Impact on Health

Americans rank alcohol and drug abuse as the nation’s most serious public health problem, ahead of cancer, heart disease and depression.[29]  In Denver, rates of smoking, drinking and illicit drug use are higher than they are in the rest of Colorado and the nation.  The negative impact on the health of Denver residents is also greater.

This chapter presents the most currently available data on the prevalence and health consequences of substance abuse in Denver.  Information comes from a variety of sources, such as self-report surveys, treatment admissions and hospitalization and death records. Whenever possible, trends in Denver are compared to those in the rest of Colorado and the country.

Prevalence of Substance Use in Denver

Tobacco Use
During the past decade, Denver adults have reported higher rates of smoking than in the rest of the state and the nation, according to the Behavioral Risk Factor Survey (BRFS) sponsored by the Centers for Disease Control and Prevention (CDC).  Smoking rates, however, appear to have dropped recently.  During the 1990s, the BRFS consistently found that one in four Denver adults said they were current smokers.[30]  But in 2000, less than one in five (19 percent) Denver adults reported themselves to be current smokers.  By comparison, 26 percent of adults nationwide were current smokers in 2000, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Household Survey on Drug Abuse.[31]  The results of the 2001 BRFS, which are expected by Summer 2002, will confirm whether Denver has sustained this encouraging downward trend in smoking.

Binge Drinking and Chronic Drinking
Rates of binge drinking (five or more drinks on one occasion at least once during the past month) by Denver adults have generally ranged from 20 to 25 percent, which is considerably higher than in the rest of Colorado or nationally, where rates have hovered at around 15 percent.[32]  Far more men in Denver report binge drinking: in 1999, almost four times as many men (40 percent) as women (11 percent) said they were binge drinkers.

Rates of chronic drinking (at least 60 drinks in the past month) are also higher among Denver adults, ranging from 5 to 6 percent, compared to 3 to 5 percent in the rest of Colorado and the country.[33]  Like binge drinking, chronic drinking shows a persistent gender gap.  One in ten men in Denver reported chronic drinking in 1999, compared to one in 45 women.

The high rates of binge and chronic drinking in Denver revealed by the BRFS are reinforced by other data showing high rates of drinking statewide in Colorado.  According to the National Household Survey on Drug Abuse, in 1999 nearly two-thirds of Colorado adults were current drinkers, compared to half of adults nationwide.[34]  Based on alcoholic beverage sales data, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that per capita alcohol consumption—beer, wine and spirits—is about 20 percent higher in Colorado than in the United States as a whole.[35]  (Some portion of Colorado’s overall alcohol consumption is of course attributable to tourists and other visitors from out of state, but the national figures with which Colorado is compared also include out-of-state drinkers.)

Nationwide and in Colorado, per capita alcohol consumption declined significantly over the course of the 1980s.  But while the downward trend continued for the nation as a whole during the 1990s, per capita consumption in Colorado leveled off and began to increase.   U.S. consumption averaged 2.28 gallons of pure alcohol per capita from 1991-1994, then fell by 4 percent to 2.18 gallons from 1995-1998.  By contrast, consumption in Colorado rose slightly from 2.61 gallons in 1991-1994 to 2.62 gallons in 1995-1998.  The state’s 1995-1998 average alcohol consumption amounted to the equivalent of two six-packs of beer per person every week.[36]

Illicit Drug Use
Colorado adults report higher rates of illicit drug use, including marijuana, than the nation as a whole.[37]  Although specific survey data for illicit drug use in Denver are not available, treatment admissions data for Denver residents give some sense of the extent of the problem.  According to the Colorado Department of Human Services’ Alcohol and Drug Abuse Division (ADAD), Denver residents accounted for one-quarter of all treatment admissions in the state for cocaine or heroin abuse from fiscal year (FY) 1998 through FY2002,[38] even though the city made up only 13 percent of Colorado’s population age 12 and older during this time.[39]  In addition, ADAD estimates that nearly half of Colorado’s more than 15,000 injecting drug users live in Denver.[40]  These figures suggest that the prevalence of drug abuse in Denver is higher than in the rest of the state.

Youth Smoking, Drinking and Other Drug Use
The most recent data on substance use among Denver youth were collected in 1995, as part of the CDC Youth Risk Behavior Survey of high school students.[41]  The Denver public schools are currently conducting surveys on substance use and other risk behaviors among 7th, 8th and 9th graders, but this information is not yet available.

In 1995, 13 percent of Denver high school students reported smoking regularly (20 or more days a month), lower than  in the rest of Colorado and nationwide (16 percent).  Recent cocaine use was also lower among Denver youth (2 percent, compared to 4 percent in Colorado and 3 percent nationwide).  However, both drinking and marijuana use were substantially higher in Denver, where 57 percent of high school students reported past-month drinking, compared to 53 percent in the rest of Colorado and 52 percent nationally.  Thirty-nine percent of Denver high schoolers reported past-month marijuana use, compared to 29 percent in the rest of Colorado and 25 percent nationally.  Denver youth also were more likely to have started drug use at a young age. This is particularly troubling since youths who begin drinking or using drugs early are far more likely to develop serious problems later.[42]

Smoking, Drinking and Other Drug Use among Pregnant Women
Smoking during pregnancy is the most important preventable risk factor for low birthweight —which is a leading cause of fetal and neonatal deaths—and increases the risk of sudden infant death syndrome.[43]  Drinking during pregnancy can result in birth defects and mental retardation associated with fetal alcohol syndrome.[44]

The CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) includes questions on smoking and drinking during pregnancy.  According to PRAMS, Denver’s rate of smoking among women who gave birth from 1997-1999 (12 percent) was lower than in the rest of Colorado as well as in 13 of the 15 other states participating in PRAMS.  Only Georgia and New Mexico recorded lower rates.[45]  Other data from the National Center on Health Statistics show that the proportion of all Denver births to mothers who smoked dropped by half in the past decade.  Denver’s rate has remained below the national average since 1997.[46]

However, drinking rates among pregnant women in Denver (9.6 percent) and the rest of Colorado (9.0 percent) are considerably higher than in any of the other 15 states participating in PRAMS (which averaged 4.6 percent).[47]  Denver women account for almost a third of pregnant women in treatment for alcohol or other drug abuse in Colorado, according to statewide admissions records at treatment programs that report to ADAD.[48]

Adverse Health Impacts

Alcohol, tobacco and other drugs affect the health and well-being of Denver residents who use them as well as those who do not, while adding to the city’s health care costs.  Smoking greatly increases the risk of premature death from a number of chronic diseases, including cancer and heart and respiratory diseases.  Heavy drinking over prolonged periods can cause irreparable liver damage and a number of other often fatal diseases.  Even mild alcohol and other drug intoxication can impair driving ability and lead to motor vehicle crash injuries and deaths.  Acute alcohol and drug intoxication (overdose) can kill directly, and injection drug use is an important factor in the transmission of HIV and other types of infectious diseases.  The Denver Health and Hospital Authority (DHHA) estimates that at least 12 percent of its annual operating budget is devoted to services related to alcohol, tobacco and other drug abuse.  In FY2002, DHHA spent $35.9 million on medical care for patients with diagnoses directly attributable to smoking, drinking and other drug use, and another $9.1 million on alcohol detoxification and methadone maintenance treatment.[49]

Substance abuse also undermines families and puts children at risk of harm.  On any given day, an average of 1,900 Denver children are in out-of-home placements.  According to the Denver Department of Human Services, 71 percent of these cases are the result of parental substance abuse.[50]

The toll of substance use on Denver’s health can be measured in deaths, illnesses and injuries, drawing on data from various health surveillance systems.  One in every four deaths in the city is related to smoking, drinking or other drug use.[51]  Smoking is by far the leading killer, taking the lives of more than 800 Denver residents each year.[52]

Alcohol-related diseases and injuries in Denver claim 300 lives annually, while other drug use is responsible for an additional 100 deaths, including deaths from AIDS where the virus was transmitted by contaminated drug injection syringes.[53]  Overall, Denver’s death rate from alcohol and other drugs is double the rate in the rest of Colorado and 54 percent higher than the national rate.[54]

Illnesses and Deaths Attributable to Smoking and Drinking
Denver’s death rate from smoking is on par with the national average[55] but is significantly higher than in the rest of Colorado.  From 1994-1998, Denver’s smoking-related death rate was 40 percent higher than in the rest of the state.[56]

The severity of alcohol’s impact on the health of Denver residents is evident in trends in illnesses and deaths associated with heavy or prolonged alcohol use.  According to the NIAAA, the disease categories most closely associated with heavy and prolonged drinking are alcoholic psychoses, alcohol dependence syndrome, alcohol abuse, and chronic liver disease and cirrhosis. [57] Measured in terms of hospital discharges and deaths, the toll taken by these diseases in Denver is considerably more severe than in the rest of Colorado and nationwide.

Alcohol-Related Hospitalizations and Deaths
From 1994 through 1998, Denver residents accounted for more than 25 percent of all hospital discharges statewide in which the primary diagnosis was an alcohol-related disease.[58]   During this  period, the national rate of alcohol-related hospital discharges declined;[59] however, Denver’s rate rose, climbing to nearly double the national average by 1998 (35 per 10,000 residents age 15 and older, compared to 19 per 10,000).  Denver’s hospital costs also rose.  In 1998, Denver’s 1,500 alcohol-related hospitalizations amounted to more than 7,800 hospital days.[60]

Denver residents accounted for 27 percent of deaths statewide from 1994-1998 in which the underlying cause was alcohol-related.[61]  During that time, Denver’s death rate from drinking (24 deaths per 100,000 residents) was nearly double the rate nationwide (13 per 100,000).[62]

Alcohol-Related Motor Vehicle Crash Fatalities
The NIAAA estimates that more than one in three accidental falls and one in four accidental shootings nationwide are alcohol-related.[63]  Nationally, motor vehicle accidents are the most significant cause of accidental alcohol-related fatalities.[64]  Crashes involving alcohol are usually more severe than other types of crashes, involving higher speeds and frequent failure by the driver and passengers to wear seatbelts.[65]  From 1996-2000, Denver averaged 27 alcohol-related crash deaths per year, accounting for 11 percent of the statewide total.[66]  In 1999, the most recent year for which comprehensive data are available, Denver’s rate of alcohol-related crash fatalities was slightly higher than in the rest of the state but lower than the national average.[67]

Illnesses and Deaths Due to Drug Abuse
As with alcohol-related diseases, the adverse consequences of drug abuse can be tracked through hospitalizations and deaths.  In Denver, information on drug-related hospitalizations is gathered in terms of hospital discharges and in terms of emergency department episodes.  The Colorado Department of Public Health and Environment manages the state’s hospital discharge records.   SAMHSA operates the Drug Abuse Warning Network (DAWN), which tracks drug-related hospital emergencies and drug-related deaths in metropolitan areas across the country.

