures. The 2009 N‐SSATS indicate 10% of all clients in treatment were either in residential or hospital in‐patient treatment programs. The state of Arizona is able to provide a more accurate picture. According to the 2008 Annual Report of Substance Abuse Treatment Programs prepared by ADHS/DBHS, brief or long term residential treatment services were provided to 8.6% of enrollees receiving Arizona’s publicly funded substance abuse treatment services. If we use the total number of people using outpatient services in Mohave County as the figure for “total enrollees” in Mohave County (1591 persons), and apply the 8.6% state average, we can estimate that approximately 137 people in Mohave County would have used some type of residential treatment service in 2008. The 2009 Annual Report of Substance Abuse Treatment Programs indicates 9.5% of enrollees received substance abuse treatment services. When this statewide average is applied to Mohave County (for 1360 enrollees), it is calculated that in 2009 approximately 129 Mohave County residents would have used residential treatment services. Currently Mohave County fully utilizes their available CD residential beds, which means approximately 60 people per year receive state funded residential treatment. Therefore, Mohave County’s utilization rate is roughly 54% under the statewide average. If the statewide average determined by ADHS/DBHS is used to determine the need in Mohave County, another six to seven CD residential beds should be allocated to Mohave County to serve its treatment needs. The state of Arizona claims there is little geographic variation in the prevalence of need for substance abuse treatment and the demand for treatment varies most by population size, with denser areas of the state experiencing highest demand (p.20, 2010 SAPT Block Grant Application). However, when population is compared to the number of enrollees in Arizona’s publicly funded substance abuse treatment programs, we see in 2009 NARBHA had 15.9% of the enrollees although their five counties consist of 11.6% of the state’s population. In contrast, Maricopa County has 60.3% of the states’ population, but only 39.5% of the enrollees. Logically, if the prevalence of need was based upon the population, the percentage of the population within a region should equal the percentage of enrollees in publicly funded substance abuse treatment programs. Furthermore, the whole point of the often touted SAMHSA surveys is to assess the severity/needs of the substance using population in regions throughout the country. If the prevalence of need for substance abuse treatment and the demand for treatment was truly the same everywhere, why not just survey a small population in the country, determine the need at that location and use the estimates from there throughout the country? Certainly, local variables exist which influence a region’s treatment needs. Yet in determining the [107] treatment needs of the NARBHA region, the SAPT Block Grant application simply multiplies the population of that region by a national average for the population in need of treatment for an illicit drug or alcohol use problem (derived from the 2008 NSDUH). SAMHSA’s statewide and sub‐state values, which are universally higher than national values, were ignored. Arizona recognizes families involved in the child welfare system as the population within the state which is in greatest need of treatment services. This population is served by Arizona Families F.I.R.S.T. (AFF). The Needs Capacity Report (April 2008), prepared by ADHS/DBHS, was specifically prepared to assess the need of this population for treatment throughout the state. It did this by comparing the total number of treatment services in a county to the population of the county. However, the fact that multiple services may be provided by a single provider was mentioned in the report but not considered in the calculations. Also, the capacity of outpatient service providers was not discussed. Nevertheless, the report concluded Mohave County had among the lowest need for additional treatment services whilst Maricopa County had the highest need. Yet a review of referrals to the AFF Program shows that Mohave County has a significantly higher number of referrals per capita than the state average (which is driven by Maricopa County). Furthermore, as was previously discussed, while Mohave County has an abundance of regular outpatient treatment providers, it has no residential treatment providers. The report states the number of treatment services per 100,000 adults for AFF clients is reported as highest in NARBHA’s area, however it also points out that AFF indicates their clients receive a less intensive level of service than is needed while waiting for the availability of a more appropriate, higher level of care. In consideration of this, there