Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Funded by the U.S. Substance Abuse and Mental Health Services Administration November 2016 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Acknowledgements The Wisconsin Department of Health Services (DHS) would like to thank the following people who contributed their expertise in developing the Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016. Department of Health Services: Division of Care and Treatment Services Christine Niemuth, MA Paul Krupski Prevention Coordinator Prevention Coordinator Bureau of Prevention Treatment and Recovery Bureau of Prevention Treatment and Recovery Mary Raina Haralampopoulos, MSW, PS Prevention Specialist Bureau of Prevention Treatment and Recovery Department of Health Services: Division of Public Health Milda Aksamitauskas, MPP Richard Miller Section Chief, Health Analytics Section Research Scientist Office of Health Informatics Office of Health Informatics Anne Ziege, PhD Research Scientist Office of Health Informatics University of Wisconsin: Population Health Institute Sara Lindberg, PhD, MS Director of Evaluation Research Rebecca Tuholski Associate Research Specialist Sarah Linnan, MA, CHES Senior Research Specialist For questions about this report, contact: Joyce Allen, Director Bureau of Prevention Treatment and Recovery Division of Care and Treatment Services Department of Health Services 1 W. Wilson St., Room 850 Madison, WI 53703 Joyce.Allen@wisconsin.gov 608-266-1351 Media with questions about this report should contact the Wisconsin Department of Health Services Media Line at 608-266-1683 or dhsmedia@wisconsin.gov This report is available online at http: www.dhs.wisconsin.gov/stats/aoda.htm Suggested Citation Wisconsin Department of Health Services, Division of Care and Treatment Services and Division of Public Health. Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 (P-45718-16). Prepared by the Division of Care and Treatment Services, Division of Public Health, and the University of Wisconsin Population Health Institute. November 2016. 2 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table of Contents Acknowledgments ................................................................................ 2 Table of Contents................................................................................. 3 List of Tables and Figures ....................................................................... 5 Acronyms........................................................................................... 8 Executive Summary ............................................................................. 10 Wisconsin Overview ............................................................................. 12 Consequences Consequences of Alcohol Consumption ................................................. 13 Alcohol-Related Deaths Acute Conditions Chronic Conditions Alcohol-Related Illnesses and Injuries Alcohol-Related Motor Vehicle Injuries Alcohol Abuse or Dependence Alcohol-Related Hospitalizations Alcohol-Related Offenses Alcohol-Related Crime and Arrests Alcohol-Related School Suspensions and Expulsions Consequences of Other Drug Consumption ............................................ 37 Other Drug-Related Deaths Other Drug-Related Illnesses and Injuries Other Drug Abuse or Dependence Neonatal Abstinence Syndrome Hepatitis C Other Drug-Related Hospitalizations Other Drug-Related Offenses Other Drug-Related Crime and Arrests Other Drug-Related School Suspensions and Expulsions Consequences of Alcohol and Other Drug Consumption ............................. 53 Treatment Alcohol and Other Drug-Related Offenses Alcohol and Other Drug-Related Crime and Arrests 3 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Consumption Alcohol Consumption ....................................................................... 64 Current Alcohol Use Binge Drinking Heavy Use of Alcohol Per Capita Alcohol Consumption Underage Drinking Age of Initiation Alcohol Use by Women of Childbearing Age Drinking Before and During Pregnancy Other Drug Consumption .................................................................. 85 Illicit Drug Consumption Marijuana Cocaine Heroin Inhalants Methamphetamine Nonmedical Use of Prescription Drugs Risk Factors Community-Level Risk Factors for Substance Use Disorders ....................... 95 Alcohol Availability Other Drug Availability Perception of Harm Shared Risk Factors (for Mental Illnesses and Substance Use Disorders) ....... 100 Early Life Experiences Depression and Suicide Appendix 1: Indicator Definitions .......................................................... 103 Appendix 2: Data Sources.................................................................... 108 4 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Tables and Figures Tables Consequences of Alcohol Consumption Table 1. Alcohol-related motor vehicle deaths, Wisconsin by county ............................. 18 Table 2. Suicide deaths, Wisconsin and the U.S. ..................................................... 22 Table 3. Alcohol-related liver cirrhosis deaths, Wisconsin and the U.S. .......................... 22 Table 4. Alcohol-related motor vehicle injuries, Wisconsin by county............................ 24 Table 5. Prevalence of alcohol abuse and dependence, age 12 and older ....................... 26 Table 6. Alcohol-related hospitalizations, Wisconsin ................................................ 27 Table 7. Alcohol-related hospitalizations, Wisconsin by county ................................... 28 Table 8. Operating while intoxicated (OWI) and liquor law arrests, Wisconsin by county ........................................................................... 33 Table 9. Alcohol-related suspensions and expulsions, Wisconsin by county ...................... 36 Consequences of Other Drug Consumption Table 10. Drug-related deaths, Wisconsin and the U.S. .............................................. 38 Table 11. Illicit drug abuse or dependence, Wisconsin by age ...................................... 40 Table 12. Drug-related hospitalizations, Wisconsin ................................................... 44 Table 13. Drug-related hospitalizations, Wisconsin by county ....................................... 45 Table 14. Opioid-related hospitalizations, Wisconsin by county .................................... 48 Table 15. Drug law arrests, Wisconsin by county ...................................................... 50 Table 16. Drug-related suspensions and expulsions, Wisconsin by county ......................... 52 Consequences of Alcohol and Other Drug Consumption Table 17. Treatment admissions, Wisconsin by primary substance ................................. 53 Table 18. Property crimes, Wisconsin by county ...................................................... 58 Table 19. Violent crimes, Wisconsin by county ........................................................ 60 Table 20. Disorderly conduct arrests, Wisconsin by county .......................................... 63 Alcohol Consumption Table 21. Current alcohol use, high school students, Wisconsin by race/ethnicity .............. 66 Table 22. Current alcohol use, adults, Wisconsin by age and sex, and U.S. median ............. 68 Table 23. Current alcohol use, adults, Wisconsin by race/ethnicity ................................ 68 Table 24. Current alcohol use, adults, Wisconsin by county ......................................... 69 Table 25. Maximum drinks per occasion, Wisconsin by age and sex ................................ 70 Table 26. Binge drinking, high school students, Wisconsin by race/ethnicity ..................... 71 Table 27. Binge drinking, adults, Wisconsin by age and sex, and U.S. median.................... 73 Table 28. Binge drinking, adults, Wisconsin by race/ethnicity ...................................... 73 Table 29. Binge drinking, adults, Wisconsin by county ............................................... 74 Table 30. Heavy drinking, adults, Wisconsin by age and sex, and U.S. median ................... 76 Table 31. Heavy drinking, adults, Wisconsin by race/ethnicity ..................................... 76 Table 32. Alcohol use initiation before age 13, high school students, Wisconsin by sex ................................................................................ 79 Table 33. Alcohol use initiation before age 13, high school students, Wisconsin by race/ethnicity .................................................................. 80 5 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Other Drug Consumption Table 34. Other drug use, age 12 and older, Wisconsin and the U.S. .............................. 85 Table 35. Current marijuana use, high school students, Wisconsin by race/ethnicity ........... 89 Table 36. Marijuana use initiation before age 13, high school students, Wisconsin by race/ethnicity .................................................................................. 89 Table 37. Lifetime heroin use, high school students, Wisconsin by race/ethnicity .............. 91 Table 38. Lifetime methamphetamine use, high school students, Wisconsin by race/ethnicity .................................................................................. 93 Risk Factors Table 39. Alcohol outlet density, Wisconsin by county ............................................... 96 Table 40. Offered an illegal drug on school property, high school students, Wisconsin by race/ethnicity .................................................................. 98 Table 41. Perceived parental disapproval of alcohol use, high school students, Wisconsin by race/ethnicity .................................................................. 99 Figures Consequences of Alcohol Consumption Figure 1. Alcohol-related deaths, Wisconsin by cause ............................................... 14 Figure 2. Alcohol-attributable fall deaths, Wisconsin ............................................... 15 Figure 3. Alcohol–attributable poisoning deaths, Wisconsin ........................................ 16 Figure 4. Alcohol-related motor vehicle deaths, Wisconsin and the U.S. ......................... 17 Figure 5. Recreational vehicle deaths, Wisconsin ..................................................... 20 Figure 6. Suicide deaths, Wisconsin and the U.S. ..................................................... 21 Figure 7. Alcohol-related motor vehicle injuries, Wisconsin ........................................ 23 Figure 8. Alcohol abuse and dependence, Wisconsin and the U.S. ................................. 26 Figure 9. Alcohol-related hospital charges, Wisconsin ............................................... 27 Figure 10. Arrests for operating a motor vehicle while intoxicated (OWI), Wisconsin and the U.S. ........................................................................ 31 Figure 11. Liquor law arrests, Wisconsin and the U.S. ................................................. 32 Consequences of Other Drug Consumption Figure 12. Drug-related deaths, Wisconsin and the U.S. .............................................. 38 Figure 13. Drug-related deaths involving opioids, cocaine and/or benzodiazepines, Wisconsin ........................................................................................ 39 Figure 14. Heroin, methadone, and other opioid-related deaths, Wisconsin....................... 40 Figure 15. Neonatal Abstinence Syndrome cases, Wisconsin.......................................... 41 Figure 16. Newly reported cases of Hepatitis C, Wisconsin ........................................... 43 Figure 17. Newly reported cases of Hepatitis C, Wisconsin by age .................................. 43 Figure 18. Drug-related hospitalization charges, Wisconsin .......................................... 44 Figure 19. Opioid-related hospitalizations, Wisconsin ................................................. 47 Figure 20. Drug law arrests, Wisconsin and the U.S. ................................................... 49 Consequences of Alcohol and Other Drug Consumption Figure 21. Alcohol and other drug abuse clients receiving services with public funds, Wisconsin ........................................................................................ 54 Figure 22. Public funds expended for alcohol and other drug abuse treatment, Wisconsin ..... 54 Figure 23. Publicly funded treatment for prescription drug abuse, ages 12-25, Wisconsin ...... 55 6 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 24. Property crime offenses, Wisconsin and the U.S. ......................................... 56 Figure 25. Violent crime offenses, Wisconsin and the U.S. ........................................... 57 Figure 26. Disorderly conduct arrests, Wisconsin and the U.S. ....................................... 62 Alcohol Consumption Figure 27. Alcohol use, high school students, Wisconsin and the U.S. .............................. 65 Figure 28. Alcohol use, adults, Wisconsin and the U.S. median ...................................... 65 Figure 29. Current alcohol use, high school students, Wisconsin and the U.S. .................... 66 Figure 30. Current alcohol use, adults, Wisconsin and the U.S. median ............................ 67 Figure 31. Binge drinking, high school students, Wisconsin and the U.S. ........................... 71 Figure 32. Adult binge drinking prevalence by state: Low, high, and U.S. median ............... 72 Figure 33. Heavy drinking, adults, Wisconsin and the U.S. median .................................. 75 Figure 34. Per capita alcohol consumption, Wisconsin and the U.S. ................................ 77 Figure 35. Underage drinking, Wisconsin and the U.S. ................................................ 78 Figure 36. Alcohol use initiation before age 13, high school students, Wisconsin and the U.S. ........................................................................ 79 Figure 37. Current alcohol use, women ages 18-44, Wisconsin and the U.S. median ............. 81 Figure 38. Binge drinking, women ages 18-44, Wisconsin and the U.S. median ................... 82 Figure 39. Alcohol consumption, three months before pregnancy, Wisconsin and PRAMS states .................................................................. 84 Figure 40. Alcohol consumption in last three months of pregnancy, Wisconsin and PRAMS states .................................................................. 84 Other Drug Consumption Figure 41. Lifetime use of illicit drugs, high school students, Wisconsin and the U.S. .................................................................................... 86 Figure 42. Use of marijuana, illicit drugs other than marijuana, and pain relievers for nonmedical purposes, Wisconsin by age group ........................................ 86 Figure 43. Current marijuana use, high school students, Wisconsin and the U.S. ................. 88 Figure 44. Lifetime marijuana use, high school students, Wisconsin and the U.S. ................ 88 Figure 45. Lifetime cocaine use, high school students, Wisconsin and the U.S. ................... 90 Figure 46. Lifetime heroin use, high school students, Wisconsin and the U.S...................... 91 Figure 47. Lifetime inhalant use, high school students, Wisconsin and the U.S. .................. 92 Figure 48. Lifetime methamphetamine use, high school students, Wisconsin and the U.S. ...... 93 Figure 49. Use of prescription pain relievers for nonmedical purposes, age 12 and older, Wisconsin and the U.S. ........................................................................ 94 Risk Factors Figure 50. Physical abuse, sexual abuse, or home environment substance abuse before age 18, Wisconsin...................................................................... 100 Figure 51. Major depressive episode and serious suicidal thoughts, Wisconsin and the U.S. .... 101 Figure 52. Major depressive episodes and suicidal thoughts, Wisconsin and the U.S. by age ............................................................................ 102 7 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Acronyms ACEs AEDS ARDI ATVs BAC BCD BJIA BPTR BRFS BRFSS BTS CDC CIUS CM CPI DCTS DHS DHHS DMHSAS DMV DNR DOJ DOR DOT DPH DPI DSM-IV DSPS ECC FARS FASD FBI HCV HIV HSRS ICD ISES MSAs NAS NCHS NHTSA NIAAA NIDA NSDUH OHI OJA OWI PARS PPS Adverse Childhood Experiences Alcohol Epidemiological Data System Alcohol-Related Disease Impact All-Terrain Vehicles Blood Alcohol Content Bureau of Communicable Diseases Bureau of Justice Information and Analysis Bureau of Prevention Treatment and Recovery Behavioral Risk Factor Survey (Wisconsin) Behavioral Risk Factor Surveillance System (National) Bureau of Transportation Safety Centers for Disease Control and Prevention Crime in the United States Clinical Modification Consumer Price Index Division of Care and Treatment Services (Formerly DMHSAS) Department of Health Services (Wisconsin) Department of Health and Human Services (federal) Division of Mental Health and Substance Abuse Services (Currently DCTS) Division of Motor Vehicles Department of Natural Resources Department of Justice Department of Revenue Department of Transportation Division of Public Health Department of Public Instruction Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Department of Safety and Professional Services Ethanol Conversion Coefficients Fatality Analysis Reporting System Fetal Alcohol Spectrum Disorders Federal Bureau of Investigation Hepatitis C virus Human Immunodeficiency Virus Human Services Reporting System (used through 2012, now PPS) International Statistical Classification of Diseases and Related Health Problems Individual Student Enrollment System Metropolitan Statistical Areas Neonatal Abstinence Syndrome National Center for Health Statistics National Highway Traffic Safety Administration National Institute on Alcohol Abuse and Alcoholism National Institute on Drug Abuse National Survey on Drug Use and Health Office of Health Informatics Office of Justice Assistance Operating While Intoxicated Police Accident Reports Program Participation System 8 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 PRAMS RSE SAE SCAODA SAMHDA SAMHSA SEOW TEDS UCR WISEdash WISH WHO YRBS YRBSS Pregnancy Risk Assessment Monitoring System Relative Standard Errors Small Area Estimation State Council on Alcohol and Other Drug Abuse Substance Abuse and Mental Health Data Archive Substance Abuse and Mental Health Services Administration State Epidemiological Outcomes Workgroup Treatment Episode Data Set Uniform Crime Reporting System Wisconsin Information System for Education Data Dashboard Wisconsin Interactive Statistics on Health World Health Organization Youth Risk Behavior Survey (Wisconsin) Youth Risk Behavior Surveillance System (National) 9 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Executive Summary The Wisconsin Department of Health Services (DHS) studies the patterns, causes, and effects of substance use to inform its prevention priorities. This effort started in 2006 with the establishment of the State Epidemiological Outcomes Workgroup (SEOW). Soon after, the first Epidemiological Profile on Alcohol and Other Drug Use in Wisconsin was published. New reports have been published every other year since 2006. The Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016, is a compilation of data from various sources. The indicators cover substance use, misuse, and abuse as well as the resulting consequences. Also included is a review of factors at the community and individual levels that increase the risk for substance use, misuse, and abuse. From each data source, this report presents the most recent available year of data, trend information from previous years, and United States (U.S.) comparisons when available. County-level data tables are included when available to assist in developing local needs assessments. Alcohol Use Remains High The per capita alcohol consumption rate in Wisconsin is 1.3 times higher than the national rate. The alcohol consumption rate for adults is 10 percentage points above the national rate (63% vs. 53%). Heavy drinking among adults is more common in Wisconsin than the nation as a whole. Wisconsin’s rate of adult binge drinking (22%) is third highest across all states and U.S. territories. Wisconsin women of childbearing age consume alcohol at levels higher than their national peers. Consequences of Alcohol Consumption Outpace National Rates Given Wisconsin’s alcohol consumption patterns, it is not surprising that the rates at which Wisconsin experiences the consequences associated with alcohol use have also tended to be higher than national rates. Since 2008, rates of alcohol abuse and dependence have been higher in Wisconsin than the nation as a whole. Wisconsin's rate of death from alcohol-related liver cirrhosis has risen since 2008 as has the rate of alcohol-related deaths from causes other than liver cirrhosis. The latest available data show that Wisconsin has 1.2 times the national rate of arrests for operating while intoxicated (OWI) and almost three times the national rate of arrests for liquor law violations. However, since 2010, Wisconsin’s rate of alcohol-related motor vehicle deaths has been similar to the national rate. Patterns of Other Drug Use Follow National Trends Across the country and in Wisconsin there has been a surge in the use of prescription drugs for nonmedical purposes. The misuse of these substances is most prevalent among young adults. In 20132014, 9 percent of Wisconsin adults age 18-25 reported using pain relievers for nonmedical purposes in the past year. Among high school students in 2013, 15 percent reported illicit use of prescription drugs at some point in their lives. Deaths Due to Improper Drug Use Increase Wisconsin’s age-adjusted rate of drug-related deaths increased from 2010 to 2015. Wisconsin’s number of drug-related deaths has exceeded 500 in nine of the past 10 years. In 2015, 873 Wisconsin residents died as a direct consequence of illicit drug use. The most prevalent category of drug mentioned on death certificates for drug-related deaths in 2015 was “other opioids,” by itself or in combination with other drugs. Heroin was the second most prevalent category and benzodiazepines were third. Wisconsin’s rate of drug-related deaths is lower than the national rate. Positive Trends Emerging Wisconsin’s rate of drinking among high school students has decreased since 2005, as has the proportion of Wisconsin students who initiate alcohol use before age 13. Also decreasing steadily is the 10 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 percentage of high school students who engage in binge drinking, now below the national rate. For the fifth year in a row, Wisconsin’s rate of alcohol-related motor vehicle deaths was similar to the national rate after years of exceeding it. Wisconsin’s rate of nonfatal injuries from alcohol-related crashes also has been declining steadily. While national rates for current and lifetime use of marijuana increased slightly in 2013, the Wisconsin rates decreased. Five Areas of Focus Based on the data presented in this report, DHS and its community partners are committed to addressing the following substance use issues that impact the health and safety of all state residents. • Underage drinking (ages 12-20) • Adult binge drinking (ages 18-34) • Drinking among pregnant women • Drinking and driving (especially among people ages 16 to 34) • Opioid use for nonmedical purposes (with a focus on people ages 20-54). 