1. High-risk Drinking Among Youth (12-17):

What are the consequences of high-risk drinking among youth in your county?

There is a higher than average involvement with the juvenile justice system as a direct result of alcohol violations and other associated criminal conduct. We note the predictive nature of this type of drinking and the resultant adult substance abuse problems. There has been a lower commitment to school and lower academic achievement experienced by our students. The number of students reporting that they were drunk or high at school is higher than the state average as is the rate of feeling unsafe at school. Analysis of the 2006 MYDAUS results places our students 2nd in the state for the Risk Factor Rebelliousness.

In your county, is there a connection between the following intervening variables and the consumption of alcohol or the consequences of high-risk drinking? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	Based on survey results, adults think that law enforcement do a good job of enforcing the underage drinking laws; in contrast youth don't agree that there is a likelihood that they will be caught in possession.
A recent compliance check sweep contracted through the Sheriff's Office and conducted at retail alcohol sellers revealed the highest rate of compliance in the state. A comparison of 2004 and 2006 MYDAUS results indicated that students believed that alcohol has become harder to get. The reported drinking rate has declined from 2004 to 2006	
Retail access 	Survey results from adults indicate that many adults think that retailers are careful about selling to minors but a larger number were unsure. Recently completed compliance checks confirm that businesses are acting responsibly. Many adults have concerns about marketing, promotion and product placement at stores according to survey and Focus Group responses.	
Social access 	Adult survey responses indicate that 97% of respondents felt that youth "sometimes" or "always" have access to alcohol at unsupervised parties and 86% felt that youth "sometimes" had access at supervised parties.
Most of Jail inmates interviewed reported that they first obtained alcohol from an older friend or relative. On the 2006 MYDAUS nearly 60% of Waldo County 10th, 11th, and 12th grade students said that if they were offered a drink at a party "they would just drink it". 	
Promotion 	Survey responses indicated that 85% of respondents felt that youth were "sometimes" (52%) or "always" (33%) influenced by advertising and marketing practices	
Perceived risk of harm of use	Survey responses indicated that 66% of respondents felt that youth were "rarely" influenced by the perception of harm from drinking. Results for high school students completing the 2006 MYDAUS revealed that the majority of students perceived tobacco as having the greatest risk of harm followed by regular use of marijuana. Occasional marijuana use and alcohol use were considered to represent a lower level of risk. Interviews with Waldo County Jail inmates disclosed the belief that they thought they could control their substance use and that had they known the risks of addiction that they might never have started. 	
Community norms 	A high level of adult use of alcohol and other substances and ineffective messages by parents apparently results in a MYDAUS finding that our communities present a high risk of Laws and Norms Favorable to Drugs. This perception is confirmed by the opinions of community leaders in surveys and Focus Group discussion.	
Family norms	Survey responses from adults revealed the belief that while 59% of parents send a clear message that drinking is dangerous, 18% rarely communicate this message. Focus Group discussion was stronger in expressing concerns about lack of parental monitoring of youth behavior and worse, role-modeling substance use. Discussion also identified family problems including violence and divorce, busy schedules, and stressed single parent families as contributing to the problem. 	

1.	High-risk Drinking Among Young Adults (18-29):

What are the consequences of high-risk drinking among young adults in your county?

Our Deputy District Attorney and Sheriff have reported that roughly 2/3 of people involved in criminal activity are under the influence of alcohol, even though an alcohol violation may not have been charged. According to Maine's Treatment Data System, among 18 to 29 year olds, alcohol was identified by 48.2% of patients as their primary drug. Of the whole population
of treatment admissions, 88% reported their age of first use of alcohol between 11 and 18 years of age. The 18 - 29 age group made up 29% of those admitted for alcohol treatment.  Lack of availability of mental health treatment options is seen to exacerbate the substance abuse problem as people are seen to "self-medicate".

In your county, is there a connection between the following intervening variables and the consumption of alcohol or the consequences of high-risk drinking? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	The Waldo County Sheriff's Office and Belfast Police Department adopted the Model Enforcement Policy developed by the AG's Office and the Criminal Justice Academy and trained their staffs. Violation citations have gone up. Most of our county is very rural with few police patrols. Enforcement is more difficult. The Sheriff's Office has contracted out to perform alcohol retailer compliance checks and the Belfast Police Department is conducting compliance checks of licensed bars and restaurants.     	
Retail access 	There are 103 alcohol licensees in our county and only 6 of the smallest communities have no retail outlet. In addition to beer and wine sales, most of the communites have agency stores where distilled spirits are available. From focus group discussion,there is a perception that clerks at these stores may have low skills, inadequate training and high turnover resulting in some increased violations of underage sales and sales to intoxicated persons. In adult surveys, 64.7% of respondents felt that it was "always easy" to buy alcohol in their community.	
Social access 	Young people report in surveys and focus groups that "there is nothing to do" and so they use substances.  Opinions expressed in surveys and focus groups suggest that young people engaged in building trades and other industries are influenced by older adults in the use of alcohol and other substances. Starter level jobs for young people in the service sector bring them into contact with young adults who may influence and support alcohol and other substance use.	
Promotion 	Survey responses indicated that 85% of respondents felt that youth were "sometimes" (52%) or "always" (33%) influenced by advertising and marketing practices. Product placement in stores and advertising campaigns that are tied to athletic events were seen by Focus Group participants to promote over-consumption. While most of our county does not have bars, Belfast has some competition between bars to lure young adults with music, and pricing specials.	
Perceived risk of harm of use	While we don't have sufficient data on this issue for this age group, there appears to be a connection with the early intitation of aclohol use and later young adult behavior. The social norm appears to support use.
There are insufficient messages about the risk to health or other consequences and the abusive patterns may already be set.	
Community norms 	Early intiation rates for the use of alcohol help establish a pattern of drinking. Young people report in surveys and focus groups that "there is nothing to do" and so they use substances. High levels of alcohol use by older adults sets and reinforces the norm. There is a perception that there is a "drinking culture" in our county that provides poor role-modeling for young adults. Jail inmate interviewees expressed that they may have been deterred from a pattern of substance abuse had they felt more a part of a community. Alcohol and drug use initiation was described as an effort to appear more mature. 	
Family norms	As with younger drinkers, young adults appear to be influenced by family patterns and may have genetic susceptibility to alcohol addiction.
Focus Group participants reflected on the role-modeling of parents or parent figures as a contributing factor.	