Drug-Related Hospital Discharges
From 1994-1998, Denver averaged nearly 500 hospital discharges where the primary diagnosis was drug related (including drug overdose, drug dependence, drug psychoses and nondependent abuse of drugs).[68]  During this period, Denver’s rate of drug-related hospital discharges was more than double the rate in the rest of the state (90 per 100,000 population, compared to 42 per 100,000). [69]   Drug overdose was the primary diagnosis in more than half of these discharges.[70]

Drug-Related Hospital Emergency Department Episode
DAWN tracks the total number of drug-related hospital emergency department (ED) episodes and mentions of particular drugs, including alcohol when it has been used in combination with another drug.  DAWN’s published reports provide information for entire metropolitan areas, including central cities and their surrounding counties.[71]  But for certain metropolitan areas, including Denver, DAWN data can be disaggregated to reveal trends in the central city itself.  For Denver,  DAWN shows considerably higher rates of drug-related hospital emergencies than the national average.  From 1996-2000, Denver averaged 563 drug-related hospital ED episodes per 100,000 residents age 6 and older, nearly 2½  times higher than the national average (227 per 100,000).[72]  Denver’s rates of mentions for alcohol-in-combination, cocaine, heroin, marijuana and methamphetamine were also well above the national averages.[73]

Unlike the hospital discharge data discussed above, DAWN drug episodes are recorded according to the location of the hospital where they occur, not according to the patient’s address.  In the Denver metropolitan area (Denver and neighboring Adams, Arapahoe, Douglas and Jefferson counties), hospitals within the city handle far more drug cases than their suburban counterparts.[74]  While Denver accounted for less than 30 percent of the metropolitan area population in the year 2000, city hospitals recorded the majority (54 percent) of the area’s 4,945 drug-related ED episodes, including 60 percent of cocaine mentions, 63 percent of methamphetamine mentions and 92 percent of heroin mentions.  Marijuana was the most notable exception to the rule; city hospitals recorded 31 percent of total marijuana ED mentions in the year 2000, with the majority occurring in the surrounding counties.

Drug-Related Deaths
Based on reports from medical examiners, DAWN also tracks deaths due to drug abuse in metropolitan areas across the country, including Denver and its surrounding counties.[75]  The number of drug deaths recorded in Denver surged from 72 in 1996 to 135 in 1999, before declining slightly to 123 in 2000.  Of the city’s 123 drug-related deaths in 2000, 95 were the direct result of drug abuse, such as overdoses.  In 28 other cases, drugs were a contributing factor but not the sole cause of death.  The majority of Denver’s drug-related deaths—61 percent in 2000—involved more than one type of drug, with cocaine, alcohol-in-combination and heroin predominating.[76]

DAWN’s drug-related mortality reports do not include a national average rate of drug-related deaths.  However, DAWN does report on drug-related deaths in several cities comparable in size to Denver, including Baltimore, New Orleans, St. Louis and Washington, D.C.  In 2000, Denver’s drug-related mortality rate exceeded the rates in New Orleans, St. Louis and Washington, D.C., while Baltimore’s rate far exceeded all the others.[77]

HIV and AIDS Incidence and Mortality
Denver accounts for more than half of the injection drug use (IDU) related HIV and AIDS cases in Colorado.[78]  Since the onset of the AIDS epidemic, 532  Denver residents diagnosed with IDU-related AIDS have died, accounting for more than half of such deaths statewide.  The 370 Denver residents with IDU-related AIDS who remain alive constitute 42 percent of living IDU-related AIDS cases in the state.

The rate of  new IDU-related AIDS  diagnoses in Denver substantially exceeds the rates in the rest of Colorado and nationally.  Although Denver’s rate of newly-diagnosed cases declined significantly from 1995-2000, the city still has a new diagnosis rate nearly five times higher than the rest of Colorado and more than double the U.S. rate.[79]  In addition, Denver’s death rate due to IDU-related AIDS remains substantially above the rate in the rest of the state and the nation. The city’s IDU-AIDS death rate was nearly 14 times higher than the rate in the rest of Colorado and nearly double the U.S. rate.[80]

Unmet Need for Treatment in Denver

No official estimate of treatment need exists for Denver.  On the basis of state and local  substance use survey results, treatment admissions data and indicators of adverse health consequences due to alcohol and drug use, Drug Strategies estimates that between 45,000 and 60,000 Denver residents age 12 and older need treatment for substance abuse and addiction.[81]  The fairly wide range of this estimate underscores that it is necessarily speculative, and based on extrapolations from a variety of different data sources.

About 2,000 Denver residents participate in community-based treatment annually, according to FY1998-2002 admissions data from programs that report to Colorado’s Alcohol and Drug Abuse Division (ADAD).[82]  (Programs required to report to ADAD include all those that receive any public funding, as well as all methadone maintenance programs and all juvenile justice programs.)  Another 1,500 Denver residents participate in treatment each year while on probation with the Denver Drug Court.[83]  In addition, 1,800 Denver residents take part in court-ordered drinking driver programs, and about 4,500 are admitted to detoxification programs.[84]  For many people dependent on alcohol or other drugs, detox is a critical first step in the treatment process.  Without subsequent treatment, however, detox alone is unlikely to lead to sustained periods of reduced substance use or abstinence.[85]

There is no recent estimate of the number of Denver residents participating in treatment at programs which are not required to report to ADAD and which do not serve Denver Drug Court probationers.  Based on past estimates, if another 3,500 people are assumed to be in treatment, then the total number of Denver residents in treatment over the course of a year rises to about 7,000.  By any measure, Denver has a very wide treatment gap.  At least 35,000 people who would benefit from treatment are not receiving it.

