Alcohol and Drug Abuse in High Risk Geographic
Areas of the State of Delaware
An Analysis of the Need for Treatment in the Household
Population Aged 18 Years and Over
Prepared for
State of Delaware
Health and Social Services
Division of Alcoholism, Drug Abuse, and Mental Health
by
Health Services Policy Research Group
College of Human Resources, Education, and Public Policy
University of Delaware
October, 1999
Alcohol and Drug Abuse in High Risk Geographic Areas
of the State of Delaware:
An Analysis of the Need for Treatment within the Household Population
Aged 18 Years and Over
State of Delaware
Health and Social Services
Division of Alcoholism, Drug Abuse, and Mental Health
Robert A. Wilson
Health Services Policy Research Group
College of Human Resources, Education, and Public Policy
University of Delaware
ii
Table of Contents
Chapter 1: Introduction
6
Chapter 2: Alcohol and Drug Use
11
Chapter 3: Alcohol and Drug Abuse and Dependence
12
Chapter 4: Summary and Conclusions
21
Appendix: Response Rate for 1997-1998 Statewide
Alcohol and Drug Survey
24
iii
List of Figures
Figure 1: Sampling Frame for High Risk Area Study
7
Figure 2: Map of High Risk ZIP Code Areas
9
Figure 3: Respondent Sample by ZIP Code Area
10
Figure 4: Alcohol and Drug Use by Lifetime and 18-Month Prevalence
11
Figure 5: DSM-IV Criteria for Substance Abuse
12
Figure 6: DSM-IV Criteria for Substance Dependence
13
Figure 7: Alcohol and Drug Abuse and Dependence in
High Risk Geographic Areas
14
Figure 8: Lifetime Prevalence of Alcohol Abuse
and Dependence
15
Figure 9: Map of Lifetime Prevalence of Alcohol Abuse
and Dependence by ZIP Code Areas
16
Figure 10: Last 18-Month Prevalence of Alcohol Abuse
and Dependence
17
Figure 11: Map of ZIP Code Areas with 18 Month
Highest Prevalence of Alcohol and Drug Abuse
18
Figure 12: Lifetime Drug Use by ZIP Code Area
19
Figure 13: Map of Lifetime Drug Use by ZIP Code Area
20
Figure 14: Survey Based Need for Alcohol and Drug Treatment
22
Figure 15: Map of Need for Alcohol and Drug Treatment
High Risk ZIP Code Areas
23
iv
Preface
This report is the second of a series focusing on the need for alcohol and drug and
alcohol treatment services in the State of Delaware. These studies analyze the
prevalence of alcohol and drug abuse and the patterns of treatment throughout the
State. This project is supported by the federal government through an ongoing State
Needs Assessment program initiated by the Substance Abuse and Mental Health and
Mental Health Administration, Center for Substance Treatment (CSAT). This report is
prepared for the State of Delaware, Health and Social Services, Division of Alcoholism,
Drug Abuse, and Mental Health administer the studies. This analysis is performed by
the University of Delaware, Health Services Policy Research Group.
Special acknowledgement is due to the following people:
…Elizabeth Ableman produced the prevalence estimations and needs assessment
calculations.
…Na Yang and Guneet Knaur performed much of the computer work.
…Patricia Powell prepared the tables and graphs.
…Mary Jo McDuffie and David Pizzi prepared the maps.
…The Advisory Committee of the Division of Alcoholism, Drug Abuse, and Mental
Health reviewed the findings and provided valuable insights.
…Staff of the Division of Alcoholism, Drug Abuse, and Mental Health provided technical
assistance and encouragement throughout the research.
v
Chapter 1: Introduction
INTRODUCTION
Background. Studies of the need for substance abuse treatment typically focus on the
prevalence of pathological alcohol and drug use. Prevalence refers to the number of
persons manifesting substance abuse within a specific time frame who reside in a
specific geographic area. In this study both an eighteen-month and one year
prevalence window is employed. Based on interviews with a random sample of
residents of the area, the number of people with clinically defined alcohol and drug
problems is estimated. By comparing the estimates of the number of people with
alcohol and drug problems with the number treated for substance abuse, an estimate of
the need for treatment is produced.