2.	
High-risk Drinking Among Other Adults (30 and over):

What are the consequences of high-risk drinking among other adults in your county?

Our Deputy District Attorney and Sheriff report that alcohol is involved in more than 2/3 of the criminal conduct in our county even though an alcohol violation may not be charged. Hospitilizations for acute alcohol disorders are 70% higher in Knox and Waldo counties compared to the rest of Maine. Alcohol related deaths in men are 30% higher in this region than the rest of the state. (Eastern Maine Healthcare Health Planning Report - 2002)

In your county, is there a connection between the following intervening variables and the consumption of alcohol or the consequences of high-risk drinking? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	Survey respondents quantified the  problem of adult drinking; 38% said adult drinking was "serious" and 53% said it was "very serious". While 56% of adult survey respondents answered that law enforcers "sometimes" enforce alcohol violations, 27% said they were not sure.	
Retail access 	82% of survey respondents said that it was "sometimes' or "always" easy for adults to obtain alcohol in their community.	
Social access 	88% of survey respondents stated that adults "sometimes" (85%) or "always" (3%) needed to have alcohol at a party to "have a good time"	
Promotion 	While 71% of survey respondents felt that adults are "sometimes" (56%) or "always" (15%) influenced by the way media portrays drinking, 27% felt that adults are "rarely influenced by media portrayals.	
Perceived risk of harm of use	73% of survey respondents felt that adults only "sometimes" understand the consequences of alcohol use. Data shows that more than 50% of Waldo County adults participated in binge drinking in the 12 months prior to the survey in 2004.	
Community norms 	47% of survey respondents felt that the community "rarely" sends a clear message that high risk drinking is dangerous.	
Family norms	Focus group discussion and survey responses highlighted the opinion that in many ways, norms and traditions were the leading contributor to substance abuse problems with adult role modeling and lack of parental monitoring being of primary concern.   	

3.	
Marijuana Use Among Youth (12-17):

What are the consequences of marijuana use among youth in your county?

According to the Maine Treatment Data Systems report, 100% of Waldo County residents seeking treatment for marijuana use began using the drug prior to age 18. Inmate interviews at the Waldo County Jail disclosed that 55% had used marijuana for the first time between the ages of 12 and 15. 50% of those 12 to 17 seeking treatment reported marijuana as their primary drug. Of all those seeking treatment for marijuana, 22% were between 12 and 17.   2006 MYDAUS results demonstrate a higher than State average consumption of marijuana by high school students.

In your county, is there a connection between the following intervening variables and the consumption of marijuana or the consequences of its use? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	64% of survey respondents indicated that people believed that enforcement of marijuana laws "sometimes" or "always" occurred. Law enforcement officers interviewed said that they were now more likely to find youth in possession of prescription drugs than marijuana.	
Retail access 	87% of adult survey respondents felt that it was "sometimes" (42%) or "always" (45%) easy to buy marijuana in their community. According to 2006 MYDAUS data, youth reported a continued downward trend in use and when compared with 2004 reported that marijuana was harder to get, although 43% still  reported that it was "very easy" to get.	
Social access 	24% of adult survey respondents reported that they believed it was "always" possible and 69% said that it was "sometimes" possible to get marijuana at unsupervised youth parties. Supervised parties were seen as being less likely to include marijauna. Interviews with Waldo County Jail inmates revealed that all in the study group had previously used marijuana, 55% had first used between the ages of 12 and 15 and the most frequent source was friends and peers. 	
Promotion 	The majority of adult survey respondents were "not sure" about the impact of media on marijuana use, but 30% felt that media "sometimes" promoted use and 13% felt that media "always" promoted marijuana use by youth.	
Perceived risk of harm of use	According to 2006 MYDAUS results, the use of cigarettes is considered by youth to represent a greater health risk than the regular use of marijuana. Jail inmate interviews revealed that some young people feel that if they had truly understood the risks of use they would not have used. 53.3% of adult survey respondents felt that youth "rarely" understand the risks of marijuana use.	
Community norms 	Adult use of marijuana in Waldo County is about 4% based on the General Population survey.  Waldo County Jail inmates interviewed told us that some had obtained marijuana first from parents or friend's parents. Inmates also told us that their drug use was influenced by a lack of connection to the community. They suggested that they were likely to use in order to appear more mature.  	
Family norms	Interviews with Waldo County Jail inmates disclosed that many had initially obtained marijuana from parents or other family members. Focus Group discussion regarding parental behaviors and monitoring practices indicated the opinion that adult role-modeling and lack of parental monitoring are of concern. 2006 MYDAUS results indicate that parental attitudes favorable to antisocial behavior are a common risk factor among the grades surveyed.	
4.	
Marijuana Use Among Young Adults (18-29):

What are the consequences of marijuana use among young adults in your county?

