Hancock County Substance Abuse Prevention Plan - Maine

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Hancock County Substance Abuse Prevention PlanPartners: Hancock County Planning Commission Hancock County Sheriff’s Office Bucksport Bay Healthy Communities Healthy Peninsula Healthy Acadia Union River Healthy Communities WEBSITE: www.healthyhancock.orgRevised: 11/01/07

Table of ContentsExecutive Summary . 4Introduction. 5The Case for a Coordinated Substance Abuse Prevention Plan . 5How to use the Hancock County Substance Abuse Prevention Plan. 6Strategic Prevention Framework. 6CMCA – A Science Based Intervention Paradigm. 8Methodology for Prevention Planning in Hancock County. 9State of the County. 11Understanding Place . 11Population . 11Economy . 13Conclusions. 14Substance Abuse over the Life Course . 14Protective and Risk Factors for Youth. 16Indicators and Correlates of Substance Abuse – Youth to Young Adults. 17Substance Abuse . 17Illegal and High Risk Activity . 20High School Completion. 21Substance Abuse and Other Criminal Activity. 22Indicators and Correlates of Substance Abuse –Adults. 24Indicators and Correlates of Substance Abuse –Seniors. 29SPEP Outreach Process and Findings. 30A Plan for Substance Abuse Prevention . 31Overview. 31Vision for Hancock County . 31Goals, Intervening Variables and Strategies. 32Resource Matrix for Hancock County . 321. Underage Drinking. 332. High Risk Drinking. 353. Elder Alcohol Abuse. 374. Illegal Drug Use. 395. Prescription Drug Misuse . 406. Marijuana Prevention. 41Connecting Resources to Strategies. 42Types of Organizations . 42Age Groups . 42Intervening Variables. 42Resources . 43Cultural Competency . 43Implementation . 50Creating a Work Plan. 50Sample Memoranda of Understanding . 51Appendices. 52Appendix 1: Resource Matrix Spreadsheet (Excel format) . 522

Appendix 2: Three Year Action Plans for Select Partners . 52Appendix 3: Memoranda of Understanding for Select Partners. 52Appendix 4: Healthy Hancock (Circ. 2005 –Major organizational changes in 2007 are notreflected in this chart). 533

Executive SummaryHancock County faces serious challenges and opportunities as we grapple with substance abuseand the epidemic of underage drinking. Everyone is affected directly or indirectly by drug andalcohol abuse. Abusers face a myriad of problems, but so do their families, friends and widercommunities.The Hancock County Substance Abuse Prevention Plan (HC-SAPP) provides readers with anoverview of the problems we are confronting, a snap shot of people and programs that areworking to prevent and resolve problems associated with substance abuse and strategies forreducing problems in the future.Readers are encouraged to join in the prevention effort. To this end, the plan offers modelvoluntary agreements that will help us to structure our efforts to prevent substance abuse in thefuture.4

IntroductionThe Case for a Coordinated Substance Abuse Prevention PlanThis Substance Abuse Prevention Plan for Hancock County brings together an assessment ofour current situation and proposes six major goals addressing a diverse range of concerns: Underage DrinkingHigh risk substance abuseElderly Substance Abuse Illegal drug usePrescription Drug AbuseMarijuana AbuseA comprehensive substance abuse intervention plan should include elements of prevention,interdiction, enforcement and treatment. This plan is focused primarily on prevention, butendorses techniques, such as consistent enforcement of laws that have effects beyond prevention.Hancock County has great needs and many assets to prevent substance abuse. The datapresented in the plan suggest that substance abuse, school dropout rates and crime have beenincreasing in Hancock County. Concentrated local enforcement efforts such as targetingunderage drinking parties are effective, but problems often emerge in new locations or newforms.Even a casual look at the local news points to the regional nature of the substance abuse problem.Drug arrests, often occurring in Ellsworth, involve residents of multiple outlying towns as wellas visitors from other states. The supply chain for drugs and alcohol often begins far away, butmost often ends where there is a critical mass of customers. Each drug or form of alcoholicbeverage has a unique supply chain.Recognizing that substance abuse is a statewide problem with regional and local consequences,the Maine Office of Substance Abuse is working with the Maine Center for Disease Control todevelop regional public health infrastructure to assist local, county and state agencies throughcoordinated prevention efforts.The 2006–2010 Maine Substance Abuse Prevention Plan states,“The goal of this grant is ambitious - to prevent the onset and reduce the progression ofsubstance abuse across the lifespan by taking a public-health approach. To meet thesegoals, the SPF-SIG is based on outcomes-based prevention efforts that focus at thepopulation-level on the consumption of alcohol and other drugs and their consequences.(OSA SPF, 2006)5

