National Substance Use Survey Indicates Some Success for Early Intervention Among Teens

Results of the 1999 National Household Survey on Drug Abuse indicate that multimillion-dollar media campaigns by the federal government and private organizations and better communication between parents and children about the hazards of substance use may be having some success in reducing the use of illicit drugs and tobacco by teenagers in the age 12- to 17-year age group. Drug use in this group declined by 9 percent last year and 21 percent over the past two years, according to the survey. Cigarette smoking declined from 19.9 percent in 1997 to 15.9 percent last year.

The survey was based on a sample of 67,000 people from the civilian noninstitutional population age 12 and older—the largest sampling ever done for the annual survey. According to the survey, 9 percent of teenagers in the 12- to 17-year-age group reported past-month use of illicit drugs in 1999, compared with 11.4 percent in 1997. Current use of marijuana in this group declined even more, from 9.4 percent in 1997 to 7 percent in 1999, a 26 percent decrease.

In presenting the survey results at a press conference in late August, both Donna Shalala, Secretary of the Department of Health and Human Services, and Barry McCaffrey, national drug control policy director, said that they were extremely encouraged by the results for this group. However, they expressed concern about 18- to 25-year-olds (young adults), for whom the survey showed a significant increase in illicit drug use. Rates of drug use in this group are up 28 percent over the past two years, from 14.7 percent in 1997 to 18.8 percent in 1999. Marijuana use also rose 28 percent among young adults, from 12.8 percent in 1997 to 16.4 percent in 1999.

The survey results highlight the importance of drug use interventions among people in younger age groups, said McCaffrey. Nearly 9 percent of those who used marijuana for the first time at age 14 or younger used drugs as an adult, whereas just 1.7 percent of those who used it for the first time at age 18 or older used drugs as adults. As McCaffrey noted, "Plain and simple, the younger a person is when first trying marijuana, the greater the risk of drug dependency later. Young people may think they are experimenting, but, as this study shows, they are really gambling with their futures."

Increased illicit drug use among 18- to 25-year-olds was largely attributed to perceptions they formed about using illicit drugs and patterns of drug use established when they first began using, which was during the crack epidemic of the early 1990s.

The rate of alcohol use among youths 12 to 17 and in the general population has remained relatively flat for the past several years. According to 1999 national data, 19 percent of teens in the 12- to 17-year age group reported that they drank at least once in the past month, and 7.8 percent reported past-month binge drinking, defined as having five or more drinks on the same occasion.

Current use of alcohol was reported by almost half of all persons in the survey who were age 12 and older (47.3 percent), which translates into 105 million Americans. Approximately one-fifth of Americans age 12 and older—about 45 million people—reported binge drinking at least once in the 30 days before the survey. The highest prevalence of both binge drinking and heavy drinking—defined as five or more drinks on the same occasion on at least five different days in the past month—was found among young adults between the ages of 18 and 25; 38.3 percent reported binge drinking and 13.3 percent reported heavy drinking. An estimated 12.4 million Americans age 12 and over are heavy drinkers.

Although consumption of alcoholic beverages is illegal for those under 21 years of age, the survey found that 10.4 million respondents in the 12- to 20-year group reported alcohol use. The survey also found that for reported alcohol use in the past month, binge drinking, and heavy alcohol use, 21 is the peak age of prevalence.

Results of the 1999 survey showed that the prevalence of current drinking rose with increasing age, from 3.9 percent among youths age 12 to 66.6 percent for 21-year-olds. About 60 percent of persons in both the 21- to 25-year age group and the 26- to 29-year group reported current alcohol use. Alcohol use dropped slightly among persons in their 30s and 40s, to about 57 percent for 30- to 34-year-olds and 55 percent for those age 45 to 49. Past-month drinking was reported by 47.2 percent of persons in the 50- to 64-year-old group and 32.7 percent of persons age 65 and older.