According to the Maine Treatment Data System18.7%  of county  residents aged 18 - 29 who sought treatment last year reported that their drug of choice was marijuana. Of all those seeking treatment from Waldo County, 52% were in the 18 to 29 age group. All of the inmates who participated in interviews at the Waldo County Jail reported using marijuana previously. 

In your county, is there a connection between the following intervening variables and the consumption of marijuana or the consequences of its use? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	Law enforcement officers have told us that they are less likely to find marijuana in vehicle searches now than to find prescription drugs. Adult survey responses reflect the belief that law enforcement is enforcing the laws.	
Retail access 	71% of survey respondents indicate the opinion that marijuana is "sometimes" or "always" easy for adults to buy in Waldo County communities.  Waldo County Jail inmate interviewees frequently disclosed having purchased drugs (including marijuana) from friends, peers, or dealers.	
Social access 	Interviews with inmates from Waldo County Jail revealed that participants often received marijuana from friends and peers that shared the drug with them.  72% of survey respondents indicate the opinion that adults "sometimes" have access to marijuana during social events.	
Promotion 	There is little evidence of a linkage between promotion of marijuana and consumption of marijuana by young adults. 41% of survey respondents indicated a belief that media “rarely” influences consumption and 22% said they were “not sure”.	
Perceived risk of harm of use	A number of the younger inmates from the Waldo County Jail that were interviewed indicated that they may not have initiated or may have exercised more control over their substance abusing behaviors if they had known the repercussions before hand.	
Community norms 	56% of survey respondents indicated their opinion that the community does not send a clear message that marijuana is dangerous.  A number of Waldo County Jail inmates interviewed during the assessment disclosed that they had initially begun using drugs in order to feel 'cool' and 'mature'.  Some interviewees also indicated that a stronger connection to the community may have prevented uptake of susbtance abuse.	
Family norms	47% of survey respondents indicated their opinion that parents are "sometimes" or "always" sending a clear message to their children that use of marijuana is dangerous.  	
5.	
Marijuana Use Among Other Adults (30 and over):

What are the consequences of marijuana use among other adults in your county?

According to Maine Treatment Data Systems of all Waldo County residents who received treatment for marijuana in 2006, 26% were aged 30 and over. More than 75% of a group of inmates interviewed were over the age of 30 and all disclosed having previously used marijuana.

In your county, is there a connection between the following intervening variables and the consumption of marijuana or the consequences of its use? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	Law enforcement officers have told us that they are less likely to find marijuana in vehicle searches now than to find prescription drugs. Adult survey respondents believe that law enforcement is enforcing the laws.	
Retail access 	71% of survey respondents indicate the opinion that marijuana is "sometimes" or "always" easy for adults to buy in Waldo County communities.  Waldo County Jail inmate interviewees frequently disclosed having purchased drugs (including marjuana) from friends, peers, or dealers.	
Social access 	Interviews with inmates from Waldo County Jail revealed that participants often received marijuana from friends and peers that shared the drug with them.  71.9% of survey respondents indicate the opinion that adults "sometimes" have access to marijuana during social events.	
Promotion 	There is little evidence of a linkage between promotion of marijuana and consumption of marijuana by adults. 41% of survey respondents indicated a belief that media “rarely” influences consumption and 22% said they were “not sure”.	
Perceived risk of harm of use	A number of the younger inmates from the Waldo County Jail that were interviewed indicated that they may not have initiated or may have exercised more control over their substance abusing behaviors if they had known the repercussions before hand.	
Community norms 	56.2% of survey respondents indicated their opinion that the community does not send a clear message that marijuana is dangerous.  A number of Waldo County Jail inmates interviewed during the assessment disclosed that they had initially begun using drugs in order to feel 'cool' and 'mature'.  Some interviewees also indicated that a stronger connection to the community may have prevented uptake of susbtance abuse.	
Family norms	47% of survey respondents indicated their opinion that parents are "sometimes" or "always" sending a clear message to their children that use of marijuana is dangerous.  	

6.	
Non-medical Use of Prescription Drugs Among Youth (12-17):

What are the consequences of non-medical use of prescription drugs among youth in your county?

According to Maine Treatment Data Systems of individivuals treated for abuse of "opiates and synthetics" in 2006, 34.38% indicate their age of first use was between 14 and 18.  75% of Waldo County Jail inmates interviewed report having first abused presription drug between the ages of 16 and 20.