ENDNOTES:

[29].       RoperASW.  Social Education Survey, December 7 - December 9, 2001.  Conducted for the Council of Public Relations Firms.  Princeton, NJ: RoperASW, 2001.

[30].       Colorado Department of Public Health and Environment and U.S. Centers for Disease Control and Prevention.  The CDC sponsors the Behavior Risk Factor Survey (BRFS), which is administered annually in Colorado by the Department of Public Health and Environment.  According to BRFS results  for 1990-1999, an average of 26.1 percent of Denver adults were current cigarette smokers (ever smoked 100 cigarettes and currently smokes everyday or some days), compared to 22.5 percent of adults in the rest of Colorado and 22.8 percent of adults nationwide over the same years.  According to the BRFS, the rate of current smoking among Denver adults during the 1990s was therefore 16.0 percent higher than in the rest of Colorado and 14.5 percent higher than the national average.

[31].       Substance Abuse and Mental Health Services Administration.  Summary of Findings from the 2000 National Household Survey on Drug Abuse.  September 2001.

[32].       Colorado Department of Public Health and Environment and U.S. Centers for Disease Control and Prevention.  The CDC sponsors the Behavior Risk Factor Survey (BRFS), which is administered annually in Colorado by the Department of Public Health and Environment.  Since 1993, questions on alcohol use have been included in the Colorado survey every other year (e.g., 1993, 1995, 1997 and 1999).  According to BRFS results  for 1993, 1995, 1997 and 1999, an average of 20.7 percent of Denver adults engaged in binge drinking (five or more drinks on one occasion at least once during the past month), compared to 15.9 percent of adults in the rest of Colorado and 14.5 percent of adults nationwide on average over the same years.  The rate of binge drinking among Denver adults is therefore 30.2 percent higher than in the rest of Colorado and 42.7 percent higher than the national average.

[33].       Colorado Department of Public Health and Environment and U.S. Centers for Disease Control and Prevention.  The CDC sponsors the Behavior Risk Factor Survey (BRFS), which is administered annually in Colorado by the Department of Public Health and Environment.  Since 1993, questions on alcohol use have been included in the Colorado survey every other year (e.g., 1993, 1995, 1997 and 1999).  According to BRFS results  for 1993, 1995, 1997 and 1999, an average of 5.1 percent of Denver adults engaged in chronic drinking (at least 60 drinks in the past month), compared to 4.0 percent of adults in the rest of Colorado and 3.1 percent of adults nationwide.  The rate of chronic drinking among Denver adults is therefore 27.5 percent higher than in the rest of Colorado and 64.5 percent higher than the national average.

[34].       Substance Abuse and Mental Health Services Administration.  Youth Substance Use: State Estimates from the 1999 National Household Survey on Drug Abuse.  September 2001.  “Current” alcohol use is defined as having at least one drink in the past 30 days.

[35].       National Institute on Alcohol Abuse and Alcoholism.  Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977-98.  December 2000.

[36].       At 4.5 percent pure alcohol, an average 12-ounce beer contains .54 ounces of pure alcohol.  One gallon (128 ounces) of pure alcohol is equivalent to 237 12-ounce beers; 2.62 gallons or pure alcohol is therefore equal to 620.9 12-ounce beers per person per year, or 11.9 beers (nearly two six-packs) per person per week.

[37].       Substance Abuse and Mental Health Services Administration.  Summary of Findings from the 1999 National Household Survey on Drug Abuse.  Revised November 2000.  The state-by-state prevalence estimates in the 1999 NHSDA include measures of past-month use of any illicit drug, any illicit drug other than marijuana, and marijuana.  On all three measures, Colorado adults exhibited higher use rates than the national averages: 8.9 percent versus 6.4 percent for use of any illicit drug; 3.1 percent versus 2.7 percent for any illicit drug other than marijuana; and 7.4 percent versus 4.6 percent for marijuana.

[38].       Colorado Alcohol and Drug Abuse Division.

[39].       Colorado Department of Local Affairs.

[40].       Colorado Department of Public Health and Environment.  HIV & AIDS in Colorado: Colorado’s Epidemiologic Profile of HIV and AIDS Cases Reported Through March 2000.  August 2000.

[41].       Centers for Disease Control and Prevention. “Youth risk behavior surveillance—United States, 1995.”  Morbidity and Mortality Weekly Report, 45 (Surveillance Summary 4), September 1996.

[42].       G. R. Hanson.  “New Vistas in Drug Abuse Prevention.”  NIDA Notes, 16(6):3-4, February 2002.  According to Hanson, Acting Director of the National Institute on Drug Abuse:  “The impact of drug abuse prevention could be tremendous, especially in light of the fact that adolescence often is a critical period for initiation of drug abuse.  Most chronic drug abusers start experimenting with intoxication in adolescence or young adulthood.  While populations are constantly changing ... it remains generally true that people who do not abuse drugs during the decisive years before age 25 are unlikely ever to develop a serious drug problem.”

B. Grant & D. Dawson.  “Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey.”  Journal of Substance Abuse, 9:103-100, 1997.  According to Grant and Dawson, youth who begin to drink early (before age 15) are four times more likely to develop alcohol dependence than those who begin at age 21.  Each year’s delay in initiation of drinking greatly reduces the likelihood of later alcohol problems.

Substance Abuse and Mental Health Services Administration.  Summary of Findings from the 1999 National Household Survey on Drug Abuse.  Revised November 2000.  According to the 1999 National Household Survey on Drug Abuse, among adults who first used marijuana before age 15,  9 percent were dependent on an illicit drug in the past year, compared with fewer than 2 percent of adults who first tried marijuana at age 18 or older.

