One More For the Rhode

highest rate of drug-use, lowest of needs-meeting treatment

by by Erin Schikowski

In May, the US Department of Health and Human Services (DHHS) published a study on drug use across the states. Based on 2006-2007 National Surveys on Drug Use and Health, the May report compares the percentages of persons 12 and older using illicit drugs—defined as marijuana, cocaine, crack, heroin, hallucinogenic substances, inhalants, and prescription psychotherapeutics used for nonmedical purposes—from state to state. Rhode Island led the pack at 12.5 percent, with Iowa boasting the lowest incidence at 5.2 percent.

In August, a brief New York Times article titled “State-by-State Drug Use (Or, Rhode Island Needs More Rehab)” conspicuously drew attention to Rhode Island’s status as the heaviest illicit drug-using state in the country. According to the DHHS report, Rhode Island has the highest percentage of people “needing but not receiving treatment for an illicit drug use problem,” and the data indicates that young Rhode Islanders are particularly in need of treatment not received. In this category, Rhode Island sits at the top of the list in the age categories of 12-17 and 18-25. In this last age bracket, a lamentable 12.1 percent need and fail to receive treatment.

No, no, no
It seems reasonable to wonder whether Rhode Island’s high rate of drug abuse is related to its size or population density. According to the 2000 US census, the state had the second-highest population density per square mile, after New Jersey, as of that time, over 90 percent of Rhode Islanders were living in an urban area.

In Rhode Island, the state Department of Mental Health, Retardation & Hospitals (DMHRH) division of Substance Abuse Treatment Services (SATS) is responsible for “planning, coordinating and administrating a comprehensive statewide system of substance abuse, treatment, and prevention activities.” Last year, Rebecca Boss served as the administrator of SATS and currently works as supervisor of program services and licensing for both SATS and the Mental Health and Developmental Disabilities division, all of which falls under the DMHRH.

In explaining why Rhode Island might be the heaviest illicit drug-using state in the nation, she said, “Rhode Island is really a city-state; because it’s so small, none of it is really considered to be rural. It would be better to compare Rhode Island to, say, Philadelphia or Los Angeles because the makeup of the economy has more to do with a city-state structure than, for example, a Montana—which has a lot of rural communities.”

Boss also pointed to several cultural factors that might make Rhode Islanders more likely to use substances and less likely to receive the treatment they need. She explained that in urban areas, and especially in the Northeast, people are less likely to meddle in their friends’ and neighbors’ affairs. She said, “It’s not real warm, you don’t get southern hospitality up here. Everybody minds their own business—‘don’t ask don’t tell.’ So whereas an intervention might have occurred say, at a doctor’s office or at a neighbor’s, here in the Northeast people are a little more hesitant to ask personal questions or intervene in that way.” She also explained that unlike Utah—which is home to the largest Mormon population and has only about six percent of people 12 and over using illicit drugs—Rhode Island lacks “any kind of strong cultural influence where alcohol or drug use is really prohibited.”

Boss also suggested the high number of colleges and universities as a possible factor behind the data for needing but not receiving treatment. In both the US Census and the SAMHSA study, college students are considered residents of the state in which they attend school; this means Rhode Island college students were factored in to the SAMHSA data.

In many ways, Boss explained, the college-age population is a hard one to reach for intervention. She explained that many adults don’t end up seeking treatment until they’ve met serious consequences of their substance abuse, and many college students simply haven’t reached that stage. “Until you’ve wrapped your car around a telephone pole,” she said, “or had some other social consequences of your substance use, you’re not likely to want to seek help. It’s also an age group that doesn’t generally have health insurance; that could affect it too.”

Amongst Rhode Island colleges and universities, student insurance plans vary. Brown, for example, requires that every student have health care, and the university’s Student Health Insurance Plan provides some treatment for substance abuse—including inpatient hospitalization, partial hospitalization, and intensive outpatient services.