In your county, is there a connection between the following intervening variables and the consumption of prescription drugs for non-medical use or the consequences of this type of use? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	54.5% of community survey respondents indicated their opinion that school policies regarding non-medical use of prescription drugs are "sometimes" or "always enforced".  Discussions with police officers revealed that they are finding prescription medications on youth more often than they are finding marijuana.	
Retail access 	Community survey respondents expressed some uncertainty regarding youth access to prescription medications through retail stores.  There is little evidence linking retail access to youth consumption of prescription drugs.  While direct sales to youth may not be identified as an issue in the county, a high volume of sales to the population in general was identified as a problem, thus making prescriptions more readily available to youth.	
Social access 	Interviews with inmates in Waldo County Jails indicated that prescription drug parties take place within the county.  Inmates also indicated that, as youth, friends and peers often gave or sold them prescription drugs.  This was reinforced by focus group discussions regarding "pharm" parties where prescription drugs are consumed.  90.4% of respondents to the community survey indicated that youth "sometimes" or "always" have access to prescription drugs at unsupervised parties.	
Promotion 	   Focus group discussions suggested that the media and frequent promotions of prescription medications may give youth the impression that medications are safe.   	
Perceived risk of harm of use	Waldo County Jail inmates disclosed that they may not have initiated substance use had they known the repercussions at the time.  Participants in a focus group expressed their impression that youth may feel that prescription medications are safe to use due to their presence on television, and their frequent use by adults.	
Community norms 	Focus group discussions highlighted the perspective that pills are considered "cool" by youth.  This is reinforced by Waldo County Jail inmate interviews indicating that users felt "cool" and "mature" when they initiated substance abuse.  Interviewees from the Waldo County Jail disclosed that additional involvement in the community may have prevented them from taking up substance abusing behaviors.	
Family norms	Focus Group discussion revealed the attitude that adult and parent behavior may constitute poor role-modeling and influence the behavior of youth. Lack of parental monitoring places youth at risk for early initiation of dug use.  	
7.	
Non-medical use of Prescription Drugs Among Young Adults (18-29):

What are the consequences of non-medical use of prescription drugs among young adults in your county?

In Jail inmate interviews at the Waldo County Jail, 73% of inmates said that they had used prescription drugs not prescribed to them and 89% of those said that the drug used was a narcotic. In these interviews, inmates spoke about selling drugs and stealing as a means to support their habit. According to the Treatment Data Systems report, 37.5% of patients admitted for treatment of "other opiate and synthetic" addiction were between 19 and 25 years of age when they first used.  41% of all people admitted for treatment of “opiate and synthetic” addiction, were between 18 and 29 years of age.

In your county, is there a connection between the following intervening variables and the consumption of prescription drugs for non-medical use or the consequences of this type of use? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	Law enforcement officers report that they are seeing more prescription medication abuse than marijuana abuse. 65% of survey respondents reported that they believed that the laws were “sometimes” or “always” enforced.	
Retail access 	Focus group discussion highlighted the availability of prescription drugs due to perceived "over-prescribing" and lack of control by physicians. Jail interviews reinforced this impression and provided information about prescription drug parties. One inmate suggested that physicians should be testing patients to see if they are taking their medications and in the correct dosage.	
Social access 	Inmate interviews disclosed the existence of prescription drug use at parties and the ease of getting pills from friends. According to reports from the Prescription Monitoring Program, Waldo and Knox counties have the highest rate per capita of prescriptions for Type II, III, and IV drugs.	
Promotion 	Focus Group discussion included concerns about advertising and the implication that prescriptions were safe. Media messages were seen as being difficult to ignore.	
Perceived risk of harm of use	Focus Group discussion centered on the belief that advertising messages overwhlemed caution and that prescriptions are seen as safe and pure and offer a "quick fix". Users are confident in dosage amounts and feel that they have control.	
Community norms 	Available data suggests that a high volume of prescriptions are written for legitimate purposes and some drugs get diverted into the black market. One factor is a high number of elder adults with chronic disease and multiple prescriptions, some of which are unused and additionally subject to theft. Inmate interviews disclosed that the use of drugs was associated with being "cool" or more mature.	
Family norms	Focus Group discussion revealed the attitude that adult parent behavior is influencing the behavior of youth by role-modeling. Lack of parental monitoring places youth at risk for early intiation of dug use. The early intiation of drug use is predictive of adult problems. Cultural patterns of substance abuse in our county predict some genetic predisposition to addiction. 	

8.	
Non-medical use of Prescription Drugs Among Other Adults (30 and over):

What are the consequences of non-medical use of prescription drugs among other adults in your county?

  In Jail inmate interviews at the Waldo County Jail, 73% of inmates said that they had used prescription drugs not prescribed to them and 89% of those said that the drug used was a narcotic. 75% of this group were older than 30. In these interviews, inmates spoke about selling drugs and stealing as a means to support their habit. According to the Treatment Data Systems. of county residents seeking treatment for prescription drug abuse, 47% were over age 30.     