[43].       Centers for Disease Control and Prevention.  Pregnancy Risk Assessment Monitoring System (PRAMS) 1998 Surveillance Report.  2000.

[44].       Centers for Disease Control and Prevention.  Pregnancy Risk Assessment Monitoring System (PRAMS) 1998 Surveillance Report.  2000.

[45].       Colorado Department of Public Health and Environment and U.S. Centers for Disease Control and Prevention.  The CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS), administered in Colorado by the state Department of Public Health and Environment, includes questions on smoking and drinking during pregnancy.  Colorado’s annual PRAMS survey sample is large enough to permit specific estimates for pregnant women in Denver and those in the rest of the state, with results available for the years 1997-1999.  According to PRAMS, among Denver women who gave birth from 1997-1999, 12.1 percent smoked during the last three months of pregnancy, compared to 13.6 percent of women who gave birth in the rest of Colorado.  Denver’s 1997-1999 rate of smoking during pregnancy was lower than in all but two of the 15 other states participating in PRAMS in 1997 and 1998, with only Georgia (11.0 percent in 1997) and New Mexico (11.5 percent in 1998) recording lower rates.

[46].       Annie E. Casey Foundation.  The Right Start for America’s Newborns: A Decade of City and State Trends (1990-1999).  Baltimore, MD:  Annie E. Casey Foundation, 2002.  According to data from the National Center for Health Statistics (NCHS) as presented by the Annie E. Casey Foundation, between 1990 and 1999, the proportion of all Denver births to mothers who smoked during pregnancy dropped from 21.0 percent to 10.0 percent.  Denver’s percent of births to mothers who smoked dropped below the national average for the first time in 1997 (11.5 percent compared to 13.2 percent), and remained below the national average in 1998 (11.0 percent compared to 12.9 percent) and in 1999 (10.0 percent compared to 12.6 percent).

[47].       Colorado Department of Public Health and Environment and U.S. Centers for Disease Control and Prevention.  The CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS), administered in Colorado by the state Department of Public Health and Environment, includes questions on smoking and drinking during pregnancy.  Colorado’s annual PRAMS survey sample is large enough to permit specific estimates for pregnant women in Denver and those in the rest of the state, with results available for the years 1997-1999.  According to PRAMS, among Denver women who gave birth from 1997-1999, 9.6 percent drank alcohol during the last three months of pregnancy, compared to 9.0 percent of women who gave birth in the rest of Colorado.  Denver’s 1997-1999 rate of drinking during pregnancy was considerably higher than the rates recorded in any of the other 15 states participating in PRAMS (which averaged 4.6 percent).

[48].       OMNI Institute.  Colorado Prevention-Related Indicators Report: ADAD Planning Region 2.  July 1990.  (Produced by OMNI Institute for the Colorado Alcohol and Drug Abuse Division).

[49].       Denver Budget and Management Office and Denver Health and Hospital Authority.

[50].       Denver Department of Human Services.

[51].       Colorado Department of Public Health and Environment.  From 1994-1998, an average of 4,836 Denver residents died per year.  Based on CDPHE mortality data, 1,231 of these deaths (25.5 percent) were attributable to cigarette smoking (832 deaths); alcohol use (303 deaths); or other drug use (96 deaths, including 44 deaths due to injection drug use-related AIDS).

[52].       Colorado Department of Public Health and Environment.  “Cigarette smoking: The toll in Colorado.”  Health Statistics Section Brief No. 38. November 2000.  Among Denver residents from 1994-1998, smoking was the cause of an annual average of 832 deaths.

[53].       Colorado Department of Public Health and Environment.  For the period 1994-1998, Denver’s average annual number of alcohol-related deaths (303) and drug-related deaths (52) were calculated based on CDPHE data for specific conditions identified by NIAAA and NIDA and corresponding to particular codes in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).  For the same five-year period, the figure for Denver’s average annual number of injection drug use-related AIDS deaths (44) is based on data maintained by CDPHE’s HIV/STD Surveillance Program.  

[54].       Colorado Department of Public Health and Environment and National Center for Health Statistics.  From 1994-1998, Denver’s annual alcohol-related death rate of 58.5 per 100,000 and residents drug-related death rate of 18.5 per 100,000 residents totaled 77.0 deaths per 100,000 residents.  During this five-year period, Denver’s overall alcohol and drug-related death rate was twice as high as in the rest of Colorado (38.7 per 100,000) and 54 percent higher than the national average (50.0 per 100,000).

[55].       Colorado Department of Public Health and Environment.  “Cigarette smoking: The toll in Colorado.”  Health Statistics Section Brief No. 38. November 2000.

Centers for Disease Control and Prevention.  “Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1995-1999.”  Morbidity and Mortality Weekly Report, 51(14):300-303, April 2002.

The annual average U.S. smoking-attributable death rate from 1995-1999 was 165.2 deaths per 100,000 residents, slightly (2.9 percent) higher than Denver’s annual average rate for 1994-1998 (160.6 per 100,000).

[56].       Colorado Department of Public Health and Environment.  “Cigarette smoking: The toll in Colorado.”  Health Statistics Section Brief No. 38. November 2000.  From 1994-1998, Denver’s annual average smoking-attributable death rate (160.6 deaths per 100,000 residents) was 40.6 percent higher than the rate in the rest of Colorado (114.2 per 100,000).

[57].       National Institute on Alcohol Abuse and Alcoholism.  State Trends in Alcohol-Related Mortality, 1979-1992.  September 1996.

