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• Federal Fiscal Year 2008 Annual Synar Report
• The 2003 Hawaii Student Alcohol, Tobacco, and Other Drug Use Study (1987-2003), Ka Leo O Na Keiki, Hawaii Adolescent Prevention and Treatment Needs Assessment
• The 2002 Hawaii Student Alcohol, Tobacco, and Other Drug Use Study (1987-2002) Hawaii Adolescent Prevention and Treatment Needs Assessment - Executive Summary
• 2000 Hawaii Student Alcohol, Tobacco, and Other Drug Use Study (1987-2000), Ka Leo O Na Keiki, Hawaii Adolescent Prevention and Treatment Needs Assessment - Executive Summary
• 1998 Substance Abuse in Hawaii - Adult Population Household Survey
• 1998 Hawai`i Household Survey of Substance Abuse and Treatment Needs - Executive Summary
• 1998 Hawai`i Student Alcohol and Other Drug Use Survey
• 1996 Hawai`i Student Alcohol and Other Drug Use Survey
• 1996 Blind Study of Substance Abuse and Need for Treatment Among Women of Childbearing Age in Hawai`i
• 1995 Hawai`i Adult Household Survey of Substance Use and Treatment Needs

1995 Hawai'i Adult Household Survey of Substance Use and Treatment Needs

During 1994 to 1996, the Hawaii Department of Health, Alcohol and Drug Abuse Division (ADAD) conducted a family of substance abuse treatment needs assessment studies which were funded by the Center for Substance Abuse Treatment. The core of the family of studies was an adult household telephone study. This survey of 5,800 Hawaii residents provided information on the need for substance abuse treatment services for adults at the State and county levels.

To determine whether a person should be diagnosed as dependent on or abusing a particular substance, the diagnosis criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd revised edition (DSM-III-R), were used. A diagnosis of substance dependence requires meeting three of the nine DSM-III-R criteria and having some of the symptoms of disturbance that have persisted for at least one month, or have occurred repeatedly over time. The three criteria for dependence measure: 1) undesired excessive use, including resulting tolerance and withdrawal sickness; 2) problems in the critical realms of a person's life that are a result of excessive use; and 3) failed attempts to control substance use without help. A diagnosis for substance abuse requires that two criteria are met: 1) continued use despite having recurrent social, occupational, psychological or physical problems exacerbated by it; and 2) recurrent use in situations where it is physically hazardous. The following table provides estimates for combined diagnoses of abuse and dependence:

Need for Treatment: Estimates of Adult Dependence and Abuse

1996 Hawaii Student Alcohol and Other Drug Use Survey

In the spring of 1996, the State of Hawaii Department of Health, Alcohol and Drug Abuse Division, and the University of Hawaii Speech Department collaborated in a study designed to determine prevalence and trends in drug use, treatment needs, and related factors for public and participating private school students statewide. The survey was conducted among six, eighth, tenth, and twelfth graders in all the public schools and a quarter of the private schools in Hawaii. The sample included all students in these grades who received parental consent. Student participation was limited to students with parental consent, those who wanted to participate, and who attended school on the day of survey administration (N = 15,533). Surveys were administered to students by teachers using written administration and proctoring procedures during a regularly scheduled classroom meeting time. The 1996 Student Alcohol and Drug Use Survey assessed use through scales which utilized quantity-frequency measures for both alcohol and tobacco use. The scales included a six level scale for tobacco use and an alcohol use scale. In addition, DSM-III-R criteria focussing on problem behaviors associated with alcohol and drug use were incorporated into the instrument.

The key objectives pursued in this study were: 1) assessment of the need for substance abuse and dependence treatment; 2) development of an accurate picture of the current drug use situation among Hawaii adolescents in schools; 3) providing comparable data to that in previous Hawaii adolescent substance use surveys; and 4) development of data which facilitate prevention and intervention efforts, specifically the need for substance abuse treatment. This study represents a continued effort by the State of Hawaii to track trends in substance use by adolescents. It builds on studies conducted by the Hawaii Department of Education dating back to 1987, and will permit the development of comparable data for tracking trends in alcohol, illicit drugs, and tobacco use.