Turned inside-out
In her Cranston office, Boss’s window faces out onto one of the state’s medium security prisons. A light grey-colored building with thin windows ringed in red brick, the prison is a prominent feature of the state department grounds; employees see it every day. Boss estimates that between 60 and 80 percent of Rhode Island inmates are dealing with substance abuse issues.

In between periodic glances out over the prison grounds, Boss explained that the Access to Recovery (ATR) grant Rhode Island received last year has been immensely beneficial for inmates dealing with substance abuse. The ATR is a federal grant awarded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the same group that came out with the May report on state-by-state substance use. The grant gives Rhode Island $8.3 million over three years to provide clients with six-month treatment.

The SAMHSA website explicitly specifies that one of the ATR’s targeted treatment recipients is newly released inmates from the state’s Adult Correctional Institution. According to the US Bureau of Justice Statistics for 2003, Rhode Island also had the highest percentage of its adult population on probation, at about 3.1 percent. Boss says the focus on treating inmates and newly-released offenders is relatively new, and that the Rhode Island Department of Corrections has been especially forward thinking in this respect. Prison facilities in Rhode Island offer a three-tiered treatment program consisting of modified therapeutic communities, intense day treatment, and weekly outpatient sessions—funded largely in part by the ATR grant.

Boss looks at what an ATR grant did for Connecticut, which it received in 2006 and used to improve the state’s treatment apparatus. She hopes the data for Rhode Island will improve in the coming years once the ATR grant money has been put to similar uses here.

Seeing God’s face in RI
Boss pointed to one specific area where the state could be doing a better job: opioid abuse. She explained, “Heroin abuse is a very big problem in Rhode Island, along with the increase in the use of prescription drugs—particularly pain relieving drugs like Vicodin, Percodan, and Oxycontin.” According to numbers from the DHHS Treatment Episode Data Set, in 2007 approximately 20 percent of Rhode Islanders admitted to treatment for substance abuse were seeking help with a heroin problem. Boss added, “There are two drugs that are very effective in treating opioid dependence: Methadone and Suboxone. Neither one of those is adequately funded to deal with the heroin problem.”

Treating problems like depression and psychological stress that tend to accompany heroin use is particularly important. Data compiled by the Arbour Counseling Services reveals that in Rhode Island, 39 percent of adults served via the state mental health authority had a co-occuring mental health and alcohol-or-other-drug-related disorder. Perhaps owing in part to the poor economy and high rate of unemployment, the DHHS data showed that more than 13 percent of Rhode Islanders aged 12 and older experienced “serious psychological distress” within the past year, placing the Ocean State fifth in the nation behind West Virginia, Utah, Missouri, and Kansas.

The prison demographic isn’t the only group that’s had a history of difficulty obtaining treatment, though. Oftentimes the cost of treatment is one of the largest obstacles preventing people from seeking help. Boss said that earlier this year, employees from the DMHRH visited the Providence tent city Camp Runamuck and offered treatment covered by the ATR grant. “We had one person go to detox who was able to access treatment through the ATR grant,” said Boss, “but other people there declined. That’s part of it too, those who need treatment but aren’t receiving it—that doesn’t necessarily mean that they want treatment and aren’t receiving it.”

It is unclear exactly what the parenthetical “Or, Rhode Island Needs More Rehab” piece of the Times article title actually meant to suggest. The state has a total of 54 treatment facilities, about 70 percent of which are private non-profits—so the treatment infrastructure is there. Although Rhode Island does have a high rate of illicit drug use, Brown University associate professor of political science Peter Andreas warns that these numbers are rough guesstimates at best. He said in an email interview that, “Getting accurate statistics on drugs is notoriously problematic. Rhode Island appears to lead the list by a small margin in some of these numerical categories, but is by no means an extreme outlier.”

Rhode Island’s status as the heaviest illicit drug-using state is the result of various complicated factors, not the least of which is its size and similarity to a “city-state,” as Boss put it. Unfortunately, the SAMHSA data did not list the number of people needing and receiving treatment. Without this data, it is difficult to paint a portrait of the state’s effectiveness in providing treatment to those who need it.

ERIN SCHIKOWSKI B’11 did not inhale.