PRC Region 8 2015 Regional Needs Assessment

2015
Regional Needs
Assessment
REGION 8: UPPER SOUTH TEXAS
PREVENTION RESOURCE CENTER
South Texas Centre
AT&T Building
7500 US Hwy 90 West,
Suite 100
San Antonio, TX 78227
210.225.4741
www.prcregion8.org
p. (210) 225-4741
f. (210) 225-4768
amoore@sacada.org
www.prcregion8.org

2015 Regional Needs Assessment
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San Antonio Council on Alcohol and Drug Abuse
South Texas Centre AT&T Building
7500 US Hwy 90 West, Suite 100
San Antonio, TX 78227
210.225.4741
www.prcregion8.org
The Regional Needs Assessment has been
conducted to provide the state, the PRC, and
the community at large with a comprehensive
view of information about the trends,
outcomes and consequences associated with
drug and alcohol use in Region 8.
THANK YOU TO ALL OUR PARTNERS
The State Collaborative began formally in
2013 when the state transformed all 11
Regional Drug and Alcohol Clearinghouse
Organizations into a Central Data
Repository.
The Regions within Texas agreed to put
aside their competitive business practices
to conduct a comprehensive drug and
alcohol needs assessment in the interest in
improving the awareness of the
community by working together.
SACADA was founded in 2014, making this
the initial RNA for Region 8.
Collaboration within Region 8 has developed
a powerful network of citizens, community
organizations and businesses.

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Message
from Our
Executive
Director
It is my great honor and privilege to serve as the Executive Director for
the San Antonio Council on Alcohol and Drug Abuse. I passionately
believe in the great work this organization has provided our
community for over 53 years, and I’m excited about the new
opportunities we have in bringing hope and healing through
prevention and intervention services.
We know that substance abuse is one of the leading problems that
affects San Antonio. It isa significant factor in broken homes, domestic
violence, child abuse, health problems, soaring medical costs, crime,
DWI fatalities, unplanned pregnancies, school performance problems,
truancy, high dropout rates, loss of productivity and many workplace
issues. Its effects reach far beyond the user to family, friends, the
workplace, and the entire community.
Collaboration with other organizations and agencies is crucial in
preventing substance abuse and addiction. Working with our many
partners, we are making our community safer and healthier. By
utilizing community assessments and implementing evidence-based
strategies, we will be able to monitor our success and be strategic in all
the work we do.
I’m extremely grateful to our Board of Directors, Staff and Community
Partners for their unwavering support of the San Antonio Council on
Alcohol and Drug Abuse. Together, we’re reducing the impact of
substance abuse and addiction.
Sincerely,
Abigail Moore MA, LPC, LCDC, ACPS
Executive Director
San Antonio Council on Alcohol and Drug Abuse

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Proudly Serving South Central Texas
The Prevention Resource Center (PRC) Region 8 proudly serves the 28 counties of South
Central Texas by providing access to data regarding alcohol, tobacco, and other drug use
and misuse, as well as behavioral, mental, and physical health issues related to drug use.
PRC 8 also collaborates with community stakeholders and builds strong partnerships with
organizations that collect data through questionnaires, needs assessments, surveys, focus
groups, and informant interviews.
Our Mission
The mission of the Prevention Resource Center 8 is to serve as a central data repository
and substance abuse training liaison for the Region 8 community. As the central data
repository, the PRC will develop a Regional Needs Assessment (RNA) that will tell the story
of the 28 counties. The data collection will include, but is not limited to, the state’s three
main priorities of alcohol, marijuana and prescription drugs.
ACKNOWLEDGMENTS
The members of the Needs Assessment Team for Region 8 include:
GYNA JUAREZ, M.P.A., ACPS PRC REGION 8 DIRECTOR
BETSY JONES, TOBACCO PREVENTION SPECIALIST
TERESA STEWART, REGIONAL COMMUNITY LIAISON
HORTENCIA C. CARMONA, M.S., REGIONAL EVALUATOR
ALEXIS LAWRENCE, M.S., REGIONAL COMMUNITY LIAISON

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Table of Contents
Executive Summary................................................................................................................................ 7
What is the PRC?..................................................................................................................................... 7
Key Concepts in This Report ................................................................................................................. 10
Adolescence...................................................................................................................................... 10
Epidemiology.................................................................................................................................... 10
Risk and Protective Factors............................................................................................................... 11
Consequences and Consumption ...................................................................................................... 12
Introduction.......................................................................................................................................... 14
How to Use This Document............................................................................................................... 14
Methodology .................................................................................................................................... 15
Process.............................................................................................................................................. 15
Quantitative Data Selection............................................................................................................ 156
Qualitative Data Selection .................................................................................................................17
Demographic Overview ........................................................................................................................ 18
State Demographics ......................................................................................................................... 18
Regional Demographics.................................................................................................................... 35
Environmental Risk Factors...................................................................................................................48
Education..........................................................................................................................................48
Criminal Activity................................................................................................................................52
Mental Health ...................................................................................................................................63
Social Factors.................................................................................................................................... 70
Accessibility ......................................................................................................................................80
Perceived Risk of Harm .....................................................................................................................90
Regional Consumption..........................................................................................................................94
Alcohol..............................................................................................................................................95
Marijuana..........................................................................................................................................99
Prescription Drugs .......................................................................................................................... 104
Tobacco ...........................................................................................................................................107
Emerging Trends............................................................................................................................. 109
Consequences..................................................................................................................................... 123
Mortality......................................................................................................................................... 124
Legal Consequences ....................................................................................................................... 128

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Hospitalization and Treatment ....................................................................................................... 132
Economic Impacts........................................................................................................................... 140
Environmental Protective Factors........................................................................................................147
Community Domain........................................................................................................................ 149
School Domain................................................................................................................................ 156
Family Domain................................................................................................................................ 160
Individual Domain........................................................................................................................... 164
Trends of Declining Substance Use ..................................................................................................170
Region in Focus....................................................................................................................................171
Gaps in Services ...............................................................................................................................171
Gaps in Data.....................................................................................................................................172
Regional Partners.............................................................................................................................172
Regional Successes ..........................................................................................................................173
Comparison to State/Nation ............................................................................................................174
Conclusion ...........................................................................................................................................175
References...........................................................................................................................................178
Appendices......................................................................................................................................... 185
Glossary of Terms ................................................................................................................................217

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Executive Summary
The Regional Needs Assessment (RNA) is a document assembled by the Prevention Resource Center in
Texas Region 8 (PRC 8). This needs assessment has been conducted to provide the state, the PRC, and
the community at large with a comprehensive view of information about the trends and outcomes
associated with regional and statewide drug and alcohol use. The assessment was intended to enable
PRCs, DSHS, and community stakeholders to effect long-term strategic prevention planning based on
the most up-to-date information relative to the needs of the community. The data obtained and
presented regionallycan be usedby local agencies,community providers,citizensof the community,and
Texas DSHS to better understand the needs of the communities and to evaluate how best to serve these
needs.
Defining community needs requires a thoughtful, scientific, and qualitative approach. Community is not
a set of numbers, but a tapestry of collective experiences, lifestyles, histories, traditions, and
expectations. While Texas offers a cultural, geographical, and social experience of diversity, it is also
culturally similar across all of its towns and cities. While each town from the gulf coast to the Hill Country
is brilliantly distinctive in its own structure, Texans are resilient, industrious people united by a singular
pride.
The information presented in this document has been acquired by a team of regional evaluators through
state and local resources, and compared with state and national rates. Secondary data such as local
surveys, focus groups, and interviews with key informants may also allow for input from others in the
community, whose expertise lends a specific and qualitative description to identified issues. It is not the
aim of this document to assume causation between any substance and prevalence rate in any given area
or cultural context.
What is the PRC 8?
Prevention Resource Center, Region 8, is a program of the San Antonio Council on Alcohol and Drug
Abuse (SACADA) providing substance abuse prevention services to twenty-eight counties in Upper
South Texas. PRC-8 is one of eleven PRCs supported by the Texas Department of State Health Services
(DSHS). These centers are part of a larger network of youth prevention programs and community
coalitions. This network of substance abuse prevention services works to improve the welfare of Texans
by discouraging and reducing substance abuse. Their work provides valuable resources to address the
state’s three prevention priorities of (1) under-age drinking, (2) marijuana use, and (3) prescription drug
abuse, as well as tobacco and other illicit drugs. These priorities are outlined in the Texas Behavioral
Health Strategic Plan developed in 2012.
Our Purpose
There are eleven regional Prevention Resource Centers serving the State of Texas. Each PRC acts as the
central data repository and substance abuse prevention training liaison for its region. The Prevention
Resource Centers also collaborate with local community and county data resources to maximize regional
data collection,identify trainingneedsin the community andthe region,andassist in conducting tobacco
retailer compliance checks.