Findings:

Lifetime prevalence (which refers to any previous use) of illicit drug use and tobacco use have gradually increased since 1987, whereas any alcohol use has stabilized or decreased. Marijuana use is responsible for most of the increase in illicit drug use. All other illicit drug use has generally declined or increased very little since 1993. Since 1993, cigarette use has increased by approximately ten percentage points at each grade level with nearly twice as many sixth graders reporting lifetime use of cigarettes in 1996 as compared to 1993. Hawaii lifetime prevalence reports for tobacco, alcohol and illicit drugs are generally similar to or slightly lower than nationwide reports. Lifetime prevalence reports of inhalant and smokeless tobacco use are lower in Hawaii compared to the nation.

Illicit drug use in the past 30 days increased for all grade levels, with 26.3% of twelfth graders reporting the use of an illicit drug during the previous 30 days in 1996 compared to 19.7% in 1993. Nearly four times as many sixth graders and nearly twice as many eighth graders in 1996, compared to 1993, reported monthly use of at least one illicit drug. Thirty day prevalence rates for marijuana use show the greatest increase since 1993, increasing more than five percentage points at all grade levels (except sixth grade) in 1996.

From 1993 to 1996, more than a ten percentage point increase in monthly prevalence reports of alcohol use occurred at all grade levels. The monthly prevalence of alcohol use reported in 1996 is five times greater for sixth graders (increasing from 2.5% to 14.4%). Thirty-day use among eighth graders has doubled, increasing from 15.2% to 30.2% between 1993 and 1996. The monthly prevalence of cigarette use has increased at all grade levels among Hawaii students with the largest increases occurring in the sixth and eighth grades. Thirty-day prevalence rates of cigarette use for sixth graders went from 2.1% to 10.8% between 1993 and 1996. For eighth graders, levels of cigarette use during the last 30 days increased from 14.3% in 1993 to 25.5% in 1996.

Prevalence for use during the past 30 days for illicit drugs and alcohol are generally higher than the nation while cigarette use tends to be lower. In Hawaii, 26.3% of twelfth graders vs. 25.5% of those nationwide report using an illicit drug during the previous 30 days. For marijuana, 25% of Hawaii twelfth graders vs. 21.9% of those nationwide report using an illicit drug during the past 30 days. Thirty-day prevalence rates for cocaine use are higher among Hawaii twelfth graders (3.6%) compared to those of the nation (2.0%). Roughly twenty-six percent of Hawaii tenth graders report smoking cigarettes within the last 30 days compared to 30% nationwide. For twelfth graders, 28.9% of Hawaii youth vs. 34.0% of mainland youth report smoking in the last 30 days. More Hawaii eighth graders (25.5%) report smoking cigarettes within the last thirty days compared to the nation (21.0%). Thirty-day prevalence rates for the use of any alcohol are lower for Hawaii twelfth graders (46.3%) compared to the nation (50.8%). However, daily use of alcohol by Hawaii twelfth graders (4.7%) is slightly higher than nationwide (3.7%).

Diagnosis estimates for dependence and abuse indicate that over 3,000 youth statewide need treatment for alcohol abuse with an additional 2,227 needing treatment for drug abuse. Additionally, 3,160 youth require treatment for both alcohol and drug abuse, leading to a combined total of 8,426 students who have either an alcohol abuse problem, drug abuse problem or both. Treatment needs (by percentage of the population) for alcohol and/or drug abuse are highest in Hawaii County (13.9%), Maui County (12.8%), and in Kauai County (11.4%). Hawaii and Maui Counties have double the percentage of sixth and twelfth grade students needing substance abuse treatment compared to Kauai County or the City and County of Honolulu.

Estimated Need* For Adolsecent (Grades 6-12) Alcohol and Drug Abuse Treatment

Less than one-third of the students with treatment needs have utilized treatment facilities. The majority of the students who reported they needed help for an alcohol, tobacco, or other drug-use problem also reported that they had difficulty seeking help. For all grades, the four most common reasons reported for not seeking help were having no idea where to go for help, students thinking they could solve the problem themselves, students fearing that teachers or parents would find out, and being afraid that they would get in trouble with the law, or both.

1996 Blind Study of Substance Abuse and Need for Treatment Among Women of Childbearing Age in Hawaii

Recent evidence shows that prenatal substance exposure can be extremely harmful, resulting in problems such as low birth weight, developmental problems and abnormalities, premature birth, and health-related disorders. Most research focuses on problems resulting from heavy, long-term use of substances such as alcohol and crack cocaine and the complications related to this use, or the causal link between tobacco use and low birth weight. However, short-term and occasional use may also cause birth complications and congenital defects and may provide indications of an unhealthy lifestyle that can have negative effects on the health and development of infants and children. All of these problems can have lasting social and economic consequences on a family and the population as a whole. The cost of care for a premature infant or a child with developmental abnormalities, and the emotional costs on a parent raising such a child, are all preventable. It is cost-beneficial to learn more about this population and prevent further problems from developing.

