Guest MINDSETTER™ Fine: How Many Drugs & How Much Alcohol Do Rhode Islanders Use?

Guest MINDSETTER™ Fine: How Many Drugs & How Much Alcohol Do Rhode Islanders Use?

Too many Rhode Islanders are using drugs and alcohol. Most experts believe that two to four percent of us are dependent on or addicted to drugs and close to eight percent of us are addicted to alcohol at any one time. About a hundred thousand of us – 10 percent – are susceptible to dependence and addiction, a susceptibility that comes from a mixture of genetic, social, and psychological risk factors. Which means ninety percent of us – the great majority -- can and do use drugs and alcohol relatively safely, confusing the debate, as few of us want to give up a freedom to use substances that create relaxation and enjoyment in order to protect others from a potential harm.  But no one who drinks or uses or smokes knows with any certainty whether they are at risk before they smoke, drink, or use.

More 110,000 Rhode Islanders – eleven percent  –  use a prescription medication with potential for abuse every month (opiates, benzodiazepines, and stimulants).  At least a third of those – or about 30,000 Rhode Islanders, are using those drugs for non-medical purposes. While we can count the number of doses prescribed and the number of people who got those prescriptions, we have no way to count how many people consume alcohol month by month, how much marijuana is consumed, or how much heroin, cocaine, fentanyl, and other street drugs are being consumed. There are yearly measures of per capita alcohol consumption (and Rhode Island is just about five percent above average, from the perspective of yearly consumption) – but those measures get to us too late to impact the way we address alcohol use today.

The best information we have about how many Rhode Islanders use is from survey data, which is not as precise a measure as actual measures of consumption, but it is the best we have. Those data tells a worrisome story.  In 2014, Rhode Islanders had among the highest number of drugs and alcohol users per capita in the nation. 7.7 percent of us, or 69,000 Rhode Islanders over the age of 12 were dependent on or abused alcohol. 3.4 percent of us, or 30,000 Rhode Islanders, reported being dependent on or abusing illicit drugs.  And 12.75 percent of us, or about 114,000 Rhode Islanders, reported using marijuana in the last month.  There are also 13,126 Rhode Islanders authorized to possess marijuana in Rhode Island and they are authorized to possess 32,815 ounces – or just over one ton – of marijuana at any one time.

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Taken together with our prescription drug use, between 114,000 and almost 325,000 Rhode Islanders are using or report the use of some form of potentially addictive substance monthly – and that doesn’t include casual drinkers. Between 114,000 and 243,000 Rhode Islanders are using drugs illicitly or are dependent on or abuse alcohol. (The range is provided because many people use, and die from the use of, multiple substances. The real number is probably in the middle of the range, likely close to 200,000.) That suggests that more than one third of the 895,345 Rhode Islanders aged 12 and over are using something, and one quarter of us are doing that illicitly, habitually or are dependent or addicted.  Yikes.

Some people will object that many people are moderate, stable users.  I’m an adult, people say, I can control my own use. While that may be true for individuals, it doesn’t explain the association between our collective use and drug overdose death.  We have to entertain the notion that our culture of use may be creating an environment in which more people start, more people use, and more people progress to addiction and death. It may be helpful to think of use, dependency, addiction, and death as if drug and alcohol use were a contagious disease. If one person had a disease and dies, that’s a tragedy.  If the disease spreads, and people get it from one another, that’s a public concern, which requires public attention and public intervention.

If no one were using or dependent on drugs and alcohol, no one would be overdosing.
 
 

Michael Fine, M.D. was Director of the Rhode Island Department of Health 2011-2015.  He is a family physician.