11 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Wisconsin Overview Wisconsin is home to an estimated 5.8 million residents (U.S. Census Population Estimates, 2015). Wisconsin has a predominantly White population (86%), which is followed in size by Black or African American (6.3%), Asian (2.3%), two or more races (1.8%), and American Indian and Alaska Native (1.0%). In addition, 5.9 percent of Wisconsin residents are Hispanic or Latino. Wisconsin covers more than 54,000 square miles. The state includes 72 counties; 190 cities, 407 villages, and 1,255 towns; and 11 federally recognized tribal nations (Wisconsin Demographic Services Center, 2015). There are very urban areas, such as Milwaukee County, with about 3,933 people per square mile, and very rural areas, such as Iron County with about 8 people per square mile (U.S. Census Bureau, 2010 Census; and Wisconsin Demographic Services Center 2015 Final Estimates). Source: Ingram, D.D., and Franco, S.J. (2014). 2013 NCHS urban-rural classification scheme for counties. National Center for Health Statistics. Vital Health Stat 2(166). http://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf Note: See Appendix 1 for definitions of urban-rural classifications. It is within the context of these demographic characteristics that substance use, misuse, and abuse in Wisconsin must be examined. 12 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Consequences Consequences of Alcohol Consumption Alcohol is the most frequently consumed substance of use and misuse in Wisconsin, contributing to consequences that affect all state residents. In 2015, alcohol was a factor in at least 2,008 deaths and 2,907 motor vehicle crash injuries in Wisconsin. In 2013, the economic burden resulting from excessive alcohol use totaled $6.8 billion dollars. 1 Causes of death and injury can be either fully attributable to alcohol or partially attributable in a specified fraction to alcohol (see Alcohol-Related Deaths, below). Alcohol is also a factor in a large proportion of property and violent crimes (in addition to homicide, which is included in “other alcohol-related causes of death”), and the number of crimes attributable to alcohol are not currently quantifiable as they are for deaths and injuries. Alcohol-Related Deaths Alcohol is a factor in many causes of death. Some causes, such as alcoholic liver cirrhosis and alcohol-related motor vehicle crash deaths, are 100 percent attributable to alcohol, while fractions for other causes are much smaller. The Alcohol-Related Disease Impact (ARDI) software application specifications from the U.S. Centers for Disease Control and Prevention (CDC) identify 54 chronic and acute conditions for which a proportion, or fraction, of deaths is attributable to excessive alcohol use. 2 These proportions were applied to Wisconsin death records in 2015. Of the 51,251 deaths in Wisconsin in 2015, approximately 2,008 were attributable to excessive alcohol use. Of the alcohol-related deaths, 58 percent were due to acute conditions; 42 percent were due to chronic conditions. 1 Black P.D. and Paltzer J.T. (2013). The Burden of Excessive Alcohol Use in Wisconsin. University of Wisconsin Population Health Institute. 2 For each of the 54 conditions, ARDI specifies a distinct fraction of cases attributable to alcohol. The number of alcohol-attributable deaths can be estimated by multiplying the number of deaths for each condition by the specified alcohol-attributable fraction and summing over conditions. This method was used to estimate the total number of alcohol-related deaths in Wisconsin, as well as the subset of “other” alcohol-related deaths (other than those from alcoholic liver cirrhosis and motor vehicle crashes). 13 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 In Wisconsin in 2015, the majority (58%) of alcohol-attributable deaths were from acute causes, such as motor-vehicle crashes, falls, and poisonings. The remaining 42 percent of alcohol-related deaths were from chronic conditions such as liver cirrhosis and cancer (Figure 1). Alcohol-attributable acute causes of death in the “other” category include homicide, drowning, firearm injury, hypothermia, aspiration, occupational injury, and child maltreatment. For more information on the International Statistical Classification of Diseases and Related Health Problems (ICD) codes corresponding to chronic and acute conditions included in the “other” category, see https://nccd.cdc.gov/DPH_ARDI/Info/Methods.aspx The state-level rate of “other” alcohol-related deaths per 100,000 population has been gradually trending upward since 2004, and was at 25.9 deaths per 100,000 population in 2015 (not shown). Figure 1. Alcohol-related deaths, Wisconsin by cause, 2015 Other Acute Conditions 13% Other Chronic Conditions 43% Self-Injury 17% Motor and Other Vehicle 15% Poisoning 18% Acute 58% Chronic 42% Cirrhosis 57% Falls 37% Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services. Note: Wisconsin resident deaths from acute (1,157) and chronic (851) alcohol-related causes in 2015 totaled 2,008. 14 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Acute Conditions Falls and poisoning are the two largest categories of acute alcohol-related deaths identified by the ARDI application. Alcohol-Related Fall Deaths Based on ARDI specifications, the alcohol-attributable fraction of deaths from falls is 32 percent. In 2015, 429 deaths from fall-related injuries were attributable to alcohol, exceeding the number of deaths from alcoholic liver cirrhosis (354). Older adults particularly are at risk for death from falls, including those where alcohol is a factor. Overall, approximately 85 percent of fall deaths occur in the age group 65 and older; thus it is likely that in 2015, approximately 365 fall-related deaths attributable to alcohol involved adults in this age group. Fall deaths are gradually increasing in tandem with the aging of the population (Figure 2). As with younger age groups, older adults in Wisconsin consume alcohol at somewhat higher levels than their age peers in the U.S. as a whole. 3 There is also evidence that binge drinking thresholds should be lower for older adults based on changes in metabolism, increased potential for drug interactions, and more numerous medical problems that occur with advancing age. 4 Thus, fall deaths and injuries related to alcohol are likely to increase in the state as the population continues to age. Figure 2. Alcohol-attributable fall deaths (all age groups), Wisconsin, 2006-2015 600 500 429 400 300 292 289 300 309 316 2006 2007 2008 2009 2010 332 349 378 388 2013 2014 200 100 0 2011 2012 2015 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services. 3 Behavioral Risk Factor Surveillance System (BRFSS) trends over time indicate that Wisconsin adults are more likely to consume alcohol excessively across all age groups compared to adults in other states and the nation as a whole. 4 Merrick, E.L., Horgan, C. M., Hodgkin, D., Garnick, D.W., Houghton, S.F., Panas, L., . . . Blow, F.C. 2007. Unhealthy drinking patterns in older adults: Prevalence and associated characteristics. Journal of the American Geriatrics Society, 56(2), 214-233. 15 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol-Related Poisoning Deaths Based on ARDI specifications, the alcohol-attributable fraction of poisoning deaths is 29 percent (excludes acute alcohol poisoning, which is 100 percent attributable to alcohol). The number of poisoning deaths attributable to alcohol increased from 142 in 2006 to 210 in 2015 (Figure 3). Figure 3. Alcohol-attributable poisoning deaths (all age groups), Wisconsin, 2006-2015 600 500 400 300 200 241 142 155 2006 2007 139 154 151 2008 2009 2010 175 182 2011 2012 220 210 2014 2015 100 0 2013 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services Note: Excludes acute alcohol poisonings, which are 100 percent attributable to alcohol. 16 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol-Related Motor and Recreational Vehicle Deaths Alcohol-Impaired Driving Fatalities While Wisconsin remains above the national average for alcohol-related motor vehicle deaths, both the national and state rates have decreased since 2012 (Figure 4). Of the 212 alcohol-involved traffic fatalities in 2014, 78 percent involved individuals with a blood alcohol content (BAC) above the .08 legal limit (Fatality Analysis Reporting System [FARS]). Of the 507 traffic fatalities in Wisconsin in 2014, 42 percent were alcohol-related, meaning the deaths involved individuals with a BAC of .01 or above. In the U.S. in 2014, 30 percent of all traffic fatalities were alcohol-related. Figure 4. Alcohol-related motor vehicle deaths, rate per 100,000 population, Wisconsin and the U.S., 2010-2014 (BAC = .01+) 10.0 U.S. Wisconsin 8.0 6.0 4.7 4.2 4.4 3.7 3.5 2010 2011 4.0 3.7 3.6 3.4 3.1 2012 2013 2014 4.0 2.0 0.0 Source: Fatality Analysis Reporting System, National Highway Traffic Safety Administration, U.S. Department of Transportation. Note: Due to a change in the definition of alcohol-impaired driving fatalities by the National Traffic Safety Administration, the rates reported in previous versions of this report using the old definition are no longer available. The rates in this figure have been updated to reflect the new definition. 17 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 1. Alcohol-related motor vehicle deaths, rate per 100,000 population, Wisconsin by county, 2010-2014 Death Rate per 100,000 County 2010 2011 2012 2013 2014 Adams 19 10 5 0 5 Ashland 6 6 0 6 0 Barron 4 0 0 7 0 20 13 13 7 0 Bayfield Brown 4 4 2 2 1 Buffalo 22 0 7 0 15 Burnett 0 0 19 13 13 Calumet 6 2 6 0 4 Chippewa 5 6 6 8 2 Clark 6 3 0 12 3 Columbia 4 9 7 4 2 Crawford 6 6 0 0 6 Dane 2 2 3 3 3 Dodge 3 3 2 1 3 Door 0 4 0 4 4 Douglas 2 7 9 5 2 Dunn 7 0 0 9 5 Eau Claire 2 3 4 2 2 23 0 23 0 0 1 5 7 2 2 Florence Fond du Lac Forest 11 22 22 33 0 Grant 6 6 0 4 4 Green 3 8 3 8 0 Green Lake 5 10 0 0 5 Iowa 8 8 0 13 0 Iron 17 0 0 17 0 Jackson 0 5 10 5 0 Jefferson 4 4 1 5 2 Juneau 4 15 11 15 4 Kenosha 4 3 3 5 4 Kewaunee 5 10 0 5 0 La Crosse 2 3 3 0 2 Lafayette 12 24 0 12 0 Langlade 5 5 15 5 15 Lincoln 7 3 14 7 3 Manitowoc 7 5 7 6 10 Marathon 2 4 2 5 1 18 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 1. Alcohol-related motor vehicle deaths, rate per 100,000 population, Wisconsin by county, 2010-2014 (continued) Death Rate per 100,000 County 2010 2011 2012 2013 2014 Marinette 12 14 14 2 5 Marquette 13 6 13 0 0 Menominee 0 0 0 0 0 Milwaukee 3 2 3 2 2 Monroe 2 4 4 4 0 Oconto 19 8 5 3 11 Oneida 6 3 3 11 3 Outagamie 3 2 2 1 2 Ozaukee 1 1 8 2 0 Pepin 0 0 0 0 27 Pierce 15 10 17 0 5 5 11 11 0 9 Polk Portage 11 1 10 6 4 Price 0 0 0 7 0 Racine 1 4 1 3 4 17 11 6 6 28 Rock 5 6 6 1 2 Rusk 0 7 0 0 0 St. Croix 1 6 2 0 2 Sauk 8 0 3 3 11 Sawyer 6 6 6 6 0 Shawano 2 14 5 2 2 Sheboygan 1 3 2 3 2 10 5 5 5 5 Trempealeau 7 3 0 7 3 Vernon 7 7 23 0 7 Vilas 5 9 5 19 0 Walworth 3 7 5 5 4 Washburn 0 0 6 13 6 Washington 8 2 5 2 2 Waukesha 1 2 3 2 2 Waupaca 8 11 4 10 2 Waushara 4 16 12 4 12 Winnebago 4 5 2 3 2 Wood Wisconsin 1 3 0 4 1 4 4 4 3 3 Richland Taylor Source: Bureau of Transportation Safety, Wisconsin Department of Transportation; population data for county rate calculations are from the U.S. Census. 19 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol-Related Recreational Vehicle Deaths In 2015, 40 percent of recreational vehicle deaths in Wisconsin were alcohol-related. Recreational vehicles include all-terrain vehicles (ATVs), boats, and snowmobiles (Figure 5). Deaths involving snowmobile operators and/or passengers represent the highest percentage of alcohol-related fatalities among recreational vehicle users. During the 2014-2015 season, 75 percent of snowmobile deaths were alcohol-related, up from 57 percent during the 2013-2014 season. Figure 5. Recreational vehicle deaths, alcohol-related and total number, Wisconsin, 20112015 All Recreational Vehicle Deaths 100 Alcohol-Related Recreational Vehicle Deaths 80 60 56 51 55 58 50 40 20 31 31 24 22 2012 2013 20 0 2011 2014 2015 Source: Snowmobile Safety and Enforcement Reports, All-Terrain Vehicle Enforcement and Safety Reports, and Wisconsin Boating Program Reports, Wisconsin Department of Natural Resources. 20 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol-Related Suicide Deaths The fraction of suicides where alcohol is a factor is 23 percent based on ARDI specifications. In 2015, there were 859 suicides in Wisconsin, of which approximately 198 were attributable to alcohol based on the ARDI specifications. Wisconsin’s rate of suicide remained slightly higher or close to the national rate as of 2014, the most recent year for which comparison data are available. (National figures are not yet available for 2015). The mortality rate from suicide increased in Wisconsin, from 12.8 in 2014 to 14.9 in 2015 per 100,000 population (Figure 6). The suicide rates presented in Figure 6 are age-adjusted for purposes of comparison between Wisconsin and the U.S. in order to remove the effects of differences in age distributions between the two populations. In 2014, the suicide mortality rate in Wisconsin was close to the rate of the U.S. (Table 2). Figure 6. Suicide deaths, age-adjusted rate per 100,000 population, Wisconsin and U.S., 2006-2015 20 16 12 11.8 10.9 12.5 11.3 12.6 11.6 12.6 12.4 11.8 14.9 14.4 13.4 12.1 12.3 13.0 12.6 12.6 12.6 12.8 8 U.S. Wisconsin 4 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention Wonder. Note: 2015 U.S. data not available at the time of publishing. 21 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 2. Suicide deaths, age-adjusted rate per 100,000 population and total number, Wisconsin and the U.S., 2008-2015 U.S. Wisconsin 2008 2009 2010 2011 2012 2013 2014 Rate/100,000 2015 11.6 11.8 12.1 12.3 12.6 12.6 13.0 Total number 35,969 36,837 38,307 39,442 40,600 41,149 42,773 Rate/100,000 12.6 12.4 13.4 12.6 12.6 14.4 12.8 14.9 Total number 737 724 792 736 734 853 736 859 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention Wonder: http://wonder.cdc.gov/mortSQL.html. Note: 2015 U.S. data not available at the time of publishing. Chronic Conditions Alcohol-Related Liver Cirrhosis Deaths Alcohol-related liver cirrhosis refers to liver damage caused by heavy drinking over an extended period of time. Wisconsin’s age-adjusted rate of alcohol cirrhosis mortality has been slightly below rates for the nation as a whole for a number of years. However, Wisconsin rates have been rising slightly over the past few years, reaching 5.2 per 100,000 population in 2015 (354 deaths). National comparison data is not available for 2015 (Table 3). Table 3. Alcohol-related liver cirrhosis deaths, age-adjusted rate per 100,000 population and total number, Wisconsin and the U.S., 2008-2015 2008 U.S. Wisconsin 2009 2010 2011 2012 2013 2014 2015 Rate/100,000 4.5 4.6 4.7 4.8 5 5.1 5.4 Total number 14,864 15,183 15,990 16,749 17,419 18,146 19,388 Rate/100,000 4.1 4.2 4.5 4.4 4.9 4.9 5.1 5.2 Total number 260 265 288 291 317 333 352 354 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services/ Centers for Disease Control and Prevention Wonder: http://wonder.cdc.gov/mortSQL.html. Note: 2015 U.S. data not available at the time of publishing. 22 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol-Related Illnesses and Injuries Alcohol-Related Motor Vehicle Injuries Total motor vehicle crashes involving injuries in Wisconsin decreased in 2014, while the number of alcohol-related motor vehicle crash injuries increased by one. This slight increase interrupted a gradual downward trend in the annual number of alcohol-related motor vehicle crash injuries (Figure 7). Figure 7. Alcohol-related and total nonfatal motor vehicle injuries, rate per 100,000 population, Wisconsin, 2005-2014 1,400 Total Crash Injuries 1,200 1,000 Alcohol-Related Crash Injuries 966 904 898 822 800 732 719 703 689 696 691 600 400 200 108 102 99 76 67 62 52 51 46 47 2006 2007 2008 2009 2010 2011 2012 2013 2014 0 2005 Source: Bureau of Transportation Safety, Wisconsin Department of Transportation; population data for county rate calculations are from the U.S. Census. 23 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 4. Alcohol-related motor vehicle injuries, rate per 100,000 population, Wisconsin by county, 2010-2014 Nonfatal Injury Rate per 100,000 County 2010 2011 2012 2013 2014 Adams 125 53 96 116 111 Ashland 74 12 75 37 44 Barron 70 48 54 37 33 107 80 119 79 126 Bayfield Brown 86 49 55 53 45 Buffalo 29 103 140 81 104 Burnett 129 90 97 84 39 Calumet 49 24 69 44 36 Chippewa 75 54 59 36 55 Clark 52 52 52 49 35 Columbia 84 90 51 39 39 Crawford 78 48 72 72 60 Dane 43 38 37 41 43 Dodge 62 80 55 53 59 Door 43 75 57 75 43 Douglas 43 32 68 16 36 Dunn 59 50 50 32 70 Eau Claire 37 36 45 46 40 136 228 68 45 67 Fond du Lac 49 51 49 39 48 Forest 97 76 119 98 33 Grant 90 51 64 37 72 Green 76 70 100 95 70 Green Lake 26 47 58 26 68 Iowa 42 76 38 50 118 Iron 85 34 34 51 17 Jackson 98 58 73 44 87 Jefferson 56 54 43 45 69 Juneau 116 60 71 78 105 Kenosha 84 67 89 58 52 Kewaunee 34 73 48 29 58 La Crosse 60 53 62 49 44 Lafayette 65 101 59 59 112 Langlade 70 60 25 66 56 Lincoln 70 35 24 38 45 Manitowoc 64 53 44 42 58 Marathon 51 57 36 50 30 Florence 24 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 4. Alcohol-related motor vehicle injuries, rate per 100,000 population, Wisconsin by county, 2010-2014 (continued) Nonfatal Injury Rate per 100,000 County 2010 2011 2012 2013 2014 Marinette 60 55 82 96 70 Marquette 65 13 72 118 39 Menominee 0 0 0 94 46 Milwaukee 46 41 37 37 32 Monroe 67 73 47 75 59 Oconto 85 66 56 64 66 Oneida 72 70 42 28 81 Outagamie 59 40 43 37 37 Ozaukee 46 66 54 23 42 Pepin 27 94 94 148 54 Pierce 66 46 46 39 36 109 109 109 66 59 Portage 93 44 69 49 61 Price 71 50 93 36 86 Racine 76 68 47 38 56 Richland 55 94 28 61 39 Rock 95 77 70 62 72 Rusk 75 41 55 27 41 St. Croix 46 37 42 35 42 Sauk 92 81 85 82 86 Sawyer 97 102 114 72 66 Polk Shawano 124 124 77 69 65 Sheboygan 43 38 33 36 23 Taylor 73 82 73 63 48 Trempealeau 80 45 65 38 85 Vernon 60 50 60 63 46 149 103 51 158 79 Walworth 72 56 54 61 52 Washburn 101 82 76 38 63 Washington 59 61 60 66 43 Waukesha 44 30 32 27 30 Waupaca 113 95 63 86 50 Waushara 106 130 78 41 45 Vilas Winnebago 64 46 57 46 45 Wood Wisconsin 40 62 55 52 46 51 34 46 55 47 Source: Bureau of Transportation Safety, Wisconsin Department of Transportation; population data for county rate calculations are from the U.S. Census. 25 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol Abuse or Dependence The Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV), defines alcohol abuse and dependence based on experiences over a 12-month period. For the DSM-IV definition of abuse and dependence, see Appendix 1. The estimated percentage of Wisconsin residents age 12 and older with alcohol abuse and dependence was 8 percent in 2013-2014 (Figure 8). Since 2009-2010, Wisconsin young adults age 18 to 25 have had higher rates of alcohol abuse and dependence than other age groups (Table 5). Figure 8. Alcohol abuse and dependence, age 12 and older, Wisconsin and the U.S., 20082014 10% 8% 8% 6% 8% 8% 7% 7% 7% 8% 7% 7% 7% 7% 6% 4% U.S. Wisconsin 2% 0% 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Table 5. Alcohol abuse and dependence, age 12 and older, Wisconsin by age, 2009-2014 Age 12-17 18-25 26+ 20092010 5% 17% 6% 20102011 4% 15% 6% 20112012 3% 15% 6% 20122013 4% 16% 7% 20132014 4% 17% 7% Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. 26 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol-Related Hospitalizations The number of alcohol-related hospitalizations in Wisconsin decreased approximately 6 percent between 2007 and 2014, from 49,478 to 46,532. The rate of alcohol-related hospitalizations has declined in rate since 2010 (Table 6). Charges for alcohol-related hospitalizations (adjusted for inflation) increased, from $947 million in 2005 to more than $1.3 billion in 2014 (Figure 9). Hospital charges are the total facility charges for the length of stay and are not the same as actual costs paid by any payer; they do not include physician or other ancillary charges. Table 6. Alcohol-related hospitalizations, rate per 100,000 population and total number, Wisconsin, 2007-2014 Rate/100,000 Number 2007 877 49,478 2008 884 50,119 2009 856 48,625 2010 857 48,718 2011 831 47,343 2012 841 48,074 2013 804 46,060 2014 810 46,532 Source: Wisconsin hospital inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. Figure 9. Alcohol-related hospital charges (inflation-adjusted to 2014 dollars), in millions, Wisconsin, 2005-2014 $1,500 $1,300 $1,100 $947 $1,003 $1,074 $1,130 $1,175 $1,214 $1,215 2009 2010 2011 $1,277 $1,304 2012 2013 $1,380 $900 $700 $500 $300 $100 2005 2006 2007 2008 2014 Source: Wisconsin hospital inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. Note: Charges are not the same as actual costs paid by any payer; see Appendix 1. Charges shown have been adjusted for inflation to 2014 dollars. 