This study explores on alcohol and drug problems in high-risk ZIP code areas of the
State of Delaware. Twenty ZIP code areas were identified as being at risk for having a
high prevalence of alcohol and drug abuse. A sample of the residents of these areas
was interviewed. The interview required about 25 minutes. A number of social
indicators were used to select the ZIP code areas to be characterized as high risk ZIP
code areas were selected based on 1990 Census data and a series of social indicators
drawn from State agencies.
The indicators used to identify high risk areas included the following indicators were
drawn from the 1990 federal population census:
percent of civilian labor force, age 16 and over, unemployed;
percent of males, age 15 and over, divorced or separated;
percent of females, age 15 and over, divorced or separated;
percent of occupied housing units with more than one person per room;
percent of employed persons, aged 16 years and over, who are operators,
percent of service workers and laborers;
percent of families in 1989 with income below the poverty level;
percent of female headed households; and
percent of age 25 and over with less than a ninth grade education.
High Risk ZIP code areas are also characterized by social indicators reflecting alcohol
and drug problems (Figure 1). These indicators include: alcohol and drug mortality
rates, alcohol- and drug-related court processings, hospital discharges in which
substance abuse is indicated, and a composite health demographic indicator of alcohol
and drug problems. The mortality indicators measure alcohol- and drug-related deaths
by ZIP code. The composite variable for alcohol deaths includes deaths indirectly
attributable to substance abuse, drug and alcohol-related underlying causes of deaths,
and deaths directly attributable to alcohol. The composite variables for alcohol and drug
6
related deaths include both drug-related underlying cause of death and multiple cause
of death. Cause of death was derived from ICD-9 codes extracted from death
certificates for all Delaware decedents from 1988-1992.
Alcohol- and drug-related criminal prosecution ratios measured the proportion of total
cases processed in Delaware’s Superior Court from July 1, 1987 through June 30, 1992
which were associated with drugs or alcohol. Alcohol and drug-related hospital
discharge ratios measured the proportion of total hospital discharges from 1992 to 1994
that registered to drug or alcohol problems.
Figure 1
Sampling Frame for High Risk Area Study
Rank of Alcohol and Drug Mortality Ratios, Alcohol and Drug Arrest Ratios, Hospital Discharge
Ratio, and Composite Health Demographic Profile Rank for Top 20 Delaware ZIP Code Areas.
Zip
Code
Areaa
Pop'n
Aged
18-69b
19962
3,123
19802 20,397
19933
3,132
19973 13,619
19901 34,158
19945
3,988
19801 10,956
19805 30,119
19947
8,520
19975
3,613
19968
3,204
19943
5,239
19956
6,818
19971
5,308
19720 34,767
19734
3,349
19966
9,503
19977
8,194
19934
6,121
19958
7,648
_____________
Alcohol
Related
Deathsc
41
23
32
39
34
15
36
13
42
40
27
30
18
38
20
16
26
21
11
35
Drug
Alcohol Drug
Alcohol
Drug
Health
Related Related Related Related
Related Demogr
Deathsd Courte Courtf Hospitalg Hospitalh Profilei
Filings
Discharge Discharge
41
15
41
35
39
30
22
36
22
40
41
36
32
30
18
30
35
36
36
38
16
26
32
24
24
41
40
19
18
30
35
42
28
39
21
24
18
37
26
42
42
36
17
33
24
37
34
36
38
12
25
32
5
40
1
35
38
31
26
13
32
31
27
33
6
24
42
34
42
8
4
16
39
18
35
5
36
24
34
27
12
41
10
13
15
22
20
34
33
30
29
16
19
38
40
16
28
5
29
27
29
24
30
4
31
25
16
40
19
20
34
12
24
40
27
11
39
15
16
7
ZIP
Code
Rankj
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
a. These are the twenty highest ZIP code areas in the State with respect to the Health Demographic
Profile. Higher numbers indicate more severe alcohol and drug problems or in the case of the Health
Demographic Profile a higher risk of problems.
b. 1990 Census population
c. ZIP code area rank on alcohol-related mortality
d. ZIP code area rank on drug-related mortality
e. ZIP code rank on alcohol-related court processings
f. ZIP code rank on drug-related court processings
g. ZIP code rank on alcohol-related hospital discharges
h. ZIP code rank on Health Demographic Profile
I. ZIP code rank is average rank of indicators a-h. ZIP code 19962 is the ZIP code area with the highest
composite score.
