Epidemiologists use various survey methods to "take the pulse" of a community and gauge its well being in relation to key indicators of public health. The results of a survey recently released by New Mexico's Department of Health show that the communities of Rio Arriba County are under great stress from widespread alcohol and drug abuse. New Mexico leads the nation in numerous key indicators of substance abuse related sickness and mortality, and Rio Arriba County leads the state in those same markers of a community's physical and mental health. New Mexico's alcohol related traffic mortality rate is the second highest in the nation. Rio Arriba County is ranked among the top five counties in the state in the rate of alcohol related traffic accident fatalities. In New Mexico, mortality due to alcoholism is 97 percent higher than what should be expected based on national alcoholism mortality rates. Rio Arriba County has the highest rate of alcohol related mortality in the state and the second highest rate of drug related mortality. From 1995 to 1998 seventy-seven (77) documented deaths have been directly attributed in the county to overdoses of illegal substances.

Taken together, Rio Arriba County ranks among the top five counties in New Mexico in five indicators used to directly gauge a community's alcohol and drug related well-being: alcohol-related mortality; drug-related mortality; driving while intoxicated; alcohol-related traffic crashes; and alcohol-related traffic crash fatalities. The county is also ranked among the highest in the state in two key indicators indirectly related to public health: unemployment and homicide. Statewide, epidemiologists consider substance abuse to be a "particularly pervasive problem in the state." In Rio Arriba, the Board of County Commissioners has formally resolved (in the County's Strategic Plan for Substance and Alcohol Abuse and Treatment) that "substance and alcohol abuse and their corollary impacts are the greatest threat to the health of the residents in the county." The Commissioners go on to state that " . . . addiction has become an epidemic in Rio Arriba County and must be addressed as an emergency using the principles of public health and epidemiology."

Public health statistics alone do not portray the full social impact of substance abuse in any community. Like most jurisdictions coping with the crises of widespread addiction, Rio Arriba County is also experiencing an increase in drug trafficking, theft, and other crimes that come with increased demand for illegal drugs. While no comprehensive crime survey has been recently conducted in the area, state police officers believe that the county's high rates of homicide, property crimes, domestic abuse, assault and battery, and DWI are directly attributable to the widespread demand for and abuse of alcohol and drugs. This viewpoint is shared by many officials in the state's criminal justice system. Indeed, a representative of New Mexico's Public Defender Office serving Rio Arriba County indicated in discussions with members of OJP's Response Team that at least 90 percent of all criminal cases in the county are directly related to chemical dependency.

The financial/opportunity-lost cost of addiction and drug related crime is also significant, particularly for an economically poor jurisdiction like Rio Arriba County. The Board of Commissioners estimates that at least 10 percent of the County's $10.1 million operational budget is spent incarcerating substance abusing offenders in the county's detention facility. This represents a significant drain on the budget of an impoverished community such as Rio Arriba. And, as the Commissioners point out in their Strategic Plan, "This is money that cannot be used for schools, economic development, health care, roads, etc."

But in the end it may be the non-quantifiable impacts of addiction and substance abuse that have the most insidious effects on a community. Statistics cannot measure the pain felt by a family that has suffered the loss of a loved one due to the actions of a drunk driver; nor can they gauge the long term effects on children who watch their parents transported to an emergency room because of an overdose of drugs.

Unfortunately, what was once a habit among a minority of the population has blossomed into a chronic problem that is so widespread and pernicious that it threatens public safety in the county, as well as the stability of public and private institutions alike, including the family itself. One brief point illustrates the dimensions of this problem. Alcohol and drug treatment providers often include the family as an important part of the addicted individual's relapse prevention program. But in Rio Arriba County the pattern of drug abuse and addiction has been so closely linked with intra-familial/inter-generation relationships that public health officials in the state and treatment providers in the county consider the family unit as a risk-factor that is directly related to use/abuse rather than a protective factor that can be used to fight addiction.

Clearly, the problem of addiction is widespread and elected officials and community leaders acknowledge that it is the most significant challenge confronting Rio Arriba County. Public health authorities, elected officials, and treatment providers acknowledge that the need for prevention programs and treatment services targeted on the residents of Rio Arriba County is substantial, and that additional financial resources may be required to effectively combat drugs and crime in the County. To date, the demand for treatment has not matched the underlying need because of the community's unfortunate acceptance of substance abuse and the flagrant use of alcohol. The need for additional resources may become particularly acute when community norms change and the public's demand for treatment rises.

However, there is also agreement that significant resources are already being spent on drug prevention and treatment programs in North Central New Mexico and that more money alone will not solve the problem. The State Department of Health's Region II, the area in which Rio Arriba County is located, currently receives a preponderance of the state's prevention and treatment funds. Last year nearly $21.00 was spent per capita in Rio Arriba on prevention, while $44.00 was spent per capita on treatment.(3) This represents the largest per capita expenditure on prevention and treatment in any county in the state. These funds will be augmented by an influx of an additional $500,000 earmarked for treatment as a result of legislation recently signed by Governor Gary Johnson. Yet the county's outcome indicators for substance abuse, as discussed earlier in this report, are among the worst in the state.