In your county, is there a connection between the following intervening variables and the consumption of prescription drugs for non-medical use or the consequences of this type of use? 	If yes, what is the connection (contributing factors) and how do you know this?  	
Enforcement 	Law enforcement officers report that they are seeing more prescription medication abuse than marijuana use.	
Retail access 	Focus Group discussion highlighted the availability of prescription drugs due to perceived “over-prescribing” and lack of control by physicians. This is further complicated by our region’s large and growing elderly population who are being prescribed numerous medications. 90% of respondents to our community survey indicated a belief that adults “sometimes” try to fraudulently fill prescriptions at pharmacies.	
Social access 	We have little information about the link between social access and the misuse of prescription drugs in this population.  One inmate who was interviewed (aged 43) reported being present at parties where some in attendance were using prescription drugs.	
Promotion 	Focus Group discussion included concerns about advertising and the implication that prescription medications were safe. Media messages were seen as being difficult to ignore.	
Perceived risk of harm of use	Discussion in focus group and Core Group meetings touched upon the perspective that some elderly individuals felt safe when mixing alcohol and prescriptions. Prescription drugs were seen to be “safe” because they are controlled, the dosage is certain, and the purity was not suspect.	
Community norms 	Some responses to the community survey and opinions expressed in discussion suggest that adults may “self-medicate” to address issues of pain, because of challenges meeting society’s expectations or due to the stress of adverse social and economic circumstances.	
Family norms	We do not have any evidence of a connection between family norms and prescription drug misuse for this population.	

 

 

 What We Know    

Consumption Patterns

MYDAUS, 2006 for Waldo County:
•	% of students in Waldo County who reported ever having used/abused prescription drugs (13.1%) and inhalants (12.6%) is higher than the state (12.0% & 12.2), although these differences are not statistically significant.
•	Reported lifetime abuse/misuse of prescription drugs is markedly higher in the later grades, growing from 3.9% of students in the 6th grade to peak at 25.3% of students in the 11th grade.
•	Lifetime use of inhalants resembles a bell curve.  Reported lifetime use grew from 9.2% of the students to peak at 19% of the students in the 9th grade, only to shrink to 8.7% of the students in the 12th grade.
•	30-day previous use of alcohol is reported as being most prevalent (27.1%) followed by marijuana (14.2%).  These are followed by 13.1% of students who report ever having abused prescription drugs and 12.6% of students who report ever having abused inhalants.
o	30-day previous alcohol use increased steadily between the 6th (4.9%) and 12th (50%) grades.
o	30-day previous use of marijuana increased steadily between the 6th (1.3%) and 12th (29%) grades.
o	Reported lifetime abuse/misuse of prescription drugs is markedly higher in the later grades, growing from 3.9% of students in the 6th grade to peak at 25.3% of students in the 11th grade.
o	Lifetime use of inhalants resembles a bell curve.  Reported lifetime use grew from 9.2% of the students to peak at 19% of the students in the 9th grade, only to shrink to 8.7% of the students in the 12th grade.

Treatment Data Systems: Clients admitted between 2006-1-1 and 2007-1-1 with reported residence in Waldo 
•	The majority of patients admitted reported alcohol as their primary detail dug of first use (64.27), followed by marijuana (12.3%), opiates and synthetics (other than methadone or heroin/morphine) (11%), and heroin/morphine (6.15%).
•	The majority of patients admitted reported their primary age of first use being between 14 and 18 years for all patients, those reporting alcohol, marijuana, or ‘other opiates and synthetics as their primary detail drug.
o	44.87% of all patients admitted reported their primary age of first use was between 14 and 18 years.  19.23% reported 46 or older, and 16.92% reported it was between 11 and 13 years of age.
o	For alcohol 62.31% reported their age of first use as between 14 and 18 and 25.63% reported it was between 11 and 13.
o	For Opiates and Synthetics other than Methadone and/or Heroin/Morphine 34.38% report their primary age of first use between 14 and 18, 28.12% report between 26 and 35, and 21.88 report it was between 19 and 21.
•	The majority of patients admitted were male (60.73%). This trend extends through patients who report their primary detail drugs as alcohol (74%), marijuana (73.68%), or ‘other opiates and synthetics’ (61.76%).
•	The majority of patients admitted were educated up through the 12th grade (or achievement of their GED) (49.74%), to be followed in frequency by those patients who completed from 0 to 11 years of formal education (35.9%).  These proportions are similar for patients who report their primary detail drugs as alcohol, marijuana, or ‘other opiates and synthetics’.
•	The majority of patients admitted fell into the $0-$10,000 income bracket (71.35%), followed in frequency by those that fell into the $10,001-$25,000 income bracket (24.05%).  This trend extends to those patients admitted who reported alcohol or marijuana as their primary detail drug, but not to ‘other opiates and synthetics’ which is completely dominated by the $0-$10,000 income bracket.

Health Planning Report for the Knox-Waldo Region – 2002
•	Elderly men in the Knox-Waldo region were more likely than the state or their regional peers to report chronic heavy drinking.  Hospitalization rates among the elderly for acute alcohol disorders were also higher than the state and their regional peers (by nearly 70%).  Likewise alcohol related deaths was higher in the Knox-Waldo area than among peers and state (by 30%).
•	Acute drug-related hospitalizations among working adults was higher than among their regional peers (by 50%) but not higher than the state.

Fifth District Court: Cases closed between February 5-9, 2007 at Belfast District Court
•	Out of 38 cases closed 15 were elated to substance abuse.  Of these 15 cases 7 dealt with alcohol, 3 dealt with marijuana, and 2 dealt with prescription drugs.

Juvenile Automated Substance Abuse Evaluation: records for calendar year ’06 (Jan. 1, ’06 – Dec. 31, ’06) foe evaluations in Waldo Co.
•	Out of 30 records found, 16 were referred for further substance abuse evaluation or assessment.  Of these 5 were referred to intensive outpatient treatment following detoxification and 1 was referred to residential care and medical monitoring due to apparent addiction.