The Alcohol and Drug Abuse Division (ADAD) developed a study of women of childbearing age in the State of Hawaii. Women from public and private pregnancy clinics throughout the State participated in the study and were asked to provide anonymous, confidential information about their drug and alcohol use, the frequency of their use of substances, their treatment history for substances, characteristics of their use, and the frequency of their husband's or male friend's drug and alcohol use. The survey instrument also collected information on the socioeconomic characteristics of the population surveyed so that ADAD would be able to use state resources more efficiently by directing services and information to the women who demonstrate higher levels of use.

Participants in the study were asked to complete a 6-part survey instrument which asked questions about:

1. Ever use of and addiction to substances. Questions regarding the ever use of 10 substances and a question regarding the ever use of drugs with a needle. For drugs that respondents reported using, the age at first use was asked. Respondents were also asked if they had ever been dependent on or addicted to each of 10 substances, and if they were currently dependent on or addicted to: alcohol, tobacco, marijuana/hash, cocaine/crack, methamphetamine, heroin/methadone/opiates, sedatives, tranquilizers, inhalants, and hallucinogens.
2. Frequency of use of substances. Questions regarding how frequently the women had used the 10 substances identified in question 1. Options for responses were: none in the past year, about once a year, about once every 3 months, about once a month, every few weeks, about once a week, every few days, or every day.
3. Treatment history. Questions concerning past treatment for alcohol, heroin, cocaine/crack, methamphetamine and other drugs. For these drugs, respondents were asked about whether they had ever received treatment, if they could currently use treatment for any of these substances, and if they would enter treatment if it were affordable or available to them.
4. Characteristics of use. Questions related to psychiatric diagnosis criteria (DSM-III-R) for abuse and dependence on substances. These questions were asked for alcohol, tobacco, marijuana, and other drugs.
5. Frequency of use by husband or male friend. Questions about the frequency of use of the respondent's husband or female friend using the same questions and substances that the women responded to for themselves in question 2.
6. Sociodemographic information. Questions about age, highest level of education, race, health insurance, income, whether the respondent was currently trying to get pregnant.
   

Blind urinalysis. Surveys were precoded with a number that was also affixed to a sample of the respondent's urine specimen that was sent to a laboratory for drug testing. After each specimen had been tested for the medical purpose for which it was provided, the remainder of the specimen was tested for the presence of a variety of drugs.

Drug Screen Results: Results of toxicology tests for major illicit drugs indicate rates of drug use among pregnant and non-pregnant women receiving reproductive services (pregnancy tests) are similar:

Urine Test Results for Study Respondents, by Pregnancy Status and County *

Ever use of substances

To determine how widely used various substances are in the clinic population, we analyzed the proportion of women in the total sample who reported ever using any of the 10 substances asked about on the survey. The information presented here shows the proportions of women reporting ever use of the five most commonly used substances in the sample.

Of the ten substances on the survey, women reported using alcohol, tobacco, marijuana, cocaine/crack, and methamphetamine in the greatest numbers. Injection drug use was lower than ever use of all drugs.

• 84.5% of the total sample reported ever using alcohol. The proportions of women who had used alcohol across counties ranged from 80.5% in Kauai County to 86.9% in Hawaii County.
• 67.2% of the total sample reported ever using tobacco. The proportions range from 76.3% in Hawaii County to 59.3% in Honolulu County.
• 54.9% of the women survey reported ever using marijuana, with the counties that had the highest reports of ever use being Maui and Hawaii Counties (61.9% and 61.5%).
• Almost 23% of the total sample reported ever using cocaine or crack. County differences ranged from 30.1% in Maui County to 16.2% in Honolulu County.
• Just over 18% of the women in the sample reported ever use of methamphetamine. Cross county differences were large, with 8.5% of the women in Kauai County and 23.9% of the women in Maui County reporting use.
• Only 2.3% of the sample reported ever injecting drugs, indicating that injection drug use may not be as critical a problem as use of other drugs among women in this sample.