27 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 7. Alcohol-related hospitalizations, total number and two-year rates per 100,000 population, Wisconsin by county, 2012-2014 County Adams Number in 2014 114 Ashland Barron Bayfield Rate per 100,000 2012-2013 2013-2014 465 505 210 1,442 1,388 343 773 756 115 855 822 Brown 1,714 717 680 Buffalo 67 709 563 Burnett 67 473 447 Calumet 137 252 259 Chippewa 543 859 823 Clark 260 785 761 Columbia 490 828 832 Crawford 97 645 570 Dane 3,497 705 678 Dodge 608 692 674 Door 177 650 613 Douglas 51 88 97 Dunn 276 645 632 1,078 977 147 224 Eau Claire Florence 1,021 12 Fond du Lac 800 750 772 Forest 118 1,196 1,308 Grant 206 352 374 Green 252 640 657 Green Lake 116 795 656 Iowa 118 465 466 Iron 37 970 780 Jackson 153 924 838 Jefferson 503 620 598 Juneau 246 800 859 Kenosha 1,504 893 889 Kewaunee 127 650 597 La Crosse 1,101 915 925 Lafayette 80 448 471 Langlade 133 794 697 Lincoln 308 914 983 593 760 749 1,021 804 758 Manitowoc Marathon 28 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 7. Alcohol-related hospitalizations, total number and two-year rates per 100,000 population, Wisconsin by county, 2012-2014 (continued) Rate per 100,000 County Marinette Number in 2014 311 Marquette 134 940 839 Menominee 77 2,207 1,885 Milwaukee 10,897 1,144 1,143 665 655 2012-2013 790 2013-2014 775 Monroe 303 Oconto 210 600 603 Oneida 354 1,049 1,014 1,302 681 690 662 736 739 Pepin 41 525 574 Pierce 110 318 275 Polk 257 523 530 Portage 614 777 827 Outagamie Ozaukee Price Racine Richland Rock 116 892 882 1,944 984 988 120 739 738 1,522 918 922 Rusk 104 642 642 St. Croix 270 331 326 Sauk 482 803 770 Sawyer 142 767 822 Shawano 293 732 706 Sheboygan 911 881 832 Taylor 77 494 423 Trempealeau 216 712 689 Vernon 166 642 631 Vilas 353 1,532 1,592 Walworth 714 677 696 Washburn 108 636 631 Washington 1,018 716 734 Waukesha 2,874 782 742 Waupaca 401 742 738 Waushara 179 724 706 Winnebago 1,251 Wood Wisconsin 781 46,532 828 768 1,153 1,079 822 807 Source: Wisconsin hospital inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. Note: Hospitalization numbers and rates are based on patient’s county of residence. Attributable fractions based on ARDI software are at: https://nccd.cdc.gov/DPH_ARDI/default/default.aspx. 29 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol-Related Offenses Alcohol-Related Crime and Arrests Operating a Motor Vehicle While Intoxicated Results from the National Survey on Drug Use and Health’s (NSDUH) “State Estimates of Drunk and Drugged Driving” report released in 2012 5 indicate the prevalence of alcohol-impaired driving in Wisconsin—like binge drinking—are among the highest in the nation. Using several combined years of survey data, NSDUH estimated that 24 percent of Wisconsin residents ages 16 and older drove impaired by alcohol within the previous year, almost twice the national rate of 13 percent. Given this, it is not surprising that rates of OWI arrests and convictions of repeat OWI offenders are higher in Wisconsin than in the nation as a whole (Figure 10). In 2014, 24,754 people were arrested for OWI in Wisconsin. Of the 24,012 drivers convicted of an OWI in 2014, 15,277 were first offense OWI; 7,913 were for second to fourth offense OWI; 759 were fifth to seventh offense OWI; and 63 had had eight or more OWI offenses (Wisconsin Department of Transportation [DOT]). Of drivers convicted of OWI offenses in 2014, 1,132 were under the age of 21 at the time of the violation. The median BAC test result for 2014 OWI citations was 0.16 percent, twice the legal limit. Wisconsin is the only state where the first OWI offense is a traffic violation. The first OWI offense is only criminalized if the driver is convicted of causing injury or death while operating while intoxicated or if a person under age 16 is present in the vehicle. Nevertheless, Wisconsin has 1.2 times the national rate of OWI arrests, and 2.9 times the national rate of other liquor law violations. 5 Substance Abuse and Mental Health Services Administration. (2012). The NSDUH report: State estimates of drunk and drugged driving. http://www.samhsa.gov/data/2k12/NSDUH109/SR109StateEstDrunkDrugDriving2012.htm 30 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 10. Arrests (adult and juvenile) for operating a motor vehicle while intoxicated (OWI), rate per 100,000 population, Wisconsin and the U.S., 2005-2014 1,000 800 752 775 U.S. 761 715 Wisconsin 712 626 550 600 400 529 465 463 479 544 481 469 457 390 409 2011 2012 369 431 351 200 0 2005 2006 2007 2008 2009 2010 2013 2014 Source: Crime and Arrests in Wisconsin, Wisconsin Office of Justice Assistance (2005 -2012); Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center (2013-2014), Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice, Criminal Justice Information Services Division, Federal Bureau of Investigation, U.S. Department of Justice. 31 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Liquor Law Violations According to the Wisconsin Department of Justice, liquor law violations are “violations of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beverages, not including driving under the influence and drunkenness.” Wisconsin’s arrest rate for liquor law violations has declined every year from 2006 to 2014. Nevertheless, it remains above the national rate (Figure 11). In 2014, 18 percent of all liquor law arrests in Wisconsin were of juveniles. Figure 11. Liquor law arrests (adult and juvenile), rate per 100,000 population, Wisconsin and the U.S., 2005-2014 1,000 826 817 800 U.S. 775 Wisconsin 739 666 559 600 506 464 361 400 300 200 201 217 212 207 186 166 161 141 2011 2012 112 101 2013 2014 0 2005 2006 2007 2008 2009 2010 Source: Crime and Arrests in Wisconsin, Wisconsin Office of Justice Assistance (2005 -2012); Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center (2013-2014), Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice, Criminal Justice Information Services Division, Federal Bureau of Investigation, U.S. Department of Justice. 32 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 8. Operating a motor vehicle while intoxicated (OWI) and liquor law arrests, rate per 100,000 population, Wisconsin by county, 2013 and 2014 OWI Arrests Rate per 100,000 County Adams 2013 613 Liquor Law Arrests Rate per 100,000 2014 596 2013 43 2014 92 Ashland 218 168 317 112 Barron 131 118 26 39 Bayfield 311 206 20 53 Brown 380 269 380 290 Buffalo 806 393 0 59 Burnett 480 402 58 39 Calumet 232 172 212 114 Chippewa 446 294 240 129 Clark 352 286 136 98 Columbia 726 604 344 275 Crawford 103 362 0 199 Dane 381 372 305 419 Dodge 397 383 348 209 Door 580 476 326 311 Douglas 426 447 338 494 Dunn 475 550 1,353 1,322 Eau Claire 576 482 975 939 1,057 1,029 0 0 Fond du Lac 450 469 318 229 Forest 381 629 218 217 Grant 502 387 967 621 Green 450 482 333 439 Green Lake 499 609 252 236 Iowa 328 340 194 76 Iron 408 642 289 270 Jackson 466 692 39 34 Jefferson 430 349 357 227 Juneau 246 187 67 64 Florence Kenosha 328 301 635 680 Kewaunee 257 267 189 136 La Crosse 489 436 1,123 964 Lafayette 421 485 712 414 Langlade 461 446 61 96 Lincoln 402 237 267 52 Manitowoc 443 440 363 301 Marathon 483 426 398 292 33 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 8. Operating a motor vehicle while intoxicated (OWI) and liquor law arrests, rate per 100,000 population, Wisconsin by county, 2013 and 2014 (continued) OWI Arrests Rate per 100,000 Liquor Law Arrests Rate per 100,000 County Marinette 2013 399 2014 624 2013 387 2014 246 Marquette 424 379 7 0 4,112 2,605 23 0 Menominee Milwaukee 386 316 139 125 Monroe 629 502 274 251 Oconto 74 48 64 45 Oneida 531 670 423 406 Outagamie 518 486 443 348 Ozaukee 402 374 540 461 Pepin 378 500 27 27 Pierce 397 253 478 377 Polk 757 780 134 34 Portage 344 445 225 298 Price 542 357 314 93 Racine 327 366 111 110 Richland 246 280 73 129 Rock 404 402 289 235 Rusk 355 301 266 61 St. Croix 285 276 194 79 Sauk 634 575 1,552 758 Sawyer 897 807 150 60 Shawano 696 563 457 328 Sheboygan 411 388 264 199 Taylor 536 397 116 121 Trempealeau 471 426 106 61 Vernon 382 412 33 37 Vilas 839 818 890 367 Walworth 759 744 1,117 767 Washburn 498 511 372 183 Washington 452 444 303 189 Waukesha 410 427 167 114 Waupaca 544 644 204 141 Waushara 462 476 90 160 Winnebago 578 507 665 501 Wood 556 513 349 242 Wisconsin 465 431 361 300 Source: Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center, Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice. Note: Wisconsin Department of Natural Resources and Division of State Patrol crime data are included in the statewide total, and are not included in specific counties. 34 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol-Related School Suspensions and Expulsions Public school districts in Wisconsin are required to report discipline data about suspensions, expulsions, and other removals to the Wisconsin Department of Public Instruction (DPI). According to DPI, suspensions are “absences from the school imposed by the school administration for disciplinary reasons” and expulsions are “sanctions imposed on students by formal school board action which, for purposes of discipline, prohibit students from attending school.” Rates of public school suspensions and expulsions vary for multiple reasons, including differences in the prevalence of behaviors related to alcohol use and difference in policies or diversion programs related to whether a suspension or expulsion is issued. The data reported in Table 9 includes all grade levels (K-12). 35 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 9. Alcohol-related suspensions and expulsions in public schools, rate per 1,000 students, Wisconsin by county, 2013-2014 school year County Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon Number of Incidents 5 0 1 1 25 0 1 1 4 0 1 2 57 3 1 6 1 20 0 23 0 0 2 1 3 0 0 13 2 23 1 5 1 0 7 2 16 Rate/1,000 Students 3.1 0.0 0.1 0.7 0.6 0.0 0.4 0.3 0.4 0.0 0.1 0.9 0.8 0.4 0.3 0.9 0.2 1.4 0.0 1.5 0.0 0.0 0.4 0.3 0.8 0.0 0.0 1.0 0.5 0.8 0.3 0.3 0.3 0.0 1.5 0.2 0.8 County Marinette Marquette Menominee Milwaukee* Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine* Richland Rock Rusk Saint Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood Wisconsin Number of Incidents 1 0 1 57 3 0 0 26 7 0 1 11 10 1 47 0 9 3 0 6 1 9 4 1 0 1 1 7 1 6 44 0 0 28 14 Rate/1,000 Students 0.2 0.0 1.2 0.4 0.4 0.0 0.0 0.7 0.6 0.0 0.1 1.5 1.1 0.5 1.6 0.0 0.3 1.5 0.0 0.5 0.4 1.6 0.2 0.3 0.0 0.2 0.4 0.4 0.4 0.3 0.7 0.0 0.0 1.2 1.1 528 0.6 Source: WISEdash Public Portal, Wisconsin Department of Public Instruction. *Milwaukee and Racine county data include charter schools. Note: Each incident is counted separately regardless of whether repeat infractions are by the same or different students. 36 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Consequences of Other Drug Consumption For the purpose of this report, “other drugs” refers to both illicit drugs and prescription drugs used for medical and nonmedical purposes. Many data sources do not separate these two categories. When possible, this report includes drug-specific information. Like alcohol, the arrest, illnesses, injuries, and deaths resulting from other drug use, misuse, and abuse impacts all state residents. Wisconsin rates of abuse, dependence, and deaths due to other drug use are similar to, or lower than, national rates. The rate of arrests for drug law violations is also lower in Wisconsin than nationally. Other Drug-Related Deaths There is evidence of change over time in the pattern and volume of drug-related deaths in Wisconsin. Between 2006 and 2015, the increase in overall drug-related deaths that began in earlier years continued (Figure 12 and Table 10). The rate of drug deaths in Wisconsin remained lower than the national rate through 2014, the most recent year for which U.S. data are available. Wisconsin’s age-adjusted rate of drug-related mortality increased from 9.3 deaths per 100,000 population in 2006 to 15.3 deaths per 100,000 in 2015 (Figure 12). Wisconsin’s number of drug-related deaths has exceeded 500 in seven of the past eight years. In 2015, 873 Wisconsin residents died as a direct consequence of illicit drug use (Table 10). Drug-related motor vehicle fatalities have increased substantially in the past 10 years. In 2014, 21 percent of all motor vehicles injuries were drug-related, up from 3 percent in 1994 (Bureau of Transportation Safety [BTS], DOT). 37 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 12. Drug-related deaths, age-adjusted rate per 100,000 population, Wisconsin and the U.S., 2006-2015 25 U.S. Wisconsin 20 13.9 15 10.9 10.9 10.9 9.3 2006 2007 5 8.4 10.5 9.1 9.0 2009 2010 14.6 15.5 15.3 11.3 10.9 10 9.3 13.8 13.8 13.8 2013 2014 11.3 0 2008 2011 2012 2015 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention Wonder: http://wonder.cdc.gov/mortSQL.html. Table 10. Drug-related deaths, age-adjusted rate per 100,000 population and total number, Wisconsin and the U.S., 2008-2015 2008 U.S. Wisconsin 2009 2010 2011 2012 2013 2014 Rate/100,000 10.9 10.9 11.3 13.9 13.8 14.6 15.5 2015 Total number 33,300 33,639 35,059 43,544 43,819 46,471 49,714 Rate/100,000 8.4 9.1 9.0 10.5 11.3 13.8 13.8 15.3 Total number 482 525 512 601 633 792 795 873 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services/ Centers for Disease Control and Prevention Wonder: http://wonder.cdc.gov/mortSQL.html. Annual numbers of heroin and other opioid-related deaths in the state increased steadily from 2006 to 2015. The proportion of drug deaths with a mention of opioids, the largest category, increased from 60 to 74 percent. The proportion of drug deaths with a mention of benzodiazepines increased from 17 to 26 percent between 2006 and 2015, with a peak of 31 percent in 2013 and 2014, while mentions of cocaine have decreased steadily since 2006 (Figure 13). Between 2006 and 2015, the proportion of drug deaths where heroin is mentioned increased more than fivefold, from 5 to 32 percent (Figure 14). 38 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Overall, what is known about current trends in drugs-of-choice appears to be reflected in the death reports. A steady rise in the mentions of heroin in drug-related deaths may reflect increasing substitution of heroin for prescription drugs among opioid users due to heroin’s lower cost and increasing availability. With no standards for consistency or dosing as with prescription drugs, heroin use carries significant risk of overdose. Figure 13. Proportion of drug-related deaths involving opioids, cocaine and/or benzodiazepines, Wisconsin, 2006-2015 100% All Opioids Cocaine Benzodiazepines 80% 60% 60% 40% 30% 64% 64% 28% 17% 20% 67% 68% 26% 72% 30% 31% 24% 24% 16% 14% 13% 13% 10% 11% 2008 2009 2010 2011 2012 2013 19% 20% 65% 73% 77% 31% 13% 74% 26% 13% 0% 2006 2007 2014 2015 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services. Note: Opioids include heroin, methadone, and other opioids, including synthetic narcotic pain relievers such as oxycodone and hydrocodone, as well as morphine and its derivatives. More than one substance may be mentioned in the death record. Benzodiazepines include central nervous system depressants such as Valium®, Librium®, and Xanax®. More than one drug may be mentioned in the death record. 39 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 14. Proportion of heroin, methadone, and other opioid-related deaths, Wisconsin, 2006-2015 70% Heroin Methadone 60% Other Opioids 50% 40% 30% 38% 22% 40% 25% 39% 13% 5% 6% 2006 2007 42% 2008 42% 42% 28% 29% 44% 40% 33% 32% 21% 16% 10% 46% 21% 20% 0% 43% 16% 13% 2009 14% 2010 12% 2011 10% 9% 10% 2012 2013 2014 8% 2015 Source: Wisconsin resident death certificates, Division of Public Health, Wisconsin Department of Health Services. Note: Other opioids refer to any prescription opioids—with morphine-like effects. More than one substance may be mentioned in the death record. Some opioid deaths involve both heroin and prescription opioids. Other Drug-Related Illnesses and Injuries Other Drug Abuse or Dependence Rates of illicit drug abuse or dependence among people age 12 and older in Wisconsin have stayed relatively consistent since 2009 at about 3 percent (not shown). There are differences between age groups, however. In 2013-2014, Wisconsin residents ages 18-25 were more likely to abuse or be dependent on illicit drugs (7%) than were those ages 12-17 (4%) or over age 26 (2%). Table 11. Illicit drug abuse or dependence in the past year, age 12 and older, Wisconsin by age, 2009-2014 Age 12-17 18-25 26+ 20092010 5% 7% 2% 20102011 4% 6% 2% 20112012 4% 6% 1% 20122013 4% 7% 1% 20132014 4% 7% 2% Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. 40 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Neonatal Abstinence Syndrome (NAS) Neonatal Abstinence Syndrome (NAS) refers to the effects on a fetus or newborn of maternal drug use. It involves either drug withdrawal symptoms or “noxious influences” 6 of drugs. Drug withdrawal refers to babies who are born addicted because their mothers are drugdependent. Noxious influences refer to babies exposed to substances through the placenta or breast milk but who are not necessarily addicted. The number of cases of NAS in Wisconsin is on the rise due in part to an increased use of prescription drugs and heroin. Since 2008, the rate of NAS from drug withdrawal has increased more sharply than the NAS rate from noxious influences (Figure 15). Figure 15. Neonatal Abstinence Syndrome (NAS) cases, rates per 1,000 hospital births, Wisconsin, 2008-2014 10.0 8.6 9.0 8.0 8.0 7.0 5.9 6.0 4.7 5.0 4.0 3.0 2.0 6.2 2.8 3.4 3.7 2.8 2.7 2008 2009 1.0 4.1 4.3 Drug Withdrawal 2.9 2.2 Noxious Influences 0.0 2010 2011 2012 2013 2014 Source: Wisconsin inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. 6 Noxious influences affecting the fetus or newborn through placenta or breast milk include narcotics, alcohol, cocaine, hallucinogens, and unspecified substances. 41 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Hepatitis C Hepatitis C virus (HCV) is the most common blood-borne infection in the U.S. and outbreaks of HCV have coincided with prior misuse of prescription opioids. 7, 8, 9 Strong evidence supports the link between the equipment used for injecting drugs and transmission of HCV. It is estimated that 50 percent of people who inject drugs become infected with HCV within five years of injecting. 10 When HCV infection is undiagnosed and untreated, it can cause adverse health effects, most importantly cirrhosis of the liver, liver cancer, and liver failure. Based on national estimates of age, sex, and race-specific prevalence of HCV antibody, approximately 90,000 Wisconsin residents have evidence of HCV infection. 11 In Wisconsin, between 2011 and 2015, an average of 2,955 people with HCV infection were reported annually (Figure 16). The rate of HCV infections among people age 15-29 more than doubled during that time period, from 40 to 87 cases per 100,000 population (Figure 17). Surveillance data suggests that most HCV infections in this age group resulted from recent injection drug use. Human immunodeficiency virus (HIV) infection is also a risk of injection drug use, although this risk is less common than HCV infection. In 2015, five out of 225 individuals newly diagnosed with HIV in Wisconsin reported injection drug use. 12 7 Centers for Disease Control and Prevention. (2012). Notes from the field: Hepatitis C virus infections among young adults—rural Wisconsin, 2010. Morbidity and Mortality Weekly Report, 61(10), 358. 8 Centers for Disease Control and Prevention. (2011). Notes from the field: Risk factors for Hepatitis C virus infections among young adults—Massachusetts, 2010. Morbidity and Mortality Weekly Report, 60(42), 1457-1458. 9 Centers for Disease Control and Prevention. (2008). Use of enhanced surveillance for Hepatitis C virus infection to detect a cluster among young injection drug users—New York, November 2014—April 2007. Morbidity and Mortality Weekly Report, 57(19), 517-521. 10 Hagan, H., Pouget, E.R., Des Jarlais, D.C., and Lelutiu-Weinberger, C. 2008. Meta-regression of Hepatitis C virus infection in relation to time since onset of illicit drug injection: The influence of time and place. American Journal of Epidemiology, 168(10):1099-1109. 11 Wisconsin Department of Health Services, AIDS/HIV Program. (2016). Wisconsin Hepatitis C virus surveillance annual review, 2015: Newly reported cases, prevalent cases, and trends. https://www.dhs.wisconsin.gov/publications/p00440-2015.pdf 12 Wisconsin Department of Health Services, AIDS/HIV Program. (2016). Wisconsin HIV/AIDS surveillance annual review: New diagnoses, prevalent cases, and deaths through December 31, 2015. https://www.dhs.wisconsin.gov/publications/p0/p00484.pdf 42 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 16. Number of newly reported cases of Hepatitis C virus, Wisconsin, 2006-2015 4,000 3,745 3,200 3,217 2,400 2,352 2,373 2,438 2,463 2,563 2,615 2,638 2,355 2006 2007 2008 2009 2010 2011 2012 2013 1,600 800 0 2014 2015 Source: Bureau of Communicable Diseases, Division of Public Health, Wisconsin Department of Health Services. Figure 17. Newly reported cases of Hepatitis C virus, rate per 100,000 population, Wisconsin by age, 2011-2015 120.0 105.0 100.0 79.6 80.0 60.0 57.9 73.1 56.8 40.4 54.2 17.9 16.2 0.7 1.1 2011 2012 40.0 20.0 86.4 68.7 78.3 61.8 86.9 Age 0-14 74.8 65.2 57.7 Age 15-29 Age 30-49 Age 50-69 Age 70+ 0.0 13.4 14.0 14.8 0.4 0.7 1.3 2013 2014 2015 Source: Bureau of Communicable Diseases, Division of Public Health, Wisconsin Department of Health Services. Note: The increased rate of HCV among older adults is probably the result of a new recommendation to screen people born during 1945-1965 for chronic HCV. 43 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Other Drug-Related Hospitalizations The number of drug-related hospitalizations in Wisconsin increased steadily between 2007 and 2012, but decreased in 2013 and 2014. There were 14,710 Wisconsin hospitalizations defined as drug-related in 2014 (Table 12). Drug-related hospitalizations include such diagnoses as drug psychoses, drug dependence, drug-related polyneuropathy, and accidental and purposeful poisoning by drugs. Total charges for drug-related hospitalizations, inflation-adjusted to 2014 dollars, rose each year between 2006 and 2013, but dropped slightly in 2014 (Figure 18). Charges for drug-related hospitalizations in Wisconsin totaled $327 million in 2012, an increase of 49 percent from $233 million in 2006 (Figure 18). Several counties in southeastern and northeastern Wisconsin had increases in two-year drug hospitalization rates from 2012-2013 to 2013-2014 (Table 13). Caution should be used in interpreting the changes, especially for small counties where minor changes in numbers can produce large increases in rates. Table 12. Drug-related hospitalizations, rate per 100,000 population and total number, Wisconsin, 2007-2014 2007 Rate/100,000 Number 2008 2009 2010 2011 2012 2013 2014 251 260 257 266 267 270 266 256 14,178 14,756 14,605 15,135 15,224 15,454 15,220 14,710 Source: Wisconsin hospital inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. Figure 18. Drug-related hospitalization charges, in millions, Wisconsin, 2006-2014 (inflation-adjusted to 2014 dollars) $400 $350 $283 $300 $250 $233 $242 2006 2007 $310 $311 $317 2009 2010 2011 $327 2012 $352 $347 2013 2014 $200 $150 $100 $50 $2008 Source: Wisconsin hospital inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. Note: Hospital charges are the total facility charges for the length of stay and are not the same as actual costs paid by any payer; also, they do not include physician or other ancillary charges (see Appendix 1). 