Substance Abuse Surveys: Compiled Key Informant surveys and those distributed through Survey Monkey
•	A majority of respondents reported that alcohol use by youth is a very serious issue in Waldo Co. (51.4%) followed by 37.1% who reported that it is a serious issue.
•	52.9% of respondents responded that alcohol use by adults is a very serious issue in Waldo Co., and 38.2% reported that it is a serious problem.
•	42.9% of respondents reported that prescription drug use by youth is a very serious issue in Waldo Co. and 37.1% reported that it is a serious issue.
•	The majority of respondents reported that prescription drug use by adults is a very serious issue in Waldo Co. (70.6%) and 14.7% reported that it is a serious issue.

Focus Group: Held among Key Informants on March 7, 2007
•	Police noticing more kids with pills on the street.
•	Abuse of prescription drugs has increased over the years.  Waldo County reports the highest rate of prescriptions written for Class II, II and IV drugs. 

Jail Interviews: 11 interviews conducted on March 14
•	All inmates interviewed reported using alcohol previously and all reported participating in binge drinking.(5 or more drinks on one occasion for men, 4 for women) Of these 36% reported first using between the ages of 12 and 15, and 55% reported using between 16 and 20.
•	All inmates interviewed reported using marijuana previously.  Of these 55% report their age of first use as between 12 and 15.
•	73% of inmates interviewed report having used prescription drugs that were not prescribed to them, 8 out of 9 of whom report that narcotics were among the prescriptions that they abused.  75% of these report having first used between the ages of 16 and 20.
•	64% report having used LSD and 55% report having used Cocaine.

Summary:
Based on the above data abuse of alcohol and prescription drugs appear to be the most problematic substances out of those investigated.  This seems to be the case across the different age groups, although age of first use appears to be different dependent on which substance is under scrutiny.  For alcohol it appears to be common that individuals initiate use under the age of 18 while for prescription drugs initiation is roughly equal across those age groups that fall between 14 and 21 years of age.  It is noteworthy that an enormously disproportionate number of abusers (or at least those that obtain treatment) qualify as low income, as revealed by the data originating with the Treatment Data Systems.

Based on these findings it is recommended that a strategic prevention plan focus on alcohol and prescription drug abuse across the life span.  This plan should also target low income populations.  Additionally the early age of first use for alcohol suggests that a plan addressing alcohol abuse should definitely employ early intervention strategies.

Intervening Variables and Contributing Factors

Jail Interviews: 11 interviews conducted on March 14
•	Friends and family were cited most frequently as their initial source of alcohol and several indicated that this happened in a party setting.
•	The sources most frequently cited for marijuana include friends and peers that shared the drug with them.
•	Cited sources for prescription drugs include a mix of friends and peers that either gave them the pills or sold it to them.  Additionally doctors and legal prescriptions were identified as being sources, or the origins of an addiction.
•	Usage by friends and peers and the perception that use would help them fit in was thought to have caused or encouraged inmates first use of drugs or alcohol.  One respondent also indicated that choosing to use provided him with a feeling of maturity.  Yet another responded that he became hooked on prescription after he as initially prescribed it by a doctor.
•	Most interviewees indicated that knowing the repercussions (legal, physical and social) may have kept them from initiating use.  Additionally involvement in a community (religious in this case) was identified as being influential in aiding former abuser’s recovery, and another indicated that a strong, yet understanding, social network/support system would have helped.

Focus Group: Conducted on March 7, 2007 with approximately 11 people in attendance
•	One of the strongest threads observable in the discussions of the focus group was that youth often do not perceive prescription medication as being harmful due to a variety of reasons including: the perception that pills are controlled, the observance of adults taking prescribed medication appropriately, the observance of companies selling prescription medication (leading to the interpretation that it is safe), and a lack of understanding about drug schedules.  The media was also mentioned as a potential source of this given that prescription drug ads can be viewed frequently and that this fosters the perception that these drugs are okay because they are on television.
•	There was a strong perception that pills are ‘cool’ and considered acceptable among youth, as smoking was previously.
•	Perceptions of parents that tie in with parental monitoring practices came up at several points as a perceived lack of concern over monitoring by parents and a lack of embarrassment over their children’s behavior.
•	The group perceived several causes of youth substance abuse to be tied to adult modeling.  This was revealed through comments entailing that teens are observing adults doing dangerous and inappropriate things that then become the norm for them and that parents are much closer to their kids with regards to behavior.  Further it was mentioned that there is a lack of positive role models and mentors in the community.
•	Issues revolving a round family modeling featured prominently, but was primarily advocated by one strong voice.  The perception forwarded was that the breakdown of the dual-parent household robbed children of a model for healthy relationships and a potentially positive mentor when one parent is not allowed to play a prominent role in their child’s life.  This was further perceived as lying at least partially on the shoulders of family court.
•	The group observed that youth are not connected with, or engaged in, the community, thus leading to a surge in at-risk youth.
•	Medical professionals and the distribution of prescription drugs were also implicated by the group.  It was noted on a few occasions that there is a lot of over-prescribing and irresponsible prescribing.