7
A composite alcohol and drug indicator rank was computed for each ZIP code
area. The Composite Social Indicator rank for each ZIP code area was derived
by combining the eight social indicators. A map showing the location of the ZIP
Code Areas from which the interview sample was drawn is shown in Figure 2.
8
Figure 2
High Risk ZIP Code Areas
State of Delaware
High Risk Area Study, 1997-98
Southwest Wilmington
and Elsmere
19805
19802 North Wilmington
19801 Central Wilmington
19720
New Castle
19734
Townsend
19977
Smyrna
Leipsic/Dover
19901
19934
Camden-Wyoming
19962
Magnolia
19943
Felton
19960
Lincoln
Milton
19968
Bridgeville
Georgetown
Seaford
Lewes
19958
19933
19971
Dewey/
Rehoboth Beach
19947
19973
Millsboro
Laurel
19956
19966
Frankford
19945
19975
Health Services Policy Research Group
University of Delaware
9
Selbyville
Study Base. The survey sample consisted of 2,859 adults aged 18 years and
above who were residents of the high risk ZIP code areas. Estimations of the
prevalence of substance abuse were calculated using the WESTVAR statistical
program. This procedure allows for the specification of a confidence band
around the estimates of alcohol and drug abuse that takes into account the
multistage sample. The sampling stages included telephone exchange and
eligible respondent within household. The demographic composition of the
sample is shown in Figure 3.
Figure 3
High Risk Area Study
Respondent Sample by ZIP Code Area
ZIPCODE
County
Community
FEMALE
19720
19734*
19801
19802
19805
New Castle
New Castle
New Castle
New Castle
New Castle
19901
19934
19943
19962*
19977
19933*
19945*
19947
19956
19958
19966
19968*
19971
19973
19975*
Total
Kent
Kent
Kent
Kent
Kent/NC
Sussex
Sussex
Sussex
Sussex
Sussex
Sussex
Sussex
Sussex
Sussex
Sussex
New Castle
Townsend
Central Wilmington
North Wilmington
Southwest Wilmington
and Elsmere
Leipsic/Dover
Camden/Wyoming
Felton
Magnolia
Smyrna
Bridgeville
Frankford
Georgetown
Laurel
Lewes
Millsboro
Milton
Dewey/Rehoboth
Seaford
Selbyville
MALE
Total
224
23
86
135
183
220
21
78
117
192
444
44
164
252
375
207
38
37
24
54
20
25
50
45
51
65
19
41
85
25
1437
210
38
38
22
72
19
26
53
43
48
56
21
37
88
24
1423
417
76
75
46
126
39
51
103
88
99
121
40
78
173
49
2860
*These ZIP codes are excluded from cross-area comparisons because of the insufficient sample
size within these areas.
10
Chapter 2: Alcohol and Drug Use
Alcohol and Drug Use
Ninety-three percent of the adult residents of high risk areas reported consuming
alcohol at least once during their lifetimes. Sixty-seven percent had used alcohol
within the 18 months prior to the interview. Thirty-two percent had used an illegal
drug within their lifetimes and approximately four percent reported had used
drugs within the last 18 months. Approximately four percent of the respondents
had used marijuana within the last 18 months. Less than one percent had used
hallucinogens, cocaine (crack) and heroin.
Figure 4
High Risk Area Study
Alcohol and Drug Use by Lifetime and 18-Month Prevalence
Substance
Alcohol
Marijuana
Hallucinogens
Cocaine/Crack
Heroin/Opiates
Any Drug
Alcohol and/or Drug
Lifetime Users
Percentage
93.1
31.9
5.0
6.6
1.1
32.7
93.6
*Number of heroin/opiates is to small for statistical reliability
11
18-Month Users
Percentage
66.8
3.8
0.1
0.1
*
3.8
67.3
Chapter 3: Alcohol and Drug Abuse and Dependence
Alcohol and Drug Abuse and Dependence
Treatment need in a geographic area is gauged through standardized questions
on alcohol and drug abuse and dependence in the 18 months prior to the
interview. Prevalence estimates are based on interviews with 2,859 respondents
aged 18 years and above reside in High Risk ZIP Code Areas of the State. The
interview incorporates the DSM-IV criteria to screen for alcohol and drug abuse
and dependence. The DSM-IV criteria for alcohol and drug abuse are shown in
Figure 5. The DSM-IV criteria for alcohol and drug dependence are shown in
Figure 6.