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Our Regions
Region 1: Panhandle and South Plains
Armstrong, Bailey, Briscoe, Carson, Castro,
Childress, Cochran, Collingsworth, Crosby, Dallam,
Deaf Smith, Dickens, Donley, Floyd, Garza, Gray,
Hale, Hall, Hansford, Hartley, Hemphill, Hockley,
Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn,
Moore, Motley, Ochiltree, Oldham, Parmer, Potter,
Randall, Roberts, Sherman, Swisher, Terry,
Wheeler, and Yoakum Counties.
Region 2: Northwest Texas
Archer, Baylor, Brown, Callahan, Clay, Coleman,
Comanche, Cottle, Eastland, Fisher, Foard,
Hardeman, Haskell, Jack, Jones, Kent, Knox,
Mitchell, Montague, Nolan, Runnels, Scurry,
Shackelford, Stonewall, Stephens, Taylor,
Throckmorton, Wichita, Wilbarger, and Young
Counties.
Region 3: Dallas/Fort Worth Metroplex
Collin, Cooke, Dallas, Dallas, Denton, Ellis, Erath,
Fannin, Grayson, Hood, Hunt, Johnson, Kaufman,
Navarro, Palo Pinto, Parker, Rockwall, Somervell,
Tarrant, and Wise Counties.
Region 4: Upper East Texas
Anderson, Bowie, Camp, Cass, Cherokee, Delta,
Franklin, Gregg, Harrison, Henderson, Hopkins,
Lamar, Marion, Morris, Panola, Rains, Red River,
Rusk, Smith, Titus, Upshur, Van Zandt, and Wood
Counties.
Region 5: Southeast Texas
Angelina, Hardin, Houston, Jasper, Jefferson,
Nacogdoches, Newton, Orange, Polk, Sabine, San
Augustine, San Jacinto, Shelby, Trinity, and Tyler
Counties.
Region 6: Gulf Coast
Austin, Brazoria, Chambers, Colorado, Fort Bend,
Galveston, Harris, Liberty, Matagorda,
Montgomery, Walker, Waller, and Wharton
Counties.
Region 7: Central Texas
Bastrop, Bell, Blanco, Bosque, Brazos, Burleson,
Burnet, Caldwell, Coryell, Falls, Fayette, Freestone,
Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon,
Limestone, Llano, Madison, McLennan, Milam,
Mills, Robertson, San Saba, Travis, Washington, and
Williamson Counties.
Region 8: Upper South Texas
Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt,
Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales,
Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney,
La Salle, Lavaca, Maverick, Medina, Real, Uvalde,
Val Verde, Victoria, Wilson, and Zavala Counties.
Region 9: West Texas
Andrews, Borden, Coke, Concho, Crane, Crockett,
Dawson, Ector, Gaines, Glasscock, Howard, Irion,
Kimble, Loving, Martin, Mason, McCulloch, Menard,
Midland, Pecos, Reagan, Reeves, Schleicher,
Sterling, Sutton, Terrell, Tom Green, Upton, Ward,
and Winkler Counties.
Region 10: Upper Rio Grande
Brewster, Culberson, El Paso, Hudspeth, Jeff Davis,
and Presidio Counties.
Region 11: Rio Grande Valley/Lower South Texas
Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim
Hogg, Jim Wells, Kenedy, Kleberg, Live Oak,
McMullen, Nueces, Refugio, San Patricio, Starr,
Webb, Willacy, and Zapata Counties.

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Regional Evaluators
Regional PRC Evaluators are responsible for developing data collection strategies, conducting surveys
and focus groups, analyzing data, creating reports and databases for the central data repository, and
collaborating with the DSHS Statewide Prevention Evaluator. The evaluators also work with Community
Liaisons and Prevention Specialists to identify potential collaborators and provide data resources.
Regional PRC Evaluators are primarily responsible for gathering alcohol and drug consumption data and
related risk and protective factors within their respective service regions. Their work in tracking
substance use patterns is disseminated to stakeholders and the public through a variety of methods
including fact sheets, social media, traditional news outlets, presentations, and reports such as this
Regional Needs Assessment. Their work serves to provide state and local agencies valuable prevention
data to assess target communities and high-risk populations in need of prevention services.
How We Help the Community
The data we collect serves as a useful tool in Data-Driven Decision Making (DDDM). Over the past two
years, the PRC teams have taken the cause of the data initiative into the community through
presentations, workgroup meetings, and media awareness activities to inform decision-makers and
others about the significance of data. Once published,the analysis in these reports will be made available
to the public and marketed as a regional tool.

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Key Concepts in This Report
As one reads this document, two guiding concepts will appear throughout. The reader will become
familiar with a focus on the youth population (adolescence), and an approach from a public health
framework (epidemiology). Subsequent to understanding reasons for the targeted youth demographic
and public health approaches, readers will be presented with discussions about other key concepts such
as risk and protective factors, consequences, consumption factors, and contextual indicators.
Substance use is not restricted to any age, gender identification, race, ethnicity, cultural experience, or
religious affiliation. While the incidence and prevalence rates of substance use among all demographics
are concerning, evidence indicates that prevention work done with adolescents has a positive and
sustainable community impact (Treatment Research Institute, 2014). Most concerning are the effects
that substance use has on youth brain development, the potential for high-risk behavior, possible injury,
and death. Also concerning are social consequences such as poor academic standing, negative peer
relationships, aversive childhood experiences, and overall community strain (Healthy People 2020).
Adolescence
The Texas Department of State Health Services maintains the definition of Adolescence as ages 12-17
(Texas Administrative Code 441, rule 25.), while the World Health Organization (WHO) and American
Psychological Association (APA) both define adolescence as the period of age from 10-19. Many
scientists and professionals prefer to define adolescence in terms of developmental milestone markers
including behaviors, cognitive reason, aptitude, attitude, and competencies. Both the WHO and APA
concede that there are characteristics generally corresponding with adolescence, such as the hormonal
and sexual maturation process, social change in prioritization emphasizing peer relations, and attempts
to establish autonomy.
The National Institute on Drugs and Alcohol (NIDA) and National Institute on Mental Health (NIMH)
support an expanded definition of adolescence beyond the age of 19. Neurological research indicates
that the human brain is not fully developed until approximately age 25. The Massachusetts Institute for
Technology hosts the Young Adult Development Project, one of many research-based entities that
provide an overview of brain development into the mid-twenties. The frontal lobe of the brain known for
judgment andreason isthe last to develop.These recent findings are particularlyimportant in developing
a greater understanding of prevention work with the college-aged groups most likely to experiment with
high-risk behaviors.
The information presented in the RNA is comprised of regional and state data mined from different
sources, and will therefore consist of different age subsets. Some domains of youth data may yield
breakdowns that conclude with age 17, for instance, and some will end at age 19. The authoring team has
endeavored to standardize the information presented here.
Epidemiology
Epidemiology is the theoretical framework for which this document evaluates the impact of drug and
alcohol use on the public at large. As a study of disease, when applied to drug and alcohol use trends,
epidemiology underscores thispublichealth concern asboth preventable andtreatable. According to the
World Health Organization, “Epidemiology is the study of the distribution and determinants of health-
related states or events (including disease), and the application of this study to the control of diseases
and other health problems” (WHO, 2014). The WHO is one of many research-based agencies that

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endorse the examination of drug and alcohol trends, the associated harms and treatments, as well as
policy development, from an epidemiological perspective.
The Substance Abuse Mental Health Services Administration (SAMHSA) has also adopted the epi-
framework for the purpose of surveying and monitoring systems which currently provide indicators
regarding the use of drugs and alcohol nationally. Ultimately, the WHO, SAMHSA, and others endeavor
to create an ongoing systematic infrastructure (such as a repository) that will enable effective analysis
and strategic planning for the nation’s disease burden, while identifying demographics at risk and
evaluating appropriatepolicyimplementation for prevention andtreatment.Manystates have evaluated
drug and alcohol use from an epidemiological perspective for the last several years and have gained
ground in prevention work as a result. By investigating risk factors, protective factors, and consequences
of substance abuse-related issues, society can address causality rather than merely identifying
symptoms. Ongoing surveillance of data necessitates the standardization of measurement with regard
to indicators, which translates to methodological processes at the state and regional levels.
Risk and Protective Factors
Adiscussion ofRisk and Protective Factors isessentialto understanding how prevention work iscurrently
done in at-risk populations. There are many personal characteristics that influence or culminate in
abstinence from drug and alcohol use, the comprehension of which is relevant to grasping the big picture
of substance use and potential for substance use disorders (SUD). Historically, professionals and others
believed that the physical properties of drugs and alcohol were the primary determinant of addiction.
Science has more recently determined that while the effect of substance use is initially a reward in and
of itself, the individual’s physical and biological attributes play a significant role in the potential for the
development of addiction.
Genetic predisposition and prenatal exposure to alcohol, when combined with poor self-image, self-
control, or social competence, are influential factors in substance use disorders. Other risk factors
include family strife, loose-knit communities, intolerant society, and exposure to violence, emotional
distress, poor academics, extreme socio-economic status, and involvement with children’s protective
services, law enforcement, and parental absence. Protective factors include an intact and distinct set of
values, high IQ and GPA, positive social experiences, spiritual affiliation, family and role model
connectedness, open communications and interaction with parents, awareness of high expectations
from parents, shared morning, afterschool, meal-time or night time routines, peer social activities, and
commitment to school.
Kaiser Permanente originated and now collaborates with the Centers for Disease Control on the Adverse
Child Experience study, which compared eight categories of negative childhood experiences against
adult health status. Participants were surveyed on the following experiences: recurrent and severe
physical abuse, recurrent and severe emotional abuse, and contact sexual abuse growing up in a
household with: an alcoholic or drug user, a member incarcerated, a mentally ill, chronically depressed,
or institutionalized member, the mother treated violently, and both biological parents not being present.
The study results underscore the reality of adverse childhood experiences as more common than
typically perceived, and exhibit a prominent relationship between these experiences and poor behavioral
health management later in life.

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Examination of risk and protective factors provides a meaningful understanding of how and why youth
substance use trends develop from an epidemiological perspective. Accessing data that links childhood
experiences with current behavioral health trends allows prevention planners to identify core
determinants where attention should be focused. Trends become more obvious when consequences and
consumption factors are surveyed, as they are considered the distribution of a public health problem. In
other words, today’s reported history enables researchers and practitioners to implement tomorrow’s
prevention initiatives. Beverly Tremain, an epidemiologist with the Center for Applied Prevention
Techniques states, “Today’s incidence rates are tomorrow’s prevalence rates.”
Consequences and Consumption
A tangible way to understand drug and alcohol trends is through sequentially analyzing consequences
and consumption patterns. This often occurs at the community level after a notable tragedy has taken
place, such asa drunk driving incident involving a fatality. Support for prevention standardsmaybe more
pronounced in the wake of such tragedies. On the other hand, prevention efforts are often unnoticed
during times of calm. The epidemiological approach calls for consistent examination of consequences
and consumption. This highlights how the public deals with tragedies as well as aversive health trends
and the effectiveness of prevention efforts during “calm” years.
Consequences and consumption will be described in this document as it relates to alcohol, prescription
drugs, and illicit drugs. This will enable the reader to conceptualize public health problems in an
organized manner. SAMHSA has provided an excellent example of how these concepts are tied together
with alcohol. “With respect to alcohol, constructs related to consequences include mortality and crime,
and constructs related to consumption patterns include current binge drinking and age of initial use. For
each construct, one or more specific data measures (or ‘indicators’) are used to assess and quantify the
prevention-related constructs. Indicator data is collected and maintained by various community and
government organizations.” Therefore, the state of Texas will continue to build an infrastructure for
monitoring trends by examining consequence-related data followed by an assessment of consumption.
There is a complex relationship between consequences and consumption patterns. Many substance-
related problems are multi-causal in nature, and often include exacerbating and sustaining dynamics
such as lifestyle, family culture, peer relations, education level, criminal justice involvement, and so on.
Because consumption and consequences are intertwined and occur within a constellation of other
factors, separating clear relationships is difficult. Researchers must look at aggregate data in order to
ascribe meaningful relationships to the information obtained.
Consumption data alone may be vulnerable to inaccuracy, as it is often gathered through the self-report
process, and may not include co-occurring aspects of substance use problems. Moreover, stakeholders
and policymakers have a vested interest in the monetary costs associated with substance-related
consequences. As such, the process may appear to be a method of working backwards, however it
incorporates a pragmatic version of inductive reasoning.
Consequences
For the purpose of the RNA, consequences are defined as adverse social, health, and safety problems or
outcomes associated with alcohol, prescription, or illicit drug use. Consequences include events such as
mortality, morbidity, violence, crime, health problems, academic failure, and other undesired events for
which alcohol and/or drugs are clearly and consistently involved. Although a specific substance may not