MYDAUS, 2006 for Waldo County
•	In descending order, the five most prevalent risk factors for respondents from Waldo County in grade 6 were: low commitment to school (54%), attitudes favorable to antisocial behavior (47.3%), intention to use drugs (46.1%), laws and norms favorable to drug use (43.7%), and rebelliousness (43.7%).  The two most prevalent protective factors were social skills (73.1%) and school opportunities for positive involvement (65.3%)
•	In descending order, the five most prevalent risk factors from Waldo County in grade 8 were: lower academic achievement (49.2%), interaction with antisocial peers (47.8%), parental attitude favorable to antisocial behavior (46.2%), sensation seeking (43%), and low commitment to school (41.8%).  The two most prevalent protective factors were social skills (70.4%) and school opportunities for positive involvement (62.5%).
•	In descending order, the five most prevalent risk factors from Waldo County in grade 10 were: parental attitude favorable to antisocial behavior (53.4%), interaction with antisocial peers (52.8%), lower academic achievement (50.8%), laws and norms favorable to drug use (50.6%), and attitudes favorable to antisocial behavior (49.3%).  The two most prevalent protective factors were school rewards for positive involvement (67.2%) and belief in the moral order (64.3%).
•	In descending order, the five most prevalent risk factors from Waldo County in grade 12 were: rewards for antisocial behavior (57.4%), parental attitude favorable to antisocial behavior (56.6%), perceived risk of drug use (55%), parental attitude favorable to drug use (53.3%), and interaction with antisocial peers (53.1%).  The two most prevalent protective factors were school opportunities for positive involvement (63.1%) and social skills (57.3%).
•	School opportunities for positive involvement appeared within the top three most prevalent protective factors for all grades.  Likewise social skills and belief in the moral order appeared in the top three for at least three grades.
•	 Interaction with antisocial peers and parental attitude favorable to antisocial behavior appear among the top five most prevalent risk factors for at least 3 grades.
•	Although a general rise in most risk factors from 6th to 12th grade is noticeable, some factors rose quite steeply, such as attitudes favorable to drug use (15.7% in grade 6 to 46.9% in grade 12), perceived risk of drug use (22.9% - 55%), parental attitude favorable to drug use (12.7% - 53.3%).
•	Risk factors such as interaction with antisocial peers (35.4% - 53.1%), parental attitude favorable to antisocial behavior (31.7% - 56.6%), perceived availability of drugs (24.3% - 47.6%), rewards for antisocial behavior rose steeply (28.2% - 57.4%), and early initiation of drug use (17.9% -  40.2%) rose somewhat more moderately between the 6th and 12th grades.

Key Informant Survey – Statistics : February – March 2007
•	With regards to underage drinking, social access to alcohol at unsupervised parties and promotions of alcohol were felt to be a strong influence.  A lack of understanding regarding the risk of drinking and social access at supervised parties were also considered to be the most influential risk factors in the County.

Drinking among youth						
Question	Never	Rarely	Not Sure	Sometimes	Always	
Q3A. Social Access: Do you think youth have access to alcohol during supervised parties? 	0.0%	2.9%	8.6%	85.7%	2.9%	
Q3B. Social Access: Do you think youth have access to alcohol during unsupervised parties?	0.0%	0.0%	2.9%	61.8%	35.3%	
Q4. Promotion:  Do you think youth are influenced by the way media portrays drinking?  	0.0%	3.0%	12.1%	51.5%	33.3%	
Q5. Perceived Risk of Harm: Do you think youth understand the consequences of alcohol use?	0.0%	65.7%	2.9%	31.4%	0.0%	

•	Retail access to alcohol was strongly felt to be influential in the high risk drinking behaviors among adults.  This was followed by social access, promotion, and perceived risk of harm.

High risk drinking among adults						
Question	Never	Rarely	Not Sure	Sometimes	Always	
Q2.  Retail Access: Do think it is easy to buy alcohol in your community?	0.0%	0.0%	17.6%	17.6%	64.7%	
Q3.  Social Access: Do you think adults feel that they have to have alcohol at a party to have a good time?	0.0%	0.0%	11.8%	85.3%	2.9%	
Q4. Promotion: Do you think adults are influenced by the way media portrays drinking? 	0.0%	20.6%	8.8%	55.9%	14.7%	
Q5. Perceived Risk of Harm: Do you think adults understand the consequences of alcohol use?	0.0%	21.2%	3.0%	72.7%	3.0%	

•	Retail access through dealers, and social access at unsupervised parties were felt to have a strong influence on youth use of Marijuana.

Marijuana Use Among Youth						
Question	Never	Rarely	Not Sure	Sometimes	Always	
Q2.  Retail Access: Do you think it is easy for youth to buy marijuana in your community?	0.0%	0.0%	12.9%	41.9%	45.2%	
Q3B. Social Access: Do you think youth have access to marijuana during unsupervised parties?	0.0%	0.0%	6.9%	69.0%	24.1%	

•	Retail access through dealers and the degree to which officials enforce the law were considered to have the strongest effect on adult use of marijuana.