The newly designed 1999 survey is interactive, bilingual, and computer based, and for the first time results are broken down for the 50 states and the District of Columbia. Prevalence for current illicit drug use ranged from a low of 4.7 percent in Virginia to a high of 10.7 percent in Alaska. Six of the ten states with the highest rates of current illicit drug use were in the western region. Eight of the ten states with the lowest rates were in the southern region.

However, considerable variation was found within the regions. Utah, a western state, had a relatively low rate of illicit drug use, 6.2 percent, and Delaware, a southern state, had one of the higher rates, at 8.5 percent. The range among states for illicit drug use among 12- to 17-year-olds ranged from 8 percent in Utah to 18.3 percent in Delaware.

The Summary of Findings From the 1999 National Household Survey on Drug Abuse is available on the Web site of the Substance Abuse and Mental Health Services Administration at www.samhsa.gov.

APA Board Approves Practice Guideline for the Treatment of Patients With HIV-AIDS

A practice guideline to help psychiatrists care for adults with HIV-AIDS was approved in July by the American Psychiatric Association's board of trustees. The guideline is based on a comprehensive review of the literature and represents a synthesis of current scientific knowledge and rational clinical practice.

The guideline was drafted by an APA work group of seven psychiatrists active in clinical practice chaired by J. Stephen McDaniel, M.D., of Atlanta. The work group was advised by a group of 15 consultants and APA area liaisons. Drafts were reviewed by 12 organizations and more than 60 individuals, whose comments are incorporated in the guideline.

The guideline is divided into two main parts—treatment recommendations and a review and synthesis of the available evidence. The treatment recommendations are coded on the basis of whether they are offered with substantial clinical confidence or moderate clinical confidence or whether they may be recommended in individual circumstances. The guideline states that "all psychiatrists need to have an adequate fund of knowledge about HIV-AIDS." Because scientific knowledge about HIV and AIDS advances rapidly, the addresses of several Web sites where clinicians can find updated information are provided both in the text and as an appendix.

The section on formulation of a treatment plan addresses care of patients at high risk of HIV infection and those who are already infected. Risk reduction strategies and postexposure prophylaxis are covered. Recommendations for the psychiatric management of HIV-positive persons include diagnosis and treatment of dementia and cognitive disorders, delirium, mood disorders, substance use disorders, anxiety disorders, psychotic disorders, adjustment disorders, and sleep disorders.

A section on the environmental and clinical features that affect treatment examines race-ethnicity, sexual orientation, gender, age, economic factors, and features of urban and rural settings. Suicidality, bereavement, axis II disorders, and psychoimmunology are addressed, as are alternative and complementary treatments, institutional settings, and stress-related problems among health and mental health care providers.

The guideline will be released as a supplement to the November issue of the American Journal of Psychiatry.

Three New Books Describe Promising Practices in Treatment of Children

The Center for Mental Health Services has released three volumes as part of its ongoing series called Systems of Care: Promising Practices in Children's Mental Health. Seven other volumes in the series were published last year.

The first volume in the new group, Cultural Strengths and Challenges in Implementing a System of Care Model in American Indian Communities, profiles five projects for American Indian children, who have been shown to have more serious mental health problems than children in other ethnic groups in the United States. The evaluation study, which used data from focus groups and key informants, including medicine men and women and community elders, identified 18 promising practices that address the integration of culture and tradition as a resource for helping children and their families.

The second volume in the group, Using Evaluation Data to Manage, Improve, Market, and Sustain Children's Services, was designed to help providers and evaluators of children's services translate the broad array of data typically collected in public-sector programs into clear and meaningful reports that can illustrate resources and gaps in their own programs while summarizing expenditures and outcomes. The report describes promising practices at children's programs in seven states. It focuses on how these programs have developed and sustain a supportive "evaluation culture" in which data are consistently collected and used. Specific examples illustrate how the collected data were critical to decision-making processes or brought about program and policy changes.

The third volume addresses how administrators can ensure fiscal survival for the interagency systems of community care promoted by federal law for children with serious emotional disturbance and their families. On the basis of conversations with site directors, policy makers, and others, For the Long Haul: Maintaining Systems of Care Beyond the Federal Investment documents the experiences of those who have secured state and local funds to sustain programs originally started with federal grants.