Figure 5
DSM-IV Criteria for Substance Abuse
A. A maladaptive pattern of substance use leading to clinically significant
impairment or distress, as manifested by one (or more) of the following:
1) Recurrent substance use resulting in a failure to fulfill major role
obligations at work, school, or home (e.g., repeated absences or poor
work performance related to substance use; substance-related absences,
suspensions, or expulsions from school; neglect of children or household)
2) Recurrent substance use in situations in which it is physically hazardous
(e.g., driving an automobile or operating a machine when impaired by
substance use)
3) Recurrent substance-related legal problems (e.g., arrests for substancerelated disorderly conduct)
4) Continued substance use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of the
substance (e.g., arguments with spouse about consequences of
intoxication, physical fights)
B. The symptoms have never met the criteria for Substance Dependence
for this class of substance.
Source: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American
Psychiatric Associations, 1994.
12
Figure 6
DSM-IV Criteria for Substance Dependence
A maladaptive pattern of substance use, leading to clinically significant
impairment or distress, as manifested by three (or more) of the following:
(1)
tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to
achieve intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount
of the substance
(2)
withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance (refer to
Criteria A and B of the criteria sets for Withdrawal from the specific
substances)
(b) the same (or a closely related) substance is taken to relieve or
avoid withdrawal symptoms
(3)
the substance is often taken in larger amounts or over a longer
period than was intended
(4)
there is a persistent desire or unsuccessful efforts to cut down or
control substance use
(5)
a great deal of time is spent in activities necessary to obtain the
substance (e.g., visiting multiple doctors or driving long distances),
use the substance (e.g., chain smoking), or recover from its effects
(6)
important social, occupational, or recreational activities are given
up or reduced because of substance use
(7)
the substance use is continued despite knowledge of having a
persistent or recurrent physical or psychological problem that is
likely to have been caused or exacerbated by the substance (e.g.,
current cocaine use despite recognition of cocaine-induced
depression, or continued drinking despite recognition that an ulcer
was made worse by alcohol consumption)
Specify if:
With Physiological Dependence: evidence of tolerance or withdrawal
(i.e., either Item 1 or 2 is present)
Without Physiological Dependence: no evidence of tolerance or
withdrawal (i.e., neither Item 1 or 2 is present)
Source: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American
Psychiatric Association, 1994.
13
Alcohol Abuse and Dependence Differences across High Risk ZIP-Code Areas
This study estimates the prevalence of substance abuse and dependence across
the high-risk geographic areas of the State of Delaware. Prevalence is
measured through responses to an interview administered to 2,860 respondents.
The number of completed interviews for each ZIP code area determines the
feasibility of using the survey to measure prevalence within the area. ZIP code
areas with fewer than 75 completed interviews were not included in the analysis.
Fourteen ZIP Code areas met this minimum sample size. The appropriate
statistical procedure for studying relatively rare phenomena, such as drug abuse,
is the Poisson distribution. Geographic Areas having a significantly higher
prevalence of substance abuse were identified through this procedure. ZIP code
areas with a prevalence significantly higher than the overall high-risk sample are
designated with an asterisk (*).
Approximately three percent of the adult population of the High Risk ZIP Code
Areas was dependent on alcohol or abused alcohol within the 18 months prior to
the interview (Table 7). Alcohol abuse and dependence poses a clear hazard to
general health and to the capacity to function in family and work roles. Alcohol
abuse is a significant safety hazard at work, in motor vehicles, and in marine craft
and airplanes. Pathological substance use effects not only the alcohol abuser
and his immediate social environment, but also the broader community.
Approximately one-half a percent of the population residing in these areas
manifests drug abuse or dependence within the prior 18-months (Figure 7).