[58].       Colorado Department of Public Health and Environment.  From 1994-1998, Denver residents accounted for 26.5 percent of Colorado’s annual average of 4,083 hospital discharges in which the primary diagnosis was an alcohol-related disease.

[59].       National Institute on Alcohol Abuse and Alcoholism.  Trends in Alcohol-Related Morbidity Among Short-Stay Community Hospital Discharges, United States,  1979-1999.  December 2001.  From 1994-1998, the U.S. rate of alcohol-related hospital discharges declined steadily from 22.6 discharges per 10,000 population 15 and older to 19.3 per 10,000.   According to data maintained by CDPHE, Denver’s rate of alcohol-related hospital discharges rose from 21.1 per 10,000 in 1995 to 35.2 per 10,000 in 1998, 82.4 percent higher than the U.S. rate in 1998.

[60].       Colorado Department of Public Health and Environment.

National Institute on Alcohol Abuse and Alcoholism.  Trends in Alcohol-Related Morbidity Among Short-Stay Community Hospital Discharges, United States,  1979-1999.  December 2001.

In 1998, the 1,526 hospital discharges of Denver residents receiving medical care for alcohol-related diseases amounted to 7,837 hospital days, based on NIAAA’s national average length of stay estimates for various alcohol-related diseases.

[61].       Colorado Department of Public Health and Environment.

National Institute on Alcohol Abuse and Alcoholism.  State Trends  in Alcohol-Related Mortality, 1979-1992.  September 1996.

From 1994-1998, Denver accounted for 27.1 percent of Colorado’s 2,107 deaths in which the underlying cause was related to “very heavy and/or prolonged use of alcohol,” a term defined by NIAAA to include cirrhosis, alcohol dependence syndrome, nondependent abuse of alcohol, and alcoholic psychosis.

[62].       Colorado Department of Public Health and Environment and National Center for Health Statistics.

National Institute on Alcohol Abuse and Alcoholism.  State Trends  in Alcohol-Related Mortality, 1979-1992.  September 1996.

From 1994-1998, Denver’s average annual death rate due to “very heavy and/or prolonged use of alcohol,” (a term defined by NIAAA to include cirrhosis, alcohol dependence syndrome, nondependent abuse of alcohol, and alcoholic psychosis) was 23.8 deaths per 100,000 residents.  Denver’s rate was 1.89 times higher than the national average during the same five-year period (12.6 per 100,000).

[63].       National Institute on Alcohol Abuse and Alcoholism.  State Trends  in Alcohol-Related Mortality, 1979-1992.  September 1996.

[64].       National Center for Health Statistics.

National Institute on Alcohol Abuse and Alcoholism.  State Trends  in Alcohol-Related Mortality, 1979-1992.  September 1996.

NIAAA estimates that 42 percent of motor vehicle traffic and non-traffic accident fatalities nationwide are alcohol-related.  From 1994-1998, according to data maintained by the National Center for Health Statistics, alcohol-related motor vehicle crash fatalities were the single leading cause of alcohol-related accidental deaths nationwide, averaging 8.1 deaths per 100,000 population.

[65].       According to the Colorado State Patrol, in the year 2000, 59 percent of motor vehicle crashes caused by driving under the influence (DUI) resulted in fatalities or injuries.  When DUI was not the cause of the crash, 31 percent resulted in fatalities or injuries.

[66].       Denver Police Department and National Highway Traffic Safety Administration.  From 1996-2000, Denver averaged 27 alcohol-related crash fatalities per year, 11.4 percent of the statewide average of 234 fatalities per year. 

[67].       Denver Police Department and National Highway Traffic Safety Administration.  In 1999, Denver had 6.3 crash fatalities per 100,000 registered vehicles, slightly higher than the rate in the rest of Colorado (6.1 per 100,000) but lower than the national rate (7.5 per 100,000).

[68].       Colorado Department of Public Health and Environment.  From 1994-1998, Denver averaged 487 hospital discharges per year in which the primary diagnosis was drug-related.

[69].       Colorado Department of Public Health and Environment.  From 1994-1998, Denver’s annual average rate of hospital discharges in which the primary diagnosis was drug-related was 90.0 per 100,000 residents, 2.15 times higher than the rate in the rest of Colorado (41.8 per 100,000).

[70].       Colorado Department of Public Health and Environment.  From 1994-1998, of Denver’s annual average of 487 hospital discharges in which the primary diagnosis was drug-related, 270 (55.4 percent) were due to drug overdose.

[71].       Substance Abuse and Mental Health Services Administration.  Year-End 2000 Emergency Department Data from the Drug Abuse Warning Network (DAWN).  July 2001.

[72].       Substance Abuse and Mental Health Services Administration.  Year-End 2000 Emergency Department Data from the Drug Abuse Warning Network (DAWN).  July 2001.  The published DAWN report provides hospital emergency department (ED) data for 21 metropolitan areas in their entirety, without distinguishing between trends in each metro area’s central city and its surrounding counties.  SAMHSA’s Office of Applied Studies  provided Drug Strategies with hospital emergency department data for the City & County of Denver and for the surrounding counties separately.