How to use the Hancock County Substance Abuse Prevention PlanThis plan is directed to a wide audience. We are all affected by substance abuse and we all havea role in prevention. Local leaders play a particularly important role in creating an open andcollaborative atmosphere. Leaders come from many domains, including state and localgovernment, schools, health care, private voluntary organizations, businesses and families. Thisplan engaged people who work every day in related fields, including substance abuse treatment,law enforcement, community health promotion and substance abuse treatment. While the planidentifies issues, intervening variables and general strategies, it does not prescribe specificactions for all stake holders. We encourage people who are engaged in “doing” this good work totake time to see how their work can fit into the goals, objectives and strategies described here.Section 1: The State of the County identifies substance abuse trends in Hancock County andrelated patterns such as crime, education and health. We also consider existing regionalprograms that are engaged in the effort to prevent substance abuse and reduce the negativeconsequences where they occur. Where possible, this analysis is presented in relationship to thepopulation “at risk” of substance abuse. This analysis looks at children and teens, young adults,middle age adults and seniors separately where applicable.Section 2: Programs for Substance Abuse Prevention describes how the public is involved increating a healthier future. Community and school leaders, community health advocates,business and law enforcement are collaborating to create new programs and better coordinateexisting programs to prevent substance abuse. Public participation is a key to understanding thecultural factors related to substance abuse and building our regional cultural competence.Section 3: Vision, Goals, Objectives and Strategies is a plan for our communities to worktogether to prevent and reduce substance abuse. The plan concludes with voluntary agreementsor memorandum of understanding (MOU) that will help us to structure our efforts to preventsubstance abuse in the future.Strategic Prevention FrameworkThe Maine Strategic Prevention Framework (SPF) Plan is being implemented through a series ofstate level initiatives supported at the local level through Strategic Investment Grants (SIG). TheMaine Office of Substance Abuse led the effort to write the 2006 Substance Abuse PreventionStrategic Prevention Framework Plan. This plan adopts intermediate and long term outcomes.The SPF provides a framework for local and regional initiatives, but does not prescribe detailedsolutions.6

Major Outcomes Expected to Result from Strategic PlanIntermediate Outcomes Strengthen state level substance abuse prevention infrastructure Strengthen local level substance abuse prevention infrastructure Primary and secondary prevention efforts result in positive changes in skills, beliefs,knowledge, attitudes, perceptions and norms within the communitiesLong Term Outcomes Decrease in alcohol and other drug abuse, including: high risk drinking, marijuana,prescription medications, and methamphetamine Decrease in morbidity, mortality, injury, and disability related to substance use/abuse(source: OSA SPF, 2006)The state plan stresses scientifically measurable goals and objectives stated as a series ofoutcomes. The matrix that follows provides a summary of adopted strategies, short-term,intermediate and long term outcomes.The State Plan targets consumption outcomes:1. Reduce high-risk drinking among Maine youth (12-17).2. Reduce high-risk drinking among Maine young adults (18-25).3. Reduce marijuana use, abuse of prescription medications, and use of other drugs amongMaine youth (12 -17)4. Reduce marijuana use, abuse of prescription medications, and use of other drugs amongMaine young adults (18-25)5. Slow the spread and reduce the use of methamphetamines in Maine. (While Maine’s SPFSIG will not be funding prevention initiatives around Meth, they will collaborate withother programs to address this)State-level priorities: Enhance data infrastructure and epidemiological analysis capacityCoordinate funding streamsStrengthen the substance abuse prevention workforceIntegrate substance abuse and other public health prevention effortsLocal-level priorities: Conduct county-wide needs assessment; mobilize and builds capacity; and develop astrategic plan Implement culturally appropriate evidence-based primary and secondary preventionprograms and services Monitor and evaluate the process and effectiveness of local grantees Train and strengthen a skilled and culturally-competent prevention workforce7