Figure 7
Alcohol and Drug Abuse and Dependence
High Risk Geographic Areas
State of Delaware, 1997-98
Alcohol Abuse and/or
Dependence
Drug Abuse and /or
Dependence
Alcohol and/or Drug
Abuse Dependence
18 Month Prevalence
Percentage
Estimate
Low High*
3.2
2.1
4.2
Lifetime Prevalence
Percentage
Estimate Low
High*
6.9
5.4
8.3
0.05
.01
.07
2.1
1.4
2.8
3.4
2.4
4.5
7.9
6.4
9.4
*High-low percentage are lower and upper 95 percent confidence bonds, computed with Westvar
program
14
Slightly over three percent of the high risk Delaware population, aged 18 years
and above, abused or was dependent upon either alcohol or drugs in the 18
months prior to the interview.
Lifetime Alcohol Abuse and Dependence. Prevalence was significantly higher in
four ZIP Code areas than in the overall high-risk area sample. These areas
included ZIP Codes 19720 (New Castle), 19801 (Central Wilmington), 19802
(North Wilmington), 19805 (Southwest Wilmington/Elsmere) and 19977
(Smyrna), (Figure 8, Figure 9).
Figure 8
Lifetime Prevalence of Alcohol Abuse and Dependence (DSM-IV)
High Risk Area Study Survey
State of Delaware, 1997-1998
Percentage of Population Aged 18 Years and Above
Zipcodes
County
Community
Lifetime Alcohol Abuse
and Dependence (DSM)
Frequency (%)
19720
19801
19802
19805
New Castle
New Castle
New Castle
New Castle
19901
19934
19943
19977
19947
19956
19958
19966
19971
19973
Kent
Kent
Kent
Kent/New Castle
Sussex
Sussex
Sussex
Sussex
Sussex
Sussex
New Castle
Central Wilmington
North Wilmington
Southwest Wilmington/
and Elsmere
Leipsic/Dover
Camden/Wyoming
Felton
Smyrna
Georgetown
Laurel
Lewes
Millsboro
Dewey/Rehoboth
Seaford
4.5*
17.1*
7.6*
9.3*
5.5*
9.3
5.4
9.5
4.9
3.4
3.0
5.8
7.7
2.3
*p <.05 (Poisson).
These ZIP code Areas are significantly higher in alcohol abuse and dependence than the overall
high-risk area sample.
15
Figure 9
Alcohol Abuse and Dependence within Lifetime of Respondent
ZIP Code Areas With Highest Prevalence
High Risk Area Study, State of Delaware, 1997-98
Southwest Wilmington
and Elsmere
19805
19802 North Wilmington
19801 Central Wilmington
New Castle
19720
Highest Prevalence Areas
2.3% - 5.5%
5.5% - 17.1%
19977
Smyrna
19901
Camden-Wyoming
Felton
Leipsic/Dover
19934
19943
Lewes
Georgetown
19958
19947
Seaford
Laurel
19973
19966
19956
Health Services Policy Research Group
University of Delaware
16
19971
Dewey/
Rehoboth Beach
Millsboro
Alcohol Abuse and Dependence within Last 18 Months. Prevalence of alcohol
abuse and dependence was highest in ZIP Code areas 19720 (New Castle),
19801 (Central Wilmington), 19802 (North Wilmington), 19805 (Southwest
Wilmington/Elsmere), 19901 (New Castle) and 19977 (Smyrna), (Figure 10,
Figure 11).
Figure 10
Last 18-Month Prevalence of Alcohol Abuse and Dependence (DSM-IV)
High Risk Areas by ZIPCode Area,
State of Delaware, 1997-1998
Percentage of Population Aged 18 Years and Above
Zipcode
Area
County
Community
19720
19801
19802
19805
New Castle
New Castle
New Castle
New Castle
19901
19934
19943
19977
19947
19956
19958
19966
19971
19973
Kent
Kent
Kent
Kent/New Castle
Sussex
Sussex
Sussex
Sussex
Sussex
Sussex
New Castle
Central Wilmington
North Wilmington
Southwest Wilmington
and Elsmere
Leipsic/Dover
Camden/Wyoming
Felton
Smyrna
Georgetown
Laurel
Lewes
Millsboro
Dewey/Rehoboth
Seaford
Percentage of Population
with 18-Month Alcohol
Abuse and Dependence (DSM)
(3.1)*
(7.9)*
(2.8)*
(4.8)*
(2.2)*
(5.3)
(2.7)
(3.2)
(1.9)
(1.0)
(3.3)
(2.6)
(2.3)
*p <.05 (Poisson)
These ZIP code areas are significantly higher in 18 month prevalence than the high risk area as a
whole.