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be the single cause of a consequence, measureable evidence must support a link to alcohol and/or drugs
asa contributing factor. The WorldHealth Organization estimates alcoholuse asthe world’sthirdleading
risk factor for loss of healthy life, and that the world disease burden attributed to alcohol is greater than
that for tobacco and illicit drugs. Evaluation of the global impact of drug and alcohol-related
consequences presents a consistent and reliable allegory of local consequence and consumption factors.
Consumption
SAMHSA defines consumption as “the use and high-risk use of alcohol, tobacco, and illicit drugs.
Consumption includes patterns of use of alcohol, tobacco, and illicit drugs, including initiation of use,
regular or typical use, and high-risk use.” Some examples of consumption factors for alcohol include
terms of frequency, related behaviors, and trends, such as current use (within the previous 30 days),
current binge drinking, heavy drinking, age of initial use, drinking and driving, alcohol consumption
during pregnancy, and per capita sales. Consumption factors associated with illicit drugs may include
route ofadministration,such as intravenoususe andneedle sharing.Needle sharing isan example ofhow
a specific construct yields greater implications than just the consumption of the drug: it may provide
contextual information regarding potential health risks like STD/HIV and hepatitis for the individual, and
contributes to the incidence rates of these preventable diseases. Just as needle sharing presents multiple
consequences, binge drinking also beckons a specific set of multiple consequences, albeit potentially
different from needle sharing.
The consumption concept also encompasses standardization of substance unit, duration of use, route of
administration, and intensity of use. Understanding the measurement of the substance consumed plays
a vital role in consumption rates. Alcoholic beverages are available in various sizes and by volume of
alcohol. Variation occurs between beer, wine, and distilled spirits; within each of these categories, the
percentage of pure alcohol varies. Consequently, a unit of alcohol must be standardized in order to derive
meaningful and accurate relationships between consumption patterns and consequences. The National
Institute on Alcohol Abuse and Alcoholism (NIAAA) defines a “drink” as half an ounce of alcohol, or 12
ounces of beer, a 5-ounce glass of wine, or a 1.5-ounce shot of distilled spirits. The NIAAA (2004) defines
“binge drinking” as the drinking behaviors that raise an individual’s Blood Alcohol Concentration (BAC)
up to or above the level of .08gm%, which is typically 5 or more drinks for men or 4 or more for women
within a two-hour time span. “Risky drinking” is predicated by a lower BAC over a longer span of time,
while a “bender” is considered to be two or more days of sustained heavy drinking. Standardizing units
continues to prove difficult, so guidelines have been included in the tables section of this document.
Because alcohol is legal, commercially available, and federally regulated, it is a better example to employ
regarding standardization. This is why the BAC is such an important element in determining risk
associated with consumption. Unfortunately, the purity of heroin or the amount of amphetamine found
inspeedareoftenascertainedinlabortoxicologyreports,whichareusuallyaccessible onlywhenahealth
or legal consequence has already occurred. The inability to know or regulate the purity of street drugs is
one of the riskiest determinants for consumption, and is potentially a contributing factor to the recent
epidemic of heroin overdoses in the U.S. Moreover, pharmaceutical-related consumption material has
an entirelyseparate consumptionvariation potential.There arevastpharmaceuticaldifferences ineffect,
potency, and half-life found between the various opioids, stimulants, and benzodiazepines.

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Introduction
The Department of State Health Services (DSHS), Substance Abuse & Mental Health Services Section,
funds 188 school- and community-based programs statewide to prevent the use and consequences of
alcohol, tobacco, and other drugs (ATOD) among Texas youth and families. These programs provide
evidence-based curricula and effective prevention strategies identified by the Substance Abuse and
Mental Health Services Administration’s Center for Substance Abuse Prevention (CSAP). The Strategic
Prevention Framework provided by CSAP guides many prevention activities in Texas. In 2004, Texas
received a state incentive grant from CSAP to implement the Strategic Prevention Framework, with
Texas DSHS working in close collaboration with local communities to tailor services and meet local needs
for substance abuse prevention. This strategic prevention framework provides a continuum of services
that target the three classifications of at risk populations under the Institute ofMedicine (IOM): universal,
selective, and indicated.
Our Audience
Potential readers of this document include stakeholders who are vested in the prevention, intervention,
and treatment of substance abuse in adolescents and adults in the state of Texas. Stakeholders include,
but are not limited to, substance abuse prevention and treatment providers, medical providers, schools
and school districts, community coalitions, city, county, and state leaders, prevention program staff, and
community members committed to preventing substance use.
Our Purpose
Prevention Resource Centers serve the community byproviding infrastructure andother indirect services
to support the network of substance abuse prevention providers. Beginning in 2013, PRCs became a
regional resource for substance abuse prevention data. Whereas PRCs formerly served as clearinghouses
for substance use literature, prevention education, and media resources, their primary purpose now is to
gather and disseminate data to support prevention programs in Texas. PRCs assist state and local
prevention programs by providing data for program planning and evaluation of long-term impact of
prevention efforts in Texas. Other valuable services include media campaigns, alcohol retailer
compliance monitoring, tobacco activities, and access to prevention training resources.
How to Use This Document
This RNA is a review of data on substance abuse and related variables across the state that will aid in
substance abuse prevention decision making. It seeks to address substance abuse prevention data needs
at the state, county, and local levels. The assessment focuses on the state’s prevention priorities of
alcohol (underage drinking), marijuana, and prescription drugs and other drug use among adolescents in
Texas. This report explores drug consumption trends, consequences, and related risk and protective
factors as identified by the Center for Substance Abuse Prevention (CSAP).
Purpose of This Report
This RNA was developed to provide relevant substance abuse prevention data on adolescents in Region
8 and throughout Texas. Specifically, this regional assessment serves the following purposes:
1. To discover patterns of substance use among adolescents and monitor changes in trends over
time.
2. To identify gaps in data where critical substance abuse information is missing.

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3. To determine regional differences and disparities throughout the state.
4. To identify substance use issues unique to communities and regions in the state.
5. To provide a comprehensive resource tool for local providers to design targeted, relevant,
data-driven prevention and intervention programs.
6. To provide data to local providers to support grant-writing activities and funding requests.
7. To assist policy-makers in program planning and policy decisions regarding substance abuse
prevention, intervention, and treatment in the state of Texas.
Features of This Report
This report includes an overview of regional substance abuse information as well as more detailed data
on trends and consequences of specific drugs. Since readers come from a variety of professional fields
with varying definitions of concepts related to substance abuse prevention, we include our definitions in
the section titled “Key Concepts.” The core of the report focuses on substance use data. For each of the
substances included, we focus on the following factors: age of initiation, early initiation, current use,
lifetime use, and consequences.
Methodology
This Regional Needs Assessment (RNA) incorporates data from many quantitative secondary sources
such as governmental, law enforcement, educational, and mental health organizations. Data was
obtained through agency reports and databases as well as national, state, and local surveys with relevant
information related to substance use trends, demographic information, vital statistics, criminal activity,
health disparities, educational attainment, and co-morbid mental health disorders.
PRC-8 will conduct qualitative primary research in the form of focus groups with key community
members and youth populations. The Regional Evaluators and the Statewide Prevention Evaluator
determined that the target population for the purpose of this RNA is adolescents, both males and
females. As defined in the earlier sections of this document, adolescence includes individuals ages 10-24.
Process
The state and regional evaluators collected primary and secondary data at the county, region, and state
levels between September 1, 2014 and May 30, 2015. The state evaluator met with the regional evaluator
in March 2015 to discuss the expectations of the RNA. Relevant data elements were determined and
reliable sources identified through a collaborative process among the team of regional evaluators and
with support provided by the Southwest Regional Center for Applied Prevention Technologies (CAPT).
Between October 2014 and June 2015, the state evaluator met with regional evaluators via bi-weekly
conference calls to discuss criteria for processing and collecting data. Region-specific data collected
through local organizations, community coalitions, school districts and local-level governments is
included to provide unique local-level information. Additionally, data was collected through primary
sources including one-on-one stakeholder interviews and focus groups.
Stratification of Region 8
Region 8 is comprised of 28 counties and has a geographical area of 31,637.10 square miles. Most of the
population resides in Bexar County. San Antonio is the second largest city in Texas with more than 1.3
million people. In the future, we will acquire data from smaller areas through focus groups and meetings
with local stakeholders.