Leadership from local and state elected officials, law enforcement and public health authorities, and the community is needed along with a commitment to enhance the effectiveness of programs and to increase collaboration between and among prevention and treatment providers. Leadership, program effectiveness, and coordination are three factors cited time and again by individuals at both the county and state level as being critical to the eventual success of any comprehensive effort to reduce demand for illegal drugs in Rio Arriba County.

A government entity currently providing significantly needed leadership in the field of substance abuse prevention is the Cooperative Agreement Advisory Committee (CAAC) established by the state in response to the U.S. Department of Health and Human Services (HHS) State Incentive Grants, administered by HHS's Substance Abuse and Mental Health Services Administration. The CAAC has established state-wide requirements for science-based approaches to prevention and is requiring that providers include outcome measures as a part of their criteria for program effectiveness. The CAAC has also created incentives to encourage collaboration among providers and established mandates to increase the likelihood that providers will, in fact, collaborate with each other.

The OJP Response Team recommends that the CAAC critically examine the nature and extent of prevention programs within the school system to ensure that a proactive approach is taken, and that appropriate primary and secondary prevention programs (which are research-based and culturally sensitive) are, indeed, offered to each student. In addition, the CAAC should encourage coordination of community mobilization efforts and the development of workplace prevention education programs in Rio Arriba County.

The state Department of Health's initiative to develop regional continuum-of-care (RCC) through service networks in each of the five geographic areas in the state is another example of leadership and coordination that the OJP Response Team endorses. This effort, led by the Health Department's Behavioral Health Services Division, is a regional approach to planning, coordinating, and delivering alcohol and other drug services. When coordinated with the emerging health and human service initiatives currently being planned by county officials in Espanola, it should prove to be a more effective approach to better address the treatment service needs of the residents of Rio Arriba County.

The OJP Response Team recommends that the RCC request-for-proposals include the following specifications:

After implementation of the RCC program, the OJP Response Team recommends a review of treatment availability and accessibility, and the organization and financing of programs to meet service needs within Rio Arriba County. Part of this recommended review should include the identification of any gaps in service and the development and implementation of an organized approach to fill any gaps that do exist. In this regard and in all phases of the implementation of the RCC concept, we encourage the Behavioral Health Services Division to continue to work with the Center for Substance Abuse Treatment, U.S. Department of Health and Human Services, to address technical assistance needs.

We encourage ongoing and enhanced coordination between and among the Department of Health's Behavioral Health Services Division, its Public Health Division, and Rio Arriba County's newly created Department of Health and Human Services to improve the types and quality of substance abuse prevention and treatment services in Rio Arriba County.

New Mexico also has the benefit of forward thinking leaders in the criminal justice arena. There is a consensus among both policy makers and implementers in the state's criminal justice system that substance abuse is a significant contributor to the state's crime rate and that additional steps must and can be taken to enhance coordination between the public health and public safety sectors within the state. The OJP Response Team has the following recommendations for leaders within New Mexico's criminal justice system:

Assistance Program funds within New Mexico.

We encourage New Mexico's Children, Youth, and Families Department (CYFD) and the JJAC to accelerate and enhance their ongoing efforts to expand the Communities That Care approach to the coordination and expansion of risk-based prevention strategies that are tailored to local circumstances, and to maintain state-wide compliance with the Juvenile Justice Delinquency Prevention Act. In particular, we endorse the CYFD/JJAC's "Restoring Justice" initiative aimed at [a] reducing minority over-representation in the juvenile justice system, [b] supporting innovative community policing approaches that empower local police to directly cite eligible juveniles into alternative sanctions rather than detention facilities and [c] promoting community protection, juvenile offender accountability and rehabilitation, family strengthening and victim/community restoration.

Substance abuse and crime are the most visible symptoms of a constellation of underlying social and economic problems in Rio Arriba County. Reducing the demand for illegal drugs and improving the quality of life in the county will require a multi-dimensional strategy that includes a wide range of interventions aimed at enhancing public health and safety, revitalizing neighborhoods, improving schools and opportunities for youth, spurring and sustaining economic development and strengthening and supporting healthy, functional families. The next section of this report describes an infrastructure that can be used to coordinate initiatives in each of these areas in Rio Arriba County.

3. State Department of Health officials caution, however, that while a substantial portion of the state's treatment dollars go into Rio Arriba County, and while the county has a high concentration of residential treatment services, a majority of the beds made available by these providers serve clients from other parts of New Mexico or neighboring states. These clients, unlike many of the residents of Rio Arriba County, 55 percent of whom do not have health insurance, have the ability to pay for long-term residential treatment.

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