Epidemics in the Justice System: Alcohol and Rural CourtsLinda L. Chezem, JD

Purdue UniversityIndiana Alcohol Research Center at Indiana University School of Medicine

Public Health

United States 2001 Alcohol Harmful Effects

0

500000

1000000

1500000

2000000

2500000

Total

HarmfulEffects

Chronic

Acute

Alcohol Attributable Death

Minnesota 2001

0

200

400

600

800

1000

1200

Male Female Total

Total for All Causes

Chronic Causes

Acute pancreatitis

Alcohol abuse

Alcohol cardiomyopathy

Alcohol dependence syndrome

Alcohol polyneuropathy

Alcohol-induced chronic pancreatitis

Alcoholic gastritis

Alcoholic liver disease

Alcoholic myopathy

Alcoholic psychosis

Breast cancer (females only)

Cholelithiases

Chronic hepatitis

Chronic pancreatitis

Degeneration of nervous system due to alcohol

Epilepsy

Esophageal cancer

1.9 1.9

2.3

5.4

1.6

0.7

1.1

2.3

2.8

2.1

7.4

5.9

0.2

4.8

0

1

2

3

4

5

6

7

8

Male Female White NativeAmerican

Hispanic Black Asian

Pre

vale

nce

(%

)

Urban

Rural

Past-Year DSM-IV Alcohol Dependence Among 12-to-17 Year-Olds by Sex, Race-Ethnicity and Urbanicity

10.0

9.2

12.3

13.5

8.0

3.42.7

12.5

10.8

12.4

13.913.3

4.8

6.0

0

2

4

6

8

10

12

14

16

Male Female White NativeAmerican

Hispanic Black Asian

Pre

vale

nce

(%

)

Urban

Rural

Past-Year Binge Drinkers Among 12-to-17 Year-Olds by Sex, Race-Ethnicity and Urbanicity

30.4

35.236.5

31.5

33.5

22.9

18.9

34.2

36.9 37.1 36.7 37.2

21.7

28.5

0

5

10

15

20

25

30

35

40

Male Female White NativeAmerican

Hispanic Black Asian

Pre

vale

nce

(%

)

Urban

Rural

Past-Year Drinkers Among 12-to-17 Year-Olds by Sex, Race-Ethnicity and Urbanicity

Public Health Core Functions

Assessment Surveillance (how many alcohol related cases in the

courts?) Detection of alcohol use in underage or other at risk

population Policy Development

Inform, educate, and empower people about alcohol in the justice system and the health issues

Mobilize community partnerships and action to identify and solve health problems (e.g., convening and facilitating community groups to promote health about alcohol).

Assurance (about alcohol and health)

Enforce alcohol laws and regulations that protect health and ensure safety.

Evaluate effectiveness, accessibility, and quality of personal and population-based health services (e.g., continuous evaluation of public alcohol health programs).

Research for new insights and innovative solutions to alcohol problems (e.g., links with academic institutions and capacity for epidemiologic and economic analyses). 

Evaluate impact of alcohol response in the justice system

First Step

Articulate the public health impact of alcohol. Determine the impact of alcohol in the

community. Seek to better understand the public health

role of courts when alcohol is involved.

Justice System More than 20,000 Courts in US have jurisdiction

over alcohol related cases.

Fewer than 2000 drug courts in US

Dissolutions

Civil

Criminal

JuvenileProbate

Civil

Rural Courts

Cannot stand alone "The life of the law has not been logic: it has

been experience." Oliver Wendell Holmes from The Common Law, 1881

Research that applies to rural communities is essential Utilize Help set agenda

All courts are alcohol courts.

Courts are the RURAL Community Agents for INTERVENTION AND TREATMENT.

Should people have to go to court for alcohol health services?

Do rural populations have geographical and economic access to honest EVIDENCE BASED TREATMENT?

Can Drug Courts Go Country ?

Debatable (approximately 1700 courts) GAO report Only as good as the treatment provider?

Not easily transportable Limited number of judges Extremely limited justice resources Evidence based assessment and treatment

services Community dynamics

Alcohol fuels the justice system. Alcohol Alcohol plus other drugs Alcohol plus mental illness

All of the above add up to an overwhelming impact on justice.

What Research is Rural?

Not enough studies are conducted in rural communities.

Federal research dollars and foundation grants do not adequately include rural targets.

Rural and non urban communities are invisible in much research.

CAN community based urban research apply to rural?

Alcohol Law

Enforcing Underage Drinking Laws Prosecution of under 21

for possession or consumption of alcohol. Under 18 go to juvenile

court. Over 21 go to adult

court.

Underage Drinking

Alcohol is the most commonly used drug by children and adolescents.

Teens who use alcohol and drugs are more likely to be involved in violent behaviors.

Is the violence connection true for rural children and adolescents?