PRC 8 16 |P a g e
Source: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
Quantitative Data Selection
Identification of Variables
Core measures were identified for standardized comparability across Texas; additional indicators may be
selected as needed to explore issues important to a particular region.
Key Data Sources
Epidemiology acquires numerous data sources including vital statistics data, government surveillance
data and reports, CDC data, health surveys, and disease registries in order to study dynamics linked with
certain diseases or conditions.
Primary Sources
1. A document or record containing first-hand information or original data on a topic.
2. A work created at the time of an event or by an evaluator who directly experienced an event.
3. Examples: interviews, diaries, letters, journals, original hand-written manuscripts, newspaper and
magazine clippings, government documents, etc.
Secondary Sources
1. Any published or unpublished work that is one step removed from the original source, usually
describing, summarizing, analyzing, evaluating, derived from, or based on primary source
materials.
2. A source that is one step removed from the original event or experience.
3. A source that provides criticism or interpretation of a primary source.
4. Examples: textbooks, review articles, biographies, historical films, music and art, articles about
people and events from the past.
The following isa list ofcommonlyuseddata sources including data collection systemsandorganizations
with numerous reports.
 U.S. Census Bureau
 National Vital Statistics System
Region 8 Counties by Ranking Population in Texas
Atascosa 68 Kendall 79
Bandera 115 Kerr 63
Bexar 4 Kinney 219
Calhoun 112 La Salle 184
Comal 33 Lavaca 122
DeWitt 117 Maverick 57
Dimmit 160 Medina 67
Edwards 236 Real 221
Frio 127 Uvalde 98
Gillespie 100 Val Verde 65
Goliad 183 Victoria 41
Gonzales 118 Wilson 70
Guadalupe 29 Zavala 156
Jackson 141 Region 8 4
Karnes 140 Texas 2

PRC 8 17 |P a g e
 National health surveys
 Maternal and Child Health Bureau
 Behavioral risk factor surveys
 Other surveillance programs and state cancer registries
 World Health Organization
 Private organizations and universities
Data, mainly quantitative data, is imperative in epidemiology. Evaluating and documenting frequency,
type, and distribution of incidence is key to understanding substance use and abuse, what causes them,
whom is affected, and how to prevent further occurrence. Understanding data allows communities,
public officials, and stakeholders to target causes, affected citizens, and gaps in resources.
Criteria for Selection
The Regional Evaluators and the Statewide Prevention Evaluator chose secondary data sources as the
main resource for this document based on the following criteria:
1. Relevance: The data source provides an appropriate measure of substance consumption,
consequence, and related risk and protective factors.
2. Timeliness: We attempt to provide the most recent data available (within the last five years);
however, older data might be provided for comparison.
3. Methodological soundness: Data that used well-documented methodology with valid and reliable
data collection tools.
4. Representativeness: We chose data that most accurately reflected the target population in Texas
and across the eleven human services regions.
5. Accuracy: Data is an accurate measure of the associated indicator.
In this needs assessment for Region 8, regional surveys, reports, anecdotal and other qualitative data will
only be mentioned to add narrative to each section. Data employed in the following tables comes from
the most recently available datasets reflecting the criteria above.
Qualitative Data Selection
While quantitative data often takes priority in assessments, it is equally important to provide context
through the appropriate use of qualitative data. The term “qualitative data” refers to data and
information describing a specific event or set of circumstances that is not originally organized or
obtainable numerically. Together, qualitative and quantitative data help to define the scope and extent
of a community’s needs and to identify its gaps.
Key Informant Interviews
Key informant interviews involve capturing the knowledge, belief, and perspective of a person who has
an in-depth understanding of a particular subject, circumstance, geographic area, or population
subgroup. Quotations from the key informant and a summary of the interview are commonly included in
the health needs assessment.
Focus Groups
In the upcoming year, focus groups and interviews will be conducted by the PRC team in order to better
understand what members of the communities believe their greatest needs to be. The information

PRC 8 18 |P a g e
collected by this research will serve to identify avenues for further research and provide access to any
quantitative data that participants may have access to.
1. What problems do you see in your community?
2. What is the greatest problem you see in your community?
3. What evidence do you have to support this as the greatest problem?
4. What services do you lack in your communities?
Participants for focus groups will be invited from a wide selection of professionals including law
enforcement, health care providers, community leaders, clergy, educators, town council, state
representatives, university professors, and local business owners. In these sessions, participants will
discussed their perceptions of how their communities are affected by alcohol, marijuana, and
prescription drugs.
Surveys
The discussion of survey covers any motion that gathers or obtains statistical data. It can include
censuses, sample surveys, the collection of data from organizational records, and resulting statistical
events. A survey within this study is an investigation of the features of a given population by means of
gathering data from a sample of that population and estimating their features through logical use of
statistical methodology.
Demographic Overview
2014 Census data indicate that Texas added 451,321 residents in the last year, a 1.7 percent increase since
2013, totaling a population of over 26.9 million residents. Texas ranked 1st
nationally for the highest
numeric increase in population and 2nd
as the most populous state, behind California. The nation’s
regionalpopulation in theSouth,which includes Texas,grew themost at 14.3 percent.Texas’s population
growth from 2000 to 2010 was twice that of the United States as a whole. The U.S. population grew only
9.7 percent to 308,745,538 residents, the slowest growth rate in decades.
State Demographics
The Lone Star State's growth over the past decade was concentrated in its major urban regions,
according to 2010 Census population distribution data. Texas cities showed healthy growth from 2000 to
2010. Houston ranked 4th, San Antonio 7th
, and Dallas 9th
compared to other cities in the U.S. Houston
continues to be the state's largest city, with a 7.5 percent increase to 2,099,451. In 2nd
statewide, San
Antonio and its population grew 6.1 percent to 1,327,407, while Dallas, 3rd
largest city in Texas, gained 0.8
percent to grow to 1,197,816. Austin was the 4th
largest city, while Fort Worth, with 741,206 people, and
El Paso, with 649,121, ranked 5th
and 6th
in population.
Population
Texas is the second most populous state in the nation and has three cities with populations exceeding
one million: Houston, San Antonio, and Dallas. These three cities rank among the ten most populous
cities in the United States. According to the US Census 2010, six Texas cities had populations greater
than 600,000 people. Austin, Fort Worth, and El Paso are among the 20 largest U.S. cities. Texas has
four metropolitan areas with populations greater than a million: Dallas–Fort Worth–Arlington, Houston–

PRC 8 19 |P a g e
Sugar Land–Baytown, San Antonio–New Braunfels, and Austin–Round Rock–San Marcos. The Dallas–
Fort Worth and Houston metropolitan areas number about 6.3 million and 5.7 million citizens.
As of 2014, there are 26,956,958 people living in the state of Texas, an increase of 6.1 million since the
year 2000, including increases in population in all three subcategories of population growth: natural
increase (births minus deaths), net immigration, and net migration. It is estimated that as many as 1.8
million immigrants are living undocumented in Texas as of 2012, according to the Department of
Homeland Security (DHS, 2012).
Texas Metropolitan Status by County
Metropolitan Areas in this table were defined in 2013 by the Office of Management and Budget (OMB).
Metropolitan Areas are characterized by a central urban area surrounded by other urban areas that
work together economically or socially. The central urban area must have a population of at least
50,000 people with a combined regional population of 100,000.
Texas- Core Based Statistical Areas (CBSAs) and Counties
Source: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, 2013
20
22
24
26
28
P O P U L A T I O N
E S T I M AT E S , AP R I L 1 ,
2 0 0 0 , ( C E N S U S 2 0 0 0
D AT A)
P O P U L A T I O N
E S T I M AT E S B AS E ,
AP R I L 1 , 2 0 1 0 ,
( V 2 0 1 3 )
P O P U L A T I O N
E S T I M AT E S , J U L Y 1 ,
2 0 1 3 , ( V 2 0 1 3 )
P O P U L A T I O N
E S T I M AT E S , J U L Y 1 ,
2 0 1 4 , ( V 2 0 1 4 )
MILLIONS
TEXAS POPULATION
Texas Population

PRC 8 20 |P a g e
Age
Texans continue to grow older, with an average age over 33 years. At the same time, the number of
women at older ages is increasing. A grasp of the population’s age and gender structure produces
understanding of changing outcomes, and predicts upcoming social and economic encounters.
Examining age demographics is important for increasing prevention efforts, especially with potential
first-time users.
Source: SOURCE: U.S. Census Bureau, Current Population Survey, and Annual Social and Economic Supplement, 2012.
Race
Race is the key dissection of humanity, having
distinct physicalcharacteristics.It is important
to understandthata person can belongto only
one race. Although he or she belongs to just
one race, they may still have multiple ethnic
identifications. Race is socially imposed,
whereas ethnicity is not.
The census officially identifies six racial
categories: White American, Native American
and Alaska Native, Asian American, Black or
African American, Native Hawaiian and Other
Pacific Islander. "Some other race" is also used
in the census and other surveys, but is not an
official response.
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
TEXAS POPULATION BY AGE & SEX
male female
White--Anglo
(non-
Hispanic)
72%
African
American
(non-
Hispanic)
18%
American
Indian (non-
Hispanic)
1%
Asian (non-
Hispanic)
6% Other
(non-
Hispani
c)
0%
Multi-Racial
(non-
Hispanic)
3%
Race
White--Anglo (non-Hispanic)
African American (non-Hispanic)
American Indian (non-Hispanic)
Asian (non-Hispanic)
Other (non-Hispanic)
Multi-Racial (non-Hispanic)
Source: U.S. Census Bureau, Total population
estimates of the state of Texas as of July 1, 2014.

PRC 8 21 |P a g e
Ethnicity
Ethnicity is defined as being part ofor identifying witha socialgroup that hasa mutual nationalor cultural
tradition and customs. Ethnicity refers to shared cultural practices, perspectives, and distinctions that
distinguish one group of people from another, or a shared cultural heritage. The most common
characteristics differentiating other ethnic groups are ancestry, language, religion, attire, and a sense of
history. Ethnic differences are not inherited; they are learned.
The U.S. Census Bureau classifies Americans as "Hispanic or Latino" and "Not Hispanic or Latino"
because Hispanic and Latino Americans are a racially diverse ethnicity that make up the largest minority
group in the U.S. Each individual has two classifying elements: racial identity and whether or not they
are of Hispanic ethnicity. These categories are sociopolitical ideas and should not be taken as logical or
anthropological in nature according to the U.S.
Department of Labor. Therefore, no separate racial
category exists for Hispanic and Latino Americans, as
they do not establish a race, nor a national group. Each
person is asked to choose from the six racial
classifications as all Americans are included in the
numbers reported for those races. In this assessment
the information collected from the U.S. Census and
other sources identifies:
1. Persons reporting only one race.
2. Hispanics may be of any race, and are included in
applicable race categories.
Languages
The majority of the U.S. population speak English as
their first language, but many other languages are
spoken in homes as the primary language. Currently
there are 382 identified language codes, according to
the U.S. Census. These are categorized into four major
language groups: Spanish; Other Indo-European
languages, Asian and Pacific Island languages, and All
Other languages. A more comprehensive subcategory
divides the 382 codes into 39 languages and language
groups.
According to the U.S. Census Bureau, 2009-2013 5-
Year American Community Survey, about 65%
(15,471,149) of Texas residents age five and older
speak English as their primary language, more than
29% (6,983,384) speak Spanish as their first language,
0.82% (193,408) spoke Vietnamese as their primary
Top 10 Non-English Languages Spoken in
Texas
Language % of Texas
Population
1. Spanish 29.46%
2. Vietnamese 0.82%
3. Chinese (including
Mandarin and
Cantonese)
0.59%
4. Other Asian Languages 0.38%
5. African Languages 0.34%
6. Tagalog 0.30%
7. German 0.29%
8. French 0.26%
9. Hindi 0.25%
10. Urdu 0.24%
Hispanic
--Latino
38%
Non
Hispanic-
-Latino
62%
Ethnicity
Source: U.S. Census Bureau, Total population estimates ofthe
state of Texas as of July 1, 2014.
Source: U.S. Census Bureau, 2009-2013
5-Year American Community Survey
Survey