44 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 13. Drug-related hospitalizations, total number and rate per 100,000 population, Wisconsin by county, 2012-2014 Rate per 100,000 2012-2013 2013-2014 County Adams Number in 2014 32 159 172 Ashland 123 698 709 Barron 94 232 219 Bayfield 54 378 414 Brown 434 203 184 Buffalo 32 236 248 Burnett 25 233 188 Calumet 40 85 91 207 312 307 44 179 163 Columbia 134 281 242 Crawford 16 166 115 Dane 963 205 191 Dodge 191 220 226 Door 32 93 107 Douglas 11 54 37 Chippewa Clark Dunn 129 240 270 Eau Claire 348 373 340 3 56 45 227 263 245 Forest 36 386 407 Grant 42 81 83 Green 65 207 195 Green Lake 32 205 165 Iowa 38 128 134 Iron 20 306 364 Jackson 47 275 230 166 185 201 Florence Fond du Lac Jefferson Juneau 73 226 248 Kenosha 489 260 271 Kewaunee 27 136 138 La Crosse 347 319 299 Lafayette 16 107 83 Langlade 31 235 175 Lincoln 51 241 221 Manitowoc 274 343 360 Marathon 162 207 157 45 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 13. Drug-related hospitalizations, total number and rate per 100,000 population, Wisconsin by county, 2012-2014 (continued) Rate per 100,000 Number in 2014 76 2012-2013 2013-2014 230 186 Marquette 33 245 222 Menominee 24 458 524 4,256 452 451 Monroe 108 275 259 Oconto 36 176 138 Oneida 88 320 292 Outagamie 362 184 198 Ozaukee 227 260 256 Pepin 6 128 101 Pierce 54 109 114 Polk 64 175 166 136 273 225 County Marinette Milwaukee Portage Price Racine Richland Rock 20 189 157 489 238 255 45 187 221 505 286 307 Rusk 36 130 174 St. Croix 80 118 102 158 233 235 40 229 253 Sauk Sawyer Shawano 49 147 124 304 285 275 Taylor 17 104 102 Trempealeau 64 243 213 Sheboygan Vernon 55 171 179 Vilas 95 457 468 Walworth 192 220 202 Washburn 32 265 230 Washington 299 231 229 1,036 262 253 Waupaca 85 198 181 Waushara 42 186 186 Winnebago 323 213 198 Wood 219 315 296 14,710 268 261 Waukesha Wisconsin Source: Wisconsin hospital inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. Note: Hospitalization numbers and rates are based on patient’s county of residence. 46 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Opioid-Related Hospitalizations Rates of hospitalization for prescription drug abuse and dependence without regard to payment source provides a broader look at the problem of prescription drug misuse. Wisconsin’s opioid-related hospitalizations rate has not leveled off and has gradually increased over the years (Figure 19). Twenty-nine of Wisconsin’s 72 counties (40%) experienced increases in opioid-related hospitalization between 2012 and 2014 (Table 14). Figure 19. Opioid-related hospitalizations per 1,000 population, Wisconsin, 2005-2014 2 1.8 1.6 1.4 1.2 1 0.9 0.9 2005 2006 1 1.1 1.2 1.3 1.4 1.5 1.5 2012 2013 1.6 0.8 0.6 0.4 0.2 0 2007 2008 2009 2010 2011 2014 Source: Wisconsin hospital inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. Note: These are hospitalizations for opioid dependence or non-dependent abuse, including methadone, codeine, and morphine, excluding heroin and opium where possible (see diagnosis codes in Appendix 2). 47 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 14. Opioid-related hospitalizations per 1,000 population, Wisconsin by county, 2012-2014 (moving two-year rates) 20122013 0.9 3.5 0.9 1.7 0.8 1.7 1.6 0.5 1.6 0.9 1.8 0.8 1.3 1.3 0.3 0.3 1.3 2.1 0.6 1.4 2.2 0.5 1.4 1.0 0.9 1.7 2.0 1.1 1.3 1.5 20132014 0.9 3.7 0.8 1.8 0.7 1.7 1.3 0.6 1.7 1.0 1.8 0.5 1.3 1.5 0.4 0.2 1.6 1.9 0.6 1.4 2.8 0.4 1.3 0.8 0.8 2.3 1.7 1.2 1.4 1.7 Kewaunee 0.5 0.6 La Crosse Lafayette Langlade Lincoln Manitowoc Marathon 1.6 0.6 1.2 1.2 2.2 1.1 1.6 0.4 1.0 1.3 2.7 0.8 County Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha 20122013 1.3 1.8 2.0 2.4 1.8 0.6 1.6 0.7 1.5 0.7 0.5 0.8 1.4 1.0 1.4 1.2 1.8 0.7 0.6 1.5 1.4 0.7 1.7 0.3 1.4 1.0 3.0 1.2 1.4 1.3 20132014 1.0 1.6 2.6 2.7 1.7 0.6 1.6 0.9 1.5 0.4 0.4 0.7 1.1 1.1 1.5 1.4 2.0 0.8 0.5 1.4 1.7 0.7 1.7 0.5 1.3 0.9 3.0 1.2 1.3 1.5 Waukesha 1.7 1.7 Waupaca Waushara Winnebago Wood 0.9 0.9 1.0 1.9 0.9 1.1 1.1 1.4 Wisconsin 1.5 1.5 County Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk St. Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Source: Wisconsin hospital inpatient discharge database, Division of Public Health, Wisconsin Department of Health Services. Note: These are hospitalizations for opioid dependence or non-dependent abuse, including methadone, codeine, and morphine, excluding heroin and opium where possible (see diagnosis codes in Appendix 2). 48 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Other Drug-Related Offenses Other Drug-Related Crime and Arrests Drug law violations are defined as the violation of laws prohibiting the production, distribution, and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or use. This includes the unlawful cultivation, manufacture, distribution, sale, purchase, use, possession, transportation, or importation of any controlled drug or narcotic substance. In 2014, there were 25,229 arrests for drug law violations in Wisconsin; 12 percent of drug law arrests were of juveniles. Arrests for possession made up 82 percent of all drug law arrests; the remainders were for sales and manufacturing. Figure 20. Drug law arrests (adult and juvenile), rate per 100,000 population, Wisconsin and the U.S., 2005-2014 800 U.S. 700 595 637 615 Wisconsin 656 600 544 531 500 400 468 466 2005 2006 456 442 2007 2008 445 453 2009 2010 491 447 495 478 474 490 454 439 300 200 100 0 2011 2012 2013 2014 Source: Crime and Arrests in Wisconsin, Wisconsin Office of Justice Assistance (2005-2012); Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center (2013-2014), Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice, Criminal Justice Information Services Division, Federal Bureau of Investigation, U.S. Department of Justice. 49 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 15. Drug law arrests, rate per 100,000 population, Wisconsin by county, 2013 and 2014 Rate per 100,000 Rate per 100,000 County Adams 2013 309 2014 378 County Marinette 2013 449 2014 477 Ashland 274 491 Marquette 189 275 Barron 57 185 Menominee 2,209 1706 Bayfield 132 106 Milwaukee 597 544 Brown 536 399 Monroe 406 410 Buffalo 621 341 Oconto 61 29 Burnett 44 356 Oneida 473 389 Calumet 202 122 Outagamie 477 357 Chippewa 178 103 Ozaukee 259 277 40 35 Pepin 297 243 Columbia 735 600 Pierce 458 219 Crawford 66 229 Polk 243 266 Dane 341 315 Portage 201 308 Dodge 320 351 Price 221 157 Door 408 375 Racine 596 600 Douglas 548 467 Richland 73 201 Clark Dunn 491 401 Rock 430 473 Eau Claire 708 824 Rusk 341 280 Florence 540 246 St. Croix 253 322 Fond du Lac 296 288 Sauk 487 56 Forest 925 542 Sawyer 307 843 Grant 199 181 Shawano 402 977 Green 209 300 Sheboygan 408 193 Green Lake 357 431 Taylor 208 319 Iowa 147 139 Trempealeau 239 334 Iron 85 169 Vernon 203 173 Jackson 175 382 Vilas 611 860 Jefferson 448 388 Walworth 770 620 Juneau 146 243 Washburn 460 662 Kenosha 553 622 Washington 401 337 Kewaunee 296 267 Waukesha 290 254 La Crosse 725 823 Waupaca 321 356 Lafayette 273 308 Waushara 245 414 Langlade 840 720 Winnebago 622 535 Lincoln 565 390 Wood 328 360 Manitowoc 253 352 Marathon 362 541 Wisconsin 454 439 Source: Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center, Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice. 50 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Other Drug-Related School Suspensions and Expulsions Rates of public school suspensions and expulsions vary by county for multiple reasons, including differences in the prevalence of behaviors related to drug activity and differences in policies or diversion programs. A few counties have consistently higher rates of suspensions and expulsions than others, and while spikes can be seen in certain years, there are no consistent upward trends. Data for the 2013-2014 school year are shown in Table 16. According to the Department of Public Instruction, drug-related means related to use, possession, sale, or solicitation of drugs identified in 21 USC Section 812(c). These offenses do NOT include use, possession, sale, or solicitation of alcohol or tobacco. The data reported includes all grade levels (K-12). 51 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 16. Drug-related suspensions and expulsions, per 1,000 students, Wisconsin public schools by county, 2013-2014 school year County Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon Number of Incidents 10 8 5 0 165 3 15 1 47 12 10 1 256 12 9 24 13 48 0 59 5 14 12 3 6 1 6 27 5 101 1 41 0 12 21 21 54 Rate/1,000 Students 6.1 3.0 0.7 0.0 3.8 1.4 5.9 0.3 5.1 2.4 1.1 0.5 3.4 1.4 2.5 3.8 2.1 3.4 0.0 3.8 3.2 2.0 2.1 1.0 1.7 1.3 1.9 2.1 1.3 3.4 0.3 2.5 0.0 3.9 4.4 1.9 2.7 County Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk Saint Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood Wisconsin Number of Incidents 19 1 18 662 22 8 12 85 13 0 13 14 45 2 151 0 140 4 38 55 9 11 14 2 6 8 3 66 4 45 97 11 16 107 25 Rate/1,000 Students 3.0 0.6 21.5 4.7 3.1 1.9 2.8 2.4 1.0 0.0 1.7 1.9 4.8 1.0 5.1 0.0 5.0 2.0 2.6 4.6 4.0 2.0 0.7 0.6 1.0 2.0 1.1 4.1 1.5 2.2 1.5 1.2 6.0 4.7 2.0 2,754 3.2 Source: WISEdash Public Portal, Wisconsin Department of Public Instruction. *Milwaukee and Racine data include charter schools. Note: Each incident is counted separately regardless of whether repeat infractions are by the same or different students. 52 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Consequences of Alcohol and Other Drug Consumption Treatment Data on the primary substance related to admissions to publicly funded treatment (Table 17) suggest widespread abuse of opioids, including heroin, throughout the state. Admissions for heroin, as one of the top three substances, are currently clustered largely in urban counties and counties in close proximity to urban areas. Over the years, the percentages of treatment admissions for alcohol and cocaine have decreased, the latter substantially, while percentages of admissions for opioids (including heroin) almost tripled between 2005 and 2014. Admissions for marijuana and “other drugs” have also increased as a percentage of treatment admissions for substance abuse (Table 17). The number of clients receiving treatment in the publicly funded sector continues a decline that began in 2009. As of 2014, the number who received services was 37,720, down from a high of 64,806 in 2006 (Figure 21). The first year of the federal health insurance mandate was 2014, which impacted publicly funded treatment. Fewer individuals needed publicly funded substance use treatment because they obtained commercial health insurance or Medicaid coverage for services. Public funds expended for alcohol and other drug abuse treatment in Wisconsin have also declined, from a high of $83 million in 2006 to a low of $67 million in 2015 (Figure 22). Table 17. Percent of treatment admissions, Wisconsin by primary substance, 2005-2014 Year Alcohol* Heroin 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 69.4% 68.7% 70.8% 74.3% 72.2% 71.6% 69.5% 68.1% 62.6% 63.0% 3.7% 2.9% 3.1% 3.4% 4.5% 4.7% 6.7% 7.3% 10.4% 11.7% Other Opiates** 3.0% 3.1% 4.1% 4.1% 5.2% 5.6% 6.2% 6.8% 7.0% 6.0% Cocaine/ Crack 11.5% 12.1% 7.6% 7.6% 6.9% 6.1% 5.7% 5.7% 5.0% 4.1% Marijuana/ Hashish 9.2% 10.8% 9.0% 9.0% 9.4% 9.6% 9.7% 9.2% 11.4% 10.7% All Others 3.2% 2.4% 1.6% 1.6% 1.8% 2.4% 2.2% 2.9% 3.5% 4.7% Source: Treatment Episode Data Set (TEDS), Substance Abuse and Mental Health Data Archive (SAMHDA), U.S. Department of Health and Human Services. *Alcohol alone or with secondary drug. ** Opiates and synthetics with morphine-like effects. 53 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 21. Number of alcohol and other drug abuse clients (in thousands) receiving services with public funds, Wisconsin, 2005-2014 80 70 64.8 62.6 60 60.9 56.1 57.7 55.8 54.5 50 50.2 40.7 40 37.7 30 20 10 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Source: Human Services Reporting System (through 2012) and Program Participation System (2013 and following), Division of Care and Treatment Services, Wisconsin Department of Health Services. Note: 2014 was the first year of the federal health insurance mandate which impacted publicly-funded treatment. Fewer persons needed publicly funded treatment because they obtained commercial health insurance or Medicaid. Figure 22. County-authorized, public funds expended (in millions) for alcohol and other drug abuse treatment, Wisconsin, 2006-2015 $100 $90 $83 $80 $74 $74 2007 2008 $81 $76 $75 $70 $71 $71 2012 2013 $68 $67 2014 2015 $60 $50 $40 $30 $20 $10 $2006 2009 2010 2011 Source: Human Services Reporting System (through 2012) and Program Participation System (2013 and following), Division of Care and Treatment Services, Wisconsin Department of Health Services. 54 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Youth and young adults ages 12-25 are one of the population groups most affected by prescription drug misuse. A steady increase over time in publicly funded treatment admissions for this type of drug abuse among youth is evident in Figure 23. It is important to note that this does not necessarily mean an increase in drug treatment overall, but is likely related to a gradual shift from abuse of other drugs, such as cocaine, to the abuse of prescription drugs. Figure 23. County-authorized, publicly funded treatment for prescription drug* abuse, ages 12-25, service admissions per 1,000 population, Wisconsin, 2005-2014 1.0 0.9 0.8 0.8 0.8 0.8 0.7 0.6 0.6 0.4 0.8 0.7 0.7 0.5 0.9 0.5 0.4 0.3 0.2 0.1 0.0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Source: Human Services Reporting System (through 2012) and Program Participation System (2013 and following), Division of Care and Treatment Services, Wisconsin Department of Health Services. Note: * Includes painkillers, stimulants, sedatives and tranquilizers. The first year of the federal health insurance mandate was 2014, which impacted publicly funded treatment. Fewer persons needed publicly funded treatment because they obtained commercial health insurance or Medicaid. 55 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol and Other Drug-Related Offenses Alcohol and Other Drug-Related Crime and Arrests Drug-related property crimes include burglary, larceny, and motor vehicle theft. These crimes are often committed to obtain money to purchase drugs. Drug-attribution rates for property crime range from approximately 7 percent for motor vehicle theft to 30 percent for burglary and larceny. Between 2005 and 2014, Wisconsin’s rates of reported property crime and violent crimes were consistently lower than U.S. rates (Figure 24 and Figure 25). Figure 24. Property crime offenses, rate per 100,000 population, Wisconsin and the U.S., 2005-2014 6,000 U.S. 5,000 4,000 Wisconsin 3,432 3,335 3,264 3,212 3,051 3,000 2,753 2,856 2,838 2,000 2,753 2,637 2,942 2,514 2,909 2,435 2,859 2,434 2,734 2,596 2,168 2,058 2013 2014 1,000 0 2005 2006 2007 2008 2009 2010 2011 2012 Source: Crime and Arrests in Wisconsin, Wisconsin Office of Justice Assistance (2005-2012), Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center (2013-2014), Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice, U.S. Department of Justice. Note: Wisconsin rates were calculated using population estimates from the U.S. Census. National rates per 100,000 were obtained directly from the source and are estimates derived from rates of growth and U.S. Census data. 56 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 25. Violent crime offenses (adult and juvenile), rate per 100,000 population, Wisconsin and the U.S., 2005-2014 800 U.S. 700 Wisconsin 600 500 469 474 467 455 432 404 400 386 387 369 279 268 280 2012 2013 2014 366 300 200 244 289 291 274 257 248 2006 2007 2008 2009 2010 252 100 0 2005 2011 Source: Crime and Arrests in Wisconsin, Wisconsin Office of Justice Assistance (2005-2012), Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center (2013-2014), Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice, U.S. Department of Justice. Note: Wisconsin rates were calculated using population estimates from the U.S. Census. National rates per 100,000 were obtained directly from the source and are estimates derived from rates of growth and U.S. Census data. 57 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 18. Property crimes, total number and rate per 100,000 population, Wisconsin by county, 2013 and 2014 2013 2014 County Adams Number Rate/100,000 Number Rate/100,000 588 2,837 489 2,369 Ashland 471 2,932 389 2,419 Barron 210 458 202 440 Bayfield 212 1,404 144 955 4,966 1,962 3,706 1,453 Buffalo 88 651 102 756 Burnett 540 3,501 514 3,330 Calumet 269 543 235 470 Chippewa 835 1,325 804 1269 Clark 279 805 202 583 Columbia 821 1,447 637 1,121 Crawford 187 1,129 251 1,514 Dane 12,600 2,505 11,305 2,221 Dodge 1,317 1,483 1,009 1,132 283 1,013 297 1,062 2,007 4,549 2,035 4,615 695 1,580 742 1,680 1,953 1,942 2,091 2,070 86 1,934 104 2,326 1,620 1,587 1,564 1,527 Forest 148 1,610 105 1,138 Grant 764 1,475 564 1,074 Green 546 1,480 473 1,280 Green Lake 294 1543 322 1,691 Iowa 233 980 214 898 Iron 53 902 91 1,538 Brown Door Douglas Dunn Eau Claire Florence Fond du Lac Jackson 255 1,237 348 1,683 1,379 1,639 1,272 1,511 427 1,593 336 1,255 3,460 2,068 3,418 2,039 247 1,200 195 947 La Crosse 2,455 2,108 2,424 2,067 Lafayette 161 955 161 952 Langlade 607 3,073 541 2,744 Lincoln 461 1,597 273 951 Manitowoc 1,302 1,605 1,475 1,822 Marathon 2,019 1,496 1,760 1,301 Jefferson Juneau Kenosha Kewaunee 58 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 18. Property crimes, total number and rate per 100,000 population, Wisconsin by county, 2013 and 2014 (continued) County Marinette Number 2013 Rate/100,000 787 1,890 680 1,639 Marquette 189 1,234 203 1,327 Menominee 126 2,961 119 2,744 39,746 4,175 39,503 4,150 Monroe 699 1,544 572 1,260 Oconto 156 413 173 457 Oneida 553 1,539 540 1,502 2,953 1,642 3,297 1,820 902 1,037 758 867 Pepin 67 903 66 892 Pierce 654 1,595 638 1,552 Polk 475 1,080 471 1,071 1,111 1,571 1,001 1,415 177 1,262 189 1,351 4,813 2,465 4,450 2,278 113 631 79 442 Rock 4,027 2,512 4,049 2,524 Rusk 177 1,208 176 1,203 St. Croix 1,011 1,180 1,062 1,232 Sauk 1,672 2,678 1,559 2,492 Sawyer 265 1,595 203 1,222 Shawano 662 1,584 552 1,322 2,073 1,799 1,992 1,727 Taylor 230 1,111 180 871 Trempealeau 222 758 221 754 Vernon 273 908 281 933 Vilas 472 2,200 440 2,046 Walworth 1,727 1,680 1,678 1,630 Washburn 335 2,113 290 1,829 Washington 2,092 1,575 1,719 1,290 Waukesha 4,761 1,212 4,614 1,171 Waupaca 979 1,870 965 1,845 Waushara 371 1,518 294 1,205 Winnebago 2,952 1,752 2,865 1,698 Wood 1,336 1,793 1,305 1,752 124,248 2,168 118,277 2,058 Milwaukee Outagamie Ozaukee Portage Price Racine Richland Sheboygan Wisconsin Number 2014 Rate/100,000 Source: Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center, Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice. Note: Wisconsin Department of Natural Resources and Division of State Patrol crime data are included in the statewide total, and are not included in specific counties. 59 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 19. Violent crimes, total number and rate per 100,000 population, Wisconsin by county, 2013 and 2014 County Adams 2013 Number Rate/100,000 2014 Number Rate/100,000 54 261 40 194 Ashland 45 280 45 280 Barron 18 39 12 26 Bayfield 29 192 27 179 592 234 596 234 Buffalo 0 0 9 67 Burnett 27 175 36 233 Calumet 20 40 20 40 Chippewa 57 90 74 117 Clark 14 40 8 23 Columbia 86 152 73 128 Crawford 14 85 19 115 1,185 263 1,128 222 Dodge 42 47 51 57 Door 25 89 10 36 Douglas 97 220 85 193 Dunn 57 130 69 156 152 151 136 135 9 202 3 67 186 182 187 183 Forest 21 228 18 195 Grant 79 153 60 114 Green 41 111 33 89 Green Lake 10 52 10 53 Iowa 17 72 32 134 Iron 8 136 7 118 28 136 17 82 172 204 106 126 Juneau 55 205 57 213 Kenosha 331 198 348 208 7 34 9 44 La Crosse 138 118 137 117 Lafayette 9 53 12 71 Langlade 17 86 13 66 Lincoln 40 139 42 146 Manitowoc 107 132 123 152 Marathon 133 99 128 95 Brown Dane Eau Claire Florence Fond du Lac Jackson Jefferson Kewaunee 60 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 19. Violent crimes, total number and rate per 100,000 population, Wisconsin by county, 2013 and 2014 (continued) County Marinette Number 2013 Rate/100,000 23 55 17 41 Marquette 1 7 1 7 Menominee 40 940 26 599 Milwaukee Number 2014 Rate/100,000 8,649 908 9,459 994 Monroe 59 130 59 130 Oconto 11 29 7 18 Oneida 66 184 67 186 272 151 274 151 21 24 49 56 Pepin 5 67 8 108 Pierce 60 146 35 85 109 248 102 232 Portage 79 112 67 95 Price 24 171 12 86 354 181 419 214 3 17 3 17 Rock 346 216 373 232 Rusk 20 136 19 130 St. Croix 53 62 49 57 Sauk 68 109 59 94 Sawyer 28 168 30 181 Shawano 28 67 27 65 165 143 186 161 Taylor 21 101 18 87 Trempealeau 16 55 17 58 Vernon 21 70 22 73 Vilas 71 331 53 246 Walworth 90 88 79 77 Washburn 26 164 33 208 Washington 85 64 89 67 Waukesha 271 69 237 60 Waupaca 55 105 77 147 Waushara 19 78 22 90 Winnebago 270 160 294 174 28 38 25 34 15,381 268 16,099 280 Outagamie Ozaukee Polk Racine Richland Sheboygan Wood Wisconsin Source: Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center, Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice. Note: Wisconsin Department of Natural Resources and Division of State Patrol crime data are included in the statewide total, and are not included in specific counties. 