CMCA – A Science Based Intervention ParadigmThe Maine Office of Substance Abuse (OSA) engages several science based programs, on of which is known as CommunitiesMobilizing for Change on Alcohol (CMCA). The CMCA paradigm presented below identifies examples of measurement andintervention for three behavioral and three attitudinal intervention strategies. This paradigm is reflected in goals, intervening variablesand strategies presented in this prevention plan.CMCA Program for Substance Abuse InterventionChanging BehaviorsChanging AttitudesEnforcement and the perception of enforcement– Measurement: Likelihood of being caught forviolation of laws– Intervention: Consistent surveillance and arrestsAdult attitudes and perception of adult attitudes incommunity– Measurement: adults in the community thinksubstance abuse is wrong– Intervention: Sticker shockParental monitoring and the perception of parentalmonitoring– Measurement: likelihood of being caught byparents– Intervention: Parental awareness trainingParental attitudes and the perception of parental attitudes– Measurement: parents think underage substanceabuse is “very wrong”– Intervention: Community-based substanceabuse awareness campaign – modeling goodpracticesSocial benefits of substance abuse and the perception ofsocial benefits– Measurement: likelihood that one would beseen as “cool” if using alcohol or drugs– Intervention: Social norms marketing andschool policies that encourage interventionEase of access and the perception of ease of access––Measurement: citations for selling alcohol tominorsIntervention: Routine retail sting operations,Server Training8

Methodology for Prevention Planning in Hancock CountyThe five step process for preparing this plan included:1. AssessmentThe goal of assessment is to define the scope of substance abuse problems in Hancock County,identifying some causes and consequences. A list of risk factors and protective factors wasexamined in this context. Risk Factors – individual, familial and environmental factors that increase the risk thatsomeone will use drugs. Protective Factors – individual, familial and environmental factors that decrease the risk thatsomeone will use drugs.2. Build CapacityThis participatory planning process was designed to bring together organizations engaged insubstance abuse prevention and build their capacity through better information, coordination andnew resources. Regional prevention programs will depend on greater investment in county andlocal prevention initiatives. Hancock County is experience significant cultural change placingnew demands for cultural competency, such as communicating in multiple languages andreaching new and relatively isolated populations.3. PlanRegional plans assist county and local organizations to set priorities. This plan is designed to fitwithin state priorities and address cross-county issues.4. ImplementThe participatory process can leverage existing substance abuse prevention programs andpartners to implement priority goals, objectives and strategies. Plans have little impact if left onthe shelf.5. EvaluateThis plan identifies measurable concerns and measurable objectives. Each objective is amilestone to the long term goal of preventing substance abuse. Completion of objectives andmeasurement of reductions in substance abuse are the key elements for evaluating this planseffectiveness.The Maine Strategic Prevention Framework (SPF) employs a logic model (pictured below) thatseeks to achieve long-term outcomes through strategic actions leading to short-term andintermediate outcomes.9

Maine Strategic Prevention Framework (SPF) Logic ModelComponentsShort-TermOutcomesStrategiesProvide financial support tocommunities and coordinatefunding streamsStateReview and refine existing datato assess sub-state differencesand needsProvide technical assistancethrough Prevention Centers ofExcellenceStrengthen the substance abuseand prevention workforceIntegrate substance abuse andother public health preventioneffortsProvide guidance, funding, andsupport for local implementation ofthe 5 SPF steps in a culturallycompetent mannerLocalConduct county-wide needsassessment with partners anddevelop strategic plan (Steps 1-3)Implement evidence-basedprimary and secondaryprevention efforts (Step 4)Increased statecapacity to addresssubstanceabuse/useIncreased localcapacity toaddress substanceabuse/useLocal preventionefforts areintegrated,accessible,culturallycompetent, andsustainableIncreasedimplementation umptionStrengthened statesubstance abusepreventioninfrastructureStrengthened localsubstance abusepreventioninfrastructurePrimary andsecondaryprevention effortsresult in positivechanges in:priority interveningfactors (skills,beliefs, knowledge,attitudes,perceptions,norms)Evaluation (step 5) & Data-Driven Decisions10Long-TermOutcomesDecrease in alcoholabuse and otherdrug use/abuseincluding:- high risk drinking- marijuana- prescription meds- methamphetamineDecrease inmorbidity,mortality, injury,and disabilityrelated tosubstanceuse/abuseConsequences