17
Figure 11
Alcohol Abuse and Dependence within Last 18 Months
ZIP Code Areas With Highest Prevalence, High Risk Area Study
State of Delaware, 1997-98
Southwest Wilmington
and Elsmere
19805
New Castle
19802 North Wilmington
19801 Central Wilmington
19720
1.0% - 2.8%
2.8% - 7.9%
Smyrna
19977
19901
Camden-Wyoming
Felton
Leipsic/Dover
19934
19943
19958
Georgetown
Seaford
19947
19973
19966
Health Services Policy Research Group
University of Delaware
18
Lewes
19971
Dewey/
Rehoboth Beach
Millsboro
Lifetime Drug Abuse and Dependence. Prevalence was significantly higher in
five ZIP Code areas than in the overall high-risk area sample. These areas
included ZIP Codes 19720 (New Castle), 19801 (Central Wilmington), 19802
(North Wilmington), 19805 (Southwest Wilmington/Elsmere), and 19977
(Smyrna), (Figure 12, Figure 13).
Figure 12
Lifetime Drug Use by Zipcode Area
High Risk Area Study
State of Delaware, 1997-1998
Percentage of Population Aged 18 Years and Above
Zipcodes
County
19720
19734
19801
19802
19805
New Castle
New Castle
New Castle
New Castle
New Castle
19901
19934
19943
19977
19947
19956
19966
19971
19973
Kent
Kent
Kent
Kent/New Castle
Sussex
Sussex
Sussex
Sussex
Sussex
Community
New Castle
Camden/Wyoming
Central Wilmington
North Wilmington
Southwest Wilmington
and Elsmere
Leipsic/Dover
Camden/Wyoming
Felton
Smyrna
Georgetown
Laurel
Millsboro
Dewey/Rehoboth
Seaford
18-Month Drug
1.4*
6.8
9.7*
2.8*
1.3*
.7
4.0
1.3
4.8*
1.0
1.1
0.0
2.6
1.2
*p <.05 (Poisson)
These ZIPcode areas have significantly higher 18-month prevalence than the high risk areas as a
whole.
Drug Abuse and Dependence within Last 18 Months. Prevalence of drug abuse
and dependence was significantly higher in only one ZIP Code area 19801
(Wilmington) (Figure 14). However, eighteen-month drug use provides some
indication of the relative intensity of the drug problem within the high-risk areas of
Delaware. Four areas register an 18-month prevalence that is significantly
higher than the high-risk areas as a whole. These areas are New Castle
(19920), Central Wilmington (19801), North Wilmington (19802), and Southwest
Wilmington/Elsmere (19805), and Dover (19901).
19
Figure 13
Drug Use Within Respondent’s Lifetime
ZIP Code Areas With Highest Prevalence
High Risk Area Study, State of Delaware, 1997-98
Southwest Wilmington
and Elsmere
19805
19802 North Wilmington
19801 Central Wilmington
New Castle
19720
0.8% - 2.5%
Townsend
2.5% - 10.6%
19734
Smyrna
19977
19901
Camden-Wyoming
Felton
Leipsic/Dover
19934
19943
19971
Dewey/
Rehoboth Beach
Georgetown
19947
Seaford
Laurel
Health Services Policy Research Group
University of Delaware
19973
19966
19956
20
Millsboro
Chapter 4: Summary and Conclusions
Summary and Conclusions
This study employs a survey of high-risk geographic areas of the State of
Delaware to explore the need for substance abuse treatment services. The need
for treatment is assessed by standardized questions measuring whether the
respondent abused alcohol and illegal drugs in the 18 months prior to the
interview. The survey applies the DSM-IV clinical criteria for substance abuse
and dependence, supported by the American Psychiatric Association. The
DSM-IV criteria encompass a wide range of pathologies including addiction and
destructive behaviors in many spheres of life. This approach produces an
estimate of the number of persons in need of treatment, in contrast to those other
surveys focusing on substance use without attention to the clinical
consequences.