The three volumes can be ordered free of charge from the Center for Mental Health Services' Knowledge Exchange Network (KEN) by calling 800-789-2647. They can also be downloaded from the KEN Web site at www.mentalhealth.org.

News BriefS

New self-assessment tool for psychiatrists: The American Psychiatric Association has developed the Psychiatric Self-Assessment and Review (PSA-R) program to help psychiatrists test their understanding of treatment advances and improve their diagnostic skills. Program participants can earn up to 25 hours of continuing medical education (CME) credits by completing the examination.

The PSA-R packet includes an examination booklet with 125 multiple-choice questions and a syllabus that comes in both print form and on a CD-ROM. The questions were developed by an APA subcommittee with assistance from the National Board of Medical Examiners. The questions cover a range of DSM-IV disorders and treatments. The examination incorporates current developments in psychiatry, such as practice guidelines, and the newer classes of medications, such as atypical antipsychotics and selective serotonin reuptake inhibitors. After participants submit their answer sheets to APA for scoring, they receive a personal score report and a book in which the correct answers are explained. Participants can compare their scores with those of their peers.

APA has produced such self-examination tools for many years. What is now the PSA-R was known in the 1980s as the Psychiatric Knowledge and Skills Self-Assessment Program.

For more information, contact Kristen Moeller, CME program manager, at 202-682-6109; e-mail, kmoeller@ psych.org. The PSA-R can be ordered from American Psychiatric Press, Inc., by calling 800-368-5777.

Carter Center endowed chair in mental health: The Carter Center and Emory University's Rollins School of Public Health have established the Rosalynn Carter endowed chair in mental health to honor Mrs. Carter's lifelong commitment to mental health advocacy. According to Greg Fricchione, director of the Carter Center's mental health program, the person who assumes the chair "will have the rare ability to make major contributions that synthesize the public mental health implications of breakthroughs in promotion and prevention sciences, neurobiology, and genetics. The chair will be in a unique position to help set the 21st-century policy agenda in this very important area of public health." For more information, contact the Carter Center at 453 Freedom Parkway, Atlanta, Georgia 30307; phone, 404-331-3900; e-mail, carterweb@ emory.edu.

People and Places

Appointments: The American Psychiatric Association's board of trustees has appointed Francine Cournos, M.D., to the new board of the American Psychiatric Publishing Group (APPG). Dr. Cournos, who is director of the Washington Heights Community Service at the New York State Psychiatric Institute, has been a member of the editorial board of Psychiatric Services since 1993. APPG was formed when APA members voted earlier this year to reorganize the association. The group will bring together two of APA's publications—American Journal of Psychiatry and Psychiatric Services—and the American Psychiatric Press.

Eight directors were appointed to the APPG board. The other seven new board members are Glen O. Gabbard, M.D., Marc Galanter, M.D., Michael F. Myers, M.D., F.R.C.P.(C.), Carolyn Robinowitz, M.D., Donald J. Scherl, M.D., Nada Stotland, M.D., M.P.H., and Thomas N. Wise, M.D.

Deborah A. Zarin, M.D., a former deputy medical director of the American Psychiatric Association and director of APA's office of quality improvement and psychiatric services, has been named director of the technology assessment program of the federal Agency for Healthcare Research and Quality (formerly the Agency for Healthcare Policy and Research).

Award:Luther Robinson, M.D., a District of Columbia psychiatrist and associate professor emeritus at Howard University College of Medicine, is the recipient of the Meritorious Achievement Award of the National Medical Association (NMA). Dr. Robinson was honored at NMA's 2000 annual convention and scientific assembly in Washington, D.C., in mid-August. NMA, whose membership comprises more than 25,000 African-American physicians, honored Dr. Robinson, a life fellow of the American Psychiatric Association, for his pioneering efforts in developing mental health services for deaf persons.