61 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 The disorderly conduct arrest rate in Wisconsin has declined since 2005 but remains far higher than the U.S. rate. Wisconsin’s rate of disorderly conduct arrests was nearly five times the national rate in 2014 (Figure 26). This disparity probably reflects a difference in what is included in this category in Wisconsin versus nationally. Specifically, the national rate excludes arrests for “drunkenness,” whereas the Wisconsin rate includes public intoxication or drunkenness in its more general category of “disorderly conduct.” That being said, Wisconsin’s rates are decreasing more sharply than U.S. rates (a 45% versus 40% decline, respectively, since 2005). Figure 26. Disorderly conduct arrests (adult and juvenile), rate per 100,000 population, Wisconsin and the U.S., 2005-2014 1,600 U.S. 1,400 Wisconsin 1,200 1,000 1,211 1,190 1,167 1,144 1,077 975 800 896 838 600 400 230 240 240 763 671 230 214 199 187 173 148 137 2008 2009 2010 2011 2012 2013 2014 200 0 2005 2006 2007 Source: Crime and Arrests in Wisconsin, Wisconsin Office of Justice Assistance (2005-2012), Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center (2013-2014), Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice, Criminal Justice Information Services, Federal Bureau of Investigation, U.S. Department of Justice. 62 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 20. Disorderly conduct arrests, rate per 100,000 population, Wisconsin by county, 2013 and 2014 Rate per 100,000 Rate per 100,000 County Adams 2013 487 2014 581 County Marinette 2013 615 2014 540 Ashland 710 634 Marquette 418 386 Barron 137 244 Menominee 3,336 2,352 Bayfield 517 192 Milwaukee 976 757 Brown 663 518 Monroe 848 744 Buffalo 222 467 Oconto 270 203 Burnett 1,005 570 Oneida 481 509 Calumet 222 182 Outagamie 702 583 Chippewa 541 388 Ozaukee 494 438 Clark 277 150 Pepin 175 365 Columbia 876 847 Pierce 697 409 Crawford 36 181 Polk 448 312 Dane 700 629 Portage 296 394 Dodge 814 672 Price 635 579 Door 648 454 Racine 663 617 Douglas 877 875 Richland 525 626 Dunn 914 652 Rock 1,298 1,225 Eau Claire 875 797 Rusk 785 601 Florence 450 157 St. Croix 396 383 Fond du Lac 816 809 Sauk 915 715 Forest 1,381 1,192 Sawyer 385 343 Grant 819 516 Shawano 761 826 Green 629 677 Sheboygan 1,145 1,151 Green Lake 924 783 Taylor 676 537 Iowa 362 269 Trempealeau 492 368 Iron 153 304 Vernon 485 442 Jackson 704 895 Vilas 979 925 1,173 910 Walworth 1,007 1,152 Juneau 504 564 Washburn 599 467 Kenosha 828 786 Washington 915 813 Jefferson Kewaunee 496 388 Waukesha 373 358 La Crosse 1,066 965 Waupaca 703 814 Lafayette 825 763 Waushara 679 697 Langlade 815 745 Winnebago 971 913 Wood 1,094 999 763 671 Lincoln 758 369 Manitowoc 582 595 Marathon 699 622 Wisconsin Source: Wisconsin Uniform Crime Reporting (UCR) Data Dashboard Center, Bureau of Justice Information and Analysis (BJIA), Wisconsin Department of Justice. 63 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Consumption Alcohol Consumption Alcohol consumption in Wisconsin is consistently higher than other states and territories and the U.S. as a whole. Binge drinking is an entrenched practice among Wisconsin adults, as evidenced by a long-term trend in Behavioral Risk Factor Surveillance System (BRFSS) estimates that consistently rank Wisconsin highest or second-highest nationally (Figure 32, page 72). Recent changes in BRFSS methodology, which included sampling of the cell phoneonly population segment and improved data weighting, have not altered this pattern. In 2011, BRFSS added cell phone sampling to its methodology in order to capture the portion of the population that was increasingly missed with traditional landline telephone survey sampling. Results from the National Health Interview Survey, a face-to-face interview survey, had previously indicated that adults in the cell phone-only population segment were more likely to binge drink than those with a landline telephone, 13 and BRFSS data with combined cell phone and landline samples have supported this early finding. In most states, including Wisconsin, BRFSS binge drinking estimates increased by 1 percent, 2 percent, or more with the 2011 changes. BRFSS results indicate that in 2014, Wisconsin continued to have a prevalence of current alcohol consumption above the national median (63% versus 53%) among adults, and the third highest prevalence of adult binge drinking (22%) among U.S. states and territories (Figure 28). Wisconsin’s rates of adult alcohol use remained higher than national averages in 2014 for all categories of consumption, including current use, binge drinking, and heavy drinking (Figure 28). Results from the NSDUH also consistently place Wisconsin in the top one or two states on current alcohol use and binge drinking. As with adults, the prevalence of alcohol use among high school students has been higher in Wisconsin than nationally in the recent past, but this pattern is changing. Data from the Wisconsin Youth Risk Behavior Survey (YRBS) have begun to show a downward trend in current alcohol consumption, binge drinking, and early initiation of alcohol among high school students in Wisconsin, suggesting that progress has been made with concerted efforts to reduce youth and underage drinking. Some of these changes mirror national trends. From 2001 through 2007, YRBS data indicated that Wisconsin had the highest prevalence of current alcohol use among high school students in the nation. A downward trend began in 2009 and was sustained in 2011, when Wisconsin had the eighth-highest prevalence of current alcohol use. As of 2013, Wisconsin was lower than the U.S. as a whole on all three alcohol consumption measures among high school students: initiation before age 13, current alcohol use, and binge drinking (Figure 27). 13 Blumberg, S. J. and Luke, J. V. (2009). Wireless substitution: Early release of estimates from the National Health Interview Survey, July-December 2008. National Center for Health Statistics. http://www.cdc.gov/nchs/data/nhis/earlyrelease/wireless200905.htm 64 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Wisconsin YRBS weighted data was not achieved for 2015 due to a limited data sample. The most recent Wisconsin weighted data from 2013 will continue to be used in the epidemiological profile until 2017 data is collected and made available. Moving forward, U.S. 2015 YRBS weighted data is included to display the national trend. Figure 27. Alcohol use among high school students, Wisconsin and the U.S., 2013 100% U.S. Wisconsin 80% 60% 35% 40% 20% 19% 33% 21% 15% 18% 0% Initiation Before Age 13 Current Use Binge Drinking Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. Figure 28. Alcohol use among adults, Wisconsin and the U.S. median, 2014 100% U.S. 80% Wisconsin 63% 60% 53% 40% 16% 20% 22% 6% 7% 0% Current Use Binge Drinking Heavy Drinking Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services; and U.S. Centers for Disease Control and Prevention. 65 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Current Alcohol Use Historically, the prevalence of current alcohol use among high school students and adults in Wisconsin has been high. Current alcohol use (at least one drink in the past 30 days) by high school students in Wisconsin has been dropping in recent years and was reported by 33 percent of Wisconsin high school students in 2013. This is below the national prevalence for the second time in three years (Figure 29). However, 65 percent of Wisconsin adults (age 18 and older) reported current alcohol use in 2013 (Figure 30). Current alcohol use remains lowest among African American high school youth compared to youth in other race/ethnicity groups (Table 21). Figure 29. Current alcohol use among high school students, Wisconsin and the U.S., 20032015 80% U.S. 70% Wisconsin 60% 50% 40% 49% 49% 42% 43% 45% 39% 41% 30% 36% 35% 33% 33% 20% 10% 0% 2005 2007 2009 2011 2013 2015 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. Table 21. Current alcohol use among high school students, Wisconsin by race/ethnicity, 2005-2013 Race/Ethnicity White African American Hispanic/Latino Asian/Pacific Islander American Indian or Alaskan Native Multiracial 2005-2007 51% 33% 43% 39% 2007-2009 47% 33% 42% 32% 2009-2011 41% 28% 37% 37% 2011-2013 37% 25% 34% 34% 51% 47% 46%* 51%* 53% 52% 45% 39% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction; U.S. Centers for Disease Control and Prevention. Note: * Interpret with caution due to small number of cases. 2015 Wisconsin YRBS weighted data missing due to limited data sample. 66 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Long-term trends in adult alcohol consumption based on data from the BRFSS are only valid through 2010, due to changes in BRFSS methodology. Beginning with 2011, new trends are being established based on combined landline and cell phone sample data and a new weighting methodology. There are indications that these methodological changes produce slightly higher estimates of adult alcohol consumption and binge drinking, but more years of data are needed to verify the differences. The prevalence of current alcohol use among Wisconsin adults has dropped only slightly since the early 2000s. Wisconsin’s current alcohol use remains highest, or second highest, in the nation from year to year. Alcohol use is highest among younger adults and males, although women of childbearing age also consume alcohol at a higher rate than adults in the U.S. overall (Table 22). According to 2012-2014 BRFSS estimates, White adults continue to have the highest rate of current alcohol use, followed by Hispanic and African American adults. Asians and American Indians have the lowest rates of current alcohol use compared to adults in other race/ethnicity groups (Table 23). Figure 30. Current alcohol use among adults (age 18 and older), Wisconsin and U.S. median, 2005-2014 100% U.S. Wisconsin 80% 68% 69% 68% 67% 67% 66% 67% 64% 65% 63% 57% 55% 55% 53% 2011 2012 2013 2014 60% 56% 55% 55% 54% 54% 54% 2005 2006 2007 2008 2009 2010 40% 20% 0% Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Current alcohol use is defined as at least one drink of alcohol in the past 30 days. Differences between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. 67 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 22. Current alcohol use among adults (age 18 and older), Wisconsin by age and sex, and U.S. median, 2005-2014 Year U.S. Wisconsin 18-24 25-44 45-64 65+ Males Females 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 56% 55% 55% 54% 54% 54% 57% 55% 55% 53% 68% 69% 68% 67% 67% 66% 67% 64% 63% 63% 62% 65% 70% 56% 61% 53% 68% 65% 62% 55% 74% 76% 75% 74% 74% 73% 70% 68% 71% 67% 71% 71% 68% 69% 68% 68% 70% 66% 66% 66% 56% 54% 56% 56% 53% 55% 56% 53% 53% 56% 74% 75% 75% 71% 74% 70% 70% 69% 69% 70% 62% 63% 62% 63% 60% 62% 64% 60% 60% 57% Females 18-44 65% 66% 68% 68% 64% 68% 67% 63% 63% 57% Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Difference between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. Table 23. Current alcohol use among adults (age 18 and older), Wisconsin by race/ethnicity, 2004-2014 Year 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2011-2013 2012-2014 African American 48% 53% 55% 55% 49% 53% 53% American Indian 65% 64% 56% 59% 51% 44% 45% Asian Hispanic White 57% 64% 56% 55% 46% 53% 48% 67% 64% 62% 60% 61% 57% 53% 69% 70% 69% 69% 68% 67% 66% Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Differences between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. 68 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 24. Current alcohol use among adults (age 18 and older), Wisconsin by county,20112014 County Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon 20112013 62% 57% 53% 66% 71% 64% 64% 76% 63% 51% 64% 60% 71% 68% 69% 47% 70% 68% 72% 74% 65% 66% 67% 52% 60% 63% 69% 67% 58% 66% 60% 72% 58% 52% 56% 66% 68% 20122014 62% 60% 56% 59% 68% 54% 65% 77% 61% 51% 67% 52% 68% 61% 67% 44% 67% 65% 73% 65% 62% 61% 67% 61% 60% 69% 61% 61% 54% 60% 66% 70% 59% 64% 61% 62% 69% County Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk St. Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood Wisconsin 20112013 50% 54% 52% 61% 57% 62% 66% 64% 75% 70% 74% 66% 68% 63% 62% 60% 60% 63% 64% 61% 65% 61% 64% 70% 63% 61% 71% 67% 65% 69% 73% 65% 72% 62% 62% 20122014 56% 52% 53% 59% 54% 64% 64% 67% 74% 67% 63% 66% 70% 60% 62% 63% 58% 65% 67% 68% 62% 56% 63% 70% 60% 56% 67% 68% 58% 75% 72% 71% 62% 64% 64% 64% 65% Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. 69 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Binge Drinking Based on differences between men and women in metabolizing alcohol, the CDC defines binge drinking as five or more drinks on one occasion for men and four or more drinks on one occasion for women. The YRBS uses the threshold of five or more drinks for both sexes, and may slightly underestimate binge drinking among high school girls. Methodological note: In 2011, BRFSS added cell phone sampling to its methodology in order to capture the portion of the population that was increasingly missed with traditional landline telephone survey sampling. That same year, the BRFSS post-survey weighting methodology was also changed. These changes rule out direct comparisons with BRFSS estimates from 2010 and earlier. Results from the National Health Interview Survey, a face-to-face interview survey, had indicated prior to 2011 that adults in the cell phone-only population segment were more likely to binge drink than were those with landline telephones, 14 and BRFSS data with combined cell phone and landline samples have supported this early finding. In most states, including Wisconsin, BRFSS binge drinking estimates increased by 1 percent, 2 percent, or more with the 2011 changes. As of 2012, Wisconsin’s overall adult binge drinking prevalence, at 25 percent, continued to be the highest in the nation. However, in 2014 Wisconsin dropped to third in adult binge drinking prevalence, at 22 percent, based on BRFSS results. Additional years of data are needed to determine if this indicates a trend. The prevalence of binge drinking remains above 25 percent for young adults and males (Table 27). Binge drinking intensity is reflected in the actual number of drinks consumed in a binge drinking episode. Although the threshold for binge drinking is four or five drinks (women versus men), among Wisconsin adult binge drinkers the average maximum number of drinks consumed is far higher than the threshold—as much as eight or nine drinks for some groups in the 2013-2014 time period (Table 25). Table 25. Average maximum number of alcoholic drinks on one occasion past 30 days, Wisconsin by age group and sex, 2005-2014 (binge drinkers only) Year 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014 18-24 8.9 10.0 10.0 9.0 8.6 25-34 8.9 8.7 8.6 10.2 8.7 35-44 7.5 7.4 8.0 8.0 7.6 45-64 6.6 6.7 6.8 7.6 6.8 65+ 5.5 5.2 5.4 6.7* 5.3 Males 8.3 9.1 9.0 9.9 8.7 Females 5.9 6.0 6.2 6.5 5.7 Total 7.6 7.9 8.0 8.6 7.6 Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: *Interpret with caution due to confidence interval half-width > 1.5. The addition of cell phone-only respondents beginning in 2011 may have increased binge drinking estimates. Differences between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. 14 Blumberg, S. J. and Luke, J. V. (2009). Wireless substitution: Early release of estimates from the National Health Interview Survey, July-December 2008. National Center for Health Statistics. http://www.cdc.gov/nchs/data/nhis/earlyrelease/wireless200905.htm 70 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 In 2013, 18 percent of Wisconsin high school students engaged in binge drinking, a decline from 24 percent in 2011. This continues a trend across several years of reduced binge drinking among high school youth, with Wisconsin’s rate now lower than the rate for the U.S. as a whole. Binge drinking among high school students in the U.S. is also trending downward, although the drop is less steep than in Wisconsin (Figure 31). White, multiracial, and American Indian youth in Wisconsin report the highest levels of binge drinking; however, the 2011-2013 prevalence for American Indian youth should be interpreted with caution due to small sample sizes (Table 26). Figure 31. Binge drinking among high school students, Wisconsin and the U.S., 2005-2015 50% U.S. Wisconsin 40% 30% 20% 31% 32% 25% 26% 26% 24% 24% 18% 22% 18% 21% 10% 0% 2005 2007 2009 2011 2013 2015 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. Table 26. Binge drinking among high school students, Wisconsin by race/ethnicity, 2003-2013 Race/Ethnicity White African American Hispanic/Latino Asian or Pacific Islander American Indian or Alaskan Native Multiracial 20032005 31% 15% 28% 20052007 33% 15% 26% 20072009 30% 14% 25% 20092011 26% 12% 20% 20112013 22% 12% 18% 24% 22% 20% 25% 21% 42% 41% 35% 30%* 40%* 26% 36% 34% 29% 23% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction; U.S. Centers for Disease Control and Prevention. * Interpret with caution due to confidence interval half-width >10%. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 71 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 The prevalence of binge drinking among Wisconsin adults 18 and older in 2014 was 22 percent (Figure 32). This placed Wisconsin third among states and territories, which is a promising sign and may indicate progress in reduction of adult binge drinking. Additional years of data will be needed to verify the presence of a trend. Figure 32. Adult binge drinking, range of state estimates: low, high, and U.S. median, 2006-2014 30% 25% 24% 24% 20% 23% 23% 23% 23% 24% 24% 25% 25% 24% 25% 22% 22% 18% 15% 15% 16% 16% 16% 8% 8% 2006 2007 2008 5% 7% 2009 2010 Wisconsin 23% 22% U.S. High U.S. Median Low 17% 10% 10% 10% 10% 2011 2012 2013 2014 15% 7% 25% 17% 10% 9% 24% 16% 0% Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: The median is the midpoint of the range of estimates for all U.S. states and territories. Differences between groups and time periods may not be statically significant. Double line indicates trend break due to methodological changes. 72 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Young adults and males in Wisconsin have higher rates of binge drinking than older adults and women; however, women of childbearing age (18-44) have a higher rate of binge drinking (20%) than U.S. adults overall (16%) (Table 27). Among race/ethnicity groups, Hispanics had the highest binge drinking prevalence for the three-year time period 2012-2014 (Table 28). Table 27. Binge drinking among adults (age 18 and older), Wisconsin by age and sex, and U.S. median, 2005-2014 Year 2005 2006 2007 2008 2009 2010 U.S. 14% 15% 16% 16% 16% 15% Wisconsin 22% 24% 23% 23% 24% 22% 18-24 33% 38% 36% 31% 37% 31% 25-44 28% 32% 29% 31% 33% 29% 45-64 21% 20% 20% 20% 19% 20% 65+ 4% 6% 8% 8% 8% 5% Males 32% 33% 27% 28% 32% 28% Females 12% 16% 17% 17% 16% 16% Females 18-44 18% 24% 25% 24% 24% 23% 2011 2012 2013 2014 18% 17% 17% 16% 24% 25% 23% 22% 41% 43% 39% 30% 32% 32% 31% 29% 19% 22% 19% 21% 7% 7% 6% 9% 31% 30% 29% 29% 17% 20% 16% 15% 27% 29% 26% 20% Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Differences between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. Table 28. Binge drinking among adults (age 18 and older), Wisconsin by race/ethnicity, 2004-2014 Year 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 African American 14% 16% 17% 17% 14% American Indian 32% 29% 25% 23% 25% 2011-2013 2012-2014 24% 19% 21% 22% 17% 18% 17% 20% 23% Hispanic/ Latino 28% 25% 21% 24% 25% White 22% 24% 24% 24% 23% 14% 14% 29% 28% 24% 24% Asian Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Differences between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. 73 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 29. Binge drinking among adults (age 18 and older), Wisconsin by county, threeyear pooled estimates, 2011-2014 County Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon 20112013 20122014 22% 22% 24% 21% 26% nr 17% 37% 25% 18% 30% 28% 25% 27% 16% 14% 27% 28% 12% 18% 21% 30% 19% nr 17% 27% 34% 22% 22% 24% nr 31% nr 22% 19% 19% 29% 19% 20% 25% 15% 27% nr 18% 31% 17% 18% 31% 22% 25% 25% 18% 12% 25% 27% 13% 19% 20% 28% 22% 21% 18% 24% 19% 18% 18% 23% nr 28% nr 22% 20% 21% 28% 20112013 20122014 Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk St. Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood 17% nr 26% 23% 20% 17% 19% 25% 26% 27% 35% 16% 27% 26% 24% 28% 18% nr 31% 29% 23% 20% 26% 25% 29% 24% 23% 23% 30% 19% 27% 21% nr 23% 22% 21% nr 23% 22% 17% 23% 19% 28% 27% 27% 30% 18% 27% 22% 25% 25% 18% 19% 29% 27% 20% 20% 23% 29% 26% 18% 21% 26% 20% 22% 22% 23% 22% 22% 23% Wisconsin 24% 23% County Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: nr = not reliable: relative standard error >30% 74 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Heavy Use of Alcohol The CDC defines heavy alcohol consumption as an average of more than two drinks per day for men and an average of more than one drink per day for women. As with binge drinking, the difference in definitions by sex is based on the different rates at which men and women metabolize alcohol. Wisconsin’s heavy drinking rate has been consistently higher than the national rate since 2005. The prevalence of heavy use of alcohol among Wisconsin adults 18 and older remained at or near 8 percent from 2005 to 2009 (Figure 33). In 2011, methodological changes were instituted in BRFSS sampling and weighting, which may help to account for a spike in 2011 to 10 percent (see pgs. 64, 70, and Appendix 2 about methodological changes). In most years, heavy use of alcohol is highest among young adults ages 18-24 and adults ages 45-64 (Table 30). In 2014, 8 percent of these age groups in Wisconsin were heavy drinkers. As Table 30 shows, women are as likely as men to drink heavily. Among race/ethnicity groups, African Americans are more likely to drink heavily based on combined data from 2012 to 2014 (Table 31). However, the estimate of heavy drinking for American Indians and Asians is not available for comparison, as the relative standard errors for these groups are too large (>30%). See Appendix 2 for information on the relative standard error. Figure 33. Heavy drinking among adults, Wisconsin and the U.S. median, 2005-2014 25% United States Wisconsin 20% 15% 10% 10% 8% 8% 7% 8% 8% 9% 8% 6% 7% 5% 5% 5% 5% 5% 5% 5% 2005 2006 2007 2008 2009 2010 7% 6% 6% 6% 2012 2013 2014 0% 2011 Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Differences between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. 