PRC 8 22 |P a g e
language, and Chinese (including Cantonese and Mandarin) is spoken as the primary language by 0.59%
(140,871). Other languages have been documented in Texas by the American Community Survey and
include German/Texas German, Tagalog, French/Cajun French, and others. In total, almost 35%) of
Texas's residents age five and older spoke a language other than English.
Concentrations of Populations
There are five large concentrations of populations in the state of Texas according to the U.S. Census:
European, Hispanic, African American, Asian, and American Indian.
English Americans prevail in eastern, central, and northern Texas; German Americans in central and
western Texas. African Americans make up one-third of the Lone Star’s population and are concentrated
in eastern Texas as well as the Dallas-Fort Worth and Houston metropolitan areas.
As of 2010 the U.S. Census shows 45% of Texas citizens identify with Hispanic heritage; these take into
account present-dayimmigrants fromMexico, CentralAmerica,and South America and include Tejanos,
whose descendants lived in Texas as early as the 1700s. Tejanos are concentrated in and around Bexar
County including San Antonio, where over one million Hispanics live. Texas has the 2nd greatest
Hispanic-identifying population in the United States, behind California.
American Indian tribes who once subsisted or migrated inside the frontiers of today’s Texas include the
Alabama, Apache, Atakapan, Bidai, Caddo, Cherokee, Chickasaw, Choctaw, Comanche, Coushatta,
Hueco, the Karankawa of Galveston, Kiowa, Lipan Apache, Muscogee, Natchez, Quapaw, Seminole,
Tonkawa, Wichita, and others. There are three federally recognized Native American tribes in Texas, one
of which is the Kickapoo Traditional Tribe of Texas in Region 8:
1. Alabama-Coushatta Tribe of Texas in eastern Texas
2. Kickapoo Traditional Tribe of Texas in the Rio Grande Valley
3. Ysleta Del Sur Pueblo of El Paso, Texas
Source: texaspolitics.utexas.edu

PRC 8 23 |P a g e
General Socioeconomics
Economic and social indicators like income, education, and social connectedness have a direct impact on
health. These socio-economic factors interact to affect quality of life within communities. Improving on
any of these factors can enhance positive well-being and outcomes throughout societies.
“By 2020, mental and substance use disorders will surpass all physical diseases as a major cause of
disability worldwide.” Stress and a lack of resources, skills, social support, or connection to the
community contribute to poor coping skills and/or harmful behaviors such as smoking, over-
consumption of alcohol and drugs, or poor eating habits. Social support, social networking, and
connection to culture protect against the health effects of living in disadvantaged circumstances.
Having a good start in life and learning can help set the path for a healthier life. Prevention gives children
life skills that help them become more resistant to substance abuse. Challenges for adults such as mental
health issues, obesity, heart disease, criminality, low literacy, and welfare dependency can be traced to
events in early childhood. Providing children with helpful environments that include positive parental
involvement and behavior, particularly during the first six years, can modify poor outcomes in later life.
“Preventing mental and/or substance use disorders and related problems in children, adolescents, and
young adults is critical to Americans’ behavioral and physical health.” SAMHSA promotes and
implements prevention and early intervention strategies to reduce the impact of mental and substance
use disorders in America’s communities. “Addressing the impact of substance use alone is estimated to
cost Americans more than $600 billion each year” (Prevention of Substance Abuse and Mental Illness,
Substance Abuse and Mental Health Services Administration, 2014).
Average Wages
According to the U.S. Department of Labor, 19 of Texas’s 26 largest counties recorded wage growth
above the 2.9-percent national increase in 2014. Average weekly wages in 5 of the 26 largest Texas
counties were at least 10% above the national average of $949 per week in the third quarter of 2014.
Texas also had four of the lowest-paying large counties in the United States, all located along the border
with Mexico.
Counties with the highest average weekly wages were located around the large metropolitan areas of
Dallas, Houston, and Austin, as well as the smaller areas of Midland, Odessa, and Amarillo. Lower-paying
countieswere concentrated in the agricultural areas of central Texas andthe Texas Panhandle, and along
the Texas-Mexico border.
254 Counties in Texas
 212 had wages below the national average
 54 counties average weekly wages under $650
 76 registered wages from $650 to $749
 52 had wages from $750 to $849
 30 had wages from $850 to $949
 42 had wages of $950 or more per week

PRC 8 24 |P a g e
Household Composition
Household and Family Size
 The number of one-person households is growing slightly.
 The total number of households in Texas grew 1,493,117 since 2000.
 The average household size increased from 2.74 persons in 2000 to 2.82 persons in 2013.
 The average family size increased from 3.28 persons in 2000 to 3.41 in 2013.
0 2,000,000 4,000,000 6,000,000 8,000,000
2013
2012
2011
2010
2000
Texas Household and
Family
total families total household
0 1,000,000 2,000,000 3,000,000 4,000,000
2013
2012
2011
2010
2000
Texas Household
Nonfamily household
Female householder, no husband present,
family household
Male householder, no wife present, family
household
Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey

PRC 8 25 |P a g e
Housing Occupancy and Tenure
As the Texas population grows, the total number of housing units tends to grow as well. The proportion
of housing units that are owner-occupied, renter-occupied, or vacant varies slightly throughout the
state as a result of boom-and-bust periods or regulatory changes which encourage or discourage
development patterns.
 The American Community Survey reported over 10 million housing units in Texas, based on 2013
estimates.
 The Texas vacancy rate is 11.8%, 0.7% below the national average.
 In 2013, 63.3% of the state’s housing units were owner-occupied, 1.6% lower than the national
ACS 2013 average.
Employment Rates
The Bureau of Labor Statistics reports that the state unemployment rate at 4.2% in April 2015, down
from 5.2% in 2014. Texas continues to trend below the national unemployment rate of 5.4%.
Employment rose in 25 of the 26 largest counties in Texas from September 2013 to September 2014.
90.6% 89.4% 87.8% 88.0% 88.2%
9.4% 10.6% 12.2% 12.0% 11.8%
0%
20%
40%
60%
80%
100%
2000 2010 2011 2012 2013
Texas Housing
Occupancy
Occupied Vacant
63.8% 63.7% 64.5% 63.9% 63.3%
36.2% 36.3% 35.5% 36.1% 36.7%
0%
20%
40%
60%
80%
100%
2000 2010 2011 2012 2013
Texas Housing Tenure
Renter-occupied housing units
Owner-occupied housing units

PRC 8 26 |P a g e
U.S. Job Growth, 2004-2014
Texas Job Growth
Among the largest counties in Texas, employment was highest in Harris County (2,269,500) in
September 2014, followed by Dallas County (1,558,500). Tarrant, Bexar, and Travis Counties had
employment levels exceeding 600,000. Combined, the 26 largest Texas counties attributed for 80.1% of
total employment within Texas. According to the Texas Data Center, the US Department of Labor, and
the Bureau of Labor Statistics, the Lone Star State continues to lead the country in job development for
over a decade, even through the recession.
Source: Demographic Characteristics and Trends in Texas: Dr. Lloyd Potter, State Demographer, Texas State Data Center, the University of Texas at San Antonio
Source: Texas Labor Market Review, April 2015

PRC 8 27 |P a g e
Industry
Texas has numerous resources, a forceful economy, and an exceptional quality of life. Place of work are
categorized into industries based on their primary product or activity as decided from figures on annual
sales volume. Industry statistics are delivered by the North American Industry Classification System
(NAICS) and are revised every five years.

PRC 8 28 |P a g e
Employment estimates released by TWC are produced in cooperation with the U.S. Department of
Labor’s Bureau of Labor Statistics. Growing industries include Mining and Logging, Construction,
Manufacturing, Trade/Transportation/Utilities, Financial Activities, Professional and Business Services,
Education and Health Services, Leisure and Hospitality, Information and Government, and Other
Services.
Texas added 320,400 nonagricultural jobs between March 2014 and March 2015 for an annual growth
rate of 2.8%, compared with 2.3% for the U.S. as a whole. The private sector for the state contributed
304,300 jobs, an increase of 3.2%, in comparison with 2.6% for the nation’s private sector. Texas’s
seasonally adjusted unemployment rate fell to 4.2% in March 2015 from 5.3% in March 2014, while the
U.S. rate fell from 6.6% to 5.5% during the same time.
Texas has added an estimated 287,000 seasonally adjusted jobs over the past year, including an
additional 1,200 positions during the month of April 2015. Texas added jobs in seven of eleven major
industries, with more than 260,000 currently available jobs posted on WorkInTexas.com as of April 2015.
Job increases were led by the Leisure and Hospitality industry, which added 6,900 positions. The
Information industry showed its largest monthly gain since June 2000 with 3,400 jobs. Other Services
gained 2,800 jobs, followed by Trade/Transportation/Utilities, which grew by 2,100 positions.
NAICS Industry Structure
The NAICS industry hierarchy classifies data to the six-digit level. The first level consists of the Goods-
Producing and Service-Providing industries. Below this is the Super Sector level. The third layer is the
Sector level. Statewide data is published at both the Super Sector and Sector levels. Data for the 254
Texas counties is published at the Super Sector level only.
Mar-15 Mar-14 Absolute Percent
Texas 11,728,000 11,407,600 320,400 2.8%
US 140,326,000 137,214,000 3,112,000 2.3%
Mar-15 Mar-14 Absolute Percent
Texas 9,863,600 9,559,300 304,300 3.2%
US 118,035,000 114,989,000 3,046,000 2.6%
Mar-15 Mar-14 Mar-15 Mar-14
Texas 4.2% 5.4% 4.2% 5.3%
US 5.6% 6.8% 5.5% 6.6%
Sources: Texas Workforce Commission and U.S. Bureau of Labor Statistics
Texas and U.S. Labor Markets
NonFarm Employment
Private Employment
Unemployment Rate
Change
Not Seasonally Adjusted Seasonally adjusted

PRC 8 29 |P a g e
TANF Recipients
According to the US Department of Health and Human Services, “a welfare recipient is any person living
in a family where someone received benefits from any of just three programs—Temporary Assistance to
Needy Families (formerly Aid to Families With Dependent Children), Supplemental Security Income, and
the Supplemental Nutrition Assistance Program (or food stamps).” According to the Advisory Board on
Welfare Indicators, “A family is dependent on welfare if more than 50% of its total income in a one-year
period comes from TANF (which replaced AFDC), SNAP (formerly food stamps) and/or SSI, and this
welfare income is not associated with work activities.”