Marijuana Use Among Adults						
Question	Never	Rarely	Not Sure	Sometimes	Always	
Q1. Enforcement: Are marijuana use laws enforced by police in Waldo County?  	0.0%	6.5%	19.4%	61.3%	12.9%	
Q2.  Retail Access: Do you think it is easy to buy marijuana in your community?	0.0%	0.0%	29.0%	35.5%	35.5%	
•	Social access at unsupervised parties was felt to be influential in the non-medical use of prescription drugs by youth.  It should be noted that there was quite a bit of uncertainty regarding youth misuse/abuse of prescription drugs.

Non-medical use of prescription drugs among youth					
Question	Never	Rarely	Not Sure	Sometimes	Always	
Q3B. Social Access: Do you think youth have access to prescription drugs during unsupervised parties?	0.0%	0.0%	9.7%	71.0%	19.4%	

•	Retail access to prescription drugs was considered the most influential  factor in adult abuse/misuse, followed by a lack of understanding regarding the risks involved in non-medical use.

Non-medical use of prescription drugs among adults				
Question	Never	Rarely	Not Sure	Sometimes	Always	
Q2.  Retail Access: Do you think adults try to fill fraudulent prescriptions at local pharmacies?	0.0%	0.0%	10.0%	90.0%	0.0%	
Q5. Perceived Risk of Harm: Do you think adults understand the consequences of non-medical prescription drugs use?	0.0%	20.0%	15.0%	65.0%	0.0%	

Key Informant Survey – Comments: February – March 2007
•	In addition to the other substances identified respondents noted heroin and meth approximately 4 times, and cocaine and inhalant usage three time.
•	Poverty, underemployment, and other socioeconomic variables were cited frequently throughout the comments submitted by respondents.  Some of the explanations for this revolved around the anxiety and sense of failure generated by lack of finances and substance abuse as a way of self-medicating against such things.
•	The behaviors of adults was also cited frequently.  Respondents felts that there was often parent/adult promotion of substance abuse either directly or modeling it indirectly through their own use (whether it be through over-consumption of alcohol or use of other substances).  One respondent implied that partaking in the same behavior as their model allows them to feel “adult”.
•	Respondents further identified the medical and prescribing institutions as being responsible for much of the misuse/abuse of prescription drugs.  According to respondents prescribers are over-prescribing or prescribing irresponsibly (i.e. not checking up on whether their patients are getting drugs from other doctors, or ignoring patients that they realize may have a problem).
•	Concerns over parental monitoring arose from the survey as well, although to a lesser degree than those above.  Respondents noted a lack of parental oversight and/or a lack of concern on parent’s part over substances such as alcohol.  Further respondents feel that a lot of parents do not expect that their child could ever have a problem with substance abuse.
•	A need to increase understanding and education regarding the risks of substance abuse was also commented upon by several respondents.  
•	Lastly, the media was considered by some respondents to be part of the issue.  These ranged from an unattainable “image of success” promoted by the media that then leads to unmet expectations and anxiety, to simple.

Summary:
Based on the data presented above a number of intervening variables have been identified as contributing to the likelihood that an individual or population will engage in substance abuse.  Due to the organization of the information compiled in this assessment intervening variables can be viewed by age group (youth or adult), and subsequently by substance (alcohol or prescription drugs).

The variables identified as being most relevant to alcohol abuse among youth (ages 14 – 18) include perceptions or knowledge of risk, community norms, parental monitoring, and adult modeling.   Of these, adult modeling and parental monitoring came up most frequently.  The former, according to the various data sources reviewed, is an effect of the responsibility of adults and their behavior (risky or otherwise), the presence of mentors, parental attitude’s favorability towards antisocial behaviors either directly or indirectly, and a the presence of models for working relationships.  The latter variable was expressed to be the effect of parent’s awareness that there is cause for concern, concern regarding some substances (such as alcohol), and harboring attitudes favorable to antisocial behavior.

The variables identified as being most relevant to youth prescription drug abuse included youth norms, access and availability, community norms, parental monitoring, and adult modeling.  Although these variables appear with very similar frequency parental modeling and adult modeling stuck out again for much the same reasons.  The intervening variable here described as youth norms is fueled by the presence of and interaction with antisocial peers, the perception that the choice to abuse is linked with maturity, and other factors not explored in depth.  Community norms appears to be fueled by youth engagement in the community and the presence of a support network.  Lastly access and availability is largely felt to be mediated by prescriber practices, including a wide variety of responsible (or irresponsible) practices.

All of the variables identified as factoring into high risk drinking among adults appear to have roughly the same amount of influence.  These include perception/knowledge of risk, community norms, and retail access.  According to the data sources explored herein perception/knowledge of risk is largely a matter of the perceived consequences of substance abuse, including health, social and legal repercussions.  The factors contributing to community norms are much the same for adult alcohol abuse as those identified for youth prescription drug abuse (engagement in the community and the presence of support networks).  Lastly retail access was largely unexplored, but may include such factors as the number of outlets from which alcohol is available and serving practices.

For adult abuse of prescription drugs access and knowledge/perception of risk emerged most frequently as influential variables.  In this case factors contributing to access among adults closely resemble those contributing to prescription drug access among youth, largely falling on the shoulders of prescriber practices.  Knowledge/perception of risk, on the other hand, does not fully resemble other instances where this variable was perceived as influential.  While it still refers to the wide range of health, legal, and social repercussions, in this case knowledge/perception of risk also refers to perceptions of control over dosage and purity of the medication, and media saturation/perceptions of acceptability.