Extent of use of substances

To better understand how the use of substances may be affecting the lives of the women in the sample, it is important to look at two categories of reported use: how often one uses substances and DSM-III-R diagnosis characteristics. To determine what proportion of women in the sample may have a problem with certain substances, the sample was analyzed for the proportion of women who report using a particular substance at least once a week in the past year. (For the purposes of this analysis, women who use both drugs and alcohol but only use alcohol at least once a week are included in the category, "Alcohol Only at Least Once a Week," and women who use only drugs at least once a week are included in the category, "Drugs Only at Least Once a Week"). When broken down by women who report using alcohol only at least once a week, and both drugs and alcohol at least once a week, the data show that for the total sample:

• 7.5% or 73 of the women reported using both alcohol and drugs at least once a week in the past year. Almost 10% of these women were under age 18, while another 9.0% were between ages 18 and 24.
  
• 5.9% or 57 of the women reported using drugs only at least once a week. Broken down by age, women under 18 had the largest proportion of women (9.3% or 15 women) who reported using drugs only at least once a week. Caucasian women (7.9% or 21 women) made up the highest proportion reporting the use of drugs only at least once a week.
  
• 18.3% or 178 of the women reported using alcohol only at least once a week. Broken down by age, the largest proportion of women in any age group (29.5% or 18 women) reporting use of alcohol only at least once a week were those in the 35 and older group.
  

Further analysis of drug use shows that the drugs women reported using at least once a week were marijuana, cocaine or crack, methamphetamine, sedatives, tranquilizers, and hallucinogens. None of the women reported using heroin or inhalants at least once a week. If tobacco had been included in this analysis, the proportion of women who reported using a drug at least once a week would have been much higher since 63.8% of the women who reported ever using tobacco reported such use at least once a week.

Other patterns of alcohol and drug use were reported by women as follows:

For alcohol use:

• 23.8% of the women who reported using alcohol said that they had use it in larger amounts than they had intended to in the past year.
• 7.2% of the women who reported using alcohol used it for longer periods of time than they had intended to in the past year, and 4.3% reported spending a lot of time getting over its effects.
• 8.6% of the women who reported using alcohol said that they missed work or school or were unable to do their daily chores in the past year, while 4.7% of the women who used alcohol in the past year said they had faced problems with family, friends, work, school, or police because of their alcohol use.

Further analysis showed that reports of having these characteristics of alcohol use were as prevalent in the under-18 group as in the other age groups. This indicates that alcohol use, if not more prevalent, may be problematic among these young women. Further analysis found that these relationships did not differ significantly across counties.

For tobacco use:

• 29.5% of the women who reported using tobacco (n=193) said that they use larger amounts of tobacco than intended in the past year, and 28.7% of the women who used tobacco said they used tobacco for longer periods than intended in the past year.
• 29.5% of the women who reported using tobacco said that they tried, but were unable to cut down on their tobacco use.
• 9.0% of the women who reported using tobacco said that they spent a lot of time getting over its effects, while 6.1% said that they felt sick because they had cut down or stopped using tobacco.

Further analysis showed that reports of these characteristics of use were high among women in the under-18 age group. When compared to the other age groups, almost all of the characteristics were significantly higher for the under-18 group. Tobacco use among these young women may be problematic and could have future impacts on increases in low birthweight infants.

For marijuana use:

• 13.3% of the women who reported using marijuana said that they had used larger amounts of marijuana than intended in the past year.
• 8.2% of the women who reported using marijuana said that they had missed work or school or were unable to do their daily chores in the past year because of their marijuana use.
• 8.1% of the women who reported using marijuana said they had use marijuana for longer periods of time than they had intended to in the past year.
• 7.1% of the women who reported using marijuana said that they had to use more to get the desired effect in the past year while 5.6% reported that they had used marijuana to get over hangover/withdrawal symptoms or to keep from getting sick in the past year.

Again, further analysis shows that reports of these characteristics of use for women under the age of 18 were as high or higher than the reports of use by women 18 years of age or older. All of these relationships were found to be statistically significant among the youngest group of women, indicating that use and abuse of marijuana may be a problem among these women and could have severe lifetime consequences. Most of these relationships were not found to be statistically significant across counties. Findings are reported in the following table:

Use Characteristics of Women Meeting Dependency Criteria by County

Hawaii Department of Health
Alcohol and Drug Abuse Division
601 Kamokila Blvd. Room 360
Kapolei, Hawai'i, 96707
(808) 692-7506