PRC 8 30 |P a g e
The Temporary Assistance for Needy Families (TANF) program is designed to help needy families
attain self-sufficiency. Temporary Assistance for Needy Children is formerly AFDC, Aid for Families with
Dependent Children. Cash assistance, or "welfare," is disbursed by the Texas Health and Human Services
Commission, TxHHSC, formerly the Texas Department of Human Services. Single and two-parent
families are eligible for aid based on financial need, and must engage in work or work-related activities
to remain eligible.
One Time Temporary Assistance for Needy Families helps families solve a short-term crisis. Households
are eligible for temporary assistance in cases of job loss, loss of financial support, underemployment, or
a crisis situation such as loss of transportation/shelter or a medical emergency. Recipients must engage
in work-related activities in order to remain eligible.
OTTANF has lowered reliance on TANF, allowing more resources to support individuals with barriers to
employment, including those with substance abuse or mental health issues. The rate of substance use
among welfare recipients is likely to be greater as the number of recipients decreases, because
participants with fewer obstacles to employment are likely to use temporary services.
According to the 2000 report Addressing Substance Abuse Problems among TANF Recipients: A Guide for
Program Administrators:
 1 in 5 welfare recipients abuses drugs and/or alcohol.
26,912
31,594
36,107
41,489
44,608
47,620
45,275
50,439
57,373
66,133
77,825
TANF BASIC PROGRAM TANF Basic Program
One-Parent and Child
Only Cases
686
910
1,106
954
1,046
1,277
992
930
1,404
1,898
2,539
TANF STATE PROGRAM
TANF State Program
Two-Parent Cases
78
100
134
168
169
236
268
283
387
1,358
903
TANF ONE-TIME PROGRAM
TANF One-Time
Program Cases
26
28
35
42
45
69
39
62
42
32
82
TANF GRANDPARENTS PROGRAM
TANF Grandparents
Program Cases

PRC 8 31 |P a g e
 10.5% of recipient’s age 15 and older report illicit drug use in the past month.
 10.6% of female adults in households receiving aid have “some impairment” involving alcohol or
other drugs.
 27% of females over the age of 14 receiving aid abuse alcohol or other drugs.
 37% of women 18-24 receiving aid have used illicit drugs or engaged in binge drinking.
 1 in 20 welfare recipients has difficulty holding regular employment due to substance use.
 5.2% of adults in welfare households are dependent on alcohol or other drugs.
 7.6% of recipients are dependent on alcohol and 3.6% are dependent on other drugs.
 27% of mothers over age 14 receiving aid abuse alcohol or other drugs, compared to 9% of other
women.
While the majority of alcohol and drug users are not public assistance recipients, substance use issues are
more common in the welfare population than in the general population. This is not meant to suggest a
causal relationship between substance abuse and welfare receipt; rather, it reflects the fact that people
at risk for substance abuse are overrepresented in the welfare population.
Texas Supplemental Nutrition Assistance Program (SNAP)
More than 3.9 million Texans receive food benefits from the Supplemental Nutrition Assistance Program
(SNAP). SNAP provides monthly benefits that help eligible low-income households purchase healthy
food. For most households, SNAP funds account for only a portion of their food budgets; they must also
use their own funds to buy enough food to last throughout the month. Recipients are eligible for SNAP
benefits based on residence, citizenship, employment services, work requirements, resources, income,
and social security numbers.
While many Texans receive food assistance 27.1% of Texas children still have food insecurity, the inability
to access nutritious food. National data from the U.S. Census Bureau and U.S. Department of Agriculture
determined that Zavala County in South Texas has the highest rate of food insecurity in the nation.
Nearly half the children in Zavala County are at risk of hunger.
Texas is one of eight states that impose a lifetime ban on both TANF and SNAP benefits for individuals
with felony drug convictions.
SNAP AT A GLANCE
According to the U.S. Census Bureau 2009-2013 5-Year American Community Survey, out of 8.8 million
Texas households:
 Almost 1.2 million households receive SNAP benefits
 24.9% have one or more residents 60 years and over
 66.8% have children under age 18
 52.4% receiving SNAP are below poverty level
 42% have at least one household member with a disability

PRC 8 32 |P a g e
Source: The United States Department of Agriculture (USDA), Supplemental Nutrition Assistance Program (SNAP), Annual State Level Data: FY 2010-2014
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Race
Households recieving SNAP by Race
White African American Asian American Indian/ AN/NA/ Other PI Other/two or more races
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ethnicity
Households recieving SNAP by Ethnicity
Hispanic White-non hispanic other-non Hispanic
5,447,397,414
5,993,125,493 6,006,734,649
5,934,441,831
5,330,650,619
FY 2010 FY2011 FY2012 FY2013 FY2014
TEXAS SNAP: BENEFITS
Benefits
3,500,000
3,600,000
3,700,000
3,800,000
3,900,000
4,000,000
4,100,000
Texas SNAP: Participants
Avg. Monthly Participation- Persons
1,400,000
1,450,000
1,500,000
1,550,000
1,600,000
1,650,000
1,700,000
Texas SNAP: Households
Participating
Avg. Monthly Participation- Housholds

PRC 8 33 |P a g e
$270.00
$280.00
$290.00
$300.00
$310.00
$320.00
$330.00
Texas SNAP: Monthly
Household
Avg. Monthly Benefits per Household
$115.00
$117.00
$119.00
$121.00
$123.00
$125.00
$127.00
$129.00
Texas SNAP: Monthly
Person
Avg. Mothly Benefits per person
438,532,682
434,569,783
433,304,585
1,596,864
1,557,496
1,544,770
3,826,274
3,715,414
3,684,002
FEB-14 JAN 2015 -
P R ELI M INAR Y
FEB 2015 -
I NI TI AL
LATEST TEXAS SNAP
PARTICIPATION & BENEFITS
SNAP Benefits SNAP Housholds SNAP Participants

PRC 8 34 |P a g e
Federal Benefits Denied to Drug Offenders
Texas is one of the few states that continue to impose a full ban on TANF and SNAP benefits for
individuals with felony drug convictions. The federal ban on TANF and SNAP benefits has been in effect
since 1996 with the signing of the Personal Responsibility and Work Opportunity Reconciliation Act
(PRWORA). PRWORA imposed a denial of
federal benefits to individuals convicted in state
or federal courts of felony drug offenses. The
ban is imposed for no other offenses but drug
crimes. Its provisions that subject individuals
who are otherwise eligible for receipt of SNAP or
TANF benefits to a lifetime disqualification
applies to all states unless they act to opt out of
the ban. As of 2011, 37 states either fully or
partially enforce the TANF ban, while 34 states
either fully or partially enforce the SNAP ban.
Source: GAO analysis of federal law, GAO-05-238 Denial of Federal
Benefits
Child Nutrition Programs
The National School Lunch Program (NSLP) is a federally assisted meal program providing nutritious
low-cost or free lunches to more than 3 million Texas children in public and private schools, residential
institutions, and juvenile correctional institutions.
Texas Level Child Nutrition
Table
FY2010 FY2011 FY2012 FY2013 FY2014
National School Lunch
Participation 3,352,757 3,401,746 3,374,154 3,314,611 3,322,460
Meals Served 559,012,658 565,877,470 553,231,282 561,616,917 561,428,486
Cash Payments 1,148,951,410 1,197,859,307 1,208,097,479 1,313,210,138 1,352,110,572
Commodity Costs 111,274,444 122,407,751 128,978,087 114,926,509 154,674,858
School Breakfast
Participation 1,635,423 1,744,587 1,786,414 1,818,710 1,864,859
Meals Served 274,505,543 292,635,028 296,630,348 312,178,181 318,776,536
Cash Payments 405,772,076 439,611,825 457,608,859 495,699,455 518,897,627
Special Milk
Half-Pints Served 280,465 218,703 162,687 121,638 107,566
Child and Adult Care Food
Avg. Daily Attendance 315,295 307,976 351,922 369,515 409,466
Meals Served 195,784,705 200,905,491 202,035,064 204,530,523 207,907,315
TANF SNAP
Full Ban Modified Ban NO Ban Full Ban Modified Ban NO Ban
AK AR KS AK AR DE
AL AZ ME AL AZ IA
DE CA MI GA CA KS
GA CO NH MO CO ME
IL CT NJ MS CT MI
MO FL NM SC FL NH
MS HI NY TX HI NJ
NE IA OH WV ID NM
SC ID OK WY IL NY
SD IN PA IN OH
TX KY RI KY OK
VA LA VT LA PA
WV MA WY MA RI
MD MD SD
MN MN VT
MT MT WA
NC NE
ND NC
NV ND
OR NV
TN OR
UT TN
WA UT
WI VA
WI
TOTAL 13 24 13 9 25 16

PRC 8 35 |P a g e
Cash Payments 249,685,221 259,332,648 271,131,370 285,454,670 303,447,828
Summer Food Services
Avg. Daily Attendance 162,502 173,243 176,587 180,355 181,174
Meals Served 15,747,612 16,143,253 17,860,474 17,414,743 17,868,686
Cash Payments 36,094,568 37,494,624 42,012,960 42,079,455 44,268,651
Source: The United States Department of Agriculture (USDA), Child Nutrition Tables, State Level Tables: FY 2010-2014
Texas Level Tables
Current Activity
Feb 2014 Jan 2015 Feb 2015 % change
Feb15 vs Feb14
National School Lunch
Participation 3,350,928 3,389,981 3,386,614 1.1%
School Breakfast
Participation 1,852,119 1,869,686 1,885,738 1.8%
Source: The United States Department of Agriculture (USDA), Child Nutrition Tables, State Level Tables--Current Activity
Regional Demographics
DSHS Region 8 includes a 28-county area of South Central Texas. This area borders the Rio Grande River
and Mexico in the west and the Gulf Coast in the east. Region 8 contains almost every type of
geographical setting found in Texas: rolling hills and plains, hill country, coastal plains, brush country,
and desert. In 2010 the region had an estimated population of 3 million, with over half residing in Bexar
County. The Region 8 PRC is located at the San Antonio Council on Alcohol and Drug Abuse (SACADA).
Source: www.dfps.state.tx.us/About_DFPS/region/images/REGION8.GIF
Population
The regional population in 2014 was 2,751,696. The population density is 87 persons per square mile,
while Texas has a population density of 96.3 persons/sq. mi. and the U.S. has 87.4 persons/sq. mi. The
total land area for Region 8 is 31,637.1 square miles.