Supporting Research

NESARC Data. Teenagers who begin drinking before age 15

have four times the risk of developing alcohol dependence later in life.

Adolescents with histories of extensive alcohol use have noticeable changes in brain function that impair learning, memory, and problem solving; smaller hippocampal volume.

EUDL: What Works? Law is to prevent youthful

consumption. Office of Juvenile Justice

and Delinquency Prevention program.

360,000 to each state and discretionary grants of $1 million.

Required to have justice system participate in community coalition

Research Response NIAAA is evaluating the

EUDL program in rural communities of 7 states to determine the effectiveness of programs.

The “National Evaluation” Excluded communities of under 50,000.

Why Do We Need Research?

Difficult to enforce Uneven Lack of police resources

Legal process is expensive

Results can be harsh

Community programs have limited resources.

Communities have limited attention spans.

Rural Research Needed

What prevention programs can be effective in rural settings?

Who needs intervention and treatment in rural communities?

How can service delivery be economically accessible?

What are barriers to research? Can methodologies be developed to

compensate for small numbers?

Fetal Alcohol

Law and policy not supported by research. Punitive laws used to prevent mother from

drinking may be more harmful. Laws are unenforceable. Research about rural and small town

attitudes indicates need for more studies.

Rural Questions about FASD

Purpose: This 2-part study examines gender differences in attitudes and perceived barriers to intervention in a large community sample of persons living in rural and small-town environments in Kentucky (n = 3,346). The study also examines rural/small-town prenatal service providers' perceptions of barriers to assessment and intervention with pregnant substance abusers (n = 138).

Findings: Overall results of the community sample suggest that neither males nor females were knowledgeable about the harmful effects of alcohol use during pregnancy. Results also indicate substantial gender differences in alcohol attitudes, knowledge, and perceived barriers. Further, prenatal care providers identified several barriers in assessment and treatment of pregnant women with alcohol use problems in rural and small-town communities, including lack of knowledge and comfort with assessment as well as a lack of available and accessible treatment for referrals.

Cite

Rural and small-town attitudes about alcohol use during pregnancy: A community and provider sample Logan TK, Walker R, Nagle L, Lewis J, Wiesenhahn D JOURNAL OF RURAL HEALTH 19 (4): 497-505 FAL 2003 Abstract: Context: While there has been considerable research on prenatal alcohol use, there have been limited studies focused on

women in rural and small-town environments. Purpose: This 2-part study examines gender differences in attitudes and perceived barriers to intervention in a large

community sample of persons living in rural and small-town environments in Kentucky (n = 3,346). The study also examines rural/small-town prenatal service providers' perceptions of barriers to assessment and intervention with pregnant substance abusers (n = 138).

Methods: Surveys were administered to a convenience sample of employees and customers from 16 rural and small-town community outlets. There were 1503 males (45%) and 1843 females (55%) ranging in age from under 18 years old to over 66 years old. Surveys also were mailed to prenatal providers in county health departments of the 13-county study area, with 138 of 149 responding.

Findings: Overall results of the community sample suggest that neither males nor females were knowledgeable about the harmful effects of alcohol use during pregnancy. Results also indicate substantial gender differences in alcohol attitudes, knowledge, and perceived barriers. Further, prenatal care providers identified several barriers in assessment and treatment of pregnant women with alcohol use problems in rural and small-town communities, including lack of knowledge and comfort with assessment as well as a lack of available and accessible treatment for referrals.

KeyWords Plus:LOW-BIRTH-WEIGHT, SUBSTANCE-ABUSE, DRINKING, LIFE, RISK, CONSEQUENCES, PREVENTION, BEHAVIOR, CHILDREN, GROWTH

Addresses: Logan TK, Univ Kentucky, Ctr Drug & Alcohol Res, Dept Behav Sci, 1151 Red Mile Rd,Suite 1-A, Lexington, KY 40504 USA Univ Kentucky, Ctr Drug & Alcohol Res, Dept Behav Sci, Lexington, KY 40504 USA Bluegrass Reg Mental Hlth Mental Retardat Board I, Lexington, KY USA

NCJFCJ

SPRING 2004 – VOLUME 55 – NO. 2 FETAL ALCOHOL SPECTRUM DISORDERS

(FASD) AND THE ROLE OF FAMILY COURT JUDGES IN IMPROVING OUTCOMES FOR CHILDREN AND FAMILIES

by Diane V. Malbin Abstract: Fetal Alcohol Spectrum Disorder (FASD) is

a physical disability that is 95% under diagnosed and 40 times over-represented in juvenile justice.

My Suggestions

DEMAND research that is relevant and applicable to the rural communities.

Consider the appropriate role of the courts around alcohol abuse and dependence and the unique circumstances of the rural courts.

Promote a better understanding of rural alcohol issues as systemic public health concerns.

Alcohol use disorders are an epidemic that the justice system cannot prevent nor cure.

….

But the community can