[73].       The Substance Abuse and Mental Health Services Administration’s Office of Applied Studies provided Drug Strategies with hospital emergency department (ED) data for the City & County of Denver and for the surrounding counties separately.  Denver’s rates can be compared to the national averages.  From 1996-2000, Denver’s rate of alcohol-in-combination ED mentions was 2.6 times higher the national rate (199.3 mentions per 100,000 population age 6 and older, compared to 76.6 per 100,000).  Over the same five-year period, Denver’s rate of cocaine mentions was 2.5 times the national rate (174.3 vs 68.8 per 100,000); Denver’s rate of heroin mentions was 3.1 times the national rate (103.2 vs 33.6 per 100,000); Denver’s rate of marijuana mentions was double the national rate (63.1 vs 31.4 per 100,000); and Denver’s rate of methamphetamine mentions was 3.5 times the national rate (18.5 vs 5.3 per 100,000).

[74].       The Substance Abuse and Mental Health Services Administration’s Office of Applied Studies provided Drug Strategies with hospital emergency department (ED) data for the City & County of Denver and for the surrounding counties separately.

[75].       Substance Abuse and Mental Health Services Administration.  Mortality Data From the Drug Abuse Warning Network, 2000.  January 2002.

[76].       Substance Abuse and Mental Health Services Administration.  Mortality Data From the Drug Abuse Warning Network, 2000.  January 2002.  Denver’s 123 drug deaths in 2000 included 239 drug mentions, 59 percent of which were cocaine (57 mentions), alcohol-in-combination (45 mentions), and heroin (40 mentions).

[77].       Substance Abuse and Mental Health Services Administration.  Mortality Data From the Drug Abuse Warning Network, 2000.  January 2002.  In 2000, Denver’s drug-related mortality rate (22.2 deaths per 100,000 population) exceeded the rates in New Orleans (21.3), St. Louis (21.3) and Washington, D.C. (17.5), while Baltimore’s rate (55.3) far exceeded all the others.

[78].       Colorado Department of Public Health and Environment.  Through June 2001, Denver had recorded 902 cases of AIDS in which exposure to HIV infection was related to injecting drug use (IDU).  Drugs were also a factor in the transmission of HIV among another 756 Denver residents who have tested positive for the virus but have not yet been diagnosed as having AIDS.  Denver’s cumulative total of 1,658 cases of IDU-related HIV and AIDS accounted for 53.5 percent of such cases in Colorado.

[79].       Colorado Department of Public Health and Environment and U.S. Centers for Disease Control and Prevention.  Although Denver’s rate of newly diagnosed drug-related AIDS cases fell from 15.4 per 100,000 population in 1995 to 8.8 in the year 2000, it was still nearly five times higher than the year 2000 rate for the rest of Colorado (1.8) and more than double the year 2000 U.S. rate (4.1 per 100,000).

[80].       Colorado Department of Public Health and Environment and U.S. Centers for Disease Control and Prevention. At 5.5 deaths per 100,000 residents in 1999, Denver’s IDU-related AIDS death rate was nearly 14 times higher than the rate in the rest of Colorado (0.4) and nearly double the U.S. rate (2.9).

[81].       Colorado Department of Human Services, Alcohol and Drug Abuse Division.  Alcohol and Drug Use and Abuse in Colorado, 1995.  1998.

Substance Abuse and Mental Health Services Administration.  Summary of Findings from the 1999 National Household Survey on Drug Abuse.  Revised November 2000.

SAMHSA’s 1999 National Household Survey on Drug Abuse (NHSDA) estimated that 5.5 percent of Colorado residents ages 12 years and older were dependent on alcohol or illicit drugs during the past year.  For  reasons having to do with the accuracy of self-report surveys (see below), NHSDA’s estimate should be considered the lower bound of the true rate of alcohol and illicit drug dependence in Colorado, i.e., no less than 5.5 percent of Coloradans were dependent in 1999.

ADAD’s 1995 Colorado household survey found that 8.0 percent of Coloradans ages 18-59 were dependent on (5.2 percent) or abusive of (2.8 percent) alcohol or drugs, yielding a total of 8.0 percent considered in need of treatment for substance abuse.  Although the age groups considered in each survey differed, the dependence estimates (5.5 percent for the 1999 survey, 5.2 percent for the 1995 survey) were similar.  Like the NHSDA, the results of ADAD’s 1995 Colorado household survey should be considered the lower bound of the true rate of substance abuse and dependence in Colorado.  Moreover, ADAD’s 1995 survey did not include residents ages 12-17, a group whose rates of substance abuse and dependence were higher than most other age groups in previous statewide surveys.  The 8.0 percent figure should therefore be considered a conservative estimate of the extent of treatment need in Colorado.

Both the NHSDA and ADAD 1995 household survey are based on respondents’ self-reports about types of behavior that are often stigmatized and, in some cases, illegal.  This stigma is generally understood to lead to an unknown—and probably not insignificant—number of inaccurate responses, tending toward producing prevalence estimates that are lower than the real levels.  The social unacceptability of the behaviors being surveyed suggests that those who refuse to respond are, as a group, more likely to be smoking, drinking or using illicit drugs than those who do respond.  This is not a trivial problem:  Each year, about 20 to 25 percent of selected individuals do not respond to the NHSDA questionnaire.  The data that is actually collected can shed no light on the behavior of the non-respondents, but it is reasonable to believe that those who fail to respond use the surveyed substances more frequently (and probably in greater amounts) than those who do respond, on and whose self-reports the estimates are entirely based.

