Indicator Description
More deaths result from substance use than from any other preventable health condition.  Premature deaths are a commonly-cited measure of the harm from substance use. Putting this in the context of your community can greatly increase the impact of your indicator report.

Deaths related to use may be the result of disease associated with chronic use or misuse, of disease from high risk behavior resulting in exposure to infectious agents, or of unintentional injury associated with alcohol or drug use, such as driving or boating under the influence.

What to Measure

Estimates of the number of substance use-related deaths are typically based on the known number of actual deaths for certain causes in a community.

• Age-specific death rate: the number of deaths for specific age groups, divided by the number of people in the age-group population.
• Age-adjusted rate: this approach involves statistically weighing the death counts each year to reflect the population age groups of a specific baseline year.

What you measure will be largely dependent on the types of reports available from your local and state health departments.

• Direct alcohol deaths: These include alcoholic psychoses, alcohol dependence syndrome, non-dependent use of alcohol, alcoholic polyneuropathy, alcohol cardiomyopathy, alcoholic gastritis, alcoholic fatty liver, alcoholic cirrhosis of liver, alcoholic liver damage (unspecified), excessive blood level of alcohol, and accidental poisoning by ethyl alcohol, not elsewhere specified.
• Indirectly-related alcohol deaths: A portion, but not all, of 25 other death causes are attributable to alcohol use. These deaths include certain malignant tumors, diabetes, pneumonia, cirrhosis, and pancreatitis.
• Direct drug deaths: Drug withdrawal syndrome in newborns, poisoning by opiates and other narcotics or psychotropic agents, accidental poisoning by opiates, methadone, barbiturates and other substances, and suicide by specific drugs.
• Indirectly-related drug deaths: A portion, but not all, of the deaths from AIDS, endocarditis, cerebrovascular stroke, congenital syphilis, burns, hepatitis A, B, and C, trauma, and tumors.
• Tobacco-related deaths: A portion, not all, of the deaths from various tumors, respiratory disease deaths, cardiovascular disease, coronary artery, coronary heart, myocardial infarction, peripheral vascular disease, cerebrovascular stroke, and newborn low birth weight.

Where to Find Local Data

• State or local health department.
• Coroner's office.
• Drug Abuse Warning Network (DAWN): DAWN is a public health surveillance system that monitors drug-related visits to hospital emergency departments and drug-related deaths investigated by medical examiners and coroners.
• Centers for Disease Control and Prevention.

Interpretation Guidelines

• Because deaths are relatively infrequent, only large communities can meaningfully interpret changes in death rates over time. Smaller communities may want to average the death data from several years so they can compare them to other time periods.
• It is safe to presume that the deaths identified as substance use-related are an undercount of the true number. The stigma associated with alcohol and drugs leads to sensitivity in reporting these types of diseases as the cause of death.
• Injury deaths are more likely to reflect substance use patterns among young users. Tracking injury deaths may reveal different trends from disease deaths.

Resources

Drug-Related ICD-9-CM Diagnoses and Diagnostic Related Groups. National Institute on Drug Abuse. Assessing Drug Abuse Within and Across Communities, In press. Rockville, MD: The Institute, 2005.

North Charles Research and Planning Group. A Substance Abuse Indicator Chart Book for North Dakota Second Edition, September 2002.