can be no doubt with all in‐patient services out of the county, Mohave County’s AFF clients who need CD residential care, are likely receiving a lesser level of care than they require. With respect to hospital admissions, it is MSTEPP’s view that some admissions to hospitals for medical complaints which do not have an AOD as a primary diagnosis could nevertheless have an AOD as an underlying problem which is not disclosed. It is likely that a certain (unknown) percentage of people seeking medical care do not self report their drug history which may be an underlying cause to the medical complaint. Therefore, the actual number of people who enter the hospitals with an OAD is likely significantly greater than the reported numbers. Finally, it is interesting to examine the substance abuse treatment patterns for Fort Mojave Tribe because it is a sub‐population of Mohave County which has its own behavioral health agency. The logical premise is that with a significantly smaller population to administer to, the tribe’s behavioral health agency is able to be more responsive to its members. For the past four years, Fort Mohave Tribe Behavioral Health has observed increasing numbers of adults requiring substance abuse treatment. The number of people requiring in‐patient treatment increased in 2008 and has maintained at a high level through 2009. In 2008, 13% of clients received in‐patient treatment, and in 2009, approximately 11% of clients received in‐patient treatment. It is noteworthy that the Fort Mohave Tribe’s need for in‐patient treatment is significantly higher than the statewide average of 8.6% or Mohave County’s 3.8%. [108] 5.0 DISCUSSION AND RECOMMENDATIONS 5.1 Discussion Substance abuse destroys lives and negatively impacts the community at multiple levels. The costs associated with substance abuse are far ranging and borne by all. The impact of substance abuse on families, at the workplace, within the schools, upon the health care system, and in the courts and jails is undeniable. Nevertheless, it should be kept in mind that not all substances are illegal and not all use is abuse. Such may be the case for alcohol and prescription drugs. Although the line between use and abuse may be disputed, the consequences of substance abuse are not. For example, the correlation between substance abuse and child abuse is irrefutable. In Mohave County, this relationship is exceptionally strong. Furthermore, Mohave County has among the highest rates of child abuse reports and investigations in Arizona. Multiple other indicators also imply a high level of substance abuse in Mohave County. For example: 
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The percentage of juvenile male drug arrests has doubled in the past five years. It is accepted that approximately 30% of property crimes are attributable to illegal drug use and Mohave County has among the highest rates of property crime in Arizona. Arizona’s Crime in Arizona Report shows Mohave County had more synthetic narcotic (i.e. methamphetamines) related arrests between 2006 and 2008 than any other Arizona county reviewed. Arrests for other dangerous drugs has also risen to very high levels. From 2006 through 2008, Mohave County had the highest percentage of alcohol related crashes in the state. Records from the Arizona Criminal Justice Commission indicate Mohave County ranks among the counties with the highest number of drug court cases, per capita, statewide. The number of dependency case filings and the number of children in dependencies have steadily increased in the past four years. When these data are considered alongside SAMHSA’s NSDUH results which report approximately 94% of substance abuse estimates in Northern Arizona are above the national average, it is sensible to infer Mohave County has a substantial substance abuse problem. In fact, when we consider that in statewide comparisons, Mohave County’s substance abuse indicators are frequently among the highest in the state, it is reasonable to estimate that Mohave County’s rate of substance abuse may also be among the highest in the state. By establishing that Mohave County has a significant substance abusing population, we may infer that it also has a large need for treatment services. In accordance with this inference, SAMHSA reports that between 2006 and 2009 regular outpatient treatment services were utilized significantly more in Mohave County than the rest of Arizona. In fact, the dramatically higher percentage of clients in Mohave County using regular outpatient services as compared to all of northern Arizona (the NARBHA [109] region) or southern Arizona (which includes Phoenix and Tucson) is so substantial, it is striking. To accommodate the great need for outpatient services, NARBHA has recently added new outpatient facilities in Mohave County. Having