The High Risk Area Survey was administered in twenty ZIP code areas
throughout the State of Delaware. The designation of high risk is based on an
area’s demographics and its alcohol and drug problems confirmed through social
indicators. The social indicators include mortality, criminal court processing,
substance treatment admissions, and hospital discharges. The survey gauges
the prevalence of current clinically defined alcohol and drug problems in
geographic areas that have a both high-risk demographic profile and a high-risk
social indicator profile. This approach is similar to the use of a fish-finder to
predict the probable location of schools of fish. The fish-finder points to the
areas of the sea with a high probability of having a lot of fish. The high-risk area
profile points to the areas on the land with a high probability of having a high
prevalence of clinically-defined substance abuse. By targeting geographic areas
of high risk, scarce resources can be directed to study of the populations at
highest risk.
The High Risk Area Survey identifies five ZIP-Code areas that are significantly
higher in the prevalence of alcohol and drug dependence in the 18 months prior
to the interview (Figure 14, Figure 15). These locales include 19720 (New
Castle), 19801 (Central Wilmington), 19802 (North Wilmington), 19805
(Southwest Wilmington/Elsmere), and 19901 (Leipsic/ Dover). Only one area,
however, is significantly higher than the others in drug abuse and dependence
(19801, Central Wilmington).
21
Figure 14
Survey Based Need for Alcohol and Drug Treatment
High-Risk ZIP Code Areas, State of Delaware, 1997-1998
ZIP-Code Areas with Highest Prevalence of Alcohol and Drug Dependence
in 18 Months Prior to Interview
ZIP Code
Area
County
Community
19720
19801
19802
19805
New Castle
New Castle
New Castle
New Castle
19901*
Kent
New Castle
Central Wilmington
North Wilmington
Southwest Wilmington
and Elsmere
Leipsic/Dover
Drugs
X
Alcohol
X
X
X
X
X
*Estimated from 18-month drug use
The final step in the planning process is to examine the gaps between the need
for treatment services and the actual utilization of treatment services. This study
focuses on the respondents who have abused or been dependent upon alcohol
or drugs within the 18 months prior to the interview, are classified substance
abusers or substance dependent. This population is the target for alcohol and
drug treatment.
The survey confirms that five geographic areas have a significantly higher need
for treatment service than other areas throughout the State. However, it must be
emphasized that interviews delving into illegal behavior by respondents, such as
the use of illegal drugs, should be considered as but one possible sign of the
need for treatment. Collectively, the wide range of substance abuse indicators
employed in this study, including the survey and a full range of social indicators,
present a balanced profile of the need for substance treatment across the
geographic areas of Delaware. The final report of this series will integrate the
findings from all of the studies conducted in this needs assessment. Surveybased estimates of substance abuse prevalence will be treated as one of many
possible indicators of the need for treatment in a geographic area. The goal will
be to present a balanced profile of treatment need based on demand for
treatment, social indicators, demographics, and survey findings.
22
Figure 15
Survey-Based Need for Alcohol and Drug Treatment,
High Risk ZIP Code Areas,
State of Delaware, 1997-98
Southwest Wilmington
and Elsmere 19805
19802 North Wilmington
19801 Central Wilmington
19720
New Castle
Highest Alcohol & Drug Prevalence
Highest Alcohol Prevalance
Townsend
19734
High Risk ZIP Codes
Smyrna
19977
19901
Camden-Wyoming
Felton
19934
Leipsic/Dover
19962
Magnolia
19943
Lincoln
Milton
19960
19968
19933
Bridgeville
19958
Seaford
Laurel
19971
Dewey/
Rehoboth Beach
19947
Georgetown
19973
19966
19956
19945
19975
Health Services Policy Research Group
University of Delaware
23
Lewes
Millsboro
Frankford
Selbyville
Appendix
24
Survey Response Rate Calculation
Line #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Status
Number/Rate (%)
10,398
Disconnected
Unanswered
Known working
(=Line 1 - Line 2 - Line 3)
Working business
Working residential
(= Line 4 - Line 5)
Ineligible respondents
Known eligible respondents
(= Line 6 - Line 7)
Estimated eligible respondents for unanswered
calls
(= Line 8/Line 6 * Line 3)
Total eligible
(= Line 8 + Line 9)
Refused to be interviewed
Selected respondents not available
Incomplete interviews
Completed interviews
Response rate
(= Line 14/Line 10)
1,070
2,226
Total in sample
25
7,102
391
6,711
1,253
5,458
1,810
7,268
2,452
0
0
3,006
41.36%