State of the CountyUnderstanding PlaceThe unique geography of Hancock Countyunderlies the way we live. The ruggedcoastline with ready access to rich fisheries,spruce forests, granite quarries and wildblueberry lands formed the basis of anatural-resource based economy for morethan two centuries. While these resourcescontinue to provide opportunities for multigenerational families, they are subject tocycles of growth and decline, as well as themore predictable seasonal cycles. Asopportunities in traditional jobs recede,alternatives emerged in manufacturing andFigure 1Hancock County’s Scenic Beauty Drawsthen in a variety of service occupations.Tourists and Drives the EconomyThe decline of many traditionaloccupations, the rise of the service sector, the growing presence of seasonal housing and the inmigration of retirees contribute to a sense of social and economic dualism. There is gatheringevidence that the county will experience an accelerating rate of change.Hancock County is characterized by diverse geographic and cultural communities. While manycounty statistics are close to those for Maine as a whole, a closer look reveals stark contrastsamong and even within Hancock County’s towns. Understanding place is essential to designingappropriate substance abuse prevention igure 2 Population Growth (US Census)11Maine1,000,00040,00017918 01018318 0518 0718 0919 0119 0319 05019719 090The population of Hancock County isgrowing at an annual rate of 1%, morethan double the rate for Maine as awhole. Population in 2000 was 51,560, upfrom 46,948 in 1990. Migration is driving growth, socialand economic change. We aregaining retirees, but continue to loseyoung adults. Seasonal residents and touristsdramatically increase HancockCounty’s summer population andworkforce.Hancock CountyPopulation

Hancock County is “aging” Aging boomers and inmigration contribute to arecord setting population ofelderly. The children of the babyboom are now adults. A second echo of the babyboom is starting as boomergrandchildren are born. Outmigration of young adults tocolleges and other labormarkets over the last 15years is expected to reducethe size of the second echo.Hancock County100 to 104 years90 years80 years70 years60 years50 years40 years30 years20 years10 yearsImplications Population growth isUnder 1 year-600-400-2000200400600expected to increasesubstance abuse, though notFemale Malenecessarily the rate. Migration introduces change, potentiallyFigure 3 1990 Population Pyramid for Hancock Countyadding to the diversity of substanceabuse patterns. A large proportion ofpeople moving to Hancock County are relatively prosperous retirees that have not increasedlevels of illegal drug use perceptibly.Schools Enrollments are Flat or DecliningHancock County, like most of Maine, isseeing significant declines in schoolenrolment. The largest declines have alreadyoccurred in primary schools while highschools will lose enrollment for several yearsinto the cock County is he following development maps contrastFigure 4Enrollment in all Hancock County PublicHancock County in 1960 when most townsSchoolswere classified as primarily rural with aprojection to 2050 at which time most towns will be classified as emerging suburban orsuburban/urban.12

Figure 5 State Planning Office Land Use Analysis National population growth since the 1960s has shifted from urban to rural areas. Many ruralareas are losing their historic character as housing subdivisions and commercial developmentovertake the countryside.High costs for land and housing are pushing affordable housing into Hancock County’sinterior and into Washington County.Enclaves of higher-priced shorefront homes are more likely to be occupied only seasonally.Implications Interior communities of Hancock County have very limited local resources to cope withproblems associated with substance abuse. Not all drug problems are “urban” – illegal methamphetamine labs are often located inremote rural places. Hancock County’s long and complex shoreline is also a potential entry point for smugglers.EconomyHancock County is Prosperous but Highly SeasonalHancock County’s economy is growing as it transitions from resource-based fishing, farming,forestry and mining to service and retail. Seasonality has been a constant throughout. Tourismis particularly important in the new economy, with more than three million visits to AcadiaNational Park and growth along the coast from Castine to Gouldsboro. Demand for labor onMount Desert Island increases dramatically during the summer and early autumn then plummetsfor the winter and spring months. Year-round employment is also increasing, particularly inhealth care, real estate and professional services. County Median Household Income has increased by 17% from 30,700 in 2000 to 36,000in 2006. Incomes are highest on the coast.Hancock County and particularly Mount Desert Island have highly seasonal patternseconomic activity driven by summer tourism and summer residentsSeasonal economic tides result in labor shortages every summer and significantunemployment and under employment during the “off-season.”13