established the need for regular outpatient services in Mohave County far exceeds the rest of state, does the same need hold true for in‐patient or residential treatment? It’s certainly a possibility, but assessing this need requires that we consider residential utilization rates elsewhere in the state. When we apply the statewide average utilization rate (as determined by the Arizona Department of Health Services) for residential treatment by AHCCCS enrollees to Mohave County, we conclude that at least 129 to 137 people per year are in need of publicly funded residential treatment. Considering the conservative limits placed on this calculation, including the use of the statewide average when Mohave County ranks well above the state average for outpatient services, these estimates are probably low. Mohave Mental Health Clinic reports they send approximately 60 people per year to West Yavapai Guidance Clinic (Hillside) for residential treatment and this fully utilizes the maximum number of allocated beds to Mohave County by NARBHA. Therefore, according to own DHS’s estimate, Mohave County has a need for residential treatment beds that far exceeds the number of allocated beds actually granted to Mohave County. Although the need for additional residential treatment beds for Mohave County is clear based on the actual utilization rates in Arizona, additional factors must be considered when evaluating Mohave County’s need for residential treatment. The lack of residential treatment beds allocated to Mohave County only touches upon the problem. Even if the number of beds available at Hillside to Mohave County were to increase, the need for a residential facility within the county limits would remain. The reasons for this are: A. Successful residential treatment program includes family involvement. Therefore, the facility needs to be within a reasonable driving distance from home. Hillside is too far away from Mohave County to expect reasonable family involvement. B. A local facility translates into shorter wait times. Generally speaking, if a client needs a bed and a bed is available locally, that client can occupy that bed the same day. The treatment needs of a client as they are assessed at a given time must be provided at that time…not two weeks from now. C. Clients are more likely to enter a residential facility if it is local. Many clients have lived in Mohave County for a long time and do not wish to travel outside the county for treatment services. They are more comfortable moving to a facility that is within familiar territory. Additionally, parents are resistant to moving far away from their children. D. Mohave County judges have indicated they are overburdened with substance abuse related cases and the Sheriff has people undergoing detoxification and substance abuse recovery in jail. These officials hope that a local residential treatment facility may pave the way for people to receive the treatment they need instead of using the jail for this purpose. [110] Furthermore, considering that Mohave County has the largest population in Northern Arizona on AHCCCS (as of 2009) and the Median Household Income is well below the state average, the need for publicly funded treatment services is likely the highest in northern Arizona. This would include both residential treatment and detoxification services. Detoxification is another important service which, for the most part, is absent from Mohave County. Arizona DES states that the average utilization of detoxification services in Arizona was 2.8% in 2008 and 2.6% in 2009. When these state‐wide averages are applied to the Mohave County, the estimated number of people needing detoxification services is between 36 and 45 people per year. A person will not be admitted to a CD Residential Treatment program if they are in need of medical detoxification. Although many people may choose to detoxify themselves at home, others need help. This help must be convenient and timely. At this time, the only publicly funded detoxification service provided in the county is done by the Level I Subacute facility at Mohave Mental Health Clinic. Consideration for admission to the Level I Subacute Facility for medical detoxification is done on a case by case basis. Since the efficacy of medical detoxification as a stand‐alone treatment event is not encouraging, it is not uncommon for a referral to a CD Residential Treatment program to be considered following medical detoxification. Not having a local treatment facility which can provide reliable, timely medical detoxification, as well as CD Residential Treatment creates the need for a client to wait for some portion of time to enter medically necessary treatment. Asking these people to wait runs the risk of closing a window of opportunity for treatment. Mohave County needs a better solution. Fortunately, the