Lacking any Denver-specific estimate of substance abuse and dependence (treatment need), the 1995 ADAD survey figure of 8.0 percent (corroborated by the 1999 NHSDA dependence estimate) can serve as a point of reference for calculating a plausible estimate of the number of Denver residents in need of treatment for substance abuse.  Simply applying the 8.0 percent ADAD figure for Colorado to the current number of Denver residents 12 years and older (472,788 in 2002, according to the Colorado Department of Local Affairs) would yield an estimate of about 37,800 city residents in need of treatment for substance abuse and dependence.  However, given that the 8.0 percent rate for Colorado should be interpreted as the lower bound, and given numerous measures suggesting that alcohol and other drugs are bigger problems in Denver than in the rest of the state, there are strong reasons to believe that the number of Denver residents in need of treatment is substantially higher than 37,800.  As detailed in Chapter II of this report, Denver’s alcohol and illicit drug use rates are typically higher than in the rest of Colorado, and the health impacts—as measured in illnesses and deaths—are considerably more severe.

Rates of chronic drinking have typically been higher among Denver adults than in the rest of Colorado (29.3 percent higher in the 1990s).  The adverse health consequences of heavy drinking have also been greater.  Denver’s rate of hospital discharges in which the primary diagnosis is alcohol-related has been consistently more than double the rate in the rest of Colorado (2.3 times higher in the 1990s).  So too for Denver’s death rate from diseases in which alcohol is the underlying cause (2.4 times higher than the rate in the rest of the state in the 1990s).

With respect to illicit drug use, survey data are lacking, but treatment admissions data suggest a  higher prevalence of cocaine and heroin use among Denver residents than elsewhere in Colorado.  Denver residents enter treatment for cocaine or heroin abuse at far higher rates than do other Colorado residents (2.3 times higher from FY1998-2002).  Also, illnesses and deaths associated with illicit drug use occur more frequently among Denver residents.  Rates of hospital discharges related to drugs (overdose, dependence, psychosis, and nondependent abuse) are typically double the rate in the rest of the state (2.1 times higher in the 1990s).  And Denver’s rate of drug-related deaths is typically about triple the rate in the rest of Colorado (3.4 times higher in the 1990s).  Moreover, Denver’s death rate due to injecting drug use-related AIDS was 8.8 times higher than in the rest of Colorado from 1990-2000.

Each of these measures attest to the comparatively greater severity of alcohol and other drug problems in Denver, and together they provide good reason to believe that a higher proportion of the city’s residents meet the criteria of alcohol or drug dependence or abuse than 8.0 percent 1995 estimate for Colorado as a whole.  Drug Strategies therefore estimates that somewhere in the range of 9.5 to 12.7 percent of Denver residents age 12 and older (between 45,000 and 60,000 people) are in need of treatment, a range that is between 20 and 60 percent higher than the 37,800 estimate resulting from simply applying the 8.0 percent figure to Denver’s current population.

The fairly wide range of this 45,000-60,000 treatment need estimate underscores that it is necessarily speculative, and based on extrapolations from a variety of different data sources.  If anything, this estimate is conservative, given the reliance on self-report survey data.  The true number of Denver residents in need of treatment is unlikely to be any lower than 45,000; on the other hand, if Denver’s substance abuse problems are considered to be 80 percent to 100 percent more severe than in the rest of Colorado (rather than the 60 percent used to derive the 60,000 estimate), then as many as 68,000 or 75,000 Denver residents would be considered in need of treatment.

Colorado Alcohol and Drug Division and Office of Denver Adult Probation.  About 2,000 Denver residents participate in community-based treatment annually, according to FY1998-2002 admissions data from programs that report to Colorado’s Alcohol and Drug Abuse Division (ADAD).  (Programs required to report to ADAD include all those that receive any public funding, as well as all methadone maintenance programs and all juvenile justice programs.)  Another 1,500 Denver residents participate in treatment each year while on probation with the Denver Drug Court.  In addition, 1,800 Denver residents take part in court-ordered drinking driver programs, and about 4,500 are admitted to detoxification programs. (For many people dependent on alcohol or other drugs, detox is a critical first step in the treatment process.  Without subsequent treatment, however, detox alone is unlikely to lead to sustained periods of reduced substance use or abstinence.)  There is no recent estimate of the number of Denver residents participating in treatment at programs which are not required to report to ADAD and which do not serve Denver Drug Court probationers.  Based on past estimates, if another 3,500 people are assumed to be in treatment, then the total number of Denver residents in treatment over the course of a year rises to about 7,000.

[82].       Colorado Alcohol and Drug Abuse Division.  ADAD’s Drug and Alcohol Coordinated Data System (DACODS) includes client admission and treatment exit records from publicly funded service providers in the state.  An unduplicated count of admissions provides the number of individuals who enter treatment over the course of a year, given that some individuals may enter treatment more than once during the same year.  The unduplicated count will therefore be lower than the total number of admissions recorded over the course of a year.  For the five-year period from fiscal year (FY) 1998 through FY2002, an annual average of 1,873 Denver residents entered treatment (not including detoxification) at programs reporting to ADAD (FY2002 data are based on admissions for the first half of the fiscal year).  Over this period, there was a steady downward trend until FY2002, with the number of Denver residents entering treatment falling from 2,271 in FY1998 to 1,503 in FY2001, a 33.8 percent drop.  Based on admissions for the first half of FY2002, the total number of Denver residents entering treatment for the entire year would be 1,978, a return to the level of FY1999 (but still 12.0 percent below the FY1998 level).

[83].       Office of Denver Adult Probation.

[84].       Colorado Alcohol and Drug Division.

[85].       G. Chang & T. R. Kosten.  “Detoxification,” in J. H. Lowinson et al. (eds), Substance Abuse: A Comprehensive Textbook, 3rd Edition.  Baltimore: Williams and Wilkins, 1997. 


Introduction | Impact on Health | Impact on Crime
Economic Costs | Policy and Programs
Looking to the Future | Data Tables | Sources



© Drug Strategies, 2002