75 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 30. Heavy drinking among adults (age 18 and older), Wisconsin by age and sex, and U.S. median, 2005-2014 Year U.S. Wisconsin 18-24 25-44 45-64 65+ Males Females 2005 2006 2007 2008 2009 2010 5% 5% 5% 5% 5% 5% 8% 8% 7% 8% 8% 6% 11% 12% 10% 14% 14% ** 8% 8% 6% 7% 8% 7% 8% 8% 7% 8% 6% 8% 3% 4% 4% 5% 6% 3% 9% 8% 7% 9% 9% 7% 7% 8% 7% 7% 6% 6% Females 18-44 8% 10% 7% 7% 7% 6% 2011 2012 2013 2014 7% 6% 6% 6% 10% 9% 8% 7% 11% 10% 9% 8% 13% 9% 9% 7% 9% 9% 8% 8% 5% 6% 4% 6% 11% 8% 8% 8% 8% 9% 7% 7% 10% 10% 9% 7% Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Differences between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. Table 31. Heavy drinking among adults (age 18 and older), Wisconsin by race/ethnicity, 2004-2014 Year 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2011-2013 2012-2014 African American 5% 7% 7% 6% 6% 9% 7% American Indian 7% 5% 10% 11% 12% ** 5% Asian 3% 2% 4% ** ** ** ** Hispanic/ Latino 11% 9% 8% 10% 13% 6% 5% White 8% 7% 7% 7% 7% 9% 6% Source: Behavioral Risk Factor Survey, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: ** Estimate not reliable due to relative standard error >30% (see Appendix 2). Differences between groups may not be statistically significant. Double line indicates trend break due to methodological changes. 76 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Per Capita Alcohol Consumption Per capita consumption is the average amount of alcohol consumed per person, based on the population age 14 and older. Standard drink serving sizes are 12 ounces of beer, 8-9 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of distilled spirits or liquor. Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA). What is a standard drink? https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink In 2014, Wisconsin’s consumption was 655 standard drinks per person (Figure 34), which is equivalent to approximately 334 servings of beer, 76 servings of wine, and 245 servings of liquor, well above the national average. Figure 34. Per capita alcohol consumption of standard drinks, age 14 and older, Wisconsin and the U.S., 2005-2014 1,000 900 800 700 651 660 661 665 656 649 656 660 499 505 511 511 506 499 503 513 664 655 513 512 600 500 400 300 United States 200 Wisconsin 100 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA), Alcohol Epidemiologic Data System. (2016). Apparent per capita alcohol consumption: National, state and regional trends, 1977-2014. http://pubs.niaaa.nih.gov/publications/surveillance104/CONS14.htm 77 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Underage Drinking For purposes of clarification, NSDUH data are presented here because they include estimates for young people ages 12-20, which is an appropriate age span for estimating underage drinking. The other major sources of data on alcohol use, the BRFS and the YRBS, only provide data for adults ages 18 and older and high school students respectively. While current alcohol use reported by Wisconsin high school students was below the national prevalence in 2013 (Figure 27, page 65), underage drinking, defined by the NSDUH as drinking by youth ages 12 to 20, is higher in Wisconsin than the nation as a whole. Wisconsin youth are more likely to report both current drinking (at least one drink in the past month) and binge drinking (defined by NSDUH as five or more drinks on one occasion in the past month). In 2013-2014, 28 percent of Wisconsin youth ages 12-20 reported current alcohol use (Figure 35). This is down from 29 percent in 2012-2013 (not shown). In addition, 18 percent of Wisconsin youth ages 12-20 reported binge drinking in the past month. This has stayed the same since 2010 (not shown). Figure 35. Underage drinking, Wisconsin and the U.S., 2013-2014 50% U.S. 45% Wisconsin 40% 35% 28% 30% 25% 23% 18% 20% 14% 15% 10% 5% 0% Underage Drinking Underage Binge Drinking Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services. 78 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Age of Initiation The percent of Wisconsin high school students who had initiated alcohol use before age 13 declined between 2005 and 2013, from 24 to 15 percent (Figure 36). Prevalence of beforeage-13 initiation among boys exceeded that among girls in each of those years (Table 32). However, the gap between males and females has virtually closed on this measure. From 2011 to 2013, Hispanic/Latino, American Indian, and multiracial students were most likely to report initiating alcohol use before age 13 (Table 33). Figure 36. Alcohol use initiation before age 13 among high school students, Wisconsin and the U.S., 2005-2015 50% U.S. Wisconsin 40% 30% 20% 26% 24% 24% 21% 19% 24% 19% 19% 17% 19% 15% 10% 0% 2005 2007 2009 2011 2013 2015 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: The Youth Risk Behavior Survey asks high school students whether they began using alcohol “other than a few sips” before age 13. 2015 Wisconsin YRBS weighted data missing due to limited data sample. Table 32. Alcohol use initiation before age 13 among high school students, Wisconsin by sex, 2005-2013 Sex 2005 2007 2009 2011 2013 Female 19% 20% 17% 16% 14% Male 28% 27% 22% 21% 15% Source: Youth Risk Behavior Surveillance Survey, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 79 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 33. Alcohol use initiation before age 13 among high school students, Wisconsin by race/ethnicity, 2005-2013 Race/Ethnicity White African American Hispanic/Latino Asian or Pacific Islander American Indian or Alaskan Native Multiracial 2005-2007 23% 26% 30% 2007-2009 20% 28% 30% 2009-2011 17% 23% 27% 2011-2013 15% 18% 25% 22% 20% 19% 17% 31%* 17%* 27%* 35%* 31% 28% 29% 23% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. * Interpret with caution due to confidence interval half-width >10%. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 80 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Alcohol Use by Women of Childbearing Age Recent BRFS results indicate that current alcohol use among Wisconsin women of childbearing age is still much higher than the national prevalence. In 2014, 57 percent of Wisconsin women ages 18-44 consumed alcohol in the previous 30 days compared to a prevalence of 50 percent in all states and U.S. territories (Figure 37). Binge drinking among women is defined by the CDC as four or more alcohol drinks on one occasion. Past-month binge drinking, an indicator of excessive alcohol consumption, is also more prevalent among Wisconsin women in this age group compared to women in all states and territories (20% versus 17%, Figure 38). Figure 37. Current alcohol use among women ages 18-44, Wisconsin and the U.S. median, 2005-2014 100% U.S. 90% Wisconsin 80% 70% 65% 66% 68% 68% 64% 68% 67% 63% 63% 57% 60% 50% 40% 53% 54% 51% 50% 51% 52% 2008 2009 2010 55% 52% 52% 50% 2012 2013 2014 30% 20% 10% 0% 2005 2006 2007 2011 Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Difference between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. 81 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 38. Binge drinking among women ages 18-44, Wisconsin and the U.S. median, 2005-2014 50% U.S. 45% Wisconsin 40% 35% 30% 24% 25% 20% 5% 24% 24% 29% 23% 26% 20% 18% 15% 10% 25% 27% 19% 16% 14% 11% 15% 15% 15% 2008 2009 2010 17% 17% 17% 2012 2013 2014 0% 2005 2006 2007 2011 Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Differences between groups and time periods may not be statistically significant. Double line indicates trend break due to methodological changes. 82 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Drinking Before and During Pregnancy The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing annual survey of new mothers conducted by state health departments and coordinated by the CDC. Wisconsin began participating in PRAMS in 2007. PRAMS contacts women three to six months after a live birth to ask about health and risk behaviors prior to, during, and shortly after pregnancy. Weighted PRAMS data represent the population of new mothers for the identified year. In 2011, the most recent year for which there is comparable national data, 67 percent of new mothers in Wisconsin consumed alcohol in the three months before they became pregnant. (Figure 39). The proportion of new mothers who drank alcohol during the last three months of pregnancy was much lower than the proportion that drank during the three months before pregnancy. Still, 8 percent of new mothers in Wisconsin consumed alcohol during the last three months of their recent pregnancy (Figure 40). Drinking during pregnancy is a concern because of fetal alcohol spectrum disorders (FASD). FASD is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. 15 FASD have been associated with alcohol consumption patterns that produce high BACs, such as binge drinking. 16 15 Substance Abuse and Mental Health Services Administration. (2007). The physical effects of fetal alcohol spectrum disorders. 16 Centers for Disease Control and Prevention. (2012). Alcohol use and binge drinking among women of childbearing age – U.S., 2006-2010. Morbidity and Mortality Weekly Report, 61(28), 534-538. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6128a4.htm?s_cid=mm6128a4_e%0D%0A 83 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 39. Alcohol consumption in the three months before pregnancy, Wisconsin and PRAMS states, 2009-2013 100% Median of PRAMS States Wisconsin 80% 69% 68% 60% 59% 57% 67% 69% 67% 57% 40% 20% 0% 2009 2010 2011 2012 2013 Source: Pregnancy Risk Assessment Monitoring System (PRAMS), Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Data for U.S. was not available for 2012 and 2013. Not every state collects PRAMS data. Figure 40. New mothers who consumed alcohol in the last three months of pregnancy, Wisconsin and PRAMS states, 2009-2013 20% Median of PRAMS States Wisconsin 15% 10% 9% 7% 7% 8% 8% 8% 8% 6% 5% 0% 2009 2010 2011 2012 2013 Source: Pregnancy Risk Assessment Monitoring System (PRAMS), Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. Note: Data for U.S. was not available for 2012 and 2013. Not every state collects PRAMS data. 84 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Other Drug Consumption Illicit Drug Consumption The use of drugs other than alcohol remains a problem in Wisconsin. Overall, consumption patterns of illicit drugs in Wisconsin mirror national trends (Table 34). Based on results from the 2013 YRBS, Wisconsin high school students have lower lifetime use rates than students in the nation as a whole in the use of all four categories of drugs shown (Figure 41). 17 Marijuana continues to be the drug most frequently used by Wisconsin high school students, with misuse of prescription drugs second, followed by inhalants and cocaine (Figure 41). Rates of marijuana, other illicit drugs, and nonmedical use of prescription pain relievers are consistently highest among young adults ages 18-25 (Figure 42). Table 34. Past year and past month use of other drugs, age 12 and older, Wisconsin and the U.S., 2013-2014 Any illicit drugs Illicit drugs other than marijuana Marijuana Cocaine Nonmedical use of pain relievers Past Year Wisconsin 3%* -13% 2% 4% U.S. 3%* -12% 2% 4% Past Month Wisconsin U.S. 10% 3% 8% --- 8% 3% 6% --- Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Note: Dashes -- indicate data not available. * indicates past year dependence on or abuse of illicit drugs. 17 Wisconsin YRBS did not ask about heroin use in 2013. 85 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 41. Lifetime use of illicit drugs among high school students, Wisconsin and the U.S., 2013 50% U.S. 41% Wisconsin 40% 31% 30% 18% 20% 15% 9% 10% 6% 6% 4% 0% Marijuana Prescription Drugs* Inhalants Cocaine Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. * Use of prescription drugs without a prescription (question wording: "…such as OxyContin®, Percocet®, Vicodin®, codeine, Adderall®, Ritalin®, or Xanax®"). Note: Wisconsin YRBS did not ask about heroin use in 2013. 2015 Wisconsin YRBS weighted data missing due to limited data sample. Figure 42. Use of marijuana, illicit drugs other than marijuana, and pain relievers for nonmedical purposes age 12 and older, Wisconsin by age group, 2013-2014 50% Ages 12 to 17 Ages 18 to 25 40% Ages 26 and Older 18% 20% 10% Past Year Use Past Month Use 30% 7% 5% 9% 7% 4% 3% 5% 3% 0% Marijuana Illicit Drugs, Not Marijuana Pain Relievers Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Note: Use of marijuana and use of illicit drugs other than marijuana is use in the past month; use of pain relievers is use in the past year. 86 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Marijuana Marijuana use has a wide range of effects. It seriously impairs judgment and motor coordination and, contrary to common belief, marijuana can be addictive. Short-term effects include problems with memory and learning, distorted perception, difficulty in thinking, problem solving, and loss of coordination. 18 Long-term marijuana use affects brain development. For individuals who start using marijuana as teenagers, the drug may affect how the brain builds connections between the different areas of the brain where thinking, memory, and learning functions take place. Individuals who use marijuana heavily often report having lower life satisfaction, poorer mental health, poorer physical health, and more relationship problems. 19 YRBS results indicate current marijuana use—defined as use within the previous 30 days— among Wisconsin high school students has been similar to, or slightly lower than, use among high school students nationally for several years (Figure 43). In 2013, current use dropped to 17 percent in Wisconsin, compared to 23 percent nationally. As with current use, lifetime use of marijuana among high school students has increased slightly in recent years in the U.S. The prevalence of lifetime use was similar in the state and nationally from 2005 to 2011 (Figure 44). Wisconsin’s prevalence dropped noticeably in 2013, but more data is needed to determine whether this signals a trend. 18 Substance Abuse and Mental Health Services Administration. (2016). Marijuana (cannabis). http://www.samhsa.gov/atod/marijuana 19 National Institute on Drug Abuse. (2016). DrugFacts—What is marijuana? http://www.drugabuse.gov/publications/drugfacts/marijuana 87 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 43. Current marijuana use among high school students, Wisconsin and the U.S., 2005-2015 50% U.S. 45% Wisconsin 40% 35% 30% 25% 20% 20% 15% 10% 20% 20% 16% 22% 21% 23% 22% 21% 19% 17% 5% 0% 2005 2007 2009 2011 2013 2015 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. Figure 44. Lifetime marijuana use among high school students, Wisconsin and the U.S., 2005-2015 100% U.S. Wisconsin 80% 60% 40% 38% 38% 37% 37% 37% 37% 37% 34% 20% 41% 39% 31% 0% 2005 2007 2009 2011 2013 2015 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 88 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 In the years 2011 and 2013 combined, current marijuana use was highest among African American, American Indian, and multiracial high school students (Table 35). The overall prevalence of marijuana initiation before age 13 among Wisconsin high school students was 6 percent in 2011-2013 (YRBS, not shown). Early initiation of marijuana use was highest among African American, American Indian, and multiracial high school students (Table 36); however, the estimate for American Indian students should be interpreted with caution, as the confidence interval half-width is large. Table 35. Current marijuana use among high school students, Wisconsin by race/ethnicity, 2005-2013 Race/Ethnicity White African American Hispanic/Latino Asian or Pacific Islander American Indian or Alaskan Native Multiracial 2005-2007 16% 32% 24% 10% 2007-2009 18% 31% 23% 10% 2009-2011 18% 34% 18% 16% 2011-2013 17% 34% 18% 16% 26% 37% 32% 39%* 24% 24% 26% 29% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. * Interpret with caution due to confidence interval half-width >10%. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. Table 36. Marijuana use before age 13 among high school students, Wisconsin by race/ethnicity, 2005-2013 Race/Ethnicity White African American Hispanic/Latino Asian or Pacific Islander American Indian or Alaskan Native Multiracial 2005-2007 10% 23% 16% 6% 2007-2009 5% 14% ** 6% 2009-2011 4% 13% 6% 9% 2011-2013 4% 15% 8% 8% ** 17% 23%* 31%* 14% 13% 15% 14% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. * Interpret with caution due to confidence interval half-width >10%. ** Estimate not reliable due to relative standard error of 30%. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 89 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Cocaine Cocaine users face the possibilities of arrest, drug dependence, injury, and death. Compared with non-users, cocaine users are more likely to experience a hemorrhagic stroke (sudden bleeding in the brain) at a significantly earlier age, and experience poorer outcomes after treatment. 20 Lifetime use of cocaine among high school students in Wisconsin dropped steadily from 2005 to 2013, and has been lower than the national prevalence since 2009 (Figure 45). Due to small sample sizes, estimates by race/ethnicity for lifetime cocaine use are not shown. Figure 45. Lifetime cocaine use among high school students, Wisconsin and the U.S., 2005-2015 20% U.S. Wisconsin 15% 10% 8% 8% 5% 7% 7% 6% 6% 7% 5% 4% 4% 2011 2013 5% 0% 2005 2007 2009 2015 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 20 Esse, K., Fossati-Bellani, M., Traylor A., and Martin-Schild, S. (2011). Epidemic of illicit drug use, mechanisms of action/addiction and stroke as a health hazard. Brain Behavior, 1(1), 44-54. 90 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Heroin One of the most significant risks a heroin user faces is dependence on the drug. Users who inject heroin also risk contracting HIV, HCV, and other infectious diseases. Most new HCV infections in the U.S. each year are among injection drug users. Data presented include the most recent YRBS for which lifetime use of heroin was asked (2011). The prevalence of lifetime heroin use among high school students in Wisconsin declined from 2 percent in 2005 to 1 percent in 2011 (Figure 46). New data on heroin use among Wisconsin high school students are not available for 2013 or 2015. Figure 46. Lifetime heroin use among high school students, Wisconsin and the U.S., 20052015 10% U.S. 8% Wisconsin 6% 4% 3% 3% 3% 2% 2% 2% 2% 2% 2% 2013 2015 2% 1% 0% 2005 2007 2009 2011 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. Table 37. Lifetime heroin use among high school students, Wisconsin by race/ethnicity, 2005-2011 Race/Ethnicity White African American Hispanic/Latino Asian or Pacific Islander American Indian or Alaskan Native Multiracial 2005-2007 2% 3% 4% 6% 2007-2009 1% 3% 3% 3% 2009-2011 1% 5% ** ** ** ** ** 9% 6% 4% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. ** Estimate not reliable due to relative standard error of 30%. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 91 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Inhalants Prolonged sniffing of the highly concentrated chemicals in solvents or aerosol sprays can induce irregular and rapid heart rhythms and lead to heart failure and death within minutes of a session. This syndrome, known as sudden sniffing death, can result from a single session of inhalant use. The effects of use include lightheadedness, hallucinations, delusions, and many feel less inhibited and less in control. Chronic exposure to inhalants can produce significant, sometimes irreversible, damage to the heart, lungs, liver, and kidneys. 21 Lifetime use of inhalants among Wisconsin high school youth dropped steadily across the time period 2005 to 2013 (Figure 47), and was 6 percent in 2013, about half of what it was in 2005. In 2013, lifetime use of inhalants among high school students remained higher than lifetime cocaine use both in Wisconsin (6% versus 4%, respectively) and nationally (9% versus 6%, respectively). Figure 47. Lifetime inhalant use among high school students, Wisconsin and the U.S., 2005-2015 30% U.S. Wisconsin 25% 20% 15% 10% 12% 11% 13% 12% 11% 9% 10% 7% 10% 8% 5% 6% 0% 2005 2007 2009 2011 2013 2015 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 21 National Institute on Drug Abuse. (2012). DrugFacts—Inhalants. https://www.drugabuse.gov/publications/drugfacts/inhalants 92 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Methamphetamine As well as being highly addictive, methamphetamine use can lead to neurological damage and psychotic behaviors. Data presented are from the YRBS for years in which the question on lifetime use of methamphetamine was asked. Lifetime methamphetamine use among Wisconsin high school students decreased between 2001 and 2011, following a national trend (Figure 48). Among high school students in 2009-2011, White students reported the lowest prevalence of lifetime methamphetamine use (2%), while multiracial students reported the highest (7%, Table 38). Figure 48. Lifetime methamphetamine use among high school students, Wisconsin and the U.S., 2005-2015 20% U.S. Wisconsin 15% 10% 6% 5% 6% 4% 4% 0% 2005 2007 4% 4% 3% 3% 3% 2013 2015 2% 2009 2011 Source: Youth Risk Behavior Surveillance System, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. Note: Question on methamphetamine use was not asked in 2013. 