PRC 8 36 |P a g e
Report Area Total Population Total Land Area (sq.
mi.)
Population Density (per
sq. mi.)
Ranking Population in Texas
Region 8 2,751,696 31,637.10 87 4
Atascosa 47,774 1,219.54 36.8 68
Bandera 20,601 790.96 25.9 115
Bexar 1,817,610 1,239.82 1,383.10 4
Calhoun 21,806 506.84 42.2 112
Comal 118,480 559.48 193.9 33
DeWitt 20,503 908.98 22.1 117
Dimmit 10,897 1,328.88 7.5 160
Edwards 1,884 2,117.86 0.9 236
Frio 18,065 1,133.50 15.2 127
Gillespie 25,357 1,058.21 23.5 100
Goliad 7,465 852.01 8.5 183
Gonzales 20,312 1,066.69 18.6 118
Guadalupe 143,183 711.3 184.9 29
Jackson 14,591 829.44 17 141
Karnes 15,081 747.56 19.8 140
Kendall 37,766 662.45 50.4 79
Kerr 49,953 1,103.32 45 63
Kinney 3,586 1,360.06 2.6 219
La Salle 7,369 1,486.69 4.6 184
Lavaca 19,581 969.71 19.9 122
Maverick 55,932 1,279.26 42.4 57
Medina 47,399 1,325.36 34.7 67
Real 3,350 699.2 4.7 221
Uvalde 26,926 1,551.95 17 98
Val Verde 48,623 3,144.75 15.5 65
Victoria 90,028 882.14 98.4 41
Wilson 45,418 803.73 53.4 70
Zavala 12,156 1,297.41 9 156
Texas 26,956,958 (V2014) 261,231.71 96.3 2
U.S. 318,857,056 (V2014) 3,531,905.43 87.4 -
Source U.S. Census Bureau: State and County Quick Facts; (The vintage year (e.g., V2014) refers to the final year of the series (2010 thru 2014)).

PRC 8 37 |P a g e
Age
Age distribution representsthe population for Region8byage group. See Appendix Pfor age distribution
by county.
Race
This chart displays the total population in Region 8 by the six racial categories identified by the U.S.:
White American, Native American and Alaska Native, Asian American, Black or African American, Native
Hawaiian and Other Pacific Islander, and Two or More Races.
-
50,000
100,000
150,000
200,000
250,000
Region 8 Age Distribution
Region 8
white
79%
Black/African
American
6%
American
Indian/Alaska
Native
1%
Asian
2%
Native Hawaiian
and Other Pacific
Islander
0%
Some Other Race
9%
Two or More Races
3%
Race Region 8
white
Black/African American
American Indian/Alaska Native
Asian
Native Hawaiian and Other Pacific Islander
Some Other Race
Two or More Races

PRC 8 38 |P a g e
Ethnicity
This chart shows the population by Hispanic or Latino Ethnicity of any race of the population for Region
8.
Even though the Hispanic population accounts for 54% of Region 8, certain areas contain a larger
percentage of Hispanic population. See Appendix F for a detailed analysis of ethnic populations within
Region 8.
Languages
The majority of the Region 8 population speak English as their
first language, but many other native languages are spoken in
homes. The growing population of English language learners is
identified in this report as it can cause language barriers to
obtaining services. About 61% (1,500,099) of Region 8 citizens
ages five and older speak English at home as their first
language, while more than 36% (891,829) speak Spanish as
their first language. Further language data for region 8 is
provided in Appendix D.
Concentrations of Populations
METROPOLITAN AREAS
San Antonio–New Braunfels is an eight-county metropolitan area referred to as
Greater San Antonio. U.S. Census estimates showed the Greater San Antonio
area population increased from 1,711,703 in 2000 to 2,328,652 in 2014, making
it the 25th
largest metropolitan area in the United States. San Antonio–New Braunfels is the third-largest
metro area in Texas after Dallas–Fort Worth–Arlington and Houston–The Woodlands–Sugar Land. It is
also the second-fastest growing metropolitan area in Texas.
Region 8 Non-
Hispanic/Latino
46%
Hispanic/Latino
54%
Race Region 8
Region 8 Non-Hispanic/Latino
Hispanic/Latino
Top 10 Non-English Languages Spoken in
Region 8
Language % of Region 8 Population
1.Spanish 36.14%
2.German 0.47%
3.Tagalog 0.27%
4.Chinese 0.23%
5.Vietnamese 0.23%
6.Other Asian 0.30%
7.German 0.29%
8.French 0.26%
9.Hindi 0.25%
10.Urdu 0.24%
Source: U.S. Census Bureau, 2009-2013 5-Year
American Community Survey

PRC 8 39 |P a g e
Census Area Estimated
population as of
July 1, 2014
2010 Census 2000 Census 1990 Census
San Antonio–New Braunfels
Metropolitan Statistical Area
2,328,652 2,142,508 1,711,703 1,407,745
Atascosa 47,774 44,911 38,628 30,533
Bandera 20,892 20,485 17,645 10,562
Bexar 1,855,866 1,714,773 1,392,931 1,185,394
Comal 123,694 108,472 78,021 51,832
Guadalupe 147,250 131,533 89,023 64,873
Kendall 38,880 33,410 23,743 14,589
Medina 47,894 46,006 39,204 27,312
Wilson 46,402 42,918 32,408 22,650
Source: U.S. Bureau of the Census: Metropolitan Areas. Population Division
Victoria Metropolitan Statistical Area, sometimes referred to as the Golden Crescent region, consists of
three counties in the Coastal Bend region of Texas, anchored by the city of Victoria. As of the 2000
census, the Victoria MSA had a population of 111,163.
Census Area Estimated
population as of
July 1, 2014
2010 Census 2000 Census 1990 Census
Victoria Metropolitan Statistical
Area
98,630 94,003 91,000 80,341
Calhoun 21,806 21,381 20,645 19,053
Goliad 7,465 7,210 6,923 5,980
Victoria 90,028 74,361 84,077 86,793
Source: U.S. Bureau of the Census: Metropolitan Areas. Population Division
SOVEREIGN NATION
The Kickapoo TraditionalTribe ofTexas,previously
recognized as the Texas Band of Traditional
Kickapoo, is one of three federally acknowledged
tribes of Kickapoo people. The other Kickapoo
tribes are the Kickapoo Tribe of Indians of the
Kickapoo Reservation in Kansas and the Kickapoo
Tribe of Oklahoma. The tribe had a village under
the international bridge across the Rio Grande.
The Kickapoo Indian Reservation of Texas is
located on the U.S.-Mexico border in western
Maverick County, just south of the city of Eagle
Pass, as part of the community of Rosita South. It
has a land area 118.6 acres and a 2010 census
population of 721 persons. The Texas Indian
Commission officially recognized the tribe in 1977.
Source: 2010 CENSUS - TRIBAL TRACT REFERENCE MAP: Kickapoo (TX) Reservation

PRC 8 40 |P a g e
MILITARY CITY, USA
San Antonio is home to six U.S. military installations, their supporting governmental and commercial
institutions, and many military-related organizations.
 Joint Base San Antonio (JBSA) – Consists of Fort Sam Houston, Randolph AFB, and Lackland AFB.
 Fort Sam Houston – North of downtown San Antonio.
o Home to more than 27,000 military personnel and civilians.
o Brooke Army Medical Center (BAMC) trains 25,000 people annually.
 Randolph Air Force Base – Northeast side of San Antonio in the town of Universal City.
o Houses pilot training and a large contingency of support personnel.
o Headquarters of the Air Education and Training Command (AETC).
 Lackland Air Force Base – West side of San Antonio.
o 6,000 enlisted Air Force personnel in recruit training (basic training) at any given time.
o Wilford Hall Medical Center is the largest medical facility in the Air Force and over 120 other
units.
 Kelly Air Force Base/Kelly Field – Adjacent to Lackland AFB.
o Semi-functional base supporting the Air Force and city of San Antonio.
o Military aircraft repair base and major aerospace support facility for Boeing.
 Brooks AFB/Brooks City Base – Joint project between San Antonio and the Air Force in southeast
San Antonio.
o Medical training facility training over 5,000 aeromedical personnel each year.
 Camp Bullis – in the Texas hill country north of San Antonio
o 30,000 acre military reservation used for field exercise training, medic training, and combat
preparation
Total Active Duty U.S. Texas Total Active Duty Joint Base San Antonio
Military: 1,305,292 Military: 124,796 Fort Sam Houston Population: 161,971
Air Force: 307,378 Total Military Civilians: 50,253 Lackland AFB Population: 117,994
Army: 491,911 Army: 80,830 Randolph AFB Population: 15,942
Coast Guard: 40,564 Army Civilians: 28,643
Marine Corps: 184,688 Navy: 6,337
Navy: 321,315 Navy Civilians: 1,504
Air Force: 33,878
Air Force Civilians: 16,338
Marine Corps: 1,980
Coast Guard: 1,771
Defense Department Civilians: 3,768
Total Military Civilians: 50,253
Source: Defense Manpower Data Center, 2015, military installations.dod.mil
Illicit drug use is lower in the armed forces than among civilians, according to the National Institute on
Drug Abuse (NIDA), however, heavy alcohol, tobacco use, and prescription drug abuse are on the rise.
Military culture, deployments, stigma, and lack of confidentiality are some reasons identified as causing
substance use or preventing military members from seeking treatment. NIDA has found that military