1999 Taxable Monthly Sales (1,000)Bar Harbor 14,000 12,000BuildingSupply 10,000FoodGeneralMerchandise 8,000Other Retail 6,000Auto 4,000Restaurants 2,000Lodging 0JANMARFEBMAYAPRJULJUNSEPAUGNOVOCTDECImplications Rising incomes provide communities with resources to pay for schools, after schoolprograms, community buildings and special events for all ages. Expanding economies offer employment opportunities and opportunities for recreationand entertainment that provide alternatives to substance abuse. Seasonality can contribute to substance abuse among the unemployed and marginallyemployed, particularly during extended periods of unemployment. Seasonal, temporary and part time employees are far less likely to have health insurance,access to employee assistance programs (EAP) and programs that treat substance abuse. The seasonal tourism creates demands for bars, exposing local children to alcoholpromotions and use.ConclusionsHancock County is in transition with a growing, but aging population. The economy, onceanchored by the production of blueberries, wood and wood products, granite and marinefisheries, has moved swiftly to being service-based with tourism, health care and researchshowing strong employment gains. Seasonality continues to be a challenge, with strong, evenhectic, summer peaks in activity to long winters with relatively high unemployment rates.Growth is changing our communities, with more housing. As growth is driven by migration andprimarily by migration of retirees, our substance abuse concerns cover the full life course.Substance Abuse over the Life CourseWe will now review risk and protective factors and substance abuse patterns over the life course.We will consider patterns for youth, adults and retirees as data permit. Each section willsummarize factors that have been found to increase (risk) or reduce (protective) substance abuseand provide local and regional data indicating the current state of the county.14


Protective and Risk Factors for YouthHancock County’s youth are in most respects similar to youth throughout Maine. Our rural andsmall town environment reduces somewhat their exposure to high risk behaviors associated withillegal drug use and crime. Most have the opportunity to attend small primary and secondaryschools with favorable student to teacher ratios. Even in this environment, however, youth are atrisk. The following table summarizes protective and risk factors gleaned from national researchand adapted to the Hancock County environment.Protective factorsPositively influenced through caringrelationships with family, friends, schooland communityRisk factorsIncrease risk of substance abuse,particularly for this age groupSchoolInterest in schoolwork and successPositive school experiencesProud of accomplishmentsNot interested in schoolwork or schoolsuccessLow commitment to schoolLower academic achievementPoor family managementPerson who lives in home who usesalcohol/drugsParental attitudes favorable to antisocialbehaviorCommunity and PeersGood social skillsPositive reinforcement and opportunities forcommunity involvementPositive peer groupNew factors emerge by grade 10FamilyFamily rewards for positive involvementPrimary caregiver/parent interested inchild’s school successesFriends’ use of drugs/alcoholIntention to use drugs/alcoholPerceived risk of drug use lowEarly initiation of drug/alcohol useLaws and norms favorable to drug useSources: A Parent’s Guide to: Your Infants and Child’s Resilience, Protection, and ThreatsHealthy Peninsula 2004 Community AssessmentMaine Youth Drug and Alcohol Use Survey (MYDAUS) 200616

Indicators and Correlates of Substance Abuse – Youth to Young AdultsRecent data suggest there is reason to be concerned in Hancock County about substance abuseand related problems.Substance AbuseFigure 6Source: MYDAUS, 2006Recent studies indicate that unsafe and illegal consumption of drugs and alcohol is flat or evenrising after many years of decline. (MYDAUS) The 2006 Maine Youth Drug and Alcohol UseSurvey (MYDAUS) indicates that that over 13% of students in grades six to twelve haveengaged in binge drinking and / or use of illegal drugs, very similar to the state as a whole. Useof tobacco and marijuana is higher in Hancock County that the state.Hancock County closely mirrors state incidence of binge drinking, with rates rising from onset insixth grade to a peak in twelfth grade. Significant increases occur between 8th grade and 9thgrade (7%), and 10th grade and 11th grade (9%). The first jump reflects the move of manyHancock County students into High School in 9th grade. The second jump may reflect increasingfreedom associated with attaining driver’s licenses.17

Source: MYDAUS, 200618

Source: MYDAUS, 2006Hancock County reported use of marijuana among high school students appears to mirror thestate, with an unusual spike in reported use by 11th grade students. Reported use increasessignificantly almost every year. The 15% increase in reported use mirrors a significant increasein reports of binge drinking between 10th and 11th grades. The decline in reported use by 12thgraders is not common suggesting that the spike in 11th grade reported use may be a statisticalanomaly. Whether or not this is the case, prevention efforts at all ages and all grades appear tobe justified.19

Illegal and High Risk ActivityFigure 7 Source: MYDAUS, 2006Survey data suggest that Hancock County youth are engaging in high risk acti

The Case for a Coordinated Substance Abuse Prevention Plan This Substance Abuse Prevention Plan for Hancock County brings together an assessment of our current situation and proposes six major goals addressing a diverse range of concerns: Underage Drinking Illegal drug use High risk substance abuse Prescription Drug Abuse

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