2015 Wisconsin YRBS weighted data missing due to limited data sample. Table 38. Lifetime methamphetamine use among high school students, Wisconsin by race/ethnicity, 2005-2011 Race/Ethnicity White African American Hispanic/Latino Asian or Pacific Islander American Indian or Alaskan Native Multiracial 2005-2007 5% 3% 6% 10% ** 8% 2007-2009 3% 4% ** 8% ** 7% 2009-2011 2% 5% ** 6% ** 7% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. ** Estimate not reliable due to relative standard error >30%. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 93 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Nonmedical Use of Prescription Drugs Wisconsin is in the midst of an epidemic of nonmedical use of prescription drugs. Nationally, narcotic-pain-reliever-related emergency department visits involving nonmedical use of pharmaceuticals increased 117 percent from 2005 to 2011, and leveled off from 2008 to 2011. Among narcotic pain reliever-related emergency department visits involving nonmedical use that occurred in 2011, 44 percent involved narcotic pain relievers only. In the remaining 56 percent of these visits, additional drugs were involved, the most common of which were antianxiety medication and insomnia medication (28 percent). 22 In 2014, the national rate of drug overdose deaths involving natural and semisynthetic opioids (e.g., morphine, oxycodone, and hydrocodone), 3.8 per 100,000, was the highest among opioid overdose deaths, and increased 9 percent from 3.5 per 100,000 in 2013. 23 As of 2013, 15 percent of Wisconsin high school students reported using prescription drugs (such as OxyContin®, Percocet®, Vicodin®, codeine, Adderall®, Ritalin®, or Xanax®) for nonmedical purposes at some point in their lives (Figure 41, page 86). During 2013-2014, 4 percent of Wisconsin residents age 12 and older reported using pain relievers for nonmedical purposes in the past year (Figure 49), which is the same as the national average. The prevalence of past year use was highest among young adults age 18 to 25 (9%, Figure 42, page 86). Figure 49. Use of prescription pain relievers for nonmedical purposes in the past year, age 12 and older, Wisconsin and the U.S., 2009-2014 10% U.S. Wisconsin 8% 6% 4% 5% 5% 5% 5% 5% 4% 5% 4% 4% 4% 2011-2012 2012-2013 2013-2014 2% 0% 2009-2010 2010-2011 Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. 22 Crane, E.H. (2015). The CBHSQ report: Emergency department visits involving narcotic pain relievers. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Administration. 23 Centers for Disease Control and Prevention. (2016). Increases in drug and opioid overdose deaths—U.S., 20002014. Morbidity and Mortality Weekly Report, 64(50), 1378-1382. 94 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Risk Factors Risk factors are characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of problem outcomes. Community-level factors that heighten the risk of experiencing problems with alcohol and drug use include the availability, accessibility, acceptability, and affordability of substances. Individual factors that increase the risk of alcohol and other drug use include childhood victimization, posttraumatic stress disorder, and other effects of trauma and depression. Risk factors that affect behavioral health (both substance use disorders and mental illness) outcomes are referred to as “shared risk factors.” Some shared risk factors are listed below. • Shared societal risk factors include social norms and laws favorable to substance use, as well as racism and a lack of economic support. • Shared community risk factors include neighborhood poverty and violence. • Shared relationship risk factors include intimate partner violence, parents who use drugs and or alcohol or who suffer from mental illness, child abuse and or maltreatment, and inadequate supervision. • Shared individual risk factors include a person’s genetic predisposition to addiction or exposure to alcohol prenatally. 24 Community-Level Risk Factors for Substance Use Disorders Alcohol Availability Community-level factors that heighten the risk of experiencing problems with alcohol include the per capita number of alcohol outlets in a community. 25 Table 39 shows the number of alcohol licenses in relation to the number of people in Wisconsin counties. In 2014-2015, the overall alcohol outlet density in Wisconsin was 1.5 outlets per 500 people. Differences in alcohol outlet density by county are difficult to interpret. Rural counties may have a higher number of outlets relative to population, but these outlets may be small and serve many fewer people than a single outlet in a large city. Also, county-level rates may mask great variations in density for various locations within a given county. 24 Substance Abuse and Mental Health Services Administration. (2015). Risk and protective factors. http://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/risk-protectivefactors. 25 Popova, S., Giesbrecht, N., Bekmuradov, D., and Patra, J. (2009). Hours and days of sale and density of alcohol outlets: Impacts on alcohol consumption and damage: A systematic review. Alcohol and Alcoholism, 44(5), 500516. 95 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 39. Alcohol outlet density: licenses per 500 population, Wisconsin by county, 20142015 County Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon 2014 Population* 20,844 16,071 46,020 15,059 253,156 13,594 15,462 49,715 63,038 34,697 56,795 16,628 502,251 89,203 27,976 44,196 43,917 100,477 4,450 102,424 9,253 52,603 36,822 19,114 23,809 5,915 20,630 83,974 26,934 167,258 20,652 116,740 16,914 19,847 28,816 81,320 134,803 Total Licenses Issued 99 98 156 143 624 85 96 124 224 145 209 84 1,130 269 257 196 110 236 44 295 78 200 111 83 108 98 93 273 131 373 96 304 78 111 151 275 387 96 Licenses/ 500 people 2.4 3.0 1.7 4.7 1.2 3.1 3.1 1.2 1.8 2.1 1.8 2.5 1.1 1.5 4.6 2.2 1.3 1.2 4.9 1.4 4.2 1.9 1.5 2.2 2.3 8.3 2.3 1.6 2.4 1.1 2.3 1.3 2.3 2.8 2.6 1.7 1.4 # Class A Licenses Issued 19 22 43 31 179 21 28 27 53 36 59 26 333 63 71 39 34 63 11 81 14 65 28 21 31 36 24 88 31 129 19 80 21 34 34 64 101 # Class B Licenses Issued 81 76 120 116 444 64 70 102 174 108 155 56 911 209 186 161 81 173 39 219 63 147 83 65 78 88 73 196 100 282 76 246 57 80 118 211 284 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Table 39. Alcohol outlet density: licenses per 500 population, Wisconsin by county, 20142015 (continued) County Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk St. Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood Wisconsin 2014 Population* 41,605 15,399 4,236 949,741 45,339 38,014 36,082 180,022 87,116 7,445 41,107 44,237 70,882 14,155 195,461 17,995 160,104 14,790 85,735 62,092 16,676 41,859 115,362 20,733 29,184 29,977 21,523 102,837 15,948 133,071 392,761 52,435 24,511 168,216 74,954 Total Licenses Issued 223 73 8 1,890 151 190 244 510 238 43 124 165 231 98 457 56 328 83 283 179 198 375 198 99 131 100 228 330 94 303 777 218 103 403 229 Licenses/ 500 People 2.7 2.4 0.9 1.0 1.7 2.5 3.4 1.4 1.4 2.9 1.5 1.9 1.6 3.5 1.2 1.6 1.0 2.8 1.7 1.4 5.9 4.5 0.9 2.4 2.2 1.7 5.3 1.6 2.9 1.1 1.0 2.1 2.1 1.2 1.5 5,732,981 16,934 1.5 # Class A Licenses Issued 63 20 5 460 45 38 43 137 56 14 35 55 49 24 141 18 80 18 54 113 31 44 94 23 40 27 47 80 28 77 216 51 32 89 64 # Class B Licenses Issued 161 53 3 1,460 106 150 195 372 181 42 94 111 186 75 314 43 249 65 145 198 146 155 285 77 96 72 182 248 70 226 559 170 73 317 168 4,470 12,839 Source: Wisconsin Department of Revenue (DOR), reflecting liquor licenses issued and reported to the DOR for the period beginning July 1, 2014, and expiring July 1, 2015. *Wisconsin Department of Administration estimates. *See Appendix 1 for list of license classes included in each category. Note: Some establishments are issued more than one type of liquor license. The reported total number of licenses per county is the number of establishments issued a license. The numbers reported for A and B licenses are the total for that license type. 97 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Other Drug Availability The school environment, where students function on a daily basis, conveys information about which behaviors are acceptable or unacceptable in society as a whole. Activity related to illegal substances is a major concern in schools, particularly in high schools (see also suspensions and expulsions related to alcohol or drugs pages 36 and 52). The YRBS asks high school students if they were “offered, sold or given an illegal drug on school property” in the past 12 months. As Table 40 indicates, 20 percent of students overall, and 25 percent or more of African American, American Indian, Hispanic and multiracial students, were presented with the opportunity to obtain an illegal drug at school during the time period 2011 to 2013 (two separate years combined). This is a slight reduction from previous years. Table 40. Offered an illegal drug on school property, high school students, Wisconsin, by race/ethnicity, 2005 -2013 Race/Ethnicity White African American Hispanic/Latino Asian or Pacific Islander American Indian or Alaskan Native Multiracial 2005-2007 20% 30% 38% 27% 2007-2009 20% 30% 36%* 20% 2009-2011 19% 28% 32% 18% 2011-2013 18% 25% 30% 16% 32%* 26%* 20%* 31%* 27% 27% 31% 28% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. *Interpret with caution due to confidence interval half-width > 10%. Note: Differences between groups may not be statistically significant. Survey question wording: “was offered, sold or given an illegal drug on school property in the past 12 months.” 2015 Wisconsin YRBS weighted data missing due to limited data sample. 98 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Perception of Harm Parental attitudes about substance use can influence the consumption behavior of children and adolescents. The belief that others do not approve of alcohol or other drug use can be a deterrent to initiating use. Table 41 shows Wisconsin YRBS results indicating the proportion of high school students, by race/ethnicity, who perceive that their parents would disapprove of their using alcohol two or more times per month. Clear majorities of students from all racial and ethnic backgrounds believe their parents would disapprove of this behavior. White students are less likely to perceive parental disapproval (66%) compared to students in other race/ethnicity groups. Table 41. Perceived parental disapproval of alcohol use, high school students, Wisconsin, by race/ethnicity, 2007-2013 Race/Ethnicity White African American Hispanic/Latino Asian or Pacific Islander American Indian or Alaskan Native Multiracial 2007-2009 62% 74% 68%* 68% 69%* 63% 2009-2011 37% 74% 68% 75% 66%* 67% 2011-2013 66% 72% 74% 72% 73%* 69% Source: Youth Risk Behavior Survey, Wisconsin Department of Public Instruction and U.S. Centers for Disease Control and Prevention. *Interpret with caution due to confidence interval half-width >10%. Note: 2015 Wisconsin YRBS weighted data missing due to limited data sample. 99 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Shared Risk Factors for Mental Illnesses and Substance Use Disorders Early Life Experiences Certain early-life experiences are known to be associated with a higher risk for both adult mental illnesses and substance use disorders. Adverse Childhood Experiences (ACEs) are negative life events or experiences that occur during childhood and have the potential to impede healthy development. These experiences include childhood physical abuse, sexual abuse, and substance abuse in the household. ACEs are linked to the following health threats among Wisconsin adults: • Higher rates of depression • Increased health risk behaviors • Poor general health • Occurrence of chronic health conditions 26 In 2014, 27 percent of Wisconsin adults reported they experienced substance abuse in their home environment while growing up, 17 percent reported being physically abused (hit, beaten, or kicked) by a parent or another adult once or more than once, and 11 percent reported they had been sexually abused as a child (ever touched by, or made to touch, an adult or person at least five years older, or forced to have sex by an adult or a person at least five years older) (Figure 50). Figure 50. Percent of adults who experienced physical or sexual abuse, or home environment substance abuse before age 18, Wisconsin, 2014 50% 40% 30% 27% 20% 17% 11% 10% 0% Substance Abuse in Household Physical Abuse by Parent/Adult Sexual Abuse by Adult/Older Person Source: Behavioral Risk Factor Surveillance System, Division of Public Health, Wisconsin Department of Health Services/Centers for Disease Control and Prevention. 26 Wisconsin Child Abuse and Neglect Prevention Board. (2016). The influence of adverse childhood experiences on the health of Wisconsin citizens in adulthood (revised version). https://preventionboard.wi.gov/Documents/WisconsinACEBrief%282011-13%29WEB_9.16.pdf 100 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Depression and Suicide Mental illnesses and substance use disorders frequently co-occur. Moreover, treatment for mental illnesses such as anxiety and depression can include the prescribing of controlled substances. This creates conditions for potential abuse and diversion of prescription medications. In 2013-2014, an estimated 7 percent of Wisconsin adults reported experiencing a “major depressive episode” in the past year, and 4 percent reported having serious suicidal thoughts in the past year (Figure 51). These are the same percentages seen nationally; however, there are slight differences between age groups in Wisconsin versus the nation (Figure 52). Figure 51. Major depressive episode and serious suicidal thoughts in the past year, age 18 and older, Wisconsin and the U.S., 2013-2014 10% U.S. 8% Wisconsin 7% 7% 6% 4% 4% 4% 2% 0% Major Depressive Episode Past Year Suicidal Thoughts Past Year Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. 101 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Figure 52. Major depressive episode and serious suicidal thoughts in the past year, Wisconsin and the U.S. by age, 2013-2014 14% Major Depressive Episodes Suicidal Thoughts* 12.3% 12% 10% 12 to 17 years 11.0% 18 to 25 years 9.4% 9.0% 26+ years 7.6% 7.4% 8% 6.2% 6.3% 6% 4% 3.3% 3.3% 2% 0% U.S. Wisconsin U.S. Wisconsin Source: National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Note: Data not available for suicidal thoughts for the population age 12 to 17 years. 102 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 APPENDIX 1 Indicator Definitions Wisconsin Overview – Measure of Urban and Rural Counties The 2013 NCHS Urban-Rural Classification Scheme for Counties is a county-level scheme with six levels: four metropolitan (large central metro, large fringe metro, medium metro, and small metro) and two nonmetropolitan (metropolitan and noncore). Counties are assigned to one of these six levels based on: 1) their status under the February 2013 Office of Management and Budget's delineation of metropolitan statistical areas (MSA) and nonmetropolitan statistical areas, 2) the population size of MSAs, and 3) the location of principal city populations within the largest MSAs (1 million or more population). From the most urban to the most rural, the six levels of the 2013 NCHS scheme are defined according to the following classification rules: Metropolitan categories • Large central metro—Counties in MSAs of 1 million or more population that: 1) contain the entire population of the largest principal city of the MSA, or 2) have their entire population contained in the largest principal city of the MSA, or 3) contain at least 250,000 inhabitants of any principal city of the MSA. • Large fringe metro—Counties in MSAs of 1 million or more population that did not qualify as large central metro counties. • Medium metro—Counties in MSAs of populations of 250,000 to 999,999. • Small metro—Counties in MSAs of populations less than 250,000. Nonmetropolitan categories • Micropolitan—Counties in micropolitan statistical areas. • Noncore—Nonmetropolitan counties that did not qualify as metropolitan. Measures of Consequences Mortality • • Number of deaths—Numbers of cause-specific deaths were derived from Wisconsin and U.S. death certificate data. See Appendix 2 (“Mortality data” section) for details about the data source and methods. Age-adjusted mortality rate—Age-adjusted rates per 100,000 population were calculated using the direct method based on the year 2000 U.S. standard population. Motor Vehicle Deaths and Injuries Alcohol-related motor vehicle crashes are those in which at least one driver, pedestrian, or bicyclist was drinking before the crash. • Alcohol-related motor vehicle deaths—Deaths resulting from alcohol-related crashes that occur within 30 days of the crash. Includes drivers, passengers, pedestrians, and bicyclists. 103 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 • Note: Alcohol-related motor vehicle death data in this report come from two sources: the Fatality Analysis Reporting System (national and state-level deaths) and the Traffic Crash Facts report produced by the Wisconsin Department of Transportation (county-specific deaths). For more information about how the two sources compile total numbers of deaths, see Appendix 2, “Other Data Sources for this Report.” Alcohol-related motor vehicle injuries—Nonfatal injuries resulting from motor vehicle crashes where alcohol was determined to be a factor, including injuries to drivers, passengers, pedestrians, and bicyclists. Abuse or Dependence • • Alcohol and Drug Abuse—definition of abuse by the DSM-IV is one or more of the following in the same 12-month period: (1) Recurring use resulting in failure to fulfill important role obligations; (2) recurrent use in situations in which it is physically hazardous; (3) recurrent substance-related legal problems; and (4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. In addition, symptoms have never met criteria for dependence. Alcohol or Drug Dependence—definition of dependence by the DSM-IV is three or more of the following in the same 12-month period: (1) Tolerance; (2) withdrawal; 3) substance often taken in larger amounts or over a longer period than intended; (4) persistent desire or unsuccessful efforts to cut down or control substance use; (5) a great deal of time spent in activities necessary to obtain the substance, use it, or recover from its effects; (6) important social, occupational, or recreational activities given up or reduced because of substance use; (7) use continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance. For information about the incorporation of DSM-IV definitions of substance abuse and dependence into NSDUH measures, go to: http://www.samhsa.gov/data/sites/default/files/NSDUH-MethodSummDefs2014/NSDUHMethodSummDefs2014.htm Hospitalizations • • • Numbers of hospitalizations—The number of hospitalizations (hospital inpatient discharges) related to alcohol and the number related to use of other drugs. See Appendix 2, “Wisconsin inpatient hospitalization data” section, for details about the data source and methods. Each hospitalization is one inpatient stay. A person may have more than one stay in any time period. Wisconsin residents hospitalized in another state are not included. Some border counties will have rates significantly higher than those estimated here. Hospitalization rate—The rate of alcohol-related hospitalizations per 100,000 population, and the rate of other drug-related hospitalizations per 100,000 population. Hospital charges—Total hospital charges for alcohol-related hospitalizations, and total hospital charges for drug-related hospitalizations. Hospital charges are the total facility charges for the entire length of stay. Charges are not the same as the actual costs paid by any particular payer, which depend on negotiated discounts and other arrangements, and do not include physicians’ and other professional fees. Hospital charges in this report have been adjusted for inflation to 2014 dollars. 104 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Crime and Arrests • • Wisconsin and county—Crimes and arrests reported by Wisconsin law enforcement agencies using the Wisconsin Uniform Crime Reporting System to the Federal Bureau of Investigation (FBI) and the Wisconsin Office of Justice Assistance (OJA) Statistical Analysis Center. Crime rates per 100,000 population are defined and calculated as the number of crimes divided by population, multiplied by 100,000. These two sources provide rates per 100,000 population for reported index crimes (property offenses and violent offenses), plus numbers of arrests for index crimes and numbers of crimes/arrests for non-index crimes. U.S.—Crimes and arrests reported to the FBI by law enforcement agencies using the UCR System. School Suspensions and Expulsions Drug-related and alcohol-related suspension and expulsions from school are reported by school districts to the Individual Student Enrollment System (ISES). The number of incidents was obtained for each school district from its Wisconsin School District Performance Report. Incidents per 1,000 students are defined and calculated as the number of incidents divided by the count of enrolled student on the fall count date (third Friday of September), obtained from Wisconsin Information System for Education Data Dashboard (WISEdash), multiplied by 1,000. Although some school districts cross county lines, districts were reported within the county listed in WISEdash. Treatment The number of alcohol and other drug abuse clients in Wisconsin receiving publicly funded services and the total public funds expended for alcohol and other drug abuse treatment in the state were obtained from the Human Services Reporting System (HSRS) (through 2012) and Program Participation System (PPS) from 2013 to present, DCTS, DHS. No comparable U.S. data on public funds expenditures were available. Measures of Consumption: Alcohol Age of Initiation YRBS: The percentage of students who used alcohol ("more than a few sips") before age 13. Current Alcohol Use • YRBS: At least one drink of alcohol on one or more of the past 30 days. • BRFS: At least one drink of alcohol in the past 30 days. Binge Drinking • YRBS: Five or more drinks of alcohol in a row on one or more of the past 30 days. • BRFS: Five or more drinks on one occasion, one or more times in the past 30 days (both sexes, through 2005). As of 2006, the threshold for women was changed to four drinks on one occasion in the past 30 days. Heavy Use of Alcohol BRFS: More than two drinks per day for men and more than one drink per day for women. 