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 Science-based prevention programs are being implemented in New Mexico. Substance abuse prevention programs are being evaluated statewide. Special prevention initiatives address issues specific to Native American communities and communities along the Mexican border. More than $9 million per year helps fund local DWI programs. Operation DWI enhances law enforcement. 12,000 adults per year are admitted to alcohol and drug treatment.
Increase availability of effective treatment and prevention services. Increase school-affiliated mental health/substance abuse services. Use collaboration between state agencies to improve access to child, adolescent and adult behavioral health services under Medicaid/SALUD! Direct substance abuse and mental health prevention services to elementary and middle school aged youth. Provide family-focused prevention services (e.g., parenting skills, improving parent-child relationships, conflict resolution, mediation). Provide overdose prevention education to persons at risk for drug and alcohol overdose.
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 The abuse of alcohol and other drugs is one of New Mexico’s most serious problems. The effects are seen everywhere: personal health, family, work, education, and the legal and correctional systems. In each of these we can see the impacts of alcohol and illicit drugs, leading to illness, crime and the incarceration of large numbers of New Mexicans. Alcohol and drugs can harm people directly; e.g., overdose, cirrhosis of the liver, or blood-borne disease spread by shared needles and other injection equipment. They may also be dangerous in other ways; for instance, alcohol puts people at high risk for violent injuries and “accidents”. Using these substances can disrupt people’s relationships, families and work. When one uses substances in ways that are damaging, the diagnosis of alcohol or drug abuse may apply. Addiction to any of these is known as alcohol or drug dependence. Tobacco is both addictive and harmful, and is covered in a previous chapter. The most commonly abused substance (except tobacco), and the one that the largest number of people are addicted to, is alcohol. Nationally, in any one year nearly one out of twenty-two could be given a diagnosis of alcohol dependence (alcoholism). The corresponding figure for other drug dependence is 1.8% (about one out of every 56 persons).(1) The 1999 State of Health in New Mexico Report showed that alcohol consumption has been the leading cause of premature death in New Mexico. This was due to cirrhosis of the liver as well as alcohol-involved motor vehicle crashes, suicide and homicide. In fact, our statewide rate of alcohol-involved traffic crash deaths was more than twice the national rate.(2) Some may question whether alcohol can be blamed for all the alcohol-involved injury deaths. For example, there are probably some traffic crashes where even though the victim had been drinking, the crash would have occurred anyway. Therefore, Figure 1 shows a slightly different view of the problem, limited to deaths from illnesses where the primary cause was alcohol use. Even then (excluding traffic deaths, suicides and homicides), New Mexico’s rate of such deaths, 1995-1997, is more than double the national rate.(2)
Like many health problems, those connected with drugs or alcohol often start in adolescence or even earlier. The New Mexico School Survey of 1997 (grades 7 through 12) showed that 29% of students had the kinds of problems with drinking that are typical of alcohol abuse or dependence. Equally disturbing, 24% of high school students reported driving after using alcohol or other drugs. There are large differences between counties in substance-related deaths and alcohol-related crashes (Figure 1). While alcohol can do a lot of harm, other drugs bring additional health hazards. Across the United States, injection drug use has contributed to the spread of HIV/AIDS. In New Mexico, rates of HIV/AIDS infection are still low even among injection drug users; however, alarmingly, over 80% of injection drug users are infected with Hepatitis C, and over 60% with Hepatitis B. Over a period of years, these infections can lead to liver cancer or liver failure. These numbers are grounds for concern for other reasons. If HIV gains a foothold among New Mexico’s injection drug users, it will spread just as widely as hepatitis has done. HIV/AIDS could then become a larger problem, as it is in some other states. Effective, available drug treatment programs are needed to help people quit. Nevertheless, for those individuals who have not yet chosen (or been able) to quit, needle exchange programs allow access to clean equipment, thus halting the spread of blood-borne diseases like hepatitis and AIDS. The approach is similar to what drinkers do by choosing a “designated driver” who will drive them home. They choose to drink, while still protecting themselves from a recognized harm, i.e., motor vehicle crashes. Both treatment and needle exchange programs exist in New Mexico. The more people we can reach with either or both of these, the more we can protect New Mexicans from the worst effects of drug use. During 1990-1997, New Mexico had the highest death rate from drugs among the states, twice as high as the U.S. national rate, and the highest rate of heroin overdose deaths. These deaths frequently involve combinations of heroin with other drugs and/or alcohol. A specific harm reduction method for heroin users has recently been reported from England and Australia: providing addicts with naloxone (an antidote for heroin and other opiates) -- as emergency treatment for overdose. When injected under the skin, naloxone will reverse the effects of heroin in 15 minutes or less, so in cases of heroin overdose it can be a life-saving drug. It acts only as an antidote, and since it does not lead to any “high”, there is no incentive to abuse it. In fact, it can induce withdrawal symptoms in addicts, a fact which has been cited as a possible drawback. The legal issues involved in naloxone administration still need to be clarified. Often, people who suffer from substance abuse or dependence have other diagnosable mental disorders as well. For example, in national studies, among adults who had diagnosable drug or alcohol abuse or dependence (over a one-year period), 43% also had at least one other diagnosable mental disorder. Similarly, 28% of adults who met diagnostic criteria for alcohol dependence in a one-year period also had major depression.(1) Treating people with these combinations of illnesses is especially challenging. Unfortunately, treatment programs for substance use disorders and other diagnosable mental disorders have been based on different types of training and credentials, and they are funded by different federal agencies. When addiction treatment programs lack clinical mental health skills, and mental health professionals lack expertise with addictions, patients who suffer from both types of problems are not well served. Alcohol and other drug use poses difficult social as well as medical problems. Alcohol is legal in most jurisdictions, and it is promoted as effectively as any other consumer product. As with other illnesses, some individuals seem to be especially prone to addiction. Some of this is genetic, and some of it seems to be related to early life experiences. Therefore, even though substance use is a behavior and an individual choice, it is strongly influenced by factors out of the individual’s control, often in childhood. As a society, we do not have a consensus as to the nature of the problem, and our ways of dealing with it are inconsistent: some of the time we treat addictions as illnesses, but at other times we treat them as moral failings or criminal offenses. Once addiction has developed, recovery can be difficult, and the damage can be severe. Individuals have been able to recover, with the help of effective treatment programs; but not all treatment approaches are equally effective. As a society, we need to support interventions that actually help people. In this respect, recent controversy about the legal status of drugs may be useful: we need to be asking ourselves whether current policies are working, and if not, then what other policies and practices might be more effective.     Behavioral Health Services Division, New Mexico Department of Health (treatment, prevention)
Crisis Response (24 hour per day hotline/referral)
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