California is one of the largest states in the nation, with more than 37 million people as of 2010. As of 2018, the state itself is the fifth largest economy in the entire world, surpassing the entirety of the United Kingdom.
At its southernmost point, California shares a border with Mexico, which is one of the main entry points for illegal drugs to enter the U.S. There is also a large coastline along the Pacific, with many ports shipping to and from dozens of nations, leading to further import of illegal drugs. With so many people in such a prosperous area, and exposure to several kinds of dangerous intoxicants both legal and illegal, California’s addiction treatment industry has been revised and refocused several times over the past few decades.
With millions of residents in California, addiction rates are high — 8.5 percent of Californians struggle with addiction, or substance use disorders, which is around 3 million people. Of those, unfortunately, only about 10 percent receive the treatment they need to manage this chronic health condition.
Two decades ago, California struggled with the highest rates of drug-involved overdose deaths in the entire country, with the rate climbing 30 percent between 1999 and 2015, largely due to the epidemic of addiction to prescription opioids and heroin. Between 1999 and 2016, drug overdose deaths rose from 8.1 percent to 11.2 percent in the state.
However, California has acted to manage these crises in several ways. Understanding the current substance abuse trends can highlight how the state has worked to get more people into addiction treatment, and how lawmakers and medical professionals in the state will continue to help those in need.
• Alcohol: According to a recent survey, 6.4 percent of Californians met the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defining alcohol use disorder (AUD), colloquially called alcoholism. AUD is the most common form of addiction in the Golden State.
Alcohol caused more nonfatal admissions to the emergency room than all other drug overdoses combined, including opioid abuse. Alcohol is a problem among all ages of California’s residents, including adolescents. By 11th grade, more than 50 percent of students have tried alcohol at least once. Between 2010 and 2014, 7 percent of people who met the criteria for AUD got treatment, while 93 percent did not get the help they needed.
• Opioids: Although California has lower rates of opioid abuse and addiction compared to many other states in the country, heroin continues to be a particular problem. About 95 percent of the large state’s leaders have joined a coalition to reduce opioid abuse, particularly involving overprescription of narcotic painkillers, leading to a 12 percent drop between 2015 and 2016 in opioid prescriptions.
Unfortunately, illicit heroin is produced in South and Central America and then shipped up through California’s southern border, exposing more people in the state to the dangerous narcotic and increasing the risk of addiction to it. Illicit fentanyl has been added to heroin in recent years, leading to a rapid increase in overdose deaths primarily in the Northeast and Midwest, but increasingly in the California too. Between 2006 and 2017, the number of heroin-involved ER admissions in the state more than tripled. In addition, 0.6 percent of California’s population struggles with pain medication addiction.
• Marijuana: The state legalized recreational marijuana use in the 2016 election cycle, and the law was fully in effect as of January 1, 2018. California is now the U.S.’s largest market for legal marijuana, both medical and recreational.
Greater acceptance of marijuana use is likely to increase the risk of addiction among all ages, including adolescents, who are at the most risk of developmental harm from drugs and alcohol. By 11th grade, according to a report, 40 percent of California’s adolescents have tried marijuana, and 13.2 percent report using marijuana in the prior year; 34 percent of young adults, ages 18 to 25, abused marijuana in the prior year, while 13.5 percent of adults 26 and older report abusing the drug.
In 2015, before marijuana was legalized for recreational use, about 15 percent of people entering addiction treatment reported this drug as their primary substance of abuse.
• Illicit drugs: About 3.3 percent of California’s population struggles with abuse of illicit substances, like methamphetamine, MDMA, cocaine, LSD, or heroin. Less than 1 percent of California’s adolescents abuse cocaine, while 7.2 percent of young adults, 18 to 25, abuse the drug, and 1.8 percent of adults 26 and older abuse the stimulant.
Amphetamines of any kind, including meth, were involved in 33.8 percent of nonfatal ER admissions between 2012 and 2014; 4.4 percent involved cocaine; and 0.6 percent involved hallucinogens like psilocybin or LSD. Between 2010 to 2014, 88 percent of people struggling with any illicit drug did not get the help they needed, while 12 percent entered addiction treatment.
To reduce the impact of substance abuse in all communities across this large western state, California committed to updating their substance abuse laws and programs, and they continue to do so. In 2018, the state reported that it was undertaking a major effort to expand and improve substance abuse treatment through Medi-Cal, the state-level implementation of federal Medicaid funding.
Part of finding appropriate addiction treatment involves expanding the types of programs available because everyone has unique needs for treatment. For example, about 3.4 percent of California’s residents report having any mental illness (AMI) occurring alongside addiction, which is called co-occurring disorders; and 1.1 percent of the state’s large population reported that they had a serious mental illness (SMI) occurring with a substance abuse disorder.
People with co-occurring disorders need addiction treatment that can help them change their behaviors around substances while understanding the symptoms of their mental illness. Treatment should help them learn to manage both conditions at the same time. As of 2015, 48.5 percent of California’s treatment programs offered specific programs for co-occurring disorders treatment.
Steps that California’s state-funded programs are taking include the Medication Assisted Treatment (MAT) Expansion Project, which aims to help 20,000 people struggling with opioid addiction. The goal is to prevent opioid overdoses and deaths by offering greater access to MAT to manage opioid detox, primarily through greater access to buprenorphine tapering. The program is entering Version 2.0 soon, adding three more medications approved by the U.S. Food and Drug Administration (FDA) to help people struggling with addiction to narcotics.
Unfortunately, California’s rates of alcohol or drug addiction treatment involving commercial health care plans were slightly lower than the national average in 2016. The National Committee for Quality Assurance Standards (CNQA) defines good addiction treatment as:
• At least one initial treatment visit within two weeks of being diagnosed with a substance use disorder (the initial phase).
• Two follow-up visits within a month of initial treatment (the ongoing phase).
Only one in three Californians met the initial phase criteria (34 percent nationally met this criteria), and 1 in 10 Californians were in the ongoing phase (compared to 12 percent nationally).
Over 85 percent of California’s adults who got addiction treatment received help through an outpatient program; 12.8 percent got help through a residential, or non-hospital-based, program; and 1.8 percent were hospitalized for their addiction treatment. One in three adults received MAT to manage their withdrawal symptoms.
In 2015, there were 1,004 outpatient treatment facilities in California, 23 percent of which offered MAT; 521 non-hospital residential programs were available, none of which offered MAT; and there were 30 hospital inpatient programs. Since 2013, there has been a slow decline in the number of available treatment programs, but an increase in the percentage of outpatient programs offering MAT.
There are several approaches to finding addiction treatment in California, starting with the state’s health department. The California Department of Health Care Services (CDHCS) administers several mental and behavioral health programs for all ages. The California Society of Addiction Medicine (CSAM) also provides resources for residents of the state on detox and rehabilitation.
The California Association of DUI Treatment Programs (CADTP) focuses specifically on helping people overcome alcohol use disorder and drive safely. The California Consortium of Addiction Programs and Professionals (CCAPP) provides certification and membership to organizations that meet specific criteria above and beyond the state’s definition of safe and effective treatment.
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California’s Opioid Death Rate Is Among the Nation’s Lowest. Experts Aren’t Sure Why. (October 27, 2017). Los Angeles Times.
Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5. (July 2016). National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Legal Weed in California: A Consumer’s Guide. (April 20, 2018). Los Angeles Times.
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