PRC 8 41 |P a g e
personnel with multiple deployments and combat exposure are more susceptible to developing
substance use or abuse.
According to the Department of Defense 2011 Health Related Behaviors Survey of Active Duty Military
Personnel:
 Illicit and Prescription Drugs
 Prohibited substance use (excluding prescription drug misuse) in the military was low, with
about 1.4% reporting illicit drug, synthetic cannabis, or inhalant use in the past 12 months.
 24.9% of active duty personnel reported prescription drug use (including proper use and
misuse) in the past 12 months, composed of pain reliever (20.0%), sedative (13.4%),
stimulant (2.8%), and anabolic steroid (1.4%) use and misuse.
 1.3% of active duty personnel reported prescription drug misuse in the past 12 months. Of
those who reported prescription drug use in the past year, 5.7% reported misuse, with
steroids (16.6%) and stimulants (11.6%) most commonly misused among prescription drug
users.
 89.8% of active duty personnel reported receiving drug testing in the past year, with 27.5%
tested in the past month, 62.3% tested within the past 2-12 months, 8.4% tested more than
12 months ago, and 1.8% reported no history of drug testing.
 Alcohol Use
 Among current drinkers, 39.6% reported binge drinking in the past month, with the Marine
Corps reporting the highestprevalence of binge drinking(56.7%),andthe Air Force reporting
the lowest prevalence (28.1%). Across all military branches, 9.9% were classified as
abstainers, 5.7% were former drinkers, and 84.5% were current drinkers; 58.6% of all
personnel were classified as infrequent/light drinkers, 17.5% were moderate drinkers, and
8.4% were classified as heavy drinkers.
 Heavy drinkers were more often in the Marine Corps (15.5%), had a high school education
or less (12.6%), were 21-25 years old (13.2%), unmarried (11.9%), and stationed OCONUS
(9.9%).
 Active duty personnel who were heavy drinkers, initiated alcohol use at earlier ages, or
drank at work more often reported higher work-related productivity loss, serious
consequences from drinking, and engagement in risk behaviors than personnel who
reported lower levels of drinking, began drinking at older ages, or did not drink at work.
 Across all drinking levels, 11.3% of active duty personnel were classified as problem drinkers
(AUDIT≥8), with 58.4% of heavy drinkers considered problem drinkers compared to 22.6%
of moderate drinkers and 3.8% of infrequent/light drinkers.
 About one-fifth (21.3%) of active duty personnel reported consuming an energy drink
combined with alcohol in the past 30 days; this group was more often male (22.4%), had a
high school education or less (29.7%), were 18-20 years old (37.8%), unmarried (27.5%) or
married with a spouse not present (24.8%), junior enlisted E1-E4 (28.0%), and stationed
OCONUS (24.2%).
 The most common reasons for drinking among current drinkers were to celebrate (50.2%),
enjoyment of drinking (46.2%), and to be sociable (33.4%). The most commonly reported
deterrent to drinking among all personnel was cost (22.6%), with abstainers, former

PRC 8 42 |P a g e
drinkers, and infrequent/light drinkers endorsing this more often than moderate and heavy
drinkers.
 1.5% of all active duty personnel indicated being currently in treatment or likely to seek
treatment in the next 6 months for alcohol use. Of possible treatment options, seeking help
from church (30.0%) or a military chaplain (29.7%) were most endorsed, and military
residential treatment facilities (13.2%) and private residential treatment outside the
military (12.7%) were most often cited as unfamiliar resources.
 Tobacco Use
 58.7% of active dutypersonnel wereabstainers orformersmokers (17.3%).Outof the 24.0%
of current smokers, 8.2% were classified as infrequent smokers, 12.6% were light/moderate
smokers, and 3.2% were heavy smokers.
 Similar to alcohol, earlier age of initiation for cigarette smoking was associated with being
a heavy smoker in adulthood, with those who started smoking at age 14 or younger more
likely to be a heavy smoker than those who began smoking at age 21 or older, particularly
for males.
 Current cigarette smokers were more often in the Marine Corps (30.8%), male (25.2%), had
a high school education or less (37.1%), werejunior enlisted E1-E4 (30.3%) or E5-E6 (28.0%),
and were stationed OCONUS (25.6%).
 The most commonlycitedreasons forcigarette smoking among currentheavysmokers were
to help relax or calm down (83.6%) and to help relieve stress (81.5%). In addition, over half
(52.9%) reported smoking when drinking alcohol.
 Infrequent smokers more often reported that limiting areas where smoking is permitted and
increasing prices on military installations would deter smoking compared to light/moderate
and heavy smokers.
 Across all services, 49.2% reported any nicotine use in the past 12 months, with over 60%
of Marine Corps reporting nicotine use in the past year. For all personnel, 22.6% reported
cigar use, 10.2% reported pipe use, and 19.8% reported smokeless tobacco use in the past
12 months.
 When examining new forms of smokeless tobacco, 4.6% reported using electronic or
smoking nicotine delivery products, less than 1% reported using nicotine dissolvables or
nicotine gel, and 1.6% reported using caffeinated smokeless tobacco in the past 12 months.
 Among heavy cigarette smokers, 45.2% endorsed prescription medication most often as the
preferred form of treatment for nicotine dependence.
 The UCANQUIT2online quitsupportwas the leastrecognized of the treatmentoptions,with
19.4% of infrequent smokers, 14.5% of light/moderate smokers, and 10.8% of heavy
smokers indicating that they were not familiar with the treatment option.
 Among daily smokeless tobacco users, 44.3% endorsed stopping all at once or “cold turkey”
as the preferred method of cessation, and 15.7% were unfamiliar with the UCANQUIT2
online quit support method.
 Culture of Substance Use
 Active duty personnel reported that peers engaged in alcohol use (89.0%), cigarette use
(73.1%), and smokeless tobacco use (61.2%) in their off-duty hours. Although less often
reported, 6.5% reported peer marijuana use, and 4.5% reported peer prescription drug
misuse.
 Cigarette (81.9%) and smokeless tobacco (77.7%) use was perceived highest among the
Marine Corps compared to other services. In addition, peer alcohol use was perceived more

PRC 8 43 |P a g e
often in the Marine Corps (92.3%) and Coast Guard (92.9%), and peer marijuana use was
perceived as highest in the Coast Guard (10.6%) than all other services.
 Active duty personnel reported that leadership most often deterred marijuana (92.8%) and
prescription drug misuse (90.6%), and 51.2% reported leadership deterrence of alcohol,
cigarettes (50.0%), and smokeless tobacco (48.1%). Leadership deterrence of alcohol was
more often reported in the Navy (61.2%), and tobacco deterrence was more often reported
in the Navy, Air Force, and Coast Guard than in the Army and Marine Corps.
 Heavy drinkers reported higher network facilitation meaning meeting regularly with others
and they are large enough to provide continuous use or misuse of cigarette use (88.2%),
marijuana use (15.2%), andprescription drug misuse (10.4%) compared to light or moderate
drinkers. In addition, heavy and light/moderate smokers perceived higher peer facilitation
of cigarette use than other smoking levels.
Source: 2011 DOD Survey of Health Related Behaviors among Active Duty Military Personnel (2011 Active Duty HRB Survey)
 Suicides and Substance Use
 Suicide rates in the military were lower than among civilians in the same age range, but in
2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008.
 The 2010 report of the Army Suicide Prevention Task Force found that 29% of active duty
Army suicides from FY 2005 to FY 2009 involved alcohol or drug use.
 In 2009, prescription drugs were involved in almost one third of military personnel suicides.
(NIDA March, 2013).
VETERANS IN TX AND REGION 8
According to SAMHSA, thousands of troops leave active duty service yearly and become military
veterans within their communities. Veterans are more likely than others to fall victim to substance abuse
as a means of coping with traumatic situations faced during their service.
According to the 2013 National Survey on Drug Use and Health, 1.5 million veterans aged 17 or older
(6.6% of veterans) had a substance use disorder in the past year. About 1 in 15 veterans had a past year
substance use disorder, whereas the national average among persons aged 17 or older was about 1 in 11,
or 8.6%. The rate of substance use disorders among veterans ranged from 3.7% among pre-Vietnam-era
veterans to 12.7% among those serving since September 2001.
There are an estimated 21.2 million veterans in the U.S. according to the Census, and about 2.2 million
military service members and 3.1 million immediate family members. As of September 2014, there are
about 2.7 million American veterans of the Iraq and Afghanistan wars and at least 20% of Iraq and
Afghanistan veterans have PTSD and/or diagnosed depression.
Report Area Veterans
Region 8 231,185
Texas 1,583,272
U.S. 21,263,779

PRC 8 44 |P a g e
 Illicit and Prescription Drugs
 Patients in U.S. Department of Veterans Affairs hospitals are victims of drug overdose twice
as often as the national average.
 Opioids such as morphine, oxycodone, and methadone are the drugs that patients most
frequently misuse and abuse.
 Alcohol Use
 Veterans show increased rates of binge drinking more often than they abuse drugs.
 Alcohol abuse is the most serious substance abuse issue in the veteran community.
 Many soldiers abuse alcohol as a coping mechanism for untreated mental health issues.
 Suicides and Substance Use
 Veterans commit 22 suicides per day, or 8,000 per year, and 11,000 non-fatal suicide
attempts a year.
 Male veterans are twice as likely as male civilians to commit suicide.
 Suicide rates go up as people age.
 More men than women die from suicide.
 Veterans Courts in Texas
 Courts are now being implemented
across the country to provide a team-
based approach to ensure an
appropriate treatment for the
underlying risk factors that can
contribute to criminal behavior.
Currently, 65 drug courts in 20 states
work exclusively with the veteran
population.
 One in five veterans has symptoms of a
mental health disorder or cognitive
impairment.
 One in six veterans who served in
Operation Enduring Freedom and
Operation Iraqi Freedom suffer from a
substance abuse issue. Research
continues to draw a link between
substance abuse and combat–related
mental illness.
In the absence of community involvement, great stress falls upon military households. Many veterans
face critical problems such as trauma, suicide, homelessness, and/or involvement with the criminal
justice systemwhich scars families and neighborhoods.NIDA,SAMHSA,andother government agencies
are supporting research to understand the causes of drug abuse and other mental health issues among
military personnel, veterans, and their families, and how best to prevent and treat them.
Source: Texas Bar Journal, Vol. 75, No. 8

PRC Region 8 2015 Regional Needs Assessment

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