105 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Per Capita Consumption of Alcohol The NIAAA reports data on per capita gallons of ethanol (pure alcohol) sold in a state, based on the population age 14 and older. Ethanol conversion coefficients (ECC)—the proportion of pure alcohol for each beverage type (beer, wine, and liquor)—and standard drink serving sizes were used to convert gallons of ethanol into the number of standard drinks. 1 gallon = 128 ounces (reported gallons * 128) = Number of standard drinks by type of alcohol. (standard drink size * EEC) EEC Beer: 0.045, Wine: 0.129, Spirits: 0.411 Standard drink size Beer: 12 ounces, Wine: 5 ounces, Spirits: 1.5 ounces Details about the methodology used to determine gallons of ethanol consumed per capita and EEC can be found at: http://pubs.niaaa.nih.gov/publications/surveillance104/CONS14.htm Underage Drinking NSDUH: Drinking among youth 12-20 years of age, with current drinking defined as alcohol use in the past month, and binge drinking as five or more drinks on at least one day in the past month. Measures of Consumption: Other Drugs Age of Initiation (Marijuana) YRBS: The percentage of high school students who tried marijuana for the first time before age 13. Current Use of Other Drugs • Current use of marijuana  NSDUH: Smoked marijuana in the last month.  YRBS: Used marijuana one or more times during the past 30 days. • Current use of illicit drugs other than marijuana  YRBS: Used any illicit drugs other than marijuana in the past 30 days.  NSDUH: Used any illicit drugs other than marijuana in the past month. • Current use of pain relievers for nonmedical purposes YRBS: Used pain relievers for nonmedical purposes in the past 30 days. Lifetime Use of Illicit Drugs • Lifetime use of marijuana YRBS: Ever used marijuana, one or more times. • Lifetime use of cocaine YRBS: Ever used any form of cocaine, one or more times. 106 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 • • • Lifetime use of inhalants YRBS: Ever “sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high,” one or more times. Lifetime use of heroin YRBS: Ever used heroin, one or more times. Lifetime use of methamphetamine YRBS: Ever used methamphetamines, one or more times. Past Year Use of Prescription Drugs for Nonmedical Purposes NSDUH: Used pain relievers for nonmedical purposes in the past year. Measures of Risk Factors Alcohol Outlet Density • Class A liquor licenses include all Class “A” beer (off-sale), Class A liquor (off-sale), and Class A beer/Class A liquor (includes wine) off-sale only. • Class B liquor licenses include all Class “B” beer only (on/off-sale), Class “B” Liquor only (winery), and “Class B” beer, and “Class B” liquor. 107 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 APPENDIX 2 Data Sources This report includes data from a variety of data sources. Descriptions of types and sources of data are provided below. Survey Data: Sample Sizes and Error The sample sizes in Table A1 below are for the whole state. Sample numbers for specific segments of the population, such as race/ethnicity groups, are smaller—in some instances much smaller—which reduces the precision and reliability of estimates. 27 In this report, the relative standard errors (RSE) of estimates were used to determine their reliability, and thus to determine whether or not the estimates should be reported. Where RSE was greater than 30 percent, estimates were not reported. 28 As indicators of reliability, sample size and RSE are typically consistent with each other; where they differ, we used RSE as the deciding factor. For estimates where RSE was within the acceptable range but the 95 percent confidence interval half-width was greater than 10 percent, a caution was added about data interpretation. Table A1 shows Wisconsin statewide sample sizes for the BRFS, the YRBS, the NSDUH, and the PRAMS. Details of each survey follow the table. Table A1. Survey data included in this report: Wisconsin sample sizes Survey BRFS* 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 4,503 4,900 8,532 7,435 7,075 4,553 4,781 5,302 5,299 6,589 7,045 6,188 2,389 YRBS** NSDUH* ** PRAMS 917 915 2,094 915 2,434 3,043 2,843 968 883 943 889 902 875 867 1,874 1,878 1,863 1,778 2,761 2,697 2,939 ** 945 * BRFS county estimates in the report are based on three-year aggregations of data (2005-2007, 2006-2008, and 2008-2010) and are weighted to represent county populations. ** 2015 Wisconsin YRBS weighted data missing due to limited data sample. The most recent Wisconsin weighted data from 2013 will continue to be used in the epidemiological profile until 2017 data is collected and made available. Moving forward, U.S. 2015 YRBS weighted data is included to display the national trend. *** NSDUH estimates in the report are based on two-year aggregations of data. See page 111 for NSDUH description of data. 27 As an example, the 2013 YRBS sample numbers for American Indian and Hispanic high school students are 37 and 69, respectively. Although the YRBS estimates by race/ethnicity used in the report are for two survey years combined, the total American Indian sample size for 2011 and 2013 is only 58. 28 RSE is the standard error of an estimate divided by the estimate itself, multiplied by 100. A RSE of 30 percent is the cut-off used by most federal health surveys for publishing estimates. 108 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Methodological Information about the Surveys Behavioral Risk Factor Survey (BRFS) www.cdc.gov/brfss and dhs.wisconsin.gov/stats/BRFS.htm The Wisconsin BRFS is a representative, statewide telephone survey of adults age 18 and older. The Wisconsin BRFS is part of the national BRFSS, a collaboration between the CDC and health departments in all states and U.S. territories. BRFSS is state-based and does not have a separate national sample. National BRFSS estimates are the medians (midpoints) of the distributions of state-level estimates. CDC weights BRFSS data by state to account for nonresponse and sample design, and to adjust for the demographic characteristics of state populations. Wisconsin county-specific BRFS estimates in this report were calculated using a three-year aggregated data file reweighted to represent each county's population. BRFSS now samples both landline and cellular telephone numbers in all states and territories. Estimates using combined landline and cell phone BRFSS data from 2011 and forward should not be directly compared to estimates from earlier years, due to both the addition of cell phone sampling and the implementation of a new weighting methodology. Trends identified before 2011 are assumed to be broken as of that year. BRFSS landline sampling and respondent selection excludes adults living in institutions or other group quarters. Cell phone interview protocol includes verification of the age of the informant/respondent (to include only adults ages 18+), and verification of type of residence. College students living in dormitories are eligible for the cell phone interview, although very few actually appear in the sample. BRFSS results are representative of the adult population with either a landline or cellular telephone, or both, and who reside in non-institutional settings. The CDC weights each state’s landline and cell phone data as one (combined) statelevel data file. Youth Risk Behavior Survey (YRBS) http://dpi.wi.gov/sspw/yrbs and https://nccd.cdc.gov/youthonline/App/Default.aspx The YRBSS, of which the Wisconsin’s YRBS is a part, is a school-based survey conducted among students in grades 9-12 in public high schools. The YRBS has both national and state samples. The state and national samples are separate, and in some cases, schools may be selected as part of both samples. The YRBS is conducted in odd-numbered years. The Wisconsin DPI oversees the administration of the Wisconsin YRBS. Sampling for state YRBS follows a two-stage cluster design. Schools are selected as clusters using probability proportional to size, and classes are randomly selected within schools from among required subjects or time periods. Sampling for the national YRBS is a three-stage procedure, with counties and groups of counties as the first stage. Wisconsin YRBS weighted data was not achieved for 2015 due to limited data sample. The most recent Wisconsin weighted data from 2013 will continue to be used in the epidemiological profile until 2017 data is collected and made available. Moving forward, U.S. 2015 YRBS weighted data is included to display the national trend. 109 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 National Survey on Drug Use and Health (NSDUH) nsduhweb.rti.org/ The NSDUH (formerly the National Household Survey on Drug Abuse) is a scientific, annual survey of the U.S. population age 12 and older, sponsored by SAMHSA in the U.S. Department of Health and Human Services (DHHS). NSDUH respondents include persons living in households, non-institutionalized group quarters (including shelters, rooming houses, college dormitories, migrant workers’ camps, and halfway houses), and civilians living on military bases. Interviews are conducted face-to-face at the respondent’s residence. The NSDUH uses small area estimation (SAE) to produce estimates for most states, including Wisconsin, as its state-level sample sizes are too small to produce direct estimates. The NSDUH state-level estimates of drunk and drugged driving are an exception and are direct estimates using four years of survey data. Additional information about NSDUH methodology can be found at http://www.samhsa.gov/data/population-data-nsduh/reports?tab=33 Pregnancy Risk Assessment Monitoring System (PRAMS) PRAMS, is an ongoing survey of new mothers conducted jointly by the CDC and state health departments. PRAMS asks new mothers about their experiences, social circumstances, risk behaviors, and health before, during, and shortly after pregnancy. Wisconsin began participating in PRAMS in 2007. As of 2016, PRAMS operates in 47 states, two major cities, one tribal health board jurisdiction, and Puerto Rico, and represents approximately 83 percent of all live births in the U.S. In Wisconsin, each month a stratified sample of approximately 235 mothers is randomly selected from recent Wisconsin birth certificates. An introductory letter is mailed to each woman in the sample two to four months after the baby’s birth. The PRAMS survey is mailed a few days later. A reminder letter as well as a second and third survey packet is sequentially mailed to mothers who do not respond. Mothers who do not respond to the mailings are telephoned to attempt to complete an interview. Some PRAMS questions are required by CDC and are common to all participating states, while other questions are selected by states to inform and evaluate current and emerging state and partner public health priorities, programs, and policies. Wisconsin PRAMS uses both English and Spanish mailed materials and conducts telephone interviews in both languages. The Wisconsin PRAMS Program is a collaboration between the Bureau of Community Health Promotion and Office of Health Informatics (OHI), Division of Public Health (DPH), DHS. More information is available at http://www.cdc.gov/prams/ and https://www.dhs.wisconsin.gov/stats/prams/index.htm. 110 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Other Data Sources for this Report Mortality Data Data on deaths of Wisconsin residents from alcoholic liver cirrhosis, alcohol-related causes other than cirrhosis and motor vehicle crashes, and drug-related causes were obtained by the OHI, DPH from Wisconsin resident death certificate files. U.S. data was obtained from CDC Wonder (http://wonder.cdc.gov/mortSQL.html). Data on alcohol-related crash deaths were obtained from the FARS (see below). Data on deaths from recreational vehicle crashes are from the DNR (http://dnr.wi.gov/). Estimating other alcohol-related mortality ICD-10 is the standard set of codes used to identify causes of death recorded on death and health records. http://www.who.int/classifications/icd/en/ The numbers of alcohol-related deaths from causes other than alcoholic liver cirrhosis and motor vehicle crashes were estimated from the Wisconsin mortality file using ARDI specifications from the National Center for Chronic Disease Prevention and Health Promotion (see https://nccd.cdc.gov/DPH_ARDI/default/default.aspx). These specifications define 54 conditions or groups of conditions and associate each with a distinct fraction of cases attributable to alcohol. Staff from OHI in the Division of Public Health used the ARDI specifications to identify deaths from these conditions with the ICD-10 codes specifying underlying causes of death. Alcohol-attributable deaths for specific causes were estimated by multiplying the number for each condition by the associated alcohol-attributable fraction. Total “other” alcohol-attributable deaths were estimated by summing over the conditions. A table showing the alcohol-related conditions, their ICD-10 codes, and the alcoholattributable mortality fraction for each is available by request from OHI (DHShealthstats@wisconsin.gov). Deaths from opioids (including heroin) Wisconsin opioid-related deaths were defined using the following ICD-10 codes: Heroin-related deaths Underlying cause of death equal to: X40-44, X60-64, X85, or Y10-14; AND contributing cause of death equal to: T40.1 (Poisoning by narcotics and psychodysleptics – Heroin). Opiate-related deaths Underlying cause of death equal to: X40-44, X60-64, X85, or Y10-Y14; AND contributing cause of death equal to: T40.2 (Poisoning by narcotics and psychodysleptics—Other opioids), T40.3 (Poisoning by narcotics and psychodysleptics—Methadone), or T40.4 (Poisoning by narcotics and psychodysleptics—Other synthetic narcotics). 111 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Fatality Analysis Reporting System (FARS) Mortality data on traffic crashes in Wisconsin and the U.S. is from the FARS, a comprehensive, national traffic fatality data system produced in conjunction with the National Highway Traffic Safety Administration (NHTSA). FARS incorporates data from multiple sources to arrive at the total number of deaths, by state, attributable to motor vehicle crashes, for both overall crashes and crashes where alcohol was a factor. FARS draws on the following sources of data: • Police accident reports (PARS) • State vehicle registration files • State driver licensing files • State highway department data • Vital statistics • Death certificates • Coroner/medical records • Emergency medical service reports For additional information about FARS, see: http://www.nhtsa.gov/FARS Wisconsin Inpatient Hospitalization Data Data on inpatient discharges are reported quarterly by all non-federal Wisconsin hospitals, as required by Wisconsin statute and rule. These data are extensively edited and corrected. Estimating alcohol-related hospitalizations ICD-9 is the 9th revision of the International Classification of Diseases system defined by the World Health Organization (WHO). The clinical modification (CM) of ICD-9, or ICD-9-CM, for use in hospitalization diagnosis coding, is defined by the U.S. Centers for Medicaid Services and updated annually. http://www.cdc.gov/nchs/icd/icd9cm.htm As was done for alcohol-related mortality, the numbers of alcohol-related hospitalizations were estimated from Wisconsin inpatient hospitalization data using ARDI specifications from the National Center for Chronic Disease Prevention and Health Promotion. (See https://nccd.cdc.gov/DPH_ARDI/default/default.aspx.) These specifications define 54 conditions or groups of conditions and associate each with a distinct fraction of cases attributable to alcohol. Staff from OHI used the ARDI specifications to identify hospitalizations for these conditions with the ICD-9-CM codes specifying the principal diagnosis and the first eight other reported diagnoses. Total alcohol-attributable hospitalizations were then estimated by multiplying the number for each condition by the associated alcohol-attributable fraction and summing over conditions. A table showing the alcohol-related conditions, their ICD-9-CM codes, and the alcoholattributable fraction for each is available by request from the Health Analytics Section of the OHI (DHShealthstats@wisconsin.gov). 112 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 Drug-related hospitalizations Drug-related hospitalizations were defined using the following ICD-9-CM codes: ICD-9-CM Code 292 304 357.6 E850-E858 E980.0-E980.5 Description Drug psychoses Drug dependence Polyneuropathy due to drugs Accidental poisoning by drugs, medicinal substances, and biologicals Poisoning by drugs and medicinal substances, unknown whether accidentally or purposefully inflicted A person may have more than one stay in any given time period. Wisconsin residents hospitalized in another state are not included. In OHI, hospital data system records for all Wisconsin residents hospitalized as inpatients in a Wisconsin hospital and discharged in the years shown in the tables were examined for the presence of the defined drug-related conditions in the ICD-9-CM principal diagnosis code or any of the first eight other diagnoses reported. NAS was defined using the following ICD-9-CM codes: ICD-9-CM Code 779.5 760.7 Description Drug withdrawal Noxious influences affecting fetus or newborn through placenta or breast milk Population Estimates, Statewide and by County OHI produces mid-year population estimates for the counties and state of Wisconsin by age groups, sex, race, and ethnicity for non-census years. These estimates are used to calculate population-based health statistics, including the rates in this report except those obtained directly from national sources. The population data used to calculate the rates in this report are available from the Wisconsin Interactive Statistics on Health (WISH) population module: http://dhs.wisconsin.gov/wish/main/wis_pop/wis_pop_home.htm Crimes and Arrests in Wisconsin https://wilenet.org/html/justice-programs/programs/justice-stats/library.htm Prepared annually by the Department of Justice (DOJ), Crime in Wisconsin and Arrests in Wisconsin (formerly a single report titled Crime and Arrests in Wisconsin) provide numbers of crimes and arrests among adults and juveniles at the state and county levels. Crimes are reported by local law enforcement agencies using the UCR System. These reports provided data from 2005-2012. Data from 2013 and after were retrieved using the Wisconsin UCR Data Dashboard Center, BJIA in the DOJ: http://www.doj.state.wi.us/dles/bjia/ucr-arrest-data. DOJ emphasizes sub-county-level crime rates, and in some instances shifts crime and population data from one county to another to provide more accurate information about citylevel crime. For example, the city of Appleton includes areas in three counties, Calumet, Winnebago, and Outagamie, and DOJ shifts crime and population data for the portions of Appleton lying in Calumet and Winnebago counties to Outagamie County in order to produce 113 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 one Appleton city rate. Calumet County is particularly affected by this practice, although all three counties are affected to some degree, and caution should be exercised in interpreting their rates. Crime in the U.S. (CIUS) https://ucr.fbi.gov/crime-in-the-u.s Produced annually by the FBI, U.S. Department of Justice, CIUS provides national and (some) state-level data on crimes and arrests. Data are transmitted to the FBI by state and local law enforcement agencies using the UCR System. School District Populations by County, Wisconsin WISEdash http://wisedash.dpi.wi.gov/Dashboard/portalHome.jsp DPI publishes data that it collects each year from all Wisconsin public schools based on federal and state requirements via a data portal called the WISEdash. While some school districts cross county lines, districts were reported within the county listed in WISEdash. Student enrollment by district was also obtained through WISEdash based on the fall count date (third Friday of September). Wisconsin District and School Performance Reports https://apps2.dpi.wi.gov/sdpr/spr.action Each year, DPI also provides public performance reports for all public schools and districts in Wisconsin covering topics such as achievement test results, attendance, high school completion, participation, staffing, finance, and discipline. Data about disciplinary removals and the incidents leading to those removals are reported to the ISES. Specific data regarding drug-related and alcohol-related suspensions are made available by school year and district through the annual performance reports. Wisconsin Traffic Crash Facts http://www.dot.wisconsin.gov/safety/motorist/crashfacts/ Wisconsin Traffic Crash Facts is produced annually by DOT and includes a separate sub-report on the role of alcohol in motor vehicle crash injuries and deaths. Injury and fatality data in the report are based on information provided to the state Division of Motor Vehicles (DMV) in reports submitted by police officers on the scene of crashes. The 2013 and 2014 Wisconsin Traffic Crash Facts reports were not available at the time this report was developed. Data were provided directly from BTS within DOT. 114 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 115 Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016 P-45718-16 (11/2016) 116