State of Arizona Department of Health Services maintains that it is firmly committed to “increasing access to care and reducing barriers to treatment” and “emphasizing consumer and family involvement in an individual’s treatment program”. Further, it encourages data‐driven decision making and wishes to improve the quality and timeliness of service delivery. Based on these assertions which were recently stated in their 30 September 2010 SAPT Block Grant application, the treatment gaps identified in this report should be remedied so as to provide the access to care and family involvement that the state claims to champion. Although the focus of this Needs Assessment was on Mohave County’s adult population, the treatment needs of youth were also made clear in this report. In particular, the dramatic increase in drug related arrests of juvenile males over the past five years indicates a growing problem. The striking increase in prescription drug abuse in the schools is also alarming. These concerning statistics are supplemented by NSDUH’s estimates, which indicate that illicit drug use other than marijuana and nonmedical use of pain relievers are exceptionally high among northern Arizona youth. Unfortunately, DES reports there are fewer residential treatment facilities for persons under 18 in NARBHA’s region than in the rest of Arizona. NARBHA is also reported to have insufficient outpatient treatment services for juveniles. With respect to prevention, the NSDUH leaves no doubt that additional work needs to be done throughout northern Arizona on educating the public about the dangers of substance abuse. Its [111] estimates for “Perceptions of Risk of Substance Use” showed that all ages in the rural north demonstrated a decreasing perception of risk for using cigarettes, marijuana and alcohol. In fact, northern Arizona ranks the worst in the state for perception of risk for nearly every substance and for all groups. Another area of concern was the lack of prevention programs in Mohave County that were eligible for funding by the SAPT Block Grant. Other counties, including smaller less populated counties, appear to have a greater variety of preventative interventions eligible for funding. Upon reviewing the prevention programs elsewhere and in light of NSDUH’s estimates, it appears that Mohave County should consider developing additional data‐driven, evidence‐based prevention programs for its population. 5.2 Recommendations Based on the scope and severity of Mohave County’s substance abuse problem as well as an assessment of publicly funded treatment resources available to those in need, MSTEPP has identified the following treatment objectives: 1. Increase the number of residential treatment beds allocated to Mohave County to at least twelve beds. 2. Establish a CD residential treatment facility within Mohave County to service the local adult population; both men and women. 3. Establish a medical detoxification facility within Mohave County to service the local adult population preparing to enter the CD residential treatment facility. 4. Provide transportation services throughout Mohave County for those who do not have the means to travel to treatment providers. 5. Provide transportation services to families members who do not have the means to travel to the CD residential treatment facility so they may be involved in the treatment program. 6. Develop incentives for those in recovery to encourage them to remain clean. 7. In consideration that Mohave County probably has the highest rates of methamphetamine use in the state, conduct additional research to determine if a Methamphetamine Center of Excellence would be viable within the county. 8. Conduct further assessment to establish the need for a CD residential facility for youth. 9. Conduct further assessment to establish the need for additional transitional housing programs in Mohave County. 10. Maintain a community brochure of current substance abuse treatment referral options with annual revisions and updates. 11. Encourage substance abuse prevention and awareness education throughout Mohave County. [112] 6.0 BIBLIOGRAPHY CHAPTER ONE Arizona Commerce Population Projections, 2006‐2009. From http://www.azcommerce.com/EconInfo/Demographics/Population+Projections.htm U.S. Census Bureau: State and County QuickFacts. Data Derived from Population Estimates, Census of Population and Housing, Small Area Income and Poverty Estimates. Last Revised: 16‐Aug‐2010. From http://quickfacts.census.gov/qfd/states/04000.html County Statistics of the United States. From Wikipedia, the online encyclopedia. http://en.wikipedia.org/wiki/County_statistics_of_the_United_States CHAPTER TWO Kingman Police Department. Annual Report. From www.kingmanpolice.com. (a) Year 2005 (b) Year 2006 (c) Year 2007 (d) Year 2008 (e) Year 2009 Arizona Criminal Justice Commission, Enhanced Drug and Gang Enforcement (EDGE) Report. From http://www.azcjc.gov/ACJC.Web/publications/publications.aspx?ServId=1003 (a) Fiscal Year 2005 (b) Fiscal Year 2006 (c) Fiscal Year 2007 (d) Fiscal Year 2008 (e) Fiscal Year 2009 [113] Arizona Department of Public Safety. Crime in Arizona Report. www.azdps.gov/About/Reports/Crime_In_Arizona/ (a) Year 2006 (b) Year 2007 (c) Year 2008 (d) Year 2009 Arizona Department of Transportation, Motor Vehicle Division, Motor Vehicle Crash Facts. From http://www.azdot.gov/mvd/statistics/crash/index.asp (a) Year 2006 (b) Year 2007 (c) Year 2008 CHAPTER THREE Arizona Department of Economic Security, Division of Children, Youth and Families, Administration for Children, Youth and Families. Child Welfare Reporting Requirements Semi‐Annual Report. From https://www.azdes.gov/appreports.aspx?category=57 (a) For the period of 1 April 2009 – 30 September 2009 (b) For the period of 1 October 2008 – 31 March 2009 (c) For the period of 1 April 2008 – 30 September 2008 (d) For the period of 1 October 2007 – 31 March 2008 (e) For the period of 1 April 2007 – 30 September 2007 (f) For the period of 1 October 2006 – 31 March 2007 (g) For the period of 1 April 2006 – 30 September 2006 State of Arizona. Annual Report for State, Child Protective Services Expedited Substance Abuse Treatment Fund. [114] (a) Fiscal Year 2007 (b) Fiscal Year 2008 Hutchison, Linnae and Blakely, Craig. Substance Abuse – Trends in Rural Areas. Arizona Criminal Justice Commission, Enhanced Drug and Gang Enforcement (EDGE) Report. From http://www.azcjc.gov/ACJC.Web/publications/publications.aspx?ServId=1003 (a) Fiscal Year 2005 (b) Fiscal Year 2006 (c) Fiscal Year 2007 (d) Fiscal Year 2008 (e) Fiscal Year 2009 CHAPTER FOUR United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH),2002‐2008 SubState Report of Substance Use & Serious Psychological Distress, from www.oas.samhsa.gov United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH),2007‐2008 State Estimates of Substance Use & Mental Health, from www.oas.samhsa.gov United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National Survey of Substance Abuse Treatment Services (N‐
SSATS): 2009, Data on Substance Abuse Treatment Facilities. Center for Applied Behavioral Health Policy, College of Human Services, Arizona State University Arizona Families F.I.R.S.T. Program Annual Evaluation Report, Prepared for Arizona Dept of Economic Security, Division of Children, Youth and Families, http://www.cabhp.asu.edu (a) 1 July 2005 – 30 June 2006, released December 2006 (b) 1 July 2006 – 30 June 2007, released November 2007 ( c) 1 July 2007 – 30 June 2008, released January 2009 (d) 1 July 2008 – 30 June 2009, released January 2010 [115] State of Arizona, Office of the Auditor General (July 2009). Performance Audit, A Report to the Arizona Legislature, Department of Health Services, Division of Behavioral Health Services – Substance Abuse Treatment Programs, Report No. 09‐07, from www.azauditor.govv/Reports/State_Agencdies/Agencies/Health_Services_Department_of/Health_Servi
ces_Department_of.htm State of Arizona, Office of the Auditor General (23 June 2010). Department of Health Services – Substance Abuse, Auditor General Report No. 09‐07, Initial Follow‐Up Report, from www.azauditor.gov Arizona Department of Health Services, Division of Behavioral Health Services. Annual Report on Substance Abuse Treatment Programs, Submitted Pursuant to ARS 36‐2023, from www.azdhs.gov/bhs/ (a) Fiscal Year 2008, 31 December 2008 (b) Fiscal Year 2009, 31 December 2009 State of Arizona, Governor’s Office for Children, Youth and Families, Division for Substance Abuse Policy/ Arizona Substance Abuse Epidemiology Work Group/ Arizona Department of Health Services, Division of Behavioral Health Services/ Arizona Department of Economic Security, Division of Children, Youth and Families (April 2008). Substance Abuse Treatment Services Capacity Report, from www.azdhs.gov State of Arizona, Department of Health Services, Division of Behavioral Health Services (1 July 2010). Letter regarding budget crisis, from www.azdhs.gov Nelson, Laura Dr., Arizona Department of Health Services, Division of Behavioral Health (28 July 2010). Letter regarding budget crisis, from www.azdhs.gov Application for Federal Substance Abuse Prevention and Treatment (SAPT) Block Grant, OMB No. 0930‐
0080 The Substance Abuse Epidemiology Work Group, State of Arizona Governor’s Office for Children, Youth and Families, Division for Substance Abuse Policy (2007), Arizona Statewide Substance Abuse Epidemiology Profile. Arizona Department of Vital Statistics Records, 2008 Center for Disease Control, Behavioral Risk Factor Surveillance Systems, 2008 Arizona Statewide Substance Abuse Epidemiology Profile, 2007 Mohave County Tobacco Youth Survey, (MCTYS‐06) [116] [117]